Case scenario A – Jack

Personal details
Jack is 44 years old.
He lives at Hoxten Park with his wife, who works full time.
They have two children aged 15 years and 6 years.
Pre-injury hobbies include model shipbuilding and gardening (his wife has reported that he takes great pride in his garden).

Details of injury
Jack was working as an electrician and fell off a roof. He sustained a frontal brain injurys and has residual weakness in his left arm.
Neuropsychological assessment indicated that he is concrete and rigid in thought. At times he can also be inflexible and mildly impulsive. His memory/learning ability remain fairly intact.

Goals within TLU
Jack spent some time in the acute rehabilitation ward in hospital before transferring to a share house in the community (a Transitional Living Unit or TLU) to continue rehabilitation. The primary goal within the TLU is to assess his independence and increase the functionality of his left arm

Problems arising
The TLU is currently full of young males, with whom Jack has nothing in common. Staff find that he constantly gravitates toward them and that he is always hovering around the office doorway.
When he speaks with staff, it is mostly to complain about the other residents (complaints range from ‘dobbing on them’ about tasks not completed to criticisms of their character and the ‘youth of today’).
On the odd time, staff have witnessed low level frustration toward the other residents, with the occasional verbal outburst. No real aggression has been noted.

Questions

• What is the main problem
• What do you want the outcome to be?
• Is there anything currently reinforcing this behaviour (Are staff making this worse?)
• What potential reinforcers are available to you?
• Devise a way to use this reinforcer to manage this behaviour.
• Are there other issues you need to consider?