1 Module 2b Managing Physically Dangerous and/or Severely Disruptive Behavior Reactive Plans For Students With Autism Spectrum Disorder Prepared By: Claire Greer, Consultant for Autism, Severe & Multiple Disabilities

2 “When dealing with violent or potentially violent events there is nothing that can be done to make the situation pleasant” “Intervention” by Sprick

3 The goal of the intervention, once you have a violent or potentially violent event, is to help staff respond quickly, safely and professionally.

4 Planning for Safety? 1.Create action plan which includes reactive responses. 2.Develop record keeping and reporting procedures. 3.Determine if other agencies should be or are involved. 4.Implement reactive plans immediately to ensure safety.

5 Step 1 Create action plan which includes reactive responses.

6 Adult Response

7 Consider the Following Actions 1.Use room clear –Helps ensure everyone’s safety. –Physical restraint more likely to have negative consequences Identify where class will go What the class will do during this time Who will supervise

8 Consider the Following Actions 2.Use of isolation, seclusion or time- out If student can be safely escorted to designated area

9 Isolation Definition “Isolation: a behavior management technique in which a student is placed alone in an enclosed space from which the student is not prevented from leaving.” N.C. Gen. Stat. § 115C-391.1(b)(5)(House Bill 1032).

10 Isolation

11 Isolation 1.the isolation space is appropriately lighted, ventilated and heated or cooled; 2.the duration of the isolation is reasonable in light of the purpose for the isolation; 3.the student is reasonably monitored; and 4.the isolation space is free from objects that could unreasonably expose the student or others to harm. N.C. Gen. Stat. § 115C-391.1(f)(House Bill 1032).

12 Seclusion Definition “Seclusion: the confinement of a student alone in an enclosed space from which the student is (a) physically prevented from leaving or (b) incapable of leaving due to physical or intellectual capacity.” N.C. Gen. Stat. § 115C-391.1(b)(10)(House Bill 1032).

13 Seclusion may be used in the following circumstances: 1.as reasonably needed to respond to a person in control of a weapon or other dangerous object; 2.as reasonably needed to maintain order or prevent or break up a fight; 3.as reasonably needed for self-defense; 4.as reasonably needed when a student’s behavior poses a threat of imminent physical harm to self or others or imminent substantial destruction of school or another person’s property;

14 Seclusion 5. When used as specified in the student’s IEP, Section 504, Behavior Intervention Plan; and –student is constantly monitored by an adult in close proximity who is able to see and hear the student at all times; –the student is released from seclusion upon cessation of the behaviors that led to the seclusion or as otherwise specified in IEP, 504, or behavior intervention plan; –the confining space has been approved for such use by the local education agency; –the space is appropriately lighted, ventilated and heated or cooled; and –the space is free from objects that unreasonably expose the student or others to harm. N.C. Gen. Stat. § 115C-391.1(e)(1)(House Bill 1032).

15 Seclusion shall not be considered: a reasonable use of force when used solely as a disciplinary consequence. N.C. Gen. Stat. § 115C-391.1(e)(2)(House Bill 1032).

16 Time-Out Definition “Time-out’: a behavior management technique in which a student is separated from other students for a limited period of time in a monitored setting.” N.C. Gen. Stat. § 115C-391.1(b)(11)(House Bill 1032).

17 Types of Time-Out Non-Exclusionary Contingent Observation Exclusion

18 Consider the Following Actions 3.Use of Physical Restraint –When student and/or others are at risk for serious physical harm (i.e., head banging, hitting) –Physical restraint should always be used as a last resort. Staff must be properly trained in procedures

19 North Carolina Statutory Law N.C. Gen. Stat. § 115C-390. School personnel may use reasonable force. 1.) To quell a disturbance threatening injury to others; 2.) To obtain possession of weapons or other dangerous objects on the person, or within the control, of a student; 3.) For self-defense; 4.) For the protection of persons or property; or 5.) To maintain order on school property, in the classroom, or at a school-related activity on or off school property.”

20 Physical Restraint (House Bill 1032) Definition “’Physical restraint’ means the use of physical force to restrict the free movement of all or a part of a student’s body.” N.C. Gen. Stat. § 115C-391.1(b)(8)(House Bill 1032).

21 Physical restraint shall not be: considered a reasonable use of force when used solely as a disciplinary consequence. N.C. Gen. Stat. § 115C-391.1(c)(3)(House Bill 1032).

