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
Calm: Cooperative behavior and compliance.
Triggers: Events causing anxiety or agitation.
Agitation: Display of unfocused and anxious behavior.
Acceleration: Behavior becomes more threatening and less compliant.
Peak: Most dangerous stage with intense and possibly harmful actions.
De-escalation: Withdrawal from the situation and confusion.
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.