d6-emergency protocol copy€¦ · in today’s class you will learn… d-6 implement...

Registered BehaviorTechnician Course

Presented by Chaza Attar, BCBA�2

The course content was created by Chaza Attar and is the property of Autism Therapy & Training Inc.

All rights are reserved

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This training program is based on the Behavior Analyst Certification Board (2018) RBT task list (2nd ed.) and is designed to meet the 40-hour training requirement for the RBT credential.

The program is offered independent of the BACB.

Program Information

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Remember!● Quiz● Active Listening● Scrabble Words

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In today’s classYou will learn…

D-6 Implement crisis/emergency procedures according to protocol

● Prevention and Safety● Protection and de-escalation● Treatment● As an RBT and frontline staff, you will be faced

with a variety of behaviors.● It is essential that you are trained accurately on the

implementation of protocols and strategies. �6

CrisisPrevention

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● Severe problem behaviors put both the client and others in danger.

● It is our top priority to keep our clients safe, as well as ourselves and others.

● It is essential that antecedent interventions are used to identify triggers to problem behaviors.

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CrisisPrevention

● Handling problem behaviors can sometimes be overwhelming and cause some distress.

● Remember, don’t take the behavior personal. It’s not about you.

● Try to be understanding and empathetic.● Stay calm and do not overreact

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CrisisPrevention

● Don’t judge.● Use non provoking verbal and nonverbal behaviors.● The way you stand, position your hands or words you

use.● Precursor behaviors are behaviors that precede the full

blown behavior● Understanding triggers of the problem behavior● Identifying precursor behaviors that occur ● i.e. throwing a toy, stomping around the room

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CrisisPrevention

● Know your learner and what may trigger them.○ Loud noises, strong scents, messy classroom,

touching their shoulder, saying a specific word○ Removal of a reinforcer or denial of a reinforcer○ Hunger, thirst, too warm, need to use the washroom○ Wet sleeves

What triggersYour learner?

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● If you know your learner comes in tired and typically will engage in problem behavior because of this, what do you do?○ Start the day slow (warm up to the day)○ Start with easy and fun tasks (mand training, playing with

most preferred activities)○ Avoid jumping into hard tasks or programs right from the

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AntecedentStrategies

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Ask Yourself!● When was the last time they ate?● When did they last drink? ● Is the learner looking sick?● Have they been to the washroom?● Are they warm to the touch?● Check the session notes ● Slept well? Ate well? Good morning?

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● Our goal is to prevent a crisis. We do NOT want to provoke behaviors

● We want to protect the learner from harm and injury at all times

● We want to de-escalate the behavior as quickly as possible● Aggressive, self-injurious behaviors and property

destruction are crisis behaviors that we want to decrease or prevent

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PreventativeMeasures

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● If there is no behavior protocol, don’t run a protocol to decrease some behavior

● Ensure you are running programs accurately so that you are not triggering behaviors

● Pay close attention to your learners body language and facial cues

● If a behavior occurs, protect the learner, yourself and other students �14


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● When precursor behaviors occur, an RBT should be near the learner (1-2 arms length away)

● Depending on the learner and the severity of their behavior, you don’t want place further demands on the learner

● Give them time to settle down and then redirect them

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● Be prepared and ready to de-escalate● Keep your hands in a neutral position ● Low hands near waistline, for young children● High hands near chest area, for taller individuals● Keep fingers together

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● Keep your environment safe.● Individuals that engage in severe behaviors may

use objects or items in the room as weapons. Remove these objects.

● No hot drinks in the room, sharp objects, scissors, pencils may need to be removed from the environment.

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● Keep your client safe. Protect their head by placing your hands in a way to block self-injury or bangs against hard surfaces.

● Don’t remove the client from the room. This can cause injury to you or the client.

● Keep others safe. Remove others from the room.● Keep yourself safe. Always stand behind or beside the client

when handling a behavior, never in front. ● Don’t corner yourself in a room.● You will need a strong communication system. Code phrases or

words to alert other staff. Call for help. �18


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Imagine…● Mike is 14 years old and engages in severe aggression.

