What is “Acquired Brain Injury” (ABI)?
Acquired brain injury (ABI) refers to damage to the brain caused by events after birth, rather than as part of a genetic or congenital disorder. Causes can be from traumatic injury (e.g., car accident, assault, neurosurgery, sporting accident) or nontraumatic injury (e.g., stroke, brain tumour, hypoxia, alcohol abuse, meningitis). ABI can cause impairments in cognition (thinking), physical abilities, emotion regulation, or behaviour control. As a result, people with ABI can have temporary or permanent problems in these areas.
There are a number of ‘textbook’ definitions of challenging behaviours, but perhaps an easy way to think of this is that challenging behaviours are those that cross the boundary of acceptability in a given situation. For example, making a flirtatious comment to someone in a singles bar may be accepted as part of the scene. The same comment made by a client to therapist during a therapy session would be considered as getting in the way of rehabilitation, and therefore, challenging or problematic.
Professional footballers can be very physically aggressive on the field, and can seriously injure opponents or knock them out. This can be considered good, strong play. The same behaviour from a client may lead to retaliatory assault or police charges, and is considered challenging behaviour. Whether a behaviour is challenging can depend as much on the context as on the specific behaviour itself.
When we assess a client’s behaviour prior to treatment / intervention, we consider not just the behaviour said to be challenging, but also the context in which it occurs.
“Complex case” is a term used to describe people who have multiple diagnoses (such as ABI, mental health problems, intellectual disability) and who need support from a variety of service systems (e.g., housing, case management, mental health services, corrections). Because there is no simple ‘off the shelf’ approach to addressing these situations, and they demand the coordination of many services, they challenge the service system’s ability to manage them well. An important consideration for these cases is that someone’s diagnosis may not be clear, nor is the treatment approach. But there is often consensus about what behaviours are problematic, and that can be the starting point for how to build a unified service response.