Crisis Management and Applied Behavior Analysis--Special Guest Kim Warma from Pro-ACT, Inc.

Episode Transcript
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SPEAKER_00 (00:00):
Welcome to ABA on Tap, where our goal is to find
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we

(00:23):
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.

(00:43):
So without further ado, sitback, relax, and always analyze
responsibly.

SPEAKER_01 (00:55):
All right, all right.
Welcome back to yet anotherinstallment of ABA on Tap.
I am your co-host, Mike Rubio,along with Mr.
Daniel Lowry.
Mr.
Dan, how are you, sir?

SPEAKER_00 (01:06):
I'm great.
I'm very excited about today andtoday's guest, one that we've
been looking forward to havingon for a while.
I'm seeing some technicaldifficulties last week, but we
got it together and, yeah, veryexcited about today.

SPEAKER_01 (01:19):
We're very grateful that our guests would agree to
come back.
We have been facing sometechnical difficulties some life
events.
It's been a little while sincewe've been in the studio, sir.
So it's really good to be back.
Good to continue with themomentum here on the guests.
We do pretty well at creatingcontent and coming up with good
content.
And then as of late, Mr.
Dan, we have other peoplehelping us with that because

(01:42):
they so graciously agree to comeon the show.
So I am going to, I've said thisbefore, you bring stuff to the
table, I bring stuff to thetable, and then one of us drives
a little bit more than the otherin any given episode.
So I'm Sometimes we share thatpretty well.
I'm going to let you drivetoday, sir.
All right.
I think this one's yours.
So without further ado, pleaselead us into our guest, and then

(02:04):
we'll let her give us a littlebackground and kick us off here.

SPEAKER_00 (02:07):
All right.
So very excited to have KimWorma, the president of ProAct,
Inc., with us today.
And please, if I butcheranything, please correct me.
I'm trying to get my terminologyand make sure that I'm correct.
Did I get that all right, Kim?

SPEAKER_02 (02:26):
You got it perfectly.

SPEAKER_00 (02:27):
Excellent.
The president of PROACT, Inc.
Many of you may use PROACT or aderivative of that as a crisis
management kind of protocol andsomething that's just been very
well utilized here in the fieldof ABA, something here in San
Diego a lot of the ABA companiesuse, and something that I think

(02:49):
I'm really excited to have Kimcome talk a little bit about
what PROACT is, but also justkind of some of the
methodologies and the reasonsbehind it, because I think a lot
of times people have one idea ofwhat PROACT is, and then when
they get the training, they arejust enlightened to a whole
different kind of world ofstrategies and things that can
just make the generalapplication of ABA better.

(03:13):
So without further ado, Kim,thank you so much for joining us
today.
I really, really appreciate yourtime.

SPEAKER_02 (03:18):
I'm happy to be here.

SPEAKER_00 (03:21):
So could you maybe start with talking a little bit
about maybe your experience andwhat brought you, how you maybe
found yourself into PROACT, andthen maybe we can get a little
bit into what PROACT is?

SPEAKER_02 (03:34):
Of course.
I've had a long history withPROACT and started with the
organization by training peopleprimarily training folks who
would become instructors whowould then go back into their
own organizations and train.

(03:55):
And I did that for a number ofyears.
It was an awesome experience, Ithink, because for me, my own
background at that point was inresidential.
residential treatment, and I hadworked with a variety of age
ranges.
But in providing training tofolks who would go back into
their own organizations to useProAct, I got exposure to a lot

(04:18):
of other treatment environments,a lot of other professionals,
and it just really broadened myscope and understanding of
what's out there and how ProAct,I think, fits how people can use
the PROACT principles to work intheir own organization and

(04:39):
support the people that theyserve.
I like the flexibility of it andhere I am, decades later.

SPEAKER_00 (04:48):
And you worked with the founder, right?
You worked directly with PaulSmith, is that correct?

SPEAKER_02 (04:55):
I did.
I knew Paul and worked with him.
And Paul's story is aninteresting one in that Paul,
kind of the piece about Paulthat I think is the most unique
is that Paul is a Quaker.
And so his focus was onnonviolence.

(05:16):
And when Paul first came to workin the treatment environment and
clinical treatment, he actuallywas a, He was a conscientious
objector in the Vietnam War andso was doing work in a
psychiatric treatmentorganization facility and became

(05:37):
concerned about the amount ofassault or violence that he saw
and witnessed in thatenvironment.
And that's what kind of promptedhis work in developing what was
originally called PART,Professional Assault Response
Training.
That was in 1975.
In 2002, PART became PROACTTraining, and at that point,

(06:03):
Paul was no longer involved inthe organization.
But I think the fact that theprinciples Paul established
early on have remained intactfor the duration of heart, and
now they are the same principleswe continue to use with PROACT.
And again, as I mentioned, theflexibility, it's the

(06:27):
adaptability and flexibility ofthose PROACT principles that
allow them to remain the sameand allow them to work in a
whole host of treatmentenvironments with a variety of
professionals.

SPEAKER_00 (06:41):
That's something

SPEAKER_02 (06:42):
I

SPEAKER_00 (06:43):
really like, that you mentioned that flexibility,
because when we train, we trainto, and again, we're doing this
from kind of the ABA guys, andthat's one portion of the
individuals that we train, butwe train people from group
homes, from hospitals, fromshort-term residentials,
longer-term residentials.
I think we've even trained somecorrections individuals.
There is a wide breadth ofindividuals that this

(07:06):
methodology is suitable andapplicable for.

SPEAKER_02 (07:10):
Absolutely.
And also age ranges.
In addition to those differentenvironments, whether it's
children, adolescents, adults,geriatric populations.
So the adaptability to all thosefolks is what is one of PROAC's
big strengths, I believe.

SPEAKER_00 (07:30):
And the systematic approach, too, if I understand
correctly, and as it's playedtelephone and gotten to me, I
haven't butchered anything, thatwhen Paul was at, I think it was
Camarillo State Hospital, hejust noticed that there wasn't
really a plan or a systematicapproach and everybody was kind
of doing their own thing.
And he kind of sought to find away to get everybody on the same

(07:53):
page so that they could minimizeinjuries so that everybody
wasn't doing their ownindividual thing on the same
page.
in response to these crisissituations.
Is that pretty accurate fromyour experience?
Did I report that correctly?

SPEAKER_02 (08:08):
I think in terms of history, it is.
I think also when you look backat what was going on in 1975, 50
years ago, the whole nature oftreatment, treatment
environments, and the peoplethat were being served was
different.
And so...
It was about creating some kindof consistency.

(08:30):
And over the course of years, ofcourse, different organizations
have come in to fill that gap,and different organizations
choose to fill it a little bitdifferently.
What sets PROACT apart, Ibelieve, now and then is, again,
this set of principles that weuse, as opposed to a real
technique-driven program.

(08:53):
Techniques are about...
following very clear rules.
There's a step A, a step B, anda step C.
And with PROACT, the whole focushere is to say, who are the
people that I'm working with?
What are the needs that theyhave?
And how do I best address thoseneeds in this moment to reduce
the potential for furthercrisis, for injury of the

(09:18):
client, the other, and theprofessional?
And it's that adaptability Thatis what PROACT considers its
systematic approach.
It's the idea that we give you aset of questions, and that's the
system.
The questions that help us toimplement the principles.

SPEAKER_00 (09:38):
I agree from seeing it from both sides, from
delivering it as a Proact Inc.
trainer, but also the in-serviceinstructor delivering the
material to my companies, that Ithink one of the weaknesses in
ABA, I don't know if it's aweakness, something that I've
found is that people wanttechniques.
And I'm just taking out ofproduct for a second.

(10:00):
But people want to know, when Iwork with Johnny, what should I
do?
Or when I work with Susie, whatshould I do?
When Susie tantrums, how do Iget Susie to stop tantruming?
And what happens is...
and we teach these techniques,which I think oftentimes we do
in ABAs, we say, okay, well,maybe you should, when Susie
tantrums about the iPad, maybeif you ignore her until she
stops, then...

(10:21):
you can go about it that way.
But then what happens is thatperson takes that response and
uses it for every time Susietantrums for every reason, but
not only Susie, uses it forJohnny and Sally and Thomas and
everyone else.
And then what happens is we havethese treatments which are not
well fit for that individual.
There was context which madethem reasonable for one
situation, but not holistically.

(10:44):
And I really found that ProActwas really, really useful And
actually sometimes challengingin the beginning to teach these
people because they come inwanting these answers and we're
like, well, let's think aboutit.
What alternatives do you have?
And then we have to think aboutthe alternatives and the
alternatives that you mightoffer today might be different
than tomorrow.
So at first it can be verychallenging, but I've always

(11:05):
said that.
I think one of the mosteffective trainings, and in ABA
we mandate this 40-hour RBTtraining, that we could give a
new staff would be PROACTtraining, because PROACT teaches
you how to think and how toprocess like a framework, and
then you can individualize itfrom that.
So it's more like outside in,whereas a lot of our trainings
teach inside out, and I thinkpeople get lost.

