PROFESSIONAL CRISIS MANAGEMENT

1. PROFESSIONAL CRISIS MANAGEMENT Arrow Child and Family Ministries

2. What We’ll Cover Today • Prevention • De-escalation • Post-crisis Intervention

3. The stages of crisis stages • A crisis occurs in _____ or steps. In most cases, individuals do not immediately begin a crisis with no warning at all. • We might describe an individual as calm at first, then upset or agitated, then “out of control” and finally they begin to calm again. PCM uses different names for these stages.

4. The stages of crisis • There are four stages of crisis: • Stable functioning • Pre-crisis • Crisis • Post-crisis

5. The stages of crisis Stable functioning • _______________ is the stage where the person is “in a good mood.” Their behavior is appropriate to the situation and they are happy (or neutral), productive and generally cooperative.

6. The stages of crisis Pre-Crisis • ________ is when people begin to get upset. Their behavior is usually quite different than normal and their behavior might be very obvious (yelling in anger) or more subtle (suddenly very quiet, no eye contact).

7. The stages of crisis • ____ is when the person is being aggressive, hurting themselves, or destroying property. This is when Parents must physically stop them. This course will not address crisis behaviors directly. Crisis

8. The stages of crisis post-crisis • Finally, there is _________ which comes after the crisis. At this stage the person is beginning to calm down again. • In this course, we are only going to talk about Stable Functioning, Pre-crisis, and Post-Crisis.

9. What causes crisis behaviors? • Medical conditions - Youth without good ___________ may show crisis behaviors because they don’t know how to make the pain stop and can’t let someone else know what hurts. • Being exposed to unpleasant events-Unpleasant events (aversives) can also cause crisis behaviors. These can be mildly unpleasant (being called a name) or as severe as traumatic events like physical or sexual abuse. Some types of punishments can also cause crisis behaviors as well. language skills

10. What causes crisis behaviors? • Losing an item, a privilege, or a loved one - Often times, individuals will go into crisis if they lose something or someone. Losing a personal possession, a privilege, or even a loved one can contribute to crisis behaviors. • Being unable to get something you want - Sometimes an individual may go into crisis if there is something that they want very much, but cannot get. A similar situation is when the person is used to getting something at a particular time (a favorite TV show) but when the time arrives, that thing is not available.

11. When do we use Prevention Strategies? During ________________we use what are called _________strategies. These strategies range from re-arranging the person’s work and living surroundings, to meeting their daily needs, to teaching them much needed coping skills. Prevention strategies are used _______ the person becomes upset (pre-crisis) and have the greatest long-term benefit for the individual. stable functioning prevention BEFORE

12. General Strategies relationships • Maximize __________: Developing a good relationship with a person makes it easier to calm them down when they get upset. • Maximize _____: People with more options can get their needs met in many more ways than someone with no options. This can help prevent people from becoming upset. • Maximize ____: These are skills that people need to get their needs met. Examples are learning how to ask for what you want, learning how to wait, learning how to relax or learning how to get help when you need it. Some examples are daily living skills, social skills, vocational skills and coping skills. choice skills

13. Specific Prevention Strategies • There are two primary ways to help people with prevention strategies: • ____________________(things that you can do for the youth) • _____________________(things that you can teach the person to do for themselves) Arrangement Strategies Skill Teaching Strategies

14. Specific Prevention Strategies It is important to get quite a bit of information about an individual so that you can successfully prevent crisis behaviors. In the sections that follow, it will be necessary to understand the kinds of things that will cause crisis behaviors for a particular person. It will also be important to know which ____ they do and do not have as these can also greatly affect crisis behaviors. skills

15. Prevention Strategies: Basic Needs • The basic needs include all of those things we need to live such as food, drink, sleep, and general health. Health problems would include anything that causes the person pain or discomfort. An imbalance of any of these things can lead to _____________. crisis behaviors

16. Prevention Strategies: Basic Needs (Examples) • Problem: Jean-Paul, a man with a developmental disability, begins to get upset whenever he has gone more than 3 hours without food. • ___________________: Make sure to send a snack with him that he can eat at mid-morning. • ___________________: Teach Jean-Paul how to use a vending machine at their workplace. Arrangement Strategy Skill Teaching Strategy

17. Prevention Strategies: Surroundings • A person’s surroundings can affect crisis behaviors a great deal. Living and working spaces can be too hot, cold, noisy, cramped, too dim, too bright or too crowded. Surroundings include anything that causes a person to feel comfortable or uncomfortable. People who are comfortable usually have fewer crisis behaviors.