Pulling on anything he can see, ripping things, throwing objects and running out of the room.

● Sarah is a therapist working with Mike in his treatment centre. ● She’s going out with the girls later tonight and decided to wear

high heels, her beautiful long earrings and straightened her hair and left it untied.

● She has been growing her nails for this evening and got them painted. She’s so excited.

● She figured she’s only working with Mike for an hour.�19

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● Mike came in to the treatment centre in, what everybody describes as a, “bad mood”. Sarah only has the hour so she places all his program targets on him to get through it quickly.

● Mike begins throwing the teaching material, but Sarah keeps going. Then he pulls her hair and drags her across the room.

● He finally releases her hair and runs towards the door. Sarah gets up and starts running, but is having a hard time with the heels she has on.

● She gets close enough and grabs him so he doesn’t leave the school, but she scratches his arm instead.

● Mike drops to the floor and his arm is bleeding.�20

Imagine…

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What went wrong?

Code● Avoid earrings● Avoid items in your hair such as hair clips that can

be removed and used as a weapon.● Avoid necklaces or any items around your neck

such as a scarf that could be used to choke you.● Wear long sleeves when working with children that

pinch or scratch to protect your skin.

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Dress

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● Wear running shoes and comfortable clothing● Avoid flip slops, slippers that could slow you down

when a behavior occurs● Avoid tight clothing● Avoid high heels● Keep your hair up and away from the client’s reach● Clipped nails

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Dress

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Code● The next day, Sarah comes in wearing running

shoes, no jewelry and her hair tied back. ● As she’s working with Mike, she pulls out all his

favourite activities and games. She plays with one then places it on the floor, plays with another then places it on the floor. All around her work area are boxes of activities and games.

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Imagine…

● As they were playing, she told Mike to tidy up because she had to leave for the day. Mike didn’t want to clean up so he pushed her, threw toys at her.

● As she was trying to get up and stop him, she tripped over the activities and fell flat on her face.

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Imagine…

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What went wrong?

● Avoid clutter around your table or classroom.● Keep your area tidy so if a behavior occurs you

can run without tripping or hurting yourself.● Always be ready with learners that are a flight

risk or tend to run.

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● The treatment team decided to use locks on all main doors so that Mike does not escape the classroom.

● They placed them high enough so that he could not reach, but the teachers could.

● One day, one of the staff brings in her learner but forgets to lock the main door.

● Sarah notices the unlocked door from a distance, but doesn’t lock it since Mike will be leaving in 15 minutes anyways. �28

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Imagine…

● As Mike is walking to the washroom, he suddenly bolts to the front door, opens it and leaves.

● Sarah is caught off guard, she ran as fast as she could but couldn’t catch up to him. �29

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Imagine…● Don’t block entrances or exits to the room by using tables

to block. In case of an emergency, this can slow people down.

● Keep all doors locked, use safety locks and handles to decrease the chances of children escaping the classroom.

● Some clients may need to have two staff at all times.● Follow your school or centres protocol

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● If behaviors get out of control and staff are unable to support the client, you may need to call 911.

● Follow your school or centres protocol. ● Be aware of your organization’s preventative

strategies.● If you don’t know them, find out what they are. Do

not wait for that emergency situation to occur�31


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● Sarah took a week vacation and returned to the treatment centre as usual. She sat with Mike and worked with him.

● Mike began biting himself and Sarah attempted to block it, but when she did… he bit her.

● A staff member quickly said “Hey Sarah… did you read the updated protocol?”.

● Sarah had not reviewed any of the protocols. �32

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Imagine…

● Be sure you have reviewed all behavior protocols● If you have been away, revisit them or get updates● Your supervisor is responsible for ensuring proper

implementation.● Weekly supervision or potentially more supervisions

may be required depending on client and your training.

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● Sarah presents Mike with a math test. He begins pushing it away then reaches over and pulls her hair.

● She attempts to remove his fingers by unrolling them, as she was doing that she heard a crack and he began screaming.

