CASE DESCRIPTION: The facility is experiencing challenges in effectively communicating with and meeting the needs of a resident who has multiple medical and mental health diagnoses. Because the resident has limited ability to express his needs verbally, his behaviors are thought to be his way of both self-soothing and communicating. These behaviors frequently lead to escalations, as staff may have difficulty interpreting and responding appropriately.
UNIQUE CHALLENGES: The resident has multiple diagnoses, including schizoaffective disorder, autism spectrum disorder, severe intellectual disability, dysphagia, pseudobulbar affect, and blindness, which impact his ability to communicate effectively with staff. The facility reported challenges in managing the resident’s behavioral symptoms, as staff are often unable to determine or understand his underlying needs. The facility reported that the resident exhibits behaviors such as physical aggression, disrobing, hand fidgeting, and rocking. They observed that current de-escalation strategies, such as offering Mountain Dew, speaking in calm voices, and providing snacks, are usually used only after the resident has already escalated. The facility expressed its desire to intervene earlier and more efficiently.
The facility lacks foundational knowledge of mental health, as well as proactive tools needed to prevent escalation or to recognize initial stages of distress. The current strategies in place are reactive rather than preventive.
COE-NF SOLUTION: The Regional Behavioral Specialist (RBS) suggested the facility adopt an improved approach to non-verbal communication to better support staff working with this resident. It is recommended to utilize resources such as The Do’s and Don’ts of Nonverbal Communication and De-Escalation Strategies In-Service Toolkit. Additionally, the RBS suggested establishing and maintaining a routine that includes reminders and preparation for transitions.
Incorporating items from the Comfort Menu – COE-NF, such as weighted blankets, fidget items, and a rocking chair, can help facilitate self-soothing, especially after potentially overwhelming situations like mealtimes. The RBS also emphasized the importance of continuing to use calm verbal communication and documenting behavior patterns to better understand this resident’s needs.
OUTCOME/BENEFITS: The facility reported that the consultation was extremely helpful, as it enabled staff to identify the resident’s needs more quickly and improved communication among team members about his care and support. They report increased efficiency in recognizing his needs and enhanced staff coordination. “So far, we have been primarily focused on improving communication and trying to understand his needs. We’ve put a radio in his room and are working to find some fidgets. Everything has been positive.” Staff were able to implement recommendations such as creating and maintaining a daily schedule, using the Comfort Menu to find things that help de-escalate and comfort him, such as placing a radio in his room to play soft jazz and singing, which both helped with the post breakfast breakdown. Additionally, he engaged in painting for over two hours without any issues, indicating these strategies were effective.
Moreover, 63 of the 70 employees have completed the COE-NF On-Demand Learning De-Escalation Module included in the in-service toolkit.
As a result, they reported:
- Increased awareness of residents’ needs
- Adoption of new practices/interventions
- Adapted programs and policies
