Crisis Management in ABA

Crisis management involves procedures for safely responding to dangerous behaviors that pose an immediate risk of harm to the client or others. While the primary focus of ABA is on prevention and teaching appropriate behaviors, RBTs must be prepared to respond effectively when crisis situations occur. This guide outlines evidence-based approaches to crisis management within an ABA framework.

Understanding Crisis Behaviors

Crisis behaviors are serious challenging behaviors that require immediate intervention due to safety concerns.

Characteristics of Crisis Behaviors

• Safety risk: Pose immediate danger to self or others
• High intensity: Severe enough to cause injury or damage
• Rapid onset: Often escalate quickly
• Emotional arousal: Accompanied by heightened emotional state
• Temporary nature: Eventually de-escalate with appropriate management

Common Types of Crisis Behaviors

1. Self-Injurious Behavior (SIB)

Behaviors that cause physical harm to one’s own body.

Examples:

• Head-hitting or head-banging
• Severe self-biting
• Eye-poking
• Self-cutting or scratching
• Forceful self-hitting

2. Aggression

Behaviors directed toward others that can cause physical harm.

Examples:

• Hitting, kicking, or biting others
• Throwing objects at people
• Using weapons or implements to harm others
• Forceful pushing or shoving
• Hair pulling or scratching others

3. Property Destruction

Behaviors that damage physical environment or possessions.

Examples:

• Breaking furniture
• Throwing objects with force
• Tearing or destroying materials
• Breaking windows or walls
• Overturning heavy furniture

4. Elopement

Leaving supervised area in an unsafe manner.

Examples:

• Running into traffic
• Fleeing from supervision in dangerous areas
• Leaving building during extreme weather
• Escaping into restricted or hazardous areas
• Hiding in unsafe locations

Crisis Prevention: The Foundation of Management

The most effective crisis management is prevention through proactive strategies.

Preventive Approaches

1. Functional Behavior Assessment (FBA)

Understanding why behaviors occur to develop effective prevention strategies.

Key components:

• Identifying antecedents that trigger behaviors
• Determining functions maintaining behaviors
• Analyzing patterns and setting events
• Developing function-based interventions
• Ongoing monitoring and adjustment

2. Environmental Modifications

Altering physical environment to reduce triggers and increase safety.

Strategies:

• Removing hazardous items
• Creating clear physical boundaries
• Reducing sensory triggers (noise, light, crowding)
• Arranging furniture for easy movement and supervision
• Designating safe spaces for de-escalation

3. Instructional Modifications

Adapting teaching approaches to prevent frustration and promote success.

Approaches:

• Matching tasks to skill level
• Breaking instructions into manageable steps
• Providing visual supports
• Offering choices within activities
• Building in frequent breaks

4. Teaching Coping and Communication Skills

Equipping clients with appropriate ways to express needs and manage emotions.

Skills to teach:

• Requesting breaks or help
• Expressing emotions appropriately
• Using calming strategies
• Problem-solving techniques
• Self-monitoring of emotional state

5. Reinforcement Systems

Using positive reinforcement to strengthen appropriate behaviors.

Implementation:

• Reinforcing calm behavior
• Rewarding use of coping strategies
• Providing high rates of reinforcement during difficult periods
• Creating motivation for appropriate behavior
• Teaching self-reinforcement

The Crisis Cycle

Understanding the typical progression of crisis behaviors helps in effective intervention.

Phases of the Crisis Cycle

1. Calm Phase

Baseline state when the individual is regulated and responsive.

Characteristics:

• Engaged in activities appropriately
• Responsive to instructions
• Using typical communication
• Displaying normal affect
• Showing typical movement patterns

Intervention focus: Maintain through positive behavior support and teaching

2. Trigger Phase

Events or conditions that initiate the cycle toward crisis.

Characteristics:

• Exposure to known antecedents
• Subtle changes in behavior
• Minor signs of discomfort
• Initial indicators of stress
• Changes in typical patterns

Intervention focus: Remove triggers or support through trigger

3. Escalation Phase

Increasing signs of distress and agitation before full crisis.

Characteristics:

• Increased motor activity
• Vocal changes (volume, tone)
• Decreased responsiveness to intervention
• Visible physiological signs (flushing, breathing changes)
• Precursor behaviors to crisis

Intervention focus: De-escalation strategies and redirection

4. Crisis Phase

Peak intensity of dangerous behavior requiring safety interventions.

Characteristics:

• Dangerous behaviors occurring
• Maximum emotional intensity
• Minimal receptiveness to reasoning
• Fight-or-flight physiological state
• Safety concerns at highest level

Intervention focus: Safety procedures and crisis management techniques

5. De-escalation Phase

Gradual reduction in intensity following crisis peak.

