A Review of Crisis Intervention Training Programs for Schools
Abstract and Figures
Recentadvocacyorganizationreports, Congressionalhearings,andproposed federallegislationhavecalledattention totheabusiveuseofphysicalrestraint proceduresinschoolsettings.Asa result,administratorsandschoolofficialswonderwhethertheyshouldpur chase“crisisintervention”trainingfor staffandfacultymembersfromoutside vendors.Unfortunately,thereislimited informationavailableregardingthe contentofthesetrainingprograms,and thevendorswhoprovidethistraining viewthesubjectmatterasproprietary andconfidential.Asaresult,itcanbe difficultforschoolstoobtaininforma tionthatmighthelpthemmakechoices aboutthetrainingtheyarepurchasing. Comparingdifferentprograms’empha sisoncertaintopics,coursecontent, duration,andtypeofinstructioncan assistadministratorsandeducatorsin selectingacrisisinterventiontraining programthatismostappropriatefor theirschool.
Figures - uploaded by Joanna Stegall
Author content
All figure content in this area was uploaded by Joanna Stegall
Content may be subject to copyright.
... Dr. Kim Masters has long advocated for the use of pulse oximetry as a cost-effective and relatively easy way to monitor indicators of physiological danger during restraint (Masters, 2007;Masters & Wandless, 2005). A review of crisis intervention training programs by Couvillon, Peterson, Ryan, Scheuermann, and Steggall (2010) showed that the all restraint training programs reviewed provided some degree of training in monitoring Physical Restraint and Seclusion in Schools | 43 students' physical states and symptoms of physical distress during restraint. Although the amount and nature of that training varied, none of the programs reported training in the use of pulse oximetry or automated external defibrillator (AED). ...
... Although there are a host of evidence-based interventions that have demonstrated efficacy in reducing maladaptive behaviors-such as functional communication training (Durand & Carr, 1991), functional analysis and function-referenced interventions (Kurtz et al., 2003), and token systems and self-management interventions (Shogren, Lang, Machalicek, Rispoli, & O'Reilly, 2011)-these techniques require specialized knowledge. Lacking that knowledge, practitioners conceivably may rely on ineffective practices that set the stage for challenging behaviors (Couvillon et al., 2010), leading to behaviors that result in restraint or seclusion. ...
... Currently there are a number of proprietary commercial crisis intervention training programs that train professionals from a wide range of professions who deal with aggressive behaviors, including law enforcement, mental health, and education. Couvillon et al. (2010) identified about 21 such training programs that participated in their survey, although several others may not be included in that list. It should also be noted that, although these proprietary training programs appear to be the predominate form of training provided in schools, it is possible that some schools have or will develop their own training programs on these topics. ...
Examines the use of physical restraint and seclusion procedures in school settings.
... De-escalation training helps employees learn crisis prevention and management skills through behavioral competencies (Gaynes et al., 2016). The de-escalation training curriculum was based on an Applied Behavioral Analysis (ABA) framework, using positive and negative reinforcement, behavioral modification, and verbal de-escalation techniques to enable employees to apply the best prevention interventions (Cooper et al., 2020;Couvillon et al., 2010). ABA strategies have been successful in improving cognitive performance, language skills, and adaptive behavior skills for populations, such as individuals diagnosed with autism spectrum disorders (Warren et al., 2011), attention-deficit hyperactivity disorder, rehabilitation for people with brain injury, substance use disorder, and intellectual disabilities (Couvillon et al., 2010). ...
... The de-escalation training curriculum was based on an Applied Behavioral Analysis (ABA) framework, using positive and negative reinforcement, behavioral modification, and verbal de-escalation techniques to enable employees to apply the best prevention interventions (Cooper et al., 2020;Couvillon et al., 2010). ABA strategies have been successful in improving cognitive performance, language skills, and adaptive behavior skills for populations, such as individuals diagnosed with autism spectrum disorders (Warren et al., 2011), attention-deficit hyperactivity disorder, rehabilitation for people with brain injury, substance use disorder, and intellectual disabilities (Couvillon et al., 2010). The de-escalation program implemented was found to be easily accessible and supported by the University of Iowa Hospitals and Clinics, a Huntington's Disease Society of America's Center of Excellence, and the de-escalation techniques were not previously used by the facility in this study. ...
INTRODUCTION
Little is known about reducing the challenges for caregivers and patients with Huntington’s disease (HD). HD creates behavioral disturbances, cognitive decline, and motor disorder progression over the lifetime requiring some individuals to need long-term facility care.
AIMS
There are concerns about safety and confidence of employees caring for residents with HD.
