Thursday, August 14, 2014

Behavioral Assessment

Lyn recently underwent a behavioral assessment to determine if behavioral therapy would be of assistance to her.  The assessment was sent to Mom last week and we reviewed it together when I arrived.  There were a number of errors and some concerning statements which prompted us to ask for some time with the therapist to review the assessment.

The therapist had some time early yesterday morning.  We were able to meet in person and go over each item.  The errors were easy to correct and quickly resolved.  For example, it said "support staff" instead of "mother" and it referenced "both biological parents" having provided care for Lyn's life.  Lyn hasn't seen our father since December of 1978 and the reference to him has been removed from the assessment.

The concerning statements ended up just needing explanations.  At two points in the assessment, we read "Socially destructive.  At risk of self-harm."  We read that as meaning that Lyn was socially destructive and that she could hurt herself physically.  We were glad to learn that we were incorrect.  The therapist explained that Lyn's dementia causes paranoia and anxiety which is socially destructive because Lyn no longer works to maintain casual relationships.  Her social circle is getting smaller because she's no longer cognitively able to engage in social small talk.  If another day hab client asks a question and Lyn thinks the question is about her, she withdrawls from social interactions with the other client as a result of her paranoia which is a direct result of the Alzheimer's.

This plays into the "At risk of self-harm" statement.  Lyn is not at risk of cutting or other forms of physical self-harm.  In this context, the reduction of social interactions and the increase of social isolation is viewed as harmful to the individual.  These statements are considered standard for these assessments though they were very concerning to our initial reading of them.

The time and explanation the therapist provided was greatly appreciated.  She helped clarify our understanding of her assessment of Lyn.  The interaction was educational, interesting and well received.  She took a time to also set the context for the service plan that she will write up.  It will be more targeted to the day hab staff and Lyn's respite provider.  The therapist indicated she was happy to review the assessment with us and to answer our questions because she often wonders if her assessments are read in detail by those who are engaged in the care of her clients.  She often receives no feedback at all.

So, if you end up engaging the services of a behavioral therapist to help mitigate the anxiety of an individual with dementia, please read the assessment and ask about anything you don't understand.      

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