module 04 - crisis management training

prevent scratching

- accessories (long thick clothing) - safe distance and physical proximity (behind or across table) - differential reinforcement of incompatible behaviors (reinforce folded hands or hands in pockets) - have parents clip/file client's nails - reinforce replacement behaviors

prevent biting

- accessories (longer/thicker clothing) - safe distance and modify proximity ( stand behind / sit across ) - differential reinforcement of incompatible behaviors (reinforce using a chewy tube) - reinforce replacement behaviors

prevent lifting

- accessories (step stools for access to hand washing etc.) - modify physical environment to reduce eloping, climbing, other potentially dangerous behaviors - determine alternatives when maladaptive behaviors occur (client drops to floor or attempts to elope) - reinforce replacement behaviors

use of restraints

- against ACES policy to physically restrain client - physical restraint only considered as last resort when person is danger to self or others - discontinue physical restraint as soon as client and others are safe - contact supervisor to notify them of situation as soon as it is safe to do so if physical restraint is ever required for safety. 1. client incident reporting 2. funding source documentation 3. following supervisor updated behavior plans

prevent throwing objects

- clear unneeded items - avoid areas w dangerous items - work beside or behind client - reinforce replacement behaviors

additional crisis management functions of behavior

- communication (fear, anger) - control/ rigidity - medication/ medical issues

types of antecedent based interventions (MOs + SDs)

- deprivation/satiation - medical interventions - preparation - providing choices - flexibility training - prompting - creating a safe environment - limiting distractions - incorporating special interests - behavior momentum - advanced notification, countdowns and wait cards - teaching replacement behaviors - systematic desensitization - creating a stimulating environment - modifying tasks - interspersing preferred/ non-preferred activities - behavioral contracts - priming rules, expectations, and access to reinforcement (first/then) - creating opportunities - alternating passive vs active activities and providing breaks - delivery of instruction - non-contingent reinforcement - pairing teaching environment w reinforcement

key principles of disengagement skills

- position - where you are in relation to others - posture - how you hold and move your body - proximity - distance btwn individuals - biomechanics benefit - understanding how the body moves (joints and muscles) -> hold and stabilize - limits aggressive range of motion -> pull/push - pulling and pushing simultaneously in the opposite directions using momentum (energy and speed) weakens a grip while minimizing pain or injury - lever - combining momentum (energy and speed) with movement (rotation) around a single point (elbow, shoulders, hips) creates linear and angular motion which is more effective and efficient than pull/push

prevent hair pulling

- pull hair back and restrict access - use accessories (hat/hoodie) - safe distance and modify physical proximity (stand behind or sit across table from client) - differential reinforcement of incompatible behaviors (reinforce folded hands or hands in pockets) - reinforce replacement behaviors

crisis management strategies are antecedent based and consequence based interventions utilized to prevent and/or de-escalate clients w challenging behaviors and to keep clients and staff __.

- safe

aba functions of behavior:

- social positive - attn/access to tangibles - social negative - escape/task avoidance - automatic positive reinforcement - sensory stimulation - automatic negative reinforcement - pain attenuation

what is the correct order of behavior escalation cycle? 1. questioning - challenging, questioning - information seeking, refusal, intimidation, verbal release, tension reduction 2. questioning - challenging, questioning - information seeking, verbal release, refusal, intimidation, tension reduction 3. questioning - information seeking, questioning - challenging, verbal release, refusal, intimidation, tension reduction 4. questioning - information seeking, questioning - challenging, refusal, verbal release, intimidating, tension reduction

1. questioning - a. information-seeking - b. challenging 2. refusal 3. verbal release 4. intimidation 5. tension reduction

Behavior escalation cycle

1. questioning - information-seeking 1. questioning - challenging 2. refusal 3. verbal release 4. intimidation 5. tension reduction

crisis management strategies

Antecedent and consequence based interventions utilized to prevent and/or deescalate clients with challenging behaviors and to keep clients and staff safe

tension reduction may take the form of:

a drop in energy which occurs every crisis situation whether its after low-level defense behaviors (items 1-3) or after intimidation (w nonverbal client, this may take form of appearing exhausted, falling asleep or crying) reestablish communication w client, provide reinforcement after appropriate replacement behavior or completion of small part of task

client attempts to hit you, response?

block and move

t/f : bi's need to report restraints to their supervisors only when an injury occurs

f

if client incident involving restraints occurs

immediately contact supervisor, inform them of circumstances, follow ACES incident reporting procedures

client says "make me!" when you tell her to sit down. what form of behavior escalation cycle is this?

intimidation

consequence based interventions

make changes to environment AFTER behavior occurs

grab

making physical contact without consent (wrist-arm grab, neck grab, clothing grab, body grab, choke, grab, hair grab, bite) use hold and stabilize, pull/push, or lever depending on risk level involved in situation

restraint

method of one or more persons restricting another persons freedom of movement, physical activity, or normal access to their body - may cause injury or death - do not teach clients replacement behavior strategies -- keep in mind that as they age, may no longer be possible to restrain them due to size and therefore teaching appropriate replacement behaviors is crucial - may result in legal action

intimidation may take the form of:

non/verbally threatening in some manner (w nonverbal client, may take form of facial expressions (grimaces), hyperactivity) staff response/ consequence based intervention - take all threats seriously, seek assistance, wait for team to intervene (if possible), and avoid hands on approach

refusal may take the form of:

noncompliance, slight loss of rationalization (w nonverbal client: noncompliance, walking away or sitting down, change in eye contact eye contact or lack of eye contact, or seeming distracted, walking away or sitting down) set limits (simple/clear and reasonable direction that can be followed), teach alternatives, allow time for processing

client asks to use restroom in middle of challenging task. what form of behavior escalation cycle is this?

questioning - challenging

client lacks eye contact and appears distracted when BI asks question. what form of behavior escalation cycle is this?

questioning - information seeking

questioning - challenging may take the form of:

questioning authority or being evasive; attempting to draw staff into a power struggle (w a nonverbal client, this may take the form of avoidance, walking away, requesting to use the bathroom). - avoidance, walking away, or requesting to use the bathroom ignore the behavior (not client) and redirect back to task, give choices, and/or first/then statements

questioning - information-seeking may take the form of:

rational question seeking a rational response non verbal client - non-responsiveness, eye contact, lack of eye contact, walking away, or seeming distracted (give rational response, allow enough time for processing, clarify request, and/or use visuals)

modifications are made to the way we __.

react to problems to reduce/ stop them after they already occurred

clients head on table and avoids eye contact when asked to complete writing activity. what form of behavior escalation cycle is this?

refusal

modifications are made to antecedents to __.

set the stage for desired response and PREVENT or REDUCE the likelihood of maladaptive behaviors from occurring

antecedent

stimulus / event comes BEFORE behavior and triggers/cues the behavior to occur

t/f : a physical restraint may only be considered as a last resort when a person is a danger to self or others

t

?????? client sits on floor and cries after throwing item across room and getting no reaction from BI. what form of behavior escalation cycle is this?

tension reduction

verbal release may take the form of:

verbal acting out, emotional outburst, loss of rationalization, blowing off steam, screaming, swearing, high energy output (w a nonverbal client: self-injury, noises (whining, screaming, crying), tantrums, throwing objects) allow client to let off steam, remove client, audience, or unsafe items from area (if possible), remain calm, use calm voice, use visuals

client screams when given instruction

verbal release

strike

weapon (body part of object) making contact w a target (hit kick spit thrown/used object) block and move