SPEAKER_02 (11:28):
I agree with you completely.
I mean, I think that...
That's exactly what happens withthe technique.
That's also why people liketechniques, though.
If you have a technique, theywant to be able to apply it to
every single situation.
And to ask people to think andprocess requires an extra step.
However, I look at who are weserving.

(11:53):
The goal and the objective hereis to take care of our clients
and to better support and servethem and address their needs.
And so if it takes me an extrastep to consider and alter what
I'm going to do, if the outcomeis better for the client, then
that's worth it.

(12:14):
Because trying to fit a singletechnique, whether it's taking
away the iPad or ignoring forfive minutes or whatever it
might be, into every situationisn't going to address the needs
of the individual.
And so then if we're notaddressing the needs of the

(12:37):
individual, what's the likelyoutcome of that?

SPEAKER_00 (12:41):
Yeah, absolutely.

SPEAKER_02 (12:43):
The situation will tend to escalate.
The staff people will tend toget frustrated.
That level of frustrationoverlaps into what happens in
terms of the interaction withthe client.
And so...
Part of this process is let'sjust slow it down and think
about what we can do to make itwork better and more effectively
in the moment.

SPEAKER_01 (13:04):
There's an interesting locus of control or
a shift here that you're talkingabout.
When you say thinking aboutwhat's better for the client, I
think oftentimes youngerprofessionals or professionals
in ABA in a so-called crisissituation or if a child is
escalating, are immediatelythinking about what's better for
the environment, what's going tomake the parent feel better,

(13:24):
what makes those sounds or thoseactions stop so I feel better
about it.
You're talking about the clientspecifically.
I find that very interesting.
I mean, again, that's a wholeshift of we talk about
instructional control, forexample, in ABA, and the idea
that your words are shiftingthat tool.
Now let me let the clientinstruct me as to what's better

(13:44):
for them.
where I think oftentimes we'rethinking the other way.
How do we control thisout-of-control client?
You're shifting the paradigmthere.
I don't know if you can spend alittle bit more time on that.

SPEAKER_02 (13:55):
Well, I think I'm happy to.
I'm happy to try.
I think, first of all, it'sreally important for people and
everyone to understand thatPROACT isn't treatment.

SPEAKER_01 (14:09):
Excellent.

SPEAKER_02 (14:10):
All of the kids you're working with, the
clients, any organization that'susing ProAct, they are not using
it as a treatment plan, whateverkind of plan that might be.
ProAct is there to be used whensomething else happens.
From the perspective of ProAct,we say that you have a treatment

(14:31):
plan in place for the clientthat you're working with,
whoever that client should be.
And we all understand that as weare attempting to build
effective treatment plans, if wedo build effective treatment
plans and things change, thenthe existing plan might not
work.
A new plan might not work.
There are some tweaks andadaptations and modifications

(14:54):
that need to occur in thoseplans.
The goal of the treatment planisn't to trigger a client into
any kind of crisis.
Is that true?

SPEAKER_00 (15:07):
Yeah, absolutely.

SPEAKER_01 (15:09):
That sounds very logical, and then sometimes you
go out there and you see peopleat work, and it seems like maybe
they're not keeping that inmind.
Again, it's very authoritarian.
Let me control the situation,make you do what I need you to
do, and then you receive thisreinforcement.
And I'm boiling that down prettyquickly and stringently, but
yeah, I think that...
This is where you're speaking toa different mode of presentation

(15:31):
or a more dynamic mode.

SPEAKER_02 (15:34):
Exactly.
And I think, yes, that's a verybroad brush.
It's not the way it alwaysworks.
But I think we can be generallycomfortable saying that
treatment shouldn't put peoplein crisis.

SPEAKER_03 (15:47):
Yep.

SPEAKER_02 (15:48):
But that doesn't mean that there aren't people in
treatment who sometimes end upin a crisis situation.
So if we look at those twostatements, then what we know is
crisis isn't treatment.
So PROACT is there to helppeople respond and manage

(16:10):
crisis.
It's not there to do treatment.
And so what we will say often isthat if you feel like you are
consistently using PROACT tomanage a crisis situation,
you've got to go back to yourtreatment plan because
something's wrong there.
and what you're doing on thatday to day.
But also what we can recognizeis that sometimes things do get

(16:34):
pushed to a point where there'sa crisis or something external
happens and there's a crisis.
And at that point, we also needto shift our objective.
And I think this is what you'retalking about, Mike, is that
when the crisis occurs, it's notabout saying, well, we've still
got to push forward.

(16:54):
with this treatment plan andcontinue to take control or have
the same expectations that Imight have had five minutes ago.
Once we hit a point where we'rein crisis, we've got to do
something differently.
And crisis response andtreatment are not not always the

(17:16):
same thing.
They are not necessarilymutually compatible.
You've got to put the treatmentobjective aside and say, we now
have to get back to a placewhere we can bring people, well,
first we can keep them safe, butsecond, where they can begin to
learn or receive or respond tothe treatment objectives that

(17:41):
are part of that other plan.
Because we can't do both at thesame time.

SPEAKER_00 (17:47):
Yep.

SPEAKER_02 (17:47):
Does that make

SPEAKER_00 (17:50):
sense?
Oh, 100%.
I want to elaborate on a couple.
Oh, go ahead, Kim, please.

SPEAKER_02 (17:55):
No, no, go for it.

SPEAKER_00 (17:56):
I want to elaborate on a couple things you said.
So the first part, again, I justwant to reiterate because it's
so important.
Like you said, the curriculum isnot evidence-based treatment
because it's not treatment.
And what I've found is thatoftentimes what product does is
it really does find the holes inthe treatment.
We're not there.
Kind of a term that I use is ifI do my job well enough,

(18:20):
Chapters 6 through 12, theresponses, you're going to use
them less because what you'regoing to find is the holes in
your treatment that prevent youfrom getting into the crisis
pieces.
Chapters 1 through 4, where wetalk about preparation and the
professionalism, those I thinkare always pretty relevant.
But later when we talk aboutcrisis responses, because Mike

(18:43):
always has a statement, he talksabout rewriting the script.
We always say if...
you're always having to dosomething, then we're probably
always doing something first.
So if the client or the personthat we're serving is always
assaulting or always doingsomething, then we're probably
always doing something first.
And that is that treatment that,like you said, PROACT isn't

(19:05):
there to say this is exactly howyou're going to set up an
environment.
These are going to be yourantecedent strategies.
We're going to say that it'svery important that you address
antecedent strategies andtreatment.
But we're just going to say thatplease use these plans and
please have these plans.
And in the event that theseplans don't work, use them
again.
And if the event that they'restill not working, try to still

(19:25):
use them.
In the event that they're stillnot working, okay, we have some
additional strategies that mighthelp you resolve this situation
to be safe.
The last thing that I think yousaid that was so important and I
want to reiterate and pleasefeel free to expand on is the
difference between safety andlearning.
PROACT is really designed to bea safety curriculum and help

(19:46):
people maintain safety in theenvironment so that we can use
those behavior plans or thosetreatment plans or primary
plans.
But when things are escalatingto the situation, like you said,
no primary plan is designed forsomebody to be assaulted.
When it's gotten to that point,people's cognition, and I wish
maybe we'll add a visualsomewhere into this because the

(20:07):
PROACT assault crisis visual isjust...
so paramount and gives a reallyamazing visual for this.
When people escalatesignificantly, their cognition
drops.
When their cognition drops,there's not really much learning
going on there.
So like you're saying, whenwe're looking at people
assaulting, we gotta prioritizesafety to get them back to a
situation that's safe thateventually they can learn.

(20:32):
Did I kind of recap that well?
Is there anything you'd like toexpand on, Kim?
But I think what you said isjust so important, I wanted to
make sure it was reiteratedthere.

SPEAKER_02 (20:40):
No, I think you're absolutely correct.
And again, it's that piece thatas behavior, as anyone
escalates, anyone's behavior,and let's get really clear here,
everyone has behavior, not justyour client,

SPEAKER_03 (20:56):
right?

SPEAKER_02 (20:58):
So as anyone's behavior escalates, our
cognitive process is reduced.
And so that's why...
earlier when I said if yourclients are escalating and we're
pushing them further into thatescalation it's probably to your

(21:20):
point Mike is it our own why arewe continuing to push?
What are we doing?
Why are we continuing tofrustrate the client, frustrate
ourselves?

SPEAKER_01 (21:30):
The idea of discipline comes in sometimes
with that, right?
I think it's a misconceptionthere.
But to your point, I think thisidea of discipline, right?
We're helping parents, so I haveto discipline my child.
And that means that even ifthey're not listening or they're
now in an escalated state, Istill have to push forward.
So continue.

