STEVE VITTO SECLUSION & RESTRAINT

What is Seclusion and Restraint & Why should I care?? : 

What is Seclusion and Restraint & Why should I care?? STEVEN VITTO PRESENTS:

Most Restraint and Seclusion Begins with an Incident of Noncompliance to an Adult Directive : 

Most Restraint and Seclusion Begins with an Incident of Noncompliance to an Adult Directive How the adult responds to that noncompliance can escalate or diffuse the episode… Steve Vitto is a certified self defense trainer He is a certified instructor in CPI Therapeutic Crisis Intervention (TCI) Daverueux Emergency Physical Intervention Training He also has specific training in Applied Behavior Analysis Steve is a State of Michigan Positive Behavior Supports Trainer Steve is certified Balanced and Restorative Trainer Steve is currently involved in developing a PBS initiative for Expelled Youth Steve can be reached as svitto@muskegonisd.org Steve is author of the book In Search of a Heart (2004) Steve has developed and online Behavior Management Class that has been utilized in college settings for the past 7 years.

Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint : 

Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint Awareness Training Muskegon Area Intermediate School District Presented by Steven Vitto, M.A., Behavioral Specialist, M.A.I.S.D. Certified Crisis Prevention Trainer (CPI) Certified Therapeutic Crisis Intervention Trainer (TCI) Certified State of Michigan PBS Coach and Trainer Certified Balanced & Restorative Justice Trainer (BARJ)

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

Chris : 

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

Gareth : 

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

Isaiah : 

Isaiah 17 years old Four youths witnessed his death. Students say staff sat on him for three hours until he passed out and died.

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.

Mark : 

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)

Reality : 

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)

The United States Government Accountability Office- TestimonyBefore the House of Representatives, 2009 : 

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.

Part One : 

Part One Introduction

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?

Physical Restraint : 

Physical Restraint Physical Restraint is the application of physical force by one or more individuals that reduces or restricts a student’s freedom of movement. Physical restraint of a student may only be used for the purpose of providing safety and support. RESTRICTIONS IN STATE GUIDELINES

What is Physical Assistance : 

What is Physical Assistance Physically assisting someone who is accepting of your help) e.g., putting on your coat)

What is physical management? : 

What is physical management? Physically forcing someone to do something against their will (e.g., forcibly taking something away from someone, physically making someone do a task) RESTRICTIONS IN STATE GUIDELINES

What is a physical escort? : 

What is a physical escort? Physical Escort is the touching or holding a student with a minimum use of contact for the purpose of directing movement from one place to another. RESTRICTIONS IN STATE GUIDELINES

What is mechanical restraint? : 

What is mechanical restraint? Mechanical Restraint is the use of any device, article, garment, or material attached or adjacent to the student's body, which the student cannot easily remove, and that restricts freedom of movement PROHIBITED IN STATE GUIDELINES

What is seclusion? : 

What is seclusion? Seclusion means the confinement of a student alone in a secured room or other space from which the student is physically prevented from leaving. RESTRICTIONS IN STATE GUIDELINES

What is time-out? : 

What is time-out? Timeout means a behavior management technique in which a student, for a limited and specified time, is placed in an environment where access to positive reinforcement is unavailable. Timeout should not be confused with seclusion because in a timeout setting a student’s movement is not physically restricted.

What is an emergency? : 

What is an emergency? Emergency is a situation in which a student’s behavior poses imminent risk to the safety of an individual student or to the safety of others. An emergency requires an immediate intervention. RESTRICTIONS IN STATE GUIDELINES

What is a Emergency Safety Intervention? : 

What is a Emergency Safety Intervention? Emergency Safety Intervention is the use of seclusion or restraint to de-escalate student behavior that poses an imminent risk to the safety of an individual student and others. RESTRICTIONS IN STATE GUIDELINES

What is Prone Restraint? : 

What is Prone Restraint? Prone Restraint is the restraint of a person face down. PROHIBITED IN STATE GUIDELINES

What is supine restraint? : 

What is supine restraint? Supine Restraint is the restraint of a person face up.