18. Prevention Strategies: Surroundings (Examples) • Problem: Sara’s classroom gets very cold, which makes her sleepy, so she puts her head down. When the teacher tells her to wake up, she begins to disrupt the classroom by cursing and threatening. • ___________________: Show Sara how to dress in layers so that she will always be warm enough in the classroom, but can still remove a jacket or shirt when it gets too warm outside. • __________________: Let Sara sit in the sunlight near the window where it is warmer. Skill Teaching Strategy Arrangement Strategy

19. Prevention Strategies: Physical disabilities • Physical disabilities include limitations in movement, seeing and hearing. Movement problems can include trouble with walking, standing, eating, and any general movement problems (getting up stairs, through doors, etc.).

20. Prevention Strategies: Physical disabilities (Examples) • Problem: Billy is a 14-year-old boy in a classroom for children who are labeled emotionally disturbed. He wears hearing aids in both ears but many times he forgets to put them in. When he doesn’t have them in, he thinks the other boys in his class are saying bad things about him, but they actually are not. This causes Billy to threaten them, which sometimes results in aggression. • Example of Skill Teaching Strategy…… Class participation • Example of Arrangement Strategy……. Class particiaption

21. Prevention Strategies: Triggers Triggers • _______ can be seen as very specific events in a person’s surroundings that can cause either _______ or crisis behaviors. There are several categories of triggers. • _____: Taking someone into a doctor’s office can trigger crisis behaviors. • ____________: If a person dislikes sweeping, showing them a broom could trigger crisis behaviors. Upon seeing a wrestling match on TV, some adolescents may be prompted to put the person next to them in a “headlock.” pre-crisis Places Objects/events

22. Prevention Strategies: Triggers People • ______: Some crisis behaviors may occur in the presence of certain parents but not in the presence of others. Just as some people can have a calming effect on an individual, some others can actually “set them off.” • _______:This refers to how close or how far away another person is. Sometimes a particular parent may not be a trigger, but when they are too close (or too far away) the individual might begin to show pre-crisis behaviors. Distance

23. Prevention Strategies: Triggers • _____________: This does not refer to who the person is or how far away, but to how the person behaves towards the individual. These are “non-verbal” behaviors like eye contact, posture, facial expressions and hand/shoulder movements. Body language that says “I’m afraid of you” or “I’m mad at you” can increase the chances of pre-crisis or crisis behaviors. The rule of thumb here is to behave the way that you want the individual to behave (be a good model). Body Language

24. Prevention Strategies: Triggers (Examples) • Problem: James must go to the doctor’s office but may show pre-crisis behaviors when in a small room with many people (places). • __________________: Try to take James very early in the morning or try to get the very last appointment of the day when it is less crowded. • __________________: Teach James some deep breathing exercises and practice them before going to the doctor the next time. Arrangement strategy Skill teaching strategy

25. Prevention: Scheduling and Work • Work activities, whether job related, school related, or activities of daily living can either increase or decrease the chances of crisis behaviors. This depends upon their _______ and/or how _________ these activities are to the individual • Scheduling simply refers to when particular activities are to be done and includes the order and length. Other factors are whether or not the schedule is followed and how much time there is between scheduled activities. difficulty interesting

26. Prevention: Scheduling and Work (Example) • Problem: Jenny is a non-verbal woman who loves to work, but she will start showing pre-crisis behaviors if she cannot get into the room where she works by 9:00 a.m. (schedule is not followed) • __________________: Have a short job that Jenny can do until someone can arrive at her workplace to unlock the door. • ___________________: Give Jenny her own key and show her how to unlock the door with it so that she never needs to wait for staff.

