PCMA Newsletter Issue #105

Welcome to our 5th Quarterly Newsletter! We've got a busy year ahead of us! Featured in this installment are topics such as tips for instructors to make your trainings go more smoothly and how to log into our new website using your own user names and passwords. We will also be at the upcoming ABAI conference in Texas and we were also at the APDDA Conference in Louisiana, the Autism Conference in Chicago and the CALABA Conference in California. Of course we have another installment of Dr. Winston's challenging behavior challenge. Check out the stories below and, as always, we are happy to get feedback on the newsletters and we invite all of our Practitioners and Instructors to submit suggestions for future topics to Dr. Winston at winston@pcma.com.

 


COMPANY NEWS

The New BehaviorTools Multimedia Curriculum is going strong!

We have conducted several classes for the PCMA BehaviorTools and the response has been very positive! We have also developed a stand-alone DVD that will have the entire curriculum (lectures, PowerPoint slides, examples) all rolled into a single easy-to-use DVD that won't require the use of a computer or projector, just a standard DVD player and a television. If you are an Instructor and already have a BehaviorTools Disc then you can request the new Updated DVD at no charge! As mentioned in the email version of this newsletter, you may request a demo DVD of the Basic BehaviorTools Practitioner Course.

PCMA has been approved by Florida's Agency for Person's with Disabilities!

Along with several other providers of crisis management training, PCMA has been approved by APD for use with all clients of the department. Many providers were not approved, and some were approved with provisions. The PCM system is fully approved and we look forward to working with many new organizations in Florida. Florida has followed the examples set by a few other states by going to great pains to ensure that persons with disabilities in Florida are treated with the greatest care possible when it comes to reactive strategies for maintaining the safety of the individual, their peers, and the staff who serve them. You can see all of the systems approved by the state in this spreadsheet. If you are uncertain about which system to go with, we will be more than happy to provide your organization with a Gotomeeting web-based presentation to familiarize you with the PCM system and you can better understand why so many organizations have switched to our system. Contact Laraine Winston at lwinston@pcma.com to set up a web-based presentation for your organization.
 


Restraint and Crisis Intervention Practice Reform: How does your organization stack up?

Across the nation, government agencies and oversight bodies are setting new standards and passing rules and legislation intended to protect individuals who are subject to crisis management intervention. We at PCMA agree that there is much room for improvement in the use of crisis management strategies and that consumers and students can benefit tremendously from higher standards. While these rules, laws and standards vary across populations, states and types of organizations, there are clear trends developing that are likely to affect all organizations that need to use physical interventions (including those that only use transportation, i.e., escorts) to keep people safe.

Training

Increasingly, formal documented training in positive behavior support strategies (such as the prevention component in PCM and the BehaviorTools Course), crisis management strategies, or both is being mandated. Many state agencies are reviewing the available training programs and are creating lists of approved training programs

Existing Programming

Many agencies are requiring or encouraging organizations to include a strong behavioral component in organizations’ on-going daily programs. The PCM instructor’s course emphasizes the importance of this and includes some specific information on the development of a strong behavioral program. The language that is being used to describe this is typically “based on applied behavior analysis”, or “positive behavior support model”. These terms are sometimes confusing for those who are not behavioral professionals. Look for our article on these terms in the next newsletter.

Prevention

Specific training in preventing crisis behaviors is being cited as an important component. Some crisis management systems claim to include a prevention component, but in actuality only address de-escalation. De-escalation only occurs once a person is already showing signs of crisis, when it is too late for true prevention. Prevention should be emphasized in both the training and existing programming components, mentioned above.

Parent/Guardian Notification

Timely notification of parents or guardians about crisis management procedures is increasingly becoming a requirement. In some cases, organizations are being asked to obtain prior consent, notify within a specific timeframe after an occurrence (like 24 hours), or both. PCMA fully supports the rights of parents and guardians to timely notification and is available to provide them with additional information if desired.

