Return to Table of Contents / Previous Article / Next Article
This document has been archived because some of the information it contains may be out of date. (6/09)
Training and Technical Assistance Strategies for Behavior Support and Crisis Response
by Dan Baker
“Teach us how to hold them down!” Any person helping out with behavioral crises has heard this plea from care providers. When people see themselves as being at physical risk, it is not surprising that the first thing they want to know is how to restrain someone. However, behavior specialists, consultants, and crisis workers should present physical intervention and restraint as a last resort, instead emphasizing proactive supports and prevention. Reactive strategies may be necessary, but should never be the primary component of behavior crisis prevention and intervention.
A behavioral crisis is a situation in which a person is engaging in behaviors which: (a) threaten the health and safety of the individual or others, or (b) may result in the person losing his or her home, job, or access to the community. Behavioral crises are among the greatest challenges faced in supporting individuals with developmental disabilities. Ideally, all support agencies and care providers would be able to respond effectively to any level of crisis. In reality, though, agencies, families, and other support providers often face major challenges, and call in behavior specialists, clinicians or consultants to provide extra assistance and ideas.
Consultants or behavior specialists are likely to provide services that come in the form of either technical assistance or training. The goal of technical assistance or training is to assist the care providers to respond to behavioral crisis in a safe and effective manner and prevent future crises.
Steps in Technical Assistance
In technical assistance situations, the consultant provides more direct assistance and produces products designed to result in the immediate adoption of different interventions and support strategies, with specific behavior support recommendations. The consultant takes direct responsibility for certain, pre-specified outcomes, such as conducting a functional assessment or writing a behavior support plan. Another consultation design is a “non-directive consultation model.” In this model, rather than providing answers and directly generating materials and plans, the technical assistance provider presents general information and guides local persons through the process of decision-making and intervention design. Additional training is given as dictated by the situation and the type of problems being presented.
There are a number of services that a consultant might provide in delivering technical assistance. The first step is to help in defining the problem. People involved in a crisis often are not able to accurately define the crisis. They may know that a severe problem exists, but may have difficulties describing it. A second type of service that a consultant might provide is to help regular support team members identify why the problem exists. The most common way to identify reasons for problem behaviors is to complete a functional assessment, a process for identifying the things that cause and maintain a problem behavior. Third, a consultant can assist in the development of a behavior support plan, especially a comprehensive behavior support plan. In short, a behavior support plan represents steps in preventing and responding to problems or crises and improving behavior support strategies. Fourth, a consultant can train and support people who are to implement the plan, whether family members, support staff, or other types of care providers. Training for care providers and raising skill levels are among the most crucial of elements in supporting and resolving crises, and can be a key to preventing future crises. Fifth, a consultant can train, counsel, and support the person presenting the problem behavior. This may be time-intensive and is often prohibitively expensive. Sixth, and finally, a consultant familiar with resources in the community can assist with the identification of relevant support services, such as drug and alcohol programs, therapists, psychiatric services, and respite for care providers.
In most successful technical assistance efforts, the technical assistance person and the care providers have a collaborative, ongoing relationship with well-defined roles. Close attention is paid to follow-up and evaluation. Cultivation of this relationship is often a top priority throughout technical assistance efforts. Many actions can build this relationship, such as including care providers in planning and decision making, asking care provider opinions, and getting to know the care providers at least a little. A friendly, non-judgmental demeanor is of great assistance as well.
Training for Care Providers
In training situations, the trainer will provide assistance by raising the knowledge and skill level of care providers. Common training methods include lectures, workshops, demonstrations, mentoring, coaching, or media presentations. Training for care providers often is a significant component of any behavior support effort, and for long-term benefits it is important that some training of care providers occurs in the context of technical assistance provision.
Successful trainers will address the care provider question, “Why do I need to know this?” and explain at the start how the training will help with the behavioral crisis. The best training is “just in time,” as knowledge is best retained when it is put to use immediately. The longer the delay between learning and use, the less effective the training will be. This is rarely an issue in crisis response, but must be addressed in prevention.
It is also important to build on existing knowledge and relate the new information in a meaningful way to the learners’ previous experiences. For example, care providers may have never considered the importance of providing choices to people with disabilities. But they can certainly relate to their own experiences of having or not having control in their jobs or homes.
Trainers should train within or simulate the work environment whenever possible. Care providers will be able to perform best on the job or in their homes when training conditions closely match the environment in which they will be using the skills. For example, if people typically need to tolerate distractions while running a behavior support program (e.g., designing a picture schedule), they will need to practice the skill a few times in situations that resemble those conditions.
Care providers are probably nervous and anxious about what to do in crisis situations and all the new things they need to learn. They may be afraid of injury, investigations, failure, embarrassment, or of not being adequately “gifted” to provide behavior support or handle a tough challenge. If they are frightened or nervous, they are not in a good “learning state.” People learn best when they feel comfortable and safe. Trainers must consider what they can do to reduce the fear factor regarding the crisis and increase the confidence level of the trainees. A key component of the learning environment is created by language used in training. Technical jargon often is incomprehensible to care providers, and its use should be minimized.
It is extremely important for learners to be involved in the training. People do not retain information well through passive learning experiences, so trainers must be sure the learning experience is active, involving learners physically, mentally, and emotionally. Through lecture alone, most people will remember a small amount of what is said. If they are involved in discussions and demonstrations, that retention rate increases. The highest rate of retention comes with immediate use or teaching it to another.
Training for care providers regarding positive behavior support typically includes a number of different topics. Due to the comprehensive nature of positive behavior support, the specific topics depend on the unique needs of the situation. Content often is chosen initially by the trainer with input from the people who are to be trained and other stakeholders. Common topics include:
- Values in positive behavior support.
- Reasons why people with disabilities are more likely to have problem behaviors.
- Knowledge specific to types of disability or mental illness (e.g., autism or borderline personality disorder).
- Creating positive environments.
- Functional assessment.
- Data utility and collection strategies.
- Person-specific strategies.
- Evaluation strategies for plan effectiveness.
- Teamwork.
- Reactive interventions.
Conclusion
Training and technical assistance are crucial components of the effort to support all people in the community. To assure the best possible outcomes, it is critical for behavior specialists and trainers to see their roles as more than reacting to crises, telling people what to do differently, and showing care providers how to hold people down. A partnership must be forged between behavior specialists and care providers, with support for collaboration coming from all.
Dan Baker is Professional Development Specialist with the Oregon Rehabilitation Association, Salem. He may be reached at 503/585-3337 or djbaker@oregon.uoregon.edu.
Return to Table of Contents / Previous Article / Next Article
Resources: Resources and Related ICI Publications
__________
Citation: Hanson, R., Wieseler, N., & Lakin, K. (2000). Impact: Feature Issue on Behavior Support for Crisis Prevention and Response, 14(1) [online]. Minneapolis: University of Minnesota, Institute on Community Integration. Available from http://ici.umn.edu/products/impact/141/. __________ Hard copies of Impact are available from the Publications Office of the Institute on Community Integration. The first copy of this issue is free; additional copies are $4 each. You can request copies by phone at 612-624-4512 or E-mail at icipub@umn.edu, or you can fax or mail us an order form. See our listing of other issues of Impact for more information. The print design version (PDF, 448K, 28 pp.) of this issue of Impact is also available for free, complete with the color layout and photographs. This version looks the most like the newsletter as it was printed. The University of Minnesota is an equal opportunity employer and educator.