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.

State Board of Education Policy on Seclusion and Restraint : 

State Board of Education Policy on Seclusion and Restraint On December 12, 2006 the State Board of Education adopted “Supporting Student Behavior: Standard for the Emergency Use of Seclusion and Restraint”.

Context for the Policy : 

Context for the Policy Referent group created by Superintendent of Public Instruction – May 2004. Group included parents, advocates, educators, policy makers & service providers. Group charge: Develop standards for the use of seclusion and restraint; Recommend substantive strategic directives; and Recommend implementation to State Board of Education

The Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint (Supporting Student Behavior) document : 

The Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint (Supporting Student Behavior) document ▪ summarizes how a positive behavior support approach uses proactive strategies to reduce or eliminate the use of seclusion and restraint; ▪ defines the terms “seclusion” and “restraint”; ▪ outlines procedures for emergency use of seclusion and restraint; and ▪ provides a framework for training.

The Supporting Student Behavior document is rooted in best practices and drafted in the belief that: : 

The Supporting Student Behavior document is rooted in best practices and drafted in the belief that: 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 require diligent assessment, monitoring, documentation, and reporting by trained personnel.

Legal Context of the Policy : 

Legal Context of the Policy Policy is not meant to conflict with or limit corporal punishment statute. Policy is not law.

State Board of Education Policy on Positive Behavior Support : 

State Board of Education Policy on Positive Behavior Support Each school district in Michigan will implement a system of school-wide positive behavior support (PBS) strategies. (Adopted September 12, 2006)

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.

Continuum of School-wide PBS : 

Continuum of School-wide PBS

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?

Comprehensive Training for Key Identified Personnel : 

Comprehensive Training for Key Identified Personnel C. Comprehensive Training for Key Identified Personnel A Local Educational Agency (LEA) will identify sufficient key personnel to ensure that trained personnel are available for an emergency situation. Before using seclusion or restraint with students, key identified personnel who may have to respond to an emergency safety situation must be trained in: proactive practices and strategies that ensure the dignity of students; conflict resolution; mediation; 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;

Part Two : 

Part Two Standards for Seclusion and Restraint

Definitions : 

Definitions Seclusion Last resort emergency safety intervention Gives opportunity to regain control Student is confined in room or other space & prevented from leaving Continuous adult observation required Restraint Emergency intervention Gives opportunity to regain control Direct physical contact that prevents or significantly restricts the student’s movement

Justification for Use : 

Justification for Use Seclusion: Must be used only under emergency situations and if essential Emergency situations include behavior that: Poses imminent risk to the safety of the individual student Poses imminent risk to the safety of others Restraint: Must be used only under emergency situations and if essential Emergency situations include behavior that: Poses imminent risk to the safety of the individual student Poses imminent risk to the safety of others Fits the corporal punishment statute

Corporal Punishment : 

Corporal Punishment Deliberate infliction of physical pain by hitting, paddling, spanking, slapping, or any other physical force as a means of discipline. Person employed by, engaged as a volunteer or contractor may use reasonable physical force as necessary to maintain order and control in a school or school related setting for the purpose of providing an environment that is conducive to safety and learning.

Limitations : 

Limitations Seclusion not to be used for: Staff convenience Discipline or punishment As a substitute for less restrictive interventions As a substitute for training in CPI and PBS Restraint not to be used for: Staff convenience Discipline or punishment As a substitute for less restrictive interventions As a substitute for training in CPI and PBS

Prohibited Practices : 

Prohibited Practices Seclusion: Corporal punishment Depriving basic needs Child abuse Seclusion of preschool children Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort Restraint: Corporal punishment Depriving basic needs Child abuse Mechanical and chemical restraint Intentional application of a noxious substance or physical stimuli resulting in physical pain or extreme discomfort Prone restraint

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

Procedures for Use : 

Procedures for Use Seclusion and Safety: Use trained key personnel Watch for physical distress Medical assistance if needed Continuously observe Document observations Restraint and Safety: Use trained key personnel Watch for physical distress Seek medical assistance if needed Continuously observe Document observations

