Behaviours that challenge

Many patients with physical, cognitive and communication difficulties following brain injury experience everyday care tasks as confusing and threatening. With communication and language impairment being the best predictor of aggression, highly correlated with severity of aggression and use of more intrusive interventions, the SLT role in improving the quality of life and reducing restrictive practice for these individuals with behaviours that challenge (BtC) is crucial. This chapter presents a way of understanding what the BtC is communicating and how the goal to improve the individuals’ quality of life can lead to a reduction in BtC. Evidence of the positive behaviour support (PBS) approach for people with brain injury and SLTs role in this ethical intervention is described, including how SLTs can collaborate with the team in assessment, implementation of environmental changes and skills building to maximise the individual’s participation in desired activities and relationships. The worked example describes a person with multiple SLT diagnosis, how the SLT formulated possible reasons and solutions for communication breakdowns leading to BtC and the importance detailed description in designing solutions. The resources include Prompt sheet for SLT-related questions for formulate the factors causing BtC Gilbertson model for a person-centred approach to working with BtC Sample formulation for an individual with communication and swallow impairments leading to BtC at mealtimes Online swallow formulation case study Online communication behaviour record sheet example