April has been known to many as “Autism Awareness Month” and in recent years was changed to “Autism Acceptance Month”. While I think it is wonderful we are at a place of acceptance, I think it is important we don’t forget and move past the awareness part.

I am a late diagnosed ADHD/Autistic individual, an AuDHD, if you will. Years ago, when I started working in this field and learning more about autism and neurodiversity, I began to question more about myself and my own behaviors. I would read about a certain trait, see one of my clients engaging in a behavior (maladaptive or preferred), or write something into a treatment plan and the whole time think to myself, “Wait, I do this. This is something I struggle with, how am I going to teach this skill to someone else?”

Here enters the issue on the awareness part. The problem with thinking we have nailed down autism awareness and can move into acceptance is that we have not fully been made aware of how autism looks across the spectrum. When people think of autism, they typically think of little kids who are maybe non-vocal or have limited communication skills or rigidity and repetitive behaviors like to line things up or have a special interest in certain toys. This may be how one autistic person presents but the problem is, this is not how every autistic person presents. Our society isn’t aware of all the different ways neurodiverse individuals can look, act, and learn, so how can we accept the things we aren’t even aware of? Because of the lack of awareness for girls with autism, a lot of females go undiagnosed and do not get the help they need. Because of the lack of awareness for individuals with lower support needs, they also tend to go undiagnosed or unnoticed and they also do not get the help they need.

My sister and I look back on all the things I did as a child and laugh about how obvious it was that I was autistic. But “back in my day”, parents were not as aware of these traits and diagnoses and were not getting their children evaluated. I grew up learning how to mask and fit in and thinking the struggles I was facing were normal and I didn’t need any help or accommodations. For example, I did all my undergraduate and graduate schooling online because I could not take in information by sitting and listening to it in person. I needed to be able to read it, visualize it, and see the words. Bringing this story back to the beginning, as I grew older and realized I was making the same accommodations for myself as I was for the clients I supported and had so many other things in common, I wanted to dig deeper and find my own awareness. 

After being diagnosed, it still took some time to really be aware of what that meant to me and for me, and even longer for me to fully accept.  I work in this field, I teach others how to work with people who are neurodiverse, but it is still hard for me to fully acknowledge and embrace that I am autistic. It is embarrassing to admit, but because I don’t look and fit the “stereotypical” autistic person, even I don’t think I should be labeled as autistic, even though I know how I am feeling and struggling on the inside. As I learn how to lower the mask, I am learning more about myself and learning what being autistic means to me and learning how to ask for help. Autism Awareness month and Autism Acceptance month, to me, means being aware of my own neurodiversity, my own needs, and being able to accept me for me.

During Autism Acceptance month, I think it’s important to also keep in mind that we are not just accepting people who we think “fit the bill”. We are accepting all people, no matter their support needs. We need to be aware that autism comes in all different levels, genders, support needs, sensory issues, etc.  The autism spectrum is a pie chart with different sized pieces being taken out of different areas; it is not a line of more or less autistic. When your friend or coworkers approaches you and is asking for help, clarification, or an accommodation, don’t brush them off. Don’t think they are being lazy, or greedy, or selfish. More than likely, they are asking for this help because they need it and are finally strong enough to ask a trusted person in how to get it.  I know it has been a struggle for me to ask for help and an even bigger struggle in getting people to believe that I actually need it. 

About the Author

Alyssa Saterfield received her B.A. in Elementary Education from Trinity Christian College and her M.S. in Applied Behavior Analysis from The Chicago School of Professional Psychology. Alyssa started her “ABA career” working as a Certified Nursing Assistant (CNA) in a rehab center for adults with traumatic brain injuries. Since that time, she has also worked as a paraprofessional in a school for children with disabilities, taught students in general and special education (transitional age) settings, worked as a case manager for adults with disabilities, worked as a Level II Behavior Therapist for adults with disabilities in day program and group home settings, and worked in an ABA clinic for children. While working with the adult population, Alyssa was certified as a Safety Care trainer around 2015 and continued to be a trainer until she was hired as a Master Trainer at QBS in July 2021.

In a recent interview, Noelle Drake shared her unique path to becoming a Master Trainer at QBs and offered valuable insights into the world of Safety-Care and crisis prevention. Her story reveals how unexpected opportunities can lead to fulfilling careers in behavioral analysis.

An Accidental Beginning

Like many professionals in the field, Noelle naturally stumbled into behavioral analysis. Her journey began when she was teaching piano to a child with autism. Despite having no formal training in behavioral therapy, she developed a natural rapport with her student. The child’s mother, noticing this connection, recommended Noelle for a position at her son’s therapy center.

“There started my work in ABA,” Noelle explained. “I started as a behavior tech before RBT certification was even a thing.”

From there, her career progressed through various settings—therapeutic recreation, schools, home-based services, and clinics. She eventually earned her Master’s degree, became a BCBA (Board Certified Behavior Analyst), ran her own company, and finally transitioned to her current role as Master Trainer at QBS.

Becoming a QBS Master Trainer

When asked what attracted her to the Master Trainer position, Noelle’s answer was immediate: training has always been her passion.

“One thing I really enjoyed about any BCBA position that I had was training—training staff, training parents,” she shared. “Being able to do that full time was really exciting for me.”

The role allows her to use her behavioral analytic skills in unique ways, distinct from her previous positions. As she’s grown in the role, she’s developed a more thorough understanding of Safety-Care tools and how they work together to address complex situations.