● Sarah accidentally broke his finger.�34

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Imagine…

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What went wrong? ● Crisis prevention intervention (CPI) is specific training

on handling behaviors. ● Provides ways to manage crisis behaviors.● Provides correct ways to manage the client to ensure

safety.● See CPI training online for options in your local area.

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InterventionCrisis Prevention

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● Just like CPR and first aid, CPI requires a certified trainer to provide the training.

● If you work with children, teens and adults, it is highly recommended

● Its important to know how to help a client in a crisis situation so that you don’t cause more injury

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InterventionCrisis Prevention

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● Never grab the client by the arm and pull them up to stand. This often occurs with young children.

● Support the learner by placing your hands under the armpits. Don’t pull the client by the wrist or arm.

● Avoid power struggles such as pulling things away or chasing the client.

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During aBehavior

● Use minimal physical touch, instead guide the learner● Be mindful of the learner’s reaction during the

behavior. ● i.e. if they start laughing and seeking your attention.● i.e. during a compliance procedure and following

through, avoid touching the client but rather guiding them to engage in the correct behavior

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During a

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Behavior● Often, after handling a behavior you may feel

exhausted or emotional aroused.● Be sure to speak to your supervisor to express

any concerns.● Take time away to regroup for 5 or 10 minutes.

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After the

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Behavior

● First aid and CPR are offered by certified trainers.● It gives you the knowledge you need to handle

injuries or other serious situations ● All staff should be certified in first aid and CPR● Practice protocol with your team in case of an

emergency and injury● Be ready to handle situations

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First Aid

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++● Stay calm● Keep other children away from the injury site● Keep your learner calm, safe and administer

first aid practices● Call 911, notify your supervisor● Notify the family

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First Aid

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++

QuizTime!

What is the best way to dress when working with behavioral client’s?

A. Flip flopsB. Running shoesC. Bare footD. Slippers

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Questions

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Answers

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What is the best way to dress when working with behavioral client’s?

A. Flip flopsB. Running shoesC. Bare footD. Slippers

What is the best way to dress when working with a client that typically scratches?

A. ShortsB. ScarfC. Long sleevesD. Short sleeves

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Questions

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Answers

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What is the best way to dress when working with a client that typically scratches?

A. ShortsB. ScarfC. Long sleevesD. Short sleeves

What are some preventative measures you can take to ensure a safe environment?

A. Remove clutter from the floorB. Avoid blocking exits and entrancesC. Remove sharp objectsD. All of the above

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Questions

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Answers

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What are some preventative measures you can take to ensure a safe environment?

A. Remove clutter from the floorB. Avoid blocking exits and entrancesC. Remove sharp objectsD. All of the above

What are some preventative measures you can take to ensure your safety?

A. Don’t corner yourself in a roomB. Stand beside or behind the learner when

a behavior occursC. Call for support from other staff membersD. All of the above

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Questions

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Answers

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What are some preventative measures you can take to ensure your safety?

A. Don’t corner yourself in a roomB. Stand beside or behind the learner when

a behavior occursC. Call for support from other staff membersD. All of the above

The RBT was asked to use extinction on Billy’s escape maintained behavior. What would the procedure look like?

A. Let him get away from the taskB. Follow him around the room C. Do not remove the taskD. None of these

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Questions

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Answers

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The RBT was asked to use extinction on Billy’s escape maintained behavior. What would the procedure look like?

A. Let him get away from the taskB. Follow him around the room C. Do not remove the taskD. None of these

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Questions

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The RBT was asked to use sensory extinction for Sarah’s scratching behavior. What would the procedure look like?

A. Tie her hands downB. Put long sleeves on herC. Put gloves onD. None of the above

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Answers

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The RBT was asked to use sensory extinction for Sarah’s scratching behavior. What would the procedure look like?

A. Tie her hands downB. Put long sleeves on herC. Put gloves onD. None of the above

The RBT was working with Tommy who started shaking his head when he was given a task. He then started banging the table. The RBT recognized that these are behaviors that will lead into a full blown tantrum. What are these behaviors called?

