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Q: A person I serve is non-compliant with hygiene activities such as showering and shaving. How do I encourage him to be more compliant?
A: This example of non-compliance is not unlike other forms of non-compliance (e.g., refusing to do vocational work or goals, refusing to go on an outing). Unfortunately there is no "one-size fits-all" solution to this or any behavior. A behavioral approach to this issue will take into account all of the potential reasons for the non-compliance. For example, we may first try to rule out any skill deficits or potential physical obstacles. If we find that an individual's non-compliance stems from one of these causes, we may make modifications to the task or provide environmental supports to assist the individual with greater independence and success. A second step may be to look at the social consequences for refusing to shower/shave. For example, does the individual receive extra attention or "special" attention from staff who otherwise may not be as available to them (e.g., nurses, directors)? Does the individual get more leisure time in the evenings (e.g., watching TV) if he skips his shower?
If such questions do not point to a potential reason for the behavior, all is not lost. In some cases, behaviors can be successfully treated by setting up a plan to help motivate the individual. Such a plan may include drawing upon the natural consequences for good hygiene (people complement you and like to be around you) as well as setting up a more artificial (hopefully temporary) consequence such as an opportunity to earn a preferred item or activity with each instance of compliance.