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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

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NSU CRISIS PREVENTION TRAINING


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slide1

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.

nonviolent crisis intervention training program

NONVIOLENT CRISIS INTERVENTION TRAINING PROGRAM

Presented by:

Steven Vitto , M.A., CCII.

Behavioral Specialist

M.A.I.S.D.

MAISD, OCTOBER, 2011

andrew
Andrew
  • 11 years old

Died from traumatic asphyxia and chest compression.

Face-down restraint with arms crossed over chest.

angie
Angie
  • 7 years old

Stopped breathing after being placed in prone restraint position.

Death being ruled a homicide

chase
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.

chris
Chris
  • 13 years old

Asphyxiation by prone restraint

He was restrained 4 times

…in his last 24 hours

edith
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

gareth
Gareth
  • 15 years old

Died of asphyxiation by a prone restraint

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

jonathan
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.

slide10
Mark
  • 14 years old

Asphyxiation while being forcibly restrained by 3 staff

in a prone position

travis
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.

robert
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

reality
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)
reality1
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)
slide15
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.
the research
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.
slide17
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.

positive behavior supports
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
pbs emphasizes behavior that encourages learning by
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.
a training framework
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
b training components
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
slide22

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;
impact of school wide pbs on seclusion and restraint
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.
are classroom response cost systems contributing to defiance and aggression
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?
awareness of potential for violence
Awareness of Potential for Violence
  • Early Warning Signs

(threatening,heightened anxiety)

  • Other Indicators

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

  • Brain Development: “The Amigdila”
slide28

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

where it comes from
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
understanding aggressive behaviors
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]

rapid assessment
RAPID ASSESSMENT
  • THE ENVIRONMENT
  • THE AGITATED INDIVIDUAL
  • YOU
the number one reason student s loose control
The number one reason student’s loose control…
  • Perception of being treated unfairly
learn the student s triggers contra indicated behaviors strategies for the oppositional student
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
slide39
Myth
  • “You only hurt the ones you love…”
the cpi workbook
THE CPI WORKBOOK
  • Due Care for Participants (page 5)
  • Program Objectives (page 6)
  • Integrated Experience (page 7)
  • Care, Welfare Safety, and Security
stages of crisis development
Stages of Crisis Development

STAGE 1.

1. ANXIETY

APPROPRIATE STAFF RESPONSE:

SUPPORTIVE

Page 7

reduce agitation in a demand situation
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

stage 2
STAGE 2.

2. DEFENSIVE

(refusing, arguing, name-calling, threatening)

  • APPROPRIATE STAFF RESPONSE:

DIRECTIVE

(setting limits, giving choices)

Page 7

stage 3
STAGE 3

3. ACTING OUT PERSON

APPROPRIATE STAFF RESPONSE:

NONVIOLENT PHYSICAL CRISIS INTERVENTION

stage 4
Stage 4

4. Tension Reduction

APPROPRIATE STAFF RESPONSE:

THERAPEUTIC RAPPORT

proxemics kenesics
Proxemics/Kenesics
  • The invisible bubble
  • Nonverbal communication
  • Triggers

Page 8

supportive stance
SUPPORTIVE STANCE

Three reasons for using the supportive stance:

1. HONORS PERSONAL SPACE

2. ESCAPE ROUTE

3. NONTHREATENING

Page 8

paraverbal
Paraverbal
  • Tone
  • Volume
  • Cadence
remember your goal during the defensive stage
Remember your goal during the Defensive Stage
  • 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 verbal escalation continuum
THE VERBAL ESCALATION CONTINUUM
  • Questioning
  • Refusal
  • Release
  • Intimidation
  • Tension Reduction

Page 9

questioning
QUESTIONING
  • ANSWER THE QUESTION
  • PLANNED IGNORING
  • ADEQUATE RESPONSE TIME
  • ALLOW SPACE AND TIME
  • DO NOT ARGUE
  • RESTATE THE LIMIT
refusal
REFUSAL
  • DON’T ARGUE
  • SET LIMITS
  • EVALUATE HISTORY
  • CONSIDER CALLING FOR HELP
  • RESPONSE TIME
  • ENFORCE LIMITS
release or namecalling
RELEASE OR NAMECALLING
  • REMAIN CALM AND PROFESSIONAL
  • DON’T TAKE COMMENTS PERSONALLY EVEN IF THEY HURT
  • ALLOW VENTING
  • ISOLATE IF POSSIBLE
  • SET LIMITS
  • CONSIDER CALLING FOR ASSISTANCE
intimidation or threatenin g
INTIMIDATION OR THREATENING
  • DON’T RUN
  • TAKE THREATS SERIOUSLY
  • STAY CALM & PROFESSIONAL
  • DO NOT RESOND TO THREATS
  • STATE LIMITS
  • DIRECT TEAM
  • ASSESS ENVIRONMENT