Characteristics:

• Decreasing intensity of behaviors
• Beginning to respond to environment
• Physiological signs reducing
• Increased receptiveness to support
• Fatigue often present

Intervention focus: Continued calming support and transition guidance

6. Recovery Phase

Return to regulated state after crisis has passed.

Characteristics:

• Crisis behaviors have stopped
• Processing capacity returning
• May show embarrassment or confusion
• Physical fatigue common
• Gradual return to routine possible

Intervention focus: Supportive return to activities and processing as appropriate

De-escalation Strategies

De-escalation techniques are used during the escalation phase to prevent progression to full crisis.

Verbal De-escalation

Using communication strategies to reduce emotional intensity.

Techniques:

• Simple, clear language: Short, concrete statements
• Calm tone: Steady, even voice without emotional intensity
• Reduced verbal input: Minimizing language when agitation increases
• Reflective listening: Acknowledging feelings without judgment
• Offering choices: Providing limited, clear options
• Avoiding threats: Focusing on solutions rather than consequences
• Positive phrasing: Telling what to do rather than what not to do

Example:

Instead of “Stop yelling or you’ll lose computer time!” use “Let’s take a deep breath and talk quietly. Would you like to sit here or in the calm corner?”

Environmental De-escalation

Modifying the environment to reduce stimulation and promote calming.

Techniques:

• Reduce stimulation: Decrease noise, light, and activity
• Create space: Ensure adequate personal space
• Remove triggers: Take away items causing distress
• Clear the area: Move other individuals to safe distance
• Offer movement: Provide appropriate physical activity
• Change setting: Move to calmer environment if possible
• Access calming items: Provide sensory tools or comfort objects

Example:

When a client begins showing signs of escalation, dim the lights, turn off music, offer a weighted blanket, and suggest moving to the quiet area.

Physiological De-escalation

Strategies that address the physical aspects of escalation.

Techniques:

• Deep breathing: Guiding slow, controlled breathing
• Progressive muscle relaxation: Tensing and releasing muscle groups
• Movement breaks: Providing appropriate physical activity
• Sensory supports: Offering sensory tools (fidgets, pressure, etc.)
• Hydration: Offering water (addresses physiological needs)
• Position changes: Suggesting sitting vs. standing as appropriate
• Rhythmic activities: Engaging in patterned, predictable movements

Example:

Guide client through “square breathing” (4 counts in, 4 counts hold, 4 counts out, 4 counts hold) while offering a stress ball to squeeze.

Cognitive De-escalation

Strategies that address thinking patterns during escalation.

Techniques:

• Distraction: Redirecting attention to neutral or preferred topics
• Visualization: Guiding imagery of calm places or activities
• Problem-solving: Breaking down issues into manageable steps
• Perspective-taking: Offering alternative viewpoints
• Humor: Using appropriate humor to break tension
• Reframing: Presenting alternative interpretations of situations
• Cognitive scripts: Using practiced phrases or mantras

Example:

“Let’s think about our trip to the beach last week. What was your favorite part? Can you picture the waves?”

Crisis Management Procedures

When prevention and de-escalation are unsuccessful, crisis management procedures may be necessary.

Protective Strategies

Techniques to ensure safety during crisis behaviors.

1. Environmental Safety Measures

• Clearing space: Removing hazards and creating safe distance
• Protective barriers: Using furniture or positioning to create barriers
• Padding: Placing soft materials to prevent injury
• Securing objects: Removing or fastening items that could be thrown
• Exit management: Ensuring access to exits while preventing unsafe elopement

2. Personal Safety Techniques

• Body positioning: Maintaining safe stance and distance
• Protective stance: Positioning to minimize injury risk
• Blocking techniques: Using arms or objects to block strikes
• Evasion strategies: Moving away from aggression
• Clothing considerations: Removing accessories, securing loose clothing

3. Protective Equipment

• Arm guards: Protection for blocking self-injury or aggression
• Helmets: Head protection for severe head-banging
• Gloves: Protection for hands during intervention
• Padding: Body protection for staff during aggressive episodes
• Specialized equipment: Items designed for specific safety concerns

Crisis Response Hierarchy

Interventions arranged from least to most restrictive, implemented based on safety needs.

1. Redirection and Continued De-escalation

• Maintaining de-escalation attempts
• Offering highly preferred activities or items
• Using distraction techniques
• Providing additional space
• Continuing verbal support

2. Extinction and Planned Ignoring

• Withholding reinforcement for crisis behavior
• Maintaining safety while minimizing attention to behavior
• Redirecting attention to appropriate behaviors
• Implementing extinction procedures as designed
• Monitoring for safety concerns

3. Removal of Others

• Moving peers or bystanders to safe location
• Clearing the environment of unnecessary personnel
• Maintaining minimal necessary staff presence
• Reducing audience effect
• Ensuring others’ safety and supervision

4. Removal from Environment

• Guiding individual to safer location
• Using least intrusive prompts necessary
• Maintaining dignity during transition
• Selecting appropriate alternative environment
• Supporting during environmental change

5. Physical Intervention (as last resort)

• Implementing only when absolutely necessary for safety
• Using only procedures specified in behavior plan
• Applying least restrictive effective intervention
• Maintaining intervention only as long as necessary
• Documenting all instances thoroughly

Physical Interventions

Physical interventions are highly restrictive procedures used only when necessary to prevent serious harm.

