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Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with Serious Emotional
Disturbance/Behavior Disorders
US Office of Education 84.325K
H325K080308
University of Utah: High Incidence Grant
Joe Viskochil

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© Oregon Technical Assistance Corporation, and Oregon Office of Developmental Disability Services

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Provides training in Positive Behavior Support
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Grounded in the understanding and assessment of the
"meaning" of the behavior.
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Designed for people who intervene physically or nonphysically to keep individuals from harming self or others.
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Based on a proactive approach that includes evasion, deflection and escape from holding.

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1.
Respect for individuals comes first and is a requirement in any transaction between people.
2.
People who provide support to those who have challenging behavior must receive support as well.
3.
Behavior is a form of communication.
4.
Understanding of the causes and context of the behavior can aid the individuals to develop alternative, and often very creative, approaches to situations.
5.
Alternatives are always based on positive approaches-aversive or punishing approaches are never used.

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Training: 2 day (16 Hour) workshop emphasizes
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Understanding the underlying causes of behaviors
How to avoid situations that may result in physical aggression
How to avoid physical injury if such behavior occurs.
Cost ranges from $50.00-120.00 for each registrant
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Trainees
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Learn skills to prevent challenging behavior and avoid injury
Earn certificates of completion given demonstrated their skills
Can be anyone: Families, vocational staff, educators
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Trainers
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Certified by CCI/OIS
CCI continues to provide oversight and review of the trainers
Trainers and staff must be recertified every 2 years

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Skills, attitudes and temperaments necessary for people who provide support
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To recognize and avoid abusive behavior and instead promote caring and supportive behavior
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To maintain self control in crises and stressful situations
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How to analyze behaviors, contributing factors and functions of the behavior
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To build behavior supports and develop an effective plan for positive behavior intervention
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Physical methods of keeping people safe in the event of potentially unsafe behavior

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OIS is approved and regulated through the state Senior and
Disability Services office and its contractor, Center for
Continuous Improvement/Oregon Intervention
System(CCI/OIS).
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Approved by the Oregon Mental Health and Developmental
Disabilities Services Division (MHDDSD)
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Follows framework of intervention strategies outlined in
Oregon’s Administrative Rules

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Written Policy: The program shall have and implement a written policy concerning intervention procedures
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Implementation: A decision to implement a program to alter an individuals behavior shall be made by the Individual
Support Plan (ISP) team and the program described fully within the individuals ISP
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Documentation: Documentation regarding the behavior program shall include documentation of
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Informed consent of individual, guardian and ISP team
All programs and methods used to develop an alternative behavior
A functional analysis of the behavior

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Restraint: Restricting the movement of an individual or restricting the movement or normal function of a portion of the individuals body
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Physical restraint is only employed:
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As part of an Individual Support Plan intended to lead to less restrictive means of intervening
As an emergency measure if necessary to protect the individual or others from immediate harm
As a health related precaution prescribed by a physician if necessary for a specific medical or surgical procedure

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OIS prohibits the use of physical intervention in situations other than protection from immediate harm
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Any form of punishment in any intervention is also prohibited
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Abusive Techniques: outside parameters of good practice
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Humiliate or deliberately cause pain or discomfort
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Abuse of Techniques: correct techniques applied inappropriately
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Unnecessary, too long, unauthorized restraints or interventions

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Physical Preparedness: appropriate attire and mobility
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Self Control: use a preplanned response to avoid overreacting
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Behavior Plan: ISP must be developed and agreed upon
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Any possible interventions to be used must be
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Documented
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Explained
Monitored
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Functional Assessment: must accompany the Behavior Plan
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Consider nature and meaning of behavior
Close observation of antecedents, behavior and consequence
Appendix of training manual includes OIS 2000 Functional
Assessment

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Plan A: The Pro-Active Plan
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Quality of life issues, person-centered thinking, daily living skills
Replace problem behaviors with alternatives
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Plan B: Reactive Response Plan
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Make needed changes based on early warning signs
Reduce the likelihood of escalation and resume Plan A
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Plan C: Crisis Intervention
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Any restraints to maintain health and safety
Use only if the individual is at risk of harming themselves or others and after all other efforts have failed
Must be approved, documented and reviewed

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Phase 0 (Current Status): Observe and minimize triggers
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Use Plan A strategies
Routine Supervision
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Phase I (Triggering): Redirect or emphasize self-control
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Plan B Strategies
Close Supervision
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Phase II (Escalation): Crisis communication
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Simple and Direct communication
Constant Supervision

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Phase III (Crisis): Potential evasion and restraint
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All intervention efforts must be specified in Plan C
Constant, multiple supervision
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Phase IV (De-escalation): Continue crisis communication
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Do not discuss consequences
Plan C component
Close supervision
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Phase V (Depletion): Remove restraint, active listening
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Close supervision for SIB, suicide or running away
Positive supports outlined in Plan B
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Phase VI (Stabilization): Reinstate Plan A activities and supervision

