NSU CRISIS PREVENTION TRAINING - PowerPoint PPT Presentation

Strategies for Defiant & Aggressive Students

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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.

NONVIOLENT CRISIS INTERVENTION TRAINING PROGRAM

Presented by:

Steven Vitto , M.A., CCII.

Behavioral Specialist

M.A.I.S.D.

MAISD, OCTOBER, 2011

• 11 years old

Died from traumatic asphyxia and chest compression.

Face-down restraint with arms crossed over chest.

• 7 years old

Stopped breathing after being placed in prone restraint position.

Death being ruled a homicide

• 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.

• 13 years old

Asphyxiation by prone restraint

He was restrained 4 times

…in his last 24 hours

• 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

• 15 years old

Died of asphyxiation by a prone restraint

Restrained by three staff members on his 4th day at the facility

• 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.

• 14 years old

Asphyxiation while being forcibly restrained by 3 staff

in a prone position

• 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 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

• 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)

• 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)

• 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.

• 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.

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.

• 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

• 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.

• 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

• All training must include:

proactive practices and strategies that ensure

the:

• dignity of students;
• conflict resolution;
• mediation;
• social skills training;
• de-escalation techniques

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;

• 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.

• 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?

• Early Warning Signs

(threatening,heightened anxiety)

• Other Indicators

(ADD/ADHD,EI,CD,ODD,etc.)

• Brain Development: “The Amigdila”

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

OPPOSITIONAL DEFIANCE DISORDER

• 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

• 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]

• THE ENVIRONMENT
• THE AGITATED INDIVIDUAL
• YOU

• Perception of being treated unfairly

• 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

• “You only hurt the ones you love…”

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

STAGE 1.

1. ANXIETY

APPROPRIATE STAFF RESPONSE:

SUPPORTIVE

Page 7

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

2. DEFENSIVE

(refusing, arguing, name-calling, threatening)

• APPROPRIATE STAFF RESPONSE:

DIRECTIVE

(setting limits, giving choices)

Page 7

3. ACTING OUT PERSON

APPROPRIATE STAFF RESPONSE:

NONVIOLENT PHYSICAL CRISIS INTERVENTION

4. Tension Reduction

APPROPRIATE STAFF RESPONSE:

THERAPEUTIC RAPPORT

• The invisible bubble
• Nonverbal communication
• Triggers

Page 8

Three reasons for using the supportive stance:

1. HONORS PERSONAL SPACE

2. ESCAPE ROUTE

3. NONTHREATENING

Page 8

• Tone
• Volume
• Cadence

• DIFFUSE AND DE-ESCALATE
• STATE CALM AN PROFESSIONAL
• AVOID EMOTIONAL AND JUDGMENTAL RESPONSES
• REMEMBER YOUR TRIGGERS
• OBTAIN BACK UP SUPPORT
• ISOLATE WHENEVER POSSIBLE
• DON’T TAKE THINGS PERSONALLY

The F.A.S.T. Program

• Questioning
• Refusal
• Release
• Intimidation
• Tension Reduction

Page 9

• ANSWER THE QUESTION
• PLANNED IGNORING
• ADEQUATE RESPONSE TIME
• ALLOW SPACE AND TIME
• DO NOT ARGUE
• RESTATE THE LIMIT

• DON’T ARGUE
• SET LIMITS
• EVALUATE HISTORY
• CONSIDER CALLING FOR HELP
• RESPONSE TIME
• ENFORCE LIMITS

• REMAIN CALM AND PROFESSIONAL
• DON’T TAKE COMMENTS PERSONALLY EVEN IF THEY HURT
• ALLOW VENTING
• ISOLATE IF POSSIBLE
• SET LIMITS
• CONSIDER CALLING FOR ASSISTANCE

• DON’T RUN
• TAKE THREATS SERIOUSLY
• STAY CALM & PROFESSIONAL
• DO NOT RESOND TO THREATS
• STATE LIMITS
• DIRECT TEAM
• ASSESS ENVIRONMENT

PAGE 9

KEYS TO SETTING LIMITS

1. SIMPLE, REASONABLE, ENFORCEABLE

2. DO’S AND DON’TS

3. WHEN TO CALL FOR HELP

• Present the expected behavior and logical consequence as a decision and place responsibility on the student.
• Always lead with the positive outcome that will occur if the student make the choice to calm down or follow directions.
• Allow a few seconds for the student to decide.
• Withdraw from the student and attend to other students. Limit direct eye-contact.
• Follow though with limits established.

