The development of a behavioural intervention plan should begin with a comprehensive assessment (including functional analysis) followed by the implementation of a detailed management plan designed to address all contributory factors including:

The implementation and potential successful outcome of a behavioural intervention plan is facilitated by:

  • The availability of appropriately experienced professionals to carry out comprehensive multidisciplinary assessments and implement a programme of rehabilitation to address all neurological sequelae of brain injury (e.g. nursing staff, Occupational Therapy, Physiotherapy, Speech Language Therapy, Psychology and medical/psychiatry doctors).
  • The availability of appropriately experienced professionals to carry out behavioural assessment (including functional analysis) and design an individualised behavioural intervention plan.
  • A programme of orientation to reduce confusion, anxiety and distress.
  • Provide the person with education to help them better understand the brain injury and its implications.
  • The ability and resources to monitor effectiveness and modify the plan as necessary.
  • Family/carers understanding the rationale for the plan and being willing to follow it consistently. Appropriate training/support is important.
  • Consideration of environmental factors which may be contributing to behavioural difficulties (e.g. elevated noise levels, high levels of stimulation, temperature) and modify to reduce triggers.
  • Modifying the person’s daily routines to include avoidance of places which may be likely to trigger behavioural outbursts (e.g. busy, noisy places) until the person becomes more able to manage their behaviour in these types of environments/situations.
  • A communicative environment adapted to the person’s needs i.e. carers who understand the need to adapt their communicative style and approach in order to facilitate successful communication and reduce behavioural difficulties.
  • Appropriate pharmacological treatment for psychiatric and behavioural difficulties including low mood, anxiety, irritability, agitation/aggression and psychosis as necessary.

Use of Legislation to Support the Management of Challenging Behaviour
Significant cognitive and communicative impairments may impact on the person’s ability to understand and consent to necessary care and treatment.  In these circumstances the Adults with Incapacity (Scotland) Act 2000 can be used to support care and treatment.

In the context of severe behavioural difficulties which are associated with significant risks (i.e. risks to self and /or others), it may be necessary to use compulsory measures to support the behavioural intervention plan as the person may not understand the need for treatment, may not be able to consent, may not be willing to engage with care and treatment (including the need to be admitted to/remain in hospital) because of significant cognitive and communicative impairments.  In these circumstances consideration may need to be given to the use of the Mental Health (Care and Treatment)(Scotland) Act 2003 to facilitate care and treatment.

It is important to seek expert advice about the use of legislation in the management of behavioural difficulties i.e. Consultant Psychiatrist/Neuropsychiatrist.

A range of interventions may be helpful in the rehabilitation and management of behavioural difficulties including:

Reinforcement
Anger Management Strategies
Additional Interventions to Support Positive Behaviour
Basic Management Strategies for Episodes of Challenging Behaviour