PAGE 9

setting limits
SETTING LIMITS

KEYS TO SETTING LIMITS

1. SIMPLE, REASONABLE, ENFORCEABLE

2. DO’S AND DON’TS

3. WHEN TO CALL FOR HELP

setting limits1
Setting Limits
  • 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.
the three don ts
THE THREE DON’TS
  • Avoid touching the person

(verbal = verbal)

  • Avoid Ultimatums
  • Avoid crowding or trapping
how to get someone to leave
How to get someone to leave
  • Consider focus of anger
  • Problem or solution
  • Remember your goal
how to avoid physical contact
How to avoid physical contact
  • 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
verbal intervention tips
Verbal Intervention Tips

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
empathic listening
EMPATHIC LISTENING

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

precipitating factors
PRECIPITATING FACTORS

FUNCTIONAL ASSESSMENT

functional assessment
Functional Assessment
  • Identifies triggers

(sets the stage for evidence based practice)

  • Identifies Approach Concerns
  • Makes a Hypothesis About Motivation
  • Helps to Establish Preventative Strategies
rationale detachment
RATIONALE DETACHMENT

OUR ABILITY TO MAINTAIN A THERAPEUTIC APPROACH

integrated experience
Integrated Experience
  • Recognizing your part in the Conflict Cycle
  • Staying Calm and Professional
staff fear
Staff Fear
  • Unproductive responses
  • Productive Responses
stage 31
STAGE 3.
  • AGGRESSIVE/DESTRUCTIVE

APPROPRIATE STAFF RESPONSE:

  • NONVIOLENT PHYSICAL

INTERVENTION

reasonable force
REASONABLE FORCE
  • MICHIGAN SCHOOL CODE
  • CORPORAL PUNISHMENT
  • DOCUMENTATION
  • SELF DEFENSE
what is not reasonable force
What is not reasonable force.
  • 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.
slide85
There are three possible outcomes of crisis:

Staff student relationship is improved

The staff student relationship is unchanged

The staff student relationship is damaged

stage 32
STAGE 3.
  • AGGRESSIVE/DESTRUCTIVE

APPROPRIATE STAFF RESPONSE:

  • NONVIOLENT PHYSICAL

INTERVENTION

terms
TERMS
  • 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?
use of emergency restraint
Use of Emergency Restraint
  • 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.

physical restraint involves direct physical contact
Physical Restraint involves direct physical contact
  • 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).

mechanical restraint
Mechanical Restraint
  • 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).
slide91
An LEA must ensure that substitute teachers are informed of all local emergency procedures, including the emergency use of seclusion and restraint.
reasonable force1
REASONABLE FORCE
  • MICHIGAN SCHOOL CODE
  • CORPORAL PUNISHMENT
  • DOCUMENTATION
  • SELF DEFENSE
use of physical force under the corporal punishment statute
Use of Physical Force under the Corporal Punishment Statute
  • 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
emergency intervention plan eip for restraint
Emergency Intervention Plan (EIP)for Restraint
  • 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
duration
Seclusion:

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

Duration
documentation and reporting
Seclusion:

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

Documentation and Reporting
best practice
Best Practice
  • 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.
personal safety techniques
PERSONAL SAFETY TECHNIQUES
  • 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

personal safety techniques1
Personal Safety Techniques
  • 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
nonviolent crisis intervention
Nonviolent Crisis Intervention
  • 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
team interventions
Team Interventions
  • Crisis Response Team
  • Team versus Solo

1. Professionalism

2. Safety

3. Documentation

Team Leader

1. Confident

2. Competent

3. Knows the AOP

Page 19

team leader duties
Team Leader Duties
  • Assess the situation
  • Develop a Plan
  • Direct the Team
  • Communicate with the AOP

The Letting Go Process

auxiliary team members
Auxiliary Team Members

1. Check

2. Address

3. Recognize

4. Engage

stage 41
STAGE 4

TENSION REDUCTION (CALMING)

APPROPRIATE STAFF RESPONSE

THERAPEUTIC RAPPORT

(OBJECTIVE PROCESSING)

therapeutic rapport
Therapeutic Rapport
  • POSITIVE BEHAVIORAL SUPPORTS
  • THE C.O.P.I.N.G. MODEL
  • ANGER REPLACEMENT TRAINING
  • LIFE SPACE CRISIS INTERVENTION
c o p i n g processing with student
C.O.P.I.N.G. PROCESSING WITH STUDENT
  • 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

c o p i n g model debriefing with staff
C.O.P.I.N.G. MODEL DEBRIEFING WITH STAFF
  • 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

slide108
There are three possible outcomes of crisis:

Staff student relationship is improved

The staff student relationship is unchanged

The staff student relationship is damaged

debriefing
Seclusion:

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

Debriefing
reoccurring behavior should a pattern of behavior
Reoccurring Behavior – Should a pattern of behavior
  • 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
thanks for being here
Thanks for Being Here!!
  • Any Questions any time, please call me at 231=767-7279

or write me at

  • svitto@muskegonisd.org