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RBT Behavior Reduction: Effective Interventions

Behavior reduction is a critical component of comprehensive behavior-analytic interventions. As an RBT, you’ll implement function-based intervention strategies designed by your supervisor to decrease challenging behaviors while teaching appropriate replacement behaviors. This section covers antecedent-based strategies, teaching alternative behaviors, extinction procedures, and crisis intervention techniques.

D-1: Identify Essential Components of a Written Behavior Reduction Plan

Function-Based Intervention Components

Target Behavior Definition:

  • Operationally defined in observable, measurable terms
  • Includes examples and non-examples
  • Specifies conditions/contexts where behavior occurs
  • Identifies measurement parameters (frequency, duration, intensity)

Example Definition: “Aggression: Any instance of hitting, kicking, biting, pinching, or scratching directed toward another person with sufficient force to cause or potentially cause physical discomfort. A new instance is recorded after 3 seconds without any aggressive behavior.”

Function Identification:

  • Clearly states hypothesized or confirmed behavior function
  • Based on functional behavior assessment/analysis
  • May identify multiple functions if applicable
  • Links intervention strategies to identified function(s)

Example Function Statement: “Based on functional analysis data, aggressive behavior is primarily maintained by escape from demanding tasks, particularly during independent work periods requiring sustained attention.”

Antecedent Modification Procedures:

  • Specific environmental changes to reduce likelihood of behavior
  • Modifications to task demands, instructions, or schedules
  • Changes to physical environment or social context
  • Establishes conditions that reduce motivation for problem behavior

Example Antecedent Modifications: “1) Reduce initial task demand length by 50% (from 10 problems to 5 problems) 2) Provide visual schedule indicating work periods and break times 3) Offer choice between 2-3 equivalent tasks 4) Use high-interest materials within task demands when possible 5) Ensure 2:1 ratio of mastered to acquisition tasks”

Replacement Behavior Procedures:

  • Identifies functional equivalent replacement behaviors
  • Specifies teaching procedures for alternative behaviors
  • Includes reinforcement schedule for replacement behaviors
  • Details prompting strategies for replacement behavior

Example Replacement Behavior Procedures: *”Teach client to request breaks using break card:

  1. Present card within reach during all work sessions
  2. Initially prompt card use every 3 minutes during work
  3. Immediately honor all break requests (30-second break)
  4. Gradually shape longer work periods before breaks
  5. Differentially reinforce appropriate break requests vs. problem behavior”*

Extinction Procedures:

  • Specifies how reinforcement will be withheld for target behavior
  • Details implementation consistent with behavioral function
  • Includes strategies for managing extinction bursts
  • Notes any behaviors that cannot be placed on extinction for safety

Example Extinction Procedures: *”When aggression occurs during work tasks:

  1. Maintain task demands despite aggressive behavior
  2. Use minimal physical interaction necessary for safety
  3. Avoid eye contact, verbal reasoning, or negotiating during aggression
  4. Continue prompting task completion using least-intrusive effective prompts
  5. Do not remove task demands following aggressive behavior”*

Reinforcement Procedures:

  • Identifies specific reinforcers to be used
  • Details schedule of reinforcement for appropriate behaviors
  • Specifies differential reinforcement procedures
  • Includes preference assessment schedule

Example Reinforcement Procedures: “1) Conduct brief preference assessment at beginning of each session 2) Provide identified reinforcers on FR1 schedule for independent break card use 3) Provide praise paired with token for each 2-minute interval without aggression 4) Exchange 5 tokens for 3-minute access to highly preferred items/activities 5) Gradually increase reinforcement intervals as behavior improves”

Crisis/Emergency Procedures:

  • Step-by-step instructions for dangerous behavior management
  • Clear criteria for different intervention levels
  • Detailed physical management procedures if authorized
  • Reporting and documentation requirements
  • Post-crisis debriefing protocols

Example Crisis Procedures: *”If aggression escalates to dangerous level (drawing blood or sustained attack):

  1. Remove other clients from immediate area
  2. Call for support from supervisor
  3. Maintain safe distance when possible
  4. Implement approved protective stance if necessary
  5. Use approved transport procedure only if imminent danger exists
  6. Document incident using Critical Incident Report within 24 hours”*

Data Collection Procedures:

  • Specifies measurement system(s) to be used
  • Details recording methods and materials
  • Identifies when data should be collected
  • Includes graphing and analysis expectations

Example Data Collection Procedures: “Record frequency of aggressive behaviors using tally counter throughout session. Document time, antecedents, and consequences on ABC form for each instance. Calculate rate of aggression per hour. Record each instance of appropriate break card use. Graph daily rates of both aggression and break card use on standard celeration chart.”