Principle of Least to Most Restrictive

While this principle is routinely applied to teaching strategies for people with special needs, it is often left out of crisis management systems used with the very same populations! Governmental bodies and oversight organizations are increasingly recognizing the importance of this principle for keeping people safe in crisis, without subjecting them to an unnecessary level of restriction. PCM users are well familiar with this principle, as it is a hallmark of the PCM system.

Clear Utilization and Termination Criteria

Oversight bodies are understandably concerned about the use of physical crisis management procedures when it is not necessary. High rates and poor outcomes of procedures are associated with overuse. Under-use of procedures can also be dangerous. Having clearly defined and easily observed criteria for beginning and ending procedures is one factor in avoiding overuse and under-use. Another factor is training staff sufficiently in the criteria, as well as good staff supervision by those who are also trained in the criteria. PCM uses the most clear and specific utilization criteria of any widely available system. The PCM criteria eliminate use for behaviors that are not continuous- an important distinction. PCM trainees are specifically tested on the criteria and these test items must be correct in order to pass the course.


RECENT AND UPCOMING PCMA PRESENTATIONS:

Thanks to all of you who stopped by our booth at the last ABA Autism Conference in Chicago. We appreciated to opportunity to say hello to existing customers and to make some new contacts with organizations that were looking to upgrade their current crisis management system.

In February we attended the APDDA Conference in New Orleans on Feb 21-24 and Dr. Winston presented on issues regarding seclusion/restraint and how to reduce the controversial emergency procedures in meaningful ways. The Association of Public and Private Developmental Disability Administrators is committed to addressing the needs of people with intellectual disabilities and other developmental disabilities. We also attended the CALABA conference in Irving California from Feb 18-20. Please come see us at the upcoming ABAI conference in San Antonio Texas May 28th to June 1st.


DR. WINSTON’S CHALLENGING-BEHAVIOR CHALLENGE!

Working With "Escape Artists!"

Some of you may find yourselves working with children or adults who have difficulty with demand situations. When a functional assessment is conducted, all too often one of the functions comes up as "escape from demands." Traditionally, many behavior analysts like to teach an appropriate escape response, like manding (asking) for a break or some other appropriate communicative response. Generally, this is a good idea, especially if the current escape response is dangerous behavior. We still must answer the question however "Why do they want to escape?" The motivation to escape arises from two main variables. The first is the aversiveness of the current demand situation and the second is the reinforcement available for complying with the demand. There must be a proper balance between the two. If the task at hand is relatively neutral (the individual doesn't outright hate it) then you might not need a very powerful reinforcer. If, on the other hand, the task is among the least preferred or something the person really dislikes, then the reinforcer earned must be very powerful and delivered very quickly after even a small effort. If this balance is not achieved, then EVERYONE tries to escape. If your salary gets cut severely, most of you will seek employment elsewhere. If your daily work becomes too demanding and/or stressful, even with the same pay, you may seek other employment.

So, there are two basic options. You can increase the size of the reinforcer (or the motivation to get that reinforcer) or you can reduce the aversiveness of the task. You can actually change some aspect of the task or the entire task itself. You can also reduce the aversiveness by increasing the level of prompting to make the individual more successful more quickly. Here are some questions you might need to start asking yourself:

1) Do they have problems with just certain tasks or all tasks? If it is only problems with certain tasks, then why? Do they have the necessary skills to perform the task correctly? Do they make many errors? Does it take a level of fine-motor coordination that makes it difficult? Does it require a great deal of physical contact from staff?

2) Do they have problems only when certain staff ask them to do a task?

3) Are there times when the exact same task with the exact same reinforcer produces escape, and then some times where it doesn't? For example, some individuals will attempt to escape from a demand only when they are tired or sick.

