abcd approach to problem solving

The ABCDE Decision-making / Problem Solving Model

by Dr. Kenneth Acha, MD, DMin. | Aug 5, 2018 | DECISION MAKING , FAITH & GROWTH , LEADERSHIP HABITS , STRATEGY

The ability to solve problems effectively or to make good decisions is vital for success. Over the years, I’ve been intentional about my decision making and have read extensively on problem-solving and decision making. With elements from sources I’ve come across, I’ve put together a simple approach that I use to solve my problems. I call it the ABCDE Decision-making model or ABCDE Problem Solving Model. Use it if you find it useful.

Step1: Prepare to solve the problem.

• Create a conducive environment
• Gather the right team (key stakeholders) to solve the problem.
• Avoid groupthink by creating an atmosphere where people can contribute freely without fear that they or their ideas will be judged negatively or rejected by the other participants.

Step 2: Apply the ABCDE framework. 

ABCDE stands for Analyze, Brainstorm, Choose, Do it, and Evaluate the results.

• Analyze the problem. To analyze means to examine methodically by separating into parts and studying their interrelations. Break the issue down and study it. Analyze, assess, and research the situation to ascertain the problem. After doing so, come up with a problem summary that clearly defines the real problem. To assess and analyze the problem, you may use root cause analysis to get to identify the root cause. At this stage, you get to the bottom of things and define the root cause, the real problem. You ascertain the problem. After knowing the real problem, you move to the next stage. Tools at this stage include a) Root Cause Analysis, and b) The 5 Whys. Part of analyzing a problem includes acquiring more information to understand it.
• Brainstorm to generate options/solutions. Brainstorm multiple ideas with multiple stakeholders using Charette Procedure. If needed, affinity grouping and multi-voting can be used to categorize and choose options from the ideas generated during brainstorming.
• Choose. Consider (evaluate) each option carefully and choose one . Choose the best solution (or a few options) to focus on. Decide and act. I apply my WISE PATH  filters to each option to help me narrow done to one or a few to focus on.
• Do it . Implement the decision.
• Evaluate the results. After implementation, evaluate the implemented solution and learn from it.
• Follow up and Fix any kinks.

**Note that throughout the entire process, you should collect and process information as needed for each step.

Other resources on the subject

• How to create a differential diagnosis . (Problem-Solving in Medicine)
• Mindtools.com article titled, How to make decisions .
• Vroom-Yetton decision model.
• The Kepner-Tregoe Method.
• Rapid Problem Analysis .
• https://www.lucidchart.com/blog/decision-making-process-steps
• https://www.designorate.com/brainstorming-using-charette-procedure/

About the Author

Dr. Kenneth Acha, MD, DMin.

Kenneth’s mission is to use medicine, spiritual formation, poverty alleviation, and leadership development to help people live lives to the fullest. He holds two doctorate degrees: the first is in medicine and the second is in spiritual formation. He is a practicing U.S. physician, an assistant professor of medicine, and a senior professor of leadership and spiritual formation at Servants University (SU). Kenneth is also a core faculty in the department of orphan care and poverty alleviation at SU and the founder and president of the Kenneth Acha Foundation, an organization that has helped thousands of orphans in Cameroon and trained many leaders since 2005.

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• LEADERSHIP HABITS
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What is Albert Ellis’ ABC Model in CBT Theory? (Incl. PDF)

REBT served as a sort of precursor to the widely known and applied Cognitive-behavioral therapy (CBT), and the ABC Model is still commonly used as a treatment in CBT interventions.

This article will cover what the ABC Model is, how it and REBT relate to CBT, and finally, how the ABC Model works to target dysfunctional thoughts and beliefs.

Before you read on, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a detailed insight into Positive CBT and will give you the tools to apply it in your therapy or coaching.

This Article Contains

• A Brief History on CBT & REBT

What Is The ABC Model?

• How To Treat Cognitive Distortions & Irrational Beliefs

5 ABC Model Worksheets (PDF)

A take-home message, frequently asked questions, a brief history on cbt & rebt.

Modern CBT has its direct roots in Aaron Beck’s Cognitive Therapy (CT), which he developed when he decided that contemporary treatments for depression focused too much on past events rather than current beliefs (such as the belief that one is not good enough or not worthy of love and respect.) (Beck, 2011).

Beck’s CT has its own roots, though, and Albert Ellis’s REBT is one of those roots. Specifically, REBT is “ the original form and one of the main pillars of cognitive-behavioral therapies (CBT)” (David et al., 2018).

In other words, REBT is both a precursor to and a form of CBT; it is still used today as a standalone form of therapy in some cases. The main thing that sets REBT and CBT apart from preceding cognitive therapies is that REBT and CBT both target beliefs as a fundamental course of treatment.

For the purposes of this article, we can consider REBT to be a subset of CBT, and we can consider the ABC Model to be a core component of many treatment plans in both REBT and CBT.

Another way to think about it is that “our emotions and behaviors (C: Consequences) are not directly determined by life events (A: Activating Events), but rather by the way these events are cognitively processed and evaluated (B: Beliefs)” (Oltean et al., 2017).

Further, the model states that it’s not a simple matter of an unchangeable process in which events lead to beliefs that result in consequences; the type of belief matters, and we have the power to change our beliefs. REBT divides beliefs into “rational” and “irrational” beliefs. The goal when using the ABC model in treatment is to help the client accept the rational beliefs and dispute the irrational beliefs.

This disputation process is what results in the model often being referred to as the “ABCDE” Model. In this updated model, the D stands for the Disputation of Beliefs and E stands for the new Effect, or the result of holding healthier beliefs (Jorn, 2016).

Disputation is not an original part of the ABC Model, as it happens outside of the “ABC” part (such as in the case of disputing an irrational belief to turn it into a rational belief), and the new Effect is another subsequent factor: the result of that disputation.

Calling it the “ABCDE” Model instead of the “ABC” Model simply makes these two steps more explicit, but they are present regardless of what one calls it.

In these models, this is what a typical series of thoughts might look like:

• A: Activating Event (something happens to or around someone)
• B: Belief (the event causes someone to have a belief, either rational or irrational)
• C: Consequence (the belief leads to a consequence, with rational beliefs leading to healthy consequences and irrational beliefs leading to unhealthy consequences)
• D: Disputation (if one has held an irrational belief which has caused unhealthy consequences, they must dispute that belief and turn it into a rational belief)
• E: New Effect (the disputation has turned the irrational belief into a rational belief, and the person now has healthier consequences of their belief as a result)

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These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

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How To Treat Cognitive Distortions & Irrational Beliefs

When it comes to applying the ABC Model (whether that’s in CBT, REBT, or any other form of therapy or coaching):

A key element is helping clients see the connection between an event that may serve as a trigger, and how irrational evaluations may cause emotional and/or behavioral consequences that often in turn lead to increased distress or conflict.

(Malkinson & Brask—Rustad, 2013)

This is the main idea behind the ABC Model and a popular notion in most forms of therapy; one does not necessarily have to change their environment to become happier and healthier, they simply have to recognize and change their reactions to their environment. This takes a little self-awareness, but that’s something we are all able to do with a bit of effort.

This theory is supported by the fact that three 45-minute learning sessions about the ABC Model have been shown to be effective in reducing symptoms of depression and anxiety as well as reducing dysfunctional thinking while increasing self-esteem and feelings of hope (Saelid & Nordahl, 2017).

This finding is even more impressive with the added note that 90% of the participants in this study “ reported not having had any previous knowledge of the links between thoughts, feelings, and behavior.”  Simply becoming more aware of the relationship between them made it a powerful tool!

In fact, the ABC Model partially works by making clear this connection between their beliefs and their emotions, which helps people see that the events around them do not need to dictate their emotions.

The ABC Model has not only been successful in treating anxiety, depressive symptoms, and self-esteem issues; it has been shown to target anger issues as well effectively (Fuller et al., 2010). This treatment is especially promising because participants in the study were able to deal with their anger while confronting potential anger triggers, rather than by merely avoiding anger triggers.

After all, there are some anger triggers we simply can’t avoid if we want to live a full, meaningful life–things like traffic, confrontations with people we love, etc.

In cases of unhealthy anger and other instances of unhealthy negative emotions, the key thing to understand is the difference between rational and irrational beliefs (Ziegler & Smith, 2004). However, in certain situations, the ABC Model cannot merely be deployed as-is.

In mild situations, the ABC Model works by turning irrational beliefs about activating events into rational beliefs, which in turn leads to better consequences and emotions. In some cases, such as grief, it is not about turning irrational beliefs into rational beliefs, but it is instead about legitimizing, validating, and normalizing the beliefs that are present.

For example, treating someone who is grieving, such as someone in mourning from losing a child, requires a modification. This is because, in the case of grief, “‘logical’ disputation is not useful, but instead, legitimizing and normalizing is used: losing a child is in and by itself not logical” (Malkinson & Brask-Rustad, 2013).

Grief is not an emotion that heeds logic, and it should not be attacked with the same vigor with which things like anger and negative self-talk can be confronted. In such cases, the ABC model should be applied with care, and only after validating the difficult emotions the client is facing.

In less acute cases, where the issues are more garden-variety irrational beliefs, this model has great success. Even the most rational and reasonable among us have struggled with irrational beliefs, it’s simply a matter of degree.

These irrational beliefs must be examined and confronted if the client is to experience relief from them, and that is what the ABC model does. There are many types of irrational beliefs–known formally as “ cognitive distortions ”–that have been identified, and all can benefit from this treatment.

The image below gives a short demonstration on the ABC model in action. In this case, the negative event is that a student doesn’t get selected for choir after her audition. The event (A) leads to this thought: “ I have a terrible voice. I’m never going to be any good at singing. ” This is the belief (B), which results in the consequences (C): the student is sad about her singing and gives up practicing instead of continuing to work on it.

Let’s expand on this idea with an example of the ABC model in action during treatment for a cognitive distortion. Imagine a counselor is working with a woman who suffers from black-and-white thinking; when she makes a mistake, she thinks to herself, “ I’m such a failure. I’m not good at anything .”

The counselor informs her about the ABC model and walks her through how to tackle it.

Unexamined, her cognitive distortion plays out like this:

A – Activating Event – the client makes a mistake. B – Belief – the client has a thought that says she is a failure and that she is not good at anything. She accepts it uncritically. C – Consequence – the client feels awful about her mistake and about herself in general, leading to depressive symptoms and making it tough for her to try again.

With her counselor’s help, the woman realizes that she is not a helpless victim to this process; she can do something about the “B” part of the model. She does not need to accept the thought as true, she can decide that it’s just a thought and treat it as such.

Her new process looks like this:

A – Activating Event – the client makes a mistake. B – Belief – the client has a thought that says she is a failure and that she is not good at anything. C – Consequence – the client feels awful about her mistake and about herself in general, but she remembers that she can question the cognitive distortion. D – Disputation – she questions the thought. She tells herself that everyone makes mistakes and that one mistake does not mean she is worthless or that she is not good at anything. E – New Effect – the client accepts that we all make mistakes and replace the negative thoughts with this positive thought. She commits to learning from her mistake and trying again in the future.

You can see the important work happening in D (Disputation). The client has realized that her thoughts are simply thoughts, they do not determine who she is. She takes control by rejecting the thought and purposely replacing it with a more realistic and more positive thought.

This extremely short worksheet simply lists the five steps of the ABC model in descending order.

It starts with the Activating Event — something happens to you or in the environment around you — where you have space to write down your activating event.

Next is Beliefs — you have a belief of interpretation regarding the activating event —  followed by space for you to identify your own belief or interpretation that you would like to change.

The third step is Consequences, described as “ Your belief has consequences than include feelings and behaviors .” Here you can write down what happens to you as a result of the belief you identified.

Next, the worksheet describes Disputations of Beliefs: “ Challenge your beliefs to create new consequences .” This is where you look critically at the belief you wrote down and see whether it’s accurate and helpful. If it is not accurate, not helpful, or neither accurate nor helpful, this is your opportunity to craft a new belief.

