NSU CRISIS PREVENTION TRAINING

1. Strategies for Defiant & Aggressive Students ` NSU CRISIS PREVENTION TRAINING BREAKING DOWN THE WALLS Presented by: Steven Vitto, M.A., CCII., CTCI., MIBLSI Coach, Behavior Specialist, Muskegon Area ISD Certified Self Defense Instructor in TCI, CPI, Davereuz Emergency Intervention Training, N.A.P.P.I.

2. NONVIOLENT CRISIS INTERVENTION TRAINING PROGRAM Presented by: Steven Vitto , M.A., CCII. Behavioral Specialist M.A.I.S.D. MAISD, OCTOBER, 2011

3. Andrew • 11 years old Died from traumatic asphyxia and chest compression. Face-down restraint with arms crossed over chest.

4. Angie • 7 years old Stopped breathing after being placed in prone restraint position. Death being ruled a homicide

5. Chase • 17 years old Asphyxiation by a prone restraint He was restrained for refusing to stop talking and not following instructions. According to an autopsy he died after suffocating on his own vomit.

6. Chris • 13 years old Asphyxiation by prone restraint He was restrained 4 times …in his last 24 hours

7. Edith • 15 years old Restraint Asphyxia – She was looking at a family photograph when a male aide instructed her to hand over the "unauthorized" personal item. The dispute escalated into a face-down floor restraint

8. Gareth • 15 years old Died of asphyxiation by a prone restraint Restrained by three staff members on his 4th day at the facility

9. Jonathan • 13 years old Restrained in a van while staff were running errands. Though he was clearly having difficulties breathing they continued running their errands… for another 1½ hours.

10. Mark • 14 years old Asphyxiation while being forcibly restrained by 3 staff in a prone position

11. Travis • 13 years old The autopsy indicated he died because of the face-down on the ground restraint. Restrained 1½ hours.   Denied request for asthma meds.

12. Robert • 12 years old Asphyxiation while restrained after a dispute about his… missing teddy bear He was restrained for 10 minutes, face down on the floor. The staffer who restrained the boy left him lying, unresponsive, on the floor

13. Reality • 142 deaths in the US from 1988 – 1998 due to S/R, reported by the Hartford Courant (Weiss et al, 1998) • 111 fatalities over 10 years in New York facilities due to restraints (Sundram, 1994 as cited by Zimbroff, 2003) • At least 16 children (<18 y.o.) died in restraints in Texas programs from 1988 – 2002, reported by local media (American-Statesman, May 18, 2003) • At least 14 people died and at least one has become permanently comatose while being subjected to S/R from July 1999 to March 2002 in California (Mildred, 2002)

14. Reality • 50 to 150 deaths occur in the US each year due to S/R estimated by the Harvard Center for Risk Analysis(NAMI, 2003) • Federal Office of the Inspector General identified 42 of 104 (42%) SR deaths from 08/99 – 12/04 were not reported.(OIG, 2006)

15. The United States Government Accountability Office- TestimonyBefore the House of Representatives, 2009 • Children with disabilities were more likely to suffer death as a result of seclusion and restraint. • These children were sometimes restrained and secluded even when they did not appear to be aggressive without parental consent. • Face down and other restraints that block air to the lungs can be deadly. • Teachers and staff in these cases were often NOT trained in the use of these techniques.

16. The Research • Over 85% of restraints, management, seclusion, begin with students refusing to follow a staff direction. • How staff deal with this noncompliance plays a big part in whether the student’s behavior diffuses or escalates. • There is no research supporting the use of forced compliance as a behavioral change strategy. • There is a significant increase in children with ODD, ADHD, ASD, Social Maladjustment, Down Syndrome in our schools. • Staff need to be trained in how to deal with oppositional, defiant and aggressive behavior. • Most staff have little training in this area.

17. SUPPORTING STUDENT BEHAVIOR: Standards for the Emergency Use of Seclusion and Restraint Nothing in this policy is intended to conflict with or limit the use of the “reasonable physical force” permitted in Act 451 of 1976, Section 1312(4), otherwise known as the Corporal Punishment Act.

18. Positive Behavior Supports • the most effective strategies for supporting positive student behavior begin with meaningful instruction • provided by highly trained professionals in a safe environment which promotes dignity for all students; • school-wide systems of positive behavioral support to address challenging behavior will increase instructional time for all; and • seclusion or restraint should be used only in an emergency and requires diligent assessment, monitoring, • documentation, and reporting by trained personnel

19. PBS emphasizes behavior that encourages learning by: • building relationships; • creating routines; • teaching skills/rules/expectations; • identifying replacement behaviors for behaviors that • interfere with learning; • making problem behavior less effective, efficient, and • relevant; and • making the desired behavior more functional and • adaptive.

