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Restraint Reduction With Positive Behavior Supports and CPI Training

By Doug Johnson and Jennifer Taylor | 0 comments
Restraint Reduction With Positive Behavior Supports and CPI Training
Over the last year and a half, our school has undertaken a journey to build a school community around the idea of hope.
 
Hope is a powerful force.
 
To hope means to expect with confidence. Hope frames our expectations of ourselves, our colleagues, and our students in a way that implies a high degree of certainty for an expected outcome.
 
As members of the Nonviolent Crisis Intervention® training team at our school, we hope that staff have the skills to address behavioral issues. What we have learned through our journey is that hope has to be supported by specific and deliberate action. In order to have hope, we must also have a plan.
 
The result of our efforts in community building and acting with intention has been a significant reduction in the use of restraint at our school.
 

School context

 
We work in a school that specifically serves students with conduct disorder, oppositional defiance disorder, and those who have significant mental health disorders.
 
Our students are troubled. They are at risk. They are at risk for school failure and dropping out. They are at risk for becoming involved in criminal activities, often using and abusing drugs and alcohol.

All of our students share a common entry requirement. They must have engaged in physical violence directed at school staff or other students.
 
In the 2014–2015 school year, our school underwent a significant staffing change. We had an almost complete teaching staff turnover, including administration. September and October of 2014 were volatile. We had 50 significant behavioral escalations, 28 of which (56%) resulted in physical restraint. Through the course of those two months we also had several staff injuries, some of which required significant time off from work. We found ourselves in a state of hopelessness. The only thing that we knew with a high degree of certainty was that something had to change. It was evident that we needed a plan.             
 
Our plan involved two components:
  1. Schoolwide implementation of positive behavior support (PBS/PBIS) plans
  2. The development of a committee responsible for training staff weekly in Nonviolent Crisis Intervention® concepts with a focus on CPI’s Applied Physical Trainingâ„  and PBIS materials
These components have allowed staff to come together as a team and build their confidence in addressing physically violent behavior.
 
Staff built their confidence in addressing violent behavior with these two things


Positive Behavior Supports

 
Positive behavior supports (PBS) ask staff to look at the root cause of behaviors.
 
This philosophy of behavioral management begins with the premise that all behavior serves a purpose. All behavior is a form of communication that individuals are using to have their needs met. Unwanted behavior persists because it serves a purpose for the individual; it meets their needs.
 
This mode of thinking forced staff to consider physical behavior differently. Suddenly the students who were acting out were not mean, or spiteful, or vindictive; they were students who had needs that were not being met in the school environment, and who had developed strategies to effectively get their needs met. This represented a considerable shift in thinking about student behavior.
 
In order to implement PBS and to place our students on a path toward achieving measurable behavioral growth, two things needed to happen:
  1. We needed to become comfortable and proficient in objectively discussing both the causes and consequences of acting-out behavior; and
  2. Staff needed to develop capacity in the use of functional behavioral assessments to determine how we could shift student behaviors to become more socially acceptable while still allowing students’ needs to be met.  
These two components proved to be instrumental in successfully implementing positive behavior supports in our school context.
 
Staff needed the opportunity to practice speaking objectively about physically violent behavior. Staff met both as a school team and in grade groups to speak about the behaviors that they were observing in their classrooms. Through these processes, staff were encouraged to investigate and examine possible events that contributed to the behaviors that they were seeing. These events were far-ranging and, for our students, could include such things as:
  • Suspected electronics addiction
  • Medication changes
  • Conflict at home
  • Behaviors occurring at specific times of the day  
As staff began to think about behavior as a form of communication instead of as an attempt to injure people or disrupt the proceedings of the school, their response to violent escalations started to change.
 
Through the use of functional behavioral assessments, we now take a very thorough look at the students we all serve and their most pressing needs.
 
This meant developing a framework with which to identify a key behavior for each of our students to work on improving and a means by which we could assess this growth. We taught staff that each behavioral incident they were seeing in their classrooms had four components:
  1. The motivating operation—events that impact a student’s school readiness.
  2. The antecedent—an environmental event that precedes the behavior.
  3. The behavioral event—a behavior or collection of behaviors that the student engages in.
  4. The consequences of the student’s behavior—both intended and unintended.  
By breaking down the behaviors in this manner, we allowed staff to think objectively about both the “how” and the “why” that motivated their students’ behavior.
 
We explained that the components of an incident are like the explosives often featured in old cartoons.
 
why-behind-behavior-l.jpg
 
These cartoon explosives have a fuse, an incendiary device, are lit with a match, and cause an explosion.
 
The motivating operation, or motivation level in a behavioral incident, is like the fuse. Each student’s fuse can be long or short and is determined by a variety of factors, some of which include eating regularly and how well rested they are.
 
