How is Professional Crisis Management Physical Restraint Training Different from other Systems?

Only Professional Crisis Management from PCMA incorporates Dynamic Holding© in all physical aspects of the system!


Dynamic Holding© (patent pending) in crisis intervention refers to the use of multiple physical holds that are carefully designed to fit together seamlessly and are applied systematically and in a way that responds rapidly to the behavior of the individual. This provides instant feedback and reinforces behaviors that are more like relaxing, and less like aggression. These elements of Dynamic Holding© combine into a powerful behavioral strategy, known as “shaping”. Shaping is a highly effective and widely used behavioral strategy, but until PCM was developed, it was never applied to physical crisis intervention. The technique of Dynamic Holding© is the application of the principles of Positive Behavior Support (PBS) to physical support of people in crisis.

 

Crisis Interventions Using Dynamic Holding©


In PCM, if prevention and de-escalation strategies are not successful in keeping an individual or others safe during a behavioral crisis, and if the criteria for applying physical procedures are met, Dynamic Holding© is applied to transportation of an individual (sometimes called escort), vertical immobilization and, if necessary and appropriate, horizontal immobilization. This strategy requires using a less or more vivid physical prompt (i.e., less or more physical contact) that changes dynamically based on the response of the individual. The prompts change within 3 seconds of even a small change in the relaxation/resistance level of the individual. This provides feedback to the individual regardless of his or her level of communication skills. Relaxation results in less contact, and resistance or aggression results in more contact. This creates a feedback loop that includes the individual in crisis and the crisis manager. Unlike people who are simply “being restrained”, the person experiencing Dynamic Holding© is being actively taught to relax “in the moment” and has the opportunity to choose less contact or no contact at any moment by virtue of his or her own physical behavior. This results in individuals calming down very quickly.

 

Dynamic Holding© - Better by Design


Dynamic Holding© procedures are very different from “typical restraint” procedures because they provide for maximum feedback but do not produce disorientation, discomfort, or pain and are the closest to natural body movement and positioning. Individuals calm down sooner because they do not feel uncomfortable or unnecessarily coerced. The steps fit together like puzzle pieces so that very quick and consistent transitions occur. This facilitates learning on the part of staff and individuals who experience it. Because the steps of Dynamic Holding© are so similar to natural body movement and positioning, shaping an individual’s behavior toward the target behavior (independent walking, independent standing or independent lying down on a soft foam mat) is much easier for the individual to accomplish and for staff to facilitate. In addition to having the benefits of natural movement and positioning, Dynamic Holding© procedures are exceptionally reliable in reducing movement, which keeps individuals safer and reduces the duration of episodes. Faster calming of individuals and shorter episodes translate into less risk of injury for individuals and staff, less staff turnover and better outcomes for your school or facility.

 

Dynamic Holding© and Positive Behavior Support (PBS)


Positive Behavior Support is an approach that blends values about the rights of people with disabilities with a practical science about how learning and behavior change occur (Horner, 2000). Dynamic Holding© is based on well established principles from the science of human behavior and is also founded in the humanistic values supported by the Positive Behavior Support Movement and the national Behavior Analyst Certification Board. Specifically, Dynamic Holding©:

• Uses Evidence Based Strategies of Shaping, Fading, Feedback and Reinforcement
• Constantly Changes to Ensure the Least Restrictive Step is Used
• Includes Individuals as Active Participants and Facilitates Choice
• Preserves Individual Dignity and Relationships
• Avoids Discomfort, Pain, Disorientation and Unnecessary Coercion

Positive Behavior Support principles are not simply “added on” to the Professional Crisis Management training and certification system (PCM). Rather, they are at the heart of Dynamic Holding©, upon which PCM is built.