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

In this episode we are excited to have a discussion with Kim Warma, the President of Pro-ACT, Inc. Pro-ACT is a widely used crisis management curriculum that is implemented in various settings, from schools, to hospitals, to group homes/residential facilities, and many more. Dan and Mike have experience utilizing the Pro-ACT curriculum,  with Dan training the principals for over 10 years for multiple ABA companies, and can both personally vouch for its value with increasing safety and improving company culture. 

Under continuous development since 1975, Pro-ACT has evolved over the past 50 years concurrent with the focus on increasing Civil Rights for all marginalized communities to become the pinnacle training for crisis management, focusing on maintaining dignity and respect for the people that we serve. 

Mike and Dan discuss with Kim how we can all work to manage challenging behaviors safely while respecting the people that we serve. Kim poses the question repeatedly, 'Whose needs are we meeting?,' highlighting how we often lose sight of the client needs, in favor of staff needs, when they become aggressive or uncooperative. 

Sit back, relax, and enjoy this unique brew safely. When you're done please visit www.proacttraining.com to check out their services and curriculum.

Transcript

SPEAKER_00: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_01: 0:55

All right, all right. Welcome back to yet another installment of ABA on Tap. I am your co-host, Mike Rubio, along with Mr. Daniel Lowry. Mr. Dan, how are you, sir?

SPEAKER_00: 1:06

I'm great. I'm very excited about today and today's guest, one that we've been looking forward to having on for a while. I'm seeing some technical difficulties last week, but we got it together and, yeah, very excited about today.

SPEAKER_01: 1:19

We're very grateful that our guests would agree to come back. We have been facing some technical difficulties some life events. It's been a little while since we've been in the studio, sir. So it's really good to be back. Good to continue with the momentum here on the guests. We do pretty well at creating content and coming up with good content. And then as of late, Mr. Dan, we have other people helping us with that because they so graciously agree to come on the show. So I am going to, I've said this before, you bring stuff to the table, I bring stuff to the table, and then one of us drives a little bit more than the other in any given episode. So I'm Sometimes we share that pretty well. I'm going to let you drive today, sir. All right. I think this one's yours. So without further ado, please lead us into our guest, and then we'll let her give us a little background and kick us off here.

SPEAKER_00: 2:07

All right. So very excited to have Kim Worma, the president of ProAct, Inc., with us today. And please, if I butcher anything, please correct me. I'm trying to get my terminology and make sure that I'm correct. Did I get that all right, Kim?

SPEAKER_02: 2:26

You got it perfectly.

SPEAKER_00: 2:27

Excellent. The president of PROACT, Inc. Many of you may use PROACT or a derivative of that as a crisis management kind of protocol and something that's just been very well utilized here in the field of ABA, something here in San Diego a lot of the ABA companies use, and something that I think I'm really excited to have Kim come talk a little bit about what PROACT is, but also just kind of some of the methodologies and the reasons behind it, because I think a lot of times people have one idea of what PROACT is, and then when they get the training, they are just enlightened to a whole different kind of world of strategies and things that can just make the general application of ABA better. So without further ado, Kim, thank you so much for joining us today. I really, really appreciate your time.

SPEAKER_02: 3:18

I'm happy to be here.

SPEAKER_00: 3:21

So could you maybe start with talking a little bit about maybe your experience and what brought you, how you maybe found yourself into PROACT, and then maybe we can get a little bit into what PROACT is?

SPEAKER_02: 3:34

Of course. I've had a long history with PROACT and started with the organization by training people primarily training folks who would become instructors who would then go back into their own organizations and train. And I did that for a number of years. It was an awesome experience, I think, because for me, my own background at that point was in residential. residential treatment, and I had worked with a variety of age ranges. But in providing training to folks who would go back into their own organizations to use ProAct, I got exposure to a lot of other treatment environments, a lot of other professionals, and it just really broadened my scope and understanding of what's out there and how ProAct, I think, fits how people can use the PROACT principles to work in their own organization and support the people that they serve. I like the flexibility of it and here I am, decades later.

SPEAKER_00: 4:48

And you worked with the founder, right? You worked directly with Paul Smith, is that correct?

