Case scenario B - Tim

Personal details
Tim is a 21-year-old carpenter.
He lives alone in a house at Bankstown with his German Shepherd dog, which he adores (his sister lives 15 minutes away and will only mind the dog until he is discharged).
Tim denies having any hobbies, but reported that he used to play indoor cricket on a regular basis. His other interests included rally cars and ‘clubbing’ with his mates.

Details of injury
Tim was a passenger in a motor vehicle accident. The driver died.
Neuropsychological assessment indicated an overall lowering of functioning. He had mild learning/memory problems, poor planning and poor problem solving skills, and his attention and concentration were below average.

Goals within TLU
Tim 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, improve his fitness levels and returning him to independent living.

Problems arising
Staff find it hard to motivate Tim to participate in the program. He frequently sits alone and appears lethargic. He occasionally becomes argumentative when prompted by staff to attend appointments and groups – and retreats to his room if allowed.
He does not understand why he needs to be at the TLU and would prefer to lie in bed all day.

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?