Finally, the worksheet ends with Effective New Beliefs: “ Adoption and implementation of new adaptive beliefs .” This is where you have a chance to create new, more helpful beliefs and think about how you are going to incorporate them. It might help to write out a commitment to choosing one of your new beliefs the next time a specific activating event happens.

This worksheet does not offer too much explanation but could be a good resource to hand out in an office or classroom when you have time to walk your student or client through it.

Understanding our Response to Stress and Adversity Handout

This three-page informational handout , which is part of a more extensive resource created by Dartmouth College, is a great standalone way to learn about the ABC Model.

The worksheet starts with a very relatable scenario (being stuck in traffic) and discusses why we have different responses to stress.  It clearly and briefly explains what the ABC Model is, provides an example, and describes how to use it effectively.

This is a good option for someone looking to quickly learn about the ABC Model and how to use for themselves or to give their clients to take home.

ABC Problem Solving Worksheet

This worksheet serves as a prompt to help someone work through the ABC Model in the moment when they are experiencing a challenging belief and difficult consequences.

It’s a detailed worksheet to walk through each step, which is great if you don’t have time to explain everything in a session or if your client isn’t big on writing down notes. It also changes the C and the B, which can be an exciting way to look at the model. We typically notice the consequences before the beliefs so that this format can be more intuitive to people new to the ABC model.

There are several questions for each step, including:

• What is the Activating event?
• What has happened?
• What did I do?
• What did others do?
• What idea occurred to me?
• What emotions was I feeling?
• Am I feeling anger, depression, anxiety, frustration, self-pity, etc.?
• Am I behaving in a way that doesn’t work for me (drinking, attacking, moping, etc.)?
• What do I believe about the Activating event?
• Which of my beliefs are my helpful/self-enhancing beliefs, and which are my dysfunctional/self-defeating beliefs?
• What is the evidence that my belief is true?
• In what ways is my belief helpful or unhelpful?
• What helpful/self-enhancing belief can I use to replace each self-defeating or dysfunctional belief?
• What helpful/self-enhancing new belief can I use to replace each self-defeating or dysfunctional belief?
• What are my new feelings?

This would be a great resource to hang in a classroom or office as a reminder of the connection between beliefs and emotions. This worksheet is useful for people brand new to cognitive therapy or cognitive distortions because it does not require any prior knowledge about the ABC Model to use it successfully.

CBT Exercise – The ABCD Method

This exercise is similar to the above worksheet, as it also walks one through the ABC Model whenever one may need it. It may be more appropriate for adults; however, while the preceding worksheet may be more suitable for younger people (only because it is more colorful and includes more specific prompts), this worksheet breaks it down in a slightly different way:

• Activating Event – What happened? What’s stressing me out?
• Belief – What is my negative self-talk? What distorted or irrational thinking style am I using? What negative belief am I clinging to? What interpretations am I making?
• Consequence – What am I feeling? What is my behavior as a result of my beliefs?
• Dispute – Counter-thought. What realistic and grounding statement can I use instead? Is there an alternative way of thinking here that is reality-based?

For each section, there are multiple spaces to write about what happened, what you’re thinking, what the consequences are, and what better alternative thoughts would be.

This worksheet can also help regardless of one’s prior knowledge of the ABC Model.

ABC Functional Analysis Worksheet

This final worksheet presents an alternative version of the ABC Model that draws on similar cause-and-effect processes. The difference is that this worksheet does so at the level of one’s behaviors, thereby serving as a useful supplement to the worksheets above, which focus on cognitions and emotions.

If your clients find mapping the links between activating events and beliefs challenging to begin with, starting at the level of their behaviors using this worksheet may serve as a useful stepping stone to exploring self-defeating beliefs and emotional consequences.

This exercise may also be useful if your client’s motivation for engaging your services involves addressing specific problematic behaviors.

The worksheet itself comprises three columns to be filled in. These columns are labeled as follows:

• (A)ntecedents – What factors preceded the problematic behavior?
• (B)ehavior – What is the problematic behavior?
• (C)onsequences – What was the outcome of the problematic behavior?

It is recommended that you begin the worksheet at the ‘Behavior’ column, then work to assess the antecedents and consequences in turn.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

The main takeaway from the ABC Model is that while environmental factors can undoubtedly harm our lives, we do have some control over how we react and respond to those factors. For the most part, the more positively we respond, the more positive our outcomes will be.

This does not mean that no harm can come to someone with a positive attitude, but it does mean that a positive attitude can get someone through rough times quicker and more effectively. Having a positive attitude also does not cost anything, so it cannot hurt to try to keep a positive outlook.

In the true spirit of positive psychology , we would all be better off if we remembered the principles of the ABC Model. In many situations, we may not be able to change the environmental factors (or Activating Events) that occur in our daily lives; however, we can keep in mind the immense power of our own beliefs in shaping our everyday experiences.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

A (Activating event): John’s boss criticized his work in front of his colleagues during a meeting.

B (Beliefs): John believes that he is a failure and that he will never succeed in his job. He thinks that his boss and colleagues do not respect him and that he will be fired soon.

C (Consequences): John feels sad, anxious, and unmotivated. He avoids his colleagues and stops working on his projects. He spends most of his time ruminating about his perceived failure and his future unemployment.

The three stages of the ABC model are:

• A (Activating event): An event or situation that triggers negative thoughts and emotions.
• B (Beliefs): The thoughts, attitudes, and beliefs that individuals hold about the activating event. These can be either rational or irrational.
• C (Consequences): The emotional and behavioral responses that result from the beliefs.

The ABC model is a fundamental component of behavior therapy that helps individuals identify the links between their thoughts, emotions, and behaviors. In behavior therapy, the ABC model is used to understand and modify problematic behavior patterns by identifying the antecedents (A), behaviors (B), and consequences (C) that are involved.

• Beck, JS (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.), New York, NY: The Guilford Press.
• David, D., Cotet, C., Matu, S., Mogoase, C., Stefan, S. (2018). 50 years of rational-emotive and cognitive-behavioral therapy: A systematic review and meta-analysis. Journal of Clinical Psychology, 74(3), 304-318.
• Ellis, A. (2000). Can rational emotive behavior therapy (REBT) be effectively used with people who have devout beliefs in God and religion? Professional Psychology-Research and Practice, 31(1), 29-33.
• Fuller, J.R., DiGiuseppe, R., O’Leary, S., Fountain, T., Lang, C. (2010). An Open Trial of a Comprehensive Anger Treatment Program on an Outpatient Sample. Behavioral and Cognitive Psychotherapy, 38(4) , 485-490.
• Jorn, A. (2016). Rational Emotive Behavior Therapy. Psych Central. Retrieved from https://psychcentral.com/lib/rational-emotive-behavior-therapy/
• Malkinson, R., Brask-Rustad, T. (2013). Cognitive Behavior Couple Therapy-REBT Model for Traumatic Bereavement. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 31(2), 114-125.
• Oltean, H.R., Hyland, P., Vallieres, F., David, D.O. (2017). An Empirical Assessment of REBT Models of Psychopathology and Psychological Health in the Prediction of Anxiety and Depression Symptoms. Behavioral and Cognitive Psychotherapy, 45(6), 600-615.
• Saelid, G.A., Nordahl, H.M. (2017). Rational emotive behavior therapy in high schools to educate in mental health and empower youth health. A randomized controlled study of a brief intervention. Cognitive Behaviour Therapy, 46(3), 196-210.
• Sarracino, D., Dimaggio, G., Ibrahim, R., Popolo, R., Sassaroli, S., Ruggiero, G.M. (2017). When REBT Goes Difficult: Applying ABC-DEF to Personality Disorders. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 35(3) , 278-295.
• Ziegler, D.J., Smith, P.N. (2004). Anger and the ABC model underlying Rational-Emotive Behavior Therapy. Psychological Reports, 94(3), 1009-1014.

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Useful information.. I do agree

Rachael I Rosner (2011, 2014, 2018) historian studied for near 20 years the career of Beck and the origin of his Cognitive Therapy. She found out that Beck viewed his theory as new-Freudian and part of ego psychology. Also she stated that Beck borrowed heavily from Albert Ellis who was the pioneer of cognitive therapy movement. Recent research of Aurora Szenagotai, Daniel David and Arthur Freelan shows that Ellis’ Rational Emotive Behavior Therapy, the original Cognitive Behavioral Therapy, is more accurate and more effective in explaining and treating Major Depression than is Beck’s theory of Cognitive Therapy. Ellis created his theory 1955, Beck first published about Depression 1963 and launched Cognitive Therapy with a book in 1975.

Helpfull !!!

I studied with Albert Ellis, PhD in 1974 at the Institute for Rational Emotive Therapy in NYC after having read all of the papers and books that he had written. It was an outstanding moment in my life to learn directly from such an intellect. I brought him several time to my home state of Delaware for presentations at conferences and had the opportunity to speak with him personally and found him to be a very gentle and caring man, when he wasn’t angry about something trivial.

Hey, letting you know that the 3rd link does not work. (To access and print the 3rd worksheet)

Thank you for bringing our attention to this. It looks like this worksheet is no longer available, so we have now updated this section with a different worksheet (the ABC Functional Analysis Worksheet).

– Nicole | Community Manager

I see that this article is considered very well and explained same as well. This really helped me. Distinctions between the concepts also are seen well. Thanks for preparing.

Very useful and easily explained

It is very useful for me and I hope many others also.

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3 Positive CBT Exercises (PDF)

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ABCDE approach (for solving a problem)

The recipe for a positive and healthy relationship is time, trust and practice as discussed in Block 4: Relationships with others.

Adults, caregivers and friends are sources of support and encouragement to help children develop these positive relationships. Keep in mind that all children have their own temperament styles. Some may be outgoing and some may be quieter. There will also be times that there will be conflicts.

Here is one strategy:

ABCDE Approach A= Ask B= Brainstorm Solutions C=Choose a Solution to Try D=Do it! E=Evaluate

For Preschoolers:

A – What is the problem? Let child talk about the problem and how it makes them feel. B – Set limit on appropriate behavior. Ask their solutions or use a solution kit* . C – Let child choose which solution they want to try or model it for them. D – Try the solution. They can do this themselves or with you. E – Check in if the solution worked. Celebrate!

(Solution kit idea from CSEFEL )

(Here is the link for Solution kit Cue Cards Template )

For Toddlers:

A – What is the problem? Use a Feelings wheel and help them label.

B – Give at least two ideas. You can use a visual for this.

C – Help them make a choice and make sure it is clear and specific. D – Try the solution. Make sure to support them through this especially with the language. E – Vocalize to them if the solution worked or not. Celebrate with a Hug or high five.

Activity: "And Then.."

(from Rainbow Fish by Marcus Pfister)

Instructions:

1. Choose a Picture or an Illustration from a Storybook

2. Build a story with your child/children using the illustration or picture

3. Each person will take a turn to hold the book and add to the story using “And Then..”

4. The end goal is to have a positive outcome to solve the situation.

5. Refer to ABCDE Approach to check how it was used in the story that you created.

(from Talk and Work it Out by Cheri J. Meiners)

- Use a picture or book that children are familiar of, especially the characters.

- Use real life situations that children have an experience on.

- Use a stuffed toy/character toy and other tangible items.

- Make sure it is short and simple.

- Use situations that are familiar to them

- Involve family members and friends in scenarios.

(from How do Dinosaurs play with their Friends? By Jane Yolen and Mark Teague)

(from I can Share by Karen Katz)

Recent Posts

The Kissing Hand: A Story to Support Separation Through Attachment 💕

Thinking about: Building trusting relationships

Caring for yourself and your child (or children in your lives)

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Alzheimer's: The ABCDE Paradigm

Affiliations.

• 1 Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto M5T 0S8, Canada.
• 2 Departments of Medicine, Chemistry, and Pharmaceutical Sciences, University of Toronto, Toronto M55 3H6, Canada.
• PMID: 35427106
• DOI: 10.1021/acschemneuro.2c00195

Alzheimer's disease (AD) and related dementias constitute a worldwide health crisis for which the design and development of global solutions is a neuropharmacologic priority. The much-publicized failures of multiple investigational agents for AD over the past 20 years drive the need to rethink our approach to therapeutics development. Herein we present the ABCDE paradigm as a conceptual tool to facilitate the development of safe, effective therapies for AD cure: (A) accessible; (B) blood-brain barrier permeant; (C) cognitive enhancing; (D) disease-modifying; (E) environmentally nontoxic.