Procedures for Use (continued) : 

Seclusion: Proportionate and sensitive to student’s: Severity of behavior Developmental and chronological ages Size Physical, medical and psychiatric condition Gender Personal history, including history of physical or sexual abuse Restraint: Proportionate and sensitive to student’s: Severity of behavior Developmental and chronological ages Size Physical, medical and psychiatric condition Gender Personal history, including history of physical or sexual abuse Procedures for Use (continued)

Duration : 

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

Debriefing : 

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

Emergency Intervention Plan (EIP)for Seclusion : 

Emergency Intervention Plan (EIP)for Seclusion Trigger = a pattern of behavior requiring the use of seclusion occurs or is reasonably anticipated Documented steps for EIP: Detail the emergency plan Ask if a known medical condition contraindicates seclusion List possible alternative, pros and cons of each Periodic review Trained personnel

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 Emergency Intervention Plan (EIP)for Restraint

Documentation and Reporting : 

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

Data Collection System : 

Data Collection System Seclusion data must include: Frequency Relationship to suspension, expulsion and drop-out rates ID of appropriately trained key personnel and levels of education, training and knowledge A schedule for reporting and analyzing data by MDE (to be determined) Restraint data must include: Frequency Relationship to suspension, expulsion and drop-out rates ID of appropriately trained key personnel and levels of education, training and knowledge A schedule for reporting and analyzing data by MDE (to be determined)

SCENARIO #1 : 

SCENARIO #1 Johnnie brings a restricted item to school- e.g., Pokie Man cards. Johnnie’s teacher asks for the cards. Johnny curtly say’s “No way” The teacher reiterates, “Give me the cards” John refuses. The teacher physically takes the cards away. Physical Management

SCENARIO # 2 : 

SCENARIO # 2 You ask a Johnny to leave the room and go to the time-out area. John tells you to go to h-ll. I’m not going anywhere. The staff physically manage John to the “time-out” room and then hold the door Physical Escort

Scenario # 3 : 

Scenario # 3 Johnny hates to go to gym. Halfway down the hall he flops on the floor and refuses to move. The staff pull him by his feet, and pick him up and carry him to the Gym Physical Escort

Scenario # 4 : 

Scenario # 4 You have told Johnny he can’t go out for recess until his work his done. The bell for recess rings and Johnny gets up and starts to go outside even though his work is incomplete? The teacher blocks the door and physically keeps Johnny from going out. Physical Restraint

Scenario # 5 : 

Scenario # 5 Staff are working with Johnny and he throws his materials on the floor. Staff tell him to pick it up. Johnny refuses. Staff use hand over hand and force Johnny to pick up the materials. PHYSICAL MANAGEMENT

Scenario # 6 : 

Scenario # 6 Johnny’s teacher uses a red light classroom management system. John violates a class rule and the teacher tells him to move his clip from green to yellow. Johnny says “no.” The teacher moves the clip. Johnny gets mad and moves the clip back. The teacher tells Johnny to return to his seat. He refuses. The teacher physically moves Johnny to his seat. PHYSICAL MANAGEMENT

Scenario * 7 : 

Scenario * 7 In the pre-school class, Johnny is having problems sitting at circle. Consequently, the teacher uses a seatbelt to keep Johnny in his seat. MECHANICAL RESTRAINT

Scenario # 8 : 

Scenario # 8 Johnny keeps leaving music class so the teacher assistant holds him and keeps him from leaving the activity. PHYSICAL RESTRAINT

Scenario # 9 : 

Scenario # 9 Johnny hits another student in class. He continues to hit the student. The teacher holds Johnny with a basket wrap. Johnny resists and she physically moves him to the office conference room. Johnny is screaming and yelling and the teacher closes the door to keep Johnny from leaving Physical Restraint Physical Escort Seclusion

Other Potential Scenarios : 

Other Potential Scenarios Coming in from recess Removing a hat Denying Access to Computer Refusing to go to an activity Denying access to the telephone Removing property Denying privileges

Is It Restraint? : 

Is It Restraint?