METHODS
Nursing staff, administrators, and auxiliary employees were recruited from a long-term care (LTC) facility in rural Iowa, from July 2020 to August 2020. A de-escalation training intervention was delivered. The 1-day intervention included resident behaviors, planning and safety, teamwork, communication, and included role play and simulation. A pre- and post-survey measured confidence and competence in caring for people with HD before and after a training intervention. A resident medical record audit explored challenging behaviors before and after the training intervention.
RESULTS
Of 25 participants, six were registered nurses/licensed practical nurses (RNs/LPNs; 24%), four administrators (16%), eight nursing assistants (32%), and seven auxiliary employees (28%). There was improvement in employees perceived safety (33.3%), co-workers enjoyment working with HD residents (54%), understanding symptoms of HD (44.4%), confidence in job abilities (21.0%), and confidence in ability to care for patients with HD (26.3%). A medical record audit showed decreased documentation of resident aggression and care refusal post-intervention.
CONCLUSIONS
These findings suggest de-escalation training in LTC facilities increased perception of job safety, co-workers’ enjoyment, understanding HD symptoms, confidence in ability to care for patients with HD, and decreased resident agitation and care refusal.
... Department of Education, 2010). In fact, many classroom teachers have received no such preparation (Couvillon et al., 2010). Educators are expected to support students with the level of training received through teacher preparation programs, in service professional development, and previous teaching experiences. ...
... These results are particularly meaningful for practitioners working with students with significant behavioral needs, as such restrictive crisis procedures involve removing students from the classroom setting and can increase the likelihood of aggressive behaviors (Magee & Ellis, 2001). In addition, physical restraints can result in lasting psychological effects and even death in rare instances (Couvillon et al., 2010;Mohr et al., 2003). Although physical restraints may be necessary to maintain safety in certain situations, it is important that such procedures are used sparingly. ...
Alternative education (AE) settings support students with significant social–emotional and behavioral needs. Such settings often implement individualized programming; however, this presents challenges with staffing resources and training. Application of systems to address behavior on a schoolwide level could simplify training, increase staffing flexibility, and decrease use of crisis response procedures. This 2-year, descriptive case study provides an implementation example of universal behavioral supports based on a Positive Behavioral Interventions and Supports (PBIS) framework within an AE setting. Over the course of the study, a reduction in staff use of restraint and seclusion procedures was observed. Additionally, staff perceived the framework favorably. Implementation steps are described, along with differentiation of the framework to meet the needs of a heterogeneous student population within the context of the COVID-19 pandemic.
... Although there are many examples of proprietary training programs aimed at equipping caregivers with verbal de-escalation, self-protection, and physical management techniques (Couvillon, Peterson, Ryan, Scheuermann, & Stegall, 2010;Couvillon, Kane, Peterson, Ryan, & Scheuermann, 2019), there is a lack of research and consensus on an all-encompassing, bestpractice approach to safely managing behavioral crises (Reed, DiGennaro Reed, & Luiselli, 2013). Instead, there exists many separate studies on the specific components that may contribute to effective management of challenging behavior and a reduction in the use of RBMPs. ...
Restrictive behaviour management practices (RBMPs) are usually considered high risk, emergency procedures, that are used in response to perceived violent and dangerous situations. Contemporary use of RBMPs for individuals with neurodevelopmental disabilities has been controversial, primarily due to the ethical, legal, and safety concerns that have arisen historically and continue to exist regarding (a) the impingement on an individual’s personal rights and freedoms, (b) physical health risks, and (c) potential for long-term psychological harm or trauma. This chapter focuses on the history of RBMPs,
types of RBMPs commonly used to manage dangerous behaviour, implications of these practices, and practical considerations for when the use of RBMPs cannot be avoided. Finally, we describe alternatives to RBMPs, strategies to reduce restraint procedures, methods to prevent crisis situations safely, and the implications of RBMP alternatives on an individual’s long-term health.
... Similarly, teacher preparation programs do not include training related to physical restraint. Instead, schools generally purchase "crisis intervention" training that includes instruction on various physical restraint holds provided by private and mostly profit-making vendors (Couvillon et al., 2010, Couvillon et al., 2019. The proprietary nature of these programs has prevented consumer input regarding topics addressed, quality of training, or safety features. ...
The Division for Emotional and Behavioral Health (DEBH; Formerly Council for Children with Behavioral Disorders, CCBD) put forward a position paper with recommendations for the use of physical restraint procedures in educational settings. In addition to providing relevant background regarding the use of restraint, the position paper set forth a Declaration of Principles and offered specific recommendations for its use. The current paper follows up on CCBD’s position paper, elaborating on the specific recommendations as they pertain to practitioners and administrators who serve children with behavioral challenges.