Success Stories and Misconceptions

When asked about success stories she could share from her training experience, Noelle responded that perhaps the most powerful testimony to the effectiveness of Safety-Care came from an organization in one of her trainings that initially implemented the full curriculum, including physical management procedures. After several years, they realized they no longer needed to train their staff in the physical management components because the preventative strategies had been so effective.

“They were able to implement Safety-Care, use a lot of those preventative and minimization strategies to essentially completely decrease and eliminate the need for more restrictive interventions,” Noelle shared.

This success story highlights what Noelle considers a common misconception about crisis prevention: that it’s primarily about restraint training. She emphasizes that physical management is only one small part of a comprehensive approach focused on prevention and minimization.

“Crisis prevention is not restraint training,” she stated firmly. “Most of what we do is not that. We have many other tools that we’re utilizing to help improve quality, improve safety, help people meet their goals.”

Maintaining Balance While Traveling

As a Master Trainer, Noelle spends significant time on the road, training professionals across the country. This lifestyle comes with its own challenges, but she’s found ways to maintain work-life balance.

Her strategies include maintaining a consistent schedule when possible, prioritizing self-care while traveling, regularly connecting with family and friends regardless of time zone, and finding joy in exploring new cities.

For Noelle, the travel aspect is actually a benefit. “I love to travel, so that’s always a big plus for me,” she admitted. She appreciates the opportunity to contribute to “the dissemination of behavior analysis across the country in a really, really big scope.”

Advice for New Trainers

When asked what advice she would give to new Safety-Care trainers, Noelle kept it simple: “Stick with the manual. The manual is your friend.”

She recommends starting with the basic tools in Safety-Care rather than getting pulled into the specifics of individual situations too quickly. “Start there and then we can kind of help make that more specific to the individuals that you’re working with as time goes on.”

Looking to the Future

Noelle is excited about the direction of the behavioral analysis field, particularly its movement toward “more flexibility and inclusivity across disciplines.” She hopes to see BCBAs continue to improve their reputation for collaboration, moving away from rigidity toward working alongside other professionals and valuing their expertise.

Through her work as a Master Trainer, Noelle continues to contribute to this evolution, helping professionals across disciplines implement effective, compassionate approaches to crisis prevention and management.

In 2021, the Autism Society of America made a significant shift by rebranding April from Autism Awareness Month to Autism Acceptance Month. Christopher Banks, President and CEO of the organization, articulated the critical distinction: “Awareness is knowing that somebody has autism. Acceptance is when you include them in your activities, help them develop within the community, and foster meaningful connections.”

This important rename emphasizes a profound transition from mere recognition to genuine inclusion. The primary objectives of Autism Acceptance Month are to:

Raising Awareness and Expanding Education

Effective awareness goes beyond surface-level understanding. Many communities continue to harbor misconceptions about autism, often stemming from limited knowledge about:

This can lead to biases that result in discrimination. By providing education opportunities across all communities, we can work to reduce stigmas and teach community members how to offer meaningful support to individuals with autism. Advocacy plays a critical role in creating systemic change. Individuals and organizations can contribute by:

Promoting Genuine Inclusion

Creating truly inclusive environments requires intentional, thoughtful approaches. Practical strategies include:

These initiatives help individuals with autism build confidence, improve social interactions, and feel genuinely welcomed in their community.

Supporting Families

Families supporting loved ones with autism face unique challenges that often go unrecognized. Parents may experience increased stressors and siblings may struggle with feelings of being overlooked or receiving less parental attention. Meaningful support from community members involves:

Simple gestures like making sensory-friendly toys available in your home, being a reliable emotional support system, and showing genuine understanding can make significant differences.

Conclusion

Autism Acceptance Month is about more than building awareness—it’s an opportunity to transform societal understanding, promote genuine inclusion, and create supportive environments where every individual can thrive, regardless of neurodiversity.

Safety-Care by QBS provides behavioral crisis prevention training to staff who support individuals with autism and their families. Learn more about how our evidence-based, trauma-informed approach to training can reduce challenging behaviors and help create safe and supportive environments for all.

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References

Moya, M. J. (2022, April 2). Autism Acceptance Month is underway. Here’s why the name is important. USA Today. https://www.usatoday.com/story/news/health/2022/04/02/autism-acceptance-month-name-change/7243001001/

Considerations for Behavior Analysts

Behavior analysts who are looking for opportunities to get involved in their state’s restraint and seclusion policy have a variety of avenues to consider, including, but not limited to, advocating for legislation that prioritizes positive behavioral interventions & supports (PBIS), providing expert testimony on the use of restraint and seclusion, collaborating with policymakers to develop evidence-based guidelines, educating stakeholders about the harms of excessive restraint and seclusion, and actively participating in relevant committees and work groups – ensuring that any restraint or seclusion policies are aligned with ethical and best practices in behavior analysis. [1, 2, 3, 4, 5]

Key ways to engage: [1, 2, 3]

Behavior analysts can lobby at the state level, collaborate with other stakeholders on policy development, and educate relevant stakeholders on ethical and best practices for restraint & seclusion.