SPEAKER_02 (21:47):
Right.
No, I agree.
But And so that discipline canlook like a whole host of things
depending upon what people do.

SPEAKER_01 (21:56):
Very

SPEAKER_02 (22:00):
good.
which then ultimately increasesthe potential for real injury.
I would go back, Daniel, to whatyou were saying about it's not
just about assaultive behavior.
As people escalate early in thatprocess, again, our cognitive,

(22:26):
our thinking is diminished.
Our cognitive process isreduced.
And so part of it is we wantearly on to give people some
tools, and people now, I'mmeaning the professionals who
are doing these jobs, give themsome tools to understand and
observe that early escalationbecause an earlier response and

(22:48):
getting someone back to theirbaseline earlier, so stopping
that push earlier, avoids thecrisis, avoids the trauma
related to the crisis, avoidsthe potential injury, avoids the
sense that that there is nodiscipline.
Let's shift gears earlier.
It's kind of like, don't driveoff the end of the bridge.

(23:10):
Take a detour and get around tothe other side.

SPEAKER_03 (23:14):
Yeah.

SPEAKER_01 (23:16):
It's probably not a great analogy.
No, but I think some people thenmight say, well, but that took
you off course, and you'resaying, yes, that's okay.
You're not supposed to stay onthat road.
Right?
But some people might say, oh,but that deviated your course.
That changed your treatmentplan.
No, this is part of the dynamicof the treatment plan, I think
is what you're explaining.

SPEAKER_02 (23:34):
Yeah.
Yeah, and I think what I'msaying is it took me off course
because the treatment plan,something that was going on
before, Proact didn't take meoff course, the escalation took
me off

SPEAKER_01 (23:46):
course.
There you go.

SPEAKER_02 (23:47):
Proact helped me get back on course by managing the
escalation and reducing thepotential for crisis.
The sooner I can get beyond thecrisis, the sooner I can get
back on course and move backinto that learning.

SPEAKER_00 (24:02):
I like that framework, Kim.
It's kind of like the behaviorplan, primary plan, whatever you
want to call it, treatment plan,isn't working.
And if we're continuing to dosomething that's not working...
That's, you know, that'sEinstein, right?
Insanity repeating the samecourse of action and expecting a
different result.
So what Proact can actually dois give us another alternative

(24:22):
to get us back to our treatmentplan, because that's where we
want to be.
We want to be back in thattreatment plan.
But if it's not working, we gotto get that individual's
cognition back to a level thatthey're going to be receptive to
the treatment plan.
I really like that framework.

SPEAKER_02 (24:35):
Absolutely.
Absolutely.
And again, that's where we say.
And if you try it again and thesame thing happens, and if you
try it again and the same thinghappens, well, then you need to
consider adjusting the treatmentplan.
That's where modifications.
It doesn't mean you throw itout.
It doesn't mean you don't have asimilar objective.
You just have to find a newpath.

SPEAKER_01 (24:54):
There we go.

SPEAKER_00 (24:55):
Yeah, absolutely.
Because like you said, thetreatment plan wasn't written to
get to an assault or ahigh-level escalation.
So if that's happening, eitherit's a fault in the treatment
plan, which I know Mike and I,we've written tons of treatment
plans that were faulty and youlearn and you adjust it's only
faulty if you keep doing it orit's a it's a issue in

(25:15):
somebody's implementation of thetreatment plan so both of those
lead to like i think i can'tremember off the top of my head
i probably should have broughtone of my product manuals i
think it's chapter 10 when wetalk about debriefing um when we
talk about looking at theeffectiveness of the treatment
plan versus that person'simplementation of the treatment
plan i think one of those twothings is faulty so let's kind

(25:37):
of look back and and figure outwhat's going on in that
situation.
And product allows us to getback to a safe situation so we
have the ability to do that.

SPEAKER_02 (25:47):
Absolutely.
I think the other thing that wego back to is whose needs are we
meeting when?
And it's an interesting commentthat you had, Mike, about when
you've got someone working witha child and they feel like
they're trying to support aparent, the idea that they get

(26:07):
into this notion of discipline.
And so because I need todiscipline this child so the
parent understands how to dothis or isn't dealing with this
situation.
If that's not effective for theprofessional, it's not going to
be effective for the parent.

SPEAKER_01 (26:24):
Yes, very true.

SPEAKER_02 (26:26):
And so we have to step away and say, again, Whose
needs are we meeting in thismoment?
You know, are we pushing forwardbecause we want to feel like
we're doing something for theparent?
Because the focus here reallyhas to be on the kid.

SPEAKER_00 (26:48):
Right, right.
I love that.
Whose needs are we meeting then?
When?
I love that.
Love that line.

SPEAKER_01 (26:53):
So that really gives...
or really makes it importantthat we posit the idea of
crisis.
We've been using that word.
So I'm going to ask a verysimple question, because as a
parent, you might have a childthat escalates tantrums
frequently.
And you might, as the parent,interpret all of those
situations as crisis situations.
That's not necessarily whatwe're talking about here.

(27:15):
We're talking about a veryspecific definition.
Why don't you guys spend sometime talking about what that
means, crisis?
How do we define crisis?
at which point does it escalateto different levels that then
warrant us as professionals orindividuals trained in PROACT to
then take a different course ofaction?
It's a very general questionthere, but I know you guys have

(27:37):
a lot of little pieces to fillin there.

SPEAKER_02 (27:43):
Should I dive in here?
Sure.
Go ahead, Kim.
So PROACT defines crisis as inthree very specific ways.
And we could call them high,medium, and low.
We could call them...
But basically, a crisis is apoint in which there is an

(28:08):
immediate potential for risk.
Either there's an immediatethreat or there's an immediate
attempt at some kind of physicalassault, some kind of harm.
And this is a threat to aperson.
It could be self-injurious.

(28:29):
It could be injurious to theother.
But it's immediate.
It's imminent.
And basically then what defineswhether it's high, medium, or
low is the potential severity.
So I think it's important torecognize that that crisis
definition sits within aframework of what we refer to as

(28:52):
an assault cycle.
And that assault cycle has atrigger, it has an escalation.
Phase three is very limited, andthat's the crisis.
After a crisis, there's arecovery period, and then
typically following thatrecovery, you're gonna see some,
what we refer to in PRO-ACT ispost-crisis depression, which is

(29:14):
a depression sometimes of mood,sometimes of behavior.
But you will see a shift.
I think that when we talk aboutcrisis, we can talk about
responding to the crisis, butreally where the diagram, I

(29:40):
believe, between a treatmentplan and a proact as a
systematic approach overlapsmost notably is in that space
between trigger and crisis.
That's where PROACT really wantsto invest its energy.
You know, PROACT does teach somekind of physical intervention or

(30:04):
physical restraint, but ourwhole focus is avoiding that.
PROACT as a program puts moreemphasis on early intervention
and de-escalation than any ofthe other programs out there.
And that's because We believethat if we can avoid that
crisis, that's, again, betterfor everyone.

(30:25):
It's better for the staff.
It's better for the kid.
It's better for the parent inthe cases that you're talking
about.
So the goal here is, and that'swhy I was saying you want to be
able to see early on when thetrigger happens.
You don't wait until the crisisto respond.
You don't wait until there's athreat.

(30:48):
a threat to self or a threat toothers.
You don't wait until someone isphysically injuring themselves
or others.
You want to look and observe thebehavior changes that indicate
there's escalation.
Because for a lot of reasons,one is that's when you're also
seeing the cognitive shift.

(31:10):
As soon as we start escalating,the capacity for that
individual, child, adolescent,adult, their thinking is going
to be marginalized.
It's going to be reduced.
And so that means we want tobegin to change what we're

(31:31):
doing.
And that is not pushing forwardfaster and harder and more,
making more demands.
So the idea is, again, how do wereduce demands at this point so
that we can bring this personback to a place where they can
learn more effectively.

SPEAKER_00 (31:49):
I agree.
An analogy I like to provide forthat, Kim, is one of my triggers
is slow computers.
You get that wheel or you getthat computer that starts
spinning, and like you said,we're not going to get back down
to baseline by adding more ontosomebody's cognitive load.
It's the same thing with acomputer.
If the computer wheel isspinning, you can try to open as
many more programs as you want.

(32:10):
That's not going to work.
You've got to get that computerto get get itself situated you
got to remove programs in orderfor the computer to get caught
up and that's i feel like whathappens a lot with people is
that people their wheel isspinning and now everybody
around them is adding more totheir cognitive load and you
wouldn't do that with a computeryou wouldn't keep just adding
more programs to it if it'salready on overload so that's

(32:33):
kind of the analogy um i like tothink about i want to go back to
your oh go ahead kip

SPEAKER_02 (32:38):
Oh, I have something I want to say, if I can.
Yes, please.
I think that's one of the thingsthat makes PROACT very, very
different than a lot of otherprograms.
It's one of the things thatpleases me most about what we
do.
Because at that point, whatyou're talking about is you, the
operator of the computer,wouldn't keep pushing the
buttons, right?