SPEAKER_02: 4:55

I did. I knew Paul and worked with him. And Paul's story is an interesting one in that Paul, kind of the piece about Paul that I think is the most unique is that Paul is a Quaker. And so his focus was on nonviolence. And when Paul first came to work in the treatment environment and clinical treatment, he actually was a, He was a conscientious objector in the Vietnam War and so was doing work in a psychiatric treatment organization facility and became concerned about the amount of assault or violence that he saw and witnessed in that environment. And that's what kind of prompted his work in developing what was originally called PART, Professional Assault Response Training. That was in 1975. In 2002, PART became PROACT Training, and at that point, Paul was no longer involved in the organization. But I think the fact that the principles Paul established early on have remained intact for the duration of heart, and now they are the same principles we continue to use with PROACT. And again, as I mentioned, the flexibility, it's the adaptability and flexibility of those PROACT principles that allow them to remain the same and allow them to work in a whole host of treatment environments with a variety of professionals.

SPEAKER_00: 6:41

That's something

SPEAKER_02: 6:42

I

SPEAKER_00: 6:43

really like, that you mentioned that flexibility, because when we train, we train to, and again, we're doing this from kind of the ABA guys, and that's one portion of the individuals that we train, but we train people from group homes, from hospitals, from short-term residentials, longer-term residentials. I think we've even trained some corrections individuals. There is a wide breadth of individuals that this methodology is suitable and applicable for.

SPEAKER_02: 7:10

Absolutely. And also age ranges. In addition to those different environments, whether it's children, adolescents, adults, geriatric populations. So the adaptability to all those folks is what is one of PROAC's big strengths, I believe.

SPEAKER_00: 7:30

And the systematic approach, too, if I understand correctly, and as it's played telephone and gotten to me, I haven't butchered anything, that when Paul was at, I think it was Camarillo State Hospital, he just noticed that there wasn't really a plan or a systematic approach and everybody was kind of doing their own thing. And he kind of sought to find a way to get everybody on the same page so that they could minimize injuries so that everybody wasn't doing their own individual thing on the same page. in response to these crisis situations. Is that pretty accurate from your experience? Did I report that correctly?

SPEAKER_02: 8:08

I think in terms of history, it is. I think also when you look back at what was going on in 1975, 50 years ago, the whole nature of treatment, treatment environments, and the people that were being served was different. And so... It was about creating some kind of consistency. And over the course of years, of course, different organizations have come in to fill that gap, and different organizations choose to fill it a little bit differently. What sets PROACT apart, I believe, now and then is, again, this set of principles that we use, as opposed to a real technique-driven program. Techniques are about... following very clear rules. There's a step A, a step B, and a step C. And with PROACT, the whole focus here is to say, who are the people that I'm working with? What are the needs that they have? And how do I best address those needs in this moment to reduce the potential for further crisis, for injury of the client, the other, and the professional? And it's that adaptability That is what PROACT considers its systematic approach. It's the idea that we give you a set of questions, and that's the system. The questions that help us to implement the principles.

SPEAKER_00: 9:38

I agree from seeing it from both sides, from delivering it as a Proact Inc. trainer, but also the in-service instructor delivering the material to my companies, that I think one of the weaknesses in ABA, I don't know if it's a weakness, something that I've found is that people want techniques. And I'm just taking out of product for a second. But people want to know, when I work with Johnny, what should I do? Or when I work with Susie, what should I do? When Susie tantrums, how do I get 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, maybe if you ignore her until she stops, then... you can go about it that way. But then what happens is that person takes that response and uses it for every time Susie tantrums for every reason, but not only Susie, uses it for Johnny and Sally and Thomas and everyone else. And then what happens is we have these treatments which are not well fit for that individual. There was context which made them reasonable for one situation, but not holistically. And I really found that ProAct was really, really useful And actually sometimes challenging in the beginning to teach these people because they come in wanting these answers and we're like, well, let's think about it. What alternatives do you have? And then we have to think about the alternatives and the alternatives that you might offer today might be different than tomorrow. So at first it can be very challenging, but I've always said that. I think one of the most effective trainings, and in ABA we mandate this 40-hour RBT training, that we could give a new staff would be PROACT training, because PROACT teaches you how to think and how to process like a framework, and then you can individualize it from that. So it's more like outside in, whereas a lot of our trainings teach inside out, and I think people get lost.

