A Guide To Crisis Intervention Training Programs - Nebraska
-intervention-training-programsA Consumer’sGuide toCrisisInterventionTrainingProgramsElisabeth KaneReece L. Peterson,University of Nebraska-LincolnJoseph B. Ryan,Clemson UniversityMichael A. Couvillon,Drake UniversityBrenda ScheuermannTexas State UniversityJames HoganUniversity of WashingtonIllustration by Ward ZwartGoal of this presentation To be able to compare and contrastavailable crisis training programs inorder to better enableadministrators and educators toselect a crisis intervention programthat best meets their specificneeds.Slide & resources s-intervention-training-programs1
2/18/2016Definitions3 Types of TimeoutOnly one of these isSeclusion3 Types of RestraintProceduresMechanicalRestraintUse of any device (tape, tiedowns) to limit anindividual’s bodymovement.Limited use in schools;with a few exceptions, notpermitted.ChemicalRestraintUse of medication tocontrol behavior or restricta patient’s freedom ofmovementNot used by schools;however many studentsmay be on medication inschools.PhysicalRestraintUse of one or more peopleusing their bodies torestrict another’smovement.Can be used given certaincriteria are met.Inclusion Timeoutinside the classroomExclusion TimeoutOutside theclassroomSeclusionInvoluntary confinement ofa student alone in a room orarea from which the studentis physically prevented fromleaving3Types of Restraint Procedures Supine restraints Prone restraints Basket hold restraints Physical escorts2
2/18/2016U.S.DepartmentofEducation,Office forCivil Rights,DataCollection,2011-12. Over 70,000 students subjected tophysical restraint Over 37,000 students subject toseclusion. Nevada (96%), Florida (95%), andWyoming (93%) reported the highestpercentages of physically restrainedstudents with disabilities. Nearly 4,000 IDEA students subject tomechanical restraintOf studentssubjected torestraint, 75%were studentswith adisability.Office of Civil Rights2014 ReportU.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-123
2/18/2016Of studentssubjected toseclusion58% werestudentswith adisabilityOffice of CivilRights 2014ReportU.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-12.4
2/18/2016STRONG ADVOCACY CONTINUES!H.R. 927Some states - policy activity.The Keeping All StudentsSafe ActMassachusetts, Virginia & Washington , Nebraska – recent examplesThe bill in the House hasbeen re-introduced; noaction and none likely.How Safe Is The SchoolhouseJESSICA BUTLER. UPDATED JULY 25, 2015 An updated guide to staterestraint and seclusion laws, regulations, rules and policies in effect as of July25, 2015; SSA - Every Student Succeeds Act‘‘(1) DESCRIPTIONS .—Each State plan shall describe— .‘‘(C) how the State educational agencywill support local educational agencies receiving assistance under this part to improve schoolconditions for student learning, including through reducing— ‘‘(i) incidences of bullying andharassment; ‘‘(ii) the overuse of discipline practices that remove students from the classroom; and‘‘(iii) the use of aversive behavioral interventions that compromise student health and safety;“ p.41-42 of pdfTwo previous studies of the content ofcrisis intervention programs Farrell and Cubit (2005) covered contentof training for aggression managementtraining programs intended for nursesand others in mental health settings. Farrell and Cubit compared andcontrasted how 28 programs traindiverse components, such as, levels ofrisk, communication, physical restraint,seclusion, debriefing, etc. They concluded most programs includedinformation on personal safety for staffand clients, and recommended refreshercourses. However they did not discusspsychological costs. Only 7 trainedrestraint, and only 1 discussed the risksof restraints. Couvillon, Peterson, Ryan,Scheuermann, and Stegall (2010),surveyed similar content topics fortraining delivered to schools. The study found that the average rangebasic training length was 12 to 16hours, but varied greatly, and variedbased on level of training. They also found substantial variation inthe emphasis put on major topics oftraining (e.g., conflict de-escalationversus restraint procedures).5
