presented by Robert Karol
Behavioral dyscontrol refers to manifestations of inappropriate conduct. It includes noncompliance/nonadherence, physical aggression, verbal aggression/threats, sexual inappropriateness, poor safety/judgment, elopement, wandering, making demands/being manipulative, hoarding, social withdrawal, self-injurious behavior, suicidal ideation/behavior, somatic complaints, unawareness of deficits, hallucinations/delusions, etc.
Behavioral dyscontrol after brain injury can be treated. There are three basic intervention methods: therapeutic discussion, skill building, and contingencies. However, it is crucial that these be applied with an understanding of how to adjust them for the needs of people with brain injury. The goal of this course is to delineate the nature of each intervention, the pitfalls of its use in therapeutic treatment of those with brain injury, and how to adjust each to be most successful. This course is Part 3 of a four-part series of courses on behavioral dyscontrol following brain injury.
Dr. Karol is President of a group private practice, Karol Neuropsychological Services & Consulting, in Minneapolis, that specializes in counseling for persons with brain injury and other disabilities, neuropsychological and rehabilitation evaluations, program development consultation for organizations, workshops & staff training, and case consultation for providers, insurers, and attorneys. Dr. Karol has also recently served as Vice President of Brain Injury Services responsible for Brain Injury Services’ programmatic leadership, marketing, and admissions for a provider of long-term care, assisted living facilities, and other services through specialty programs across multiple states. Prior work was as Director of a hospital based behavioral program for people with challenging levels of behavioral dyscontrol who had failed other programs, but were able to return to the community through his program. Dr. Karol is Board Certified by the American Board of Professional Psychology (ABPP) as a Rehabilitation Psychologist and is Certified by the Academy of Certified Brain Injury Specialists (ACBIS) as a Certified Brain Injury Specialist Trainer (CBIST). He received the American Psychological Association Rehabilitation Division Lifetime Practice Excellence Award in 2015 for “excellence in clinical practice and contributions to the field of rehabilitation psychology.” He is a member of the Minnesota Academy of Medicine. He has authored four books:  Neuropsychosocial Intervention: The Practical Treatment of Severe Behavioral Dyscontrol After Acquired Brain Injury published by CRC Press,  Overcoming Grief and Loss after Brain Injury and  Therapists’ Guide to Grief and Loss after Brain Injury both published by Oxford University Press, and  Behavior Plan Workbook: How to Conceptualize and Treat Behaviors after Brain Injury published by Lash and Associates. Other publications include a book chapter Principles of behavioral analysis and modification in Brain Injury Medicine and its revision Principles of behavioral analysis and treatment as well as a chapter, Issues in Consultation, in Practical Psychology in Medical Rehabilitation. He has published an invited article Neurobehavioral Crisis Hospitalization: On the Need to Provide Specialized Hospital Brain Injury Crisis Programming in the Brain Injury Professional and an invited article Team Models in Neurorehabilitation: Structure, Function, and Culture Change in the journal NeuroRehabilitation. He has given more than 350 invited workshops, keynote addresses, seminars, and lectures, and he has conceived and hosted 13 annual conferences at two different hospitals, while serving on the planning committee for over another 30 conferences. He has been a national speaker for both Health Ed and CMI/PESI. He is the American Psychological Association’s Rehabilitation Division 22 Liaison to the Board of Professional Affairs. He has served on the Division 22 Communication Committee and is currently on its Practice Committee and Strategic Planning Task Force. He co-founded the Minnesota Brain Injury Alliance, serving on its Board of Directors for 14 years and he is a past Chairman of the Board. He is currently on its Conference Planning Committee. He is on the Board of Directors of the United States Brain Injury Alliance and its Governance Committee. He has also served on the Education Committee of Care Providers of Minnesota, the state affiliate of the American Health Care Association/ National Center for Assisted Living. He has been on the Mayo Clinic TBI Model Systems Regional Advisory Council. He served for 6 years on the Board of Directors of Accessible Space, Inc., which provides brain injury residential programming. He served on the Advisory Committee of Opportunity Partners’ TBI Metro Services, which provides brain injury vocational services. He has consulted with Vinland Center, which provides chemical health programming for people with brain impairment and at both Karcher Foster Services and Restoration Services of Minnesota, providers of group homes for people with brain injuries. He has advised the Minnesota Department of Human Services regarding brain injury on  its Traumatic Brain Injury Program Advisory Committee, and is its senior member and now planning to be its chair-elect,  its Neuropsychological Services Ad-Hoc Committee, and  its Needs of Adults with Brain Impairment Committee. He served on the Minnesota Department of Corrections Traumatic Brain Injury Expert Advisory Panel and has provided consultation services regarding brain injury to psychologists in the Minnesota Department of Corrections. He has served on the Supreme Court of Minnesota Board of Law Examiners Special Test Accommodation Panel. He has also served on Minnesota Psychological Association committees including Payor Committee, Statewide Referral Service Advisory Committee, and Hospital/Medical Psychology Committee. He is an Adjunct Professor at Argosy University.
Therapeutic discussion, or counseling, is one of the major interventions for behavioral dyscontrol. It addresses people’s views of their disabilities and provides insight into coping with them so as to avoid behavioral dyscontrol. However, it must be adjusted for the needs of people with brain injury. In fact, many of the adjustments apply to any communication between professionals and people with brain injury (e.g., nurse to patient). The goal of this chapter is to explain how to conduct therapeutic discussion with persons with brain injury.
Skill building is often used to treat behavioral dyscontrol. Skill building attempts to provide the person with alternative methods for responding to situations in order to avoid behavioral dyscontrol. However, how one teaches skills can be crucial. The goal of this chapter is to explain the concept behind skill building and to discuss how to best accomplish it.
Behavioral dyscontrol can be treated with the use of consequences. Consequences—rewards or punishments—following a behavior lead people to change their behavior next time by increasing behavior that leads to rewards or decreasing behavior that leads to punishment. However, the use of consequences is complex and must be undertaken with care, particularly when used in treating persons with brain injury. The goal of this chapter is to review the application of consequences and their strengths and pitfalls.