A. Problem BehaviorB. Antecedent BehaviorsC. Precursor behaviorsD. Pre-behaviors �56

Questions

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Answers

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The RBT was working with Tommy who started shaking his head when he was given a task. He then started banging the table. The RBT recognized that these are behaviors that will lead into a full blown tantrum. What are these behaviors called?

A. Problem BehaviorB. Antecedent BehaviorsC. Precursor behaviorsD. Pre-behaviors

Your learner is showing signs of distress which usually leads to a full blown aggressive behavior, you should be about…

A. Three to four feet awayB. One to two arms length awayC. In front of the learnerD. Stay back and let it all settle down

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Questions

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Answers

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Your learner is showing signs of distress which usually leads to a full blown aggressive behavior, you should be about…

A. Three to four feet awayB. One to two arms length awayC. In front of the learnerD. Stay back and let it all settle down

Our number one goal is toA. Provoke behaviorB. Prevent a crisis situationC. Escalate a situationD. None of these

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Questions

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Answers

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Our number one goal is toA. Provoke behaviorB. Prevent a crisis situationC. Escalate a situationD. None of these

Linda is a daycare teacher. She has a boy with severe aggression. When a behavior begins he will stomp his feet then kick a chair and will search for a sharp object and attempt to hit someone with it. What should Linda do to ensure everyone’s safety?

A. Put scissors in locked cabinetsB. De-escalate him once she sees him stomping aroundC. Keep pencils and pens at her desk onlyD. All of these �62

Questions

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Answers

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Linda is a daycare teacher. She has a boy with severe aggression. When a behavior begins he will stomp his feet then kick a chair and will search for a sharp object and attempt to hit someone with it. What should Linda do to ensure everyone’s safety?

A. Put scissors in locked cabinetsB. De-escalate him once she sees him stomping aroundC. Keep pencils and pens at her desk onlyD. All of these

Linda is a daycare teacher. She has a boy with severe aggression. All the teachers bring their hot coffees into the classroom and place them high on a shelf. What should Linda do to ensure everyone’s safety?

A. Bring the coffee’s to a lower shelf to prevent a spillB. Do nothing, the coffees are high on a shelfC. Tell the teachers to keep their coffees in the staff

room onlyD. All of these �64

Questions

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Answers

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Linda is a daycare teacher. She has a boy with severe aggression. All the teachers bring their hot coffees into the classroom and place them high on a shelf. What should Linda do to ensure everyone’s safety?

A. Bring the coffee’s to a lower shelf to prevent a spillB. Do nothing, the coffees are high on a shelfC. Tell the teachers to keep their coffees in the staff

room onlyD. All of these

The RBT denies John access to his preferred reinforcer because he made a mistake on his math worksheet. John has tendencies of throwing tables and chairs when denied access to a reinforcer. There is no protocol in place. John begins screaming and throwing chairs. What should the RBT do?

A. Call for helpB. Have other teachers remove the other students from the

classroomC. Stay back and give him time to de-escalate D. All of these

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Questions

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Answers

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The RBT denies John access to his preferred reinforcer because he made a mistake on his math worksheet. John has tendencies of throwing tables and chairs when denied access to a reinforcer. There is no protocol in place. John begins screaming and throwing chairs. What should the RBT do?

A. Call for helpB. Have other teachers remove the other students from the

classroomC. Stay back and give him time to de-escalate D. All of these

The RBT denies John access to his preferred reinforcer because he made a mistake on his math worksheet. John has tendencies of throwing tables and chairs when denied access to a reinforcer. There is no protocol in place. John begins screaming and throwing chairs. What could the RBT have done differently?

A. Spoke to her supervisor about the math errorsB. Not denied access to the reinforcerC. Attempted to prevent this behaviorD. All of these �68

Questions

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Answers

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The RBT denies John access to his preferred reinforcer because he made a mistake on his math worksheet. John has tendencies of throwing tables and chairs when denied access to a reinforcer. There is no protocol in place. John begins screaming and throwing chairs. What could the RBT have done differently?