2/18/2016Purposes the of present study Need for Couvillon et al. (2010) Update in context of:– Policy changes– Increased safety concerns– To also address seclusion– Highlight major similarities and differences– Address lack of consensus for content & focus– Aid consumers on purchasing decisionsThe Present StudyQuestionnaire The Couvillon, et al.questionnaire was obtained,expanded and organized into10 content sections or topics. Questions were refined with amix of both closed and openended responses. When completed it included 99questions Options created for electronic(Qualtrics) or hard copy ortelephone interview completion.Training Vendors Effort to identify all current training vendors providingtraining to schools through Internet searches andnominations. Only those providing training on restraints were included. 32 Initially identified, but 7 were no longer in business Of the remaining 25, 6 declined or did not respond, twodid not complete the questionnaire. Result was data from 17 vendors- 68% of total. Owner or lead trainer was contacted and asked tocomplete the questionnaire. Once completed the data was sent back to the vendorfor verification.6
2/18/201617 Crisis Intervention TrainingProgramsOrganization NameWebsiteCalm Every Storm, Crisis Intervention TrainingCrisis Consultant Group, LLC.crisisconsultantgroup.comManagement of Aggressive Behavior (MOAB)MOAB Training International, Inc.moabtraining.comNonviolent Crisis Intervention ProgramCrisis Prevention Institutecrisisprevention.comOregon Intervention System (OIS)Alternative Service, Inc. - Oregonois.asioregon.orgPMTPMT Associates, Inc.pmtassociates.netPro-ACT Pro-ACT, Inc.proacttraining.comProfessional Crisis ManagementProfessional Crisis Management Associationpcma.comResponseResponse Training Program LLCresponsetrainings.comRight ResponseService Alternatives Training Instituterightresponse.orgSafe and Positive Approaches Devereuxdevereux.orgSafe Crisis ManagementJKM Training Incorporatedjkmtraining.comSafe Prevention Principle and TechniquesJIREH Training and Consulting LLCjirehtraining.comSafety-CareQBS, Inc.qbscompanies.comSatori Alternatives to Managing Aggression (SAMA)Satori Learning Designs, Inc.satorilearning.comThe Mandt SystemThe Mandt System, Inc.mandtsystem.comTherapeutic Aggression Control Techniques (TACT2)SBP Consulting, Inc.tact2.comTherapeutic Crisis Intervention (TCI)Residential Child Care Project, Cornell ent by 8globalcomponents*Respondentswere asked for% of trainingallocated toeach General information anddefinitions Dangers and Risks Crisis De-escalationprocedures Restraint procedures Procedures for monitoring Debriefing and follow up Seclusion Other topic areas* Interpretations may vary based on differing terminology or understandings; use only for gross comparisons7
2/18/2016Allocation of resources across general topicsTraining Program NameCalm Every StormMOABNonviolent CrisisIntervention programOISPMTPro-ACT Professional CrisisManagementResponseRIGHT RESPONSESafe & Positive Approaches Safe Crisis ManagementSafe Prevention Principlesand TechniquesSafety-CareSAMAThe Mandt System TACT2TCITotal BasicGeneralDangersCrisisRestraint Monitoring Debriefing Seclusion Other TotalTraining Information/ & Risks De-escalation Procedures Procedures & Follow-up%%%TimeDefinitions %%%%%%16 hrs6-8 hrs5205155520152051055555510010014 hrs12 hrs8 hrs20 90510010010010014 hrs12 hrs5-14 hrs14 hrs18 00000122529010010010010010016-20 hrs12 hrs16 hrs19 hrs18-20 hrs28-32 age Allocation Across Training ProgramsSeclusion, 2Devriefing &Follow-up, 6MonitoringProcedures, 5RestraintProcedures,21Other, 11GeneralInformation/Definitions, 8Dangers &Risks, 6Crisis Deescalation, 418