... Restraint process PRTF staff train in safe crisis management (SCM), which involves verbal and physical deescalation skills (see Couvillon et al., 2010, andSlaatto et al., 2021, for reviews of crisis intervention programs). The initial training occurs over 3 days during staff orientation. ...
The early identification of youth at risk for restraint incidents is an important next step to reducing the likelihood of such incidents. Yet, the extant research has not comprehensively investigated the idiographic factors that contribute to the restraint of youth in psychiatric residential treatment facilities (PRTFs). The current study investigated client-level predictors of restraint incidents, with specific emphasis on youth client trauma history and traumatic stress symptoms as assessed at admission. Participants were children and adolescents (N = 150; 55.3% female, 66.7% White, 33.3% Black or biracial) aged 6–17 (M = 11.8 years) admitted to a PRTF in the northeastern United States. A negative binomial regression with maximum likelihood estimation was conducted to examine the relative contributions of age, gender, length of stay, number of psychiatric diagnoses, body mass index (BMI), and traumatic stress symptoms at intake to the frequency of restraint incidents. The model was significant, χ²(6, N = 150) = 30.326, p < .001, and both length of stay, β = .005, p < .001, IRR = 1.005, and traumatic stress symptoms at intake, β = .072, p = .007, IRR = 1.074, were identified as significant predictors within the model. Although length of stay is an obvious predictor of restraint incidents, the current study is the first of which we are aware to identify traumatic stress symptoms at intake as a potential indicator of restraint frequency following admission. Clinical implications of these results are discussed.
Students with emotional and behavioral disorders (EBD) can exhibit severely challenging behaviors that lead to events of crisis in an inclusive classroom. This article provides practitioners with an overview of the cycle of dysregulation experienced by some students with EBD. The article includes descriptions of stages in the dysregulation cycle, observable behaviors of students “in” the various stages, and step-by-step directions for teachers and other education professionals aiming to guide students successfully through each cycle stage and prevent further crisis.
Crisis escalation in the classroom creates a disruption to the teaching environment and increases the potential for violence in the educational setting. The importance of safe classroom climates and the adoption of programs to decrease the escalation of crisis in the classroom remains a priority for K-12 and postsecondary educational institutions. This chapter details a three-tiered approach to preventing classroom disruptive or dangerous behaviors. First, this approach details the importance of establishing a positive classroom climate through clear expectations and engaging teaching practices. The second tier describes crisis de-escalation skills and techniques for teachers to address escalating concerns in a timely and effective manner. The third tier then explains the importance of teachers reporting concerns to a centralized threat assessment or Behavioral Intervention Team (BIT) in order to allow the behavior to be considered from a school system perspective. This chapter explains why an approach encompassing all three tiers is an effective and efficient way for teachers to support efforts to prevent school violence.
This document provides policy recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint procedures in educational settings. It includes (a) an introduction with definitions of terminology; (b) a discussion of the problems with the use of physical restraint, policy on this topic, and the lack of research; (c) a Declaration of Principles; and (d) Recommendations Regarding the Use of Physical Restraint in educational settings. Although the policy recommendations in this document pertain to the United States, we believe the principles and nonpolicy recommendations are equally applicable to other countries.
Recent injuries and fatalities among students due to the use of physical restraint procedures in schools, and the resulting media attention and litigation have started to place pressure on many state and local education agencies to develop policies or guidelines concerning their use in schools. The authors investigated existing state policies and guidelines concerning the use of physical restraint procedures in educational settings across the United States. Currently, thirty-one states were identified with established guidance concerning the use of these crisis intervention procedures. Several states are either developing or revising their existing policies or guidelines. The authors reviewed the policies and guidelines which were identified in order to compare common content elements found in these documents, and make recommendations for states, schools or districts interested in developing their own policies or guidelines.
Bullying and other forms of violence among children and youth is a prevalent concern among educators, psychologists, and families alike. Families and schools represent the primary systems in children's lives, and schools and homes are their primary learning contexts. These ecological contexts provide important frameworks within which development occurs. Healthy development occurs most seamlessly when there are congruent and consistent messages delivered across contexts, and healthy and constructive relationships among them. The development of meaningful partnerships among these systems on behalf of children and youth is particularly important to produce positive, lasting outcomes. Thus, an optimal focus for interventions aimed at bullying and victimization exists in the cross-setting contexts of home and school. This chapter will focus on consultation processes for working across home and school ecologies to address concerns related to bullying and social competence. Included is information on (a) consultation strategies aimed at developing partnerships among parents and educational professionals to help develop social competence in children (i.e., bullies, victims, bystanders); (b) procedures for assessing the child and environment to identify sources of difficulties as well as facilitators to support social skillfulness; and (c) strategies for implementing interventions across home and school settings to enhance social competence.