SPEAKER_02: 11:28

I agree with you completely. I mean, I think that... That's exactly what happens with the technique. That's also why people like techniques, though. If you have a technique, they want to be able to apply it to every single situation. And to ask people to think and process requires an extra step. However, I look at who are we serving. The goal and the objective here is to take care of our clients and to better support and serve them and address their needs. And so if it takes me an extra step to consider and alter what I'm going to do, if the outcome is better for the client, then that's worth it. Because trying to fit a single technique, whether it's taking away the iPad or ignoring for five minutes or whatever it might be, into every situation isn't going to address the needs of the individual. And so then if we're not addressing the needs of the individual, what's the likely outcome of that?

SPEAKER_00: 12:41

Yeah, absolutely.

SPEAKER_02: 12:43

The situation will tend to escalate. The staff people will tend to get frustrated. That level of frustration overlaps into what happens in terms of the interaction with the client. And so... Part of this process is let's just slow it down and think about what we can do to make it work 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 talking about. When you say thinking about what's better for the client, I think oftentimes younger professionals or professionals in ABA in a so-called crisis situation or if a child is escalating, are immediately thinking about what's better for the environment, what's going to make the parent feel better, what makes those sounds or those actions stop so I feel better about it. You're talking about the client specifically. I find that very interesting. I mean, again, that's a whole shift of we talk about instructional control, for example, in ABA, and the idea that your words are shifting that tool. Now let me let the client instruct me as to what's better for them. where I think oftentimes we're thinking the other way. How do we control this out-of-control client? You're shifting the paradigm there. I don't know if you can spend a little 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's really important for people and everyone to understand that PROACT 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's using ProAct, they are not using it as a treatment plan, whatever kind of plan that might be. ProAct is there to be used when something else happens. From the perspective of ProAct, we say that you have a treatment plan in place for the client that you're working with, whoever that client should be. And we all understand that as we are attempting to build effective treatment plans, if we do build effective treatment plans and things change, then the existing plan might not work. A new plan might not work. There are some tweaks and adaptations and modifications that need to occur in those plans. The goal of the treatment plan isn'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 people at work, and it seems like maybe they're not keeping that in mind. Again, it's very authoritarian. Let me control the situation, make you do what I need you to do, and then you receive this reinforcement. And I'm boiling that down pretty quickly and stringently, but yeah, I think that... This is where you're speaking to a different mode of presentation or a more dynamic mode.