22 Example of Reactive Plans The next several slides will give examples of intervention plans

23 Example Instructional Strategies (Specially Designed Instruction) Adaptations/Modifications (Instructional, interactional, physical) Reactive Strategies (To manage misbehavior) Utilization of classroom behavior modification system using positive rewards/reinforcement Frequent feedback intervals addressing on-task and appropriate behavior Visual reminders of behavior expectations Rehearse waiting strategy Direct teaching of social skills including cause /effect, and choice/consequences, response cost Coach and model appropriate breathing/relaxation/d e-escalation techniques Visual schedule of tasks Student chosen tangible/ non- tangible reinforcers (i.e., verbal and physical cues, edible reinforcers, preferred activities.) Reinforcers should contain a social component whenever possible. Menu of positive rewards to be earned Visual timer as needed Organize non-preferred activities to be followed by preferred activities Use verbal reminders of relaxation de-escalation techniques Coach cool-down in a designated area in the classroom when behavior becomes impulsive/ inappropriate Proximity control/ verbal/ visual reminders to encourage on-task behavior Use Video Self-Modeling – using a social story event Verbal praise Modeling Verbal/visual reminder of classroom rules/ expectations- First/Then reminders Verbal, physical redirection Proximity control Direct Reminders/Warnings Sensory motor strategies Loss of points/tokens/privileges Cool-down time in designated area of the classroom, designated alternate room (if needed) CPI (Crisis Prevention Institute) procedures used as a last resort and only if safety of others or self is in jeopardy

24 Recommendations for implementation of instructional strategies: Verbal reminders 1.Specific praise and recognition should be used whenever appropriate. 2.Use First/Then reminders 3.Use forced choice Visual reminders 1.Throughout the day, XXXX is reminded visually of behavior rules, (Give me 5), these are posted as 5” x 7” inch visuals in all classrooms that XXXX visits and CHAMPS icons indicating visually the behavior expectations for that particular activity. C = Conversation expected, H = Help (How does the student get help), A = Activity (What is the activity), M = Movement (What are the student movement expectations and guidelines, P = Participation (What does good student participation in the activity look like?), S = Special Instructions (Any activity specific special instructions) 2.At least daily XXXX will review one social story. These are selected on basis of appropriateness for the upcoming activity and need. Social stories are also used to prepare XXXX for non-preferred, stressful, and or unfamiliar activities, as well as for activities in which XXXX has a particular problem. 3.XXXX should be provided with visual information when ever possible. She needs written directions, reminders, etc.

25 Cool Down If XXXX becomes overly upset she is encouraged and/or escorted, if necessary, to cool down. XXXX should be given the choice of sensory calming items. She should not be made to choose one but be offered the opportunity. While XXXX is in cool down, teacher should limit contact and verbalizations until XXXX indicates readiness with requests or appropriate behavior. Until this time, gestures or other visuals, and/or very limited language should be used instead of words to redirect XXXX.

26 Step 2 Develop record keeping and reporting procedures.

27 Record Keeping 1.Set up an anecdotal log Date and time of day Location of incident Adult supervising at time of incident Detailed description of behavior Duration of incident Action staff took to prevent injuries Consequence given (if any) Action taken to minimize future occurrence

28 Sample DateTimeAdult Supervisor Description of Behavior Duration Action by staff Conse- quence Follow- up Action

29 Record Keeping 2.Keep Summary Records Number of incidents per week or Number of minutes per week Location of incident Adult supervising at time of incident Types of severe behavior (i.e., biting, hitting) This information will be used to help judge the effectiveness of an intervention.

30 Reporting Procedures 1.Principal or designee should be notified of all restraints, seclusions, and/or isolations. All school personnel are required to notify the principal or principal’s designee promptly of any of the following incidents: any use of aversive procedures; any prohibited use of mechanical restraint; any use of a physical restraint resulting in observable physical injury to a student; any prohibited use of seclusion; or any seclusion lasting more than 10 minutes or beyond the time specified in a student’s behavior intervention plan. N.C. Gen. Stat. § 115C-391.1(b)(8)(House Bill 1032).

31 Reporting Procedures 2.Parent should be notified of all restraints, seclusions, and/or isolations. the date, time, location, duration and description of the incident and interventions

32 Step 3 Determine if other agencies should be or are involved.

33 Other Agencies Determine if other agencies are involved with the student and family. Determine if the other agency may be able to share information which may impact intervention or Determine if other agency may help with implementing intervention across environments

34 Step 4 Implement reactive plan immediately to ensure safety.

35 Implement Reactive Plan All staff need to know and understand their role as laid out in the plan –It helps if staff have practiced with one another when students are not present Staff need to communicate with one another but only one person communicates with the student

36 By preparing for the good days and the bad you can be sure staff will respond quickly, safely and professionally.