Keywords: Alzheimer’s disease; biologics; blood−brain barrier; dementia; drug design; neurodegenerative disease; neuroinflammation; small-molecule therapeutics.

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• Reversing pathology in a preclinical model of Alzheimer's disease by hacking cerebrovascular neoangiogenesis with advanced cancer therapeutics. Singh CSB, Choi KB, Munro L, Wang HY, Pfeifer CG, Jefferies WA. Singh CSB, et al. EBioMedicine. 2021 Sep;71:103503. doi: 10.1016/j.ebiom.2021.103503. Epub 2021 Sep 15. EBioMedicine. 2021. PMID: 34534764 Free PMC article.
• PTI-125 Reduces Biomarkers of Alzheimer's Disease in Patients. Wang HY, Pei Z, Lee KC, Lopez-Brignoni E, Nikolov B, Crowley CA, Marsman MR, Barbier R, Friedmann N, Burns LH. Wang HY, et al. J Prev Alzheimers Dis. 2020;7(4):256-264. doi: 10.14283/jpad.2020.6. J Prev Alzheimers Dis. 2020. PMID: 32920628 Clinical Trial.
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• Experimental and Computational Methods to Assess Central Nervous System Penetration of Small Molecules. Gupta M, Feng J, Bhisetti G. Gupta M, et al. Molecules. 2024 Mar 13;29(6):1264. doi: 10.3390/molecules29061264. Molecules. 2024. PMID: 38542901 Free PMC article. Review.
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ABCD Problem Solving with Preschoolers

A hypothetical play situation like the following scenario may occur at any time of the day in a preschool setting:

A child approaches an adult and complains about her friend, “She’s not sharing her car.” As the adult looks down, she observes a whole basket full of cars that no one is playing with. It seems obvious that the solution would be for the child to select a different car. Sometimes that works like a “Eureka!” moment for the child who happily selects a different car and continues to play with her friend. Congratulations, the adult wears her “badge of problem solver” proudly. Other times the situation is more complicated.

This is where the ABCD approach to problem solving can come in helpful. We are reminded of this approach from the teachings at Red River College.

A – Ask what the problem is. On the surface it may just seem that the child either does not notice the other cars, or just wants the car that her friend has. Probing deeper may give more insight into what is disturbing the child. Perhaps on further questioning it is discovered that the two children were sharing the car initially, but one child decided that she no longer cared to play that way.

B – Brainstorm.  Help the child come up with ideas of her own to solve the problem. She may suggest getting a different car, or using the car in the famous “5 minutes”. One of the answers may be to grab the car away. Help her choose which solution may work the best. Ask what would happen if the other child suggested 10 minutes, or if she grabbed the toy, what she thinks would happen next.

C – Choose. After discussing the pros and cons of her ideas, help her with her choice. Preschoolers may need help with vocabulary and social etiquette, or getting the attention of the child who does not want to share.

D   – Discuss. Let her know that it is all right if her solution doesn’t work. She can either try something different, or help her cope with not having the toy at all. If you still have the child’s attention, congratulate her attempt at solving the problem. Remind her that she could try this again if the situation occurs another time.

Conflict occurs in a variety of situations throughout the lifetime of a person. Although it can cause frustration, and may even be painful, learning to problem solve helps to develop patience, wisdom,  and resilience.

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Understanding Community Needs based on Community Perspectives

Understanding community needs based on community perspectives:.

Asset-Based Community Development (ABCD) – Historically, university researchers have used a “needs assessment approach” or a “deficiency model” as their approach to engaging communities around problem solving. An unintended consequence is that communities (and university researchers) can wind up viewing themselves as having overwhelming problems that can only be solved by outside experts and external resources. An alternate approach, developed by John L. McKnight and John Kertzmann from the Center for Urban Affairs and Policy Research at Northwestern University, is to develop partnerships, programs and policies based on “the capacities, skills and assets” of the people and their local communities. The ARCHES backbone support organization utilizes this approach to community assessment because:

Successful community-engaged problem solving only occurs when local people are actively involved and leading the initiatives, committing themselves and their resources to the effort.

The approach is consistent with the principles of Community-Based Participatory Research (CBPR) whereby community members participate with researches in solving community problems identified by the community – community members themselves are best-equipped to identify and prioritize the issues that are important to them, and to then collaborate to develop sustainable solutions.

Community development and change must begin from within, building on the resources which the community members already control, while working to acquire those additional resources that are not yet available.

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The six main barriers against problem-solving and how to overcome them.

Challenges. Disputes. Dilemmas. Obstacles. Troubles. Issues. Headaches.

• The uniqueness of every different issue makes the need for an also adapted and individualized solution.
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Business people discussing the plan at office photo credit: Getty

There are more than thirty different ways to call all those unpleasant and stressful situations which prevent us from directly achieving what we want to achieve. Life is full of them. This is why the ability to solve problems in an effective and timely manner without any impediments is considered to be one of the most key and critical skill for resolutive and successful leaders. But is not just leaders or top managers facing the way forward.  According to a Harvard Bussiness Review survey , people's skills depends on their level on the organization and their particular job and activities. However, when coming to problem-solving, there is a remarkable consistency about the importance of it within all the different measured organization levels.

There are small problems and big problems. Those ones that we laugh about and those that take our sleep away. Problems that affect just us or our whole company. Issues that need to be resolved proactively and others that require us to wait and observe.  There is a special kind of problem for every day of our lives, but all of them responds to a common denominator: addressing them adequately.  It is our ability to do so what makes the difference between success and failure.

Problems manifest themselves in many different ways. As inconsistent results or performance. As a failure toward standards.  As discrepancies between expectations and reality.  The uniqueness of every different issue makes the need for an also adapted and individualized solution. This is why finding the way forward can be sometimes tricky. There are many reasons why it is difficult to find a solution to a problem, but you can find the six more common causes and the way to overcome them!

1. Difficulty to recognize that there is a problem

Nobody likes to be wrong. “Cognitive dissonance is what we feel when the self-concept — I’m smart, I’m kind, I’m convinced this belief is true — is threatened by evidence that we did something that wasn’t smart, that we did something that hurt another person, that the belief isn’t true,” explains Carol Tavris. 

Problems and mistakes are not easy to digest. To  reduce this cognitive dissonance, we need to modify our self-concept or well deny the evidence. Many times is just easier to simply turn our back to an issue and blindly keep going.  But the only way to end it up to satisfactory is to make an effort to recognize and accept the evidence. Being wrong is human and until the problem is not acknowledged solutions will never materialize. To fully accept that something is not going the way it should, the easiest way is to focus on the benefits of new approaches and always remain non-judgemental about the causes. Sometimes we may be are afraid of the costs in terms of resources, time and physical or mental efforts that working for the solution may eventually bring. We may need then to project ourselves in all the fatalistic consequences that we will finally encounter in case we continue sunk in the problem. Sometimes we really need to visualize the disaster before accepting a need for change.

2. Huge size problem

Yes! We clearly know that something is going wrong. But the issue is so big that there is no way we can try to solve it without blowing our life into pieces. Fair enough. Some problems are so big that it is not possible to find at once a solution for them. But we can always break them into smaller pieces and visualize the different steps and actions that we could eventually undertake to get to our final goal. Make sure you do not lose sight of the original problem!

3. Poorly framed problem

Without the proper framing, there is no certainty about the appropriate focus on the right problem. Asking the relevant questions is a crucial aspect to it. Does your frame of the problem capture its real essence? Do you have all the background information needed? Can you rephrase the problem and it is still understandable? Have you explored it from different perspectives? Are different people able to understand your frame for the problem correctly? Answering to the right problem in the right way depends 95% on the correct framing of it!

'If I have an hour to solve a problem, I'd spend 55 minutes thinking about the problem and 5 minutes thinking about the solution' (Albert Einstein)

4. Lack of respect for rhythms

There is always a right time for preparation, a right time for action and a right time for patience. Respecting the rhythms of a problem is directly link to the success of the solution. Acting too quickly or waiting too long can have real counterproductive effects. There is a need for enough time to gather information and understand all the different upshots of a planned solution. A balance of action is crucial to avoid both eagerness and laxity. Waiting for the proper time to take action is sometimes the most complicated part of it.

5. Lack of problem'roots identification

It is quite often that we feel something is not going the way it should without clearly identifying what the exact problematic issue is. We are able to frame all the negative effects and consequences, but we do not really get to appropriately verbalized what the problem is all together. Consequently, we tend to fix the symptoms without getting to the real causes.  It is as common as dangerous and not sustainable for problem-solving. 

Make sure that you have a clear picture of what are the roots of the problem and what are just the manifestations or ramifications of it. Double loop always to make sure that you are not patching over the symptoms but getting to the heart of the matter.

6. Failure to identify the involved parts

Take time to figure out and consult every simple part involved in the problem as well as affected by the possible solution. Problems and solutions always have at the core human needs and impacts. Failing to identify and take into consideration the human factor in the problem-solving process will prevent the whole mechanism from reaching the desired final goal.

'We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in.'  ( Atul Gawande)

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Asset Based Community Development (ABCD)

Asset Based Community Development (ABCD) is an approach to sustainable community-driven development. Beyond the mobilisation of a particular community, it is concerned with how to link micro-assets to the macro-environment. Asset Based Community Development’s premise is that communities can drive the development process themselves by identifying and mobilizing existing, but often unrecognised assets . Thereby responding to challenges and creating local social improvement and economic development.

This page will describe ABCD through five key aspects.

Asset Based Approach

• Deficit Based vs Asset Based Comparison

Power of Associations

Principles for facilitating asset based community development, asset based community development in practice.

• Associations

Asset Based Community Development builds on the assets that are found in the community and mobilizes individuals, associations, and institutions to come together to realise and develop their strengths. This makes it different to a Deficit Based approach that focuses on identifying and servicing needs. From the start an Asset Based approach spends time identifying the assets of individuals, associations and institutions that form the community. The identified assets from an individual are matched with people or groups who have an interest in or need for those strengths. The key is beginning to use what is already in the community. Then to work together to build on the identified assets of all involved. The first key method of the ABCD approach is that development begins with the recognition of asset categories that can be uncovered in any community and place. When applying ABCD principles communities are not thought of as complex masses of needs and problems, but rather diverse and capable webs of gifts and assets. Each community has a unique set of skills and capacities it can channel for community development. Asset Based Community Development categorizes asset inventories into five groups, Individuals, Associations, Institutions, Place Based and Connections.

Individuals – Everyone has assets and gifts.

At the centre are residents of the community who all have gifts and skills. Individual gifts and assets need to be recognized and identified. In community development you cannot do anything with people’s needs, only their assets. Deficits or needs are only useful to institutions.

Associations – People discover each other’s gifts.

Small informal groups of people, such as clubs, working with a common interest as volunteers are called associations in ABCD, and are critical to community mobilization. They don’t control anything; they are just coming together around a common interest by their individual choice.

Institutions – People organised around assets.

Paid groups of people that generally are professionals who are structurally organized are called institutions. They include government agencies and private business, as well as schools, etc. They can all be valuable resources. The assets of these institutions help the community capture valuable resources and establish a sense of civic responsibility.

Place Based Assets – People live here for a reason.

Land, buildings, heritage, public and green spaces are all examples of assets for the community. Every place where people choose to be was chosen for good reasons, and whilst people remain those reasons remain. A place might be a centre of natural resources, a hub of activity, living skills, transit connection or marketplace. Whatever the strengths of a place are, the people of the community will be the closest to understanding it.

Connections – Individuals connect into a community.

