Reactive Strategies Protocol
Name: Edna Carry
Protocol Name: Reactive Strategies
Date Initiated:
Date Modified:
Prepared By: Dr. Thomas J. Willis
Criteria: Clinical Review
Efforts to manage the antecedents to Edna’s behavior are likely to have considerable
benefit. However, these behaviors are likely to continue in spite of such efforts. Staff / Mentor
will need measures for dealing with these behaviors when they occur. The following
procedures are suggested as initial reactive strategies. These procedures and others are
explained in more detail in the “Emergency Management Guidelines” published by IABA.
1.
Don’t Ignore. If Edna is upset, it will do no good to ignore her. There is good evidence
that ignoring will only make the problem worse. Without some response, Edna is likely
to continue to escalate.
2.
Help Her Communicate The Problem.
good reason in her mind.
When Edna escalates, there is usually a
a.
Use Active Listening to help Edna express the nature of the problem. Active
Listening itself may help de-escalate the problem by just providing an
“understanding ear.”
b.
Ask strategic questions to help Edna express the problem. Indeed, you may
know the problem. Here are some examples:
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Is something bothering you?
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Is there a problem I can help you with?
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Do you want something?
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Do you have a problem?
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What’s wrong?
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How are you feeling?
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Are you feeling OK?
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You seem to be upset about something?
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Some other phrases that might assist in encouraging the person to
communicate include “Tell me what is wrong”, “Tell me about it”. Simply showing
interest and vocalizing “hmmmm,” or “uh huh,” may be sufficient to help the
person communicate. At least it conveys the person an air of understanding
which in and of itself may have a calming effect.
3.
Help Her Solve The Problem. Once the problem is identified, discuss with Edna some
ways to solve the problem.
4.
Negotiate a Solution.
Edna may feel that what is being asked is unreasonable.
Discuss with her the problem and negotiate a solution (e.g., “One more and we are all
done.” “Why not stop and come back to it later.”).
5.
Facilitate Communication and Relaxation.
Prior to engaging in physically
aggression, property destruction or self injury, Edna may appear to be agitated or angry.
Intervention at the time she manifests these precursors may reduce the likelihood of
more severe behaviors appearing. Thus, the following approach is suggested.
When Edna initially displays agitated actions or appears to be angry, YOU should
encourage her to verbalize or in some way communicate her problem. Every effort
should be made to actively listen to messages that she is sending at the moment (e.g.,
“Leave me alone.” “I don’t want to do this.”).
If Edna continues to be agitated, YOU should encourage her to practice her
relaxation exercises with you. Basically, she should be encouraged to relax her hands
and arms, and to breath deeply and slowly. These instructions should be presented
slowly and in a low voice, and with gestures that are consistent with directions to calm
down. REMEMBER, she should NOT be forced to relax. Simply modeling may do the
job.
Edna should be encouraged to move to a quiet area where she can better gain
control. YOU might say to her “C’mon Edna. Let’s go to your room where we can talk
privately.” Once there, Edna should be encouraged to turn on her favorite “calming
music.” Calmly, quietly, using active listening along with gentle suggestions, YOU
should help Edna discuss the problem she is having and help her to gain control.
6.
Stimulus Change Strategies. At the time of an incident, or as Edna is escalating, the
introduction of a novel stimulus may interrupt the course of or terminate aggressive and
self injurious actions. Here are some examples:
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begin singing,
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7.
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engage in uncontrollable coughing,
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knock something on the floor and become totally consumed on what you did and
the need to clean it up,
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start sneezing,
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activate your beeper or phone and play like it is really something important,
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play like you forgot something important,
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ask her if she has heard any good jokes recently,
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tell her a joke (be sure you know some),
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begin dancing and acting the “fool,”
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ask her to help you “squib the nibbit,”
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ask her why the chicken crossed the road,
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drop your change on the floor and ask her to help you pick it up,
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respond to something that you hear or see (e.g., What is that” It sounds like a
siren. I wonder if there is a fire?).
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make a loud noise,
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begin swatting at imaginary flies,
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do a somersault,
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get down on the floor and begin searching for something important; and ask
Edna to help.
Instructional Control. Providing an instruction that evokes a competing behavior
might stop an aggressive, property destructive or self injurious episode (e.g., “Give me
the .” “Get me the .” “Help me .”). Asking a question may evoke a response that
also competes with such behavior (e.g., “What did you do at ?” “Where is your ?”
“Where is your radio?”). Indeed, asking Edna to help may interfere with her escalation
or the ongoing occurrence of the behavior. Here are some examples,
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Ask her to help you with something you are doing.
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Ask her to run an errand with you.
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Ask her to do you a favor.
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Ask her to help you unload something, rearrange something, help get ready for
something, etc.
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8.
8.
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Ask her to look up something that the two of you will do later in the day.
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Ask her to do something she likes (e.g., put on makeup, read with you, etc.).
Self Monitoring Instructions. Edna’s support plan contains a variety of reinforcement
and monitoring strategies so that she can “track” her own performance. One way to use
these devices effectively is to bring her attention to the “Monitoring Device” frequently
throughout the day; in other words, to encourage “Self Monitoring.” They can also be
used before a crisis and when a she is seen to be escalating into a potential crisis. The
judicious encouragement to “Self Monitor” may be all that is needed to encourage her to
use her “Self Control.” Here are some examples:
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“Hey, what time is it? Is it time to circle more points?” (Progressive Point Shift DRO)
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“How many points have you earned today?”
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“How many boxes have you earned on your PICK A PRIZE sheet?”
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“Hey let’s do our relaxation exercises so we can make some monopoly money”
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“I really want you to earn your points, Edna. What can we do to relax?”
Geographical Containment. (See 4.1 through 4.4 in the Emergency Management
Guidelines).
I would like to suggest just a couple of examples of this treatment
strategy that may apply particularly to Edna.
For example, when Edna is coming
toward staff to assault, they should not stand there in the open with hands and body
bared, prepared for physical contact. Rather, unobtrusively staff should move
themselves behind a table, a couch, a large tree, a bush, etc., and keep the object
between them and Edna. At the same time, the de-escalating verbalizations described
above should be used. This is an example of judiciously using the environment to
reduce the likelihood of physical contact. If Edna is approaching another person (e.g.,
child or adult), it may be necessary for staff to place their body between Edna and her
target. This can be done in a “bumping” fashion as staff might be using a range of
stimulus change and instructional control strategies.