Crisis Intervention

De-escalation Strategies

Apply de-escalation during the agitation and early acceleration phases.

Verbal Strategies

• Use a calm, low, slow voice. Match the client's volume only to be heard, then lower.
• Reduce verbal output—fewer words, simpler language.
• Validate the client's emotional state without reinforcing the problem behavior: "I can see this is hard."
• Offer limited choices to restore a sense of control.
• Avoid power struggles, ultimatums, or sarcasm.

Environmental Strategies

• Reduce stimulation: lower lights, reduce noise, remove audience.
• Increase physical space between the client and others.
• Remove potential projectiles or weapons of opportunity.
• Open an escape route—never corner a client.
• If safe, allow the client to move to a designated calming area.

Nonverbal Strategies

• Maintain a relaxed, open posture. Avoid crossed arms or hands on hips.
• Position body at an angle rather than squarely facing the client.
• Avoid sustained direct eye contact if it escalates the client.
• Move slowly and deliberately.

When Physical Intervention Is Necessary

Physical intervention (restraint) is justified only when there is imminent danger of serious harm to the client or others and less restrictive strategies have been attempted or are clearly insufficient.

Restrictive Procedure Hierarchy (Least to Most)

1. Verbal redirection and prompting
2. Proximity control (moving closer)
3. Stimulus removal (removing triggering stimuli)
4. Planned ignoring (only if safe and extinction is part of the plan)
5. Response blocking (blocking SIB without holding)
6. Brief physical guidance (guiding away from danger)
7. Physical restraint (holding to prevent harm—time-limited)
8. Mechanical restraint (only with specific clinical and legal authorization)

Requirements for Physical Intervention

• Documented in the behavior intervention plan with consent obtained.
• Staff trained and certified in an approved crisis management system (e.g., CPI, PCM, Safety-Care).
• Applied for the minimum duration necessary—release as soon as danger has passed.
• Continuous monitoring of the client's physical status during restraint (breathing, circulation, consciousness).
• Never applied as punishment, coercion, or for staff convenience.

Environmental Safety During Crisis

• Clear the area of other clients and unnecessary staff.
• Assign roles: one person manages the client, one monitors safety, one documents.
• Maintain line of sight at all times, especially during elopement.
• Account for all clients in the environment if one is in crisis.
• Ensure access to communication devices is maintained when possible.

Documentation During and After Crisis

During Crisis (Assign a Designated Recorder)

• Time of onset and each phase transition.
• Antecedents and setting events.
• Specific behaviors observed (topography, intensity, duration).
• Interventions applied in sequence with timestamps.
• Any injuries to client or staff.
• Duration of any physical intervention.

Post-Crisis Documentation

• Complete incident report within 24 hours.
• Notify parent/caregiver per agency policy (typically same day).
• Document in the client's clinical record.
• File mandatory reports if abuse or neglect is suspected.
• Report to supervising BCBA and clinical director.

Post-Crisis Protocols

Immediate (Within 1 Hour)

• Ensure the client's physical well-being: check for injuries, provide water, allow rest.
• Do not process the event verbally until the client is fully in the recovery phase.
• Gradually reintroduce low-demand activities.
• Staff check-in: assess for injuries, emotional state, need for support.

Same Day

• Debrief with the treatment team: what happened, what worked, what did not.
• Review the data: was this a new pattern or escalation of an existing one?
• Determine if the current BIP adequately addresses this behavior.

Within 48 Hours

• Update the BIP if the crisis reveals an inadequacy in current procedures.
• Retrain staff if procedural drift or errors contributed to escalation.
• Communicate with caregivers about plan adjustments.
• Schedule a formal team meeting if crises are recurring.

Mandatory Reporting

• Behavior analysts are mandated reporters in all US states.
• Report suspected abuse or neglect immediately per state law.
• If restraint results in injury, follow agency and state incident reporting requirements.
• Document the report: date, time, agency contacted, reference number.

Trauma-Informed Considerations

• Recognize that many clients have trauma histories that affect crisis presentation.
• Avoid interventions that may re-traumatize (e.g., physical restraint with a client who has a history of physical abuse) unless no alternative exists.
• Incorporate client preferences and sensitivities into the crisis plan.
• Debrief with the client (developmentally appropriate) after recovery.
• Review the crisis plan regularly with the client and family to ensure it reflects their values.

Staff Wellness

• Crisis events are psychologically taxing. Provide staff with debriefing and support.
• Monitor for signs of burnout, secondary trauma, and compassion fatigue.
• Ensure staff have adequate training and feel competent—competence reduces fear.
• Rotate staff assignments to prevent overexposure to high-crisis clients.

Key References

• Behavior Analyst Certification Board. (2020). Ethics Code for Behavior Analysts.
• Crisis Prevention Institute. (2020). Nonviolent Crisis Intervention Training Program.
• Luiselli, J. K. (2009). Physical restraint of people with intellectual disability: A review of implementation reduction and elimination procedures. JIDR, 53, 431–447.
• Vollmer, T. R. (2002). Punishment happens: Some comments on Lerman and Vorndran's review. JABA, 35, 469–473.