Asset Based Community Development recognises that the exchange between people sharing their gifts and assets creates connections, and these connections are a vital asset to the community. People whose gift is to find and create these connections are called connectors. It takes time to find out about individuals; this is normally done through building relationships, person by person. The social relationships, networks and trust form the social capital of a community. ABCD recognises the value of these assets, and is a practical application of building relationships to increase social capital.

Deficit Based vs Asset Based

In the past when a person had a need they went to their neighbourhood for assistance. But this has shifted today to the belief that the neighbour does not have the skills to help them. Therefore they must seek services and go to a professional for assistance. In so doing, reinforcing the form of system that divides people into providers and recipients.

Professionalised deficit based service providers have made clients of the poor. People are distanced from the support of their neighbours, who now think that they are too removed and unqualified to help. This leads to isolation of the individuals. When in difficulty people are pressured to identify themselves by their special needs that can only be validated and serviced by outside agency. But within the ABCD process this can be changed through the process of recognising community assets and changing assumptions and intent accordingly.

The second key method of Asset Based Community Development is that action is realised through the local associations who should drive the community development process and leverage additional support and entitlements.

These associations are the vehicles through which all of a community’s assets can be identified and connected to one another in ways that multiply their power and effectiveness. Users of the ABCD approach are deliberate in their intentions to lead by stepping back. Existing associations and networks (whether formal or informal) are assumed to be the source of constructive energy in the community. Community-driven development is done rather than development driven by external agencies that divide their capacity and expertise between service provision and the priorities of their continuing existence.

ABCD draws out strengths and successes in a community’s shared history as its starting point for change. Among all the assets that exist in the community, ABCD pays particular attention to the assets inherent in social relationships, as evident in formal and informal associations and networks.

ABCD’s community-driven approach is in keeping with the principles and practice of participatory approaches development, where active participation and empowerment (and the prevention of disempowerment) are the basis of practice. It is a strategy directed towards sustainable, economic and social development that is community-driven.

Most communities address social and economic problems with only a small amount of their total capacity. A large amount of the community capacity is often diverted into meeting the service and eligibility requirements of external deficit focused provision. This capacity is needed internally by the community as it reacts to challenges and seeks to lead its own development. This is the challenge and opportunity of community engagement.

Everyone Has Gifts

With rare exception; people can contribute and want to contribute. Everyone in a community has something to offer. There is no one who is not needed. Gifts must be discovered.

Relationships Build a Community

See them, make them, and utilize them. An intentional effort to build and nourish relationships is the core of ABCD and of all community building.

Citizens at the Centre

It is essential to engage the wider community as actors (citizens) not just as recipients of services (clients).

Leaders Involve Others as Active Members of the Community

Leaders from the wider community of voluntary associations, congregations, neighbourhoods, and local business, can engage others from their sector. This form of leadership utilises relationships, inclusion, showing and sharing to lead involvement based on trust.

People Care About Something

Agencies and neighbourhood groups often feel trapped by perceived apathetic responses. Apathy is a sign of bad listening. People in communities are motivated to act. The challenge is to discover what their motivation is.

Motivation to Act

People act on certain themes they feel strongly about, such as; concerns to address, dreams to realize, and personal talents to contribute. Every community is filled with invisible “motivation for action” that must be identified. Listen for it.

Listening Conversation

One-on-one dialogue or small group conversations are ways of discovering motivation and invite participation. Forms, surveys and asset maps can be useful to guide intentional listening and relationship building but cannot fill the void left by its absence.

Ask, Ask, Ask

Asking and inviting are key community-building actions. It is integral to showing that people have been listened to and their gifts are recognised. “Join us. We need you.” This is the song of community.

Asking Questions Rather Than Giving Answers Invites Stronger Participation

People in communities are usually asked to follow an outside expert’s answers for their community problems. A more powerful way to engage people is to invite communities to address ‘questions’ and lead finding their own answer, changing the role of agencies to following up with help.

A Citizen-Centred “Inside-Out” Organization is the Key to Community Engagement

A “citizen-centred” organization is one where local people control the organization and set the organization’s agenda.

Institutions Have Reached Their Limits in Problem-Solving

All institutions such as government, not-for-profits, and businesses are stretched thin in their ability to solve community problems. They can not be successful without engaging the rest of the community in solutions.

Institutions as Servants

Local people are better than outside programs in engaging the wider community. Leaders in institutions have an essential role in community-building as they lead by “stepping back,” creating opportunities for citizenship, letting people show they care, and engaging in real democracy.

ABCD is an approach built on tried and tested methods from sustainable community development practice. It is not a set formula that can be prescribed in a one size fits all manner. Here are basic common steps reflecting the experience and principles of applying an asset based approach.

1) Collect stories

Stories are collections of the cultural capital of a community. The listening conversation can engage people’s experience of successful activities that will help to uncover the gifts, skills, talents and assets within the community. From the stories, what people care about and their motivations to act can be discovered. Importantly this form of inquiry does not diminish but reinforces citizens as the centre of their community.

2) Bring together a core group

From the stories, people will emerge who have shown commitment and leadership in the past or who are currently taking a leadership role. Next bring together a group of these committed individuals who are interested in exploring the community’s assets, identifying opportunities and leading developmental action. Engaged and motivated to act on what they care about, using their strengths and gifts, these individuals will open networks of relationships inside the community.

3) Map the gifts, capacities and assets of individuals, associations, and local institutions

Citizens and their associations do the asset mapping so that they build new relationships, learn more about the contributions and talents of community members, identify connections that open opportunities and enable change. The objectives are:

Identifying associations

A list of associations can then be clustered by type and those associations most likely to participate in working together for a common purpose can be identified. In the process of identifying associations, the list of leaders in the community also expands.

Identifying individual gifts, skills, and capacities

The focus is to show people that their abilities and contributions are appreciated. A capacity inventory will be developed listing these capacities in categories such as community-building, enterprise, teaching, artistic or other skills. The categories should reflect the self identified strengths of the community, and not an external requirements list.

Identifying the assets of local institutions

This includes government services, non-government service providers and private sector businesses. These assets could be the services they provide, meeting places, the equipment and other supplies they can make available, communications links and staff who can envision the wider benefits for the whole community of stronger relationships.

Identifying physical assets and natural resources

This is a list of the potentials of a place, in which new ideas and re-imaginings can emerge. It is not a dry list for valuations, but revealing and understanding of the foundations on which development can be built. Because access and use has different conditions those which are communally owned and managed should be identified separately from those which are individually owned and managed.

Mapping the local economy

Provision of services has led to a distancing of community understanding from how their needs can be met. This process returns knowledge to people in the community of how the local economy works. With this people can see how well local resources are maximised for local economic benefit, and evaluate plans for economic development that can enhance local provision for externally provided services that drain resource away from the local economy.

4) Find and engage connectors who can build relationships

Lasting change comes from within the community and local people know what needs to change. Possibly the most vital step of Asset Based Community Development is encouraging the building of new relationships and strengthening and expanding existing ones. This is the heart of community building, and will lead to the immeasurable benefit that communities protect and support what they create.

5) Ask the gathered community to lead the creation of a community vision and plan

Asset Based Community Development’s core idea is that communities can drive the development process themselves by identifying and mobilizing existing, but often unrecognised assets . This requires a strong commitment to community driven efforts through active citizenship and participatory democratic methods. The community can meet the challenge to match assets with opportunities and decide their organising theme. A concrete, achievable and understood activity should be selected within that organising theme to begin working on right away.

6) Engage the self mobilisation of the community’s assets by action applied through association.

When people know what to do to succeed, know what success looks like, can see where to start and that it can be achieved within available resources, the chosen activity will have have a unifying and strengthening outcome. This creates the self-mobilisation as an ongoing process. Associations lead transformative efforts for local social and economic development. This leads to information sharing and realisation of what can further be achieved through new connections and association. From this emerges larger community-wide connected associations with common purpose.

7) Lever knowledge of the community’s assets and strengths to secure investments and resources needed from outside the community for community-driven development.

Institutions lead by “stepping back” into a supporting and helping role, leaving decision-making to associational leaders to facilitate within the community. Achieving a community vision begins with people that realise the power of their associations and accepting the challenge of making things happen. External resources are not sought until local resources have been utilised and clear understanding of what is needed is known. This crucially changes the dynamic of community interaction with institutions, from the community being under pressure to shape themselves to the externally provided services being offered to now utilising resource and investment that creates sustainable community development.

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ABCD Unveiled: A Deep Dive into Asset Based Community Development

1. what is asset-based community development (abcd), 2. the history and evolution of abcd, 3. building on strengths and resources, 4. the role of community engagement in abcd, 5. success stories from around the world, 6. the challenges and criticisms of abcd, 7. addressing inequities in communities, 8. creating lasting change, 9. how to implement abcd in your community.

asset-Based Community development (ABCD) is a community-driven approach to problem-solving that focuses on the strengths and assets of a community rather than its deficits and weaknesses. It is a process that empowers individuals and communities to take control of their own development by identifying and mobilizing existing resources and assets to create positive change. ABCD is based on the belief that every community has assets and resources that can be leveraged to create sustainable change.

1. The Principles of ABCD:

ABCD is based on a set of principles that guide its practice. These principles include:

- Asset mapping: The process of identifying and mapping out the resources and assets available in a community, including physical assets, skills, knowledge, and relationships.

- Community ownership: The belief that communities are the experts on their own needs and should be the ones leading the development process.

- Inclusion: The importance of involving all members of the community, including those who are traditionally marginalized or excluded from decision-making processes .

- Collaboration: The need for partnerships and collaboration between community members, organizations, and institutions to achieve shared goals.

- Capacity building: The process of developing the skills and knowledge of individuals and groups to enable them to take on leadership roles and create sustainable change.

2. Examples of ABCD in Action:

ABCD has been implemented in communities around the world, with successful outcomes. Some examples include:

- The Asset-Based Community Development Institute at Northwestern University has worked with communities in Chicago to identify and leverage existing assets to create positive change. One example is the West Side United initiative, which aims to improve health outcomes in the West Side of Chicago by building on existing community resources.

- The ABCD approach has been used in rural communities in India to empower women and improve their economic status. By identifying and mobilizing existing resources, such as skills and knowledge, women were able to create successful businesses and improve their livelihoods.

- In Australia, ABCD has been used to address social isolation and loneliness among older adults. By identifying and mobilizing existing social networks and resources, such as community centers and volunteers, older adults were able to increase their social connections and improve their well-being.

3. ABCD vs. Needs-Based Approaches:

ABCD differs from traditional needs-based approaches to community development in several ways. Needs-based approaches focus on identifying and addressing the deficits and weaknesses of a community, often overlooking its strengths and assets. In contrast, ABCD is asset-based, focusing on identifying and mobilizing existing resources and assets. Needs-based approaches often rely on external experts and resources, whereas ABCD emphasizes community ownership and collaboration. While needs-based approaches can be effective in addressing immediate problems, ABCD has been shown to create more sustainable change by empowering communities to take control of their own development.

Asset-Based Community Development (ABCD) is a community-driven approach to problem-solving that focuses on identifying and mobilizing existing resources and assets to create positive change. It is based on a set of principles that emphasize community ownership, collaboration, and capacity building. ABCD has been successfully implemented in communities around the world, with outcomes that have led to sustainable change. Compared to needs-based approaches, ABCD emphasizes community ownership and collaboration, leading to more sustainable change.

What is Asset Based Community Development \(ABCD\) - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Asset-Based Community Development (ABCD) has been around for a few decades now. It emerged in the 1980s as a response to the perceived limitations of traditional community development approaches. While traditional approaches focused on identifying and fixing problems in communities, ABCD sought to identify and build upon the strengths and assets that already exist within communities. Over the years, ABCD has evolved and expanded, and today it is a widely recognized and respected approach to community development. In this section, we will take a closer look at the history and evolution of ABCD.

1. The Origins of ABCD

ABCD emerged in the 1980s, largely as a response to the limitations of traditional community development approaches. At the time, many community development efforts were focused on identifying problems and fixing them. This approach, however, often failed to take into account the assets and strengths that already existed within communities. ABCD sought to change that by focusing on identifying and building upon those assets and strengths.

