ABCs of Behavioral Problems: Keeping Cool in a Crisis: being prepared for behaviors

Crisis Intervention Training
Behavioral crises involving people with autism are a common concern of professionals and parents. Parents don’t talk about them as much because of stigmas, but professionals rarely hold back. Sometimes the parent is blamed for spoiling the child. If so, I hope the professional has several children of his or her own, never needed to ask a question of a seasoned parent, and never made a parenting mistake with any one of their children. (People in glass houses shouldn’t throw stones!) Parenting is hard. Let’s avoid judgement and get down to work.

Why?
Crisis intervention training is not enough, but it is a necessary first step for parents and professionals: teachers, therapists, aides, and law enforcement. This post is appropriate for communication disorders. (I cannot claim to speak for mental illness.) Let me be clear. Generally, “aggressive” moves by people with communication disorders are a form of communication. Aggressive-Kids

Prevention is best. Many parents of people with autism suffer from the fear and memories of painful incidents of the past. The child’s behavior makes him a pariah, or changes how others treat him and his life choices.

First, however, you have to get everyone out of the current incident safely. The behaviors have to be addressed without judgement. Otherwise, behaviors can escalate and someone may be seriously hurt. Concepts and techniques of Crisis Intervention Training are similar regardless of the age and size of the person. I can tell you, fearing the person you love or need to work with doesn’t help the person at all. You have to be safe, confident, and fearless.

Crisis Intervention Training Should Include
This forum is not appropriate for providing crisis intervention training, but as a diligent and caring professional or family member, you should know what to ask for. The training involves learning and practicing a series of physical maneuvers that protect the responsible adult without harming the person with a disorder. If the people involved are verbal, de-escalation techniques will be covered.

Training should handle such situations as grabbing of clothing and grabbing of hair. This video from http://www.therops.com (a provider of instruction with which I have no relationship and whose training I have not reviewed) covers grabbing a shirt. 

It’s For You, & anyone living or working with people with developmental disabilities
Be prepared. Do not expect to need crisis intervention training. Do not give the training to someone who may abuse it, or abuse others. The person who could have triggered the incident may not know that he or she did, but the person who triggered it should generally step aside so another person can follow through with crisis intervention.

As a parent or professional evaluating the quality of a school, after-school, day, or residential program, check that staff and security personnel have this training. Sadly, crisis intervention training may be rare in the U.S. outside of some school settings. It is, however, perfect as topic for staff training sessions. Staff certification should be renewed every few years in any setting where physically inappropriate behavior may occur.

Here’s an example for sessions held for school transportation staff of Eden Prairie Schools:

The “A” in ABCs, an introduction to behavioral triggers
Antecedents are the “A” in “ABCs” of managing behavior.  Analyzing antecedents of a behavior is important, after the throes of an incident. Understanding these “antecedents” of behavioral problems will be the subject of further posts.

All situations that end in aggression have a kernel – medical or personal – in a concern that was not communicated effectively. These are examples from my personal experience with my son and other children with autism:

  • A middle ear infection causes pain, and the staff doesn’t understand how to help.
  • The child is expecting to see someone (a familiar therapist, a friend, a pet) at a certain time, and the person or pet isn’t there.
  • Lunch is “supposed to be” at exactly noon, and the child cannot tell you when he’s hungry, so 12:05 pm is “late.”
  • One kind of cookie is kept on the edge of the top shelf, and the child can’t see or reach it.
  • A migraine is coming on, and the child is in a public place.
  • When changing planes, the child knows a bowel movement is coming, cannot explain, refuses to leave a terminal restroom, nearly misses the connecting flight, and soils himself in-flight.

As someone who cares for and about people with developmental disabilities, I know we want to fix people. Now. That’s not realistic, but we can help, incrementally, and the people we care about can get better. Communication problems can cause a lifetime of misunderstandings, mistakes, and hurt feelings. As we fix the communication problem, we remove potential sources or future behaviors.

Coming up here: Why’d he do that! Consider “antecedents”

Copyright 2015, Laura Ann Weinberg

Autism Education Isn’t Enough: Developmental Disabilities Last a Lifetime

This is an open letter to the community about the future of people with autism. I’m in New Jersey, but this is national. You thought that your children’s childhood was tough. Our kids’ adulthood will be just as tough because the supports that most us expected for our adult children will be gone. No centers, no residences, no special programs for those in Medicaid.

Medicaid said… “Okay, we’ll insure everyone, but we can’t pay for everything; and why should people with autism (which an epidemic!) get what people disabled by brain injury, chronic illness, stroke survivors, and the mentally ill do not?” Because of that Goodwill and other workshops will be defunded, Camphill and other farms for the disabled will close, people will be given the false choice of living in private homes, or bear responsibility for their own apartment leases. No more than a small fraction of residents in a building can have any disability. Otherwise they lose Medicaid. In time, residential schools for children may close, too.

I was talking with a teacher for the hearing impaired this week. In reality, she was talking, and I listened, and cried. Decades ago, Vermont closed all the residential schools, except for one school for the deaf, and it de-institutionalized adults with developmental disabilities. A few years ago, a pair of men in Vermont with autism who are non-verbal starred in a documentary, Wretches and Jabberers. They were both: (1) living in private houses, and (2) actively taken out by advocates for the disabled to regional policy meetings. One man lived with his adult sister in a country home where he had a simple art studio. The other man, with full facial hair, was shuffled every couple of nights to a different house, and said he is “homeless.” He showed his own small room with TV in a modest house, and his belongings fit into a backpack. He struggled to understand his purpose in life.

The State of New Jersey is taking Vermont’s path, but it isn’t alone. Medicaid at the state and local levels, intends to leave our kids “homeless” as adults. February 26 was the deadline for comments, and it’s a done deal by all states in another month. A cousin in the State of CT reported its rules are restrictive, perhaps not as extreme as NJ’s. The State of PA won’t open new day programs. Providers of residential services in NY are concerned.

There should have been a clarion call 1 1/2 years ago by our national organizations when Medicaid first put out this rule. But national organizations were watching genes and kids. When all children aging out of special education n NJ were advised to enroll in Medicaid (even my son who has Medicare), the community didn’t protest. When the DDD transitioned from DDD case managers to contracted PerformCare, it looked like outsourcing. But it was a prelude to cutting the adult division. When the developmental centers were closed, it still looked like private development might be allowed to proceed if you were wise and well-heeled. Now we see that for a long time, there has been a plan to shaft our kids. We parents won’t abandon our kids, but the next generations will have tough choices: to leave them in the cold, or press families and siblings and our grandchildren into lifelong caregiving. We can and will work to chip away at the margins on Medicaid. Given that this state has refused since Florio’s time to fund obligations such as roads, and our governor is refusing court order to pay the pension settlement, we have to fight for a place in line in Trenton.

Ultimately, our kids with and without disabilities will have to fight to retain any public support in this home-rule, nickel-and-diming culture of no-new-taxes, and pay-your-own-way for every little thing. Every one of our kids deserves self-advocacy training. That’s what we can do for their future now.

Sincerely,
Blogger, MBA, MS candidate,
Proud to be a special needs hockey mom to
my son with autism, age 18, who lost his father in 9-11