Supporting a person with difficult behaviors begins when we make a commitment to know the person. Sadly, it is often the case that people who develop an intervention to stop someone from engaging in difficult behaviors do not know the individual in any meaningful sense. Instead, they see the person as someone (or something) that needs to be fixed, or modified. But attacking a person’s behavior is usually ineffective and always disrespectful.
Think about someone you know who engages in difficult behaviors. Ask yourself, ‘What kind of life is this person living?’ Consider how you would feel if you lived the person’s life. How would you behave?
What follows are 10 things you can do to support a person whose behavior is troubling you. It is not a list of ”quick fix” strategies for stopping unwanted behavior. It is a list of ideas for uncovering the real things that a person might need so that you can be more supportive.
1. Get to know the person.
The first step in supporting a person with difficult behaviors almost seems too obvious to state: get to know the person! It is too often the case that people who develop interventions to eliminate unwanted behavior do not know the person in any meaningful sense. They know the person as the sum total of his or her labels, but know little about the person as a ”whole” human being.
Make a point of spending time with the person in places that he or she enjoys, during times of the day that he or she chooses. It should be a comfortable place where both of you can feel safe and relaxed (e.g. a quiet room, a nice restaurat, a walking trail in a nearby park).
At a time that feels right (you will have to trust your intuition on this one), tell the person about your concerns and ask for permission to help(it’s rude not to). If the person has no formal means of communication, ask anyway. Sometimes people understand what is being said, but they have a difficult time letting other know that they understand.
The important point, always, is to ask the person for permission/consent to stick your nose into their business, even at the risk of seeming silly in front of people who think the person cannot understand (usually they’re wrong).
2. Remember that all behavior is meaningful
Difficult behaviors are ”mesages” witch can tell us important things about a person and the quality of their life. In the most basic terms: difficult behaviors result from unmet needs. The very presence of a difficult behavior can be a signal that something important that the person needs is missing.
Obviously there are many needs that a person may be conveying with her behaviors. A single behavior can ”mean” many things. The important point is that difficult behaviors do not occur without reason.
All behavior, even if it is self-destructive, is ”meaning-full”.
Ask the person (and/or the person’s supporters) what he or she needs to be happy. Find out who he or she counts on in a pinch. How often he or she sees loved ones and friends? What are his or hers favorite activities? Where does he or she likes to go? Ask the person what leads to unhappiness. Who are the people who the person does not like? How often he or she sees them? What are the person’s least favorite activities?
It is also important to know something about the person’s physical and emotional health. Does the person have a way to let others know what he or she needs and feels? Is the person experiencing physiological or psychological distress? What kinds of medications is he or she taking? Do they help?
”Are there times when the person exhibits this behavior frequently?” and ”Are there times when the person exhibits this behavior infrequently or not at all?” Answering this two questions can tell you a great deal about the meaning of the person’s behavior. With time you should be able to see a discernible pattern. (Hint: it often has something to do with the things a person is being asked to do, and/ or who is asking the person to do it).
3. Help the person to develop a support plan
People who exhibit difficult behaviors are usually subjected to a behavior plan at some point in their lives. Help the person and the person’s family or loved ones to develop a plan that reflects a real and authentic life. You can do this by asking some of this questions in order to develop a person centered care plan.
a) How can we help the person to achieve health and wellbeing?
b) How can we help the person to maintain his or her relationships and make new ones?
c) How can we help the person to increase his or her participation in everyday community life?
d) How can we help the person to have more choice in life?
e) How can we help the person contribution to others?
The team can ask ” Is our vision for the person similar to the vision we hold for ourselves and each other? When we think about what the person needs, do we focus on ‘fixing’ deficits or do we think about supporting the person in achieving a real life?”
4. Develop a support plan for the person’s supporters
Take time with your colleagues to develop support plans for each other. For example:
What can you do to increase each other’s level of safety and comfort when someone is behaving dangerously?
What can you do to have more fun at work?
How can you have more control over your schedule and input into decisions?
How can managers better support you?
If you stopped responding to the person’s behavior the way you do now, who would you be?
