Professional Crisis Management: Shaping Positive Behaviors

August 13, 2012 - cornerstoneac

Professional Crisis Management: Shaping Positive Behaviors

PCM (Professional Crisis Management) is a form of crisis management that focuses largely on prevention before a crisis happens and not after individuals have become non-compliant or aggressive. PCM includes Crisis Prevention, De-escalation, Intervention, and Post-Crisis Intervention components to ease situations. To become certified, “hands on” training and written tests are required to reach the skill attainment.

Deon Davis is one of Cornerstone Autism Center’s mentors in Greenwood Indiana. He conducts the PCM training that ABA (Applied Behavior Analysis) therapists who work at Cornerstone’s two locations receive. Deon was taking a break from training new staff at the West Lafayette Cornerstone center when I came up to him for a chat to learn more about crisis management and PCM.deon-01

Jarrad: The first question I have is why Cornerstone uses PCM over other types of child restraint?

Deon: We’re ABA therapists, we use shaping as a method and a technique in training new behaviors. PCM has a great concern for human dignity. Its use offers freedom from pain, gives the child freedom of choice to require the least restrictive alternatives and a focus on continuous feedback of the individual.  I like that PCM uses a process of shaping behaviors as well.

Other programs use holds and positions that have a level of discomfort. For example if a person was having a behavior that warranted physical intervention in this room, and this is a tiled concrete floor, in other crisis management programs we would restrain them to the floor. In PCM however, if a child is displaying a behavior, we would use required safety equipment, like a 2 inch thick mat, on the floor. The PCM process of restraining also has a letting go process, and a process to teach the child that there will be less intervention with less behavior. In other techniques, if you would have a noncompliant behavior then you would just give a lot of force and a lot of resistance from the one who is restraining would occur. Even if the individual became compliant, the likelihood is that they would still continue to get more force.

J: You mentioned that what you do might very well be on a foam mat. So, how do you bring that mat to the individual, or for that matter the child to the mat?

Deon: We can have somebody bring the mat to us, or we have the ability to do transportation. Whether it’s one practitioner or two practitioners transporting a child we could walk them to the area where the mat is or if they aren’t being complaint with walking along with us we would simply hold them in a standing position, also called a “vertical immobilization”, and hold them in that position and wait for someone to bring the mat to us.

J: Alright. Now is that how you would do it here in the lunch room? You wouldn’t hold them down to the floor, but instead hold them up in this “standing position” till a mat is brought over?

Deon: We would hold them in the standing position until the mat is brought to us, yes.

J: How many different types of crisis management programs have you been a part of Deon?

Deon: Without being able to name specifically the other crisis management programs, I’ve been trained in about six different techniques of physical intervention through mental health centers, department of corrections, other developmental treatment centers and training programs, and school systems.

J: Was this a program you brought over with you to Cornerstone or was this something Cornerstone introduced?

Deon: I had heard of PCM but I hadn’t participated in it before. PCM was introduced to me after Ken [Chief Clinical Officer for Cornerstone] experienced it. I know Cornerstone did some research and made some comparisons of other agencies, both in Indiana and beyond, on what they were using and what was most effective. Cornerstone, which is an ABA treatment center, decided on PCM because it was designed by other applied behavior analysts.

J: Really? That’s awesome!

Deon: Yeah, there are ingredients in PCM for training and treatment like in ABA. In less than a year I’ve had the chance to see the effectiveness of using it with individuals who had been really severe and required PCM at least twice daily. Now we don’t use any PCM with them!

J: Can you give me an example of how PCM helped with that where other restraining processes would have made it more difficult.

Deon: Ok. We had a child that had the unique ability to be able to contort himself into unique positions.

J: Like an acrobat??

Deon: Like beyond acrobatics! Like Cirque du Soleil! Because the child had the physical capability of doing that it was really difficult to use some traditional and standard techniques with him. However we continued to use the techniques in PCM to the best of our ability and staying within the guidelines of PCM. The kiddo would be largely disruptive to any programing that was going on in an area. He would be in rooms and begin hitting or spitting on other peers and staff members. He had a lot of self-injurious behavior also, like he would hit and kick himself.

J: It’s a pretty big list!

Deon: Oh yeah! His aggression would go without lessoning for 3 hours. Because PCM gives you a chance to positively shape behaviors, when a behavior would start the practitioner would simply ask the child to walk with them. If he did not offer back compliance then the next stage would be for the practitioner to place their hand on his back to encourage him. If more resistance was offered then they would hold his wrists and his triceps. If he still continued to resist from there then we would use what is called a “Sunday Stroll”, which is holding his wrist and looping our other arm through and then escort him. Our last hold to use was to wrap one of our arms around him in place until he could deescalate the behavior. Anytime the child was in those holds he would kick, flip, roll, tumble, and knock over things that we passed. Once he got to an area, we would lay out a 2 inches thick mat, lay him on it, and teach him to go through a process of brief relaxing and calming down. Because it was the same process every time, the kiddo learned the routine and the results from his certain behaviors. The calmer he became, the less steps the practitioners went to.

J: Wow! That’s really awesome.    

Deon: From this process sometimes the child would go into a room on his own when he began to feel anxious and he would lie on the mat.

J: And go through processes learned to calm down?

Deon: All by himself! When he was restrained the process of him getting up from the mat would be to say “Look at me. Hands in front. Stand up”. When he started to go without assistance I’d hear him say, “Look at me. Hands in front. Stand up”. He’d get up, put the mat away, and we would go back to programing. We have very few behaviors now. He might get off task sometimes but now we wait, encourage him to use words, which he hardly ever used to use by the way, and that’s as much intervention used. Now he’ll say, “I’m upset”, and I’ll say, “Thanks for telling me. What is it you want?” He’ll tell me what he wants and he’ll sit down and go back to work. The behaviors I first described, he was displaying consistently for about 9 months without a break. We used PCM consistently with him over a few months and now we haven’t used any of it in maybe 2 months. All of this progress has been in less than a year!

Some of the other crisis management systems that I have been trained in prior to PCM often led to the person being restrained getting hurt and the restrainer often becoming fatigued to the point of injury as well. Because of the shaping process and the child’s behaviors, the team effort, and the fact that we keep manipulation free from pain, you don’t have the damage that I know can happen. I am very much an advocate of PCM.

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August 13, 2012, cornerstoneac

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