Reflections on Behavioral Crises Prevention and Intervention in Special Education Schools in the United States
Paulauskas, Roland, The Journal of Special Education and Rehabilitation
world experience and current events
The development of civilization made crises an inseparable part of our lives. Crises manifest themselves in almost all social areas and organizations, including educational institutions. The goals of the article are to present a theoretical model of normal, deviant and antisocial behaviors, and discuss the psychosocial characteristics of emotionally disturbed adolescents situated in a residential special education school in the United States. The article also gives an analysis of their most prevalent behavioral crises, escalation stages, as well as nonviolent crisis prevention and intervention strategies. The methods that were used include scientific literature review, analysis of statistical information supplied from different government sources, review and analysis of student records, as well as the author's analytical reflections in working with emotionally disturbed youngsters in residential special education schools in the United States.
The results of the study indicate that scientists from different fields use different terminology to describe socially nonconforming behaviors.
The author presents a theoretical model of normal, deviant and antisocial behavior that could enhance better understanding and identification of high risk situations and conduct leading to serious crises. The analysis of student records revealed that most of the adolescents situated in special education residential schools are diagnosed with a number of mental health problems. This suggests that the currently prevailing care and education paradigm in the special education residential schools should shift to a more comprehensive treatment paradigm. The article also discusses the pros and cons of nonviolent crisis intervention. It is the author's opinion that all special education schools serving children with emotional disorders should adopt one of the nonviolent crisis intervention models and develop and implement crisis management policies, plans and procedures.
Key words: crisis prevention, verbal crisis intervention, nonviolent physical crisis intervention, continuum of crisis escalation, positive behavior supports.
The term "crisis" has many definitions. Crises arise in different areas of our lives and are examined by many fields of science. In a broader sense, crises are classified into those that are caused by nature (hurricanes, earthquakes, floods) or man (violence, crime, divorce, incarceration, etc.). All crises have several common features. They are usually unwelcome, related to stress, have a negative effect on the environment, the population or the economy, they may last for longer periods of time, they may have a favorable or unfavorable outcome and people are usually in need of external intervention or help to overcome their outcomes. On one hand, crises may have political, economic, financial, military or environmental nature and affect the whole society or separate nations. On the other, they manifest themselves as social, medical or psychological problems that resonate within smaller group of people, families or individuals. The origin of the word crisis comes from the Greek term "krisis", "krinein" and means "to separate or determine". In the literature, a crisis is usually defined as an unstable situation that is related to a danger or a threat; an unexpected change in the course of an illness or a disease that determines recovery or relapse; a personally stressful event during which the situation approaches or exceeds the adaptive capacities of the individual. Only Confucius ignored the negative aspects of the crises and envisioned them as new beginnings.
It would be an extreme exaggeration to say that neither in the EU countries nor the United States exist schools that could be defined as safety sanctuaries. Almost every week one can find media reports about violence and terrorism on school grounds. Needless to say, several years ago incidents resulting in the death or injury of students and teachers once considered as American phenomenon; today have crossed the boarders of many European countries. In a 1990 survey conducted in the United States involving urban high school students, it was reported that half of the examiners knew someone who had been murdered, 37% had witnessed a shooting incident and 31% observed an assault with a weapon. In addition to the above stated, 20% of the inner-city students reported to have been threatened with a gun and 12% were shooting targets (1). Despite the fact that between 1994 and 2005, the number of murder cases on school grounds has decreased from 42 to 13 and the number of juvenile arrests for murder declined from 3102 to 926, violence among adolescents and minors continues to worry educators, criminologists and mental health specialists. It should also be noted that although the rate of other serious juvenile crimes decreased from 34 to 14 cases per 1000 students, attacks on the socalled socially maladjusted youth is in rise. For example, 21% of elementary, 43% of middle and 22% of high school students often have complained of physical assaults as well as bullying and peer harassment (2).
Other types of crises in the educational institutions across the United States, having less epidemic proportions, are related to family problems, accidents, suicidal behavior, physical traumas, etc.
The author's 18 years of practical experience and research conducted in residential special education schools in the United States indicates that in most cases student behavioral crises are related to physical aggression against peers, teachers and other educational personnel. Behavioral crises are managed by utilizing different nonviolent crisis intervention techniques and post-intervention strategies that often result in significant therapeutic value for the child.
