|
| Issues and Outcomes in Crisis Management |
| Monday, May 25, 2009 |
| 10:30 AM–11:50 AM |
| North 131 A |
| Area: CSE; Domain: Service Delivery |
| Chair: Merrill Winston (Professional Crisis Management, Inc.) |
| CE Instructor: Mark T. Harvey, Ph.D. |
| Abstract: Crisis management is an important and often controversial aspect of providing treatment services to consumers in a variety of settings. Many state and local governmental bodies, as well as private organizations, are currently considering or re-considering policies that will have far reaching affects on consumers and providers, in a time of heightened sensitivity to safety and dignity issues. The potential for misinformation about true dangers and potential benefits of crisis management and restraint procedures is great and may have serious consequences for the field. Practitioners and administrators alike need realistic information on true risks and benefits to guide policy and practice. This symposium presents information on the need for effective crisis management practices and potential risks and problems associated with them. Various ways these procedures have benefitted consumers and ways that their use has been reduced in two programs as a result of emphasis on prevention and de-escalation strategies will be described and evaluated. |
| |
| Could More Intrusive be Less Restrictive?; The Debate of Physical Management |
| MARTA T. FIOL (Behavior Services of Brevard), Karen R. Wagner (Behavior Services of Brevard, Inc/UCF) |
| Abstract: If popular opinion holds that time spent in the community is the most preferred activity for individuals with DD according to advocacy and parental groups then this research could be utilized as a quality indicator for meaningful day activities. Programs for individuals with significant behavior challenges are typically seen as the most restrictive placement that an individual can attend, as demonstrated in Individual Support Documentation that indicate the goal is to transition individuals into a less restrictive environment. An analysis of the proportion of time an individual spends in restraint versus other meaningful day activities, including access to the community, was conducted for adults diagnosed with various developmental disabilities attending an Intensive Behavioral Adult Day Training Center in Central Florida. Individuals that attend this IB-ADT are unable to attend or have been terminated from other settings due to the frequency, intensity and magnitude of the dangerous and challenging behaviors displayed. These data will show that although individuals are subject to criterion based physical interventions than many individuals in other ADT’s may not be, they are able to access meaningful activities, including access to the community, at unexpectedly higher rates than one would suppose due to the nature of their behaviors. |
| |
| Highlighting Behavior Management to Reduce the Need for Crisis Management |
| JOHN BEETAR (Kennedy Krieger Institute), Aaron Parsons (Kennedy Krieger Institute), Susan Villani (Kennedy Krieger Institute) |
| Abstract: Knowing when and how to use behavior management is crucial in educational settings, particularly those that deal exclusively with special needs students. Children and adolescents with persistent and severe mental and behavioral health disorders presently receive treatment on a daily basis in special educational schools. This phenomena has been due in part to currently managed health care and short hospital stays. In addition, the Individual with Disabilities Educational Act (IDEA) states that all children must have access to an education regardless of their disability. As such, special education schools have become treatment facilities for children and adolescents who struggle on a daily basis with psychiatric disorders. Kennedy Krieger School Programs, a nonpublic special education facility in Baltimore, Maryland, has reduced the use of restraint and seclusion of students with an emphasis on the prevention and de-escalation of crises. Data will be presented and include the number of restraints and locked-door seclusions over a 7-year period. Overall, a transdisciplinary approach that includes intensive staff training, comprehensive behavioral and cognitive assessments, and ongoing monitoring are critical elements in the effective behavioral management of special education students. |
| |
| The Eventual Elimination of all Seclusion and Restraint; The Perfect Plan for the Perfect World |
| MERRILL WINSTON (Professional Crisis Management, Inc.), Neal N. Fleisig (Professional Crisis Management, Inc.) |
| Abstract: This presentation examines some recent language introduced into a Florida Legislative Bill. The paper examines some language of the bill and the implications of this language for practice in behavior analysis. This presentation attempts to correct some of the misconceptions about the use of restraint and attempts to elucidate some of the unseen benefits of restraint that go beyond the simple provision of momentary safety for an individual with disabilities. There will be a behavioral discussion of the meaning of “self-control” and how this class of behaviors can develop through the transfer of stimulus control through a fading procedure in which there is a transfer of control from actual physical holding to the mere presence of the individuals that have been paired with holding. There is also a discussion of pros and cons of various forms of restraint, the implications of not using restraint, and the difference between numerical and clinically meaningful reduction of restraint usage. |
| |
| Recognizing Ineffective, Counterproductive and Dangerous Crisis Management Procedures |
| NEAL N. FLEISIG (Professional Crisis Management, Inc.), Merrill Winston (Professional Crisis Management, Inc.), Laraine Winston (Professional Crisis Management Association, Inc.) |
| Abstract: Organizations delivering behavioral support services for individuals across educational and clinical settings often are required to use planned and reactive intervention strategies that include a variety of non-physical (gestural and verbal) interactions and physical holding. It is critical that these organizations employ these strategies in an effective and safe manner. Crisis intervention strategies may be dangerous when they are trained, designed, and implemented in such a manner that results in direct injury to the individual receiving services. Crisis intervention strategies are ineffective and or counterproductive when non-specific strategies are applied to very specific behaviors requiring a different and sometimes contrasting intervention. When this occurs, targeted crisis behaviors may increase in intensity and duration or may fail to respond at all. This presentation will present the most common ineffective, counterproductive and dangerous crisis intervention errors that educators and human service providers tend to make, and explores some ways to avoid them. |
|
| |