Important Considerations: [1, 5]

When becoming involved in policy it is important for behavior analysts to prioritize:

Resources

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3089400/

[2] https://www.apna.org/standards-of-practice-seclusion-and-restraint/

[3] https://www.rethinked.com/resources/changing-the-seclusion-and-restraint-culture-in-schools/

[4] https://disabilityrightstx.org/wp-content/uploads/2021/01/DRTx-Restraint-Report-FINAL-Dec-7-2020-2.pdf

[5] https://www.abainternational.org/about-us/policies-and-positions/restraint-and-seclusion,-2010.aspx

[6] https://safesupportivelearning.ed.gov/discipline-compendium?state=california&sub_category=Restraint+and+Seclusion

[7] https://debh.exceptionalchildren.org/position-papers-monographs/physical-restraint-seclusion-procedures-school-settings

Behavioral crisis management is the most high-risk process in the psychiatric care of children and adolescents (Paccione-Dyszlewski, et al, 2012), particularly regarding the use of restraint and seclusion. Paccione-Dyszlewski and colleagues reported in 2012 that 50 to 150 patient deaths occurred each year in the United States due to restraint and seclusion procedures, and a more recent study found that 79 restraint-related fatalities occurred for children 18 years and younger between 1993-2018 (Nunno, et al, 2021). In addition, the use of restraint and seclusion has been linked to adverse outcomes such as increasing patient aggression and injuries to patients and staff. While restraint and seclusion procedures can effectively and therapeutically manage crisis behaviors, it is imperative to develop systems for ensuring patient and staff safety and restrict the use of these procedures until absolutely necessary.

This was recognized by Bradley Hospital in East Providence, RI in the early 2000s. Bradley Hospital is a neuropsychiatric hospital serving 500 children and adolescents on a given day and acts as a teaching hospital for Brown University. In 2008, Bradley Hospital recognized a need to examine its crisis intervention model and improve its crisis management program. The goal was to reduce patient and staff injuries during crisis events, reduce the frequency of restraint and seclusion incidents, and increase patient satisfaction.

The Challenge: Rethinking Crisis Management

A Crisis Prevention & Intervention Work Group was established to examine current approaches to crisis intervention and recommend improvements to the program. The group was tasked with examining the root causes of shortcomings in crisis management and developing a project plan including goals, recommendations, and implementation. The work group selected QBS’s Safety-Care training as its crisis management program and worked with QBS to develop a training curriculum for its specific pediatric population.

The Process: Key Implementation Strategies

The hospital didn’t just adopt a new program—they created a comprehensive cultural shift.

Once the crisis prevention training curriculum was selected, Bradley Hospital added a statement on their philosophy and position on behavioral management and confirmed the training’s alignment with regulatory compliance. Two documents, De-Escalation & Crisis Management and the SafetyCare Behavioral Safety Management program were cornerstones to the hospital philosophy and its commitment to least restrictive approaches to treatment.

Program proficiency was then recommended for various staff roles across the hospital. Several staff were identified to become trainers and all staff who provided direct care to patients were required to complete the full training and annual recertification in the course. Staff with indirect support roles were trained in incident prevention and staff safety, with the goal of reducing risk to staff during crisis events. Additionally, the hospital revised job descriptions for direct care staff to include “fitness for duty requirements” to address physical and psychological demands of the role (i.e. ability to lift, bend, grasp and the ability to remain calm in crisis situations).

Furthermore, mechanical interventions (i.e. restraint beds and chairs) were eliminated from practice and transport of patients was restricted to extreme circumstances and in accordance with Rhode Island legislation. A Crisis Management Subcommittee was formed to address policies, procedures, and protocols as well as issues regarding training, personnel, and regulatory concerns.

Staff training occurred over two months and a total of 734 staff were trained in the new program. Coaching teams were formed to provide ongoing support, enforce skill acquisition, and ensure compliance across the program. Staff evaluated the training upon completion, with ratings of 97% for clarity and organization of the presentation and 96% for effectiveness of trainers and perceived knowledge gained, respectively.

The Results: System-wide Improvement

Data were collected and analyzed pre- and post-implementation on the following:

# of Patient Hours in R&S

Data were available for 21 months prior to the project and 24 months following implementation. Patient hours in restraint and seclusion fell 28.8%, from 1.11 hours to 0.91 at the 1-year follow up. A second follow-up 2 years post-project indicated a further reduction to 0.79 hours.

Frequency of Patient Injury

Data on patient injuries was also available for 21 months prior and 24 months following the project. Patient injuries dropped by 78% at the 1-year mark, from 1 injury per 180 interventions pre-project to 1 in 803 one-year post-project.

Staff Injury Data

Staff injury data was available for 12 months prior to implementation and 24 months following. Pre-project, the ratio of staff hours lost to staff hours worked was 12,528 : 1,049,896, falling to 13,008 : 2,167,113, a 49.5% reduction in work lost. Bradley Hospital estimates that the reduction correlates to approximately $470,000 in savings across the 2-year post-project period.

Patient Satisfaction

Patient satisfaction data were recorded for 1 year prior and 2 years following the project. Patient satisfaction scores for safety felt on the unit improved from 87.4 pre-project to 90.8 following implementation.

Parental Complaints

Parent complaints were documented and available for 10 years, with 2 years following implementation. Complaints received pre-project averaged 4 per year and post-project there were 0 complaints made by parents regarding restraint and seclusion.

The Human Element: Beyond the Data

Perhaps most importantly, the program shifted organizational culture. Staff moved from viewing physical management as a primary skill to prioritizing de-escalation and individualized patient care. Secondly, Bradley Hospital was able to successfully implement a hospital-wide crisis management improvement project, from task force development, curriculum vetting and customization, to training and implementation for over 700 employees in under two years, proving that systemwide change is possible for large organizations without costing significant time resources. Finally, all goals for reduced use of restrictive practices, injuries to patients and staff, and patient and caregiver satisfaction showed favorable and significant results.

This initiative demonstrates that with thoughtful design, commitment, and a focus on human dignity, healthcare institutions can transform crisis management from a potentially traumatic experience to a therapeutic intervention.