The goal of the study is to examine the most prevalent types of behavioral crises, as well as their prevention and intervention methods utilized in special education schools across the United States.
The research objectives are as the following:
1. To present an interactive model of normal, deviant and antisocial behavior from a social constructivist perspective.
2. To examine the characteristics and related behavioral crises among the population of some residential special education schools in the United States.
3. To review some of the advantages and disadvantages of nonviolent crises prevention and intervention methods.
4. To analyze the crises prevention, preparation, response and recovery model adopted by the majority of special education residential schools in the United States.
The research methods include a literature analysis, examination of student files, brief overview of personal experience working with high risk special education students, as well as an examination of some statistical data.
The Model of Normal, Deviant and Antisocial Behavior
Various definitions of socially unacceptable behavior exist in the educational, psychological and criminological literature. The following terms should be mentioned as most commonly used: delinquent, antisocial, criminal, deviant, aggressive, perversive, aberrant, etc. A number of researchers utilize some of the above adjectives as synonyms, whereas others define them as separate categories of antisocial behavior. Unresolved terminology issues sometimes confuse practitioners in better understanding and identifying the high-risk behavior that may lead to serious crisis.
Prior to the analysis of physically aggressive behavior manifestation in the schools for special education would seem appropriate to briefly overview the theoretical model of normal, deviant and antisocial conduct. The model is based on John Venn's diagram of overlapping circles that represent the relationship between the three behavior patterns (Figure 1). The author's opinion is that all of the above listed terms fit into one of the three behavioral categories or their shared zones.
Normal behavior is a social construct expressed by a set of existing norms that define justice, honor, goodness, truth and other societal values. Normalcy is often associated with social conformity and personal wellbeing. With the commodity of wellbeing, the author considers more than a state of existence or survival, but growth, development and fulfillment of personal potentials. Normalcy includes efficient perception of reality, self-awareness, ability to voluntarily control one's behavior, self-esteem and self-acceptance, ability to form affectionate relations and productive participation in everyday life. As far as conformity is concerned, it is common knowledge that what is considered as normal in one society may be accounted for abnormal or deviant in another.
Deviant conduct is a label given to nonconforming and maladaptive behaviors. Nonconforming is equivalent to not abiding by social norms. However, the best criterion for determining deviancy is its level of dysfunction and distress caused to the individual. If the behavior impairs individual growth and wellbeing it is most likely maladaptive. Even conforming conduct may be deviant if it causes personal discomfort and interferes with one's social functioning. In the psychological literature manifestation of deviant behavior is often defined as a mental disorder.
In contrast to normal and deviant conduct, the motives of antisocial behavior are related to harming another individual or breaking social rules to fulfill personal interests and gains. This behavior category in most cases includes delinquent and criminal acts. Antisocial behavior is usually a matter of choice, whereas deviancy may be determined by physiological and psychological developmental disorders.
Depending on a number of objective and subjective factors, aggressive behavior can be interpreted as normal, deviant and antisocial. For example, aggression used in self-defense is a normal reaction against somebody's hostile intentions; induction of physical or psychological suffering and humiliation to one's sexual partner (sexual sadism) is usually attributed to deviance; and aggression during an act of robbery is a manifestation of antisocial behavior.
As can be seen from the above example, there are no clear cut boundaries between the three behavior categories. The author identifies the tolerance zones as being the grey overlapping areas between the normal and the deviant behavior and the normal and the antisocial behavior. The intersection of deviant and antisocial conduct is defined as a high-risk area. Communities may often be indifferent to behaviors that fall within the tolerance zones. As far as the tolerance of deviance is concerned, we may accept occasional substance abuse or addiction to pornography. Speaking of antisocial behavior, there have been numerous cases of tolerance for such illegal act as juvenile vandalism, absenteeism from school, etc. However, society never ignores the so called high-risk area behaviors when deviancy overlaps with antisocial conduct and results in brutal and serious criminal acts. A good example is an overlap of Conduct Disorder with sexual abuse of children. If the antisocial conduct is a matter of law enforcement and prosecution and deviancy remains an area of mental health, the combination of the two of them constitutes an area of high-risk behavior and is a prerogative of all the above establishments. Needless to say, it causes direct threat to physical and psychological wellbeing and the stability of the whole society.
