Tip of the Week: How to Implement a Successful Behavioral Intervention

Creating a successful behavior intervention is more challenging than it first appears. Below, I’ve listed four essential parts for changing maladaptive behaviors and increasing desired behaviors. Most of the time, when a behavior intervention is not working, one or more of these steps has been neglected.

1.  Find a BCBA or ABA provider who can guide you through the process. Getting help from someone with experience in addressing challenging behaviors is an essential first step. They should be a wealth of information about each of the following steps, provide check-ins and troubleshooting during the intervention process, and maintain data on the behavior to insure the intervention is working.

2.  Identify the function of the behavior. There are four reasons that any of us behave: attention, escape/avoidance, access to a tangible (such as chips or a toy train), and automatic reinforcement (meaning physical sensations that are not related to social interactions, including sound, taste, touch, or a response to movement). A BCBA can be especially useful in helping to identify the function of the behavior. They may utilize an ABC chart to determine the function, which means they observe the behavior and note it’s antecedent, what the behavior looks like, and the immediate consequence. If the ABC chart is not helpful, they may perform a more formal Functional Analysis. Before any intervention is put in place, all parties interacting with the child should understand the function (or reason) for the problematic behavior.

3.  Provide a replacement behavior. As a part of the intervention, a replacement behavior should be provided. A BCBA or ABA provider should be able to help you find appropriate replacement behaviors for the problematic behavior. For example, with one student who was chewing his shirt, we introduced a replacement behavior of chewing gum. With another student who was throwing his iPad, we used tape to put an “X” on his desk and taught him to place it on the “X.” The idea is to provide an appropriate behavior that is incompatible with the problematic behavior. But that’s not always possible. For example, one of my former students was banging her head on the table during instruction. We taught her to request a break by touching a picture of a stop sign. Realistically, she was able to bang her head while simultaneously touching the stop sign, but once she learned that she got to escape the activity by touching the stop sign, she stopped banging her head in order to escape. It’s important to note that using the stop sign wouldn’t work for all head-banging behavior, but we had identified the function of the behavior and were able to introduce a replacement behavior that served the same function while meeting the skill level and needs of that individual student.

4.  Provide reinforcement for appropriate behavior. A specific plan for providing reinforcement for use of a replacement behavior and any other desired behaviors is essential. The reinforcement for the appropriate replacement behavior should serve the same function as the problematic behavior. This can sometimes be difficult to achieve, but without this aspect of intervention, you may see slow success, or no success at all.

Again, creating a multi-pronged intervention can be a challenge. It’s important to seek out help, and to take a look at research related to the problem behavior you are trying to address. It is possible to create a strong intervention that has a huge impact on your learner, but it must include the aspects listed above to have the highest potential for success.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Pick of the Week: NEW! Caterpillar Token Board – Reinforce and monitor behavioral success

Reinforce and monitor behavioral success with our brand new Caterpillar Token Board, a versatile chart that’s perfect for focusing on a specific task, behavior, or goal. This week, you can save 15%* on your Caterpillar Token Board by entering or mentioning promo code CATERP1 online or over the phone during check-out.

With a cute, furry friend, kids will be motivated to work and stay on task both at home and in school. Use the Caterpillar Token Board for a short-term goal, such as helping your child sit still at the dinner table, or getting their homework done without complaining, as well as tracking long-term goals. This token board serves as a portable reward system to encourage positive behavior and reduce anxiety. The Caterpillar Token Board comes with 8 reusable reward stars, a magnetic strip on the back for easy display, and a Suggestion Guide. Measures approximately 9 x 5 inches.

Don’t forget to take 15% off* your order of the new Caterpillar Token Board by applying CATERP1 at check-out!

*Offer is valid until 11:59pm EDT on August 19, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Tip of the Week: Minimize Tantrums with High and Low-Quality Attention

Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn’t have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

  • When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn’t allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
  • Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents.
  • The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn’t getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

Simplifying the Science: Are You Giving Your Student Enough Freedom?

One of my favorite research papers was published in the Journal of Applied Behavior Analysis in 1990 by Diane J. Bannerman, Jan B. Sheldon, James A. Sherman, and Alan E. Harchik. The title is Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap. It’s an in-depth look at the level of control practitioners can exert over the individuals they serve, and the implications of that control.

