The first step in using reinforcement as a behavioural intervention strategy is to recognise when the person is engaging in positive behaviours i.e. ‘catch them doing well’. Positive behaviours can be easily overlooked as they may be viewed as ‘normal’ behaviours and no significance is attached to them. However, for the person with brain injury ‘normal’ behaviours can be a significant, positive achievement, for example:
- Appropriate and friendly communication e.g. smiling, saying hello/thank you.
- Sitting quietly.
- Appropriately eating a meal.
- Seeking help appropriately.
- Cooperating with care interventions.
- Taking medication.
- Being thoughtful.
- Engaging in meaningful activity (e.g. therapy sessions, game, reading, chatting, watching T.V.).
- Modifying behaviour once aware that it is inappropriate or distressing to others.
It is important to recognise that the absence of difficult behaviours is in itself a positive behaviour. Therefore it is important to reinforce periods of settled behaviour.
Some reinforcers may appear to be very simple and we may not always consider them as ‘reinforcers’, however, they can be effective methods of bringing about positive behavioural change.
Helpful everyday methods of reinforcing positive behaviours include:
- Smiling as you pass by the person.
- Saying hello.
- Making positive comments about what the person is doing.
- Thanking the person for cooperating with something.
- Acknowledging when the person has made an attempt to do something they find difficult.
- Expressing appreciation of the person being patient/waiting etc
- Explicit praise e.g. well done, that’s great etc. It is important to provide praise in a respectful manner.
- Spending quality time with the person doing things they enjoy over and above normal opportunities for social interaction.
The timing of reinforcement is important. It is most effective if provided at the time the person is engaged in positive behaviour. This is especially important for people with memory impairments.
Reinforcement is most effective when provided by someone who has a good relationship with the person. In the context of a care setting it is therefore important for staff to build up a positive therapeutic relationship with the person. The therapeutic relationship is the most effective and important tool in bringing about positive behavioural change.
Another method of reinforcing positive behaviour can be by using a formal ‘reward programme’. This requires a degree of expertise to devise, monitor and adapt such a programme. Therefore specialist help should be sought from experts, who have experience in behavioural modification following Acquired Brain Injury.