People with difficulty communicating with words may express their discomfort or distress through changes in their behaviour. A change in someone’s behaviour may therefore reflect physical illness, disorder of mental health, sensory changes (vision or hearing loss) or a change in their social, physical or sensory environment. A thorough history and detailed physical assessment of the patient are required for accurate diagnosis.

Assessment and Management are based on the following considerations:

• Consider SAFETY does the behaviour constitute a serious risk to your patient or to others?
• Is there an underlying MEDICAL diagnosis?
  Consider pain and other symptoms: g. Gastro-oesophageal Reflux Disease(GORD), constipation, Urinary Tract Infection, musculoskeletal pain including pathologic fracture, itch, nausea etc
• Is there a PSYCHIATRIC diagnosis?
  Consider anxiety, depression, psychosis, bipolar disorder and other disorders of mental health
• Have ENVIRONMENTAL, changes in life circumstances or other triggers been identified and addressed? Consider changes in home, work, recreation, social activities. Consider changes in family, friends, co-residents staff – particularly experiences that may lead to loss and grief.
• Have SENSORY issues been identified and addressed? Consider sensory loss (vision, hearing) and sensory sensitivity (noise, light, touch, taste, texture)
• Is MEDICATION required?
  The indications for the use of medication to address underlying medical or psychiatric issues are the same as those for the general population.

• The use of medications primarily to modify  behaviour should only occur after
  the exclusion of underlying diagnoses and consideration of environmental and other triggers or in situations where the behaviour presents a significant danger to the person or others. Such use of medication is a chemical restraint, must only be used for a defined period of time while other strategies are put in place, and must be regularly reviewed.
• Have you reviewed all medications? Does the person’s demeanour or behaviour suggest any adverse effects?
• What NON-PHARMACOLOGIC interventions might be effective in place of or as well as medications?

• Would the client benefit from medical, psychiatric or allied health specialist REVIEW?

CDDH has developed a framework for the assessment and management of people with intellectual disabilities presenting with behaviours of concern.

Assessment Framework

We have also developed a guide for GPs on the use of psychoactive medication for adults with intellectual disabilities presenting with behaviours of concern.

Medication Review Guide for GPs

Note: Victorian Legislation defines CHEMICAL RESTRAINT as the use of a chemical substance (medication) to control or subdue a patient for the primary purpose of behavioural control. It does NOT include the use of a drug prescribed by a medical practitioner for the treatment of a diagnosed mental or physical illness.

The Restrictive Intervention Self-Evaluation Tool (RISET) is an on-line learning tool that educates the user about restrictive practices.

It is a ‘decision-making tool’ that guides the user through important information to help them understand when a restrictive intervention has occurred.

The RISET was developed to improve the disability sector’s understanding of its obligations under the Disability Act, 2006

http://www.surveygizmo.com/s3/2741253/Has-a-Restrictive-Intervention-Occurred

The Management Guidelines: Developmental Disability on eTG provides GPs with further advice on the assessment and management of behaviours in the context of a patient with a developmental disability.