It’s important to consider the ethical implications of requiring the individuals we work with to complete specified exercises at scheduled times, eat a healthy diet for all meals, and limit TV. I have seen situations in which the practitioner is holding the individual with developmental disabilities to a higher standard than they hold themselves! Most of you reading this can probably quickly rattle off the name of the last TV show you “binge-watched” or the delicious ice cream you enjoyed too much of.

So how do we teach making appropriate choices to individuals with developmental disabilities without denying the personal freedoms we all value?

One quote from the paper states, “Not only do people strive for freedom in a broad sense they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking time off from work, or taking a nap before dinner.” In an effort to teach our learners independent skills, we often neglect to teach meaningful decision-making that reflects the types of decisions neurotypical adults make every day. Since the paper was originally published, there has been more work done on promoting decision-making skills for learners with developmental disabilities, but the issues described in the paper are still relevant today.

Here are a few key considerations described:

  • We need to consider client preference when creating daily schedules, goals, and access to preferred activities.
  • A client’s refusal to participate in an activity may not be a failure to teach appropriately but an expression of preference.
  • It is important for practitioners to teach choice-making. The paper states, “Many people require teaching to help them discover their own preferences and learn to make responsible choices.” We should consider this as an essential step towards promoting independence in our clients.
  • Inflexible schedules for clients can sometimes be obstacles to opportunities for choice-making.

The paper goes on to cite multiple research articles and laws for both sides of the argument about the right to choice for those with developmental disabilities. You can read the full text here.  Overall, I consider this article to be essential reading for anyone working with clients with disabilities. It provides a lot of information to support its final conclusion that “all people have the right to eat too many doughnuts and take a nap” and we have the responsibility to teach clients how to exercise such freedoms.

WRITTEN BY SAM BLANCO, msed, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Happy Fourth of July!

Happy 4th of July!

The Fourth of July is a time of celebration for families and friends to enjoy the summer with barbecues, fireworks, and patriotic music. We hope that you will be enjoying the long weekend this year with your loved ones, whether you will be staying at home or going away.

The displays of fireworks are beautiful and inspiring. But we know that these displays do not always bring smiles and wonder to children with autism. Here are a few helpful tips we found by ABPathfinder on making your Fourth of July evening more enjoyable for you and your children:

Prepare your child. If they’re old enough to understand, tell them about the fireworks. Let them understand what will happen and emphasize that it is a safe, fun way to see some beautiful displays.

Let them in on the planning. Let the child take part in the planning. Have a picnic, determine what you’ll bring, where you’ll go. Try to provide a set time for each activity, including bringing a timer. If the child is enjoying the display, you can always turn the timer off. If the child is not enjoying the display, you can help them refocus by telling them “Look. Just 3 more minutes on the timer!”

Show them videos of displays. Help the child prepare for what they’ll see by watching videos of past firework celebrations. There are some great sources on YouTube, and it will allow the child to see the beauty of the fireworks while still in their controlled setting.

Fingerpaint some fireworks. Let the child explore the beauty of the fireworks by helping them fingerpaint their own display. Use black construction paper for the night sky and colorful paint for the exploding colors!

Provide ear plugs. Obviously, if your child has auditory sensitivity, you’ve already got this covered. But the report from some of today’s fireworks can be overwhelming. Be prepared up front for it.

View displays from a distance. There’s no reason you have to be right under the displays. Most fireworks displays are better viewed from a distance. Find out what displays are occurring in your town, then scope out some parks or parking lots where you can get a good view of the event.

Provide comfort items. Taking along a favorite blanket or teddy bear can be just the thing the child needs to keep calm. Simply holding it can provide the child with comfort and control over their environment.

Let them explore child-safe fireworks. There are a number of child-safe fireworks available that can give your child an opportunity to participate in the fun. Champagne poppers and snaps are a good way for your child to join in. Be careful with sparklers and smoke bombs, in case your child has an urge to grab the flames.

Join another special needs peer. Joining with another special needs family can also be helpful. Not only does it give your child someone to play with, but it also provides your child with a peer that can model appropriate behavior for the celebration.

Have fun. Last but not least, be sure to have fun. Showing you child that you’re not worried can be the first indicator on how they should react. Hopefully, they’ll join you in the fun!

The Fourth of July can be one of the most challenging holidays for families with Autism, but we hope that these tips can make it a fun, safe event for the whole family.