2. The Key Principles of ABCD

Over the years, ABCD has been refined and expanded, but it remains grounded in a few key principles. These principles include:

- Asset-Based: ABCD is rooted in the belief that every community has assets and strengths that can be leveraged to promote positive change.

- Community-Driven: ABCD emphasizes the importance of engaging and empowering community members in the development process.

- Collaborative: ABCD recognizes that successful community development requires collaboration and partnership among a variety of stakeholders.

- Sustainable: ABCD seeks to promote sustainable change by building on existing assets and strengths rather than relying on external resources.

3. The Evolution of ABCD

ABCD has continued to evolve over the years, with practitioners and researchers refining and expanding the approach. One notable development has been the emergence of a more nuanced understanding of assets. While early versions of ABCD focused primarily on tangible assets like buildings and infrastructure, more recent iterations have emphasized the importance of intangible assets like social networks and cultural resources. Additionally, ABCD has increasingly been integrated into other fields, such as public health and education .

4. Criticisms of ABCD

While ABCD has been widely praised for its community-driven and collaborative approach, it is not without its critics. Some have argued that ABCD can be overly optimistic and fail to adequately address systemic issues like poverty and inequality. Others have raised concerns about the potential for ABCD to be co-opted by outside interests and used to further gentrification and displacement.

5. The Future of ABCD

Despite these criticisms, ABCD remains a widely respected and influential approach to community development. As communities continue to face complex and interconnected challenges, the asset-based approach of ABCD will likely continue to be a valuable tool for promoting positive change. Moving forward, it will be important for practitioners and researchers to continue to refine and expand the approach, while also remaining mindful of potential pitfalls and limitations.

The history and evolution of ABCD is a testament to the power of community-driven , collaborative approaches to development. By building on existing assets and strengths, ABCD has helped communities to achieve sustainable, positive change. While there are certainly challenges and criticisms to be addressed, the asset-based approach of ABCD offers a valuable framework for promoting thriving, resilient communities.

The History and Evolution of ABCD - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Asset-Based Community Development (ABCD) is a development approach that focuses on the strengths and resources of a community rather than its deficiencies. The principles of ABCD are grounded in the belief that every community has assets that can be utilized to create positive change. The principles of ABCD are as follows:

1. Asset Mapping: Asset mapping is the process of identifying the strengths, resources, and skills within a community. The goal of asset mapping is to uncover the hidden talents and resources that are often overlooked. By identifying these assets, communities can build on their strengths and create innovative solutions to local problems.

2. relationship building : Relationship building is a key principle of ABCD. It involves creating strong connections between community members, organizations, and institutions. Building relationships is essential for creating a sense of community and fostering collaboration among stakeholders.

3. community ownership : community ownership is about empowering community members to take ownership of the development process. This principle recognizes that community members are the experts of their own lives and have valuable knowledge and insights that can inform the development process.

4. Inclusion: Inclusion is a core principle of ABCD. It involves creating an environment where all community members feel valued and included. This means creating opportunities for participation and engagement that are accessible to everyone.

5. capacity building : Capacity building is about building the skills, knowledge, and resources of community members. This principle recognizes that sustainable change requires a strong foundation of human and social capital.

6. Collaboration: collaboration is a key principle of ABCD. It involves working together with community members, organizations, and institutions to create positive change. Collaborative efforts can lead to more effective solutions and can help build trust and relationships within the community.

7. Innovation: Innovation is about creating new and creative solutions to local problems. This principle recognizes that traditional approaches to development may not always be effective and that new ideas and approaches are needed to create lasting change.

The principles of ABCD are interconnected and work together to create a holistic approach to community development. By building on the strengths and resources of a community, ABCD can create sustainable change that is driven by the community itself.

One example of ABCD in action is the Asset-based Community Development Institute (ABCD Institute) at Northwestern University. The institute works with communities around the world to implement the principles of ABCD and create positive change. One of their success stories is in the city of Flint, Michigan, where they worked with community members to identify and mobilize local assets to address the water crisis.

Another example of ABCD in action is the work of the Kettering Foundation, which focuses on building democratic practices in communities. The foundation uses the principles of ABCD to empower community members to take ownership of the democratic process and create positive change from the ground up.

The principles of ABCD provide a framework for building on the strengths and resources of a community to create positive change . By focusing on asset mapping, relationship building, community ownership, inclusion, capacity building, collaboration, and innovation, ABCD can create sustainable change that is driven by the community itself.

Building on Strengths and Resources - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Community engagement is an essential part of ABCD as it enables the community to take ownership of the development process and shape it according to their needs and aspirations. Community engagement involves building relationships, trust, and collaboration between community members and external stakeholders, including government agencies, NGOs, and businesses. It is a bottom-up approach that emphasizes the strengths and assets of the community and empowers them to identify and solve their own problems . In this section, we will explore the role of community engagement in ABCD and its importance in creating sustainable and equitable communities.

1. building trust and relationships : Community engagement starts with building trust and relationships between community members and external stakeholders. This involves listening to the community's concerns, needs, and aspirations, and working together to find solutions that are acceptable and sustainable. Trust and relationships are the foundation of effective community engagement and are crucial for creating a sense of ownership and participation in the development process.

2. Empowering the community: community engagement empowers the community by giving them a voice in the development process. It enables them to identify their strengths, assets, and resources and use them to address their own problems. Empowering the community fosters a sense of ownership and responsibility for the development process, leading to sustainable and equitable outcomes.

3. creating a sense of belonging : Community engagement creates a sense of belonging and identity within the community. It brings people together, fosters social connections, and promotes a shared vision for the future. By involving the community in the development process, it creates a sense of pride and ownership in the community's achievements and promotes a positive image of the community.

4. enhancing community resilience : community engagement enhances community resilience by building social capital, promoting social cohesion , and strengthening community networks . It enables the community to respond effectively to crises and challenges and to adapt to changing circumstances . Community resilience is crucial for creating sustainable and equitable communities that can withstand shocks and stresses.

Community engagement is a critical component of ABCD that enables the community to take ownership of the development process and shape it according to their needs and aspirations. It is a bottom-up approach that emphasizes the strengths and assets of the community and empowers them to identify and solve their own problems. By building trust and relationships, empowering the community, creating a sense of belonging, and enhancing community resilience, community engagement creates sustainable and equitable communities that are resilient to shocks and stresses.

The Role of Community Engagement in ABCD - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Asset-Based Community Development (ABCD) has been implemented in various parts of the world, and its impact has been remarkable. Communities have been empowered to identify their strengths and assets, and use them to achieve sustainable development . Here are some success stories from different parts of the world that showcase the power of ABCD in action.

1. South Africa: The Afrika Tikkun Project

The Afrika Tikkun Project is a South African initiative that aims to empower young people from disadvantaged communities. The project provides education, healthcare, and nutrition programs to vulnerable children and youth. The ABCD approach was used to identify the strengths and assets of the community, which were then used to develop sustainable solutions to the challenges faced by the community. As a result, the project has been successful in reducing poverty, improving education and healthcare outcomes, and empowering young people.

2. India: The Barefoot College

The Barefoot College in India is a unique initiative that uses ABCD to empower rural communities. The college trains illiterate and semi-literate women to become solar engineers, providing them with skills that can be used to bring electricity to remote villages. The ABCD approach was used to identify the strengths and assets of the rural communities, which were then used to develop sustainable solutions to the challenges faced by these communities . As a result, the Barefoot College has been successful in reducing poverty, improving access to energy, and empowering women.

3. United States: The Asset-Based Community Development Institute

The Asset-Based community development Institute (ABCD Institute) is a U.S. Based organization that provides training and support to communities around the world. The institute uses the ABCD approach to empower communities to identify their strengths and assets, and use them to achieve sustainable development. The institute has been successful in promoting community-led development, and has helped communities to develop sustainable solutions to their challenges.

4. Australia: The Stronger Smarter Institute

The Stronger Smarter Institute in Australia is an initiative that aims to improve the education outcomes of Indigenous students. The institute uses the ABCD approach to identify the strengths and assets of Indigenous communities, which are then used to develop sustainable solutions to the challenges faced by these communities. As a result, the institute has been successful in improving education outcomes for Indigenous students, and empowering Indigenous communities .

5. Canada: The Community Food Centres Canada

The Community Food Centres Canada is a Canadian initiative that aims to improve food security and reduce poverty. The initiative uses the ABCD approach to identify the strengths and assets of communities, which are then used to develop sustainable solutions to food insecurity and poverty. As a result, the initiative has been successful in improving access to healthy food, reducing poverty, and empowering communities.

The success stories from around the world show that the ABCD approach is a powerful tool for community-led development. By identifying the strengths and assets of communities, and using them to develop sustainable solutions to challenges, communities can achieve sustainable development and empowerment . These success stories provide valuable insights and lessons for communities and organizations that want to implement the ABCD approach.

Success Stories from Around the World - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Asset-Based Community Development (ABCD) is a popular approach that aims to empower local communities by utilizing their existing assets and resources. However, like any other model or strategy, ABCD has faced several challenges and criticisms. In this blog section, we will explore some of the most significant issues that have been raised about ABCD from different perspectives.

1. Overemphasis on assets: One of the main criticisms of ABCD is that it tends to focus too much on the assets and strengths of a community, while ignoring the challenges and needs that also exist. Some argue that this can lead to a skewed view of the community and create a false sense of optimism, which could hinder the efforts to address the real issues. While it is essential to recognize and utilize the assets of a community, it is equally important to acknowledge the challenges and work towards addressing them.

2. Limited focus on power dynamics: Another criticism of ABCD is that it does not adequately address power dynamics in a community. While ABCD aims to empower communities, it may not fully account for the power imbalances that exist within them. For example, some community members may have more access to resources and decision-making power than others, which could limit the effectiveness of ABCD in creating meaningful change. To address this issue, ABCD practitioners should work to engage all members of the community, including those who may not have a voice in traditional power structures.

3. Lack of scalability: Some critics argue that ABCD is not scalable and may only work in small, close-knit communities . While ABCD has been successful in many settings, it may not be as effective in larger or more complex communities. It can also be challenging to replicate ABCD in different contexts, as each community has its own unique assets and challenges. To address this issue, ABCD practitioners should be open to adapting the approach to different contexts and working with other models and strategies to create more significant change.

4. Risk of co-optation: Another challenge of ABCD is the risk of co-optation by external actors. ABCD emphasizes the importance of community-led development, but external actors may try to take over or influence the process. This can lead to a loss of community ownership and undermine the effectiveness of ABCD in creating sustainable change . To mitigate this risk, ABCD practitioners should work closely with community members and ensure that they have a meaningful role in the decision-making process.

While ABCD has many strengths and has been successful in many settings, it is not without its challenges and criticisms. Practitioners should be aware of these issues and work to address them to create more effective and sustainable change in communities. By recognizing the limitations of ABCD and working to adapt the approach to different contexts, we can continue to build upon its strengths and create more meaningful impact.

The Challenges and Criticisms of ABCD - ABCD Unveiled: A Deep Dive into Asset Based Community Development

In the realm of community development, social justice is a central tenet that aims to promote fairness, equity, and inclusion for all members of a community. Asset-Based Community Development (ABCD) offers a unique perspective on social justice , emphasizing the importance of identifying and leveraging community assets to address inequities and promote positive change. In this section, we will explore the role of ABCD in promoting social justice , and examine some of the key strategies and approaches that can be used to address inequities in communities.

1. Understanding Inequities in Communities

Before we can address inequities in communities, it is essential to have a clear understanding of the root causes and underlying factors that contribute to these disparities. In many cases, inequities are the result of systemic and structural issues that have been embedded in society for generations. These issues can manifest in a variety of ways, including disparities in access to healthcare, education, housing, and employment opportunities. To effectively address these inequities, it is important to take a holistic approach that considers the social, economic, and political factors that contribute to these disparities.

2. Leveraging Community Assets for Social Justice

One of the key principles of ABCD is the idea that every community has assets and strengths that can be leveraged to promote positive change. By focusing on these assets, rather than deficits or weaknesses, ABCD can help to shift the narrative around community development and promote a more positive and empowering vision for the future. When it comes to social justice, this approach can be particularly effective, as it allows communities to identify and build on their existing strengths to address inequities and promote positive change.

