What procedures will staff implement in a behavioral crisis situation, and how are staff trained? How does your agency develop behavioral support plans?

In a behavioral crisis, staff are trained to implement the strategies outlined in an individual’s behavior support plan. If the crisis includes imminent danger to the individual acting out and/or others, staff are trained to detect this emergency and respond accordingly. In a behavioral crisis, as defined by such imminent danger, the staff are trained to take the least restrictive actions necessary to control the behavior and prevent injuries. However, as an absolute last resort, staff me be required to physically restrain and individual briefly until the situation is safe for release. Staff who are assigned to work with individuals known to have situational dangerous behavior receive specialized training in how to de-escalate behavior, as well as contain dangerous behavior, as a last resort, with safe physical restraint that never includes pain or potentially dangerous holds, and is never used for the convenience of staff or as a punishment or consequence for assaultive behavior. Physical restraint is only to be used if an individual is actively engaged in a dangerous behavior, not afterword, and only to stop the individual from hurting someone (or self). The development of a behavior support plan is a step-by-step process. First, it’s important to rule out any underlying causes of a problem behavior that can be more easily addressed, such as a medical problem causing discomfort or an environmental concern, such as an uncomfortable temperature or excessive noise. It’s also necessary to determine if a behavior is rooted in an organic condition, such as a serious mental health problem, including schizo-affective disorder. Once all such potential causes are ruled out, and the behavior has been determined to be “behavioral” in nature by a professional behavior support specialist, such as a psychologist, then the process of developing a plan begins. A thorough behavioral assessment must be completed by the professional, which may include observation of the individual, review of documentation describing the behavior, and interviews with people who know the individual best. The professional will like initiate a “baseline,” during which caregiver staff are instructed to document incidents on behavior reports, including narrative explanatory reports about the behavior each time it occurs. This baseline documentation is typically collected for a designated time period (perhaps a month or two). With that information, which should include time, place, environmental description, and many other aspects of each incident recorded by the staff, the professional can make a determination of the “function” of the behavior. This “function” is a technical term for understanding when and under what conditions the behavior is likely to occur in order to understand what the individual is ultimately trying to accomplish by exhibiting the problem behavior. Once this functional analysis is complete, the professional can complete the plan by determining what triggers the behavior and how to adapt the environment when those triggers are present, as well as what to do if the staff are unable to actually prevent the behavior and find themselves dealing with it full blown. The plan will include steps for addressing the full blown behavior that are designed to de-escalate and reward positive replacement behaviors, which are more appropriate ways for the individual to achieve the same outcome without displaying the problem behavior. In addition, the plan will typically include instructions for how to document each behavioral occurrence, how often such documentation is reviewed, and how often the plan should be revised if it is determined to be insufficiently effective, based on a measurable reduction objective…such as “we expect the behavior problem will decrease in frequency by 50 percent in the next 6 months.”

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