Simplifying the Science: Using Evidenced-Based Practices to Increase Food Variety for Children with Autism

An essential part of ABA is providing evidence-based treatment. Research is consistently being done all around the world to determine best practices for working with learners with autism, as well as addressing many issues outside of the realm of special education. This week, we’re pleased to introduce the first in a new month series: Simplifying the Science. In this feature, BCBA Sam Blanco will highlight one paper from the world of research to help provide you with a deeper resource base. She’ll delve into the study and offer some strategies on how the findings apply to your programming needs. Our hope is that these monthly tips will shed a different light for you on the importance of looking to research for guidance.

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When faced with feeding issues, many parents or caregivers may not consider seeking out help from a BCBA or behavior analyst. There is a tendency to associate ABA with sitting at a table and completing discrete trials, but this is only one tool in a behavior analyst’s extensive toolkit. Whether you are providing intervention for feeding issues or seeking more information, it is essential to look to scientific research for help.

There are several studies available about feeding issues, and many of these studies are specific to feeding issues in individuals with autism. One such study was published in 2010 in the Journal of Applied Behavior Analysis (JABA) by Hildur Valdimarsdóttir, Lilja Ýr Halldórsdóttir, and Zuilma Gabriela SigurÐardóttir. “Increasing the Variety of Foods Consumed by a Picky Eater: Generalization of Effects Across Caregivers and Settings” provides one detailed case in which a five-year-old boy with autism refused to eat anything beyond meatballs, fishballs, fruits, and cereal. While his school had had some success with getting him to eat a few new items, the boy’s parents were unable to reproduce the same results at home.

The intervention the researchers used involved multiple steps that would require the assistance of a BCBA or skilled behavior analyst if you wanted to replicate it at home. In order to increase the number of foods this boy ate, the intervention included several behavioral techniques such as escape extinction (not allowing the child to escape mealtime upon refusing to eat or engaging in inappropriate behavior), stimulus fading (setting goals of increasing difficulty), and a schedule of reinforcement (frequency of reinforcement for appropriate behavior) that was systematically thinned as the child experienced success. By the end of the intervention, the boy was consuming 39 new, “non-preferred” foods, including 14 vegetables.

You can read the research study here, which I recommend you share with your child’s ABA provider. I also suggest taking a peek at the references listed at the end for insight into other resources. This particular study is of a five-year-old boy with autism, but you may find studies that are more relevant for your particular child.

In the end, when you’re feeling at a loss for strategies on improving your child’s eating, there is a lot of research out there. It takes time to go through it and set up a similar system for your own child, but the end result can have a huge impact on your child’s health as well as the stress-level in your home during mealtimes. It is definitely worth the effort to attain more information.

Written by Sam Blanco, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Tip of the Week: 5 Ways to Structure the Summer for Children with Autism

As the school year comes to a close, it can be quite challenging to figure out how to fill all those summer hours for any child. But if your child has autism, the challenge to provide structure can prove especially difficult. Below are a few tips to assist you in that endeavor.

Create and communicate a new routine. Introducing a new routine can be valuable in easing the transition from full days at school to full days at home. You can set the new routine to be as flexible as necessary to meet the needs of the entire family. It may start very similarly to the school day routine: getting up, eating breakfast, brushing teeth, etc. You may then include specific times of the day for outdoor play, eating lunch, going with a babysitter, or playing on the computer. Think about the activities and toys that your learner enjoys the most and provide access to them as part of the routine. Providing visual cues such as activity schedules or to-do lists can also be beneficial.

Provide social opportunities whenever possible.  In the summer months, it’s quite possible that your learner will have much less interaction with peers. You can ask the school if there are any students who might be a good play date match for your learner. You can also look into day camps, summer sports activities, or board game nights. Think about what is highly motivating for your learner and consider possibilities for related activities that could involve peer interaction.

Look at potential camps.  There are many camps available for learners with special needs. If you’re unsure about camps in your area, ask the professionals who work with your child if they are aware of camps. You can also click here to see camps for children with autism.

Provide a summer calendar.  This calendar can be created based on your learner’s current skill level. For example, with some learners, you may just have pictures showing different activities (such as a picture of a nearby water park you’re visiting in July or a picture of your learner’s grandparents if they’re visiting one weekend). With other learners, you can have a written calendar, or even have them help create the summer calendar. Each day, the learner can refer to it and anticipate what activities and events are coming up.

Set one or two goals.  Summer may prove to be the perfect time to set goals around daily living skills that can be practiced without the rush of trying to meet the school bus. Chores such as making the bed or packing a school lunch can be taught with the goal of promoting independence and continuing those skills once the new school year begins.