20. A. Training Framework • A comprehensive training framework includes: • awareness training for the broader educational community, • including pre-service training for all teachers; • awareness training for substitute teachers; and • comprehensive training for key identified personnel

21. B. Training Components • All training must include: proactive practices and strategies that ensure the: • dignity of students; • conflict resolution; • mediation; • social skills training; • de-escalation techniques

22. C. Comprehensive Training for Key IdentifiedPersonnelA local educational agency (LEA) will identify sufficientkey personnel to ensure that trained personnel are availablefor an emergency situation. Before using seclusionor restraint with students, key identified personnel whomay have to respond to an emergency safety situationmust be trained in: • proactive practices and strategies that ensure the dignity of students; • conflict resolution; • social skills training; • de-escalation techniques; • positive behavior support strategies; • techniques to identify student behaviors that may trigger emergency safety situations; • related safety considerations, including information regarding the increased risk of injury to students and staff when seclusion or restraint is used; • instruction in the use of seclusion and restraint; • types of seclusion; • types of restraint;

23. Discussion on Restraint

24. Continuum of School-wide PBS

25. Impact of School-wide PBS on Seclusion and Restraint • Implementation of a school-wide system will ensure that seclusion and restraint are used only as a last resort method. • Encourages learning by building relationships; • Teaches skills/rules/expectations; • Identifies replacement behaviors that interfere with learning; • Makes problem behavior less effective; • Makes desired behavior more functional and adaptive.

26. Are classroom response cost systems contributing to defiance and aggression? • Response to Intervention • Are we using evidenced based classroom behavior management systems at the universal level? Are classroom response cost systems evidenced based? Is there a balance, better yet, an overbalance of Positive Incentives and Feedback for Desired Behavior? • When universal consequences (e.g., Classroom Response Cost System) are not effective, or when they trigger an escalation of behavior, do we differentiate our approach? • Are we over-relying on classroom response cost systems to manage student behaviors?

27. Awareness of Potential for Violence • Early Warning Signs (threatening,heightened anxiety) • Other Indicators (ADD/ADHD,EI,CD,ODD,etc.) • Brain Development: “The Amigdila”

28. Conditions Effecting Behavior ATTACHMENT DISORDER OPPOSITIONAL DEFIANCE DISORDER CONDUCT DISORDER ATTENTION DEFICIT HYPERACTIVITY DISORDER EMOTIONAL IMPAIRMENT ANXIETY DISORDERS FETAL ALCOHOL SYNDROME ASPERGERS SYNDROME COGNITIVE IMPAIRMENT

29. OPPOSITIONAL DEFIANCE DISORDER

30. Where it Comes From… • Aggressive behavior is learned and maintained in a manner similar to other behaviors. • Three important factors to consider include modeling, positive reinforcement, and negative reinforcement. • Aggressive students often exhibit deficits in social information processing-I.e. often misinterpreting social cues and misassigning hostile intent to others

31. Understanding Aggressive Behaviors • Reactive Aggression • Affective or expressive aggression • Loss of control and emotional flooding • Emotions are dominant • Proactive Aggression • Instrumental or operant aggression • Goal oriented • Cognitions are dominant TCI TRAINING [11]

32. Traumatic or not???

33. Scott

34. An explanation of the diagram can be found on the slides that follow.

35. The Conflict Cycle

36. RAPID ASSESSMENT • THE ENVIRONMENT • THE AGITATED INDIVIDUAL • YOU

37. The number one reason student’s loose control… • Perception of being treated unfairly

38. Learn the student’s triggersContra-Indicated Behaviors Strategies for the Oppositional Student • Ultimatums • Strict Boundaries: Drawing the Line in the Sand • Counts, Warnings, Threats • Being touched • Prolonged Eye-Contact • Infringing on Personal Space • Social Disapproval • Judgmental Responses • Response Cost and Punishment • Strict Boundaries or Contracts

39. Myth • “You only hurt the ones you love…”

40. MODELING

41. THE CPI WORKBOOK • Due Care for Participants (page 5) • Program Objectives (page 6) • Integrated Experience (page 7) • Care, Welfare Safety, and Security

42. Stages of Crisis Development STAGE 1. 1. ANXIETY APPROPRIATE STAFF RESPONSE: SUPPORTIVE Page 7

43. Reduce agitation in a demand situation…. 1. Communicate concern 2. Allow the student time and a place to calm 3. Give student choices and options 4. Consider history student and knowledge of what is calming for them Page 7

44. STAGE 2. 2. DEFENSIVE (refusing, arguing, name-calling, threatening) • APPROPRIATE STAFF RESPONSE: DIRECTIVE (setting limits, giving choices) Page 7

45. DEFENSIVE STAGE

46. STAGE 3 3. ACTING OUT PERSON APPROPRIATE STAFF RESPONSE: NONVIOLENT PHYSICAL CRISIS INTERVENTION

47. ACTING OUT PERSON

48. Reactive = Traumatic

49. Proactive = Goal Oriented

50. Stage 4 4. Tension Reduction APPROPRIATE STAFF RESPONSE: THERAPEUTIC RAPPORT