Sometimes, behavior that originates from the so called tolerance zones may transition to normalcy and opposite. For example, until 1973, the American Psychiatric Association defined homosexuality as deviance. The weight of empirical data coupled with changing social norms led to the removal of homosexuality from DSM - III. Consequently, a new diagnosis, egodystonic homosexuality was introduced and described as persistent distress from a sustained pattern of unwanted homosexual arousal. In 1986 the diagnosis of homosexuality was entirely removed from DSM - IV R.
The above described model includes all the terms listed in the article and could help special educators to better understand and be able to identify juvenile behavior tolerance zones that may lead to high risk situations.
Psycho-Social Characteristics among the Population in Schools for Special Education
Probably the three most important adopted federal laws related to special education in the United States were: "The Act of Americans with Disabilities", "The Act of Individuals with Disabilities Education" and "The Act of No Child Left Behind". Since their adoption, the above mentioned laws received significant amendments and some of their names have changed.
"The Act of Individuals with Disabilities Education" guarantees free appropriate education for all children with disabilities in the least restrictive environment. Under this law, a person with a disability is defined as a child with hearing, visual, language, learning and health impairments, traumatic brain injury, mental retardation and serious emotional and behavioral disturbance.
Most of the statistical information for this study was collected from one special education residential school in the state of Massachusetts. There are over 133 private educational facilities of variable sizes in Massachusetts that have specialized in provision of educational, residential and clinical services to different disabled populations. In 2007, the Department of Social Services (DSS) placed 8979 children in special education institutions, of which 52% were boys and 48% girls, and 53% were between the ages of 12 and 17 (3). In addition to the DSS, residential placements were created and financed also by school districts governed by the Department of Elementary and Secondary Education, the Department of Youth Services, the Department of Mental Health, various insurance agencies and other private parties.
According to the data of the Department of Elementary and Secondary Education, 17.1% of all students who attended public schools in 2008 were identified as children with special needs. Official sources of the Department of Education indicate that from 1% to 2% of the public school students in the United States have serious emotional and behavioral disturbances. However, this number is estimated to be between three to six times higher (4).
The information was collected from schools that provided educational, residential and clinical services to adolescents and youth with severe emotional disturbance. All of the students had a history of sexual offending and were identified as high-risk individuals.
The study included 101 adolescents and young adults from 13 to 21 years of age (x=16.5; SD - 2.2). Ninety-four percent of the participants had one psychiatric diagnosis and 62% had two or more DSM-IV-TR (5) diagnoses. The most common diagnoses were Conduct Disorder - 54%, Oppositional Deviant Disorder - 26%, Attention Deficit and Hyperactivity Disorder - 37%, Depressive Disorder - 8%, Pedophilia - 5%, Post Traumatic Stress Disorder - 14%, Alcohol Dependence - 4% and others - 8%.* Each juvenile had offended 3.58 victims. Fiftyfour percent of the offenders had a history of psychiatric hospitalization and 52% were on psychotropic medication. Thirty-two percent of the juveniles admitted to being a victim of sexual abuse.
The above data indicates that due to the high prevalence of different mental health disorders among adolescents placed in residential special education schools, the currently existing emphasis on education and care should shift to a comprehensive treatment paradigm. It is also imperative that treatment should include psychological and behavioral crises prevention components.
Prevention from and Intervention during Behavioral Crises
In Massachusetts as well as most other states, institutions that are licensed special education facilities, such as the Department of Elementary and Secondary Education and the Office of Child Care Services, require schools and group homes serving emotionally disturbed children to adopt crises prevention policies and plans that reflect the characteristics of served populations and do not violate children's rights.
Such policy was implemented in the residential school where study data was collected. The policy was based over the U.S. Department of Education recommended model and was comprised of four phases: prevention, preparation, response and recovery (6).
The goal of prevention is to collect the necessary information in order to reduce or eliminate the risk of unwelcome events and situations. It is extremely important for administrators, teachers and support staff working in the field of special education to review student files, be aware of their developmental history, psychological and psychiatric evaluations, as well as to be familiar with the symptoms of different diagnoses and their behavioral risk levels.
