GPEP's Care Planning Services
Behavioural Assessment Tool (BAT)
The Behaviour Assessment Tool or BATis a tool that is used in conjunction with GPEP Model during the Care Review Process. This tool is used to collect assessment information on a resident/client whose behaviour has: recently changed; interferes with care; represents a danger to him/herself or others; or interferes with quality of life. The information systematically collected is then used to assist staff/family in developing an individualized care plan and can be completed by any professional staff member of the residential team.
The BAT is available in a printable and downloadable form:
Guidelines for Using the BAT and Other Tools
Use the following link (or view below) to view a detailed description of the Guidelines for Using the Behavioural Assessment Tool (BAT). In conjunction to the BAT, GPEP also uses several other assessment tools to assist with information gathering around understanding behaviours.
The Clinical Practice Guidelines (CPG) for Identification of Agitated and Excessive Behaviours is a document developed by Vancouver Coastal Health’s Residential Practice Team to assist facilities with describing and responding to behaviours. Several tools within this CPG are accessible include:
Understanding Personhood. Other tools that support staff’s understanding of who the resident is as a person can also be found below:
BAT Directions for Use
- Describe the behaviour (action that you see or hear). Consider using Identification of Behaviours and Guidelines for Interventions.
- Check "X" yes or no if the behaviour is new.
- Describe when this behaviour occurs. Consider using Behaviour Pattern Record (be specific, time of day, number of times a week, etc).
- Work through the four areas of influences which are identified in the GPEP model using the key questions (use the chart and other team members to gather the information).
Psychiatric Influences (Cue questions)
(Consider the following)
Dementia
- Does the resident have a diagnosis of dementia?
- Does the resident have a chronic progressive memory loss?
- Is the resident chronically disoriented to: time, place, and person?
- Does the resident have difficulty solving problems, making choices, and making decisions?
- Does the resident have difficulty with ADL's which are related to cognitive impairment, not physical impairment?
Delirium
- Has there been a relatively recent onset of confusion (days to weeks)?
- Does the resident demonstrate difficulty in focusing, paying attention?
- Do the symptoms of confusion fluctuate throughout the day and night?
- Is the resident restless and awake during the night and sleepy during the day? (day/night reversal)
- Does the resident have hallucinations/illusions?
- Has their level of consciousness changed (ie. Comatose to agitated)?
- Does the resident have a recent onset of difficulty with ADL's which are related to cognitive impairment, not physical impairment?
- Are there any signs/symptoms of acute illness or episodic chronic illness (infections, CHF, COPD)?
- Is medication new or has it recently been changed?
Depression
- Has the resident's mood been consistently depressed for at least two weeks?
- Is the resident anxious or irritable?
- Have you observed a decrease in appetite, weight, energy or sleep?
- Has the resident talked about wanting to die or to kill him or herself?
- Is there a decrease in the resident's ability to think clearly or concentrate?
Other
- Does the resident have a diagnosis of any of the following psychiatric disorders: Schizophrenia, Delusional Disorder, Bipolar Mood Disorder, Anxiety Disorder, etc.?
Briefly describe the behaviours that you observe in the resident that fit the syndrome of dementia, depression, delirium or other psychiatric disorder.
Identify the action to be taken, such as other assessments (MMSE, behavioral logs, Geriatric Depression Scale, Cornell Scale for Depression in Dementia (CSDD), sleep logs, weight charts, food and fluid intake logs, Confusion Assessment Method [CAMI]).
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Physiological Influences (Cue questions)
(Consider the following)
Acute Illness: Are there symptoms of any common acute illnesses?
- Infection (urinary tract infection, pneumonia, wound)
- Constipation
- Metabolic abnormalities (electrolyte imbalance, hypo/hyperglycemia, etc.)
- Dehydration
- Skin conditions (cellulitis, ulcers)
- Vascular conditions (MI, CVA)
Chronic Illness: Have any of the resident's chronic illnesses become unstable?
- Chronic Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Arthritis, Diabetes, etc.
Pain
- Is there a new onset of pain?
- Is there a worsening of chronic pain?
- Have there been any unwitnessed falls?
- Is the resident able to report pain?
- Pain management issues:
- Is the resident receiving PRN pain medication (how often is it being used)?
- Does the resident require regular pain medication?
- Is the form of medication appropriate for the resident and the degree of pain (pill, liquid, injection, patch)?
Any concerns or changes in the following?