The antecedent is the match. It is the spark that sets off the explosion. Without this antecedent, or this trigger, the behavioral incident would not have happened. Thus it’s important to identify and teach strategies to specifically target a student’s responses to those triggering events, to those factors that are often beyond staff’s control.
 
The incendiary device is the behavioral event—the behavior that the student engaged in that is considered to be unsafe, socially unacceptable, or maladaptive. While this is the easiest aspect of the behavioral assessment to identify and describe, it is often the least informative, as it simply describes behaviors and not the underlying causes of them.
 
The last, and arguably the most important aspect of a behavioral assessment, is the examination of intended and unintended consequences. This is done from both the student’s perspective and the staff’s perspective. It asks us to identify what the student hoped to achieve in the incident and whether we, as staff, reinforced the maladaptive behavior or worked to extinguish it.
 
This process was not easy.
 
There were often disagreements over which need was perceived to be the most pressing for various students, what the motivating operations were, and whether we were rewarding behavior and thus encouraging dangerously unsafe behavior or whether we were working to extinguish this behavior by providing students socially acceptable alternatives.
 
However, with perseverance, and a detailed rationale based on staff experience with these students, eventually we were able to come to consensus and agree upon a target behavior for each student in our school.
 
Through this process, we shared dialogue and developed a strong team atmosphere that fostered respect for the contributions each staff member brought toward developing a plan for positive behavioral change. By working together we engaged in a journey that resulted in feeling empowered, unified, and hopeful because we have a common understanding and approach to student behavior.
 
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Integrating PBIS with Nonviolent Crisis Intervention® training

 
Interacting effectively with a physically violent individual is a skill that is honed over time. Just as we, as a staff, needed to come to a collective understanding of the nature of physical behavior, we also needed a common understanding of appropriate response to crisis.
 
It was apparent that staff were not comfortable with responding to students who displayed extreme acting-out behavior. The result was heightened staff anxiety when staff interacted with violent students. This anxiety increased when staff were injured.
 
Our response to this was to engage in ad hoc training sessions around specific incidents where staff were injured. This approach proved to be ineffective. Staff anxiety continued to mount and injuries continued to happen.
 
It became clear that a more systematic approach would be needed. To that end, three staff members completed Instructor training in basic Nonviolent Crisis Intervention® techniques and one staff member completed advanced training.

With this in place, we developed a weekly, school-based training program that encompassed team responses to behavioral escalation, self-regulation strategies, verbal de-escalation techniques, behavioral modification, cognitive training, and advanced techniques.
 
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The formation of this training group immediately boosted staff morale, as there was tangible evidence now of an action plan in place at our school to improve safety and security for both students and staff.
 
We have a regularly scheduled morning meeting on Thursdays where all of our staff members work to improve their ability to use CPI methodology in a confident manner. We role-play scenarios that we face on a regular basis, which helps us develop skill sets for effectively dealing with the situations at our school. Proper technique development, positioning, and reflection on how we could deal with situations more effectively—and how we could prevent them—in the future guide our practice.
 

Results

 
More often than not, walking into our school building you will not notice anything out of the ordinary.
 
You will see pictures and bulletin boards on the walls; you will see students playing in the gym and cooking in the foods lab. You will notice a calm and quiet atmosphere where students are actively engaged in learning.
 
This is the most powerful evidence of our success.
 
This is the most important proof that we have been able to change our thinking about the causes of and our approaches to violent student behavior.
 
In support of the general sense of calm one feels in our school building, we have also seen a dramatic decrease in the percentage of physical restraints compared to the last school year.
 
In the 2014–2015 school year, 56% of significant physical incidents resulted in physical restraint. In the 2015–2016 school year, thus far 18% of significant physical incidents have resulted in physical restraint.
 
In addition, in the last school year, we lost 100 work days to work-related injuries involving response to violent physical behavior. This school year we have lost one work day.
 
In aggregate, this evidence indicates that our change in practice is paying dividends schoolwide for everyone involved. Staff now feel hopeful that they are working towards meaningful behavioral change with their students.
 
Doug-Johnson-1.jpgJennifer-Taylor-1.jpgDoug Johnson and Jennifer Taylor are long-time behavior learning assistance teachers. Both work in a specialized program that’s designed to meet the needs of students who have severe behavior disorders. Doug has extensive experience teaching students with special needs, First Nations students, and children in residential treatment facilities. He has been a CPI Certified Instructor since 2015. Jennifer has a master’s in Education with a focus on School Improvement and Leadership, specifically looking at interventions that improve the school experience for at-risk youth. Jen has been a CPI Certified Instructor since 2007.
 
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