Safety-Care is proven effective across many settings, including schools, clinics, residential services, and hospitals. Safety-Care is designed to be effective with all ages and a variety of diagnoses. Learn more about how our training curriculum can reduce behavioral incidents and injuries through an emphasis on prevention and de-escalation.

Learn more

Resources

Nunno, M.A., McCabe, L.A., Izzo, C.V., Smith, E.G., Sellers, D.E., & Holden, M.J. (2021). A 26-year study of restraint fatalities among children and adolescents in the United States: a failure of organizational structures and processes. Child & Youth Care Forum, 51, 661-680.

Paccione-Dyszlewski, M., Conelea, C.A., Heisler, W.C., Vilardi, J.C., & Sachs, H.T. (2012). A crisis management quality improvement initiative in a children’s psychiatric hospital: design, implementation, and outcome. Journal of Psychiatric Practice, 18, 304-311.

In a recent interview, Patrick Mulick, Director of Student Engagement at Auburn School District in Washington state, shared his district’s remarkable journey toward more inclusive practices and improved behavioral support through the implementation of Safety-Care training and other supports. With 20 years of experience in the district and a background as a special education teacher, Mulick offers valuable insights into how schools can transform their approach to behavioral challenges.

About Auburn School District

Located about 30 miles south of Seattle, Auburn School District (ASD) serves a diverse and rapidly growing population:

Identifying the Need for Change

Around 2014, Auburn began examining their data regarding students with disabilities and behavioral support:

As Mulick noted, “When we know better, we can do better.”

The Selection Process

To address these challenges, Auburn formed a Restraint & Isolation Steering Committee comprising administrators, certified staff, and classified staff. The committee:

  1. Clearly defined the problems they needed to address
  2. Sought input from colleagues across the state and country who had switched to different de-escalation programs
  3. Invited multiple program representatives to present to the committee
  4. Conducted a pilot with Safety-Care, training three trainers and approximately 40 specialists
  5. Surveyed participants, finding 100% preferred Safety-Care over their previous program
  6. Monitored implementation over several months to ensure effectiveness
  7. Formally adopted Safety-Care through their curriculum adoption committee and school board

What Made Safety-Care Stand Out

Mulick highlighted several features that made Safety-Care appealing:

Implementation Strategy

Auburn’s successful implementation involved several key strategies:

  1. Selecting the right trainers: They chose staff with strong ABA knowledge, good presentation skills, and experience across grade levels who could relate content to various scenarios.
  2. Strategic scheduling: Instead of evening sessions after full workdays, they:
    • Front-loaded training before the school year started
    • Used in-service days and conference periods
    • Created multiple scheduling options to accommodate staff needs
  3. Cultural shift: Beyond just switching programs, they:
    • Educated staff about what constitutes restraint and isolation
    • Improved reporting systems
    • Created a shortened “Foundations in De-escalation” course for staff who didn’t need full certification
    • Clarified who needed training based on their role in responding to behaviors
  4. Clear communication: The team established that anyone supporting students with challenging behaviors needed proper training, including principals, security officers, and special education staff.

Remarkable Results

The data tells a compelling story of Auburn’s success:

In the current 2024-25 school year, there have been 121 incidents of restraint to date and only 10 incidents of isolation, and the district has been able to eliminate all but 1 isolation room in its schools.

Perhaps most impressive, their elementary EBD (Emotional Behavioral Disorder) program now serves just 3 students in the entire district of 17,000 students. Middle and high school programs have similarly reduced numbers, with all students on trajectories to return to their home schools.

Sharing Success Through Demonstration Sites

Auburn’s success has led to them being selected as demonstration sites for Washington State’s RREI (Reducing Restraint and Eliminating Isolation) project. Two of their elementary schools regularly host visitors who learn about:

Advice for Other Districts

Mulick offers this wisdom for educators looking to embark on a similar journey:

“If you want to go far, you have to go together.”

He emphasizes:

Auburn’s story demonstrates how thoughtful implementation of evidence-based approaches, combined with systematic cultural change, can dramatically improve outcomes for students with behavioral challenges while creating more inclusive school environments.

Roy T Bennett said, “You can’t always control the behaviors of others, but you can always choose how to respond to it.” Let’s dive in a little deeper on this and how this relates to Safety-Care. 

I was first trained as a Safety-Care Specialist when I was working as a Direct Care Provider and I remember leaving training after two full days thinking, “I remember how to implement a wrist release, get out of a hair pull and a choke hold, and implement a one-person stability hold, but all of the preventative measures I learned on day one of training is now a blur.” Safety-Care promotes the use of least to most restrictive procedures and after leaving training, all I could remember were the most restrictive, hands-on techniques I learned on day two.

Being a Safety-Care Trainer now, it became clear that more hands-on and restrictive techniques were being used by our staff rather than the preventative techniques and de-escalation strategies emphasized in Safety-Care training. This was concerning given the psychological risks associated with using physical management. Specifically, one of our individuals who required physical management had psychological trauma due to a long-standing history of intense restraints prior to entering our services. Any time we implemented a hold, it was obvious this individual would experience re-traumatization; he would begin to withdraw from daily activities and other people, get easily startled and engage in more aggressive behaviors. Another individual found physical management highly reinforcing, and because of this, we started seeing an increase in his dangerous behaviors. In fact, after engaging in those behaviors, he would stand with his arms out, ready for staff to implement a two-person stability hold. 