Important Considerations:

• Last resort: Used only when less restrictive measures have failed
• Safety focus: Implemented solely to ensure safety, not as punishment
• Proper training: Requires specific, certified training
• Plan-specified only: Used only when included in approved behavior plan
• Minimum duration: Maintained for shortest time necessary
• Continuous monitoring: Requires constant assessment of need and safety
• Documentation: Requires thorough, immediate documentation
• Debriefing: Necessitates post-incident review and analysis

Types of Physical Interventions:

1. Physical guidance: Minimal physical contact to direct movement
2. Manual restraint: Physically restricting movement
3. Mechanical restraint: Using devices to restrict movement (highly regulated)
4. Seclusion: Involuntary confinement alone in room (highly regulated)

Note: Specific physical intervention techniques are not described here, as they should only be implemented by properly trained personnel following certified training programs and under appropriate supervision.

Post-Crisis Procedures

What happens after a crisis is crucial for learning, prevention, and recovery.

Immediate Post-Crisis Response

1. Ensure Physical Safety

• Medical assessment: Check for injuries
• Environment check: Ensure area is safe for return
• Physical needs: Address hunger, thirst, fatigue
• Documentation of injuries: Record any injuries to client or others
• Medical follow-up: Arrange if needed

2. Emotional Support

• Calm, supportive presence: Maintain non-judgmental support
• Processing as appropriate: Allow discussion if client is ready
• Emotional regulation support: Continue calming strategies
• Reassurance: Provide appropriate reassurance about relationship
• Space and time: Allow needed recovery time

3. Transition Planning

• Gradual return: Plan careful transition back to activities
• Expectations adjustment: Modify expectations temporarily if needed
• Environmental modifications: Make needed changes before return
• Support preparation: Ensure staff are ready to support return
• Success opportunities: Plan for immediate success experiences

Documentation and Analysis

1. Incident Documentation

• Objective description: Record events without interpretation
• Timeline: Note times of escalation, intervention, and de-escalation
• Interventions used: Document all strategies attempted
• Duration: Record length of crisis and interventions
• Staff involved: Note all personnel participating in response
• Injuries or damage: Document any physical harm or property damage
• Client response: Record how client responded to interventions

2. Functional Analysis

• Antecedent analysis: Identify triggers and setting events
• Behavior description: Define topography and intensity
• Consequence analysis: Determine what followed the behavior
• Pattern identification: Look for recurring elements
• Function hypothesis: Develop or refine understanding of function
• Prevention planning: Identify how crisis could be prevented

3. Team Debriefing

• Non-judgmental review: Examine incident objectively
• Procedural evaluation: Assess if procedures were followed
• Effectiveness analysis: Determine what worked and what didn’t
• Staff support: Address emotional impact on team
• Training needs: Identify additional training requirements
• Plan modifications: Discuss needed changes to intervention plan

Plan Revision

1. Prevention Enhancements

• Antecedent interventions: Develop new preventive strategies
• Skill teaching: Identify replacement behaviors to teach
• Environmental modifications: Plan setting changes
• Schedule adjustments: Modify routines if needed
• Reinforcement systems: Enhance motivation for appropriate behavior

2. De-escalation Refinement

• Early intervention: Improve recognition of early signs
• Personalized strategies: Refine techniques based on effectiveness
• Staff response: Clarify roles and responsibilities
• Communication protocols: Enhance team coordination
• Resource allocation: Ensure necessary supports are available

3. Crisis Protocol Updates

• Intervention hierarchy: Refine progression of responses
• Safety procedures: Update based on incident analysis
• Documentation requirements: Adjust as needed
• Notification protocols: Review communication procedures
• Training updates: Schedule additional training if required

Training and Preparation

Effective crisis management requires thorough training and preparation.

Staff Training Requirements

• Theoretical understanding: Knowledge of behavior principles
• Prevention strategies: Training in antecedent interventions
• De-escalation techniques: Skills in reducing behavioral intensity
• Safety procedures: Training in protective strategies
• Physical intervention: Certification in approved techniques (if applicable)
• Documentation: Training in proper incident recording
• Legal/ethical considerations: Understanding of regulations and ethics
• Regular refreshers: Ongoing practice and updates

Team Coordination

• Clear roles: Defined responsibilities during crisis
• Communication systems: Established signals and protocols
• Chain of command: Clear decision-making authority
• Support procedures: Methods for obtaining additional help
• Debriefing process: Structured post-incident review
• Ongoing planning: Regular team meetings for prevention
• Consistent implementation: Uniform approach across team members

Environmental Preparation

• Safety assessment: Regular evaluation of physical environment
• Emergency equipment: Necessary protective materials
• Communication devices: Reliable alert systems
• Space planning: Designated areas for de-escalation
• Evacuation routes: Clear paths for emergency exit
• First aid supplies: Accessible medical materials
• Documentation tools: Ready access to incident forms

Ethical and Legal Considerations

Crisis management must adhere to ethical standards and legal requirements.