Another aspect of prevention is the development and implementation of the Positive Behavior Supports (PBS) system. In August of 2009, the Secretary of Education Arne Duncan sent a letter to all State Departments of Education directing their personnel to develop new regulations that would ensure the implementation of the PBS systems in all public and private schools, thus reducing the need for more intrusive or aversive interventions. The PBS system is an empirically validated strategy to prevent and eliminate challenging behaviors and replace them with prosocial skills. Special education schools often include its components into the Individual Education Plans (IEPs). In addition to the behavioral techniques, the PBS system can be comprised of individual, group and family counseling as well as other social and psychological support.
Behavioral crises intervention was first introduced in the 18th century in French psychiatric facilities in order to restrain aggressive individuals and decrease injuries to self and others. It was pioneered by Philippe Pinel and Jean Baptiste Pussin. In addition to the physical intervention, they often utilized pharmacological and mechanical restraints. Verbal and physical crisis intervention techniques in the U. S schools date back to the 1950s. Their intention was to control the behavior of emotionally disturbed children. The model and theoretical basis for crisis intervention were developed by Fritz Redi and David Wineman (7).
Preparation for crisis situations in schools for special education is a base for teacher and support staff training and development. Among the most popular behavior crisis intervention programs in the United States are the Therapeutic Crisis Intervention (TCI) and the Nonviolent Crisis Intervention (NCI). The first one was developed at Cornell University, whereas the second at Crisis Prevention Institute, Inc. The content of both programs is similar by nature and includes verbal and protective prevention and intervention methods. The Massachusetts Department of Elementary and Secondary Education approves of both programs.
Since its incorporation in the 1980s, more than 5.4 million professionals working in the field of special education, mental health, conections, public schools, group homes and other areas of social services have participated in Crisis Prevention Institute training seminars and programs. The centers and branches of the Institute are located in the United States, United Kingdom, Australia, New Zealand, Mexico and Germany. The instruction languages of the programs are English, Spanish and German.
The philosophy of the program is based on the principals of care, welfare, safety and security. It introduces program participants to the dynamics of the development of behavior crisis, its phases and possible productive and nonproductive staff responses to them. The participants are able to practice nonverbal, paraverbal communication methods, verbal crisis intervention strategies as well as nonviolent physical crisis intervention. Part of the program addresses psychological and physical staff safety and self-protective techniques that include prevention of strikes, kicks, bites, etc. Research suggests that implementation of the above program can reduce student aggressive behavior by 82.2% (8).
The phase of preparation for crisis also includes the development of crisis intervention policies and procedures, response team identification as well as implementation of a communication plan (9). In case the situation escalates to a physical intervention phase it is imperative to know how to get in touch with the administration of the school, internal and external experts, get medical assistance or contact law enforcement agencies. During the response phase it is important to follow all crisis intervention policies and procedures and utilize the skills acquired for staff development and training programs. As it has been mentioned before, verbal or physical intervention methods are determined by the phase of crisis escalation.
Each behavioral crisis is consisted of several stages and the reaction of teaching and support staff has to be consistent with the child's behavior. The first external indication of a behavioral crisis is anxiety that can be expressed by rapid pacing, staring at on point, hand wringing, tapping of knuckles on a hard surface, etc. The most effective reaction of an educator at this phase is support, empathie listening and being less judgmental. Sometimes simple listening to the child's anxieties or fears prevents further crisis escalation.
The second phase is called defensive level. At this point, the individual becomes extremely emotional, does not want to listen to what is being said, begins to give cues of inational behavior, threatens and challenges the authority of educational personnel. This is an extremely critical time in the continuum of crisis escalation. Experience and research indicate that the best staff response to such behavior is a directive approach which entails setting behavior limits. The directive has to be very simple, clear and enforceable. Ultimatums and unrealistic demands at this stage are not effective. The child or adolescent has to understand that there are at least two alternatives and he/she may choose the most adequate solution for self and others.
When the first two approaches suffer failure, the crisis may escalate to a third phase - the acting out person. In the acting out person stage the individual loses control over his/her behavior, physically assaults other people, may use objects as weapons and becomes dangerous to self and others. Nonviolent crisis intervention standards permit physical control over acting out individuals as a last option and only in cases where a person becomes dangerous to the safety and the life of others; tries to harm himself/herself and attempts suicide; and if it becomes necessary to transfer him or her to a safer location. Property destruction does not constitute a valid reason to start using any methods. Behavior control techniques adopted by the Crisis Prevention Institute are reliable and not sophisticated to learn. They are usually performed by two people and whenever possible observed by a third person. Following the incident, all the details should be thoroughly documented. Some residential schools install security cameras and most of the recorded incidents are reviewed and analyzed at a later time by crisis prevention experts.