SPEAKER_02: 15:34

Exactly. And I think, yes, that's a very broad brush. It's not the way it always works. But I think we can be generally comfortable saying that treatment shouldn't put people in 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 up in a crisis situation. So if we look at those two statements, then what we know is crisis isn't treatment. So PROACT is there to help people respond and manage crisis. It's not there to do treatment. And so what we will say often is that if you feel like you are consistently using PROACT to manage a crisis situation, you've got to go back to your treatment plan because something's wrong there. and what you're doing on that day to day. But also what we can recognize is that sometimes things do get pushed to a point where there's a crisis or something external happens and there's a crisis. And at that point, we also need to shift our objective. And I think this is what you're talking about, Mike, is that when the crisis occurs, it's not about saying, well, we've still got to push forward. with this treatment plan and continue to take control or have the same expectations that I might have had five minutes ago. Once we hit a point where we're in crisis, we've got to do something differently. And crisis response and treatment are not not always the same thing. They are not necessarily mutually compatible. You've got to put the treatment objective aside and say, we now have to get back to a place where we can bring people, well, first we can keep them safe, but second, where they can begin to learn or receive or respond to the treatment objectives that are part of that other plan. Because we can't do both at the same 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 just want to reiterate because it's so important. Like you said, the curriculum is not evidence-based treatment because it's not treatment. And what I've found is that oftentimes what product does is it really does find the holes in the treatment. We're not there. Kind of a term that I use is if I do my job well enough, Chapters 6 through 12, the responses, you're going to use them less because what you're going to find is the holes in your treatment that prevent you from getting into the crisis pieces. Chapters 1 through 4, where we talk about preparation and the professionalism, those I think are always pretty relevant. But later when we talk about crisis responses, because Mike always has a statement, he talks about rewriting the script. We always say if... you're always having to do something, then we're probably always doing something first. So if the client or the person that we're serving is always assaulting or always doing something, then we're probably always doing something first. And that is that treatment that, like you said, PROACT isn't there to say this is exactly how you're going to set up an environment. These are going to be your antecedent strategies. We're going to say that it's very important that you address antecedent strategies and treatment. But we're just going to say that please use these plans and please have these plans. And in the event that these plans don't work, use them again. And if the event that they're still not working, try to still use them. In the event that they're still not working, okay, we have some additional strategies that might help you resolve this situation to be safe. The last thing that I think you said that was so important and I want to reiterate and please feel free to expand on is the difference between safety and learning. PROACT is really designed to be a safety curriculum and help people maintain safety in the environment so that we can use those behavior plans or those treatment plans or primary plans. But when things are escalating to the situation, like you said, no primary plan is designed for somebody to be assaulted. When it's gotten to that point, people's cognition, and I wish maybe we'll add a visual somewhere into this because the PROACT assault crisis visual is just... so paramount and gives a really amazing visual for this. When people escalate significantly, their cognition drops. When their cognition drops, there's not really much learning going on there. So like you're saying, when we're looking at people assaulting, we gotta prioritize safety to get them back to a situation that's safe that eventually they can learn. Did I kind of recap that well? Is there anything you'd like to expand on, Kim? But I think what you said is just so important, I wanted to make sure it was reiterated there.

SPEAKER_02: 20:40

No, I think you're absolutely correct. And again, it's that piece that as behavior, as anyone escalates, anyone's behavior, and let's get really clear here, everyone has behavior, not just your 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 your clients are escalating and we're pushing them further into that escalation it's probably to your point Mike is it our own why are we continuing to push? What are we doing? Why are we continuing to frustrate the client, frustrate ourselves?

SPEAKER_01: 21:30

The idea of discipline comes in sometimes with that, right? I think it's a misconception there. But to your point, I think this idea of discipline, right? We're helping parents, so I have to discipline my child. And that means that even if they're not listening or they're now in an escalated state, I still have to push forward. So continue.

SPEAKER_02: 21:47

Right. No, I agree. But And so that discipline can look like a whole host of things depending upon what people do.

SPEAKER_01: 21:56

Very

SPEAKER_02: 22:00

good. which then ultimately increases the potential for real injury. I would go back, Daniel, to what you were saying about it's not just about assaultive behavior. As people escalate early in that process, again, our cognitive, our thinking is diminished. Our cognitive process is reduced. And so part of it is we want early on to give people some tools, and people now, I'm meaning the professionals who are doing these jobs, give them some tools to understand and observe that early escalation because an earlier response and getting someone back to their baseline earlier, so stopping that push earlier, avoids the crisis, avoids the trauma related to the crisis, avoids the potential injury, avoids the sense that that there is no discipline. Let's shift gears earlier. It's kind of like, don't drive off the end of the bridge. Take a detour and get around to the other side.

SPEAKER_03: 23:14

Yeah.

SPEAKER_01: 23:16

It's probably not a great analogy. No, but I think some people then might say, well, but that took you off course, and you're saying, yes, that's okay. You're not supposed to stay on that road. Right? But some people might say, oh, but that deviated your course. That changed your treatment plan. No, this is part of the dynamic of the treatment plan, I think is what you're explaining.

SPEAKER_02: 23:34

Yeah. Yeah, and I think what I'm saying is it took me off course because the treatment plan, something that was going on before, Proact didn't take me off 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 the potential for crisis. The sooner I can get beyond the crisis, the sooner I can get back on course and move back into that learning.

