Preventing and Responding to Crisis Situations

About the Course

• Behavioral crises are disruptive and dangerous. This course helps learners identify situations that could result in a crisis and provides preventative measures.

• The course is designed for registered behavior technicians (RBTs) preparing for the RBT exam.

• Focus areas include:

  • Identifying behaviors and circumstances that can lead to crises.

  • Understanding the crisis escalation cycle.

  • Interventions aimed at preventing further escalation.

Understanding Crises

Definition of a Crisis

• A crisis is a time of trouble or danger, specifically a behavioral crisis when a person's actions become dangerous and out of control.

Examples of Crisis Behaviors

• Crisis behaviors can include:

  • Throwing or breaking objects

  • Running away

  • Verbal aggression and threats

  • Physical aggression (hitting, biting, kicking)

  • Self-injurious behaviors (e.g. head banging)

• Impact of behavioral crises can be severe on families and individuals.

The Impact of Crises

Life Limiting Effects

• Frequent crises limit choices and restrict the ability to live independently.

Financial Costs

• Crises are expensive in terms of staff time and safety measures.

• Prevention is ideal, as many individuals require interventions that cannot always eliminate crises.

Crisis Context Within Disabilities

• Individuals with autism or developmental disabilities are at a higher risk for mental health conditions and behavioral crises.

• Many caregivers only respond reactively to crisis behaviors without addressing underlying triggers.

Understanding Aggression and Self-Injury

Aggression

• Defined as behaviors that can cause harm, which can be operationally defined for clarity:

  • Topography of Behavior: Describes the physical actions involved in aggression.

  • Intensity: Measures how severe the aggressive behaviors are.

  • Environmental variables: Contextual factors that lead to aggressive acts.

Self-Injurious Behaviors

• These are intentional injuries inflicted on oneself, with various forms such as headbanging and skin picking.

• Common among those with genetic syndromes or autism, self-injurious behaviors may not always be crisis-inducing, but can be dangerous.

Elopement

• Elopement refers to leaving a designated area without permission, often resulting in unsafe situations.

• Preventative strategies may include installing locks and alarms to ensure safety.

The Crisis Escalation Cycle

Phases of Crisis

1. Calm: Cooperative behavior and compliance.

2. Triggers: Events causing anxiety or agitation.

3. Agitation: Display of unfocused and anxious behavior.

4. Acceleration: Behavior becomes more threatening and less compliant.

5. Peak: Most dangerous stage with intense and possibly harmful actions.

6. De-escalation: Withdrawal from the situation and confusion.

7. Recovery: Quietness and attempts to make amends.

Effective Intervention Strategies

Prevention Strategies

• Optimal interventions aim to prevent crises by maintaining calm and structured environments:

  • Use reinforcers and deliver clear instructions.

  • Acknowledge moments of success and provide breaks when needed.

• Be aware of clients’ signals of distress to prevent escalation.

Crisis Response

• Strategies vary across the stages:

  • During Calm, provide consistent reinforcers.

  • During Triggers, minimize tasks and simplify directives.

  • For Agitation, allow cooling off time and minimize stressors.

  • In the Peak, prioritize safety and follow crisis protocols without escalating further.

Behavior Reduction Plans

• Behavior reduction plans are crucial for managing crises:

  • Incorporate preventive strategies to limit escalations.

  • Focus on teaching replacement behaviors to address the functions of problematic behaviors.

• Important components include:

  • Operational definitions of problem behavior.

  • Strategies for teaching replacement behaviors.

  • Environmental modifications to prevent triggers.

Ethical Considerations for RBTs

• Always prioritize the client's best interests. RBTs must adhere strictly to ethics in crisis situations:

  • Follow intervention plans as trained and document all actions accurately.

  • Maintain professionalism and avoid personal biases influencing behavior.

• Continuous communication with supervisors ensures consistency and safety in crisis management.

Documentation and Data Collection

• RBTs must provide precise descriptions of behaviors during crises:

  • Use measurable and observable terms in documentation.

  • Collect data on frequency and duration to monitor interventions effectively.

  • Incident reports are vital for understanding crisis context and monitoring behavioral plans.