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Reasonable response is just enough intervention to prevent injury, and no more than necessary
SETTING/EVENT
Intimidation/Threats
REASONABLE RESPONSE
-No physical restraint
-No physical intervention
-Only physical contact to separate
Physical Contact Made
Self Injurious Behavior
For non-serious injury
-Evasive maneuvering, covering and deflecting attack
For serious injury
-Whatever is reasonable to maintain safety (restraint, 911)
Threat : redirection techniques
Non-serious contact : non-restraint
Serious contact : manual restraint

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Self Control: develop and practice self control plan
Observe and Identify: signals, setting events and triggers
Communication: Keep It Simply Stated (KISS)
Timing: use intervention strategies only when appropriate
Patience: even if strategies seem ineffective
Spontaneity: be able to modify or individualize techniques

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Be patient: the episode cannot last forever
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Most crises will be over in less than 3 minutes
Control yourself: avoid excessive force and poor judgment
Maintain personal space: crowding increases risk for both
Maintain communication: use names and brief directives
• e.g. “JOE!! Stop! Sit Down!”
Stay out of the way: stay out of striking distance
Move with the attack: move away in circular patterns
• its easier to deflect than block an attack

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Get out of the way: stay balanced and move smoothly
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Continue to communicate
Cover up: cover vital areas while moving away
Deflect blows and kicks: physical contact is momentary
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Make no attempts to hold or control individual
Close the attack by deflecting blow across middle of individual, but do not plant your feet and push
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Escape holding attacks: move toward point of contact
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Do not attempt to use pain to escape
Individual may not perceive pain; sets a bad example; is abusive
11.
Call for help

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 Forearms in front of chest
 Fingers on sides of chin, palms out
 Elbows tucked into ribs
 Feet more than shoulder width, one several inches back
 Knees flexed to 90 degrees
(sitting on chair

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PIVOT (ex: left foot pivot)
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Keep left foot still
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Pivot on ball of left foot
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Move in circular sweep
Move backwards
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FRAMING
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Arms outstretched, elbows bent
Hands perpendicular to floor
Hands six inches apart
(forming a window)
View attack through window, deflect
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BACKSTEPS
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Move rear foot back
Maintain balance
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Slide front foot back
Back straight and chin up
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SIDESTEPS (ex: move to right)
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Pull left foot into right
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Push right foot out
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Keep feet close to floor/slide
Back straight and chin up

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STEP
Stand shoulder to shoulder
Face slightly outward
Feet 200% of shoulder width
Inside foot forward
Inside knee more flexed
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BACKSTEP
Move rear feet backward
Slide front feet back
Keep feet close to the ground
Move in unison
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KNEEL
Separate legs as far as possible, maintaining comfort and balance
Lock inside hands
Kneel down on inside knee
Touch floor with locked hands
Keep back straight and chin up at all times

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Manual restraint is only appropriate when:
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Responding to very challenging and potentially injurious behavior
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The behavior can be controlled with restraint
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The intervention care-givers are sufficiently trained and can reasonably expect to achieve safe control

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Master evasion techniques
Master control techniques
Get a grip (grab clothing, if possible)
Use weight, not strength
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Avoid pain
Use only a reasonable response
Maintain a proper ratio (at least 2:1)
Be a team player (one leader communicates and directs)
Select least intrusive restraint position
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Monitor breathing and circulation (no pressure on bones, joints, lungs)

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BALANCE CONTROL
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One hand grasps belt, other grasps clothing between shoulder blades
Never grasp directly on the spine and always move backwards
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ONE AND TWO ARM SUPPORT
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One arm is held close to the chest with caregivers arm laced inside the elbow and holding the individuals same side arm away from the wrist
Other arm is free (one arm) or held by another caregiver (two arm)
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COUCH RESTRAINT
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Two staff hold individual on a couch
Less danger of falling or being knocked down

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ESCORT POSITION
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Individual is held in standing position and forcibly walked
Individuals may calm during brief restraint, remove force
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WALL RESTRAINT
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Individual is held with their back to the wall if escort is not possible
Individual can slide down wall into couch restraint
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PRONE FLOOR RESTRAINT
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Only used if all other restraints have failed
Individual is held face down on floor, limiting large major muscles
Use of a supine position allows larger muscles to be used
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Recommended only for obese, pregnant, and sexually abused
Must be authorized by the OIS Steering Committee, in writing, before its implementation

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Websites www.otac.org
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Not very relevant
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Defines OIS
Includes training opportunities
 http://forcci.org/oishomepa ge.html
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Brief description
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Program philosophy
Contact info
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None
Training Media
Article Search
 Google Scholar: None
 ERIC: None
 PsycINFO: None
 PsycARTICLES: None
 Psychology and Behavioral
Sciences Collection: None

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Kelley M Gordham, Director
Oregon Intervention System
Director, Special Projects
Center for Continuous Improvement
900 Main St, Suite 200
Oregon City, Oregon 97045
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503-594-1250, ext 27 fax 503-594-1258
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Kgordham@FORCCI.ORG