4) Do they only escape after a certain duration? That is, they are fine for the first 5 minutes, but their behavior deteriorates rapidly into crisis after 10 minutes. Be vigilant when looking for sings and symptoms of "losing them." Individuals whose behavior is beginning to deteriorate typically show clear signs. Their responses become slower, their voice volume fades, their articulation becomes worse, they avert their eyes from the task, they engage in more self-stimulatory behavior and they make more mistakes and require multiple prompts before responding. As soon as you see any of these signs you MUST take remedial action before things get worse. Many teachers never pay attention to these very important clues that the student's behavior is getting ready to take a turn for the worse!

It may really take some detective work on your part to figure out why they want to escape from a given task. The better you know the individual the easier it will be to determine what the problem is. Similarly, you might have do an analysis of problems with the reinforcement. In our last newsletter we talked about problems with reinforcers (too slow, not big enough, too easily available in other settings, etc.). That list of problems can help you troubleshoot where things are falling apart.

In most cases, if you manipulate task difficulty and/or the power of the reinforcer, you can eliminate escape motivated behavior. There are some individuals however that are so escape motivated that they want nothing to do with any sort of task or demand and they begin to escape as soon as a teacher/care-giver approaches them with that "it's time to work" look in their eye. For these most intractable individuals we have to get back to the basics of interactions and work on establishing ourselves as a conditioned reinforcer as discussed in newsletter #1. This may involve just sitting next to an individual while they do something enjoyable and making comments about what they are doing or asking questions about what they are doing. If the person starts to enjoy interacting with staff, then any demands become, well, less demanding!

As you can see, tracking down the variables that produce escape behavior can be quite an arduous task, but ultimately it produces a much better understanding of that person and makes it much easier for staff to work with them and move forward in their treatment.


INSTRUCTOR HINTS AND TIPS:

Signatures, signatures, signatures!

Please make sure that all your practitioners are signing their applications! Remember not only is PCMA protected when your students sign their applications, but YOUR ORGANIZATION is also protected. Your staff are acknowledging that they could possibly be injured during the training. Although the probability is very low, it could still happen. If your staff never sign their application, not only will they receive an incomplete status from PCMA, but they are not acknowledging that they could be injured during the training, opening your organization up to possible litigation. Remember, no one is allowed to retain their manual if they do not sign their application and you should not let them participate in the course in any manner until they sign.

Also, those Practitioners who are going to learn the supine procedure are the only people who need to sign the supine disclaimer. Many instructors are having all their Practitioners sign even when they are not learning the procedure. Thank you for helping us continue to do a great job with training documentation!

Advertise your trainings for FREE!

Many of our Instructors don't work for any one particular organization and do more of a "freelance" style of training. Some other Instructors may work for small organizations and may be having difficulty filling up a training, and no one wants to train only 3 staff if they don't have to as it is a poor use of time and resources. Anyone can advertise their training on http://www.Behavioranalysis.com which makes it fast and easy for students to sign up. Take advantage of this free service and start filling up your trainings faster!


PRACTITIONER HINTS AND TIPS:

Help take responsibility for your proper training!

PCM Instructors usually do an excellent job in their trainings, but errors can be made. That is why we put the hourly training requirements right there in your Practitioner manual. Remember the Practitioner, Practitioner 1, and Practitioner 2 courses are a minimum of 14, 18, and 22 hours respectively. Also, did you know that 1 PCM instructor cannot train more than 10 staff at any time? 2 Instructors can train up the 15 staff in one training. There can NEVER be more than 15 people in any PCM training. Any irregularity in training should be brought to the attention of your Instructor, but if you are not satisfied with their answer then please call us at 954-746-0165 and we will be happy to take your information.

EMPLOYMENT OPPORTUNITIES:

In the near future PCMA will be seeking well qualified Instructors who may be seeking part-time employment in helping us to re-certify existing instructors. We do not yet have a definite time frame, but are nearing the point of needing to hire an experienced conscientious instructor. They would receive additional training from PCMA as part of their employment. If interested in a possible position please email Dr. Winston and let him know that you are interested. Your name will be put into a database for future reference. Thank-You.