3/11/2016 Reducin ing Staff Stre ress: Pers rson-Centere red Appro roaches for r Handli ling Difficu icult lt Resid idents Nathalie de Fabrique, Psy.D. Licensed Clinical Psychologist Director of Clinical Services COTLER HEALTHCARE MAIN OBJECTIVES: • Understanding Combative Behavior • Providing alternatives to psychotropic medication • Strategies to positively handle the combative resident • Learning when to use behavioral interventions and supportive psychotherapy DEFINITION • Combative Behavior- any physically aggressive act that causes or intends to cause hurt or damage to a person or object • Most aggressive/combative behavior occur in: • Dining Room • Bath/Shower • Toileting 1
3/11/2016 CONTRIBUTING FACTORS TO AGGRESSIVE BEHAVIORS: • Organic brain disorders (vascular dementia, stroke) • Psychosocial causes • Environmental causes 3 Key Components to Managing Combative Behavior: • Assessment • Diffuse/Minimize Combative Behavior • Formulate a plan WAYS TO PREVENT COMBATIVE BEHAVIOR • General prevention techniques • Strategies specifically geared toward dementia residents • Preventing burnout in facility staff • Offering counseling/therapy to residents who can benefit 2
3/11/2016 Positive Communication • State questions or ideas in positive terms • Avoid baby talk • Do not attempt to reason or apply logic Behavioral Approaches • Identify the Problem Behavior • Identify the antecedants/trigger • Identify the reinforcer of the problematic behavior • Identify the desired behavior Therapy for Dementia Residents • Validation Therapy • Reflection • Redirection 3
3/11/2016 Therapy for Dementia Residents, Cont’d • Person-Centered Therapy • Decision-making power is in the hands of the individual • Help maintain personhood • Support individual while maximizing independence Alternatives to Psychotropic Medication • Ongoing supportive counseling • Behavioral treatment plan • Appropriate physical activity • Environmental accommodations TH THE END 4
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