3. building Community power and Agency

Another important aspect of social justice in community development is the need to build community power and agency. This means empowering community members to take an active role in shaping their own future , and providing them with the tools and resources they need to be effective agents of change. This can involve a variety of strategies, including community organizing, leadership development, and capacity building. By building community power and agency, ABCD can help to create a more inclusive and equitable society where all members have a voice and a stake in the future.

4. Addressing Systemic Inequities

While ABCD can be an effective tool for addressing inequities at the community level, it is also important to recognize that many of these disparities are the result of larger systemic issues that require broader solutions. For example, addressing disparities in access to healthcare may require policy changes at the state or national level, while addressing disparities in housing may require changes to zoning laws or affordable housing policies . While ABCD can play an important role in addressing these issues, it is important to recognize that systemic change may require a more comprehensive approach that involves multiple stakeholders and levels of government.

ABCD offers a unique perspective on social justice in community development, emphasizing the importance of identifying and leveraging community assets to address inequities and promote positive change. By empowering communities to take an active role in shaping their own future, building community power and agency, and addressing systemic inequities, ABCD can help to create a more inclusive and equitable society where all members have a voice and a stake in the future.

Addressing Inequities in Communities - ABCD Unveiled: A Deep Dive into Asset Based Community Development

Sustainability has become a buzzword in recent years, but what does it really mean in the context of asset-based community development (ABCD)? At its core, sustainability refers to the ability to maintain or improve the well-being of a community over time. In the context of ABCD, sustainability means creating lasting change that will benefit the community for generations to come. This section will explore the concept of sustainability in ABCD and provide practical tips for creating sustainable change.

1. Engage the Whole Community

One of the key principles of ABCD is that everyone in the community has assets to contribute. This principle is particularly important when it comes to creating sustainable change. If only a small group of people are invested in a project, it is unlikely to continue once those individuals move on. Instead, it is important to engage the whole community in the process of creating change. This means involving people of all ages, backgrounds, and abilities in the planning and implementation of projects. By doing so, you are creating a sense of ownership and investment in the project that will help to ensure its sustainability.

2. Build on Existing Assets

Another key principle of ABCD is that every community has existing assets that can be leveraged for positive change. When it comes to sustainability, building on these existing assets is essential. For example, if your community has a strong tradition of volunteerism, you might consider creating a volunteer program for a new project. By building on existing assets, you are creating a foundation for sustainable change that is rooted in the strengths of the community.

3. Consider long-Term costs and Benefits

When planning a project, it is important to consider both the short-term and long-term costs and benefits. While some projects may have immediate benefits, they may not be sustainable in the long-term . For example, if you are planning a community garden, it is important to consider who will maintain the garden once it is established. If there is not a plan in place for ongoing maintenance, the garden may fall into disrepair. By considering the long-term costs and benefits, you can ensure that your project is sustainable over time.

4. Create Partnerships

Creating partnerships with other organizations and individuals is another key to creating sustainable change. By partnering with other groups, you can leverage their resources and expertise to create a more robust and sustainable project. For example, if you are planning a community health fair, you might partner with a local hospital to provide free health screenings. By working together, you can create a more comprehensive and sustainable event.

5. Measure Your Impact

Finally, it is important to measure your impact over time. By tracking your progress and evaluating the success of your project, you can make adjustments as needed to ensure its sustainability. For example, if you are running a job training program, you might track the number of participants who find employment after completing the program. By doing so, you can identify areas for improvement and make changes to ensure the program is sustainable in the long-term.

Creating sustainable change is not easy, but it is essential for the well-being of communities. By engaging the whole community, building on existing assets, considering long-term costs and benefits, creating partnerships, and measuring your impact, you can create lasting change that will benefit your community for generations to come.

Creating Lasting Change - ABCD Unveiled: A Deep Dive into Asset Based Community Development

As we delve deeper into the world of Asset-based Community Development, it is essential to understand the role of community involvement in establishing a successful ABCD program. Getting involved in your community may seem like a daunting task, but it is a crucial step in implementing ABCD. In this section, we will discuss the steps to take to implement ABCD in your community and how to get started.

1. Build relationships: The first step in implementing ABCD is to build relationships with community members. It is essential to get to know the people in your community and understand their needs, strengths, and assets. Building relationships also means establishing trust, which is crucial for any community development project to be successful. This can be done through community events, meetings, or even just having conversations with people in your community.

2. Identify community assets: The next step is to identify the assets in your community. This includes not only physical assets such as buildings and parks but also social assets like community organizations and groups. Once you have identified these assets, you can begin to leverage them to address community needs. For example, if there is a community organization focused on environmental sustainability, they could work with local businesses to reduce waste and promote recycling.

3. Mobilize resources: Mobilizing resources means bringing together the assets and resources in your community to address community needs. This can include financial resources, volunteers, and skills. For example, if there is a need for a new community center, you could mobilize resources by working with local businesses to donate materials and volunteers to help with construction.

4. Create an action plan: Once you have identified community assets and mobilized resources, it is essential to create an action plan. This plan should outline specific goals, objectives, and timelines for achieving them. It should also include ways to measure progress and evaluate the success of the project. creating an action plan ensures that everyone involved is on the same page and working towards the same goals.

5. Implement and evaluate: The final step is to implement the action plan and evaluate its success. This means putting the plan into action and monitoring progress to see if the goals are being met. It is also essential to evaluate the plan regularly to make any necessary adjustments. This could include changing timelines, reallocating resources, or revising goals.

Implementing ABCD in your community requires building relationships, identifying assets, mobilizing resources, creating an action plan, and implementing and evaluating the plan. By following these steps, you can create a successful ABCD program that addresses community needs and leverages community assets. Remember, the key to success is community involvement and collaboration. By working together, we can create stronger, more resilient communities.

How to Implement ABCD in Your Community - ABCD Unveiled: A Deep Dive into Asset Based Community Development

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The ABCD approach for managing neuropsychiatric symptoms of dementia

Siple, Amy APRN, FNP, GS-C

Amy Siple is a national speaker on healthcare issues that impact older adults and the empowerment of healthcare givers. She has served the primary care needs of residents in long-term care as an NP for over 2 decades.

The author and planners have disclosed no potential conflicts of interest, financial or otherwise.

Copyright © 2023 The Author. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

The neuropsychiatric symptoms associated with dementia, often referred to as unwanted behaviors, are one of the most difficult aspects of this disorder for caregivers to navigate. This article presents strategies to manage dementia-related neuropsychiatric symptoms.

The predicted number of patients with dementia in the next 30 years represents a significant challenge to our healthcare system. It is estimated that 6.5 million had Alzheimer disease (AD), the most common type of dementia, in 2022 in the US; by 2060, this number is projected to be 13.8 million. 1,2 Since AD represents only one type of dementia, the total number of people with dementia is likely underreported.

In 2021 more than 11 million people provided approximately 16 billion unpaid caregiver hours for those with dementia. 1 Unfortunately, this represents a decline in those volunteering to render care. 2 This volunteer decline is coupled with critical decreases in healthcare workers, particularly in the long-term care industry. 3 Thus, nurses must focus on improving skills of efficacy and efficiency in caring for those with dementia.

One of the biggest challenges when caring for someone with dementia is managing the accompanying neuropsychiatric symptoms, often called “behaviors.” These include yelling, pacing, delusions, and aggression. 4 There are two primary approaches to management. The first is medication-based; the second involves searching for the root cause or etiology of the behavior and intentionally equipping caregivers with management strategies. This article explores these strategies through a representative series of case examples. Specific patient identifiers have been altered. Any similarity to actual persons, living or deceased, is purely coincidental.

The Pharmacologic Management Approach

Psychotropic medications have often been used off-label to manage neuropsychiatric symptoms associated with dementia. 5 This practice occurs despite evidence showing limited benefits and high mortality risk. 6 Patients with dementia are often sedated with several pharmacologic agents to reduce agitation and other neuropsychiatric symptoms.

Case Example 1

An NP practiced the medication-based approach to managing the neuropsychiatric symptoms associated with dementia. A particularly challenging patient would bite, kick, scratch, and spit on staff during personal care. She was generally sedated with a benzodiazepine before bathing. On one occasion, medicating her resulted in a fall, causing a forehead laceration that required sutures. When paged about this incident, the NP was rounding with a physician. He accompanied the NP and modeled engaging in a root cause analysis approach to understand the patient's unwanted behaviors. The NP and physician discovered that the patient was raped in her youth, and the direct care staff providing bathing services were primarily males of the same ethnic background as her attacker. When the physician approached the patient, he sat down to make eye contact with her and lowered his voice and tone. He dimmed the lights and played soft music. The NP watched the patient de-escalate dramatically; the NP injected local anesthetic and repaired the laceration without difficulty .

This case highlights the need to engage in trauma-informed care. Up to 90% of older adults have experienced at least one traumatic event. 7 Some will develop triggers, a stimulus that activates a painful memory or emotion, that can result in secondary traumas. Patients with dementia seem to be especially vulnerable. 8 They can find themselves in a loop in which the traumatic event replays in their mind. The use of psychotropic agents in this case example resulted in a fall with injury. 9 This event created additional trauma for the patient and increased the needed caregiver hours.

Numerous psychological symptoms result from chronic cognitive impairment, including anxiety, depression, fear, and anger. 10 A caregiver's ability to imagine themselves in the patient's position can help them gain understanding and formulate an empathetic response.

Expressive and receptive aphasia are common features of dementia. 11 For example, communicating fecal impaction without words could become impossible, even for those with a fully functioning brain. Unwanted behaviors are typically an expression of unmet needs. 12

The nurse should strive to be the best detective possible when searching for a root cause when patients with dementia exhibit unwanted behaviors. This will require a multifactorial approach. 10

The analysis starts with the first phase of the nursing process: assessment. Although the formulation of a nursing diagnosis depends on objective and subjective data, 80% of the information required for a diagnosis generally comes from the patient history. 13 Obtaining historical data from patients with dementia is often challenging because of cognitive symptoms such as memory impairment, confusion, and the patient's inability to relay the symptoms they experience. Engaging the caregivers in this process is, therefore, essential.

Case Example 2

As a former professional football player, Joe was an imposing force. His massive frame dwarfed everyone else in his memory care unit. He often became physically aggressive when frustrated. Psychotropic agents were a cornerstone of his plan of care .

One day, a physician entered Joe's room. Joe was sleeping, and the physician attempted to wake him by turning on the room light and rocking him back and forth. Joe opened his eyes and turned to look at his physician. Joe appeared confused and did not answer any of the questions being posed to him, like “How are you?” and “Do you have any pain?” He remained still as his physician auscultated his heart and abdomen while maintaining a perplexed expression. When his physician turned towards the door, Joe got out of bed. The physician turned around, and Joe grabbed him by both shoulders and pinned him against the wall. Joe did not say anything during this encounter .

The physician remained calm and spoke in a relaxed tone. A nurse in an adjacent room entered and told Joe, “It is okay. You are safe. I need you to let go of him.” Joe released the physician and took the nurse's hand as she led him back to his bed .

A few weeks after the incident with his physician, Joe was transferred to an NP's care. His body odor was readily apparent. Staff confessed Joe had not bathed in two and a half months. They said they offered bathing services, but he declined .

After reviewing his history and care plan, the NP approached Joe and began an assessment of his ankles and knees .

The NP asked about football injuries to these joints, which he confirmed. Then the NP asked, “Did coach ever make you get in the whirlpool for your ankles and knees?” He affirmed. The NP responded, “Joe, coach says we need to get in the whirlpool.”

“Coach says?”

“Coach says.”

“Well, okay. If coach says.”

The NP asked a couple of caregivers to accompany her to the bathroom. After removing Joe's shoes and socks, she helped him move into the tub. He said, “I am going to get my pants wet.”