This document provides policy recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint procedures in educational settings. It includes (a) an introduction with definitions of terminology; (b) a discussion of the problems with the use of physical restraint, policy on this topic, and the lack of research; (c) a Declaration of Principles; and (d) Recommendations Regarding the Use of Physical Restraint in educational settings. Although the policy recommendations in this document pertain to the United States, we believe the principles and nonpolicy recommendations are equally applicable to other countries.
Children and adolescents with severe emotional and behavioral problems in residential settings can become so aggressive that physical restraints are utilized to keep them and others safe. Recently, the use of physical restraints in residential treatment facilities for school-aged children has come under increased scrutiny, and there have been legislative mandates that the use of physical restraints be reduced. This article describes a quasi-experimental field study conducted to examine the effectiveness of a 2-phase (organizational and milieu) physical restraint reduction intervention in a multisite residential treatment center. Results provide support for the effectiveness of organizational-level and milieu interventions for restraint reduction. Overall, restraint rates were reduced by 59% using these interventions.
This paper outlines a bully-proofing program that aims to shift power away from the fear of bullies to the "silent majority." The Bully Project is a comprehensive systems approach which changes the attitude and environment of the school. It does this by training the staff to recognize the difference between bully and victim behavior and by using classroom groups and small group interventions with bullies and victims. Parent involvement and support from the Pupil Services Team for classroom teachers completes the comprehensive approach. Implementation for the program involves an 8-week period for training. Schools wishing to implement the program will need trained personnel who are familiar with the materials so that these workers can provide in-service training for the teachers and staff, can work directly with teachers in running classroom groups, and can run small group sessions for bullies and victims. Details are given on the cost of the program and some of its accomplishments. Evaluation data on the program is very limited, mostly anecdotal. (RJM)
This program guide for the elementary and middle school levels contains the student manual which is also published separately. Through the strategies of mediation, negotiation, and group problem solving, students learn to recognize, manage, and resolve conflict in peaceful, noncoercive ways. While accepting conflict as a natural everyday consequence of the human search for belonging, power, freedom, and fun, the strategies described help learners realize the choices that they face in conflict situations and enable them to resolve conflicts with confidence and independence. The book elucidates a vision of a peaceable climate, an understanding of conflict and of peace, and the means of resolution through communication. To foster mediation and group problem solving, the volume describes a six-step process: (1) agreeing to mediate, and accepting ground rules; (2) gathering points of view; (3) focusing on interests; (4) creating win-win options; (5) evaluating options; and (6) creating an agreement. For each chapter, the guide provides lesson plans and ideas for interactive student exercises. The appendices explain how to implement a mediation program, including advice on changing school disciplinary rules, the selection and training of mediators, and program logistics. Sample mediator contracts and parental permission forms, an annotated bibliography of children's literature, and simulations are provided. Contains 20 references. (JD)
The purpose of this pilot study was to review the effects of professional staff training in crisis management and de-escalation techniques on the use of seclusion timeout and restraint procedures with at-risk students in a K-12 special day school. An exploratory pre-post study was conducted over a two-year period, comparing the use of these behavior management interventions when all staff members were provided crisis intervention training. In addition, a brief survey was administered to all staff members concerning their training in and use of behavioral interventions. Results indicated professional staff training was effective in reducing (a) seclusion timeout procedures by more than one-third (39.4%) and (b) physical restraints (17.6%). This study also found staff members were not initiating seclusion timeout procedures primarily for the reasons they were trained (e.g., physical aggression) but rather for nonviolent behaviors such as leaving an assigned area and disrupting the classroom environment.
There has recently been increased attention given to the widely perceived gap between research and practice in school psychology and education. The purpose of this article is to describe how Centennial School of Lehigh University, an alternative day school for students with emotional and behavioral disorders, was able to successfully implement and sustain research-based practices. The use of such practices, in conjunction with organizational and systemic change, led to the significant reduction and eventually the virtual elimination of the use of and need for physical restraint and seclusionary time-out in the school, as well as a substantial increase in students' prosocial behavior. Procedures for reducing the gap between research and practice at Centennial School are discussed, including the methods used by school personnel to facilitate systems change, successfully implement research-based practices, and create a supportive organizational structure for sustaining effective practices. Possible roles for school psychologists in systems change efforts, potential barriers to the implementation of research-based practices, and recommendations as to how these barriers may be overcome also are provided. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 553–567, 2005.