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Coping with Challenging Behaviors - Teepa · PDF fileCoping with Challenging Behaviors: ... - Use objective language to describe ... - Strong & Desirable Visual Cues - Short & Effective

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Text of Coping with Challenging Behaviors - Teepa · PDF fileCoping with Challenging Behaviors: ... -...

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    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Coping with

    Challenging

    Behaviors:Becoming a Good Detective NOT a Knee Jerk Judge!

  • 2

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    ABCs to Cope with Behavior

    - A = Antecedents What starts it?

    - B = Behavior What is it?

    - C = Consequences What happens?

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Start with B

    What behaviors are we talking

    about?

    - Examples

    - Impact on Care?

  • 3

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    My Examples

    - No F PoA or HC PoA

    - Going to MD problems

    - Losing Important Things

    - Getting Lost time, place, situation

    - Unsafe task performance

    - Repeated calls & contacts

    - Refusing help & care

    - Bad mouthing you to others

    - Making up stories - confabulation

    - Undoing what is done

    - Swearing/cursing, sex talk, racial slur, ugly words

    - Making 911 calls

    - Mixing day & night

    - Sleep problems too much or too little

    - Not following care/rx plans - denying

    - No initiation cant get started

    - Perseveration cant stop repeating

    - Not talking any more

    Paranoid/delusional thinking

    Shadowing - following

    Eloping or Wandering

    Seeing things & people not there -hallucinations

    Getting into things

    Threatening caregivers

    Undressing in public not changing when needed

    Problems w/intimacy & sexuality

    Being rude - intruding

    Feeling sick not doing anything

    Use of drugs or alcohol to cope

    Striking out at others

    Falls & injuries

    Contractures & immobility

    Infections & pneumonias

    Problems w/ eating or drinking

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Why Do These Things Happen?

    - EVERYTHING is affected

    - Thoughts

    - Words

    - Actions

    - Feelings

    - It is progressive

    - More brain dies over time

    - Different parts get hit

    - Constant changing

    - It is variable

    - Moment to moment

    - Morning to night

    - Day to day

    - Person to person

    Dementia is predictable

    Specific brain parts

    Typical spread

    Some parts preserved

  • 4

    Positron Emission Tomography (PET)

    Alzheimers Disease Progression vs. Normal Brains

    G. Small, UCLA School of Medicine.

    NormalEarly

    AlzheimersLate

    AlzheimersChild

    Normal Brain Alzheimers Brainused with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

  • 5

    Learning & Memory Center

    HippocampusBIG CHANGE

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

    Understanding Language BIG CHANGE

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

  • 6

    Hearing Sound Not Changed

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

    Sensory StripMotor Strip

    White Matter Connections

    BIG CHANGES

    Formal Speech & Language

    CenterHUGE CHANGES

    Automatic Speech

    Rhythm Music

    Expletives

    PRESERVED

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

  • 7

    Executive Control Center

    Emotions Behavior JudgmentReasoning

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

    Vision Center BIG CHANGES

    used with permission from The Broken Brain: Alzheimers, 1999 University of Alabama

    used with permission from Alzheimers:The Broken Brain, 1999 University of Alabama

  • 8

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Why Might These Things NOT

    Happen?- Dementia is individualistic

    - The person doesnt have it in them

    - The situation doesnt come up

    - Other conditions keep it from happening

    - Caregivers have great skills

    - The dementia isnt bad enough yet

    - You get LUCKY!

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Go to the A

    - Antecedents

    - What is DRIVING the Behavior?

  • 9

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    What Makes STUFF Happen?

    - SIX pieces

    - The type & level of dementia NOW

    - The person & who they have been

    - Personality, preferences & history

    - Other medical conditions & sensory status

    - The environment setting, sound, sights

    - The whole day how things fit together

    - People - How the helper helps -

    - Approach, behaviors, words, actions, & reactions

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    So A Quick Look at C

    - Consequences What Happens?

  • 10

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    What Happens?

    - We blame

    - We knee jerk react

    - We treat the immediate

    - We become parental

    - We become judges

    - We give up

    - We go thru the motions

    - We use drugs #1

    anti-anxiety & anti-psychotic

    Traditionally Non-Traditionally

    Become a detective

    Get EVERYONE involved early

    and often

    Re-look & monitor - lots

    Change what is easiest first

    Change what can be controlled

    Celebrate all improvements

    Start with OURSELVES

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    What Can YOU Control? OR

    NOT!CONTROL

    - The environment setting, sound, sights

    - The whole day how things fit together

    - How the helper helps -

    - Approach, behaviors, words, actions, & reactions

    NOT CONTROL

    The person & who they have been

    Personality, preferences & history

    The type & level of dementia NOW

    Other medical conditions & sensory status

  • 11

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    For your persons with problem

    behaviors

    What are the behaviors that

    challenge you?

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Describe the Behavior

    - Consider video to investigate

    - Use a sensory approach

    - look, listen, feel, smell, taste, movement

    - Use objective language to describe

    - Check out the environment

    - Look at public, personal, intimate space issues

    - Get in their shoes & position

    - Pay attention to cues and responses

  • 12

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Most Behavior is caused by

    UNMET NEED

    combined with

    Efforts to Communicate the

    Need or Desire

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Top TEN UNMET NEEDS!

    - Hungry or Thirsty

    - Tired or Over-energized

    - Elimination need to/did

    - Temperature too hot/cold

    - IN PAIN!!!

    - Joints - skeleton

    - Creases or folds

    - Surface-surface contacts

    - Systems head/heart/gut/bladder

    - Old injury/pain sites

    Unmet Physical Needs Unmet Emotional Needs

    Angry

    Sad

    Lonely

    Scared

    BORED

  • 13

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Given the Abilities of the Person

    - Who and What SHOULD be asked to CHANGE?

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    THEN

    Use a Problem Solving Process

    Know the person

    Build Caregiver Skills & Education

    Create & Control the Environment

  • 14

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Building

    Caregiver

    Skills & Knowledge

    - Understand dementia & its progression

    - Know how symptoms affect behavior

    - Describe needs connected to behavior

    - Optimize interaction skills

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Normal Brain Alzheimers Brain

  • 15

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Dementiadoes not equal

    Alzheimersdoes not equal

    memory problems

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Alzheimers

    Disease

    Young Onset

    Late Life Onset

    VascularDementias(Multi-infarct)

    Lewy Body Dementia

    DEMENTIA

    Other DementiasGenetic syndromesMetabolic pxsETOH relatedDrugs/toxin exposureWhite matter diseasesMass effectsDepression(?) or Other Mental conditionsInfections BBB crossParkinsons

    Fronto-Temporal Lobe Dementias

  • 16

    Teepa Snow, Positive Approach, LLC to be reused only with permission.

    Four Truths About Dementia

    - At least 2 parts of the brain are dying

    - One related to memory & the on

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