A Natural Setting Behavior Management Program for Persons With Acquired Brain Injury: A Randomized Controlled Trial

Abstract 

Carnevale GJ, Anselmi V, Johnston MV, Busichio K, Walsh V. A natural setting behavior management program for persons with acquired brain injury: a randomized controlled trial.

Objective

To investigate the efficacy of a behavior management program delivered in the natural community setting for persons with brain injury and their caregivers.

Design

Three-group randomized controlled trial.

Setting

Homes and other community settings.

Participants

Thirty-seven persons with traumatic and other acquired brain injury and their caregivers.

Interventions

Natural Setting Behavior Management (NSBM) involving education and individualized behavior modification program versus education only versus control group.

Main Outcome Measures

Changes in frequency of targeted problematic behaviors. Subscale in Questionnaire on Resources and Stress, Maslach Burnout Inventory, and the Neurobehavioral Functioning Inventory.

Results

While no significant effects were detected at termination of education only (P<.075) or of NSBM (P<.56), significant treatment effects were found at the main outcome point 3 months after termination of services (P<.002). Rates of disruptive or aggressive behaviors declined significantly in the NSBM group. Differences in caregiver-rated stress, burden, and aggression were not statistically significant.

Conclusions

A program of caregiver education and individualized behavior management in natural settings can decrease the frequency of disruptive behavioral challenges. Larger studies are needed to clarify the duration and intensity of education and individualized treatment required to diminish behavioral challenges and to understand relationships with general stress and burden experienced by caregivers.

Key Words: Behavior therapy, Brain injuries, Burden of illness, Caregivers, Rehabilitation, Stress, Psychological