Remember to consider what works best for your entire family as you plan for the summer. The goal is to create opportunities for a more relaxing home environment for everybody.

Tips for Traveling with Kids with Autism

Taking any long trip when you have a child with autism can be daunting, especially when it involves long periods of time in the car or on an airplane. Below are a few tips for reducing stress during travel time.

  • Create a visual or textual schedule for your child.  Because trips don’t always go as planned (e.g. planes are delayed, you get caught in traffic), it’s probably not a good idea to list specific times that activities will be occurring. But it is helpful to show the order in which they will be happening.
  • Prepare your child for potential problems.  If possible, talk about coping methods ahead of time and practice them if possible. What can you do if you’re stuck in traffic that isn’t moving? What are your choices if we experience turbulence on the plane?
  • Provide information for your child.  Show photos, books, maps, etc. of the locations you’ll be traveling to. You can also read books or show photos of activities you’ll be participating in, such as swimming or skiing.
  • If possible, pack more than one activity bag.  Bags filled with a few favorite activites or small toys can be useful for keeping kids entertained on trips. For long trips, your child may get bored with items in an activity bag. It’s useful to keep a second one stashed in a suitcase or other bag if you’ll be on a very long flight or car ride. It can also be useful to have a separate activity bag for the return trip if you know your child may lose interest in the first one.
  • Provide options when possible.  Access to choices can go a long way in keeping kids calm. Choices can include what videos to watch, snacks to eat, etc.
  • Check in advance with guest services at hotels, resorts, or theme parks.  Ask what modifications and accessibility options they may offer. Many places offer special accommodations and are open to any unique requests you may have.
  • Prepare in advance for any sensory concerns.  Bring noise-cancelling headphones, ear plugs, fidgets, etc. to have available, as needed.

Remember that long trips are difficult for all children, and many of the tips listed above are beneficial for siblings who do not have special needs.

Guest Article: “Wandering and Autism” by Sarah Kupferschmidt, MA, BCBA

There are compelling statistics today that highlight the need to address the issue of our children wandering and going missing.  The safety of chidren with autism is an enormous concern for parents and caregivers alike.  Last month, we shared BCBA Sam Blanco’s interview with Gary Weitzen on safety, wandering, and emergency planning for individuals on the spectrum.  This week, we’re thrilled to bring you a guest article by Sarah Kupferschmidt, MA, BCBA. Sarah has written a wonderfully informative article on how to use the Behavior Skills Training framework to teach your child help-seeking behavior in cases of wandering.
Wandering and Autism
by Sarah Kupferschmidt, MA, BCBA

We seem to be hearing about more and more cases of children with autism wandering and going missing in the media.  In some of these cases the children were reunited safely with their families, but in many unfortunate instances, tragedy ensued.  There is evidence to suggest that this may be more common than most people realize.   The Interactive Autism Network (IAN) and the Kennedy Krieger Institute published a study in 2012, in the Journal of Pediatricson this very topic.  According to the study,  49% of the parents that were interviewed reported that their child with autism had wandered or bolted.  Moreover, more than half of those children that did wander actually went missing.  Compelling numbers aside, what I found even more important about the results of this study was that for obvious reasons parents reported that they were experiencing high levels of stress related to the prospect of their child wandering, but, they were also feeling helpless to a certain extent because they felt that they did not know what they could do about the wandering.

The good news in all of this is that there is hope for those families.  There are ways that we may be able to help prevent children with autism from going missing in the event that they do wander. Behavioral Skills Training (BST), which is a framework based on Applied Behavior Analysis, has been shown to be effective in teaching a variety of different skills to individuals with and/or without a disability.  Specifically, it has been shown to be effective in teaching help-seeking behavior in children with autism (Bergstrom, R., Najdowski, A.C., Tarbox, J., 2012).   This framework involves breaking a complex skill like “seeking help when lost” into its component parts and teaching the child to engage in those behaviors when relevant. For example,   in the article mentioned above, children with autism were taught what to do if they were lost in a store. The help-seeking behavior was broken down into the following steps:
  1. Shout out for the person you are with (e.g., “Mom” or “Dad”)
  2. Look for and walk over to store employee
  3. Tell the employee, “I’m lost”
These steps were taught using the BST framework which includes the following critical elements:
  1. Instructions: Explaining to the child what they should do
  2. Modeling:  Showing the child what they should do
  3. Rehearsal: Practicing with the child
  4. Feedback: Providing feedback to the child on how they did