D-2: Describe Common Functions of Behavior

Behavior Function Categories

Positive Reinforcement:

  • Behavior maintained by obtaining something desirable
  • Behavior increases/maintains because it produces access to reinforcer
  • May involve social or non-social reinforcers
  • Critical to identify specific reinforcers maintaining behavior

Socially Mediated Positive Reinforcement:

Attention:

  • Behavior occurs to obtain attention from others
  • May include positive attention (praise, conversation) or negative attention (reprimands)
  • Common function for behaviors that reliably produce reactions from others
  • Behavioral Indicators:
    • Behavior occurs more when attention is diverted
    • Behavior stops or decreases when attention provided
    • Behavior rarely occurs when receiving undivided attention
    • Behavior increases with delayed attention responses
  • Example: Child throws toys when parent is on phone, behavior stops when parent engages

Tangible/Activity Access:

  • Behavior occurs to obtain preferred items or activities
  • May develop when items/activities only provided following problem behavior
  • Often involves history of “giving in” to problem behavior
  • Behavioral Indicators:
    • Behavior occurs when items removed or denied
    • Behavior stops when items/activities provided
    • Behavior more likely when preferred items visible but inaccessible
    • Behavior often preceded by item requests
  • Example: Student knocks over desk when told computer time is over, behavior stops when allowed more time

Negative Reinforcement:

  • Behavior maintained by escaping/avoiding something aversive
  • Behavior increases/maintains because it produces removal of aversive stimulus
  • May involve social or non-social stimuli
  • Critical to identify specific aversive stimuli related to behavior

Escape/Avoidance:

  • Behavior occurs to escape or avoid demands/activities
  • Common function for behaviors during difficult or non-preferred tasks
  • May involve complete task removal or temporary breaks
  • Behavioral Indicators:
    • Behavior increases when demands presented
    • Behavior decreases when demands removed
    • Behavior often preceded by task instructions
    • Latency between demand and behavior often brief
    • Behavior rarely occurs during preferred activities
  • Example: Student tears worksheet when given math problems, teacher removes task temporarily

Sensory Reinforcement (Automatic Reinforcement):

  • Behavior maintained by sensory consequences independent of social mediation
  • Reinforcement directly produced by the behavior itself
  • May involve sensory stimulation or pain attenuation
  • Often persists in absence of social contingencies

Sensory Stimulation:

  • Behavior produces pleasing sensory feedback
  • May address sensory seeking needs
  • Often continues in absence of social attention
  • Behavioral Indicators:
    • Behavior occurs across different settings/people
    • Behavior continues when alone
    • Behavior often has rhythmic/repetitive quality
    • May increase during low-stimulation periods
    • May decrease with alternative sensory input
  • Example: Child repeatedly flaps hands while watching television, continues when no one is watching

Pain Attenuation:

  • Behavior reduces or masks physical discomfort
  • May address underlying medical issues
  • Often intensifies with corresponding medical symptoms
  • Behavioral Indicators:
    • Behavior targets specific body areas
    • Correlates with potential medical/pain issues
    • May increase during illness or discomfort
    • May decrease with appropriate medical intervention
  • Example: Child hits head during ear infection, decreases after medical treatment

Multiple-Controlled Behavior

Definition and Identification:

  • Behavior maintained by multiple reinforcement contingencies
  • May serve different functions across contexts or time
  • Requires careful functional assessment across conditions
  • Intervention must address all maintaining functions

Common Multiple-Control Patterns:

Multiple Functions Across Contexts:

  • Behavior serves different functions in different environments
  • Often involves different reinforcement histories across settings
  • Example: Screaming serves attention function at home but escape function at school

Multiple Functions Within Contexts:

  • Behavior serves multiple functions simultaneously
  • Often involves complex reinforcement history
  • Example: Tantrum produces both adult attention and removal of demands

Function Sequences:

  • Behavior begins with one function but develops additional functions
  • Often involves initial escape function with added attention function
  • Example: Child initially refuses work to escape tasks, but parental attention during refusal creates additional attention function

Assessment Implications:

  • Need for assessment across multiple settings
  • Attention to detailed antecedent and consequence patterns
  • Collection of data across varied conditions
  • Analysis of potential interaction effects between functions

Intervention Implications:

  • Must address all identified functions
  • May require different strategies across settings
  • Often involves multiple replacement behaviors
  • Consistency across environments especially important

D-3: Implement Interventions Based on Modification of Antecedents and Consequences

Antecedent-Based Interventions

Noncontingent Reinforcement (NCR):

  • Providing reinforcement on time-based schedule independent of behavior
  • Reduces motivation for problem behavior by freely providing reinforcer
  • Initially dense schedule thinned over time
  • Implementation Steps:
    1. Identify reinforcer maintaining problem behavior
    2. Establish initial dense reinforcement schedule (e.g., every 2 minutes)
    3. Provide reinforcer regardless of behavior
    4. Gradually extend interval between reinforcer deliveries
    5. Continue until practical terminal schedule achieved

Example NCR Implementation: For attention-maintained behavior:

  • Provide attention on 2-minute fixed-time schedule initially
  • Deliver brief, high-quality attention at each interval
  • Ignore problem behavior or respond neutrally
  • Gradually extend schedule to 5 minutes, then 10 minutes
  • Ensure attention quality remains high as frequency decreases

Environmental Enrichment:

  • Modifying environment to better meet client needs
  • Providing stimulation similar to that produced by problem behavior
  • Creating engaging, responsive environment
  • Implementation Steps:
    1. Identify sensory qualities of problem behavior
    2. Provide alternative items/activities with similar sensory features
    3. Enrich environment with varied stimulating materials
    4. Ensure continuous access to appropriate sensory options
    5. Rotate materials to maintain novelty

Example Environmental Enrichment: For automatically reinforced hand-flapping:

  • Provide array of fidget items with various textures
  • Set up sensory activity stations in environment
  • Incorporate movement breaks into schedule
  • Teach appropriate use of sensory tools
  • Regularly introduce new sensory materials

Demand Modifications:

  • Altering task characteristics to reduce aversiveness
  • Adjusting difficulty, length, or presentation of demands
  • Maintaining instructional expectations while reducing escape motivation
  • Implementation Strategies:
    1. Task Interspersal: Mixing easy/mastered tasks with difficult/acquisition tasks
    2. Task Choice: Offering options between equivalent tasks
    3. Task Modification: Adjusting difficulty, length, or format
    4. Break Scheduling: Building in predictable breaks during work
    5. Premack Principle: “First work, then play” sequencing

Example Demand Modification: For escape-maintained behavior during writing tasks:

  • Reduce initial assignment length to 3-5 sentences
  • Offer choice between handwriting and keyboard
  • Intersperse easy content (copying) with difficult (original composition)
  • Provide visual timer showing work periods and breaks
  • Use high-interest topics for writing assignments

Pairing:

  • Associating difficult tasks/people with reinforcing experiences
  • Building positive associations through classical conditioning
  • Gradually transferring reinforcing properties to previously aversive stimuli
  • Implementation Steps:
    1. Identify aversive stimulus triggering problem behavior
    2. Pair with highly preferred reinforcers/activities
    3. Initially keep demand level very low during pairing
    4. Gradually increase demand while maintaining pairing
    5. Fade explicit pairing as positive association develops

Example Pairing Implementation: For instructor-associated problem behavior:

  • New instructor initially only delivers preferred items/activities
  • Instructor pairs approach with favorite reinforcers
  • Instructor gradually introduces very brief, easy demands
  • Maintain high reinforcement ratio during demand introduction
  • Gradually normalize instructional interactions

Reinforcement-Based Interventions

Differential Reinforcement of Alternative Behavior (DRA):

  • Reinforcing a specific alternative behavior that serves same function as problem behavior
  • Withholding reinforcement for problem behavior
  • Teaching functionally equivalent response
  • Implementation Steps:
    1. Identify function of problem behavior
    2. Select appropriate alternative behavior serving same function
    3. Teach alternative behavior explicitly
    4. Reinforce alternative behavior richly (initially on continuous schedule)
    5. Withhold reinforcement for problem behavior
    6. Gradually thin reinforcement schedule for alternative behavior

Example DRA Implementation: For attention-maintained disruptive behavior:

  • Teach appropriate attention request (“Excuse me, please”)
  • Immediately reinforce appropriate requests with high-quality attention
  • Ignore disruptive attention-seeking behavior
  • Initially prompt appropriate requests frequently
  • Gradually reduce prompting and increase response requirements

Differential Reinforcement of Incompatible Behavior (DRI):

  • Reinforcing behavior physically incompatible with problem behavior
  • Preventing problem behavior through incompatible response
  • Often combines with extinction of problem behavior
  • Implementation Steps:
    1. Identify behavior physically incompatible with problem behavior
    2. Ensure incompatible behavior is functional/appropriate
    3. Teach incompatible behavior explicitly
    4. Reinforce incompatible behavior when problem behavior likely
    5. Withhold reinforcement for problem behavior
    6. Gradually thin reinforcement schedule

Example DRI Implementation: For stereotypic hand-flapping:

  • Teach functional play with toys requiring hand manipulation
  • Immediately reinforce appropriate toy play
  • Ensure toys available during high-risk times for hand-flapping
  • Initially prompt appropriate toy play frequently
  • Gradually shift to more natural play patterns

Differential Reinforcement of Other Behavior (DRO):

  • Reinforcing absence of problem behavior for specified time period
  • Also called differential reinforcement of zero rates
  • Reduces overall rates of problem behavior
  • Implementation Steps:
    1. Identify initial interval duration (shorter than typical inter-response time)
    2. Deliver reinforcement when no problem behavior occurs during interval
    3. Reset interval if problem behavior occurs
    4. Gradually increase interval length as successful
    5. Shift to more natural reinforcement schedule

Example DRO Implementation:

For aggressive behavior averaging every 10 minutes:

  • Set initial DRO interval at 5 minutes
  • Provide reinforcement after each 5-minute period without aggression
  • Reset 5-minute timer if aggression occurs
  • Gradually increase to 7 minutes, then 10 minutes, then 15 minutes
  • Eventually extend to naturally occurring reinforcement opportunities

Differential Reinforcement of Lower Rates (DRL):

  • Reinforcing when behavior occurs less frequently than specified criterion
  • Used when immediate elimination not feasible/necessary
  • Gradually shapes behavior toward acceptable rates
  • Types of DRL:
    1. Full-session DRL: Reinforcement provided if total behaviors fall below criterion during entire session
    2. Interval DRL: Reinforcement for each interval with fewer than criterion responses
    3. Spaced-responding DRL: Reinforcement when behavior occurs with minimum time between instances

Example DRL Implementation: For excessive question-asking (baseline 20 questions per hour):

  • Set initial criterion at 15 questions per hour
  • Provide visual counter of questions used
  • Deliver reinforcement if questions remain under criterion
  • Gradually reduce criterion to target rate (5 questions per hour)
  • Teach discrimination of essential versus non-essential questions

Token Economy Systems:

  • Systematic reinforcement system using conditioned reinforcers (tokens)
  • Tokens exchangeable for backup reinforcers
  • Allows precise differential reinforcement
  • Implementation Components:
    1. Token earning rules (behaviors that earn tokens)
    2. Token exchange system (what tokens can purchase)
    3. Exchange schedule (when tokens can be exchanged)
    4. Response cost contingencies (if applicable)
    5. Visual representation system

Example Token Economy Implementation: For classroom behavior management:

  • Define 3-5 target appropriate behaviors for earning tokens
  • Create visual token board with clear earning rules
  • Establish exchange menu with various reinforcer options
  • Set exchange periods (after session, end of day)
  • Initially provide tokens generously, then increase requirements
  • Consider response cost only after positive component established

Extinction Procedures

Definition and Purpose: Extinction involves discontinuing reinforcement for a previously reinforced behavior, leading to eventual decrease and elimination of the behavior. Extinction is typically combined with reinforcement of appropriate alternative behaviors.

Extinction Variations by Function:

Attention Extinction:

  • Withholding attention following attention-maintained behavior
  • Requires consistent implementation across all attention forms
  • Often combined with NCR or DRA for attention
  • Implementation Steps:
    1. Identify all forms of attention currently reinforcing behavior
    2. Develop plan to systematically withhold all attention forms
    3. Ensure all implementers understand plan
    4. Prepare for extinction burst
    5. Maintain consistency even with escalation

Example Attention Extinction: For attention-maintained tantrum behavior:

  • Avoid eye contact, verbal interaction, physical proximity
  • Continue ongoing activities without acknowledging tantrum
  • Redirect attention to appropriate behavior when it occurs
  • Provide noncontingent attention on time-based schedule
  • Consistently implement across all settings/implementers

Escape Extinction:

  • Preventing escape from demands following escape-maintained behavior
  • Requires continued presentation of demands despite problem behavior
  • Often combined with demand modifications and break scheduling
  • Implementation Steps:
    1. Identify escape-maintained behavior
    2. Develop demand persistence protocol
    3. Ensure ability to follow through with demands
    4. Consider safety and implementation feasibility
    5. Maintain instructional control throughout

Example Escape Extinction: For escape-maintained work refusal:

  • Continue presenting task despite refusal behavior
  • Use least-intrusive prompting necessary to ensure task completion
  • Do not remove task until completed (even partially)
  • Implement appropriate modifications to reduce task aversiveness
  • Teach appropriate break-requesting as alternative

Tangible Extinction:

  • Not providing access to items/activities following tangible-maintained behavior
  • Requires control of access to reinforcing items
  • Often combined with appropriate requesting teaching
  • Implementation Steps:
    1. Identify items/activities maintaining problem behavior
    2. Ensure ability to restrict access despite problem behavior
    3. Develop plan for safely withholding reinforcers
    4. Prepare for extinction burst
    5. Maintain consistency across implementers

Example Tangible Extinction: For tangible-maintained aggressive behavior:

  • Secure preferred items so they cannot be accessed through aggression
  • Do not provide requested items following aggression
  • Teach appropriate requesting for same items
  • Immediately honor appropriate requests initially
  • Maintain consistency even with escalation

Sensory Extinction:

  • Blocking or preventing sensory consequences of automatically reinforced behavior
  • May involve protective equipment or environmental modifications
  • Often most challenging form of extinction
  • Implementation Steps:
    1. Identify sensory consequences maintaining behavior
    2. Develop method to interrupt sensory reinforcement
    3. Ensure method is not harmful or overly restrictive
    4. Combine with sensory alternatives
    5. Monitor for emergence of response variants

Example Sensory Extinction: For automatically reinforced skin picking:

  • Provide protective gloves to prevent sensory feedback
  • Implement during high-risk situations
  • Combine with competing sensory activities
  • Teach appropriate ways to address sensory needs
  • Monitor for alternative forms of sensory stimulation

Extinction Challenges and Management

Extinction Burst:

  • Temporary increase in behavior frequency, intensity, or duration
  • Expected component of extinction process
  • May include novel problem behaviors (“extinction-induced variability”)
  • Management Strategies:
    1. Prepare all implementers for extinction burst
    2. Ensure consistency during burst (critical period)
    3. Remove dangerous objects/situations during initial implementation
    4. Have additional support available initially
    5. Document patterns for analysis

Example Extinction Burst Management: For attention-maintained screaming:

  • Brief team that screaming will likely increase initially
  • Develop specific plan for maintaining extinction during escalation
  • Specify maximum duration/intensity requiring additional intervention
  • Document baseline to compare with burst intensity
  • Continue consistent implementation until reduction begins

Spontaneous Recovery:

  • Temporary reappearance of extinguished behavior
  • May occur after periods without behavior occurrence
  • Requires continued extinction implementation
  • Management Strategies:
    1. Anticipate recovery after absences/breaks
    2. Brief new team members on extinction history
    3. Maintain extinction protocol despite reemergence
    4. Document episodes for pattern analysis
    5. Continue until recovery episodes diminish

Example Spontaneous Recovery Management: For extinguished tantrum behavior:

  • After weekend break, prepare for possible tantrum recurrence
  • Ensure consistent implementation of extinction despite recurrence
  • Continue reinforcing alternative behaviors
  • Document recovery episodes (duration, intensity, frequency)
  • Analyze patterns for prevention opportunities

Ethical Considerations with Extinction:

  • Balance short-term discomfort against long-term benefits
  • Consider least restrictive alternative approaches
  • Ensure extinction is not implemented in isolation
  • Always pair with reinforcement of alternative behaviors
  • Monitor for unintended effects or emotional responses

When to Avoid Extinction:

  • When behavior is dangerous and extinction burst poses safety risk
  • When consistent implementation cannot be guaranteed
  • When behavior serves legitimate communication function without alternative
  • When team consensus and buy-in cannot be established
  • When less intrusive approaches have not been attempted

D-4: Implement Crisis/Emergency Procedures According to Protocol

Understanding Behavioral Crises

Definition of Crisis Situation: A behavioral crisis involves behavior that poses immediate risk of injury to the client or others, significant property destruction, or extreme disruption requiring emergency intervention beyond typical behavior management procedures.

Common Crisis Behaviors:

  • Severe aggression toward others
  • Self-injurious behavior with injury risk
  • Elopement in dangerous circumstances
  • Property destruction creating safety hazards
  • Intense tantrum behavior preventing necessary activities

Crisis Escalation Cycle:

Calm Phase:

  • Typical behavior, responsive to environment
  • Rational thinking and normal interaction
  • Receptive to instructions and feedback
  • Optimal phase for teaching and prevention

Trigger Phase:

  • Exposure to triggering event or condition
  • Subtle changes in behavior or demeanor
  • May verbalize discomfort or frustration
  • Critical opportunity for early intervention

Escalation Phase:

  • Increasing emotional arousal
  • More obvious behavioral indicators
  • Less responsive to typical redirection
  • Last opportunity for preventive strategies

Crisis Phase:

  • Loss of rational control
  • Emergence of dangerous behavior
  • Requires crisis intervention procedures
  • Focus on safety rather than teaching

Recovery Phase:

  • Gradual return to calmer state
  • May include fatigue or embarrassment
  • Increased receptivity to support
  • Transition back to structured activities

De-escalation Phase:

  • Return to normal functioning
  • Opportunity for processing and learning
  • Preparation for re-entry to routine
  • Important for preventing future cycles

Crisis Prevention Strategies

Environmental Modifications:

  • Removing potential weapons or dangerous items
  • Creating clear pathways for movement/egress
  • Establishing designated calming spaces
  • Reducing sensory triggers (noise, crowding)
  • Ensuring adequate supervision in high-risk areas

Early Intervention Techniques:

  • Recognizing individual warning signs
  • Prompt redirection at first indicators
  • Offering proactive breaks during trigger phase
  • Providing calming activities or sensory tools
  • Modifying demands during vulnerable periods

De-escalation Strategies:

Proxemic Techniques:

  • Maintaining safe, non-threatening distance
  • Positioning at angle rather than direct confrontation
  • Respecting personal space boundaries
  • Using non-threatening body posture
  • Avoiding physical barriers to exit

Communication Strategies:

  • Using calm, neutral tone of voice
  • Speaking slowly and clearly
  • Simplifying verbal instructions
  • Reducing verbal demands
  • Using brief, concrete directives
  • Avoiding argumentation or questioning

Behavioral Momentum:

  • Making simple, easily followed requests first
  • Building compliance momentum with easy tasks
  • Gradually reintroducing necessary demands
  • Creating successful response opportunities
  • Providing positive feedback for compliance

Offering Choices:

  • Presenting limited, appropriate options (2-3)
  • Focusing on process rather than outcome
  • Using visual choice presentations when helpful
  • Honoring choices when safely made
  • Rebuilding sense of control through choice-making

Distraction/Diversion:

  • Redirecting attention to preferred topics/activities
  • Introducing novel, interesting stimuli
  • Changing physical location when appropriate
  • Engaging different sensory systems
  • Using humor appropriately (when relationship established)

Crisis Response Procedures

Following Written Protocol:

  • Adhering to supervisor-developed crisis plan
  • Implementing only approved procedures
  • Following specified sequence of interventions
  • Documenting all interventions as required
  • Consulting protocol during emergency when possible

Staff Coordination:

  • Establishing clear roles during crisis
  • Designating primary communicator with client
  • Assigning specific responsibilities to each team member
  • Using predetermined communication signals
  • Maintaining awareness of team positioning

Protection Procedures:

  • Removing others from immediate area
  • Creating safe distance from crisis
  • Using approved blocking procedures if necessary
  • Implementing protective equipment if specified
  • Removing dangerous objects from environment

Physical Intervention Considerations:

  • Using only as last resort when specified in plan
  • Implementing only approved/trained techniques
  • Using minimum force necessary for safety
  • Continuing verbal de-escalation throughout
  • Releasing at earliest safe opportunity
  • Documenting all instances thoroughly

Example Crisis Protocol Steps:

1. Recognize early warning signs (pacing, voice volume increase)
2. Implement preventive strategies (offer break, reduce demands)
3. If escalation continues, create safe environment:
   - Remove other clients from area
   - Remove potential weapons/dangerous objects
   - Position staff strategically (near exits, non-blocking)
4. Use verbal de-escalation techniques:
   - Calm, quiet voice
   - Simple, clear directions
   - Offer limited choices
   - Avoid threats or power struggles
5. If aggressive behavior occurs:
   - Maintain safe distance
   - Continue verbal de-escalation
   - Use approved blocking techniques if necessary
   - Call for assistance using established signal
6. If behavior poses immediate danger:
   - Implement approved physical management techniques
   - Use minimum force necessary
   - Release at earliest safe opportunity
   - Call supervisor immediately
7. Post-crisis procedures:
   - Ensure medical attention if needed
   - Document incident thoroughly
   - Debrief with team
   - Update intervention plan

Post-Crisis Procedures

Medical Assessment:

  • Checking for any injuries to client or others
  • Providing first aid as needed
  • Seeking medical attention for significant injuries
  • Documenting all medical interventions
  • Following up on any medical concerns

Emotional Support:

  • Providing calm reassurance after crisis
  • Creating safe space for emotional processing
  • Avoiding blame or punishment focus
  • Offering appropriate comfort measures
  • Allowing time for emotional recovery

Environment Restoration:

  • Returning space to safe, functional condition
  • Repairing or removing damaged items
  • Restoring typical environmental arrangement
  • Preparing for return to routine activities
  • Ensuring environment supports successful re-entry

Documentation Requirements:

  • Incident description (objective, detailed)
  • Antecedent events and triggers
  • Specific behaviors observed
  • Interventions implemented in sequence
  • Duration of crisis and interventions
  • Injuries or property damage
  • Staff involved and roles
  • Post-crisis procedures implemented
  • Parent/guardian notification

Example Documentation Form Elements:

Client: _______ Date: _______ Time: _______
Location: _______
Staff Present: _______

Antecedent Events:
[Detailed description]

Behavior Description:
[Objective description of crisis behavior]

Interventions Implemented:
[Chronological list with times]

Duration of Crisis: _______ minutes

Injuries/Damage:
[Detailed description]

Medical Attention Provided:
[Description of any medical response]

Parent/Guardian Notification:
Time: _______ Person Contacted: _______
Notification Method: _______

Follow-up Actions:
[List of required follow-up steps]

Staff Signature: _______ Date: _______
Supervisor Signature: _______ Date: _______

Debriefing Process:

  • Reviewing incident objectively
  • Identifying effective and ineffective strategies
  • Discussing prevention opportunities
  • Planning modifications to behavior plan
  • Addressing staff emotional responses
  • Scheduling follow-up supervision

Legal and Ethical Considerations

Least Restrictive Intervention:

  • Using least intrusive effective intervention
  • Implementing hierarchy of responses
  • Attempting non-physical interventions first
  • Justifying any restrictive procedures
  • Documenting rationale for intervention level

Client Dignity Preservation:

  • Maintaining privacy during crisis
  • Using respectful language throughout
  • Minimizing visibility to non-essential persons
  • Implementing interventions discreetly when possible
  • Preserving client’s personal rights

Intervention Authorization:

  • Implementing only procedures explicitly approved in behavior plan
  • Obtaining proper consent for crisis procedures
  • Following organizational and legal guidelines
  • Knowing state/region-specific regulations
  • Maintaining current training certifications

Documentation and Reporting Requirements:

  • Following mandated reporting obligations
  • Completing all required documentation promptly
  • Reporting to appropriate authorities when required
  • Maintaining accurate, objective records
  • Adhering to confidentiality requirements

Training Requirements:

  • Completing required crisis management certification
  • Maintaining current certification status
  • Participating in regular practice/refresher training
  • Documenting all crisis management training
  • Implementing only techniques included in training