After looking at these scenarios, we wanted to try whatever we could to use more of a hands-off approach as long as it was safe to do so. I remember meeting with my supervisor and expressing my concerns and wondering how we could start using less physical management and more preventative techniques instead. The best way I could describe the variety of skills staff have after completing Safety-Care training was to compare it with a buffet. Am I a little food driven? Well, maybe. When you think of a buffet, we typically grab a standard-sized plate and start from left to right. We usually start at the salad bar, loading up on the salad, moving on to the fresh fruits and veggies and grabbing some appetizers and finger foods. We then dive into the main course, consisting of all the meats and potatoes, and of course those yummy rolls. Our plates are completely full – not leaving much room for anything else – but we can’t forget to pile that yummy dessert right on top. Because dessert is the last thing we have collected on our plates, that is the first thing we typically see and will probably start with when we sit down to start eating. We completely forget that we have salad at the bottom of all that, even though that was the first thing we added to our plate.  

Looking now at teaching Safety-Care, I feel like it is a lot like that buffet. We teach all the preventative strategies early on, making our focus on least restrictive interventions first, but then we move on to teaching physical management. Day two of training is a full day of learning not only physical management but also testing the physical competencies. When staff were leaving training, they were in the same boat as I once was as a trainee; staff voiced that they remembered the last thing they were trained on, including hands-on, restrictive measures (the dessert) but less so the first thing they were trained on, including preventative measures (the salad). My supervisor requested that I run a report that pulled data on any physical management that was being used with our individuals. We were able to see how often it was being used, if it was being used correctly, and if it was even warranted in that specific situation. In a four-year span, we recognized that only two incidents of physical management were implemented. After looking a little deeper into these two incidents, both could have been handled with less restrictive techniques instead. We decided that moving forward, our company would no longer teach staff the physical management components of the training and focus on the prevention, minimization, and physical safety strategies only. 

Since this shift was implemented over the last four years, there has been a dramatic decrease in dangerous and very dangerous behaviors exhibited by our clients. In fact, we have had zero incidents of physical management since the transition. Our staff have expressed they feel more confident in using their skills and tools and it truly shows with the data I have collected and continue to collect. The surveys we provide for staff following any Safety-Care training show that the staff really like focusing deeper on the preventative techniques and de-escalation strategies. I also created a challenging behavior scale that I use during our trainings. This is a great visual aid for our staff to utilize when dealing with any disruptive, dangerous, or very dangerous behaviors. The scale illustrates 0 being minimal and 10 being very dangerous behavior. Staff understand that depending on the type of challenging behavior, it might require further judgement in evaluating the risk to best categorize it on the scale. Staff report that the behavior scale has been extremely helpful; they can implement their tools and skills according to the type of challenging behavior they are observing at that specific time. Overall, what we have discovered as an agency and continue to discover, is that sometimes, less is truly more.

About the author

Katie Reyes is the Behavior Plan Implementation Specialist for Eastern Colorado Services for the Developmentally Disabled (ECS), located on the plains of northeast Colorado. ECS serves adults with developmental disabilities ranging from 18 years of age to end of life, providing support in residential group homes, day programs, and host homes. Katie has been a certified Safety-Care trainer for over 8 years.

We continue our conversation with Katie Reyes, Safety-Care Trainer and Behavior Plan Implementation Specialist at Eastern Colorado Services for the Developmentally Disabled (ECSDD), in this second part of our Trainer Spotlight series. Read more about how Safety-Care has impacted staff and individuals served at ECSDD below.

How does Safety-Care help your team meet their crisis prevention goals?

It really helps staff use prevention skills and rapport building with our individuals to try and prevent behaviors in the first place. Knowing their history, triggers, and signals, if a behavior can’t be prevented, it helps staff respond safely to that behavior and attempt de-escalation with the individual to avoid crisis.

What do you like most about the Safety-Care curriculum?

I love that Safety-Care teaches so many preventative measures. Not just learning to respond safely to a behavior but trying to prevent the behavior from happening.

How has Safety-Care improved your client and staff outcomes? 

We have had less dangerous and very dangerous behaviors using Safety-Care over the years by really focusing on preventative techniques and de-escalation strategies. Our staff feel more confident when responding to any types of behaviors and it allows them to work together as a team using their skills and tools to de-escalate situations safely (and we’ve seen a decrease in worker compensation claims!).

Why would you recommend Safety-Care?

I would absolutely recommend Safety-Care and have quite a few times over the years. We have had a lot more success with Safety-Care than any previous types of behavioral crisis trainings we have used.

If you missed the first installment of our Trainer Spotlight with Katie, you can read it here.

Want to learn more about how Safety-Care can improve your client outcomes and safety for everyone? Schedule time to speak with our team today!

About Eastern Colorado Services for the Developmentally Disabled

Eastern Colorado Services for the Developmentally Disabled (ECSDD) is located on the plains of northeast Colorado serving adults aged 18 to end of life in residential group homes, day programs, and host homes. Since 1973, ECSDD has been serving individuals with intellectual and developmental disabilities, making it the longest running service provider in the area. Started as a grassroots effort to move people out of institutions and closer to loved ones, ECSDD’s mission is to assist in enhancing the lives of persons with varying abilities in relation to their families, education, friends, and opportunities within the community.    

Behavioral crises are not over when physical management is discontinued. As discussed in our previous blog , there are several post-incident procedures that should be implemented to address the safety and well-being of everyone involved. Additionally, there are several considerations for reducing the use of physical management over time, including support and follow-up with the student, data collection and analysis, and ongoing training and support for staff. These practices should be part of a comprehensive training program for all staff members who may need to implement physical management techniques.