• Avoid touching the person

(verbal = verbal)

• Avoid Ultimatums
• Avoid crowding or trapping

• Consider focus of anger
• Problem or solution
• Remember your goal

• Remove triggering stimulus
• Calmly explain limits
• Select a staff (or peer) who has a calming influence
• Select a novel or neutral party
• Bait to open area
• Remove other students
• Call home or police

DO

• Remain calm
• Isolate the situation
• Enforce limits
• Listen
• Be aware of non-verbals
• DON’T
• Overreact
• Get in a power struggle
• Make false promises
• Fake Attention
• Be threatening

1.Be nonjudgmental

2.Give Undivided Attention

3.Listen Carefully to what the person is really saying

4. Allow silence for reflection

5. Use re-statement to clarify messages

PAGE 10

FUNCTIONAL ASSESSMENT

• Identifies triggers

(sets the stage for evidence based practice)

• Identifies Approach Concerns
• Makes a Hypothesis About Motivation
• Helps to Establish Preventative Strategies

“If you know why, you can figure out how….”

W. Edward Deming

OUR ABILITY TO MAINTAIN A THERAPEUTIC APPROACH

• Recognizing your part in the Conflict Cycle
• Staying Calm and Professional

• Unproductive responses
• Productive Responses

• AGGRESSIVE/DESTRUCTIVE

APPROPRIATE STAFF RESPONSE:

• NONVIOLENT PHYSICAL

INTERVENTION

• MICHIGAN SCHOOL CODE
• CORPORAL PUNISHMENT
• DOCUMENTATION
• SELF DEFENSE

• Deliberate infliction of pain.
• Forced exercise or uncomfortable position.
• Dragging someone who is noncompliant but not dangerous or in danger.
• Not using safe physical management techniques.

Staff student relationship is improved

The staff student relationship is unchanged

The staff student relationship is damaged

• AGGRESSIVE/DESTRUCTIVE

APPROPRIATE STAFF RESPONSE:

• NONVIOLENT PHYSICAL

INTERVENTION

• What is restraint?
• What is physical management?
• What is physical assistance?
• What is a physical escort?
• What is mechanical restraint?
• What is seclusion?
• What is time-out?
• What is an emergency?
• What is imminent danger?

• A behavior that requires immediate intervention constitutes

an emergency. Emergency restraint must be used

only under emergency situations and if essential. An

emergency that may require the use of restraint includes

behavior that: poses an imminent risk to the safety of an

individual student; poses an imminent risk to the safety of others; or is otherwise governed by The Revised School

Code, 1976 PA 451, otherwise known as the Corporal Punishment Act.

• that prevents or significantly restricts a student’s movement. Restraint is a last resort emergency safety
• intervention. Restraint is an opportunity for the student to regain self-control. This policy on physical
• restraint is not intended to forbid actions undertaken: to break up a fight; to take a weapon away from a student; as the brief holding by an adult in order to calm or comfort; as the minimum contact necessary to physically escort a student from one area to another;
• to assist a student in completing a task/response if the student does not resist or resistance is minimal in intensity or duration; or

to hold a student for a brief time in order to prevent an impulsive behavior that threatens the student’s immediate safety (e.g., running in front of a car).

• means the use of any device, article, garment, or material attached to or adjacent to a student’s body that restricts normal freedom of movement and that cannot be easily removed by a student.

Mechanical restraint does not include:

• an adaptive or protective device recommended by

a physician or therapist (when it is used as

• recommended); or safety equipment used by the general student population as intended (for example, seat belts, safety harness on school transportation).

• MICHIGAN SCHOOL CODE
• CORPORAL PUNISHMENT
• DOCUMENTATION
• SELF DEFENSE

• In maintaining order and control, a person may use physical force upon a student:
• To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school functions if the pupil has refused to comply
• For self-defense or defense of another
• To prevent a student from inflicting harm on self
• To quell a disturbance that threatens physical injury
• To obtain possession of a weapon or other dangerous object
• To protect property

• Trigger = a pattern of behavior requiring the use of restraint
• Documented steps for EIP:
• Detail the emergency plan
• Ask if a known medical condition contraindicates restraint
• Conduct peer review by knowledgeable staff