Acceptable Use of Restraint in Schools : 

Acceptable Use of Restraint in Schools Restraint of a student most often refers to a set of proven techniques used by school personnel during extraordinary circumstances in order to secure the safety of the child and/or those persons who cannot otherwise escape harm. Unacceptable Use of Restraint in Schools The holding of a student for any length of time with a purpose or intent other than providing safety, comfort or support should be considered as avoidable and a misapplication of restraint. Physically restraining a student as a means of discipline, to force compliance, or for the convenience of a caregiver is an unacceptable practice.

Functional Behavioral Assessment : 

Functional Behavioral Assessment What purpose does the behavior serve for the student? How can you determine the answer? Watch the student, ask people, look at records and patterns When does the behavior happen? Where does the behavior happen? Who is there? What happens after the behavior?

In Other Words : 

In Other Words “Why is this person engaging in this behavior in this setting at this time?” Gordon Paul, 1967

Is it a Behavior Intervention Plan (BIP)? : 

Is it a Behavior Intervention Plan (BIP)? If the BIP focuses on what happens after a behavior occurs, it is a Behavior Management Plan. If the BIP focuses on what happens before a behavior occurs, it is a Behavior Intervention Plan.

Positive Support ? : 

Positive Support ?

Comprehensive Training In Restraint Is Important for Schools : 

Comprehensive Training In Restraint Is Important for Schools De-escalation techniques emphasized Risk of injury to students is reduced Risk of injury to staff is reduced Restraint should be respectful and enable student to regain self-control

THE REVISED SCHOOL CODE : 

THE REVISED SCHOOL CODE (a) To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school district or public school academy functions within a school or at a school-related activity, if that pupil has refused to comply with a request to refrain from further disruptive acts. (b) For self-defense or the defense of another. (c) To prevent a pupil from inflicting harm on himself or herself. (d) To quell a disturbance that threatens physical injury to any person. (e) To obtain possession of a weapon or other dangerous object upon or within the control of a pupil. (f) To protect property. (5) A person employed by or engaged as a volunteer or contractor by a local or intermediate school board or public school academy who exercises necessary reasonable physical force upon a pupil, or upon another person of Supporting Student Behavior: Standards for the Emergency Use of Seclusion and Restraint Michigan Department of Education 20

Risks : 

Risks Restraints can be a dangerous method of intervention. The Child Welfare League of American (CWLA) estimates that between 8 to 10 children die each year due to restraints with numerous others suffering various injuries from bumps and bruises to broken bones (not just in schools). Also emotional injuries to the students

Risks : 

Risks One of the leading causes of deaths during restraint is “asphyxia” which is a restriction of the person’s ability to breathe. It is referred to as restraint associated or positional asphyxia and sometimes called “Sudden Death Syndrome.” Restraint associated occurs during the process of restraining a person in a manner that causes difficulty with breathing in and out. This leads to insufficient oxygen in the blood which leads to a disturbed heart rhythm which leads to death.

Risks : 

Risks Any restraint that restricts the free movement of the chest or diaphragm may restrict breathing and contribute to positional or restraint associated asphyxia. Research shows that “prone restraints” or “floor restraints” are the most dangerous and most likely to cause asphyxia because they involve placing the child face down on the floor which puts pressure on the child’s ribs, chest.

Risks : 

Risks Students may also have risk factors such as medical conditions that exacerbate the risks of restraints. Students with asthma, epilepsy or heart conditions can be more prone to have adverse reactions, including death, with certain types of restraints. Obese students and students taking certain medications may also be more prone to adverse reactions with certain types of restraints.

Risks : 

Risks The child’s treatment or programming should focus on other methods of addressing behavior, such as PBS. If restraints are used, it is very important that safety measures to protect the child and the person restraining the child are implemented. Safety measures include training, monitoring and reporting.