Constipation
Incontinence
Sleep
Appetite
Dehydration
Weight
Medications
- Is the resident a new admission?
- Were they actually taking their medication at home?
- Have there been any changes in medication dose or frequency?
- Has the resident been refusing medication?
- Have any new medications been started?
Other Physical Influences including mobility, hearing and vision
Briefly describe the symptoms that you observe in the resident.
Identify other assessments which are required (physical exam, C&S, blood work, x-rays, intake & output logs, weight logs, BM records, movement charts, medication records, pain assessment).
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Psychosocial Influences (Cue questions)
(Consider the following)
Personal Routines
- Does the resident have specific preferences around their daily routines?
- Are there personal preferences that clash with facility routines?
Early Life Factors and Life Events
- Has the resident had an abusive/neglectful childhood (could lead to lack of trust or disrespect for authority)?
- Has the resident experienced any major life events (war, economic depression, etc.)?
- What was the resident's work history?
Significant Relationships
- Does the resident have a good social support system?
- Have the social supports changed since coming to the facility?
- What is the state of the residents current relationships?
- Is the primary support person away or experiencing added stress in their life at the moment?
Personality Style
- How do family and friends describe the resident's personality style?
- In the past, how have they handled stress? Are they comfortable talking or do they withdraw when stressed?
- Do they tend to be more independent or dependent?
- Do they tend to have a more rigid/obsessive personality style?
- Do they tend to be quiet and self-absorbed or always looking after others?
- How has placement in the facility affected their sense of role, purpose, and self-esteem?
Losses: What recent losses has the resident experienced?
- Loss of independence?
- Loss of autonomy?
- Loss of a loved one?
- Loss of their customary roles?
Interests - Individualized Interest Chart (found at the end of this section)
- Give details as to what increases the stress/anxiety of the resident
- Also include what gives them pleasure (useful for care planning)
Cultural/Spiritual beliefs and values
- Are the resident's cultural/spiritual needs being met?
- Is there conflict between the environment and the resident's culture?
- Is there conflict between cultural expectations and how care is being delivered?
Briefly describe the symptoms that you observe in the resident.
Identify other assessments which are required (SW interview, Activities assessment, Pastoral care interview, etc.).
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Environmental Influences (Cue questions)
(Consider the following)
| Physical Environment |
- Is the environment over-stimulating/not stimulating enough?
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- Is it too hot/cold/bright/dark/noisy, etc.?
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- Are there private spaces?
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- Cues to reminisce about or connect with the past?
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- Are there assistive devises to encourage independence?
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- Space to spontaneously interact with others?
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Social Environment
Communication Abilities
- Does the resident have a cognitive, physical, vision or hearing deficit that affect communication? Describe.
- What is their first language?
- Are they demonstrating aphasia: receptive or expressive aphasia?
Decision-making opportunities
- Resident/family input into decisions?
Response to Others
- Does the behaviour increase/decrease in the presence of others (in the dining room, group activities, in crowded areas, etc.)?
- Is the resident responding to the behaviours of those around him/her?
Participation in Facility Life
- How does the resident participate in the events of the facility?
- Are they involved in meaningful activities? How often in the day?
- Do they initiate interaction with others? How?
Staff Approach
- Is there an approach that works well with the resident?
- Does my body language (touch, posture, how fast I move, how loud I speak, my facial expression, etc.) affect the way the resident behaves?
Briefly describe the symptoms that you observe in the resident.
Identify other assessments which are required (OT, physical exam including vision, oral hearing, medication review.
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Summary of Actions Required
Identify: the actions required as per the assessment sheets
Indicate: who will be responsible for the action (name and discipline)
Identify: the date to be completed
Individualized Interest Chart
(FOR USE IN ASSESSING PSYCHOSOCIAL INFLUENCES)
Resident Name: _________________________________________________
| Topic/Area |
Provides Pleasure (Give Details) |
Increased Stress (Give Details) |
Family/friends/caregivers |
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Chores/tasks |
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Things to reminisce about |
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Colors/clothes/comfort items |
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Music (performers, songs, styles, instruments) |
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Forms of exercise (dance, sports, walking, etc.) |
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Games/hobbies/activities
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Entertainment (movies, TV shows, comedians, books, Broadway shows, etc.) |
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Sights/sounds/tactile sensations |
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Food/drinks |
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Adapted from: 1998 Better Directions, Inc
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