Each of these steps are fairly self-explanatory.  The instructions step is simply telling the child in words what they should do.  Perhaps you could include some visuals when you are reviewing the steps of what they should do when they get lost.  The next step is showing them how it should be done.  I typically use video models but it is possible to demonstrate it live if you don’t have a recording device.  The next steps are critical in the development of this new skill.  Set up a safe situation with the child where you can go out in the community and practice the three steps.  You could bring the visuals along with you if your child needed that little bit of extra help.  If your child did all three steps correctly it is important to praise them immediately and to let them know what they did well.  If they missed one or more of the steps let them know what they did well and remind them of what they need to do differently next time.  For example, you might say “nice job shouting out for mom or dad, next time, don’t forget to tell the cashier you are lost”.  These steps would be practiced until your child was able to do it fluently.

While the BST framework has evidence to support its use, it is important to remember that every child is unique and has different strengths and weaknesses.  In my experience, the children that would do well in this type of program have certain pre-requisite skills.  Ideally, they would already be able to follow simple instructions, have the ability to imitate, and the ability to identify strangers and familiar people.  While children with autism may be at higher risk for wandering, there are things that we can teach parents/teachers to do to help reduce the risk for compromised safety and/or harm that are grounded in ABA.  If you are worried about your child’s risk for wandering, then I would recommend you contact a local Board Certified Behavior Analyst (BCBA) that can assist you in determining if a program such as the one described above would be suitable for you and your child.

About the Author

Sarah Kupferschmidt is a Board Certified Behavior Analyst (BCBA) who has worked with hundreds of children with autism and their families across Ontario. She has had the privilege of supervising ABA programs and training clinical staff in those programs.  Currently Sarah offers parent coaching and workshops to teach parents but also educators on the most effective ways to teach children using the principles of ABA.  She is also a part-time faculty member at Mohawk College in the Autism Behavioral Science program, in the social sciences program at McMaster University, and an Adjunct Professor at Sage Graduate School.  Sarah is CEO and co-Founder of Special Appucations Inc., which is a company that creates educational products that help maximize the learning potential for children with autism because they are designed using the principles of ABA.  Sarah has appeared as a guest on CP24, CHCH news, Hamilton Life and the Scott Thompson radio show as an authority on autism.

On the Need for Crisis Intervention Training: A Guest Article by Bobby Newman, PhD, BCBA

Last week, we discussed a comprehensive checklist for parents in placing their children in the right school environment. Service providers in special education programs play a vital role in students’ daily lives at school and are expected to understand certain protocols when behavioral difficulties arise. We couldn’t think of a more appropriate article than that of Bobby Newman, PhD, BCBA to shed light on this need for crisis intervention training in order to ensure the best learning environment for students.

On the Need for Crisis Intervention Training
by Bobby Newman, PhD, BCBA-D

It was one of those moments in life that seemed scripted. A colleague and I were being given a tour of a public school, a prospective placement for a student of my colleagues. The student in question had a history of aggressive behavior towards staff and bolting from the classroom towards the street. How such physical crises were going to be addressed was thus a major concern of mine. I asked the tour guide, the principal of the school, how such matters were handled and whether staff were formally trained in any crisis intervention philosophy and techniques. She informed me that they were not, but that there were “informal things that staff had taught one another.”

As if on cue, at that very moment a student came sprinting past us, with a staff member in pursuit. The staff member reached out and grabbed the sprinting student by the back of the collar, effectively stopping him by choking him with his shirt. My usual flimsy professionalism couldn’t survive this seemingly scripted moment, not to mention the loud choking noise, and I asked, “Is that one of the things staff have shown each other?”

Further questioning revealed that when students had serious outbursts, 911 was called. My mind went to Chicago where in 2012, police were called to the home of a child with autism during a behavioral crisis with tragic results. Very little else needed to be known to determine that the student’s parents would never agree to this school placement, and I couldn’t say that I blamed them.