Signs of Physical Distress : 

Signs of Physical Distress A student who is highly agitated and is being restrained is under a great deal of physical stress. For this reason, staff must be thoroughly aware of the possible indications of physical distress and injury. A very dangerous risk to students during the implementation of restraint procedures is restraint-related Positional Asphyxia. Positional Asphyxia also termed “Restraint Asphyxia” occurs when the position of a person’s body interferes with that person’s ability to breathe, resulting in death. Improperly applied restraints techniques, particularly in the prone position, increase the risk of asphyxia. Staff must avoid force and pressure on the student’s back, chest, and diaphragm.

Signs of Physical Distress : 

Signs of Physical Distress Circulatory Extremities are cold to the touch Blue tinge to nail beds and/or area around mouth Bleeding Flushed or ashen face

Signs of Physical Distress : 

Signs of Physical Distress Respiratory Rapid, shallow breathing Panting, grunting Blue tinge to nail beds and/or area around the mouth Nasal flaring Absence of / difficulty breathing

Signs of Physical Distress : 

Signs of Physical Distress Gastrointestinal Vomiting Compliant of constipation Diarrhea

Signs of Physical Distress : 

Signs of Physical Distress Musculo-Skeletal Joint swelling Complaint of pain Redness / Bruising Deformity of limb or joint

Crisis Prevention InstructionCPIDiffusion and De-escalation : 

Crisis Prevention InstructionCPIDiffusion and De-escalation Presented by: Steven Vitto , M.A Behavioral Specialist M.A.I.S.D.

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”

Slide 86: 

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

OPPOSITIONAL DEFIANCE DISORDER : 

OPPOSITIONAL DEFIANCE DISORDER

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

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 triggersContra-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

Stages of Crisis Development : 

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

STAGE 2. : 

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

SHANE : 

SHANE

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

SETTING LIMITS : 

SETTING LIMITS SIMPLE, REASONABLE, ENFORCEABLE DO’S AND DON’TS WHEN TO CALL FOR HELP

THE THREE DON’TS : 

THE THREE DON’TS Avoid touching the person (verbal = verbal) Avoid Ultimatums Avoid crowding or trapping

Proxemics/Kenesics Be Aware of you personal space and your body language!! : 

Proxemics/Kenesics Be Aware of you personal space and your body language!! The invisible bubble Nonverbal communication Triggers

SUPPORTIVE STANCE : 

SUPPORTIVE STANCE HONORS PERSONAL SPACE ESCAPE ROUTE NONTHREATENING

Setting Limits : 

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.

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

THE VERBAL ESCALATION CONTINUUM : 

THE VERBAL ESCALATION CONTINUUM Questioning Refusal Release Intimidation Tension Reduction

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

THREATENING : 

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

STAGE 3. : 

STAGE 3. AGGRESSIVE/DESTRUCTIVE APPROPRIATE STAFF RESPONSE: NONVIOLENT PHYSICAL INTERVENTION

REASONABLE FORCE : 

REASONABLE FORCE MICHIGAN SCHOOL CODE MICHIGAN DEPARTMENT OF ED. GUIDELINES CORPORAL PUNISHMENT DOCUMENTATION SELF DEFENSE

Exercise Great Caution : 

Exercise Great Caution

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.

STAGE 4 : 

STAGE 4 TENSION REDUCTION (CALMING) APPROPRIATE STAFF RESPONSE THERAPEUTIC RAPPORT (OBJECTIVE PROCESSING)

Slide 113: 

There are three possible outcomes of crisis: Staff student relationship is improved The staff student relationship is unchanged The staff student relationship is damaged

C.O.P.I.N.G. MODEL : 

C.O.P.I.N.G. MODEL 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

PRECIPITATING FACTORS : 

PRECIPITATING FACTORS

FUNCTIONAL ASSESSMENT : 

FUNCTIONAL ASSESSMENT The Investigation

Slide 117: 

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

SHANE’S MOTIVATION : 

SHANE’S MOTIVATION

RATIONALE DETACHMENT : 

RATIONALE DETACHMENT OUR ABILITY TO MAINTAIN A THERAPEUTIC APPROACH