2/18/2016Pie charts of all of the vendor training programs are providedto illustrate variations in time allocations across all eighttopics. We pick a few as examples in discussing content topics.Selected topics to discuss today: Seclusion and Other Crisis De-escalation procedures Restraint procedures Monitoring procedures De-briefing proceduresSeclusion“Other” Topics Most training programs don’t includecomponents on seclusion– Only 8 discuss & 4 train Component interpretations vary When included in basic training, noprogram spent more than 5% ofoverall time on seclusion; range 1-5% Many adaptions, extensions, orcombinations of othercomponents When comparing allocations of timethis may explain some variation. Topics included: protectiontechniques, incident prevention,mental health, trauma,relationships, leverage, anddeflection and releasetechniques, etc. Account for unique trainingaspects9
2/18/2016SatoriGeneral Information/Definitions1%Alternativesto ManagingAggressionDangers & Risks2%Seclusion0%Other35%Debriefing &Follow-up1% MonitoringProcedures1%General Information/Definitions5%Safety-CareOther35%Crisis Deescalation40%RestraintProcedures20%Dangers &Risks5%Crisis Deescalation25%Seclusion0%Debriefing &Follow-up5% MonitoringProcedures5%RestraintProcedures20%10
2/18/2016Crisis De-escalationProcedures On average, biggest emphasisacross programs 2/3 of the programs spend themost time on crisis de-escalation– Recognize signs of agitation– Identify and manage antecedents– Assess contributing factorsThe Mandt SystemDebriefing & l Information/Definitions7%Dangers &Risks8%RestraintProcedures12%Crisis Deescalation58%11
2/18/2016SeclusionManagementDebriefing & 0%RestraintProcedures20%Dangers &Risks15%Crisis Deescalation20%Types of Restraint Procedures Due to heightened risk, it takes a certain amount of time to teach physical holds adequately Programs moving towards using “holds” versus “restraint” for political correctness Programs coin terms and have special names for holds, spend time teaching this terminology Some populations may need more focus on restraint Many programs have moved away from prone (face down) or supine (face up) holds12
2/18/2016Training Related to Restraint Procedures The % of overall time allocated to training onholds ranged from 8% to 50% Most programs dedicate between 12% -25%of their time to restraint procedures; themean was 21% The number of different types of holds trainedranged from 2 to 27 Specific Types of holds:– 4 of the 17 programs trained basket holds, 23.5%– 8 of the 17 programs trained prone restraints, 47%– 9 of the 17 programs trained supine holds, 53%Restraint Procedures TaughtTypes ofRestraints (#)PhysicalEscortsBasket HoldRestraintProne FloorRestraintSupine sYesNoYesNoYesNoYesNoNoYesYesYesNoNoYesYesSafe Prevention Principles and Techniques8Safety-CareSAMAThe Mandt SystemTACT2Therapeutic Crisis sYesNoNoNoYes---YesNoNoYesYesTraining Program NameCalm Every StormMOABNonviolent Crisis Intervention programOISPMTPro-ACT Professional Crisis ManagementResponseRIGHT RESPONSESafe & Positive Approaches Safe Crisis Management13
2/18/2016Professional Crisis ManagementDebriefing &Follow-up5%General Information/Definitions10%Dangers &Risks5%RestraintProcedures50%Crisis nviolent Crisis InterventionDebriefing &Follow-up, 10GeneralInformation/Definitions, 20MonitoringProcedures, 5Seclusion, 0Dangers &Risks, 5RestraintProcedures, 25Crisis Deescalation, 3514
2/18/2016Pro-ACTSeclusionDebriefing & 3%Follow-up8%MonitoringProcedures7%Other5%General Information/Definitions5%Dangers &Risks4%RestraintProcedures8%Crisis Deescalation60%Monitoring All teach techniques for monitoring a student’sphysical and emotional state All instruct how to identify signs of physicaldistress. Crucial to actively monitor the breathing rates ofstudents placed in a restraint 14 programs actively teach participants to monitorbreathing rate On average, relatively less time is spent onmonitoring15
2/18/2016SeclusionManagementDebriefing & olTechniques(TACT-2)Debriefing & s &Risks15%Crisis Deescalation20%General Information/Definitions 10%Dangers &Risks2%RestraintProcedures30%Crisis Deescalation50%16
