As New England Geriatric clinicians, we use a variety of forms, including initial assessment, progress notes, treatment plans, and the behavioral health consultation forms. But the Behavior Treatment Plan is perhaps the most powerful yet the most overlooked or avoided tool in our toolkit.
It is our clinical task to provide direct assessment and treatment services to the individual who resides in a nursing facility. Yet we also have an obligation to offer insights that help the facility caregivers to better understand and more effectively manage the sometimes troubling behaviors demonstrated by that resident.
Direct care staff persons at the nursing facility might observe only the external form of the nursing facility resident’s behavior – the unkempt appearance, the irritable defensiveness, and the argumentative refusals of care, the unwelcome sexual remarks, the tearfulness, the yelling, the social avoidance, or the aggressive and abusive language aimed at them. The caregiver may react in a personal manner with expressions of indignation or criticism or even patronizing efforts at persuasion.
But what is sometimes lacking is a keen awareness of the inner meanings and motives of those behaviors; the ways the behaviors represent symptoms of varied medical and psychological conditions, and the ways that the caregivers’ responses might increase or decrease the intensity and duration of those symptomatic behaviors.
Providing A More Complete Explanation
The Behavior Treatment Plan, though, can provide a window into the psychological nuances that illuminate and explain the actions of the resident. The Behavior Treatment Plan can be like a psychological MRI that provides an inside view of factors influencing a resident’s behavior.
A Behavior Treatment Plan does not simply get written and then quietly placed in the chart. By its nature it requires review and explanation and education so that the facility staff persons can understand and implement the plan. Brief staff in-service trainings should follow the writing of a plan so that it can be introduced and clarified. Those trainings allows for discussions that may be a first opportunity for the staff persons to readily understand the psychiatric diagnoses of the residents and how their psychiatric symptoms are manifested behaviorally.
Use of the Behavioral Treatment Plan can help the clinician conceptualize the messages inherent in the actions of the resident and can illustrate the links between the specific behaviors and the personal background of the resident. The resulting insights can widen the viewpoint of the sometimes perplexed facility staff person as he or she tries to appreciate and manage the needs communicated in the troubled behaviors.
Gathering together a group of unit staff persons and reading and discussing the plan and ideas for managing the resident can be mutually rewarding experiences that can directly reduce interpersonal frictions and add to the professional confidence and competence of the unit staff.