(32:59):
Yep.
It's up to you to say...
This doesn't make sense.
I'm not going to keep pushingthe buttons.
One of the things that PROACTincorporates into its training
is a focus on some professionaldevelopment so that I, as the
staff person, regardless of myrole, don't keep pushing the

(33:19):
buttons.
I have to begin to...
I have to learn, and Proactprovides, again, structures for
structured observation, formanaging my own behavior.
Because if I get frustrated,then I'm much more likely to
keep pushing the button.
If I'm not paying attention, I'mmuch more likely to keep pushing

(33:39):
the button.
And so I think...
I guess we'll...
I guess I understand why peoplecontinue to push, and it's
because if they don't haveanything else, if they don't
know what else to do, they justkeep trying the same thing.

SPEAKER_00 (33:58):
Yep.
I think that was Maya Angelouwho said, we do the best we can
with the information we have atthe time, and when we know
better, we do better.
And I've seen that absolutely beapplicable for PROACT.
I do think that the majority ofthe people Get in this field
well-intentioned and do the bestthey can.
I don't think they're trying toactively hurt people.
I agree.

(34:21):
We just did some trainings withthe paraprofessional level.
Unfortunately, in our field, alot of times the direct staff
get the least amount oftraining.
whether it's for whateverreason.
It's hard to pull them away,unions prevent it, whatever
reason.
So these people are expected tokind of do the most work and be
in the face of everything andget the least amount of
training, and then they're theones that are held accountable

(34:43):
when stuff goes haywire.
So, yeah, kind of like you'resaying, Kim, I think as these
people get more training, theydo better because they know what
to do better.

SPEAKER_02 (34:52):
Right.
And I think what we're talkingabout and what we train people
to do are things that are...
really well within the capacityof individuals because i agree
with you people don't get intothis business to do wrong they
get in because they do want toserve and support but without
training especially insituations of crisis we revert

(35:16):
to our own experience how weparent how we were parented um
how we went to school it couldbe any anything and so we need
to give people just more toolsso that they can do a better job

SPEAKER_00 (35:29):
I think additionally, too, as people run
out of options, they try to grabmore control over the situation.
And that's when they eitherstart applying less options or
even become more physicallyeither closer proximally or
start physically moving peoplebecause they don't have it.
I don't want to say they don'thave any.
They don't think they have anyother options.

(35:50):
They think that's what theiroption is.
And that's where actually thingsget escalated more.
Because like we talk about inProact, if we do our job.
Well, a lot of times people comeinto these prior trainings
thinking, oh, I'm going to learnall about restraints.
If we do our job well, you willleave here using them less and
wanting to use them less andthinking about using them less

(36:11):
because you have a lot of otherstrategies.
You don't think that somebody isnot listening to me.
I'm going to ignore and theystill don't listen to me.
I'm going to make them do it.
Those are your only options.
You're going to leave with a lotmore options so that you're not
going to have to get to thatpoint because they're not going
to escalate to that level.

SPEAKER_02 (36:26):
That's the whole idea.
That's

SPEAKER_00 (36:31):
exactly the

SPEAKER_01 (36:31):
objective.
Mike, I want to get

SPEAKER_00 (36:33):
to something you said.
Just because it's one of myfavorite slides in ProAct and a
lot of the people that I train'sfavorite slide.
You asked about crisis.
One of the early on slides talksabout there's a difference
between dangerous behavior andirritating or obnoxious
behavior.

SPEAKER_01 (36:49):
That's perfect, yes.

SPEAKER_00 (36:51):
And that, I think, resonates with Saul.
I usually joke when I presentthat.
I'm like, if we could getarrested for being obnoxious, My
girlfriend would call the copson me at least twice a week,
probably every day.
But because that doesn't jivewith somebody's wanting to,
whether it's in a school orresidential or something like
that, because it's not makingthe staff's life easier, all of
a sudden we start to escalateand we make a situation worse.

(37:13):
Kind of like Kim was talkingabout, whose needs are we
meeting when?
And so often we're thinkingabout our needs.
We're thinking about thecomputer wheel spinning.
I need to get this program open.
Well, unless I start removingprograms, I can't open up this
program.
We think about our needs andlose the needs of the client.
Like somebody being hungry,right?
A lot of people get hangry.

(37:33):
We talk about this.
The easiest way to meet that isto just feed them.
Now, maybe they might beengaging in, you know, I get
hangry, my girlfriend getshangry, a lot of us get hangry.
I can talk to her about, hey, Idon't like your attitude right
now, or she can talk to me aboutthat.
That's not going to make itchange as fast as, hey, can I
get this person some food?
And now one person might say,and this is a...

(37:55):
tangent I want to go on laterbecause I do want to get Kim's
perspective on it.
People might say, well, you'rereinforcing that person by
giving them food.
Okay, maybe.
Maybe you are.
But also, can we get them backdown to baseline so that we can
teach?
Because you can't teach whenpeople are away from baseline.
So it's all about whose needsare we meeting when?

(38:15):
I'm stealing that, Kim.
I like that.
Because so often we're focusedon our needs.
And we need to get them to stopcrying.
No, we've got to meet theirneeds first.
So that I can do

SPEAKER_01 (38:24):
this next trial.
So that I can take this data.
I need you to do this.
And no, no.
What are your needs in thismoment?
That's what I'm talking about.
I need to take care of.
This reminds me of somethingthat actually I would say I
learned from Proact.
I remember once working with achild who had pretty heavy
distress expression.
And it was a snack time during agroup session.
And somebody was trying to gether to eat.

(38:45):
And they kept doing our famousfirst then contingency.
First, you do this.
And then you get food.
And the child was saying, no,no.
And it was escalating.
And the staff member kept doingthe same thing.
So finally, I stepped in.
And again, sort of thinkingabout this idea of stop, look,
and listen.
Do less for a minute.
And if I'm going to keep doingthe same thing and getting the

(39:05):
same outcome, then I'm notreally helping anybody.
So I remember just...
getting down to the child'slevel and saying, hey, are you
hungry?
And she stopped and said, yes.
And I said, great, go do thatover there and then I'll meet
you at the table for food.
And it worked.
And I think that a lot of thetrouble that happens in ABA is
that we are so linear in ourcontingency.
We've got this three-partcontingency and it's really

(39:26):
powerful.
So I don't take anything awayfrom it.
But we tend to think that it'salways the same antecedent for
the exact same behavior for theexact same consequence and what
you're saying kim is that can'tbe in fact there's many
antecedents to many acceptablebehaviors to a variety of

(39:47):
consequences and that seems tofit right into the the proact
model if i'm not mistaken

SPEAKER_02 (39:53):
absolutely and i think part of that is to say
again that's why proact speaksto this issue and has a has a
focused content area onobservation what am i observing
when am i observing it and howis it changing to go into any
environment a con one that'smore controlled or less and just

(40:14):
assume that because you've gottwo eyes your observation skills
are in order is um not correctyou have to know what you're
looking for and you have to beprepared to look for really
small changes it's And when youdo that, again, you're looking
and saying, what's happeninghere?

(40:35):
And then I think you can...
You also spoke to something,Mike, which is about humanity.
Asking someone the simplequestion of, are you hungry?
And trying to help them meettheir need.
Because ultimately...
In the big picture, what we wantis to give people the skills and

(41:01):
the understanding of how to meettheir own needs, right?

SPEAKER_00 (41:04):
Yep.
Mike, I wanted to jump in onsomething Kim just said real
quick because you were talkingabout observation.
And we talk about the threelevels of observation in a
product.
I won't give away too muchbecause you all come get the
course and get the full thing.
But one thing that I would talkabout when I would train it as
an in-service instructor to myteam is I'd say, because we

(41:25):
would do that, that'd be likethe first part of the first day
of PROACT.
And I'd say, if you're going topay attention to any specific
thing, this chapter is going tobe the most relevant for you
because I'd find that our staffwouldn't be good at observing at
the baseline level, the routinelevel.
When people start yelling andscreaming and tantruming, then

(41:46):
everybody in the environment allof a sudden becomes really good
observers.
But they're not good atobserving at baseline, and that
creates issues because you'remissing so much, and then you're
always behind the eight ball.
We talk about the three mostcommon means of death in common
care facilities are hanging,overdosing, and cutting.
Why do you think that is, Mike?

SPEAKER_01 (42:06):
Nobody's watching, nobody's listening.
Nobody's listening.
And it doesn't make any noise.

