Saftey Crisis Management Training-Professional Crisis Management

The main reason given to contact the PCM-Association is in many cases:

'Problems with our Current Crisis Management System'

Here are some quotes describing these 'problems':

“We are told to say: 'Calm down, we are here to help you!' while the client is hitting us.”

“We are given dozens of strategies using talking to de-escalate individuals, but we work with many individuals with poor or no language at all and have no strategies for them.”

“We followed many of the suggestions of our current system and the behavior actually gets worse sometimes. It happens with suggestions like: 'If a client slaps at you, simply step back and give them space.'...”

Here are the five main reasons why most crisis management systems fail:

Poor Implementation Criteria:
They use unclear/subjective criteria for the use of restraint which leads to over and under use of restraint. As an example, many staff might begin to use restraint too soon with a client who is only cursing and screaming at them while others might use it too late allowing themselves to be hit many times.
Lack of Population Diversity Awareness:
They don’t consider the range of skills and abilities of clients/students (verbal/nonverbal child/adult for example) often using strategies in a “one size fits all” fashion.
Non Evidence-Based:
They typically do not use ABA principles or strategies and those systems that claim they do are often using ABA procedures “blindly,” that is, they are using procedures known to be effective for some individuals without respect to the function of the individual’s behavior (it is unknown why they are misbehaving).

Damages Clinical/Educational Relationships:

They damage relationships between staff and clients as they use coercive physical procedures, that is they are painful, awkward and uncomfortable. Using coercion creates counter-coercion, that is, people want to get revenge.

Ineffective Training Methodology:

They seldom attempt to train their physical procedures to fluency resulting in staff who cannot implement procedures correctly or end up inventing their own to fill in the gaps in their memory. These other systems demonstrate procedures once or twice, then participants demonstrate them back again once or twice and then they move on to the next of a long series of unconnected procedures.

What makes a crisis management system succeed?

Clearly defined implementation criteria:
The solution is to present staff with clear criteria for the use of restraint and clear instructions on which behaviors warrant physical crisis intervention procedures and which warrant non-physical de-escalation strategies. So if a client or student is screaming and cursing loudly, staff would identify the behavior as “pre-crisis” and know they should be using non-physical de-escalation strategies. A student who hits multiple times in a row would be identified as being “in crisis” and staff would prevent further injury by starting transportation procedures.
Designed to be used with diverse populations:
PCM strategies for prevention and de-escalation were designed to be used with a variety of individuals with different skill sets. There are strategies that will work well with persons with good verbal skills, poor verbal skills or none at all. Even for those with excellent verbal skills, a crisis for them might mean that all their communication completely shuts down. In this case staff must turn to strategies that can work with any skill level. Even the PCM physical procedures are designed to give ALL individuals continuous physical feedback about their behavior. This physical feedback requires no language skills at all. So whether the individual has a chronic language deficit or has just temporarily stopped using language because of a crisis, PCM has the right procedures and strategies to manage ALL individuals safely.
Evidence-based:
PCM prevention and de-escalation strategies and procedures are based on the same basic principles of learning that have been used by behavior analysts for more than half a century to effectively treat and educate individuals with special needs. Many of the strategies used by behavior analysts all over the world are used in the PCM system. Strategies like stimulus fading for removing prompts, shaping of new behavior through differential reinforcement of target behaviors, and the programmed and spontaneous use of praise and other forms of reinforcement for on-task and pro-social behaviors.
Preserves educational/clinical relationships:
The PCMA has respect for the way the body should naturally be positioned and because of this, all of our procedures are painless and comfortable, which translates to shorter crises. Because of this it is very easy to preserve the clinical/teaching relationship as the individual is not being harmed even while they are trying to harm others. The individual controls when the procedure ends by choosing to relax. The very moment the individual relaxes, the staff must begin to release, therefore the client/student is the one who decides when the procedure ends, not staff. This “shared-governance” over the individual’s behavior makes them a key decision maker in their own physical intervention rather than the victim of vengeful non-clinical act.
Fluency-based training methodology:
The PCM system uses the time-tested 'Train-to-Fluency' methodology for teaching all physical intervention skills. Participants then learn sets of 'nested' procedures, each one designed such that it contains portions of other closely related but separate procedures. These nesting procedures are then taught in forward and reverse order of intrusiveness and practiced dozens of times. Initial mastery and generalization of skills over time is ensured by teaching physical skills using distributed practice (over several days) rather than massed practice (all skills taught on a single day). Remember, teaching to fluency may initially take more time, but ultimately it saves time and money because people are taught properly the first time instead of taking shortcuts that will require more training down the line.