Managing the Crisis

From KNILT

Learning Objectives

• Participants will be able to conduct an LSI after given a specific scenario to re-enact. This will be the last part of their Personal TCIS Portfolio they will submit. This submission will can either be recorded and uploaded as a document or written as a screenplay in a Word document.
• Participants will be able to sort 3/3 escalation scenarios to the appropriate type of aggression. This should be submitted to their Personal TCIS Portfolio. This assignment can be created in a Word document or handwritten, scanned and uploaded.

Reactive and Proactive Aggression

Types of Aggression

Unfortunately, some emotions and behaviors cannot be de-escalated regardless of the staff, student or situation. When this occurs, the student is in the outburst phase of the Stress Model of Crisis. In these cases, it's important for the adult to ensure safety for the student/s, staff and classroom materials. Typically, behaviors become dangers as they continue to escalate. Holden & Holden (2013) state these disruptive behaviors is motivated by "emotional flooding" in which students express their emotions by acting our their feelings, including: hurt, fear, anger, despair, abandonment and lack of quality (p. W45). These usually occur in pain-based behaviors, previously discussed in Crisis as an Opportunity. There are two classifications of aggression, these include: reactive and proactive. Cornell University was able to determine that students who were engaging in reactive aggressive behaviors wanted to "obtain something or achieve a goal" and allow their emotions to dominate their actions. Whereas, those engaging in proactive aggressive behaviors allow their cognition to drive their behavior (p. W45). It's important for the adults working alongside children with disabilities that may affect their emotions, coping skills, language and thinking to understand both types of aggression in order to resolve the situation and determine which intervention strategy is most appropriate, as well as, effective. This is because it is our responsibility to support the child emotionally and environmentally to reduce risk and stress.

Reactive Aggression
Reactive aggression is the most commonly demonstrated aggression among children and is based primarily on the way in which they student is feeling. According to Holden & Holden, the behaviors are induced by the flood of emotions that pass through the child. Consequently, the child begins to lose control of the way in which they express themselves and result to pain-based behaviors, such as, self-injury, physical fights and fleeing (p. W45). The behaviors in which the children exhibit are out of fear, frustration or stress. It is important as adults working alongside these children to remember that these behaviors are being driven by the child's emotions; do not take them personally.

The following are examples of reactive aggression:
FEAR
Venard lives at home with his mother who physically and verbally abuses him daily. He enjoys going to school because he is surrounded by male peers and staff. However, his lead teacher was absent one day and a female substitute was leading the class. Venard ran out of the classroom, down the hallway and out the door to the parking lot.
FRUSTRATION
Cierra's mom has been unable to find a job and make ends meet. Cierra and her mother are homeless at times and rely on family and friends to help support them. One day the class was transition from the classroom to the cafeteria. While in the hallway, Cierra accidentally stepped on Haley's shoes. Haley turned around and began to stomp on Cierra's shoes.
STRESS
Joe lives at home with an older sister who is extremely smart. Their dad praises Joe's sister for her high grades and always posts her grade grades on their refrigerator at home. Joe has been learning about fractions during math class. So far, there have been 2 quizzes and Joe has been unable pass. His teacher announced that they were taking a test on what they have learned so far and began to pass out the assessment. Joe began to disrupt the class by verbally refusing to take it and ripping up his test.

Priorities While Dealing With Reactive Aggression
Immediate Response Ongoing Response
Safety Teach coping skills
Provide understanding and support Teach self-regulation skills
Remove or reduce the stimuli Provide anger management


Proactive Aggression

According to Holden & Holden, proactive aggression is most commonly found in the form of bullying in children; however, is also seen in criminals, the psychopaths, athletes and soldiers (p. W45). Those who engage in this type of aggression thoroughly plan out the way in which they will achieve

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their ultimate goal. The "aggressor" or person who plans the aggressive act is doing so to acquire a need, feeling or want. It's important for professionals to remember that proactive aggression may not occur directly after the child has been triggered or escalated. The outburst phase of the Stress Model of Crisis occurs after the event has been designed to achieve the desired effect which could take hours, days or possibly months.

