The Behavior Plan Workbook is designed to take a clinician through the steps of targeted behavior plan development. The workbook begins with forms to clarify the nature of the behavior to be changed, thus targeting individual needs of the patient. Chapters provide worksheets to comprehend and assess the influence of emotional, adjustment, and cognitive variables, social history, and health status on the occurrence of the targeted behavior. Next, worksheets guide the process of integrating the information into a comprehensive “Phenomenology of Dyscontrol,” a conceptualization of the etiology of the behavior. This is followed by utilizing worksheets to write an individualized plan. The process within the workbook concludes with a post implementation review. Upon completion of the series of worksheets, the professional will have developed flexible, comprehensive, individualized behavior plans that work.
These worksheets are based on years of expert experience in devising behavior plans that work with even the most difficult, complicated, and previously treatment resistant behaviors, but are just as applicable to more straightforward behaviors. They identify and concretize the steps senior professionals utilize experientially. After using these worksheets a few times, the steps will become second nature. As the book states, “You will be the expert other staff or programs turn to for help.” Beyond guiding practicing clinicians, the workbook has a place as a training tool for new staff and students.
|Pages||96 pages + USB Drive with Printable PDF Worksheets|
Chapter 1 – Understanding Behavioral Dyscontrol
Chapter 2 – Defining the Behavior
Chapter 3 – Necessary Information – Emotions
Chapter 4 – Necessary Information – Cognition
Chapter 5 – Necessary Information – Social History
Chapter 6 – Necessary Information – Health Status
Chapter 7 – Determining the Phenomenology of Dyscontrol
Chapter 8 – Writing the Treatment Plan
Chapter 9 – Post Plan Review and Closing Thoughts
I have worked in various settings, hospital, nursing home, and group home, treating behavioral dyscontrol either as employed staff or as an independent consultant. I have been a frontline clinical provider and a program administrator. These positions range from efforts on specialty brain injury behavioral units to general brain injury services. Throughout all of these experiences I have sought out the hardest cases. The brain is infinitely fascinating and the etiology of its behavioral manifestations when injured are a puzzle I enjoy solving. My best work happens when I think like a detective trying to piece together the clues.
The behaviors that I have treated include physical aggression against people, physical aggression against objects, verbal aggression, social inappropriateness, sexual inappropriateness, withdrawal, non-adherence, self-injurious behavior, suicidal ideation/behavior, demanding/manipulation, risk to elope/elopement, wandering, hoarding, poor safety judgment/ impulsivity, unawareness of deficits, somatization, hallucinations/delusions, and agitation, among other behaviors. In some settings these behaviors have been mild in nature and in other settings they were severe and dangerous. However, my goal has always been to have the person with a brain injury be able to function in the community and in this, following the steps in this Workbook, I have been successful.
Still, readers of this Workbook need to know that working with people who exhibit behavioral dyscontrol can sometimes be dangerous, particularly if the behavior entails physical aggression. While this book will help you with the process of treating behavioral issues, nothing can completely remove the risk. Readers must take responsibility to keep safe themselves, other people, and the person with a brain injury.
Nevertheless, I believe that behavioral dyscontrol, even when severe, is treatable. I look at every case as an opportunity to fit together the clues as to why the behavior occurs. I do not give up; when the plan is not working it is because my team and I have missed something, not because the person with a brain injury is untreatable. Do not be discouraged when initial treatment plans fail to result in sufficient behavior change. You will not get all of the clues right the first time. Be persistent; be dogged; be optimistic: be tenacious in your pursuit of the clues.
There is no such thing as unprovoked behavior. People do not act for random reasons; “unprovoked” merely means that we have not been smart enough yet to understand the distal and proximal causes of the behavior. This Workbook will take you through the steps necessary to understand the drivers of the behavior and then be able to treat them.
Behavior planning is hard work. This Workbook provides you with a step by step methodology for successfully navigating the process of plan development. At first glance completing the Worksheets can seem daunting. Rest assured, however, that after practice the process becomes second nature. You will find that after completing the Worksheets for a few persons with a brain injury you will likely internalize the steps in the Worksheets and your thinking about behavioral dyscontrol treatment will take place more easily and automatically. You will find that your internal thinking about behavior will change as your observations become structured along the lines of the Worksheets; your conceptualizations will form differently. You will notice things other staff miss. You will find yourself having insights that others do not have and seeing connections between clinical variables and behavior that are not evident to other staff.
You are to be commended for working with behavioral dyscontrol. Too often persons with a brain injury with behavioral issues are discharged as non-compliant or dangerous; they are then transferred to another facility where the process of writing them off begins anew. However, after using this Workbook you will be the expert other staff or programs turn to for help.
I hope you find it as exhilarating as I do to help persons with brain injury that everyone else has given up on.
Be innovative: do not think outside the box; throw the box away.
Robert L. Karol, Ph.D., ABPP-RP, CBIST
Review by: Dr. Dawn Neumann, an Assistant Research Professor at the Indiana University School of Medicine in the Department of Physical Medicine and Rehabilitation, and Clinical Research Faculty at the Rehabilitation Hospital of Indiana.