SPEAKER_00: 24:02

I like that framework, Kim. It's kind of like the behavior plan, primary plan, whatever you want to call it, treatment plan, isn't working. And if we're continuing to do something that's not working... That's, you know, that's Einstein, right? Insanity repeating the same course of action and expecting a different result. So what Proact can actually do is give us another alternative to get us back to our treatment plan, because that's where we want to be. We want to be back in that treatment plan. But if it's not working, we got to get that individual's cognition back to a level that they'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 the same thing happens, and if you try it again and the same thing happens, well, then you need to consider adjusting the treatment plan. That's where modifications. It doesn't mean you throw it out. It doesn't mean you don't have a similar objective. You just have to find a new path.

SPEAKER_01: 24:54

There we go.

SPEAKER_00: 24:55

Yeah, absolutely. Because like you said, the treatment plan wasn't written to get to an assault or a high-level escalation. So if that's happening, either it's a fault in the treatment plan, which I know Mike and I, we've written tons of treatment plans that were faulty and you learn and you adjust it's only faulty if you keep doing it or it's a it's a issue in somebody's implementation of the treatment plan so both of those lead to like i think i can't remember off the top of my head i probably should have brought one of my product manuals i think it's chapter 10 when we talk about debriefing um when we talk about looking at the effectiveness of the treatment plan versus that person's implementation of the treatment plan i think one of those two things is faulty so let's kind of look back and and figure out what's going on in that situation. And product allows us to get back to a safe situation so we have the ability to do that.

SPEAKER_02: 25:47

Absolutely. I think the other thing that we go back to is whose needs are we meeting when? And it's an interesting comment that you had, Mike, about when you've got someone working with a child and they feel like they're trying to support a parent, the idea that they get into this notion of discipline. And so because I need to discipline this child so the parent understands how to do this or isn't dealing with this situation. If that's not effective for the professional, 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 this moment? You know, are we pushing forward because we want to feel like we're doing something for the parent? Because the focus here really has 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 important that we posit the idea of crisis. We've been using that word. So I'm going to ask a very simple question, because as a parent, you might have a child that escalates tantrums frequently. And you might, as the parent, interpret all of those situations as crisis situations. That's not necessarily what we're talking about here. We're talking about a very specific definition. Why don't you guys spend some time talking about what that means, crisis? How do we define crisis? at which point does it escalate to different levels that then warrant us as professionals or individuals trained in PROACT to then take a different course of action? It's a very general question there, but I know you guys have a lot of little pieces to fill in there.

SPEAKER_02: 27:43

Should I dive in here? Sure. Go ahead, Kim. So PROACT defines crisis as in three very specific ways. And we could call them high, medium, and low. We could call them... But basically, a crisis is a point in which there is an immediate potential for risk. Either there's an immediate threat or there's an immediate attempt at some kind of physical assault, some kind of harm. And this is a threat to a person. It could be self-injurious. It could be injurious to the other. But it's immediate. It's imminent. And basically then what defines whether it's high, medium, or low is the potential severity. So I think it's important to recognize that that crisis definition sits within a framework of what we refer to as an assault cycle. And that assault cycle has a trigger, it has an escalation. Phase three is very limited, and that's the crisis. After a crisis, there's a recovery period, and then typically following that recovery, you're gonna see some, what we refer to in PRO-ACT is post-crisis depression, which is a depression sometimes of mood, sometimes of behavior. But you will see a shift. I think that when we talk about crisis, we can talk about responding to the crisis, but really where the diagram, I believe, between a treatment plan and a proact as a systematic approach overlaps most notably is in that space between trigger and crisis. That's where PROACT really wants to invest its energy. You know, PROACT does teach some kind of physical intervention or physical restraint, but our whole focus is avoiding that. PROACT as a program puts more emphasis on early intervention and de-escalation than any of the other programs out there. And that's because We believe that if we can avoid that crisis, that's, again, better for everyone. It's better for the staff. It's better for the kid. It's better for the parent in the cases that you're talking about. So the goal here is, and that's why I was saying you want to be able to see early on when the trigger happens. You don't wait until the crisis to respond. You don't wait until there's a threat. a threat to self or a threat to others. You don't wait until someone is physically injuring themselves or others. You want to look and observe the behavior changes that indicate there's escalation. Because for a lot of reasons, one is that's when you're also seeing the cognitive shift. 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 to begin to change what we're doing. And that is not pushing forward faster and harder and more, making more demands. So the idea is, again, how do we reduce demands at this point so that we can bring this person back to a place where they can learn more effectively.

