Coping with complex behaviors

The Complex Behavior Collaborative helps providers meet the needs of Medicaid clients with complex needs who are often aggressive, assaultive and difficult to support. The CBC program offers consultation and training to providers and clients’ natural supports, including family members.

The goal is to help clients live as independently as possible, and avoid Alaska Psychiatric Institute, jail, emergency rooms or out-of-state care. Benefits include:

  • Better quality of life for Alaskans with complex needs
  • Cost savings for the state
  • Development of a robust, competent workforce in Alaska
  • Development of infrastructure for collaborative interventions and continuity of care

Application Process

Agencies who have a potentially eligible client should contact the program. The CBC will evaluate the client. If the client is eligible, the CBC will contract with a consultant, who will support the agency through consultation and training.


Target clients for the program may be in Pioneer Homes, Alaska Psychiatric Institute, or live in the community. Eligibility requirements include clients who:

  • currently receive services from Senior & Disabilities Services or Behavioral Health
  • have housing where they can be assessed and get the pilot services
  • have behaviors that are so complex that they are
    • outside the range of expertise of local caregivers and providers, or
    • available treatment has been exhausted without success for the individual

A likely client has a cognitive impairment with complex behavior management needs and also has one or more complicating issues:

  • chronic mental illness
  • intellectual disability
  • dementia/Alzheimer's
  • brain injury
  • substance abuse


The project started in 2009, when the State and the Alaska Mental Health Trust Authority contracted with WICHE (Western Interstate Commission for Higher Education) to examine how Alaska served Medicaid clients with complex needs and challenging behaviors.

WICHE in 2010 identified gaps in Alaska's continuum of care, and suggested a model consisting of three components (executive summary):

  1. specialized training support for service providers
  2. short-term stabilization of clients
  3. medium-term intensive intervention
The first step, the 2012 pilot project, was launched with one-time funding from the legislature. 

Known at the time as The Hub, the project included adults and youth from the start. Project goals were to build in-state capacity and expertise to serve individuals with complex behavior management needs, and to keep participants in the community and out of hospitals or institutional care.

In state fiscal year 2015, 50 participants were served (31 adults, 8 adolescents, 11 children) in 17 communities. The participants experienced development disabilities, mental illness, TBI, or Alzheimer’s Disease and Related Dementias. Most participants – 30– were discharged from CBC services, and 22, or 82 percent, successfully stayed in the community.

In many cases, prior to CBC services, families had not had training available to them. Trainings provided by the CBC helped families and direct care staff to better understand behaviors and successful ways of affecting change.

The program continues to get positive reviews from agencies, families and clients, while remaining within budget.