2/18/2016De-Briefing Physical restraintprocedures can result inemotional distress for allinvolved Majority of the programsprograms teachparticipants how todebrief or follow up May include: assessingemotional state, problemsolving, & documentationSafe Prevention Principles & TechniquesDebriefing %Dangers &Risks12%Crisis Deescalation38%17
usion2%Debriefing & Follow-up2%MonitoringProcedures ions15%Dangers & Risks10%Crisis De-escalation25%Certification/lengths of training All certify Certification takes on 18 hours on average for basictraining ; range 12 – 28 Re-certification or annual update; on average 7 hours;range 3 – 20 hours Training of trainer; varied requirements– Related experience– Career in related field– Related degree, etc.18
2/18/2016Conclusions Reminder that these are gross estimates & may be more complicatedthan they appear Training is evolving and will continue to evolve Policy is impacting training General movement away from more extreme holds or ones that havecaused most danger (e.g. use of prone & supine have decreased) Larger programs accommodate/alter their content for differentpopulations/audience/organizations A lot of the training is pretty similar but with different names - Matter ofterminology – coining terms and time is spent learning those words,and also political correctness terminology (now using holds)A Consumers Guide: Identify your purposeIdentify target personnel for trainingIdentify population & setting of clients/students servingIdentify length of time required for certification for that vendorChoose a training program based on the emphases which meetsyour needsWe did not examine or compare costsConsider whether special tailoring is desired (add componentson seclusion, etc.)Consider whether a trainer of trainer model is appropriateConsider whether you need just non-physical training19
2/18/2016Research Collaborators Elisabeth KaneUniversity of Nebraska-Lincolnelisabethjkane@gmail.com Reece L. Peterson, Ph.D.University of Nebraska-Lincolnrpeterson1@unl.edu Joseph M. Ryan, Ph.D.Clemson University Michael Couvillon, Ph.D.Drake University Brenda Scheuermann, Ph.D.Texas State University, San Marcos James HoganUniversity of s-intervention-training-programs39Calm Every StormDebriefing &Follow-up, 5Seclusion, 5Other, 5Dangers & Risks,5MonitoringProcedures, 5RestraintProcedures, 15Crisis Deescalation, 5520
2/18/2016PMTDebriefing &Monitoring Follow-upProcedures ngers &Risks10%RestraintProcedures20%Crisis Deescalation40%Right ResponseGeneral Information/Definitions2%Dangers &Risks2%Other25%Crisis Deescalation31%Debriefing res30%Seclusion0%21
2/18/2016ResponseOtherDebriefing & 12%Follow-up4%General Information/Definitions 4%Dangers & Risks is Deescalation58%Seclusion0%Safe Crisis ManagementDebriefing &Monitoring ral Information/Definitions 5%Dangers & Risks 5%Crisis Deescalation45%22
2/18/2016Safe & Positive ApproachesOther29%Dangers Debriefing sIntervention(TCI)Crisis Deescalation34%RestraintProcedures18%Debriefing & Follow-up10%MonitoringProcedures5%Dangers %RestraintProcedures25%Crisis Deescalation50%23
msTHE END24
2/18/2016 7 17 Crisis Intervention Training Programs Organization Name Website Calm Every Storm, Crisis Intervention Training Crisis Consultant Group, LLC. crisisconsultantgroup.com Management of Aggressive Behavior (MOA B) MOAB Training International, Inc. moabtraining.com Nonviolent Crisis Intervention Program Crisis Prevention Institute crisisprevention.com
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DCPS School Crisis Response Plan Template 12 Roles and Responsibilities During a Crisis 14 Individual Student Crisis Protocol 17 Individual Student Crisis Plan Templates (Two Options) 20 . Each school has a crisis response plan and designated Lead for the school crisis team (SCT). 3. Central office conducts training and provides tools to .
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