No longer than needed to allow student to regain control

Elementary = no more than 15 minutes

Middle / High School= no more than 20 minutes

If more time is needed, add support staff and document to explain time extension

Restraint:

No longer than needed to allow student to regain control, but generally no longer than 10 minutes

If more time is needed, add support staff and document to explain time extension

Document each use of seclusion and reason for use

Document in writing and report immediately to building administrator

Verbally report to parent/guardian immediately or ASAP

Provide written report to parent within 24 hours

Restraint:

Document each use of seclusion and reason for use

Document in writing and report immediately to building administrator

Verbally report to parent/guardian immediately or ASAP

Provide written report to parent within 24 hours

• If you are going to put your hands on a student to move them against their will, or to inhibit their movement, it should only be when that student is presenting a physical danger to others, or is severely disrupting the school environment.

• Strike-a weapon coming in contact with a target
• Grab-obtaining control over part of someone's anatomy and trying to injure or destroy it.
• CPI’s Principals of Personal Safety

Strike

1.move

2.block

Grab

1.Weak point

2.Momentum

2.Leverage

Page 13

• Supportive Stance
• Danger Zone> Safety Zone
• Deflecting a punch
• Kick Block
• One Hand Wrist Grab Release
• Two Hand Wrist Grab Release
• Two Hands or Two Arms
• Front and Back Choke
• Bar Arm Choke
• Hair pull Release
• Bite Release

• CPI Children’s Control Position
• TCI – Seated child basket wraps
• Deveruex Two Arm Control Safety Position
• Daveruex Bear Hug Control Position
• CPI Transport Position
• CPI Interim Control Position
• Daveruex Basket Wrap Assist
• Daveuex Carry
• Prone and Supine Restraint Concerns

• Crisis Response Team
• Team versus Solo

1. Professionalism

2. Safety

3. Documentation

Team Leader

1. Confident

2. Competent

3. Knows the AOP

Page 19

• Assess the situation
• Develop a Plan
• Direct the Team
• Communicate with the AOP

The Letting Go Process

1. Check

2. Address

3. Recognize

4. Engage

TENSION REDUCTION (CALMING)

APPROPRIATE STAFF RESPONSE

THERAPEUTIC RAPPORT

(OBJECTIVE PROCESSING)

• POSITIVE BEHAVIORAL SUPPORTS
• THE C.O.P.I.N.G. MODEL
• ANGER REPLACEMENT TRAINING
• LIFE SPACE CRISIS INTERVENTION

• CONTROL-BACK IN THE DRIVER’S SEAT

“A CLEAN SLATE”

• ORIENTING- WHAT HAPPENED/DEBRIEFING
• PATTERNS- IS THERE A RECOGNIZABLE

PATTERN?

• INVESTIGATING- WHAT IS REALLY GOING ON?
• NEGOTIATING- LET’S CHOOSE A BETTER WAY.

CONFRONT IRRATIONAL BELEIFS

• GIVING-

DIGNITY

CARING

SUPPORT

• CONTROL-ARE YOU ALRIGHT??
• ORIENTING- WHAT HAPPENED? DOCUMENTATION AND DEBRIEFING
• PATTERNS- IS THERE A RECOGNIZABLE

PATTERN?

• INVESTIGATING- WHAT IS REALLY GOING ON?

CAN WE PREVENT THIS FROM

HAPPENING AGAIN

• NEGOTIATING- LET’S CHOOSE A BETTER WAY.
• GIVING

CARING

SUPPORT

COOLABORATION

Staff student relationship is improved

The staff student relationship is unchanged

The staff student relationship is damaged

Followed by debriefing with the parent and student to explore

Triggers

Whether behavior will occur again

What, if any, follow-up is needed

Restraint:

Followed by debriefing with the parent and student to explore

Triggers

Whether behavior will occur again

What, if any, follow-up is needed

• emerge, or be anticipated, which may require the
• use of emergency seclusion, the school personnel
• must:
• conduct a functional behavioral assessment;
• develop or revise a positive behavior support plan
• (PBS) to facilitate the reduction or elimination of
• the use of seclusion;
• develop an assessment and planning process conducted
• by a team knowledgeable about the student,
• including:
• the parent;
• the student (if appropriate);
• people responsible for implementation of the
• PBS; and
• people knowledgeable

• Any Questions any time, please call me at 231=767-7279

or write me at

• svitto@muskegonisd.org