At Cornerstone, our goal is to help produce meaningful change for our clients. We work to increase skills and abilities to enhance each child’s independence and quality of life. We also seek to help lessen challenging behaviors that are a barrier between them and success. Those challenging behaviors may range from mild forms of tantrums and non-compliance, to severe crisis behaviors including aggression, self-injury, and high-magnitude disruption. In these moments of crisis, it is critical to maintain the safety of the client and those around them.
Professional Crisis Management (PCM) is a crisis management system that Cornerstone utilizes in concert with ABA therapy to provide the most ethical, comprehensive treatment possible.
Professional Crisis Management Association (PCMA) is the organization that provides training and certification in the PCM system. The first edition was created in 1984 by behavior analyst, Neil Fleisig. It continues to be managed by Mr. Fleisig and a team of highly trained and experienced behavior analysts.
The primary focus is for PCM to be faded out completely. We have achieved our goal when the individual can function in any setting (Center, School, Home, etc.) without the aid of PCM procedures. Ultimately, we desire for the client to be as independent as possible. By equipping therapists with multiple strategies and techniques, they can address any situation and promote positive change for the individuals they serve.
Strategies and Procedures
PCM seeks to provide parents, teachers, and service providers with a set of strategies and procedures to address a wide range of behaviors. The safety of the individual and others is sought to be maintained through effective, ethical treatment. The four primary strategies and procedures outlined in the PCM system are listed below.
Crisis Prevention Strategies – Developing skills and abilities that promote appropriate behavior and allow the individual to better get their needs and wants met.
Crisis De-escalation Strategies – Utilizing non-physical strategies to manage challenging behavior that does not threaten the safety of the individual or those around them.
Crisis Intervention Procedures – Physically managing continuous, crisis behaviors that put the safety of the individual or others at risk.
Post Crisis Strategies – Reintegrating the individual back into daily activities as quickly as possible.
We want to set our clients up for success, and we do this through non-physical, preventative strategies. The PCM system highlights that “with an effective emphasis on prevention, the development of pre-crisis and crisis behavior is minimized, and more intrusive procedures are therefore unnecessary.” Therapists use many different strategies and techniques to create an environment that is conducive for learning. They then work on functional skills so the child can be more independent and utilize appropriate behaviors in place of more maladaptive forms (ex. Asking for juice vs Screaming). If challenging behaviors are displayed, the therapist uses pre-crisis techniques and follows behavior intervention plans that address the reason why that child is engaging in that problem behavior (ex. client screams for juice; therapist does not give juice). The therapist then prompts appropriate alternatives to get that need met in a better way (therapist prompts client to ask for juice). Through reinforcing appropriate behavior, we will be able to see those skills and abilities grow.
Despite our best efforts to use prevention and provide alternatives, crisis behavior may still occur. When crisis behaviors (continuous physical aggression, self-injury, and/or high-magnitude disruption) arise, crisis intervention procedures are utilized. These painless, ethical procedures help maintain the safety of the individual and support them through the crisis episode.
Personal Safety – These techniques assist the therapist in maintaining their own safety during aggressive acts targeted towards them. Hair pull releases, bite releases, and other procedures ensure the safety of the therapist.
Transportation – Transportation procedures involve moving an individual away from the setting that is maintaining the crisis behavior. There are steps within transportation that allow the trained individual (parent, therapist, etc.) to match the level of resistance and fade systematically once resistance begins to lessen. This allows for rapid learning even for individuals who may not be able discern vocal instructions at that time.
Vertical Immobilization – If transportation procedures are not effective and walking becomes unsafe, then vertical immobilization procedures are utilized. The client is stopped in a standing position until it is safe to continue transporting.
Horizontal Immobilization – If all other procedures are insufficient to manage the magnitude of crisis behavior being displayed, then horizontal immobilization procedures can be used. This involves gently laying the individual on a soft, foam mat and eliminating movement until attempts to engage in crisis behavior have diminished. Once resistance has stopped, the practitioners fade immediately and begin the process of getting the individual back into daily routines.
By providing treatment that supports the client through all situations and scenarios, we have seen growth in children of all levels and ability. PCM’s emphasis on the ethical treatment of those served echoes Cornerstone’s mission to Maximize those who struggle, Embrace those who love, and Fulfill those who serve. If you would like more information on PCMA you can visit its website at www.pcma.com. If you believe PCM training would benefit you and you would like information on parent/community trainings, you can contact Phillipe Sallade through email at firstname.lastname@example.org or call any of our Cornerstone locations!
October 12, 2018, Phillipe Sallade, BCaBA and PCM Instructor