SPEAKER_00 (42:10):
Right?
We are so trained to respond tonoise.
And that's, I think, one of theissues that we run into is that
we're not responding.
Like Kim said, we don't knowwhat we're looking for until
people are yelling.
And then our cognition isdropping, and we're at this
point where we're reactingrather than responding.
So intentional observation, Iwould say.

(42:30):
That's what I would tell myteam.
If we can figure out, if I cometo you and you're working with
Johnny, and I say, what are youlooking for?
Or at any point, you should belike, I'm looking for him to do
this or not doing this or goinghere.
You should be able to tell meexactly what you're looking for,
what you're observing.
Because saying observe bettermeans nothing.
It should be intentional andstrategic.
Kim, I wanted to elaborate onwhat you were saying, but I

(42:51):
don't know if there's anythingelse you'd like to say for that
observation piece.
Because I just found it soimportant for the crew that I
would teach.

SPEAKER_02 (42:58):
I think that's fairly common.
I think most people, well,people generally are attuned to
listen.
or they see big things.
But by the time the crisis haserupted, there are lots of other
things that happened in advance.
And when you say, well, youknow, what happened before?

(43:18):
People will say, I have no idea.
It just happened out of theblue.
But there were changes inbehavior.
It could have been simplemovements further away or closer
to someone.
It could have been a level oftension in someone's arms or
hands or they're standing asopposed to sitting or sitting as
opposed to standing.

(43:39):
None of those are crisismovements in and of themselves,
but they were all indicatorsthat something was changing.
And if we missed them, that's onus.
It's not on the other

SPEAKER_00 (43:51):
person.
I want to talk about a couple ofother things.
One specific part that I foundwas just so enlightening for the
team that I would train, all ofit is, but just some specific
highlights, is the communicationpiece.
And talking about the differencebetween assertive and aggressive
communication.

(44:11):
I mean, it's all very relevant.
But changing you statements to Istatements.
I found that just so important.
And taking the word need out.
Because so often, we just findourselves saying, you need to do
that.
And it's interesting.
Because when you work with kids,it's one thing.
But when you work with adultsand then they just stare at you.
And you're like...
Oh, I guess you didn't actuallyneed to do that.

(44:33):
You're not going tospontaneously combust if you
didn't do that.
So it's interesting when I do mytrainings now when you have
different, you know, you've gotpeople work with adults and work
with kids and the ones that workwith adults will look at the
ones that work with kids and belike, yeah, tell my adults they
need to do something and seewhat they do.
But replacing it with the Istatements, that was one of the
other things that.

(44:54):
I really highlighted, and theassertive communication, the
empathetic I statement, helpingsomebody understand that you're
on their team, I think is soimportant.
Rather than just being thisperson that barks instructions
down your neck, you need to dothis, you need to do this.
Like Mike, in your example, hey,I understand that you're hungry
or it looks like you're hungry.
How can I help you?

(45:14):
How can the person that I'mworking with think that we're on
their team rather than we'rejust bossing them around as an
outsider?
Kim, I don't know if you want tospeak to that, but that was the
other part.
The communication was justsomething that I found just so
relevant to the demographic Iworked with.

SPEAKER_02 (45:31):
I think it's relevant to pretty much every
demographic.
And for me, again, it goes backto that notion of as a human,
regardless of your age,regardless of your ability, I
want to respect you.
And I can respect you in anage-appropriate way, but it's
like you're a human.

(45:52):
It's just what we need to dowith other people.
But I think it's also importantto realize that I statements are
wonderful.
I think they're essential, butit's also important that you
can't put an I in front of abasically aggressive statement
and it doesn't make it an Istatement.
So to say, you need to do thisversus I need you to do this,

(46:14):
those are equally aggressive.
Because it's really still allabout something that the other
person has to do.
The empathic I statements thatyou're talking about, Daniel,
are critical in that they areabout me.
I want to help.
I want you to feel better.
I want to get you some food ifyou're hungry.

(46:35):
I want you to be able to take abreak.

SPEAKER_00 (46:39):
You're focusing on their needs.

SPEAKER_02 (46:41):
I am focusing on their needs.
And the other thing that I'vealways said is a good empathic I
statement will connect me to myreason for doing the work.
We've already talked about thefact that most people go into
this work wanting to do good.
They want to serve.

(47:03):
They want to support.
They want to help.
So a good empathic I statementreminds me and everyone else why
I'm doing that.
I want to help.

SPEAKER_01 (47:14):
I

SPEAKER_02 (47:14):
want you to feel better.

SPEAKER_01 (47:15):
I want to highlight that right there because a lot
of times in the technique ofthis, people might think we're
doing that for the other person.
I'm using these statements sothat they feel better.
What you just said is it puts usin a mindset.
and reminds us what we're thereto do.
It puts us in a less aggressivestance, more prepared to present

(47:38):
empathy, to present assistance.
I think that's really importantbecause so much of this work,
again, there's a locus ofcontrol.
We want to be in control.
We want to have instructionalcontrol.
Control is a tricky word byitself.
We're not talking aboutauthoritarianism here.
Even in the face of crisis,we're talking about
collaboration.
Is that fair to say?

SPEAKER_02 (47:58):
Absolutely, because the control isn't over the other
person.

SPEAKER_03 (48:03):
Yep, excellent,

SPEAKER_02 (48:05):
excellent.
This piece of communication andassertive communication that
we're talking about is if Ifollow up my empathic I
statement, my I statement thatreminds me why I'm here and
tells you why I'm here and Iwant to help, if I follow that
up with a choice...

(48:28):
And this is also an interestingpiece.
But this gives people back alevel of control while also
offering it to the person thatyou're working with.
So I get to pick the choices Ioffer.
That's my control.
And I'm going to pick twochoices that are perfectly
reasonable and acceptable.

(48:50):
And when I offer them, it givesthe person that I'm working with
the independence, the autonomy,the ability to make a choice.
And so much of what we do intreatment environments is take
choice away from people, whichis also kind of ironic because
our whole reason for treatmentis to help make people more

(49:13):
independent and capable, andthat includes making choices.
But if I can give two reasonablechoices and give them the
opportunity to select one, Likea huge win-win.

SPEAKER_00 (49:28):
Kim, can I ask you a question then?
Because I see this a lot, andit's actually not reinforcing
the behavior, but I see this alot with either the BCBA crowd
or just people in general.
They're like, well, because wetalk about offering
alternatives.
Well, if I offer them analternative, aren't they just
getting away with it?
Or aren't they learning thatthey can just do that?

SPEAKER_01 (49:48):
That discipline part again.

SPEAKER_00 (49:49):
Yes, which they're not.
And I'll expand on it whenyou're done.
But I would like to get yourperspective on why you would say
that is okay to do and they'renot learning or they're not just
getting away with it.
Why can we offer themalternatives even if they're not
doing the behavior that we wantthem to do?

SPEAKER_02 (50:08):
Well, first of all, I would go back to where are we
at in the timing process?
Because if we're beyond atrigger and if we're escalating,
we've already talked about thefact that we've moved outside of
the outside of the space oftreatment.
Now we're in an escalated, we'rein that crisis phase and our
focus is no longer abouttreatment and learning.

(50:29):
Our focus is how do I keep thiscrisis from getting worse and
get a person back to baseline soI can get them back to that
other place of treatment andlearning.
So at that point, my goal is tosay, if I've got someone who's
escalating, The alternatives Ioffer are to bring them back to

(50:50):
baseline.
And that's my primary objectivethen.
My primary objective is to getthem back to a safe space so
then they can go back into aplace of treatment and learning.
Does that make sense?

SPEAKER_00 (51:08):
I love it.
Because learning isn't occurringaway from baseline.
So when people are like, well,aren't they just learning that?
Well, no, because they're notlearning because their computer
wheel is spinning.
We've got to get their computerwheel to stop spinning.
I really like the way that youworded that, Kim.
And also with the alternatives,we have to be thoughtful of

(51:29):
alternatives.
of our alternatives.
That's a tongue twister.
Thoughtful of our alternativesand maybe plan some of those out
ahead of times because as weescalate, we might not be able
to think about it.
The alternative doesn'tnecessarily need to be, so if
they're hypotheticallytantruming about the iPad, the
alternative doesn't necessarilyneed to be giving them the iPad.
That's not what we're saying.

(51:49):
We're not saying give in.
We're saying what else can weoffer them to get them back down
to baseline?
And that's where I think people,like you've talked about, Mike,
with the blanket extinctionpiece and people just being
stupid so linear of, well, if Igive them anything, aren't I
reinforcing them?
No.
As long as you don't give themthat one thing, what other
alternatives?
Can we be less dense aspractitioners and be like, well,
it's either my way or thehighway.

(52:11):
How can we work together?
And what can I offer you?
Even if it's not that one thing,how can I give you something
that's going to get you backdown the baseline?
Right.

