Redefining Crisis Prevention with a Systematic Approach to Reducing Physical Management

A recap of the Safety-Care Live session presented by Melissa Meotti, BCBA

If your team uses physical management, even occasionally, you have probably been trained to release when the individual shows a period of calm behavior. It feels intuitive. It feels safe. And according to the research Melissa Meotti, BCBA, walked through in our latest Safety-Care Live webinar, it may be one of the reasons incidents last as long as they do.

That finding anchored a session built around a bigger idea: reducing physical management is not one decision. It is a system. Prevention strategies reduce how often physical management happens. Evidence-based release criteria reduce how long it lasts when it does. Teams that address both sides of the equation see the biggest change.

Here is what Melissa covered, and what your team can start doing about it.

Prevention comes first

The most effective physical management incident is the one that never happens. Melissa grounded the first half of the session in prevention strategies that reduce the need for physical management in the first place:

Modifying the environment. Many crises are predictable. When teams look closely at the conditions that precede escalation, they often find changes they can make before behavior ever intensifies: adjusting transitions, reducing known triggers, and building environments that set individuals up for success.

Non-contingent reinforcement. Providing access to preferred items, attention, or breaks on a schedule, rather than only in response to behavior, reduces the motivation for challenging behavior before it starts.

Functional communication training. When individuals have a reliable, efficient way to communicate what they need, they have less reason to escalate to get it. FCT remains one of the most well-supported interventions in the behavioral literature for exactly this reason.

The Wait Strategy. Sometimes the most effective response is a structured pause. Giving an individual time and space, with staff trained on exactly how to do that without compromising anyone’s safety, can prevent a tense moment from becoming a crisis.

None of these strategies are new to behavior analysts. What the session emphasized is treating them as an organizational system rather than individual staff judgment calls. Consistency across the team is what turns good strategies into measurable reductions.

The release criteria question most teams have not asked

The second half of the session addressed something far fewer organizations have examined: what determines when a physical management incident ends?

The most common answer is behavior-contingent release. Staff wait for a period of calm behavior, often specified for each individual, then release. The logic seems sound. But Melissa walked through research suggesting this approach can actually extend incidents and, in some cases, reinforce the very behavior teams are trying to reduce. Waiting for calm is not a neutral choice. It is an intervention, and the data on it deserves scrutiny.

The alternative she presented is Fixed-Time Release: releasing after a predetermined amount of time, regardless of behavior in the moment.

The case study she shared made the stakes concrete. A client was experiencing physical management incidents daily. Clinicians changed one variable, switching from behavior-contingent release to Fixed-Time Release with a fading procedure. Within weeks, incidents dropped to zero. Same individual. Same behavior profile. Different release rule.

For teams concerned that a fixed-time approach sounds risky, Melissa addressed this directly: Fixed-Time Release is implemented within a structured safety framework, with trained staff, clear procedures, and ongoing data review. It is not releasing and hoping. It is replacing an untested assumption with an evidence-based procedure.

What your team can do next

Melissa closed with practical steps at every level:

Before crisis: Audit your prevention practices. Are strategies like modifying the environment, non-contingent reinforcement, and FCT applied consistently across staff, or only by your strongest team members?

During crisis: Review your release criteria. If your organization defaults to waiting for calm behavior, ask what data supports that choice, and whether a Fixed-Time approach with appropriate fading procedures deserves consideration.

At the systems level: Strengthen your data review process. Incident frequency and incident duration are separate metrics, and both should inform your training and clinical decisions.

The bigger picture

Safety-Care allocates the majority of its training time to prevention and de-escalation because the evidence points in one direction: crisis prevention works. Organizations implementing Safety-Care have documented reductions of 58% or more in physical management use, along with fewer injuries and greater staff confidence.

This session extended that prevention focus into territory many programs never address. Reducing how often physical management happens matters. So does reducing how long it lasts. Both are within your team’s control.

References

Luiselli, J. K., Pace, G. M., & Dunn, E. K. (2006). Effects of behavior-contingent and fixed-time release contingencies on frequency and duration of therapeutic restraint. Behavior Modification, 30, 442- 455.

Luiselli, J. K. (2008). Effects of fixed-time release (FTR) fading on implementation of physical restraint. Mental Health Aspects of Developmental Disabilities, 11, 1-6.

Luiselli, J.K. (2009). Physical restraint of people with intellectual disability: A review of implementation reduction and elimination procedures. Journal of Applied Research in Intellectual Disabilities, 22, 126- 134.

Luiselli, J. K., Treml, T., Kane, A., & Young, N. (2000). Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities. Behavioral Interventions, 15, 317-330.

Mace, F. C., Page, T. J., Ivancic, M. T., & O’Brien, S. (1986). Effectiveness of brief time-out with and without contingent delay: A comparative analysis. Journal of Applied Behavior Analysis, 19, 79-86.

Wallace, M.D., Iwata, B.A., Hanley, G.P., Thompson, R.H., & Roscoe, E.M. (2012). Noncontingent reinforcement: A further examination of schedule effects during treatment. Journal of Applied Behavior Analysis, 45(4), 708- 878

Wordsell, A.S., Iwata, B.A., Hanley, G.P., Thompson, R.H., & Kahng, S. (2000). Effects of continuous and intermittent reinforcement for problem behavior during functional communication training. Journal of Applied Behavior Analysis. 33(2), 137-270.