SPEAKER_00: 31:49

I agree. An analogy I like to provide for that, Kim, is one of my triggers is slow computers. You get that wheel or you get that computer that starts spinning, and like you said, we're not going to get back down to baseline by adding more onto somebody's cognitive load. It's the same thing with a computer. If the computer wheel is spinning, you can try to open as many more programs as you want. That's not going to work. You've got to get that computer to get get itself situated you got to remove programs in order for the computer to get caught up and that's i feel like what happens a lot with people is that people their wheel is spinning and now everybody around them is adding more to their cognitive load and you wouldn't do that with a computer you wouldn't keep just adding more programs to it if it's already on overload so that's kind of the analogy um i like to think 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 things that makes PROACT very, very different than a lot of other programs. It's one of the things that pleases me most about what we do. Because at that point, what you're talking about is you, the operator of the computer, wouldn't keep pushing the buttons, right? Yep. It's up to you to say... This doesn't make sense. I'm not going to keep pushing the buttons. One of the things that PROACT incorporates into its training is a focus on some professional development so that I, as the staff person, regardless of my role, don't keep pushing the buttons. I have to begin to... I have to learn, and Proact provides, again, structures for structured observation, for managing 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'm much more likely to keep pushing the button. And so I think... I guess we'll... I guess I understand why people continue to push, and it's because if they don't have anything else, if they don't know what else to do, they just keep trying the same thing.

SPEAKER_00: 33:58

Yep. I think that was Maya Angelou who said, we do the best we can with the information we have at the time, and when we know better, we do better. And I've seen that absolutely be applicable for PROACT. I do think that the majority of the people Get in this field well-intentioned and do the best they can. I don't think they're trying to actively hurt people. I agree. We just did some trainings with the paraprofessional level. Unfortunately, in our field, a lot of times the direct staff get the least amount of training. whether it's for whatever reason. It's hard to pull them away, unions prevent it, whatever reason. So these people are expected to kind of do the most work and be in the face of everything and get the least amount of training, and then they're the ones that are held accountable when stuff goes haywire. So, yeah, kind of like you're saying, Kim, I think as these people get more training, they do better because they know what to do better.

SPEAKER_02: 34:52

Right. And I think what we're talking about and what we train people to do are things that are... really well within the capacity of individuals because i agree with you people don't get into this business to do wrong they get in because they do want to serve and support but without training especially in situations of crisis we revert to our own experience how we parent how we were parented um how we went to school it could be any anything and so we need to give people just more tools so that they can do a better job