SPEAKER_01 (52:19):
Now, there is sort of a defining line here, right,
in terms of, well, with regardto alternatives, at which point
does...
crisis management start offeringfewer alternatives.
Let's sort of get to that part.
So we talked about the idea ofrestraint, which I think People
erroneously equate immediatelywith crisis management.

(52:41):
So you say proact, and oh, I'mgoing to get trained in proact.
That means I'm going to learnhow to do restraint.
And they forget about all theother stuff we've just spent the
last hour talking about, which,to your point, Kim, is the most
important stuff.
The restraint is the lastresort.
It's the last piece.
But in all fairness, and pleasecorrect me if I'm wrong, it does
then start...
reducing the amount ofalternatives that we can make

(53:03):
available based on severity, Ithink is the word you used.
And when we say severity, we'retalking about risk of physical
injury or something like that.
You guys help me out here.

SPEAKER_02 (53:17):
So as it becomes more severe, the alternatives...

SPEAKER_01 (53:23):
That's what I'm asking, yeah.

SPEAKER_02 (53:27):
Maybe the...
maybe the alternatives you offerchange.

SPEAKER_01 (53:35):
Okay.
That's a better way to say it.
But they're still there.

SPEAKER_02 (53:38):
Because what we're looking at always is two
alternatives.
Again, and don't flood someone.
Don't give them four or five orsix.
Because that's like looking atthat menu where you're going,
I'm so hungry and I don't knowwhat to pick.

SPEAKER_00 (53:51):
That's why you don't go to Costco when you're hungry.

SPEAKER_01 (53:54):
And then that's not to mean that you give them two
and then they offer you a third.
You might still be able to say,sure, that's reasonable.
Yes, we can do that.
Absolutely.
If

SPEAKER_02 (54:04):
I say...
Yes.
If I say, do you want yellow orred?
And they say, how about blue?
That's still a color.

UNKNOWN (54:08):
Let's go with it.

SPEAKER_02 (54:10):
Absolutely.

SPEAKER_01 (54:11):
Okay.
I like it.
I like it.

SPEAKER_02 (54:13):
But the idea is, again, because we've already
established that as they movefurther from baseline, cognition
is impaired.

SPEAKER_01 (54:20):
Very well.

SPEAKER_02 (54:21):
So I want to keep those choices simple.
And even my I statement, thoseempathic I statements, I'm not
doing a monologue here.

SPEAKER_03 (54:30):
It's like,

SPEAKER_02 (54:31):
I want to help.
Do you want the yellow or theblue?

SPEAKER_03 (54:33):
Yep.

SPEAKER_02 (54:35):
It's really simple.
And if they come back withsomething else, if they come
back with red, I say, okay.
If they say no, I can say, okay,how about stand or sit?
I don't have to stop thatformula, if you will.

(54:55):
I can still offer alternatives.
And when we go back and talkabout, and this is what you were
saying, Daniel, The iPad nolonger has to be part of this
conversation at all.
It's not about reinforcing.
It's about saying, how do Ibring this back to baseline?

SPEAKER_00 (55:14):
So with that, you were talking about not using a
monologue.
And I think that's so importantbecause we talk about reducing
energy.
If somebody's escalating, thesituation already has way too
much energy.
So anytime we're talking, we'readding energy.
So we always talk about you wantto be very intentional and
specific with your communicationbecause we don't want to just be

(55:36):
talking just to talk.
A lot of times people do thatbecause filling air is
comfortable to people, butthat's adding energy.
So if we're going to add energy,we want to be very strategic.
I do have a question for youwith the alternatives, Kim,
because I do think it's a reallyimportant premise from Prague
that we should at least spend aminute or two talking about, is
the concept of self-control andcontrolling our own self.

(55:58):
When people escalate, obviouslywe escalate as well.
I wish I could have the visualsto reference because it's so
nice to have those.
But we escalate as well.
And that's where I think some ofthe alternatives start to falter
because we lose our ownself-control.
And now we're not thinking ofhow we can help the person, how
we can meet their needs.
Like you said, we're thinkingabout how we meet our needs.
And that all comes from, likeyou say, a point of self-control

(56:20):
and assessment.
So could you maybe speak tothat?
Because we've talked aboutprinciples, and that's pretty
much the first principle for allof our response strategies is
self-control.

SPEAKER_02 (56:29):
Yeah, I'd be happy to.
I mentioned before that we havethis early...
portion of the training thatspeaks to professional
development.
As part of that were theobservation skills that we've
already addressed.
Another piece of that isself-control.
And understanding the role thatyou play, you as a professional,

(56:49):
play in any crisis situation iscritical to the management of
that crisis situation.
I think that's another thingthat makes PROACT different is
that a lot of programs will goin and start immediately talking
about the kid's behavior or theother behavior, the client
behavior, and that that needs tobe managed.

(57:11):
Well, I'm the only other personin the room,

SPEAKER_03 (57:16):
essentially.

SPEAKER_02 (57:17):
So the best way for me to manage that is to
understand the role of myinteraction in that.
And I think anyone who's spentmuch time in this field, if you
ask them, have you ever seensomeone who was very
well-intentioned make asituation worse?
Have you ever been that person?

SPEAKER_01 (57:37):
Sure have.
Absolutely.

SPEAKER_02 (57:40):
So it's not because you wanted to.
It's because you somehow didn'thave anything else.
It takes a lot to think aboutthose things, particularly when
you're in a crisis situation.
So having a level and a plan, avery clear plan for managing
your own behavior through acrisis is critical to helping

(58:06):
you to continue to think.
That's the goal here.
We've got to be able to think sothat we can come up with those
choices so that we can notescalate escalate more
ourselves.
I think you referenced thevisual that ProAct uses, and I'm
going to try a little bit todescribe it here.

(58:27):
Please do.
Not so much the visual, but theprocess.
Yes.
For most people, when theyinteract with someone, it's
going along fine.
As something triggers the otherperson and their behavior
escalates, they have one ofthose, whoa, now what am I going
to do moments.
And if that behavior continuesto escalate, that escalating

(58:53):
behavior is what triggers meaway from my own baseline.
Because I start thinking, whatam I going to do?
What's going to happen?
How's this going to end?
Are they going to throwsomething?
Are they going to hit someone?
Are they going to hurtsomething?
What's going to happen?
And my own blue dots in my headstart spinning, and it
interferes with my ability tothink.

SPEAKER_03 (59:14):
Sure.

SPEAKER_02 (59:14):
So that...
And so we often say that thestaff person, the professional,
is one step behind the client inthis whole crisis cycle.
They've triggered and they'reescalating.
Their escalation triggers me.
If they continue to escalate, myescalation goes higher because I

(59:38):
become more concerned.
Standardly, as we escalate, Ourtendency is the classic fight or
flight, which is why people wantto control things.
Their way of moving into thatkind of fight response is to
say, well, I'm going to shutthis down now.
And they become heavy handed,whether it's verbally or

(01:00:02):
physically, they become heavyhanded in that process.
So understanding our role inmaking a situation better or
worse is essential to us gettingpeople back to baseline.
Because what we have to do issay, if I'm not going to make it
better, I don't want to make itworse.

(01:00:24):
I need to control my ownbehavior so that I can think, I
can offer the I statements, Ican offer reasonable
alternatives.
So that when I say red or yellowand they say blue, I don't just
get mad because they didn't pick

SPEAKER_03 (01:00:42):
a

SPEAKER_02 (01:00:43):
choice that

SPEAKER_03 (01:00:44):
I

SPEAKER_02 (01:00:45):
want.
So that that doesn't furthertrigger me so that I'm thinking
enough to say, yeah, no problem.
That's fine.

SPEAKER_00 (01:00:52):
Or like in the midpoint review example, like
when we're trying to get theindividual to walk through a
different door and he finallydoes it, but he's like, you
know, that's stupid orsomething.
How do we not focus on the factof them saying that they're
stupid because we're stupidbecause we're away from
self-control and focus on, hey,they're actually doing what we
want them to do, right?

SPEAKER_01 (01:01:10):
Those are my favorite examples when the
client is actually doing whatyou want them to do, but they're
not doing it exactly the way youwant, and then people comment on
that, right?
So I turned in my effinghomework.
Well, let me correct you on theeffing and forget about the fact
that you turned in yourhomework.

UNKNOWN (01:01:31):
You turned in the homework, yes.

SPEAKER_01 (01:01:31):
Yep.
It's very easy for that tohappen to anybody, yeah, for
sure.
Oh,

SPEAKER_02 (01:01:36):
yeah.
And that's also that thing,though, about we're traveling
one step behind.
Right.
Because as they finally movebeyond the crisis and say, fine,
I've turned in the effinghomework, I'm at the peak of
mine, and I'm angry.
And so I'm going to...
focus on the wrong thing.