“You are right, Joe. Let's take those off and your skivvies too.” The NP said nothing about his shirt. He complied and got in the tub. The NP started the water, eventually reaching his shirt's level. She calmly asked, “Do you want me to help you get your shirt off so it doesn't get wet?” He complied, and the NP was able to complete the bath .

Upon assuming Joe's care, the NP noted he was on an atypical antipsychotic agent and a routine and p.r.n. benzodiazepine. One of the adverse reactions of the antipsychotic agent was pseudoparkinsonism (drug-induced Parkinson Disease). In response, carbidopa/levodopa was added to his medication regimen. The antipsychotic agent had also caused drug-induced diabetes, for which metformin was added. Joe developed diarrhea after starting the metformin and insomnia and headaches after starting the carbidopa/levodopa. His diarrhea was treated with loperamide; the insomnia was treated with trazadone; and ibuprofen was given for the headaches. Although the ibuprofen was only listed as p.r.n., the staff gave it at least twice daily to treat headaches and pain secondary to osteoarthritis. Joe developed gastrointestinal bleeding; thus, a proton pump inhibitor (PPI) was needed. In addition, Joe had pneumonia twice in the past year. Benzodiazepines and PPIs are both linked to the risk of pneumonia . 14,15 In reviewing Joe's history, the NP recognized that polypharmacy was a strong contributor to his comorbidities and likely exacerbated his dementia-related neuropsychiatric symptoms .

In the ABCD Approach, the letter A stands for antecedents or activating events. 16 This involves exploring what happened before the reported behavior to search for a cause and effect.

The letter B represents the behavior that is described in detail. Nurses should report the behaviors observed, such as Joe's agitation, and precisely what the nurse saw and heard.

The letter C stands for consequences. What did the healthcare personnel (HCP) do, and how did it impact the patient's behavior? Did the HCP's response reinforce or deter the situation? Did the HCP escalate or de-escalate the tension with their actions?

Lastly, the letter D stands for deciding and debriefing. Everyone involved should be part of the debriefing and be encouraged to present their perspective on what happened. Nurses should consider how to communicate this information to other caregivers. There was an initial plan to send Joe to a behavioral therapy unit at the hospital. However, following the debriefing, staff agreed they would avoid waking Joe unless necessary. It seemed especially important to prevent startling Joe, which was incorporated into the care plan. Joe responded well to a calm and relaxed demeanor, the assurance of safety, and saying, “I need you to let go.” These are all behaviors caregivers can easily replicate and should be made a part of the care plan. Unfortunately, in this scenario, Joe was given a benzodiazepine agent following the altercation, which produced sedation, causing him to sleep for the rest of the morning. The caregiver's nonpharmacologic response was very effective in de-escalating Joe. Staff reported the decision to offer the p.r.n. benzodiazepine was based on their fear after witnessing the violent interaction. It would be worthwhile to avoid benzodiazepine and focus on nonpharmacologic interventions (see The ABCD approach ).

Information from the patient's history can be used to formulate creative responses to neuropsychiatric symptoms and de-escalate tense situations. In this case, knowledge of Joe's respect for his coach was used to encourage his compliance with personal care. However, it may not always be effective, and caregivers must be flexible.

Eliminating the neuropsychiatric symptoms associated with dementia is unrealistic because patients with moderate to late-stage dementia cannot learn new coping skills. 10,12 However, equipping caregivers with information and tools that promote meaningful interactions may reduce caregiver burden and boost caregiver confidence. 17,18 Many caregivers of patients with dementia find themselves frustrated and discouraged. They report feeling ill-prepared to understand and deal with the neuropsychiatric symptoms associated with dementia. 17,18 As a result, they may depend on psychotropic agents to sedate those with dementia. 19 The Centers for Medicare and Medicaid Services strongly discourages the off-label use of antipsychotic agents to manage behaviors in patients with dementia and emphasizes gradual dose reductions and cessation when possible. 20 Mortality may be 60% higher in patients with AD taking antipsychotic agents; that risk could double if they are on two or more antipsychotics. 21 This increase in mortality has been shown to persist over at least 12 months. 22 In 2005, the FDA issued a boxed warning for antipsychotics in patients with dementia due to fall risk, movement disorders, and death. 22 The 2019 BEERS criteria stated that antipsychotics should be avoided to treat neuropsychiatric symptoms associated with dementia unless nonpharmacologic interventions have failed and the patient is a threat to themselves or others. 23 While the overuse of antipsychotic agents has increased morbidity and mortality, they do have their place in managing some patients with dementia, particularly those with mania or psychosis. 24 In fact, brexpiprazole, an antipsychotic, was recently approved for Alzheimer's dementia-related agitation through a fast-track process by the FDA. This drug has a boxed warning for increased mortality, as do all antipsychotics used in patients with dementia. 22,25 Weighing risks against possible benefits requires extreme caution.

Benzodiazepines are used routinely and intermittently in patients exhibiting neuropsychiatric symptoms associated with dementia. 19,26,27 They have been shown to increase the risk of dementia, and further exacerbate neuropsychiatric symptoms associated with dementia. The BEERS criteria included a strong recommendation in 2019 to avoid these agents for treating insomnia, agitation, or delirium. 23 Despite this recommendation, agitation is one of the top reasons cited in long-term care centers for using these agents. 27 Rebound insomnia and rebound anxiety are well-established risks associated with benzodiazepines. 28 Benzodiazepines can also cause delirium and carry a risk of dependence. The most significant concern, however, is the high fall risk associated with benzodiazepines when used in older adults. 29

The use of psychotropic agents in treating the neuropsychiatric symptoms associated with dementia contributes to polypharmacy. Additional agents may be added to treat the adverse events associated with the psychotropic agents, further compounding the problem. The risk of drug-to-drug interactions is substantial in those taking numerous agents. Studies show the risk could be as high as 80% for those on seven or more medications. 30

The pathophysiologic process of dementia affects multiple body systems. For example, aphasia, visuospatial deficits, and apraxia are common features for individuals with Alzheimer's dementia. 31 Therefore, an interdisciplinary approach to neuropsychiatric symptoms associated with dementia is an essential component of the care plan. 32

Neuropsychiatric symptoms should be expected in patients with dementia. The most effective mitigation strategy is searching for the etiology or unmet need that prompts unwanted behaviors. Key nursing considerations include understanding the patient's history, provoking factors, and using the ABCD approach.

Equipping caregivers with the tools, resources, and skills necessary to mitigate neuropsychiatric symptoms must become a priority. Psychotropic agents may have a limited role in managing behaviors, and a careful risk versus benefit analysis needs to occur before they are prescribed. An interdisciplinary approach is key in managing dementia-related neuropsychiatric symptoms.

The ABCD approach in action

An NP was recruited to assist a long-term-care facility trying to reduce psychotropic agent use in their patients. When benchmarked against other facilities, the facility had a 61% ranking for the use of antipsychotic agents and 90% for the use of antianxiety and hypnotic agents. CMS had notified them that their high psychotropic usage could negatively impact reimbursement. The NP assumed the primary care of their residents and equipped the other nurses and patient-care staff with the information and tools necessary to mitigate the neuropsychiatric symptoms associated with dementia. During the NP's weekly visits, she asked staff to notify her if there were unwanted behaviors so she could observe them. Not only did she want to understand what was happening (ABCD approach), but she also sought opportunities to model de-escalation techniques. In addition, she offered free classes to staff on the risks associated with psychotropic agents and tips for managing dementia-related behaviors. Phone consultations with the pharmacist, activity directors, social workers, therapy staff, and families helped ensure an interdisciplinary approach. The results were dramatic: In 5 months, antipsychotic usage dropped from 61% to 9%, and antianxiety and hypnotic usage declined from 90% to 19%. Interestingly, the report of unwanted behaviors dropped from 85% to 59%. 33 It is difficult to determine if the number of unwanted behaviors decreased or if the staff's perception of them decreased.

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Alzheimer disease; behavioral symptoms; dementia; neuropsychiatric symptoms; psychological symptoms; root cause analysis

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ABCD: Alzheimer’s disease Biomarkers Comprehensive Database

Ashwani kumar.

Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh 173234 India

Ankush Bansal

Tiratha raj singh.

Alzheimer’s disease (AD) is an age-related, non-reversible, and progressive brain disorder. Memory loss, confusion, and personality changes are major symptoms noticed. AD ultimately leads to a severe loss of mental function. Due to lack of effective biomarkers, no effective medication was available for the complete treatment of AD. There is a need to provide all AD-related essential information to the scientific community. Our resource Alzheimer’s disease Biomarkers Comprehensive Database (ABCD) is being planned to accomplish this objective. ABCD is a huge collection of AD-related data of molecular markers. The web interface contains information concerning the proteins, genes, transcription factors, SNPs, miRNAs, mitochondrial genes, and expressed genes implicated in AD pathogenesis. In addition to the molecular-level data, the database has information for animal models, medicinal candidates and pathways involved in the AD and some image data for AD patients. ABCD is coupled with some major external resources where the user can retrieve additional general information about the disease. The database was designed in such a manner that user can extract meaningful information about gene, protein, pathway, and regulatory elements based search options. This database is unique in the sense that it is completely dedicated to specific neurological disorder i.e. AD. Further advance options like AD-affected brain image data of patients and structural compound level information add values to our database. Features of this database enable users to extract, analyze and display information related to a disease in many different ways. The database is available for academic purpose and accessible at http://www.bioinfoindia.org/abcd .

Introduction

Social development, better living conditions, and medical advances lead to the fact that more people have the opportunity to live longer than in the past. The aging population is a characteristic feature of demographic trends in developed countries. This trend is closely linked with the issue of increasing number of diseases in old age. The most frequently mentioned diseases in old age include dementia (Odle 2003 ). Dementia could be a syndrome, sometimes of a chronic or progressive nature, caused by the spread of brain disorder that have an effect on memory, thinking, and behavior to perform everyday activities. Alzheimer’s disease (AD) is the most common form of dementia (Román 2002 ). AD is characterized by an incurable progressive decline in psychological activities. Current treatment for the disease prescribed by food and drug administration (FDA) is basically symptomatic and relies on three enzyme inhibitors which are donepezil, rivastigmine, and galantamine, affecting acetylcholine-based system, whereas memantine, affecting the glutamatergic system (Hogan 2007 ). Since 2003, no new medicines are being approved by FDA for the treatment of AD. Mostly AD targeted the individuals aged higher than 65 years (Hung and Fu 2017 ). AD research is going on from long time, still there is no permanent cure that stops or reverses the progression of the disease which ultimately worsens the situation, and afterward results in the death of sufferers (Foley et al. 2019 ). Presently, there is no specific biomarker available which can be considered as medicinal drug target for AD identification and diagnosis that may make sure with a 100% certainty regarding AD identification. The challenges in front of scientific community include understanding of abnormalities in gene regulation, protein–protein interactions, and the consequent alterations in signaling and metabolic pathways result in AD (Vasaikar et al. 2013 ). Advancement in medical technology cause better health conditions as a consequence of which number of people of old age increases and dementia like conditions arises. Amyloid precursor protein (APP), Presenilin-1 (PS-1), Presenilin-2 (PS-2), and Apolipoprotein E-e4 (APOE4) are few key genes that are known to be involved in AD progression (McKhann et al. 2011 ), but their overall contribution is very little or too little in relation to available dementia data. There is an urgent need for substantial advances in the research area of biomarkers for assessment of risk, identification of causal factors, and disease progression monitoring (Privitera et al. 2015 ). Continuing efforts are still going on to achieve success, this includes developing medicines that would slow progression, halt, or prevent AD. Current studies on AD are underway to spot biomarkers for diagnosing and new medical specialty to hinder disease progression. Acceleration in the biomarker identification, disease prognosis, and diagnosis has been observed through the development of various specific repositories as the information provided can be helpful in planning the experiments. Therefore, our objective was to collect and consolidate this data in a single repository for assessing different AD biomarkers (Kinoshita and Clark 2007 ). Keeping in view of the above studies and available data, we designed and developed Alzheimer’s Disease comprehensive database (ABCD); which may be a fully AD dedicated online information portal for storing and retrieving varied elements within the type of information to researchers, academicians, doctors, and caregivers. The amount and type of data available in ABCD is of high quality as all the data are being manually curated for the final compilation and storage. Most of the data are experimentally either computationally validated or experimentally verified as collected from the authentic published biomedical literature.