Post-intervention or recovery phase is both of physical and emotional nature. The child calms down from the peak of energy output and regains self-control and rationality. According to Fritz Redi, the latter crisis stage is a favorable moment for a psychoanalytic reflection with the child that may result in significant behavioral and cognitive changes. Fritz Redi gave it the name life space interview. During the interview, the teacher and the child analyze deeper rooted causes of the behavioral crisis, their link to prior developmental events and establish a close therapeutic relationship. The name of the interview is related to the fact that the educator lives in the child's space (here and now) and during a crisis situation may be more useful to the child compared to psychotherapist whom the child meets based on a prior established schedule (10).
The above described life space interview was comprised of the following components:
1. The evaluation of the child's psychological state and provision of emotional support;
2. Incident interpretation from the child's point of view;
3. The establishment of motives and values related to the incident;
4. Identification of the central problem and selection of new goals;
5. Preparation of the child for "restitution" or an apology;
6. Rehearsal of the problem solution and preparation of the child for returning to the community.
Nonviolent crisis intervention has received controversial evaluations both in the United States as well as other countries. The supporters of such programs claim that they reduce juvenile aggression, teach juveniles alternative selfexpression methods in frustrating situations and safeguard them and the community from accidents. On the contrary, the critics indicate that physical intervention is dangerous and sometimes may be used as punishment. A number of unprofessionally utilized physical restraints have resulted in child injuries and deaths from asphyxia in the United States. For this reason, one of the largest organizations representing the interests of children - the Child Welfare League of America is urging for development of national crisis intervention instruction standards as well as methods of reducing intensity of aggressive behavior (11). The American Academy of Child and Adolescent Psychiatry (12), the American Psychological Association (13) and the American Medical Association (14) also support the use of nonviolent physical intervention. However, these organizations recommend for definition of the conditions under which such methods will be used, more intensive staff training and more efficient incident documentation. Physical intervention should also be compatible with the child's disability and included in his/her individual treatment plan.
Behavioral crises are becoming a reality in most educational facilities. There have been a number of conferences discussing violence prevention and intervention within the United States and the EU countries. Some of their recommendations include implementation of a number of new teacher assistant positions, additional school counseling and psychologist positions. They also include increased training and payment for teachers who tutor certain groups of children, installation of different security technologies in special education schools and implementation of various nonviolent crisis prevention programs. In addition to the above, many researchers recommend involveing parents and the community in violence prevention programs, as well as raising parental responsibility for the behavior of their children.
The author would also like to make several suggestions related to the prevention and intervention of behavioral crises for special education schools mainly concerning Eastern European countries that have a different special education philosophy and history.
1. Since most students placed in residential special education schools are diagnosed with different mental health disorders, a paradigm currently exists that suggests education and care to shift to a treatment paradigm.
2. All special education schools and other educational facilities that provide services to emotionally disturbed children and adolescents should develop official behavior crisis prevention and intervention policies and plans applicable to serve the population and will not violate children's rights.
3. The plans should include components such as prevention, preparedness for crises, intervention and post-intervention.
4. Special education schools should identify crisis intervention teams comprised of staff certified in one of the nonviolent crisis intervention programs.
5. In case of behavioral or other emergencies, it is critical to have a communication plan and policies.
6. It would be appropriate for all special education teachers and support staff to participate in crisis prevention and intervention seminars and acquire qualifications and skills in the area of verbal and physical intervention methods.
Crisis prevention and intervention should be included in college and university programs that prepare teachers, social workers and school psychologists.
1 The percentages are rounded to an equal number
PeopepeHuu / References
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Roland P AULAUSKAS
Siauliai University, P. Visinskio 25,
LT-76352, Siauliai, Lithuania
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Reflections on Behavioral Crises Prevention and Intervention in Special Education Schools in the United States. Contributors: Paulauskas, Roland - Author. Journal title: The Journal of Special Education and Rehabilitation. Volume: 12. Issue: 1/2 Publication date: January 1, 2011. Page number: 69+. © Institute of Special Education 2009. Provided by ProQuest LLC. All Rights Reserved.