SPEAKER_01 (01:01:52):
So that's to say, and I'd love both of your
insights here, that's to saythat in that escalation cycle,
we, as the adult, as theprofessional, we are also going
to face some level of escalationno matter what.
Is that fair to say?
So it's almost a process ofthen, to use that phrase we like

(01:02:15):
to use, Dan, noticing ourreaction and kicking in our
response set such that we don'ttip over into our own crisis.
Am I getting that more or lesscorrect?

SPEAKER_02 (01:02:27):
Absolutely.
Absolutely.
That escalation is a normalphysiological response.
We can't stop it.
All we can do is better manage

SPEAKER_01 (01:02:38):
it.

SPEAKER_02 (01:02:38):
And so we manage it through a plan for self-control.

SPEAKER_01 (01:02:41):
So in that sense, baseline isn't necessarily flat.
I mean, that's fair to say.
It's a little bit of an up anddown, a little bit of a slight
escalation or excitement backdown to baseline, back up, back
down.

SPEAKER_00 (01:02:51):
Yeah, think about it like a road, like a freeway,
right?
Like baselines, like thefreeway, and then like
self-control is maybe like theshoulders.
So you've got the freeway,you're kind of in the

SPEAKER_01 (01:03:00):
different lanes.

SPEAKER_00 (01:03:01):
And then you've still got the shoulders, right,
where you're not a baselineanymore, but you're in the
different lanes.
But you're not completely offthe road.
You're not in the ditch.
Exactly.
And then when you've lostself-control, you've completely
moved away from it.
Now you're completely off theroad.
So it's not like a one-laneroad.
It's like a freeway.
And kind of like Kim was talkingabout, too, the reason that
we're, because we're one stepbehind, what's so dangerous, and

(01:03:23):
I know you alluded to it, I justwanted to reiterate it, is that
we are so susceptible to make asituation worse after that
individual is moving in theright direction.
They're actually calming down.
You've argued about thehomework.
They're like, fine, I'll do myeffing homework.
So they're actually in recovery.

SPEAKER_01 (01:03:38):
But you're still pressing.

SPEAKER_00 (01:03:39):
We're still, we're ready for that fight.
And Kim, you mentioned, too,that because PROACT decreased
curriculum is an approach ratherthan techniques.
We always have to have kind of alevel of thought of how we're
going to implement that approachwithin that framework.
So because of that, self-controlis so important because within
the product curriculum, there'snever really a point of like,

(01:04:01):
let's just turn our brain offand do this technique.
It's always, let's figure outthe most effective technique
within the approach slashframework.
So we have to have self-controlto be able to do that.
Would you agree with that, Kim?

SPEAKER_02 (01:04:13):
Absolutely.
Which I think takes us all theway back to one of the things
that we started the conversationwith, which is a lot of people
really like techniques becausetechniques takes the thinking
out of the process.

SPEAKER_00 (01:04:26):
Yep.
And the blame, right?

SPEAKER_01 (01:04:28):
Well, I did it that way and it didn't work, so it
had to be the technique.

SPEAKER_02 (01:04:32):
Right.
It becomes simply animplementation process.
I did what you told me to do andit didn't work.
And what we're saying is...
We want to think about thingsbecause we've got a lot of ways
to make this work and ourprimary objective is to serve
our clients, to take care ofthat client.

SPEAKER_00 (01:04:52):
I want to talk a little bit because I would be
remiss if we didn't just atleast touch on the restraint
piece.
Yes.
And I want to talk about thatbecause I don't know why, but
sometimes, at least in myexperience and some of the
places where I've trained aswell, people come into PROACT
thinking it's going to be therestraint class and they leave
with a very differentrealization.

(01:05:13):
But, you know, I think it's onlyfour hours of the 18 hours if
they choose to go through therestraint course, which is a
totally separate curriculum.
You can be PROACT certified andnot be restraint certified.
The product training's 14 hours,the restraint's four.
I have a question for you andplease go down whatever roads
you want with this, Kim.

(01:05:33):
Our goal is to reduce the riskof restraint.
What are your thoughts on why weinclude restraint and how
teaching restraint is eitheruseful or applicable in reducing
the use of restraint.
Like why if our goal is toreduce restraint, do we teach

(01:05:53):
restraint?

SPEAKER_02 (01:05:56):
Oh, well, that's an excellent question.
So our goal is to reduce oravoid the restraint.
And that's why we spend about80% of this whole curriculum on
teaching.
ways to do that on things likeobservation, on self-control, on
understanding the assault cycle,on being able to observe when

(01:06:18):
someone's been triggered andescalating, how to identify a
thoughtful, empathic Istatement, how to give
reasonable and choices thatpeople...
So that's why we spend all thattime doing that.

UNKNOWN (01:06:35):
Okay.

SPEAKER_02 (01:06:36):
There are...
And so...
So I feel like that's where weput our energy.
So then the question is, why dowe teach restraint at all?
Because there are situationsthat occur, and people make
decisions.
I think what PROACT does is itvery clearly says, here are the

(01:07:00):
parameters for even consideringrestraint.
When we go back and talk aboutthose levels of dangerousness or
the levels of risk and the high,medium, and low, restraint
doesn't figure into low andrestraint doesn't figure into
medium.
Restraint is only considered anoption, and not the only option,
but it's only considered anoption when you get to high

(01:07:23):
levels of immediate physicalrisk.
And And we've already spokenabout the fact that things go
wrong.
That sometimes treatment plansthat we write aren't as
effective as we want them to be,or something's changed, or that

(01:07:44):
something occurred.
So when something happened, wecan always say that if we get
into that immediate risk ofserious injury, and when I talk
about serious injury, I'mtalking about a time when people
can be significantly injuredwhen you're going to need
medical intervention.

(01:08:05):
If we can reduce the risk ofserious injury, then it may be a
choice to consider restraint.
And if we consider restraint,restraint in and of itself has
the potential for a significantamount of injury.
So to not know how to manage arestraint and not know about

(01:08:30):
reducing circulation, to notunderstand positional asphyxia,
to not understand the risk ofchoosing restraint would be
irresponsible.
So that's why we teach it.

SPEAKER_00 (01:08:48):
That makes a lot of sense.
And it's also potentiallyanother tool.
Like you said, people, when theydon't have tools, they start
kind of doing all sorts ofthings.
And a lot of times people thatdon't have the tools actually do
restraint not realizing that itis restraint.
And then they do it improperlyand there's a lot of
consequences.
You know, hundreds of people dieevery year from restraints and

(01:09:10):
likely improper restraints.
You said something, Kim, it'sactually changing in my
vocabulary.
I used to say, you would catchme sometimes say the term that
we had to restrain.
And that's something that is nowrepulsive to me.
It's we chose to restrain.
And I do think that, you know,restraint, it's interesting

(01:09:32):
because the last person we hadon the podcast, talked about
some ABA companies not takingvery high behavior, for lack of
a better term, highly impactedpeople that have very dangerous
behaviors because they didn'tknow how to do restraints and
didn't have that tool in theirtoolbox to deal with them.
So restraint could be apotential tool to help with

(01:09:56):
individuals, and it is a shameto not have that tool and not be
able to serve these individualswho greatly need it.
One thing the product does doand does put in great context
of, hey, this is a very specifictool, and we're going to give
you the parameters in which youcan use it and the parameters of
how to use it as well.
So from my experience, andagain, this is just my
experience, it actuallyminimizes its use and maximizes

(01:10:19):
its effectiveness when chosen tobe used.
Kim, would you agree with that?
Did I say that correctly?

SPEAKER_02 (01:10:25):
Yeah, I think you're right.
I think if restraint is taughtwell and the risks associated
with it, and those risks go farbeyond, of course, the physical.
There are significant physicalrisks, but then there's other
things.
There's the trauma risk.

SPEAKER_01 (01:10:38):
I

SPEAKER_02 (01:10:40):
think we also, it's important to recognize that
there's physical and traumarisks to the staff as well.
But if we...
If we understand the risks, andthe reason we talk about
choosing to restrain is becauseif there's been a choice to

(01:11:01):
restrain, I also, as the staff,am going to own that.
I'm going to own the outcome ofthat.
Whether or not I choose itconsciously, but I, as the
staff, own the outcome of therestraint.

SPEAKER_00 (01:11:13):
Which could be death.

SPEAKER_02 (01:11:15):
Pardon me?

SPEAKER_00 (01:11:15):
I said, which could be death.
That could be the outcome of the

SPEAKER_02 (01:11:18):
restraint.
Which could be, right.
So I think when it's taught withan understanding of these are
the risks, these are the onlyreasons you would consider,
understand the risks, make thechoice responsibly, People do
tend to do it less.
They do find other ways ofmanaging behavior.

(01:11:40):
I think when restraint is justtaught as a casual exercise,
people don't think about therisks, and it doesn't even occur
to them that anything bad couldhappen.
It's just the next step.

SPEAKER_01 (01:11:51):
I spent at least a year in my early professional
career at a place that themoment I walked in and spent one
day there, realized that theywere...
overly using restraint as ameans of controlling behavior.
I'm happy to say that I only gotinto one situation with
restraint that entire year I wasthere, but I really love the way

(01:12:13):
you just pitched that and Ithink it's very important for
people to consider that becauseyou can come away with this easy
equality of proact is restraint,and I'm very glad you took the
time to clarify.
It is, in fact, an importantpart of it, but it's a small
percentage of it if you're doingthe whole process the way it's
supposed to be done.

(01:12:34):
Super, super important.
We have easily covered our time.
We're in no rush here.
I know there's a couple thingswe want to get to, but just
letting us know that we'resomewhere near the end.
We'll see.
We've got some good segues toentertain here.
Dan, you had something

SPEAKER_00 (01:12:51):
you wanted to jump in with?
I did.
Just like, you know...
the non-restraint pieces are atleast 80% of the product
curriculum.
The non-restraint pieces havebeen at least 80% of this
podcast, which is appropriate.
I did have one other thing totalk about, but before that,
Kim, anything else on therestraint piece?
Because I know that's anemotional piece for people and

(01:13:14):
kind of a hot-button topic, andI want to make sure that all of
the thoughts or points that youwanted to make on restraint have
been covered.
Is there anything else on thatthat you wanted to...
speak on?

SPEAKER_02 (01:13:24):
No, I think I just would share this one little
experience I had with a group anumber of years ago.
This was an organization, ahealth care organization that
had adopted PROACT as its systemfor managing crisis behavior.
And I went and met with them, agroup of them, about a year,

(01:13:47):
year and a half after they firstintroduced the content of PROACT
content.
And they said, you know, we'renot really using Proact anymore
because we don't do restraint.

SPEAKER_03 (01:13:57):
And

SPEAKER_02 (01:13:58):
I said, oh, well, really?
That means you're using Proactall the time because you're not
doing restraint.
Yeah.
And so that was a...
It's, again, people do just fallinto that pattern of thinking
that...
that that's what we do.
But we do so many other things.

SPEAKER_00 (01:14:16):
One of the gentlemen who I used to go to my
recertification classes with wasthe director at the Tascadero
State Mental Hospital up here inCalifornia.
And I remember I went toprobably four recertification
trainings with him over the last15 years.
And in the beginning, they weredoing hundreds of restraints a
year.
And by the end, not even theend, by like the middle, they

(01:14:36):
were down to like two or three.
And these are some of the mostimpacted people in the state of
California.
Just by focusing on the PROACpart not the restraint part like
we talk about you don't getbetter at reducing restraints by
doing restraints so there's somuch power and if we're talking
about the highest uh you knowimpacted people in the state

(01:14:56):
it's very feasible with theright uh you know culture and
organizations with the rightprimary plans and things like
that to see similar um effectswherever um you may be
implementing this curriculum umkim i wanted to talk you have oh
god please

SPEAKER_02 (01:15:11):
I was just going to say, because it's not the
people, it's not the client orthe patient group at that
hospital that changed.
It was the staff.

SPEAKER_00 (01:15:19):
That's a great point.
Yeah, that's a great point.
It goes with that.
Well, we just have to restrainthese clients.
No, we chose, it's us that choseto restrain them, not the
clients.

SPEAKER_01 (01:15:29):
I think what you just said there is monumental.
If I think about parenteducation in our day-to-day
work, parents are often comingto us.
They want their...
child's behavior to changeimmediately and the answer is
well what are you going to doabout your behavior around your
child and i think that that whatyou just said there about the
hospital staff highlights thatthey the patient stayed the same

(01:15:52):
the staff changed their waysthat's fact that's fantastic

SPEAKER_00 (01:15:55):
yeah kim you have a really good uh or at least i
enjoyed a lot um kind of mantraor question or saying and you
talk about the differencebetween a groove and a rut I
feel like that's one of yourquestions or sayings.
Could you speak to that a littlebit?
Because I think that's sorelevant to us in the ABA field.

SPEAKER_02 (01:16:18):
Yeah, I mean, I would be happy to.
And I do think it actually fitswith a lot of, it can fit in
with a lot of life practices.
But oftentimes as we learn newthings, try new things, we work
hard to develop an understandingof them and in that process we

(01:16:40):
figure out how to how to do itmore effectively to do it more
efficiently to do it to dosomething that engages others as
we develop our practice we canspend more time on the other
because we know what we're doingand that feels comfortable and
we do that for a while and thechallenge in life um is to not

(01:17:05):
allow you know and we we usethat term sometimes it's like
i've got it i've got this groupi'm in a group i know what i'm
doing now but the question ithink that we always have to ask
ourselves is when does thatgroup become a rut when i have
something figured out then and idon't want to change what i do
because it would require morethinking it would require me to

(01:17:29):
come up with a new process or anew alternative or to step
outside of my comfort zone.
And everybody likes to becomfortable.
So the idea isn't that goodpeople never get into a rut.
That's not what we're talkingabout here.

(01:17:50):
It's just, as I see it, it'sabout lifelong learning.
I'm an educator.
That's what matters to me.
And when I find myself too muchin a pattern, I have to check
and say, am I paying attentionto all of the other things in my

(01:18:11):
environment?
Am I paying attention to thepeople?
Am I paying attention to the newunderstanding, to the research?
Am I paying attention to, if I'min a treatment environment, am I
paying attention to mycolleagues?
Am I paying attention to theparents of this child that I'm
working with?
Am I paying attention to thesiblings of the child that I'm

(01:18:33):
working with?
And how do I take all of that inand find a new groove?
it's just my way of saying don'tget too comfy because If you get
too comfy, there's a lot ofthings you might be missing.

SPEAKER_00 (01:18:52):
I love that.
At our previous company, we wentthrough that, the one that Mike
and I were leading, I don'tknow, five, six years ago.
We were kind of looking andsaying, okay, the way we're
doing things is working.
Can we do it better?
We came up with some ways thatwe thought could be better.
When people are in the grooveslash rut, it can be very

(01:19:13):
daunting.
People can take it verypersonally, the change, and not
want to change.
We lost a lot of staff that whenwe were suggesting their groove
was a rut, they were insistingit was a groove.
And then with Proact as well, Imean, it was started 50 years
ago now and it's gone through aname change.
So I imagine if we were in thesame groove that we were in in

(01:19:35):
1975, Proact would not be nearlyas applicable and efficient and
dignified as it is today.

SPEAKER_02 (01:19:43):
Nope, it'd be a big rut.

SPEAKER_01 (01:19:46):
Well, we've covered a lot of ground.
This might be a good stoppingpoint.
We could talk with you forever,Kim.
So thank you for your time.
This has been extremelyeducational.
Love to have you back at somepoint.
We could find a different grooveto discuss.
But thank you so much for yourtime and for your patience with
us.
I am excited for our listenersto be able to take you in and

(01:20:10):
all your knowledge that youshared with us today.
So we're very appreciative.

SPEAKER_00 (01:20:13):
Anything that you would like to add in conclusion,
Kim?

SPEAKER_01 (01:20:16):
Yeah, any closing thoughts?

SPEAKER_02 (01:20:18):
No, no closing thoughts other than how much I
appreciate what you do.
It was fun to be here.

SPEAKER_00 (01:20:22):
And on our end, you've never heard us promote
any product.
I've taught PROACT to my ABAcompanies over the last, I
think, 15 years.
I can't speak highly enough.
I've said this, not just becauseKim's on here, that if you can
give your staff one training,give them the PROACT training.
It teaches people how to think.

(01:20:42):
The number one thing that directstaff is concerned about is this
kid's tantruming.
How do I get this Kid to StopTantruming.
The product will give you greatframework and approaches to how
to deal with that.
The idea that it's part of the

SPEAKER_01 (01:20:55):
basic training for any ABA agency, I think a lot of
us have moved away from it basedon time and expense or whatever
you want to call it.
I think you're right.
I think it just needs to beintegral, part of the basic.
You come in for your week oftraining and RBT certification
and somewhere early in yourtenure, you have to get that
PROAC training for sure.
I agree.

SPEAKER_00 (01:21:14):
Please, please, please.
We'll have links in ourdescription and everything if
you want to check them out.
I just can't speak highly enoughabout the curriculum.
I've seen it make a huge, hugedifference in the impact of the
people we serve.

SPEAKER_01 (01:21:27):
I'd like to do a little closing here, some
closing points.
We're saying respond, don'treact, play close attention,
always, and then we say alwaysanalyze responsibly.
Thank you so much.
Cheers.

SPEAKER_02 (01:21:41):
Thank you.

SPEAKER_01 (01:21:43):
ABA on Tap is recorded live and unfiltered.
We're done for the day.
You don't have to go home, butyou can't stay here.
See you next time.

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