The following is an example of proactive aggression:
Cierra is often neglected at home and bounces between family and friends with her mother since she is currently unemployed. Cierra was taken from her mother once after Child Protective Services removed Cierra from their apartment. She has a difficult time making friends and maintaining relationships. Mrs. Lin has been Cierra's teacher for 2 years. Unfortunately, Mrs. Lin has announced to her class that she will be leaving in a week for a few months to tend to her baby. Due to her attachment problems, Cierra has planned multiple ways to hurt their substitute teacher and has even attempted to recruit her peers.


Priorities While Dealing With Proactive Aggression
Immediate Response Ongoing Response
Safety Teach appropriate thinking, value and social skills
Containment and negotiation Record social appropriate behavior, not anti-social behavior
Engagement and reasoning


The following table has been modified by Holden & Holden and distinguishes the characteristics between reactive and proactive aggression:

Characteristics of Aggressive Youth
Aspects of Aggression Reactive Aggression Proactive Aggression
Facial Features Wide-eyed, red faced, pale (if afraid) Impassive, staring, smiling or smirking
Actions Disorganized, impulsive Deliberate, methodical
Tone of Voice Angry, loud, shrill Firm, calm, menacing
Emotions Highly aroused Apparently controlled

Performance Objective

Instructions: Describe a reactive aggressive situation and a proactive aggression situation. This can be a real-life experience or fictional scenario. Clearly label the 2 by labeling each paragraph with the corresponding title. Please bold and underline both titles. Submit your completed assignment by uploading it to the appropriate portion of your Personal TCIS Portfolio page.

Crisis Co-Regulation

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Help Me Help Myself

The immediate objective in a full blown outburst crisis situation is to make the environment safe. The first goal in crisis intervention is to "lower the stress and risk by providing emotional and environmental support". Therefore, to assist children that are in the outburst phase of stress to regulate their emotions Holden & Holden (2013) state we need to be in control of our own emotions and actions (p. W52). Cornell University has determined that an adult can help co-regulate a student in full blown crisis by asking themselves: what should I be thinking?; what should I be doing; and what should I be saying.

What to Think
It's important to appear calm in order to reduce the level of stress. The easiest way to control our emotions are to stop and think. We should ask ourselves the 3 or the 4 questions discussed in the first module. The 3 questions consist of: (1) What am I feeling now? (2) What does this student feel, need or want? (3) How is the environment effective the situation? (4) How do I best respond? (Holden & Holden, p. W52) The second way to control our emotions is to use positive self-talk (p. Holden & Holden, p. W53). Remind yourself how the behavior is due to an emotion and how the child must be hurting. Examples of positive self-talk include: "Josh must be hurting very badly today to be this upset," or "I know I can do this". Refer back to Crisis as an Opportunity for specific details on the 4 questions.
What to Do Remember that students, especially those that have encountered traumatic experiences, can take any threat that has been perceived or real trigger a fight or flight response. There it's important to prepare yourself for the upcoming situation that you are about to encounter. Cornell University suggests the 2 most important things to do while dealing with a child in crisis, take a deep breath and give the child space and time (p. W53).
• Take a deep breath to reduce the "fight or flight" response that occurs naturally in the human body. This helps to calm the body and mind while providing us a moment to observe the situation.
• Give the student time and space when appropriate. Not only does this deter from any physical threat between the child and the adult, this also allows the student time to assess the situation and relax as well.
What to Say
Consider some of the things you may think or say to people while you're upset? Now consider the feelings of the child who has faced past trauma, imagine what they may say? Holden & Holden suggest while a child is going through an outburst, it is best for the adult to say very little, this is because "it is easy to trigger the violence inadvertently by saying the wrong thing" (p. W53). The child will verbally attack through insults and threats; however the adult should use this time to "communicate understanding by using minimal encouragements, silence, nods, and few reflective statements" (p. W53). Refer back to De-Escalating the Crisis for specific details.
What to do When It's Over
After the student is no longer in a potentially violent state or situation, the intervention has been complete and the student is typically recovering or back at baseline behavior on the Stress Model of Crisis. Once the outburst situation is over, the first goal of TCIS has been achieved; however, it's time to begin the second goal of crisis intervention which includes the teaching of new coping skills through a Life Space Interview (LSI).

Life Space Interview (LSI)

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The second goal of Therapeutic Crisis Intervention is to teach the child new coping skills. This is done so through a conversation that should happen as soon as possible after the crisis has happened. This conversation is called a Life Space Interview (LSI) "is a powerful tool for teaching self-regulation skills and values" (Holden & Holden, 2013, p. W55). Based on the Stress Model of Crisis, as the child enters the recovery stage, the adult should use an LSI to revisit the students' behaviors and relate them back to their feelings to help teach new coping skills for these feelings. According to Holden & Holden (2013), the LSI should occur during the recovery phase because the child is more apt to listen and develop new skills with an adult they trust (p. W55).

The following are goals for the LSI:
1) Return the student to baseline. Allow the student to tell their side of the story as a way to vent and drain the raw emotions they still feel from the situation. This helps the student return to baseline behavior and rational thinking.
2) Clarify the events. This is the opportunity for the adult to restate exactly what the child had just said while they explained their side of the story. The student probably had a distorted version of the situation and listening to their story allows for them to take ownership and responsibility.
3) Repair and restore the relationship with the adult. This is a process that needs to occur throughout the LSI by using active listening, sharing perceptions and being supportive. This helped to rebuild any potential damage that may have occurred during the outburst.
4) Teach new coping skills. After sharing perceptions of the situation and linking the behavior to feelings, it's important that the child thinks of alternative coping skills for stressful situations that may occur in the future.
5) Reintegrate the student back into program. The student must have an alternative behavior, general expectations and have returned to baseline behavior before entering back into program.

Steps to the LSI

According to Cornell University, there are 7 steps to perform a LSI, this include the following acronym:
I Isolate the conversation
E Explore the student's point of view
S Summarize the feelings and content
C Connect feelings to behavior
A Alternative behaviors discussed
P Plan developed and new behavior practiced
E Enter the student back into the program

The first step is to isolate the conversation by finding a place to talk that has little stimulation, distraction and stress. In order for students to successfully complete the LSI, they must feel comfortable to discuss a difficult situation without feeling overwhelmed or rushed.
The second step to the LSI is the explore the student's perception of the incident by explaining their side of the story and draining any emotions. This step is one of the most difficult because the adult must know the student to elicit conversation. Sometimes, silence is preferred over open-ended questions. According to Holden & Holden (2013), people in crisis need to talk in order to work through their emotions and justify their reactions (p. W57). Active listening is an important piece to the exploration piece of the LSI and both verbal and nonverbal techniques must be used to generate a meaningful conversation that will lead to a mutual understanding.
The third step involves the adult summarizing the content previously stated by the student. During this time, the adult should be using reflective responses and relate the child's behavior to their emotions. By summarizing the scenario, the relationships between the child and adult should be resolved (Holden & Holden, p. W58).
The fourth step should allow the adult to explain the emotions and behavior that the child exhibited shortly after. The adult should emphasize the connection between the child's behavior and feelings. The fifth step focuses on the child developing new behaviors for their unacceptable options. This should occur only after the feelings and inappropriate behavior have been clearly stated and agreed upon by both parties.
The sixth step should provide the child and the adult the opportunity to practice the alternative behaviors that were previously discussed. This practice should be a rehearsal and taken seriously by both. If the student does not like the alternatives, allow this time to explore and then plan again.
The last step is entering the child back into the respective program after clearly identifying the expectations of the child, remind them of their surroundings, and offer support if the child seems hesitant.

Sample Statements

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Performance Objective

LSI Observations





Instructions: First, read the crisis scenario below. Then, use the LSI Observations worksheet to explain your actions and thoughts through each step of the Life Space Interview (LSI). Submit your complete assignment into the correct section of the Personal TCIS Portfolio page.

1. How did the staff person isolate the student from the problem situation?




2. How did the staff person explore the student's version of what happened, including:


The student's concerns about the situation?



The student's feelings about what happened?



Did the staff person share his or her view of what happened to clear up any misunderstanding or misperceptions?


3. How did the staff person summarize what the student did, how the student felt, and the sequence of events?



4. What feelings and behaviors did the staff person help the student connect?


5. What alternative behaviors and choices did the staff person help the student develop? Were ideas coming from the student validated?



6. What plan did the staff person help the student develop?




7. How did they practice the plan?



8. How did the staff person help the student enter back into the program?