Breaking Behavioral Patterns
By Donna Check
Many individuals with behavioral difficulties years post traumatic brain injury have spent time in multiple TBI behaviorally based facilities and programs around the country. Each neurobehavioral program utilizes different methods to help decrease unwanted behaviors. The most common are aggressive behaviors and inappropriate social behaviors and interactions.
Identifying the existence of behaviors that will impact an individual’s ability to progress and/or live independently can be determined within weeks to months to years after a traumatic brain injury. Because each person and injury is separate from the next, so is the amount of time a behavioral issue can present itself. Following that determination, and dependent upon the intensity of the behavioral challenge, the individual may be referred to a specialized neurobehavioral program.
Patterns developed by national neurobehavioral rehabilitation programs include providing an initial care plan and stay of four to six months, even when the individual referred has significant behavioral dysfunction resulting from a traumatic brain injury. The individual, the family, and funding source are typically unhappy with the news that such a “long period of time” is recommended in a behavioral facility. Various scenarios can take place after the initial facility placement, one being the individual does not remain in the program or leaves against medical advice. Another can occur, possibly due to behaviors, when the program can’t appropriately work with the severity of unwanted behaviors and the individual is transferred to another program.
Taking the pattern forward, the following neurobehavioral programs each project two to six months of treatment. In between one or two placements, the individual goes home. The patterns of the individual going from facility to facility learning various methods of negative and positive behavior plans and philosophies has existed for more than 25 years. This “revolving door syndrome” is further perpetuated when each facility wants to project a “short” length of stay yet the individual truly needs a longer period of a stabilization in a nurturing, supportive and positive reinforcing environment where basic daily routines include activities of specific interest and fulfillment to the individual with behavioral dysfunction. Learning constructive and appropriate methods of interacting are best learned in an uplifting environment of encouragement on a consistent daily basis.
The scenarios above are counter-productive to the most effective approach working with individuals with behavioral dysfunction resulting from a traumatic brain injury. Stability and consistency and a sense of belonging and ownership are important to all of us. Thinking in terms of four months, six months, or nine months of “behavioral rehabilitation” gives the impression, not only to the individual but to family members, that there is a “cure” or, miraculously, that the unwanted behaviors will diminish so significantly that the individual can return home or live on his or her own at the end of (yet another) six or nine months. In cases of significant behavioral dysfunction, this is setting the individual up for failure, repeated disappointments, and possibly increasing unwanted behaviors. For workers’ compensation carriers, no-fault and liability insurers, and other funding sources, costs are astronomical as typically each new admission is at a higher rate due to the severity of behaviors at the time of each admission.
At NeuLife, we believe we can make a significant difference in the lives of individuals who have gone through the revolving doors of facilities and programs, group homes, and those who have been supervised with 24/7 attendant care by a family member in the home only to need another professional “placement.” When an individual is referred to us for potential participation receiving Neurobehavioral Services, we spend a significant amount of time assessing that person. An extensive interview with family members and/or the legal guardian is conducted, and we review behavioral program reports and the medical records – including the admission and discharge reports from each facility. This extensive Screening Evaluation is conducted not only to determine whether the individual is appropriate for NeuLife but we want to have a reasonable expectation that we will be able to make a significant difference in the life of a person who literally has no place to call home due to inappropriate behaviors and a system that has been broken for many years. In cases of emergency referrals, this process can be completed within hours utilizing various members of our expert team to expedite the entire process. If necessary, admission can take place, with everything in place, the same day the referral is made.
NeuLife provides a Proposed Plan with realistic goals, both short and long term, and a length of stay projected in order that the goals can be accomplished effectively. While it may not be popular with funding sources, family members, guardians, and the individual needing our help at NeuLife, we believe it is our job to provide a realistic plan which includes clinical goals and personal goals with realistic extended timelines. Settling in to NeuLife’s lovely homelike living environment provides a comfort level in itself as our clients at NeuLife want to be here. This is half the goal as it is that sense of ownership and home that helps our client adjust and want to have as normal and independent a life as possible. Our expert professional staff provide support and services specific to each of our clients.
When an individual with a history of behavioral dysfunction resulting from a traumatic brain injury is admitted to NeuLife, a united system of support and supervision is implemented to give the client every opportunity to succeed from the earliest point possible at NeuLife. Unsuccessful patterns are broken. The new client’s direct care staff will consist of clinicians as well as Life Skills Techs, management staff, and other members of the multidisciplinary team. Positive attention is the focus and activities of interest to the client are incorporated on his or her first day at NeuLife and will continue. The intensity of positive attention and the high level of chosen activities and focus breaks the old patterns and establishes a completely new “channel” for the client. Nothing at NeuLife is similar to the client’s past experiences. The Behavior Specialist enlists those necessary to put this plan in place so the moment the Client comes in the door at NeuLife, the initial protocols are in lace and an initial Plan is implemented.
NeuLife staff maintain a positive and encouraging approach in all communications and interactions with each other and with clients. Teaching, training, modeling, and shaping behaviors creates positive interactions which can be maintained seamlessly throughout all environments. Clients observe and learn firsthand the benefits of positive and appropriate communications and interactions with others within the residential environment and in the community.
