JCPSLP Vol 19 No 2 2017

unit! On-the-job training, however, is one of the best ways to learn. Over time confidence working with patients who have BOC will build. Standard staff training programs for aggressive and violent behaviour from patients or family members is good to attend, but the techniques utilised in these programs may not always be suitable for a patient with an ABI. An individualised behaviour management plan, contributed to by the team, is likely to be a superior resource. 10 Trial and error is a way of building builds resources for the service Over time an ABI team that works together in challenging and rewarding ways develops resources that evolve as a process of trial and error. The behaviour management plan process in the ABI Unit at Caulfield hospital is a sophisticated and effective process which has evolved since the unit opened and has a tangible impact on reducing behaviours of concern and the incidence of Code Greys in the unit. An evening service trialled as a way of alleviating boredom and BOC for a group of patients in the low stimulus area was effective in reducing BOC during the afternoons and evenings for the period it ran. Another initiative trialled was the introduction of an exercise program in the low stimulus area, for patients who were unable to access the gym because of BOC.

activities during and after hours (e.g., birthday BBQ, footy celebrations, enjoyable communal activities such as cooking) can assist patients who have behaviours of concern to feel more settled and less confused. An enriched environment working party can be a way of coordinating ideas and rostering a range of tasks. 8 The family as a resource Not all patients have supportive families; however, many do. It can be distressing for families to see their loved one in a highly confused state; sometimes they are the only person who can settle a patient down. The family can also be a rich resource for information about what the person likes and does not like, what music they enjoy, if there is a television program they like, or a food they might prefer. Families will often be willing to help support behaviours of concern by being a part of the behaviour management plan (e.g., “If Paul is beginning to pace up and down the corridor he may be settled by calling his mother”). 9 Accessing formal and informal training Organisations that employ staff who work with patients with BOC usually provide extensive on-the-job training, as well as formal, general training which might be available via electronic learning systems. This is not training you put on your “to do” list if you are going to be working in an ABI

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology