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-intervention-training-programsA Consumer’sGuide toCrisisInterventionTrainingProgramsMidwest Symposium for Leadership InBehavior Disorders, February 26,2016Elisabeth KaneReece L. Peterson,University of Nebraska-LincolnJoseph B. Ryan,Clemson UniversityMichael A. Couvillon,Drake UniversityBrenda ScheuermannTexas State UniversityJames HoganUniversity of WashingtonGoal of this presentation To be able to compare and contrastavailable crisis training programs inorder to better enableadministrators and educators toselect a crisis intervention programthat best meets their risis-intervention-training-programsA Consumer’sGuide toCrisisInterventionTrainingProgramsElisabeth KaneReece L. Peterson,University of Nebraska-LincolnJoseph B. Ryan,Clemson UniversityMichael A. Couvillon,Drake UniversityBrenda ScheuermannTexas State UniversityJames HoganUniversity of WashingtonMidwest Symposium for Leadership InBehavior Disorders, February 26,2016Illustration by Ward ZwartDefinitions3 Types of TimeoutOnly one of these isSeclusion3 Types of RestraintProceduresMechanicalRestraintUse of any device (tape, tiedowns) to limit anindividual’s bodymovement.Limited use in schools;with a few exceptions, notpermitted.ChemicalRestraintUse of medication tocontrol behavior or restricta patient’s freedom ofmovementNot used by schools;however many studentsmay be on medication inschools.PhysicalRestraintUse of one or more peopleusing their bodies torestrict another’smovement.Can be used given certaincriteria are met.Inclusion Timeoutinside the classroomExclusion TimeoutOutside theclassroomSeclusionInvoluntary confinement ofa student alone in a room orarea from which the studentis physically prevented fromleaving4Slide & resources s-intervention-training-programsTypes of Restraint Procedures Supine restraints Prone restraints Basket hold restraints Physical escorts OthersThese images are forillustration. They may ormay not represent goodpractice. Most trainingprograms which continueto use prone or supinerestraint have adjustedholds to increase theirsafety.U.S.DepartmentofEducation,Office forCivil Rights,DataCollection,2011-12. Over 70,000 students subjected tophysical restraint Over 37,000 students subject toseclusion. Nevada (96%), Florida (95%), andWyoming (93%) reported the highestpercentages of physically restrainedstudents with disabilities. Nearly 4,000 IDEA students subject tomechanical restraint1

2/22/2016Of studentssubjected torestraint, 75%were studentswith adisability.Office of Civil Rights2014 ReportOf studentssubjected toseclusion58% werestudentswith adisabilityOffice of CivilRights 2014ReportU.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-12.U.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-12STRONG ADVOCACY CONTINUES!H.R. 927Some states - policy activity.The Keeping All StudentsSafe ActMassachusetts, Virginia & Washington , Nebraska – recent examplesThe bill in the House hasbeen re-introduced; noaction and none likely.How Safe Is The SchoolhouseJESSICA BUTLER. UPDATED JULY 25, 2015 An updated guide to staterestraint and seclusion laws, regulations, rules and policies in effect as of July25, 2015; SSA - Every Student Succeeds Act‘‘(1) DESCRIPTIONS .—Each State plan shall describe— .‘‘(C) how the State educational agencywill support local educational agencies receiving assistance under this part to improve schoolconditions for student learning, including through reducing— ‘‘(i) incidences of bullying andharassment; ‘‘(ii) the overuse of discipline practices that remove students from the classroom; and‘‘(iii) the use of aversive behavioral interventions that compromise student health and safety;“ p.41-42 of pdfTwo previous studies of the content ofcrisis intervention programs Farrell and Cubit (2005) covered contentof training for aggression managementtraining programs intended for nursesand others in mental health settings. Farrell and Cubit compared andcontrasted how 28 programs traindiverse components, such as, levels ofrisk, communication, physical restraint,seclusion, debriefing, etc. They concluded most programs includedinformation on personal safety for staffand clients, and recommended refreshercourses. However they did not discusspsychological costs. Only 7 trainedrestraint, and only 1 discussed the risksof restraints. Couvillon, Peterson, Ryan,Scheuermann, and Stegall (2010),surveyed similar content topics fortraining delivered to schools.Purposes the of present study Need for Couvillon et al. (2010) Update in context of:– Policy changes– Increased safety concerns The study found that the average rangebasic training length was 12 to 16hours, but varied greatly, and variedbased on level of training.– To also address seclusion They also found substantial variation inthe emphasis put on major topics oftraining (e.g., conflict de-escalationversus restraint procedures).– Address lack of consensus for content & focus– Highlight major similarities and differences– Aid consumers on purchasing decisions2

2/22/2016The Present StudyTraining Vendors Questions were refined with amix of both closed and openended responses. When completed it included 99questions Options created for electronic(Qualtrics) or hard copy ortelephone interview completion.Management of Aggressive Behavior (MOAB)MOAB Training International, Inc.moabtraining.comNonviolent Crisis Intervention ProgramCrisis Prevention Institutecrisisprevention.comOregon Intervention System (OIS)Alternative Service, Inc. - Oregonois.asioregon.orgPMTPMT Associates, Inc.pmtassociates.netPro-ACT Pro-ACT, Inc.proacttraining.com Only those providing training on restraints were included.Professional Crisis ManagementProfessional Crisis Management Associationpcma.com 32 Initially identified, but 7 were no longer in businessResponseResponse Training Program LLCresponsetrainings.comRight ResponseService Alternatives Training Instituterightresponse.orgSafe and Positive Approaches Devereuxdevereux.orgSafe Crisis ManagementJKM Training Incorporatedjkmtraining.com Result was data from 17 vendors- 68% of total.Safe Prevention Principle and TechniquesJIREH Training and Consulting LLCjirehtraining.com Owner or lead trainer was contacted and asked tocomplete the questionnaire.Safety-CareQBS, Inc.qbscompanies.comSatori Alternatives to Managing Aggression (SAMA)Satori Learning Designs, Inc.mandtsystem.comThe Mandt SystemThe Mandt System, Inc.mandtsystem.comTherapeutic Aggression Control Techniques (TACT2)SBP Consulting, Inc.tact2.comTherapeutic Crisis Intervention (TCI)Residential Child Care Project, Cornell Univ.rccp.cornell.edu/tcimainpage.html Effort to identify all current training vendors providingtraining to schools through Internet searches andnominations. Of the remaining 25, 6 declined or did not respond, twodid not complete the questionnaire. Once completed the data was sent back to the vendorfor verification. General information anddefinitionsRespondentswere asked for% of trainingallocated toeach Restraint procedures Dangers and Risks Crisis De-escalationprocedures Procedures for monitoring Debriefing and follow up Seclusion Other topic areas* Interpretations may vary based on differing terminology or understandings; use only for gross comparisonsAverage Allocation Across Training ProgramsMonitoringProcedures, p.comTrainingcontent by 8globalcomponents*Seclusion, 2Devriefing &Follow-up, 6Organization NameCrisis Consultant Group, LLC.Questionnaire The Couvillon, et al.questionnaire was obtained,expanded and organized into10 content sections or topics.17 Crisis Intervention TrainingProgramsOther, 11GeneralInformation/Definitions, 8Dangers &Risks, 6Crisis Deescalation, 41Calm Every Storm, Crisis Intervention TrainingAllocation of resources across general topicsTraining Program NameCalm Every StormMOABNonviolent CrisisIntervention programOISPMTPro-ACT Professional CrisisManagementResponseRIGHT RESPONSESafe & Positive Approaches Safe Crisis ManagementSafe Prevention Principlesand TechniquesSafety-CareSAMAThe Mandt System TACT2TCITotal BasicGeneralDangersCrisisRestraintMonitoring Debriefing Seclusion Other TotalTraining Information/ & Risks De-escalation Procedures Procedures & Follow-up%%%TimeDefinitions %%%%%%16 hrs6-8 hrs5205155520152051055555510010014 hrs12 hrs8 hrs20 90510010010010014 hrs12 hrs5-14 hrs14 hrs18 00000122529010010010010010016-20 hrs12 hrs16 hrs19 hrs18-20 hrs28-32 55155172.51050012.5003535000100100100100100100Pie charts of all of the vendor training programs are providedto illustrate variations in time allocations across all eighttopics. We pick a few as examples in discussing content topics.Selected topics to discuss today: Seclusion and Other Crisis De-escalation procedures Restraint procedures Monitoring procedures De-briefing procedures3

2/22/2016“Other” TopicsSeclusion Most training programs don’t includecomponents on seclusion– Only 8 discuss & 4 train Component interpretations vary When included in basic training, noprogram spent more than 5% ofoverall time on seclusion; range 1-5% Many adaptions, extensions, orcombinations of othercomponents When comparing allocations of timethis may explain some variation. Topics included: protectiontechniques, incident prevention,mental health, trauma,relationships, leverage, anddeflection and releasetechniques, etc. Account for unique trainingaspectsSatoriGeneral Information/Definitions1%Alternativesto ManagingAggressionSafety-CareOther35%Dangers &Risks5%Seclusion0%Other35%Debriefing &Follow-up1% MonitoringProcedures1%General Information/Definitions5%Dangers & Risks2%Crisis Deescalation40%RestraintProcedures20%Crisis De-escalationProceduresCrisis Deescalation25% On average, biggest emphasisacross programsSeclusion0%Debriefing &Follow-up5% MonitoringProcedures5%The Mandt SystemDebriefing & Follow-up7%MonitoringProcedures7% 2/3 of the programs spend themost time on crisis de-escalation– Recognize signs of agitation– Identify and manage antecedents– Assess contributing factorsRestraintProcedures20%Seclusion1%General Information/Definitions7%Dangers &Risks8%SeclusionManagementDebriefing & 0%RestraintProcedures12%Crisis Deescalation58%RestraintProcedures20%Dangers &Risks15%Crisis Deescalation20%4