A. Spoke to her supervisor about the math errorsB. Not denied access to the reinforcerC. Attempted to prevent this behaviorD. All of these

Omar is a flight risk and will bolt out of the classroom. What can the teacher do to prevent him from escaping her classroom?

A. Just keep an eye on himB. Notify the principleC. Close the doorD. None of these

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Questions

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Answers

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Omar is a flight risk and will bolt out of the classroom. What can the teacher do to prevent him from escaping her classroom?

A. Just keep an eye on himB. Notify the principleC. Close the doorD. None of these

Leila runs in the classroom. One day Leila was running and she tripped and fell. She had a big cut on her forehead and is bleeding severely. What should the teacher do?

A. Administer CPRB. Administer first aidC. Nothing, Leila needs to learn the hard wayD. None of these

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Questions

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Answers

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A. Administer CPRB. Administer first aidC. Nothing, Leila need to learn the hard wayD. None of these


A. Have someone call 911B. Administer first aidC. Notify the principle D. All of these

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Questions

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Answers

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A. Have someone call 911B. Administer first aidC. Notify the principle D. All of these

Leila runs in the classroom. One day Leila was running and she tripped and fell. She had a big cut on her forehead and is bleeding severely. What should the teacher do to prevent this situation in the future?

A. Ensure a protocol is in place to address this behavior

B. Hope it never happens againC. Block Leila in a corner so she can’t moveD. All of these �76

Questions

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Answers

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A. Ensure a protocol is in place to address this behavior

B. Hope it never happens againC. Block Leila in a corner so she can’t moveD. All of these


A. Keep reminding Leila to walk in the classroomB. Notify her supervisor immediatelyC. Block Leila in a corner so she can’t moveD. All of these

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Questions

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Answers

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A. Keep reminding Leila to walk in the classroomB. Notify her supervisor immediatelyC. Block Leila in a corner so she can’t moveD. All of these


A. Ensure a staff is always walking no more than a foot away so that they can immediately stop the behavior

B. Notify her supervisor immediatelyC. Before Leila leaves her seat to remind her to walkD. All of these

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Questions

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Answers

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A. Ensure a staff is always walking no more than a foot away so that they can immediately stop the behavior

B. Notify her supervisor immediatelyC. Before Leila leaves her seat to remind her to walkD. All of these

You take your learner to the gym room which is in the basement of the building. One day, your learner engaged in severe self injury hitting his head against the concrete floor. You called for help but no one could hear you. How could you have prevented this situation?

A. Notify your supervisor and request that you bring your cell phone with you.

B. Request walkie talkiesC. Always go with another staff memberD. All of these �82

Questions

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Answers

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You take your learner to the gym room which is in the basement of the building. One day, your learner engaged in severe self injury hitting his head against the concrete floor. You called for help but no one could hear you. How could you have prevented this situation?

A. Notify your supervisor and request that you bring your cell phone with you.

B. Request walkie talkiesC. Always go with another staff memberD. All of these

Your learner has a tendency to pull their peers hair when they walk by them. After lunch one day, all the kids were sitting on the carpet reading and your learner walked over to another peer and pulled her hair. The family was angry that this happened to their daughter because she lost a chunk of hair. How could you have prevented this situation?

A. Keep your learner in a isolated roomB. It was an honest mistakeC. Be about an arms length from your learner at all timesD. All of these

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Questions

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Answers

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Your learner has a tendency to pull their peers hair when they walk by them. After lunch one day, all the kids were sitting on the carpet reading and your learner walked over to another peer and pulled her hair. The family was angry that this happened to their daughter because she lost a chunk of hair. How could you have prevented this situation?

A. Keep your learner in a isolated roomB. It was an honest mistakeC. Be about an arms length from your learner at all timesD. All of these

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Final Thoughts

ReferencesCooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Columbus, OH: Merrill Prentice Hall.

Baer, D., Wolf, M., & Risley, T. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 91-97

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d6-emergency protocol copy€¦ · in today’s class you will learn… d-6 implement...

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