27. Prevention: Rules and Consequences • Rulesare important for both foster parents and the youth they serve. Even though some youth with poor verbal skills may not understand the rules, it can still help ensure that foster parents are ________ in the way they handle problem behaviors. • Consequences can be either things people want __________ or things that they don’t like _________. consistent (reinforcers) (punishers)

28. Prevention: Rules and Consequences • For rules to work well, they should: • Be ___ • Be ____ • Have clear ____________ (both kinds) • Rules should be reviewed at least _____ until the individual can state them without any help. • The chances of a rule being followed are small if the person cannot state the rule quickly and correctly when asked. few short consequences daily

29. Prevention: Rules and Consequences • Remember! Just because the individual knows the rules well, it does not mean that they will follow the rules! • Individuals may need reminders to help remember the rules, but if the consequences are very important to the person there is a much better chance that they will both remember and follow the rule. • Whenever you can, try to get the individual to state the rules to you instead of you always “throwing rules in their face.”

30. Prevention: Rewards • Rewards ________ are things that happen after a behavior that _______ the chances of that behavior happening again. If the behavior doesn’t increase, then what they got really wasn’t a reinforcer for that behavior. • There are three general categories of reinforcers (rewards) they are: • Things you can hold in your hand ________ • Things you can get to do ________ • Attention from others _______________ (reinforcers) increase (tangibles) (activities) (social interactions)

31. Prevention: Reinforcers (rewards) How do they prevent crisis? crisis behaviors • Many times, individuals show ____________ when they are required to do something that results in either no _________ at all, or results in things that the individual really doesn’t like/want. • If someone is motivated to do something, because they like the activity itself or because they like what the activity gets them (reinforcers), we don’t have to “pressure” them to do the activity. reinforcers

32. Tips on using reinforcers • Make sure the value of the reinforcer is great enough for what the person is being asked to do. • Make sure the reinforcer is given as soon as possible after the task/chore/job/activity is finished. If you can’t immediately give a “trip to the store”, you might be able to give a “ticket” that can be traded in later for a trip to the store

33. Social Interactions as Reinforcers • Praise is basically a form of attention which focuses on what someone did and how well it was done. • Praise comes in many different forms, some are very obvious and some can be very subtle. • Over time, praise can be changed slowly so that it refers less to how “happy” foster parents are with the individual and more to how the individual’s behavior will benefit them in other areas of their life.

34. Prevention: Some different types of praise • Here are several ways to give praise: • ______________: This is praise given to a specific person for a specific behavior, “Good job mopping Tony!” • ___________: This is praise given to an entire classroom or treatment group and is an easy way to reinforce the behavior of many individuals at the same time, “Everyone in this class is working wonderfully!” Individual praise Group Praise

35. Prevention: Some different types of praise Pivot Praise • __________: This is a good way to indirectly correct a behavior. If someone is doing the wrong behavior (looking out the window during study time) the parents find a person who is doing the correct behavior (reading their book) and gives (obvious) praise to that person. • If the person looking out the window then beings to look in their book too, the parents then praise their (now) appropriate behavior as well. • This avoids the problem of constantly saying “John, stop looking out the window and look in your book!”

36. Prevention: Some different types of praise • __________: This can be a physical or gestural movement such as a “thumbs up” or a pat on the back or a smile. It is good to use when something “bigger” might get the individual too distracted from their task. • This type of praise is good to use to “keep the person going,” or to use after an error correction. Quiet Praise

37. Prevention: Important! good • Important! Only praise the ____ behavior that you want the person to do, and not the “absence” of the ___ behavior. • Example: (Incorrect) Johnny usually kicks Cindy every day but he didn’t do it today. “Hey Johnny! Nice job not kicking Cindy today!” • Example: (Correct) “Hey Johnny! When Cindy bothered you, you came to the office to tell me about it, you are very mature! bad

38. Prevention: Teaching Survival Skills • Survival Skills are the ________ that will help someone be successful in a given setting. • Parents must understand what the survival skills are so that they will know which behaviors to _____ and _____ • Parents should avoid telling individuals to “behave themselves” or “be good” as this does not let the person know what the survival skills are for that particular setting. key skills teach praise.