Post-Incident Considerations

Safety Monitoring & Emotional Support

When possible, wellness checks should be administered by a licensed medical professional, such as a school nurse. At a minimum, staff should assess the student for breathing, any signs of pain, discomfort, or injury and address as needed. Precautions should be considered when integrating the student back into classroom activities. Be aware of proximity to peers, materials the student can access, and the potential for re-escalation during this recovery period. Temporary changes to scheduled activities, seating arrangements, etc. may need to be implemented to ensure everyone’s safety. These precautions can be faded over time as the person continues to de-escalate to their baseline calm behaviors.

The student may also require emotional support and should receive appropriate counseling from a licensed professional as needed. Some students may experience trauma from the use of physical management and these procedures may be similar to traumatic experiences they have had in the past. (It is important that when this previous trauma is identified or known, staff attempt to eliminate the use of these procedures or minimally reduce the similarity in their use and the past trauma.) Consider peers who may have witnessed the crisis event and ensure appropriate supports for them as well, if required. Additionally, staff may benefit from emotional support or counseling and should be provided with access or guidance on how to access such supports.

By adhering to these best practices, educational institutions can ensure that when physical management is necessary, it is carried out in the safest and most professional manner possible. Remember, the ultimate goal is always to return to a supportive, positive educational environment to promote safety and learning.

Data Collection & Analysis

Data collection is an important part of post-incident procedures (and should even occur during the behavioral crisis when possible). Record all details of the incident as soon as possible after it occurs. Include details such as the activity and location during which the crisis occurred, antecedents that occurred prior to the behavior, topography (or form) of the behaviors, the duration of the incident, intervention methods used by staff, and the consequences following behavior. Gather accounts from all staff involved and any witnesses, and follow established protocols for notifying administrators, parents/guardians, and relevant authorities.

Data should be graphed frequently and analyzed to identify patterns of behavior. Data analysis can help staff identify when behavior is likely to occur, for example during what activities, time of day, in the presence of particular peers or staff, or specific locations. This analysis will allow staff to make modifications to the environment and interventions to improve prevention strategies. Remember, the goal is always to learn from each incident and strengthen preventive measures to reduce the need for physical management in the future.

Ongoing Training & Support

Effective management of challenging behaviors, particularly those that may require physical intervention, relies heavily on comprehensive and ongoing training and support for all staff members. This section outlines the key components of a robust training program and emphasizes the importance of continuous education.

Behavior Management Training

Initial Comprehensive Training: All staff who may be involved in managing challenging behaviors should receive thorough training in behavioral crisis prevention and management, such as the Safety-Care curriculum. Use of the interventions that are trained should be in compliance with relevant laws, regulations, district or school policies, and ethical considerations. Comprehensive training should include prevention and de-escalation strategies, physical management techniques, and considerations for students with disabilities, trauma histories, or mental health conditions. Procedures for post-incident recovery, debriefing, documentation, and data analysis should also be included.

Regular Refresher Courses: To maintain skills and stay updated on best practices, it is recommended that staff participate in annual recertification courses. This increases the safety of everyone involved in a crisis and reduces procedural drift from the procedures over time. Quarterly or monthly reviews can also be incorporated into professional development, with brief, focused sessions on specific aspects of classroom behavior management.

Specialized, Role-based Training: Consider specific training in the following areas for various staff roles.

Training Best Practices

Below are additional recommendations for conducting crisis prevention trainings with school staff.

Behavioral Skills Training: Behavioral Skills Training (BST) is an evidence-based approach for teaching staff to implement behavior change strategies (Parsons et al, 2013). It includes describing and modeling the skill, observing staff practice the skill, providing immediate feedback and practicing to mastery.

Role Play Exercises: Staff can participate in simulated behavioral crisis situations to practice de-escalation skills. Practice coordinated responses to complex behavioral incidents with all staff who are likely to be involved in interventions with challenging behaviors.

Cross-Disciplinary Education: Broaden understanding through diverse perspectives by providing staff with opportunities to receive training across multiple disciplines.

For example, joint training sessions with mental health professionals, behavior analysts, and special education experts can be provided to classroom staff. Invite experts in relevant fields (e.g., childhood trauma, autism spectrum disorders) to share insights and best practices. Coordinate with local law enforcement and emergency services for aligned approaches to crisis situations.

Trauma-Informed Practices: Integrate trauma awareness into all aspects of training.  Educate all staff on the prevalence and impact of trauma on student behavior. Train staff in approaches that avoid re-traumatization during interventions.

Self-Care Strategies: Taking care of yourself goes a long way toward providing excellent care to the students you serve. Provide staff with tools to manage their own stress and secondary trauma. Encourage staff to seek assistance from their peers and provide assistance to other staff when necessary.

Cultural Competence: Ensure training addresses cultural considerations and diversity awareness.  Include training on cultural differences in communication and behavior.

Help staff identify and mitigate personal biases that may affect their interactions with students. Train on strategies to create a culturally responsive classroom environment.

Continuous Professional Development: Foster a culture of ongoing learning by supporting staff participation in relevant educational conferences and staying current with the latest research in behavioral interventions. Conduct in-classroom observations to assess application of skills and provide additional support as needed.

Data-Driven Training Focus: Use incident data to inform training priorities. Regularly review incident reports to identify ways to improve interventions. Things to look for include common triggers that can be removed or reduced, patterns in the interventions used (and their effectiveness or not), and consequences following behaviors. Focus training on areas where data shows the greatest need for improvement, for example how immediately or effectively staff respond to a crisis, effective teamwork during the crisis, or specific interventions used. Assess the impact of training programs on incident frequency and severity and consider altering your training approach if necessary.