Ethical Guidelines

• Dignity and respect: Maintaining client dignity even during crisis
• Least restrictive intervention: Using minimal necessary intervention
• Prevention emphasis: Focusing primarily on prevention
• Skill development: Teaching alternatives rather than just managing behavior
• Data-based decisions: Using objective information to guide interventions
• Continuous improvement: Ongoing refinement of approaches
• Client best interest: Ensuring interventions benefit the client

Legal Requirements

• Informed consent: Ensuring proper authorization for procedures
• Documentation compliance: Meeting all recording requirements
• Regulatory adherence: Following state and federal regulations
• Reportable incidents: Understanding mandatory reporting obligations
• Rights protection: Safeguarding client legal rights
• Training certification: Maintaining required credentials
• Supervision requirements: Ensuring appropriate oversight

Balancing Safety and Rights

• Individualized planning: Tailoring approaches to specific needs
• Regular review: Frequently evaluating necessity of restrictive procedures
• Fading plans: Systematically reducing restrictive interventions
• Stakeholder involvement: Including client and family in planning
• External oversight: Utilizing review committees when appropriate
• Transparent processes: Maintaining open communication about procedures
• Continuous assessment: Ongoing evaluation of risk vs. restriction

Practice Example

An RBT is working with a 12-year-old client with autism who has a history of aggression during transitions. The client begins showing signs of escalation when told it’s time to end a preferred computer activity.

Question: What crisis prevention and management strategies should the RBT implement?

Solution:

Prevention Strategies (Implement Proactively):

1. Antecedent Modifications:

   • Use visual timer to show time remaining on computer
   • Provide 5-minute and 1-minute warnings before transition
   • Use visual schedule showing next activity
   • Ensure next activity is motivating
   • Schedule transition during lower-stress periods

2. Teaching Alternative Behaviors:

   • Teach appropriate way to request more time
   • Practice transition routines during calm periods
   • Develop transition coping script
   • Create transition routine (e.g., save work, log off, push in chair)
   • Teach self-regulation strategies

De-escalation Strategies (When Early Signs Appear):

1. When client shows initial signs of frustration (fidgeting, vocal tone changes):

   • Use calm, neutral tone
   • Offer limited choices (“You can have 2 more minutes or save your work now”)
   • Remind of reinforcement for smooth transition
   • Provide transition object to carry to next activity
   • Use previously successful calming techniques

2. If escalation continues (louder voice, verbal refusal):

   • Reduce verbal interaction
   • Increase personal space
   • Offer calming tool (stress ball, deep breathing)
   • Use distraction or humor if previously effective
   • Consider offering brief break before transition

Crisis Management (If Aggression Occurs):

1. Ensure safety:

   • Create safe distance
   • Remove other clients from area
   • Position near exit
   • Remove potential projectiles
   • Use protective stance

2. Implement approved procedures:

   • Follow behavior intervention plan guidelines
   • Use only approved crisis management techniques
   • Maintain calm, neutral affect
   • Use minimal necessary intervention
   • Document incident thoroughly

Post-Crisis Procedures:

1. After client is calm:

   • Complete transition to next activity when ready
   • Provide opportunity for success in next activity
   • Avoid lengthy discussion of incident
   • Return to normal routine as soon as possible
   • Document incident completely

2. Team follow-up:

   • Analyze what triggered the incident
   • Evaluate effectiveness of prevention strategies
   • Refine transition procedures
   • Consider additional skill teaching needed
   • Update behavior plan if necessary

This comprehensive approach addresses all phases of the crisis cycle, emphasizing prevention while ensuring safety if crisis occurs.

Key Points to Remember

• Crisis management begins with prevention through understanding behavior function
• The crisis cycle includes calm, trigger, escalation, crisis, de-escalation, and recovery phases
• De-escalation strategies should be implemented at the first signs of escalation
• Physical interventions are used only as a last resort when safety is at risk
• Post-crisis procedures include documentation, analysis, and plan revision
• All crisis management must balance safety concerns with ethical and legal requirements
• The ultimate goal is teaching skills to prevent future crises
• Proper training and preparation are essential for effective crisis management
• Team coordination and consistent implementation are critical for success
• Documentation and debriefing help improve future prevention and intervention