39. Prevention: Teaching Survival Skills • Example: Instead of telling a young student to “behave” during class time, the teacher states the ___________ for success in the classroom: Raise hand before speaking Speaking only when called on Being able to copy what is on the board Keeping the right school supplies and knowing where they are survival skills

40. Prevention: Teaching Survival Skills • When these skills are clear to the teacher and to the student, the teacher can begin to praise those skills and the students will knowexactly which behaviors they did that were “good” • Sometimes the youth “has” the skill but needs to be ________ to use it. At other times, it will be necessary to _____ some survival skills or the youth might never show them. prompted teach

41. Prevention: Teaching Survival Skills • There are survival skills for every situation that a person experiences. • Any time that a youth is having difficulty in a particular situation, you should ask yourself: 1) What are the ___________? 2) Does the youth already know these skills? 3) Do we need to teach these skills? • If Foster Parent doesn’t know what the survival skills are, the chances are that the youth will not either. survival skills

42. Prevention: Pre-teaching • When parents find themselves correcting a problem behavior on a regular basis, sometimes it maybe necessary to “correct” a problem before it ever happens. • ___________ is a way of setting a person up for success. All that it requires is: 1) knowing where or when the person usually has problems and 2) which ____ they need to show instead of their problem behavior Pre-correction skills

43. Prevention: Pre-teaching Steps behaviors • Decide which ________ to tell the youth to do • Schedule a time to explain and _______ the expected behaviors • Decide when you are going to ______ the individual (usually best done right before the behavior is expected) • Give strong ___________ (praise or tangibles) after the expected behavior happens practice remind reinforcement

44. Prevention: Prompting • A prompt is simply a ___ that is given to get someone to show a certain behavior. • There are _____ prompts (talking), _______ prompts (pointing/looking at an item/pantomime) and _______ prompts (physically guiding someone). • Deciding which kinds of prompts to use and how to give them can greatly decrease the chances of crisis behaviors. hint verbal gestural physical

45. Prevention: Prompting • Verbal Prompts: These can take to form of: Commands – “Sit down now!” Instructions – “Place your napkin in your lap.” Suggestions – “It would be really great if we could get the house cleaned.” Questions – “Do you think you could wipe your feet please?” Information - “It seems to be raining outside.” (prompt to get a raincoat) • _________ should be avoided whenever possible and should be replaced with suggestions, information, or questions. • Often times, it is not ____ we ask a person to do, but ___ we ask it! Commands what how

46. Prevention: Prompting • _______ prompts can be used by themselves or can be used with verbal prompts to increase the chance that the individual will do what you asked. • Sometimes individuals will respond more calmly to a gestural prompt than a verbal prompt (pointing at a chair rather than saying “sit down”). Gestural

47. Prevention: Prompting • _______ prompts can also be useful to get a youth to show a certain behavior. • Physical prompts are not ______, that is, the person does not resist against the prompt. • Some youth may respond better with a gentle touch on the shoulder to get them to walk outside with you than they would if you used a verbal prompt for them to walk outside. Physical forceful

48. De-escalation Strategies • In ___________, the youth has already reached the stage of _______ and we are trying to get the person back to the stage of _______________. • Basically, we may have failed to prevent the pre-crisis behaviors by either using ___________ or ___________ strategies. de-escalation pre-crisis stable functioning skill teaching arrangement

49. De-escalation Strategies • Because we were not able to ______ pre-crisis behaviors, we must now act quickly by: 1) Using ___________________ 2) Prompting one of the ____ we already taught, or 3) Prompting the youth to ____________ that they frequently enjoy, or 4) ______ with the youth. prevent arrangement strategies skills begin a routine Talking

50. De-escalation strategies: Arrangement strategies • Using arrangement strategies during pre-crisis is basically the same as using them during stable functioning. The difference is that we are now doing things for the youth (changing their work, the people around them, or objects around them in an ________ way. unplanned