5. Don’t assume anything
It is easy to make the mistake of underestimating a person’s potential just because of her labels or because she has failed to acquire certain skills. This is a tragic mistake. An individual’s potential depends largely upon the adequacy of his/her support rather than some inherent flaw or ‘defect’.
Always remember that people are people first. Labels tell us nothing (in any real sense) about how we can be supportive. We must remember that people have gifts and potential that eclipse our labels.
Always remember to speak directly to the person and explain things as clearly as you can, even if the person’s labels suggest that he cannot understand (as the very least the person will understand the tone of your voice). Never speak about the person as if he were not in the room.
6. Relationships make all the difference
Loneliness is the most significant disability of our time. Many people with disabilities, young and old, live lives of extraordinary isolation. Some depend entirely upon their families for support. A brother or a sister or a mum or a dad are the only source of company. Friends are often absent altogether.
All too often, the only relationships people have are with paid staff. Although staff can offer a great deal, they change jobs frequently or take on new responsibilities. The resulting instability can be devastating to someone who is fundamentally alone.
Remember that there are many people in the community who will benefit from knowing the person and chances are that the person has already made someone’s life fuller. Be confident that she or he will make someone’s life richer again and again.
7. Help the person to develop a positive identity: We all need to be needed.
Help the person to find a way to make a contribution. Start when the person is young if you can. Giving is a lifelong endeavor. Things as simple as helping with household chores can teach the person that she can make a contribution.
Talk with the person to join a ‘volunteer/ charity organisation’ together with you or a friend(National Trust, local food shelter, an environmental group).
Remember that is is important to overcome the belief that her person has nothing to share. It takes time and determination to help the person and others to see strength and the capacity to give when deficits were all that anyone ever saw before.
8. Instead of ultimatums, give choices.
Choice is a powerful alternative to punishment. If the person’s behavior challenges you, help him to find more desirable ways to express the needs underlying the behaviors. Instead of ultimatums, give choices (e.g. Bill, I know you are upset. What would help? Would you like to go for a walk? or take a ride? You need a chance to calm down.)
Allow the person to make decisions through the day. If he has trouble making choices, find a way to help.
Don’t assume that helping the person to have more choices means letting him do whatever he wishes. Limit-setting is an important and fair part of any relationship. The real question is who is setting the limits and why. If limits are imposed upon the person without their input, and if the limits are part of a life the person is powerless, even your best advice will be interpreted as one more statement of ”do it my way or else.”
You can expect a general disregard for your advice if the person on the receiving end of the advice is ”out of power.”
Make a sustained commitment to the person and to ”fairness” in the relationship. If the person has been on the outside of power for too long, you may need to bend more often than not for awhile.
The goal is to teach the person that giving is a two-way street.
9. Help the person to have more fun.
Fun is a powerful antidote to problem behaviors. It is often the poverty of reward, not a lack of skills, that keeps people separate from community members. Many must endure reward schedules for good behavior. The very few things that they enjoy are used contingently to reinforce compliance (talk about spoiling a good thing!).
Count the number of things the person enjoys, the number of places she likes to go. Compare this to the number of things other people enjoy, the number of places other people go. Ask yourself, ”Is the person having fun? Is she experiencing enough joy? Is this an interesting life with things to look forward to?”
Help the person to add to her list of interesting (and really fun) things to do.
Make fun a goal!
10. Establish a good working relationship with the person’s GP practice.
How often have you experienced a decline in your mood or your ability to empathize with the needs of others when you don’t feel well? When we are sick, we are not ourselves.
Many people who display difficult behaviors do so because they don’t feel well. The sudden appearance of behavior problems may be a sign that the person does not feel well. Illnesses as common as cold or ear ache can result in behaviors as inconsenquential as grumpiness or as serious as head banging.
It is important to establish a good working relationship with a GP who can help the person to stay healthy and well.
Remember that it is important to go beyond a concept of health as the absence of a disease or illness.
”Feeling well” and ”being healthy” involves everything from a balanced diet to a good night’s sleep. Help the person to achieve a state of ”wellness and wellbeing”.