School Wide Strategies in Managing Defiant/Non- Compliant Behaviors

Transcription

1 School Wide Strategies in Managing Defiant/Non- Compliant Behaviors Daniella Armendariz, LPC-Intern Program therapist El Paso Behavior Health System Suzette Saucedo, LPC-Intern Program therapist El Paso Behavior Health System

2 Purpose of Presentation Provide an overview of challenging behaviors Present techniques in managing difficult situations with challenging behaviors Present techniques for effective communication Describe proactive interventions for changing challenging behaviors Identify stages of crisis and working styles

3 Basic Common Behaviors Level 1: Ordinary Behaviors E.g. Cleaning, Homework, daily routines Level 2: Extra-Ordinary Behaviors E.g. Ditching, drugs, mischievous etc. Level 3: Negative Character Traits E.g. Lying, aggression, cheating, dishonesty etc. Goal: Parent Modification Goal: Channeling/Remove Behavior Goal: Replace/eliminate behavior

4 Challenging Students Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors.

5 Defiance : Full of or showing a disposition to challenge, resist, or fight. : full of or showing defiance. : bold, impudent defiant rebels a defiant refusal. -Merriam Webster Dictionary

6 DSM-IV Oppositional Defiant Disorder Intermittent Explosive Disorder Conduct Disorder Other Specified Disruptive, Impulse-Control, and Conduct Disorder Unspecified Disruptive, Impulse-Control, and Conduct Disorder

7 DSM-5 Diagnostic Criteria Oppositional Defiant Disorder (F91.3) A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. Angry/Irritable Mood 1. Often loses temper. 2. Is often touchy or easily annoyed. 3. Is often angry and resentful. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults. 5. Often actively defies or refuses to comply with requests from authority figures or with rules. 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehavior.

8 Oppositional Defiant Disorder Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months.

9 ADHD Predominantly inattentive type (easily distracted, poor concentration) Careless mistakes in school work Limited attention to detail Poor follow through/organizational skills Loses items Forgetful Predominantly hyperactive-impulsive type (taking risks, interrupts) Fidgets Running around at inappropriate times Difficulty staying seated Talks in excess Poor impulse control Interrupts others Combination type (trouble staying on task, always on the go, constantly talking)

10 Trauma Defined An event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being

11 Types of Trauma Psychological, physical, or sexual abuse Community or school violence Witnessing or experiencing domestic violence Natural disasters or terrorism Sudden or violent loss of a loved one Military family-related stressors Neglect Serious accidents or life-threatening illness

12 Signs of Traumatic Stress Preschool Children Fear of being separated from their parent/caregiver Cry or scream a lot Eat poorly or lose weight Have nightmares Elementary Children Becoming anxious or fearful Feelings of guilt or shame Having a hard time concentrating Having difficulty sleeping Middle and High School Adolescents Feeling depressed or along May develop eating disorders or self injurious behaviors Abusing drugs or alcohol

13 Stages of Crisis and Working Styles Stage 1 Stage 4 Stage 2 Stage 3

14 Stage 1 Student Behavior Pacing Talking fast and loudly Isolating, not participating Fidgeting Intervention Listen to the student, allow for venting and build rapport Focus on their feeling (don t say calm down, anxious students or upsets students often don t have control over their emotions) Ask open ended questions Recognize signs of rising tension Reduce the level of stimulation

15 Stage 2 Student Behavior Adrenaline State (less rational, not hearing) Refusal, significant noncompliance Threatening- verbally or non-verbally, direct or indirect threats Intervention Validate the person s feelings, mention their escalating behavior and give options Use body language to minimize threat Provide reasonable alternatives Help student find a way out of their dilemma Encourage and reinforce the students good choices Demonstrate effective self-control under stress and model problem solving skills

16 Stage 3 Student Behavior Hitting, Kicking, Punching Physically hurting themselves Temper tantrum Imminent risk of danger to self or others Intervention Increase external structure, as the students internal control weakens Calmly set clear limits and expectations for behavior Assure the safety and security of everyone Provide only the necessary control required, not through intimidation or the abuse of power

17 Stage 4 Student Behavior Release of tension through crying of venting Return to baseline, recovering from adrenaline state Express feelings of guilt Directable Intervention Learn and share from the incident Staff focus is on feelings and behavior. Teachable moment Help the student regain control

18 Working Styles in Crisis Client Centered Compliance Minimalist Charismatic Credibility

19 Client Centered Most attentive to the client s feelings, thoughts, and experiences Least attentive to the client s behavior Relies upon the use of good communication and active listening skills Facilitates the expression of strong emotions Most appropriate when the client exhibits good behavioral control

20 Compliance Primary concern and focus is upon the client s behavior States the rules, consequences, and facility policies Clearly states behavioral expectations Directly addresses escalating or dangerous behaviors Provides the necessary external controls for the out of control student

