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MH Home > Geriatric MH Services Home  > Guide's Appendix 1: Worksheet for Defining the Problem

Geriatric Mental Health Services

Geriatrics Guide - Appendix 1

For Assessing Changes in Behavior in Residents of Long Term Care Facilities and.......
Getting Help When Needed

Appendix 1: Worksheet for Defining the Problem

Determine exactly what the “problem” is. Ask questions such as, but not limited to:

Who is having trouble with this behavior?

Does the person involved feel there is a problem? Yes___ No___

If yes, what do they say the problem is_____________________________________________

If yes, what does the person say is needed to solve it?

Have you tried per the person’s suggestion? Yes___ No___

What happened?_________________________________________________________________________

If the person says there’s no problem, what do they say is going on? ____________________________________

Is there something that can be done in support of the person that will end the difficult behavior? _______________
____________________________________________________________________________________________

What does the individual say/feel about what is happening?

What does the staff say/feel about what is happening?

What was happening just prior to the development of the problem? Such as, has the individual received a visitor? Who was it?

Or was she/he expecting a visit that did not come? Yes___ No___

Was there anything that happened to this individual that was out of the ordinary?

Yes___ No___ What was it? ___________________________________________________

Does this happen every time there is a problem? Yes___ No___

Why is this behavior a problem? ________________________________________________

What is the impact of having this behavior continue?

What else have you tried and what happened? _____________________________________

Then...Reconsider. Reconsider everything!

Ask each question again, ask different people if possible. You may get different observations and more helpful ideas.

Are the answers the same or have they changed? Same___ Changed___

You may find that what seemed to be problem behavior was a reasonable reaction to a situation you were not aware of, and that your investigation has shown that it wasn’t really a problem. Is it still a problem? Yes___ No___

If not, what is it? ______________________________________________________________