True or False
When debriefing with the individual, it is usually best to wait until after recovery, when the person is behaving in a manner that indicates a return to baseline patterns.
True.
Do not try to discuss or process a behavioral incident until individual is ready and willing. Do not force them to discuss an incident and DO NOT PUNISH!!!!
What should staff be doing to ensure a safe and supportive environment?
Maintain awareness of surroundings, demonstrate teamwork, encourage functional communication and honor requests, intervene at early signs of escalation and begin deescalation procedure, active listening and engaging with individuals, limit use of cellphones or making yourself “unavailable”, avoid power struggles, offer choices, avoid saying “stop” or “no” (always offer alternatives.)
What does professionalism look like during a crisis?
Remaining calm, respectful, and supportive.
Staff behavior is crucial.
Maintaining safe positioning, model calm, non-threatening behavior.
Do not take away personal items. Do not verbally threaten, bribe, use force or violate human rights in anyway. (Check yourself before you wreck yourself.)
Why should staff avoid giving too many verbal directions at once?
It can overwhelm the individual and increase frustration.
-One person (lead) talks to escalated individual.-Support staff (backup/standby) stand far enough away but close enough to help if needed. They are not talking unless instructed to do so by lead.
After a crisis, an individual appears calm. What should staff do next?
Recovery, support, monitoring, and appropriate documentation.
Do not ask the individual what happened, or revisit the situation with the individual. We are not trying to reprimand or punish anyone for their actions. Praise any approximation of cooperation during the deescalation process.
Traumatic events can affect the persons ability to feel safe, relate to others, or manage emotions.
True.
Anyone can have a history of traumatic experiences. Be mindful of your actions and words.
We have all been through something, big or small. Be kind, show empathy and respect boundaries.
List 2 examples of common triggers.
Loud noise, staff request, teasing from peers, change of schedule or routine, someone standing too close, feeling rushed, threatened, overhearing conversations, feeling bored, sick, tired, hungry, thirsty, misunderstood, unwelcome, person is unable to make needs and wants known, etc.
Remember: calmly intervene at the first signs of escalation. Use the help, prompt and wait strategies.
Why should staff not take behaviors personally?
It’s not about you, it’s about your role.
Behavior is a form of communication. It may communicate an unmet need, frustration, or distress. Rule out basic needs and medical before assuming it’s behavioral; be mindful that TBI/ABI individuals may not have control over their behavior.
An individual made a request (walk) and was prompted to sit calmly and safely (history of aggression) until task at hand (cleaning table) was completed, then staff would honor request. In between initial request, setting the expectation and though completion of task at hand, the individual displayed some disruptive but not dangerous behaviors. Which of the following is the appropriate response:
A.) “ARE SITTING DOWN? ARE YOU BEHAVING?”, or “If you want __, you have to behave.”
B.) “You’re doing great sitting safely, I love how calm your body is right now.” or “Show me you can sit safely and quietly while I finish cleaning the table, then we can___.”
(If you said A, I am disappointed.)
You can’t say things like: “ARE SITTING DOWN? ARE YOU BEHAVING NOW?”, or “If you want __, you have to behave.”
You can say something along the lines of: “You’re doing great sitting safely, I love how quiet your voice is right now.” or “Show me you can sit safely and quietly while I finish cleaning the table, then we can___.”
We should respond to challenging behavior with a confident, neutral facial expression.
True.
Staff should respond using a calm, neutral facial expression and tone of voice and use respectful language, AT ALL TIMES no matter what the situation is.
Our job is to support, not control.
Which of these characteristics of effective reinforcement?
A.) Immediate, transferrable, descriptive, inclusive, varied.
B.) Moderate, distinct, descriptive, preferred, dynamic.
C.) Immediate, distinct, descriptive, preferred, varied.
D.) Viable, non-dramatic, correlated, preferred, kind.
Effective reinforcement should happen immediately after the behavior we want to increase.
Be distinct, point out something positive and do not talk about behavior you are trying to decrease. (This is what debriefing is for...)
Be descriptive. Tell the person what you like about their behavior, no matter how silly it sounds. Avoid repeated phrases and indirect praise such as "good job."
Offer preferred reinforcement. If the consequence of a desirable behavior is something that they do not like, cannot do or cannot have access to, we will likely see an increase in more challenging and sometimes dangerous behavior.
Be varied and offer choices. No one likes getting the same thing over and over again.
Why is teamwork important and why should all staff follow behavior support plans and guidelines?
It promotes coordinated and consistent responses.
Helps maintain safety of both staff and individuals we support, decreases the likelihood of crisis behaviors, builds trusts amongst colleagues and overall enhances the quality of support we provide, ultimately resulting in more meaningful connections and honest rapport with each other the individuals who are relying on us. (And their families!!)
Disruptive behaviors have an overwhelming likelihood of causing immediate violent injury.
False.
Disruptive behaviors can disrupt learning and be distracting but do not put anyone at risk. Staff can utilize help, prompt, wait strategies when appropriate.
You are using your own force and strength when utilizing supportive guide.
False.
You are not pushing, pulling or yanking.
When using supportive guide, you are using the persons own momentum to gently guide them where they need to go.
If you are being grabbed in a way that does not allow you to use a standard Safety-Care release procedure, you should...
Call for assistance (if needed) while you get into a safe position.
Double trouble ~
1. What does it mean to identify triggers?
2. Why is offering choices helpful?
1. Recognizing events or situations that may lead to challenging behavior.
2. It provides a sense of control and promotes cooperation.
When using the prompt strategy, we should only prompt a behavior that is a “do” request rather than a “don’t” or “stop” request.
True.
Instead of: “Stop hitting,”
You can prompt: “Hands at waist.” Or “Hold this pillow for me”, “show me safe hands.”
Which of these is something we don’t do when we minimize risk in physical management?
a) Don’t apply any pressure to the head, neck, or torso.
b) Don’t transition into an internal leverage combination.
c) Don’t touch the person anywhere beyond the ankles.
d) Don’t adjust shoulders into a dominance posture.
A!!!
Don’t apply any pressure to the head, neck, or torso.
Avoid joints, pressure points and be mindful of persons general ROM and mobility.
The use of Safety Care physical management techniques to gain control of a person for staff's convenience.
Safety Care physical management should only be used when the three criteria is met.
Yes, the wait strategy works.
The best time to use the wait strategy is when there has been too many people involved in an incident, they are slowly coming down the deescalation staircase, or prompt and help strategies seem to make situation worse. Pause, wait, use that time think of your next steps.
When the function of a behavior is attention seeking, the wait strategy is extremely successful. Less attention to disruptive behavior + more attention to desirable behavior = EVEN MORE DESIRABLE BEHAVIOR. :)
Safety-Care has three criteria for use of physical management. List all 3.
1. The risk of not intervening is greater than the risk of intervening.
2. There is imminent risk of serious harm.
3. There is no other practical way to prevent that harm without physical management.