Evaluate Effectiveness of Training: Provide staff with pre- and post-assessments during training to evaluate the effectiveness of training. Gather staff input on the relevance and effectiveness of training programs. Track changes in the frequency and severity of behavioral incidents over time to determine if your training is effective in reducing challenging behaviors.

Conclusion

By prioritizing comprehensive training and ongoing education, schools can ensure that all staff members are well-equipped to handle challenging behaviors effectively and safely. This commitment to continuous learning not only enhances the skills of individual staff members but also contributes to a school-wide culture of proactive, positive behavior management.

Remember, the goal of all training and education efforts is to create a safe, supportive learning environment where the need for physical intervention is minimized, and where all students can thrive.

Interested in learning about Safety-Care’s comprehensive behavioral crisis prevention training? Learn more about how we support school staff in preventing and managing challenging behavior here.

References

Parsons, M.B., Rollyson, J.H., & Reid, D.H. (2013). Teaching practitioners to conduct behavioral skills training: A pyramidal approach for training multiple human service staff. Behavior Analysis in Practice, 6(2), 4-16.

Katie Reyes is a Safety-Care Trainer at Eastern Colorado Services for the Developmentally Disabled (ECSDD). Katie has been with ECSDD for over 19 years, serving the last 8 years as a Behavior Plan Implementation Specialist and Safety-Care Trainer. Learn more about Katie’s unique perspectives as a Safety-Care Trainer and how Safety-Care has directly impacted the population she serves.

What unique perspectives do you bring to your trainings?

We discuss and share a lot of examples that have to do with our personal experiences and with the individuals we serve. We have many years of rapport and knowledge about these individuals, which then helps provide a more meaningful training.

What do you like most about teaching Safety-Care?

I love getting to spend the day with our staff, engaging with them and sharing experiences both old and new. It gives me the opportunity to build and continue to improve rapport with the staff and learning their unique individual styles has helped tremendously for a more successful training experience.

What is your favorite Safety-Care skill and why?

I really like the Help strategy. I feel this strategy is very useful in helping our individuals express and communicate their wants and needs more appropriately. We get so used to working with our individuals that we tend to know what they want or need on a daily basis. However, when new staff come in and those veteran staff aren’t on shift, it’s very challenging trying to figure out what those wants and needs are. We really encourage using this strategy whether the individual is agitated or not to get the individual to communicate to us more effectively.

Tell us about a situation with a client where Safety-Care was implemented successfully.

We had an individual who would headbutt objects, and we knew that by talking to this individual, he would start to escalate and end up in crisis. Typically, this individual would headbutt an object, but as long as staff weren’t talking, the individual would walk away from the object pretty quickly and de-escalate. We stressed to staff to utilize the Safety-Care’s Wait strategy, monitor for safety, and only intervene if needed.

This individual had started to headbutt a glass window which became a very dangerous situation. One particular staff really struggled with staying calm and not pleading for this individual to stop knowing how dangerous it was, even though they knew this would only escalate him. I instructed the staff to still use the Wait strategy by not talking or making eye contact but to use a soft barrier (pillow, couch cushion, etc.) between the individual and the window instead. This allowed us to go from a very dangerous situation to a less dangerous situation.

The staff person came to me a few days later after following my instructions and was almost in tears because it worked! Every time the individual would headbutt the glass, the staff only placed the barrier between the individual and the glass but still didn’t make eye contact or talk. The individual de-escalated and walked away with no injury.

As a seasoned Safety-Care trainer, what recommendations do you have for new Safety-Care trainers? 

Be open to the reality that sometimes Safety-Care doesn’t always have the answer for a specific situation. All we can do is try our best with the skills and tools we are taught. I encourage you to try and build rapport with staff during training as much as you can, so staff are more comfortable and open to asking questions.

Want to learn more about how Safety-Care can improve your client outcomes and safety for everyone? Schedule time to speak with our team today!

About Eastern Colorado Services for the Developmentally Disabled

Eastern Colorado Services for the Developmentally Disabled (ECSDD) is located on the plains of northeast Colorado serving adults aged 18 to end of life in residential group homes, day programs, and host homes. Since 1973, ECSDD has been serving individuals with intellectual and developmental disabilities, making it the longest running service provider in the area. Started as a grassroots effort to move people out of institutions and closer to loved ones, ECSDD’s mission is to assist in enhancing the lives of persons with varying abilities in relation to their families, education, friends, and opportunities within the community.    

When Physical Management Becomes Necessary

Despite our best efforts to prevent behavioral crises, there may be situations where physical intervention becomes necessary to ensure the safety of the student, their peers, or staff members. It’s important to approach these situations with caution, adhering to legal and ethical guidelines while prioritizing the well-being of all involved.

Legal and Ethical Considerations

Before implementing any physical management procedures, educators and administrators must be aware of the legal and ethical framework surrounding these actions:

Federal Guidelines: The U.S. Department of Education has issued guidance on the use of restraint and seclusion in schools. Key points include:

Least Restrictive Interventions: School personnel should always use the least restrictive intervention possible to manage the situation safely.

Proportional Response: The level of intervention should be proportional to the level of risk presented by the behavior.

Duration: Physical management should be used for the shortest time necessary to ensure safety.

Documentation: All instances of physical management must be thoroughly documented and reported according to your school district and state policies.

Parent/Guardian Notification: Parents or guardians should be promptly informed of any use of physical management involving their child.

Deciding When to Use Physical Management

The decision to use physical management procedures should follow a clear, predetermined process:

Assess Immediate Risk: Quickly determine if there is an imminent risk of serious physical harm to someone.