21 Minimalist Is not particularly focused upon feelings or behavior Leaves change up to the student Tends to be the least stimulating style May be the best choice if escape is not possible for student in crisis Uses selective ignoring of a student behavior, and statments

22 Charismatic Characterized by the use of humor, but not at the students expense Relies upon the quality of the staff-student relationship Promotes mutuality and identification with students Reflects both a students feelings and behavior and offers reasonable alternatives Able to respond non-defensively when provoked or challenged

23 Credibility Opportunity for the student to learn more appropriate ways to get their needs met Primarily a teaching style Ideal style for processing an incident in the postcrisis stage Engages the student in self-reflection and problemsolving Seeks to help establish rapport

24 What Working Style is the Best?

25 Client- Centered Stage 1 Tuning-In to feelings Communication Skills Developing Rapport Structuring Active Listening Re-Establish Rapport Re-Open verbal window Develop Insight Problem-Solving Evaluate and Follow up Credibility Stage 4 Stage 2 Charismatic Use of Self in managing anger Communicate non-verbally to reduce threat Reflect feelings and behaviors Increase Rationality through verbal intervention Setting limits and Provide choices Reduce Stimulation Maintain Rapport Remain Calm Selective Ignoring Stage 3 Observing the signs of violence Ensure Personal Safety Follow through on limits Increase structure Escort to designated area Minimalist Compliance

26 Effective Tools for De-escalation

27 When Calming an Agitated Student Create a Safe Setting Limit the number of adults involved Provide adequate personal space Do not block escape routes

28 Calming an Agitated Student Show open accepting body language Allowing a cool down break Ask open-ended questions Assign reflective processing essay after misbehavior Give praise that is specific and does not embarrass the student Give problem students frequent positive attention Project calmness when approaching an escalating student Relax before responding Use non-verbal and para-verbal behaviors to defuse potential confrontations

29 Other Ideas to De-escalate Defiant Behavior Reassure the student and frame an outcome goal Identify the student wants and feelings Identify points of agreement Validate the students emotion by acknowledging it Keep verbal interactions respectful Communicate using simple direct language (E.g., John, please start your math assignment now. ) Wait a reasonable time for the student to comply (e.g., 5-20 seconds). Coach the student to take responsibility for moderating behavior

30 Have a Plan in Place Key to Maintaining Effective Behavior Prevention Expectations Monitor Encouragement Correction

31 Effective Communication Strategies

32 Active Listening Communication Techniques I-Centered Statements Pairing of Criticism with Praise (e.g. "Let me be sure that I understand you correctly ). "I want to summarize the points that you made, so that I know that I heard you right "So from your point of view, the situation looks like this " Instead of saying "You are always disrupting class with your jokes and fooling around!" Say, "Zeke, I find it difficult to keep everybody's attention when there are other conversations going on in the classroom. That's why I need you to open your book and focus on today's lesson." (a) Describe the problem behavior that you would like to see changed (b) Clearly outline appropriate behavioral alternatives (b) praise the student about some other aspect of his or her behavior or accomplishments, and finally (c) State that you value having the student as a part of the classroom community

33 Pairing of Criticism with Praise 1. Description of problem behavior: "Trina, you said disrespectful things about other students during our class meeting this morning. You continued to do so even after I asked you to stop." 2. Appropriate behavioral alternative(s): "It's OK to disagree with another person's ideas. But you need to make sure that your comments do not insult or hurt the feelings of others." 3. Specific praise: "I am talking to you about this behavior because I know that you can do better. In fact, I have really come to value your classroom comments. You have great ideas and express yourself very well." 4. Affirmation statement: "You are an important member of this class!"

34 While you can never predict behaviors your students might bring to school, you will usually achieve best outcomes by remaining calm, following pre-planned intervention strategies for misbehavior, and acting with consistency and fairness

35 Questions????

36 References: Cowin, L, Davies, R., Estall, G., Berlin, T., Fitzgerald, M., & Hoot, S. (2003). De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing, 12, Defiant. Merriam-Webster.com. Merriam-Webster, n.d. Web. 27 November Diagnostic and Statistical Manual of Mental Disorder DSM-5 th Edition (Copyright 2013), first Published in the United States by American Psychiatric Association Publishing, Arlington, VA. Copyright All rights reserved. Fishkind, A. (2002). Calming agitation with words, not drugs: 10 commandments for safety. Current Psychiatry, 1(4), Richmond, J. S., Berlin, J. S., Fishkind, A. B., Holloman, G. H., Zeller, S. L., Wilson, M. P., Rifai, M. A., & Ng, A. T. (2012). Verbal de-escalation of the agitated patient: Consensus statement of the American Association for Emergency Psychiatry Project BETA de-escalation workgroup. Western Journal of Emergency Medicine, 13(1), U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author.