Behavioural support
some extra medication to help calm her down? I don’t want her to move somewhere else, but I’ve got to consider my staff and the other residents.
Behaviour analyst Over a few weeks, I conducted several detailed assessments and observations of Mildred’s behaviour and looked at the influence staff behaviour had on her responses. Knowing that all behaviour meets a need, my role was to establish what purpose the behaviour had for Mildred and why she was engaging in distressed behaviour. During the personal care routine, the results indicated that Mildred engaged in more distressed behaviours when she was told without warning that it was time for her shower – so from her point of view it came out of the blue. The behaviour was also happening because she did not want to be seen naked, had not been offered a bath instead of a shower, and did not have the cognitive ability to know what to do with the washing items independently. As there were several causes for the behaviour, I designed a multifaceted intervention which was easy for staff to implement and that would be effective to get Mildred’s needs met. First, staff were coached to ask Mildred
every time if she wanted a bath or shower, to respect her choice, and give gentle verbal reminders in the lead up using specific language that preserved her dignity. Second, staff were taught to respect Mildred’s need for privacy through development of practical skills in how to give someone modesty alongside personal care. Third, staff were taught to model the behaviour of washing their body with soap so that Mildred was able to copy them and wash herself independently,
avoiding the need for them to touch her which she did not like. Finally, they were directed to cover up the mirror to avoid Mildred becoming distressed upon seeing her reflection. These seemingly simple interventions,
when implemented together under professional supervision, were successful in getting Mildred’s needs met while ensuring she bathed frequently enough. Mildred did not have to hit staff to communicate her needs, and they were able to develop skills which led to savings from a placement breakdown and escalating care costs, less staff turnover, and improved quality of life for Mildred and the people caring for her.
What is a behaviour analyst? Mildred’s case is extremely common and one you are probably very familiar with. However, the involvement of a behaviour analyst is one that you might not be aware of. Behaviour analysts are extensively
trained professionals from a well- established scientific field who are normally found working within autism or learning disabilities services to analyse and support with behavioural issues. Behaviour analysts are experts in human behaviour and highly skilled at creating meaningful behaviour change to increase quality of life and reduce occurrences of distressed behaviours. Behaviour analysts work within multi- disciplinary teams and collaborate with all professionals (and family) involved in someone’s care. A behaviour analyst analyses behaviour using a range of assessment tools and detailed observations to find out the function (the purpose of a behaviour) of someone’s behaviour and support them to get their needs met more
effectively. Then the behaviour analyst develops an individualised, person-centred intervention based on the assessment data and scientific evidence. This approach means their recommendations are objective and measurable and leaves no space for misunderstandings due to personal opinion or subjective measures. They train and coach caregivers to support the person living with dementia more effectively using a behavioural approach that is always positive in nature and never restrictive. Cases like Mildred’s are happening up
and down the country in dementia care. Imagine how different her case could be if her care providers had access to a behaviour analyst to run detailed analyses and train the staff in providing care in a way that prevents distressed behaviours developing in the first place.
Positive Ageing Consultancy & Training We are both Board Certified Behaviour Analysts (UKBA cert) who met during our time at Bangor University where we were studying for their PhDs. We bonded over our shared passion for providing behaviour analytic evidence-based services to support people living with dementia and their caregivers. We are enthusiastic about sharing information about the research we have conducted within care settings. As our research gained traction, it was disseminated across the globe through numerous peer reviewed scientific journals and invitations to speak at conferences. In 2021, we began Positive Ageing Consultancy & Training (PACT) to begin to bridge the gap between the effective evidence-based research in scientific journals and what was actually available to people living with dementia and their caregivers. PACT began with one aim – to improve
the lives of people living with dementia through effective, evidence based and compassionate person-centred behavioural support, and thus reduce the need for antipsychotic medication. Antipsychotic medications are often prescribed for behavioural issues, but are not effective at getting someone’s needs met, and come with additional medical risks. NICE recommends that environmental assessments (i.e., a behavioural approach) should be used before prescribing medication; however, there were no behaviour analysts providing this specialised service for people living with dementia before PACT was founded.
January 2024
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