Exponential growth of biological experimental data and the development of new tools made it easier for the research community to analyze AD data (de la Torre 2004 ; Panigrahi and Singh 2013 ; Kumar and Singh 2017 ; Panigrahi et al. 2018 ). The bottleneck of AD study lies in data analysis, because the complexity of data analysis depends on multitude of databases, tools, and heterogeneity of data involved in the study (Thangam and Gopal 2015 ). We have a tendency to collate associated data related to AD that is scattered in various web-based resources and literature for the analysis of increasingly massive biological information of AD.

The information in the form of data available in ABCD is open access to all except image section which can be accessed only by the user after accepting some term and condition and allows user to easily browse the data associated with AD and their related molecular consequences. In addition, network-level understanding of pathways using concrete information can help scientific community to pave a path to resolve AD complexity. Molecular-level information retrieval portal can interrogate the information from user-friendly interface. ABCD database management system architecture is shown in Fig.  1 . Its comprehensiveness, standardization, free availability, ease of accessibility use, and support of different user profiles make ABCD a resource of choice to the scientific community.

Workflow for data storage, processing, and searching of useful information for Alzheimer’s disease through ABCD platform. It involves GUI through Web technologies [HTML, Java Script, and Cascading Style Sheet (CSS)] and server side technologies along with database systems as Apache, PHP, and MySQL, respectively. Information flow is also being represented to complete the ABCD information architecture

Materials and methods

ABCD is fabricated as a relational database implemented in MySQL language with a web interface that was developed in PHP using phpMyAdmin platform and hosted through Apache http server (Meloni 2012 ). Figure  2 shows the manually designed entity–relationship (ER) model for ABCD to establish causal relation between different entities of AD. Figure  3 represents the architecture of ABCD which describes that data extraction from literature and other external resources and their in-between association which allows user to access and retrieve information in an easy way.

Entity–Relationship (E–R) diagram for ABCD. Information about the tables and their relationships is being represented through ER diagram. Interconnectivity of biological parameters is elaborated through standard relation parameters of ER representations

ABCD architecture, which represents the main features of the ABCD platform. The information type to be searched and explored through ABCD is indicated through hierarchical representations along with basic and advanced search options

Large data collection from standard resource in ABCD

The data stored in ABCD database have been collected from literature and online resources like PubMed, PMC, Google Scholar, Medical Literature Analysis and Retrieval System Online (MEDLINE), and NCBI (National Center for Biotechnology Information) (Greenhalgh 1997 ). ABCD contains genes, proteins, SNPs, and microRNAs (miRNAs) which collaboratively provide gene regulatory information to the researcher. For miRNA-related data, the user may get verified information from miRBASE (Kozomara and Griffiths-Jones 2014 ), an archive of annotated microRNA sequence. A custom PHP script, utilizing the Entrez API, helped us to retrieve molecular data from NCBI resources (Maglott et al. 2011 ). Information about drugs was retrieved from Chembank (Seiler et al. 2008 ) and other resources. In addition, ABCD includes manually curated data extracted from the published research articles. The data available in the current version of the ABCD cover 843 publications reporting 499 genes and 767 miRNAs as well as 404 drugs.

ABCD external links

To enrich the contents of ABCD, association with various external databases was established, which includes (1) World health Expectancy for statistics of AD and other diseases, medical subject heading (MESH) (Lipscomb 2000 ) for medical literatures related to AD; (2) National cell repository for AD (NCRAD) to retrieve genes that increase risk for AD and dementia funded by National Institute of Ageing (NIA) (Vardarajan et al. 2014 ). (3) Alzheimer’s association is the leading health organization in AD care, support, and research to have information about causes, risk factors, diagnosis, and clinical trials studies such as pharmaceutical categories and therapy indications (McKhann et al. 2011 ); (4) Alzforum portal contain repository of biomarkers, literature, risks, antibodies, animal model, mutation studies, and therapeutics (Kinoshita and Clark 2007 ), National Institute of health (NIH), an American department of health for human services have quick link to several institutes under NIH (Strimbu and Tavel 2010 ). miRBase has more research material linked with miRNAs and endogenous molecules (Griffiths-Jones et al. 2006 ). In addition, Alzheimer’s and related Disorders Society of India (ARDSI) link was also connected with ABCD; which is a body to improve quality of life of people who sufferers of dementia and maintain a record of the people affected by AD in India (Varghese 2012 ). Apart from the above-mentioned data source, some are also need to mention here like MADAM, MOLGEN, and ICHOLM database from there we collected or cross-checked different molecular entities for AD (Potter 1998 ; Cruts et al. 2012 ).

Data interface

The main ABCD interface modules are genes’ search, proteins search, gene regulatory information related search, and advanced search. All types of searches in ABCD are of independent types. These allow (1) to navigate in the database by searching genes and proteins by their name and ids. All information related to protein-coding genes is also retrievable by searching protein name or ids. In advanced search, users can search SNPs regions and mitochondrial gene in molecular search option, whereas transcription factors and the co-expressed gene under gene regulatory information search. Drug details, pathway catalogs, and image information of AD-affected brain were provided separately. For each search type, ABCD guides the user by providing sample input to avoid misspelled entries. There are two levels of control checking on inputs, a client side and a server side by applying suitable PHP script. The input nomenclature is based on the official scientific standard commonly used by online databases. The statistics on the ABCD data are reported together with a brief documentation on the usage of the database content.

Search and advanced search

The search section allows users to query the system by genes and proteins. In the Advanced Search, users can query ABCD by mitochondrial gene, co-expressed gene, SNPs, Transcription factors (TF), miRNA, pathways, and drug target. The drug target section points to genes that are targets of drugs used in the treatments. Genes are specified using the nomenclature of HGNC (Bruford et al. 2008 ) and Entrez-gene by NCBI (Maglott et al. 2011 ). Drugs are asserted by their names as reported in Chembank (Seiler et al. 2008 ). SNPs are inserted by rs# number corresponding to the nomenclature in dbSNP (Sherry et al. 2001 ). Mitochondrial gene, co-expressed gene, and SNPs are also sub-leveled in advanced search option in gene category. Major categories of ABCD are listed as below.

Genes’ search shows the location of genes on chromosome and number of exon count with their genetic association and enrichment score describe the overrepresentation of gene from gene set and association with disease phenotype (Hertz et al. 2015 ). It also reports the co-expressed gene which is expressed in symbiosis and encodes the role of genes.

Proteins’ search provides important information about protein’s physiochemical properties with their structure and function related to AD (Bairoch et al. 2005 ).

Transcription factor

The transcription factor-related information is being completed for our gene set using DAVID (Dennis et al. 2003 ).

SNPs’ search shows the SNPs present in the genes and respective SNP-id is also linked to dbSNP. If the item is not a gene, ABCD shows also the gene name linked to Entrez-gene card or the microRNAs’ (miRNAs) access number containing the SNP (Johnson et al. 2008 ).

miRNAs are a family of short, single-stranded 21–22 nucleotides-long non-coding RNAs, constituting about 1% of all human genes and the most abundant class of small RNAs in animals. miRNA option provides information about non-coding gene of AD with chromosomal location and family information about respective miRNA.

Drug search shows the gene as a target and also linked to DrugBankV4.2 together with its type and a description, if available. The data are extracted from DrugBank (targets, transporters, and enzymes) or computed by the DT-Hybrid algorithm (Wishart et al. 2006 ). For all other data, this section report details on drugs (if any) that have been associated with the searched item. In details, there are gene names linked to Entrez by NCBI (Maglott et al. 2011 ), endogenous molecules involved, and the actions that the drugs has on the targets. The information about the therapeutical indications, pharmacodynamics, pharmacological action, and eventually the effects of drug on AD, extracted from the indexed articles (Kumar et al. 2019 and references therein), will also be available.

Clinical trials

It contains information about drugs candidates, their descriptions, clinical testing starting–closing dates, stages of phase trials, etc. (Jadad et al. 1996 ).

Pathways gives the list of pathways involved in AD in which top affiliating genes are involved (Mi et al. 2007 ; Mudunuri et al. 2009 ).

AD-affected brain image data are displayed on the basis of patient-id of both male and female (Petersen et al. 2010 ). Data used in the preparation of this article were obtained from the Alzheimer’s disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). The primary goal of ADNI has been to test whether serial magnetic resonance imaging (MRI), positron emission tomography (PET), other biological markers, and clinical and neuropsychological assessment can be combined to measure the progression of mild cognitive impairment (MCI) and early AD.

For each specific data available in the database, users can visualize all details and relations with the genetic elements of which would be reported in the results by clicking search options.

Statistics section reports the amount of data by category and Fig.  4 shows the ABCD statistics. The number concerning the manually curated data is the following: 499 genes, 259 proteins, 66 SNPs, 404 drugs, 1608 drug entries for clinical trials data, etc. Here, we also consider mitochondrial genes along with different speciation genes, because epigenetic changes in mitochondrial genes are somehow linked to early onset AD (Johannsen and Ravussin 2009 ). The data presented in ABCD enriched using external sources like Alzforum, NIH, miRBASE, etc. In addition, the graphical representation of number of death and population subdivided into different age groups affected by AD was shown. Hence, the data collected would be a unified information portal for the AD research community.

Data distribution of ABCD, represented through a pie-chart. Here, major types used for the data collection are mentioned along with their respective count as stored in the database

Data maintenance

ABCD will be continuously updated, through manual screenings of new publications on PubMed. Therefore, the manual procedures will extract and evaluate genetic- and network-level information which will be incorporated in ABCD at regular intervals. In addition, researchers can suggest new or missing findings to be inserted in the database by contacting authors by filling policy agreement form and send directly to database team in our ‘Contact us’ page. Agile approach has been adopted in designing; therefore, it is easy to update ABCD at any point of time.

Data distribution

The whole database was developed through standard RDBMS technology with the MySQL and Apache server and is available on http://www.bioinfoindia.org/abcd . Search results (i.e., by gene, protein, MT gene, SNPs, transcription factor, co-expressed genes, drugs, clinical trials, image, and pathways) can be visualized in HTML format through the browse and search section of the menu. Once data are available on HTML page, it can be copied to a relevant source for further usage.

Manual screening of literature and information retrieval from online resources was the major source of data for on fact that ABCD presents solid and reliable information resource for AD. Till date, in molecular level, most studies are conducted on genes and proteins; therefore, the limited biomarkers are available for AD. It joins bits of missing information scattered publicly in the archives and associated publications, into an identical, simply accessible, and often updated information resource. Our resource ABCD will facilitate to offer a comprehensiveness concerning the most genes, proteins, SNPs, drugs, or miRNAs associated within the pathology for AD. These entities are extremely necessary for complicated biological queries underlying AD pathology. Our results show that the number of data that are scattered in numerous resources needs in depth manual effort to be captured at a single platform. In addition, we tend to report that even with comprehensive manual gather; we were not able to capture 100% of information to fill for the fundamental annotation fields. Subsequently, we commit to extend the curation pipeline by adding a lot of options in the form of information for AD particularly. Special feature as raw brain image information was also incorporated for the researcher linked to biomedical neuroimaging. We would like to comprehend our database in future, so that it will cover all the relevant RNA-sequence studies and gene expression analysis, since their massive storage space has contributed to disperse nature of the marker information. The presented database offers great potentials to the scientific world and it is anticipated that ABCD will help the mankind through information dissemination for worldwide monitoring and effective biomarkers search for AD.

Acknowledgements

AK and AB acknowledge the financial support of Jaypee University of Information Technology (JUIT) in form of Ph.D. fellowship. All authors equally acknowledge Piyush Yadav and Ajay Dharmani for their technical help. TRS acknowledges financial support from ICMR (BIC/12(33)/2012). ADNI is being acknowledged for providing real brain image data set.

We confirm that there are no conflicts of financial interest associated with this publication.

Compliance with ethical standards

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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