Confirm There Are No Less Restrictive Options: Ensure all other de-escalation strategies and less restrictive approaches to intervention have been attempted or considered and the only way to prevent harm is through physical management.

Ensure Physical Management Will Not Increase Risk: The use of physical management should not increase risk of harm to staff or students. If there is a possibility of increased risk, do not use physical interventions.

Consider Individual Factors: Take into account the student’s age and size, medical or psychological conditions, and any history of trauma when deciding if physical management is appropriate and necessary.

Team Approach: When possible, involve multiple trained staff members in the decision-making process.

Communicate Intent: In some cases, it may be appropriate to communicate to the student that physical management will be used if the dangerous behavior continues.

Prepare for Intervention: Ensure that all staff members who are intervening have been trained in proper physical management procedures.

Continuously Reassess: Throughout the intervention, continue to evaluate if restraint procedures are still necessary. As soon as it is safe to do so, staff should release from physical management and continue with de-escalation strategies.

Safety Considerations

When implementing any physical management procedures ensure that all involved staff are properly trained to use the procedure and monitor the student’s physical and emotional well-being (and each other’s). The student should be assessed for breathing and any complaints of pain and discomfort or any indication the use of physical management may be traumatizing. Avoid putting pressure on the student’s head, neck or torso. If physical management becomes unsafe (i.e. the student becomes unconscious, complains about breathing, etc) immediately release and seek medical attention.

Post-Intervention Procedures

After any use of physical management, everyone involved should be provided medical care and emotional support as needed, complete debriefing procedures, and staff should determine if any changes need to be made to the student’s behavior plan to reduce the likelihood of behavioral crisis situations occurring in the future.

Immediate Safety Check: Assess for any injuries or medical needs of the student and staff involved. If necessary, administer first aid or seek medical attention. Emotional well-being should also be assessed and support provided as needed for staff and students.

Notification and Documentation: Inform school administrators about the incident as soon as possible. Notify the student’s parents or guardians promptly, providing a clear, factual account of what occurred. Complete a detailed incident report while the events are fresh in memory. Include the following in your report:

Have a designated administrator review the incident report for completeness and accuracy and ensure the incident is properly recorded in the school’s data management system for tracking purposes. Verify that all necessary reporting requirements (district, state, federal) have been met.

Debrief with the Student: As soon as the student is calm and receptive, it is important to debrief with them to understand what happened and how we can better support them in the future to prevent similar incidents. Choose a quiet, private location for the conversation and allow the student to share their perspective on what happened.

Work with the student to identify triggers and discuss more appropriate behaviors they can engage in next time. If applicable, discuss how to repair any harm caused to relationships or property.

Staff Debriefing and Support: Gather all staff involved and any administrators responsible for decision-making for a thorough debriefing session. Discuss the sequence of events, focusing on what led to the use of physical management and the effectiveness of the intervention, and collaborate on identifying what could be done differently in future situations. Ensure staff are aware of available support services, including counseling if needed.

Review & Modify Behavior Support Plans: Assess the effectiveness of the current behavior support plan in light of the incident. Determine if there are more effective methods for preventing or minimizing similar incidents in the future and make modifications to the student’s plan accordingly.

Follow-up Actions: If modifications have been made to the student’s plan, communicate those to all staff working with the student and their legal guardians. Provide additional training as necessary to address new interventions or skill gaps identified in debriefing. Make any necessary changes to the physical environment to support appropriate, desirable behavior.

Long-term Monitoring and Evaluation: Closely monitor the student’s behavior in the weeks following the incident. Schedule follow-up meetings with the student, parents/guardians, and relevant staff as needed. Continue collecting data on behavioral incidents and analyze data to identify patterns and refine and improve overall behavior management approaches.

Conclusion

There are several considerations that should inform interventions involving physical management with students. Physical management should always be considered an emergency intervention and restraints should be as brief as possible to reduce the likelihood of harm to everyone involved. Any use of physical management should be followed by debriefing procedures with the student and all staff involved to identify modifications that can be made to prevent similar incidents from happening in the future.

In our next blog we will discuss the importance of ongoing training and education and overall best practices for the use of physical management.

Read part one of the blog series at: https://qbs.com/best-practices-for-physical-management-in-classrooms-understanding-challenging-behavior-and-how-to-prevent-it/

 

 

References

Center on PBIS. What is PBIS? Retrieved from: https://www.pbis.org/pbis/what-is-pbis

U.S. Department of Education. Restraint & Seclusion. Retrieved from: https://www2.ed.gov/policy/seclusion/index.html

Ben Ross is a Master Trainer based in Ypsilanti, MI and has been an integral part of the QBS team for over two years. Before joining QBS, Ben spent six years working in clinic-based and home-based services, supporting individuals with autism using applied behavior analysis (ABA). In his previous organization Ben was a Safety-Care Trainer delivering in-house training to staff. Ben’s passion for training staff inspired him to become a Master Trainer at QBS.

Ben’s interests in behavior analysis extends beyond training, especially when it comes to his advocacy for mindfulness. With a Master’s degree in Counseling Psychology, he has a deep interest in mindfulness-based interventions. Through his work in college settings and with children and teens in Child Protective Services, Ben has witnessed firsthand how mindfulness practices can benefit both clients and practitioners alike.

Watch the full interview to learn more about Ben and how you can implement mindfulness practices in your day-to-day life.

Read Ben’s blog on the role of mindfulness in de-escalation: https://qbs.com/calm-in-the-chaos-the-role-of-mindfulness-in-de-escalation/

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