Crisis intervention is one of those very sensitive issues in the field of developmental disabilities. There are people who want to ban the physical portion of crisis intervention training, either due to liability concerns or perhaps due to abuse concerns. I will agree that the potential for abuse exists if staff are allowed to put their hands on students/consumers. I will argue, however, that the possibility of abuse is much greater if we do not train and if we do not have formalized systems in place, or at least for mass exclusions of people from less restrictive settings due to the inability to maintain them there safely in such environments. Let me develop my argument:

  • Due to the nature of some developmental disabilities (e.g., difficulty in developing communication skills or sensory defensiveness), behavior that is not typical of same age peers can occur.
  • This behavior may sometimes take forms that can be dangerous to the person engaging in them (e.g., running into hazards or self-injurious behavior) or dangerous to those around them (e.g., aggression towards others or environmentally dangerous behavior such as object destruction).
  • At such times, we may be facing a “crisis,” when injury to self or others is imminent and probable and “crisis intervention” (verbal and possibly eventually physical) may be necessary to keep everyone physically safe. The guiding idea behind crisis intervention is to keep everyone safe. This includes the person engaging in the behavior, peers, and staff.

I wish to emphasize that a crisis is NOT an everyday occurrence. A crisis should not be routine, it should arise as a relatively infrequent occurrence that needs to be dealt with via crisis intervention protocols at that moment. I wish to distinguish crisis intervention from “behavior treatment plans,” which must be in place for behavior we often see from the individual in question. If you’re doing crisis intervention frequently, then this a matter for discussion of alterations to behavior management plans or resource allocation/availability. Crisis intervention is not a consequence meant to change the probability of behavior via a punishment contingency, and any physical interventions where one must put their hands on a student should be a last resort.

Even with this caveat in place, some would make the argument that crisis intervention training should not be provided, that it gives staff permission to be overly physical with students. While I will grant such a possibility exists, as I always tell my ethics classes, the argument about what you are not willing to do is not enough. One must be prepare to answer, “and then what?” Suppose staff were not trained. When a crisis occurred, they would be left with “doing the best they can” or otherwise improvising in the moment. Given this set of circumstances, staff would respond in their own ways to crises and injuries and abuse become probable, not just possible, as staff panic or lash out with whatever self-defense techniques they can think of or act in keeping with a faulty knowledge of body mechanics or physical hazards (witness the “choke stop” described above).

To summarize, the implications of the “do not train” argument are:

  • I know there will be crises due to the behavioral history and repertoires of the students in the program
  • I’m concerned about liability or staff becoming heavy-handed, so I’d rather not train people to safely deal with the crisis, I’d rather trust to their natural impulses or an “unofficial” policy/procedure that has grown up within the program.

What must be appreciated is that good crisis intervention training systems are based on sound behavioral principles, providing the supports the individual needs, rather than on controlling the behavior of the individual physically. The vast majority of crisis intervention training is based upon preventative measures that aim to teach the individual self-control and alternate behaviors, and to create settings that are not likely to create crises in the first place, rather than sheer physical intervention. Should a physical intervention be needed, safety is a foremost concern. Techniques are performed in such a way as to attempt to minimize injury. No technique, for example, is meant to cause pain, is meant to scare, uses impact for behavior control, or moves a limb beyond its normal range of motion.

To sum up the basic argument:

  • We know behavioral crises that can lead to serious injury may occur
  • If we do not train people, we are trusting the staff member’s individual reactions or “unofficial policy’ that cannot be traced or analyzed as it is unofficial.
  • If we do train people, however, we can create standards of conduct and accountability and we can aim at program design that avoids the need for physical intervention.

This seems to me to be our best bet for creating programs that are humane, not emotionally reactive, and encourage the development of effective problem solving strategies that rely on behavioral interventions, rather than relying on physical intervention by staff to keep everyone safe. This seems to me to be most consistent with ethical practice of Applied Behavior Analysis.

About the Author

Bobby Newman is a doctoral level Board Certified Behavior Analyst and Licensed Psychologist. Bobby is the first author on twelve books and has published over two dozen articles in professional journals, as well as numerous popular magazine articles and has hosted two series of radio call-in shows. Bobby is the Past-President of the Association for Science in Autism Treatment and the New York State Association for Behavior Analysis. A popular speaker, Bobby also provides direct treatment, staff training and consultation around the world, and has been honored for this work by several parents and professional groups. Bobby is a SCIP-R (Strategies for Crisis Intervention and Prevention, Revised) instructor and has published a manual to accompany crisis intervention training (Gentle Redirection of Aggressive and Destructive Behavior). In addition to his other clinical work, Bobby teaches non-violent crisis intervention philosophy and techniques for schools, agencies and families.