SPEAKER_00: 35:29

I think additionally, too, as people run out of options, they try to grab more control over the situation. And that's when they either start applying less options or even become more physically either closer proximally or start physically moving people because they don't have it. I don't want to say they don't have any. They don't think they have any other options. They think that's what their option is. And that's where actually things get escalated more. Because like we talk about in Proact, if we do our job. Well, a lot of times people come into these prior trainings thinking, oh, I'm going to learn all about restraints. If we do our job well, you will leave here using them less and wanting to use them less and thinking about using them less because you have a lot of other strategies. You don't think that somebody is not listening to me. I'm going to ignore and they still 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 lot more options so that you're not going to have to get to that point 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 my favorite slides in ProAct and a lot of the people that I train's favorite slide. You asked about crisis. One of the early on slides talks about there's a difference between dangerous behavior and irritating 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 present that. I'm like, if we could get arrested for being obnoxious, My girlfriend would call the cops on me at least twice a week, probably every day. But because that doesn't jive with somebody's wanting to, whether it's in a school or residential or something like that, because it's not making the staff's life easier, all of a sudden we start to escalate and we make a situation worse. Kind of like Kim was talking about, whose needs are we meeting when? And so often we're thinking about our needs. We're thinking about the computer wheel spinning. I need to get this program open. Well, unless I start removing programs, I can't open up this program. We think about our needs and lose the needs of the client. Like somebody being hungry, right? A lot of people get hangry. We talk about this. The easiest way to meet that is to just feed them. Now, maybe they might be engaging in, you know, I get hangry, my girlfriend gets hangry, a lot of us get hangry. I can talk to her about, hey, I don't like your attitude right now, or she can talk to me about that. That's not going to make it change as fast as, hey, can I get this person some food? And now one person might say, and this is a... tangent I want to go on later because I do want to get Kim's perspective on it. People might say, well, you're reinforcing that person by giving them food. Okay, maybe. Maybe you are. But also, can we get them back down to baseline so that we can teach? Because you can't teach when people are away from baseline. So it's all about whose needs are we meeting when? I'm stealing that, Kim. I like that. Because so often we're focused on our needs. And we need to get them to stop crying. No, we've got to meet their needs 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 this moment? That's what I'm talking about. I need to take care of. This reminds me of something that actually I would say I learned from Proact. I remember once working with a child who had pretty heavy distress expression. And it was a snack time during a group session. And somebody was trying to get her to eat. And they kept doing our famous first 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 doing the same thing. So finally, I stepped in. And again, sort of thinking about this idea of stop, look, and listen. Do less for a minute. And if I'm going to keep doing the same thing and getting the same outcome, then I'm not really helping anybody. So I remember just... getting down to the child's level and saying, hey, are you hungry? And she stopped and said, yes. And I said, great, go do that over there and then I'll meet you at the table for food. And it worked. And I think that a lot of the trouble that happens in ABA is that we are so linear in our contingency. We've got this three-part contingency and it's really powerful. So I don't take anything away from it. But we tend to think that it's always the same antecedent for the exact same behavior for the exact same consequence and what you're saying kim is that can't be in fact there's many antecedents to many acceptable behaviors to a variety of consequences and that seems to fit 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 speaks to this issue and has a has a focused content area on observation what am i observing when am i observing it and how is it changing to go into any environment a con one that's more controlled or less and just assume that because you've got two eyes your observation skills are in order is um not correct you have to know what you're looking for and you have to be prepared to look for really small changes it's And when you do that, again, you're looking and saying, what's happening here? And then I think you can... You also spoke to something, Mike, which is about humanity. Asking someone the simple question of, are you hungry? And trying to help them meet their need. Because ultimately... In the big picture, what we want is to give people the skills and the understanding of how to meet their own needs, right?

SPEAKER_00: 41:04

Yep. Mike, I wanted to jump in on something Kim just said real quick because you were talking about observation. And we talk about the three levels of observation in a product. I won't give away too much because you all come get the course and get the full thing. But one thing that I would talk about when I would train it as an in-service instructor to my team is I'd say, because we would do that, that'd be like the first part of the first day of PROACT. And I'd say, if you're going to pay attention to any specific thing, this chapter is going to be the most relevant for you because I'd find that our staff wouldn't be good at observing at the baseline level, the routine level. When people start yelling and screaming and tantruming, then everybody in the environment all of a sudden becomes really good observers. But they're not good at observing at baseline, and that creates issues because you're missing so much, and then you're always behind the eight ball. We talk about the three most common 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 to noise. And that's, I think, one of the issues that we run into is that we're not responding. Like Kim said, we don't know what we're looking for until people are yelling. And then our cognition is dropping, and we're at this point where we're reacting rather than responding. So intentional observation, I would say. That's what I would tell my team. If we can figure out, if I come to you and you're working with Johnny, and I say, what are you looking for? Or at any point, you should be like, I'm looking for him to do this or not doing this or going here. You should be able to tell me exactly what you're looking for, what you're observing. Because saying observe better means nothing. It should be intentional and strategic. Kim, I wanted to elaborate on what you were saying, but I don't know if there's anything else you'd like to say for that observation piece. Because I just found it so important 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 has erupted, there are lots of other things that happened in advance. And when you say, well, you know, what happened before? People will say, I have no idea. It just happened out of the blue. But there were changes in behavior. It could have been simple movements further away or closer to someone. It could have been a level of tension in someone's arms or hands or they're standing as opposed to sitting or sitting as opposed to standing. None of those are crisis movements in and of themselves, but they were all indicators that something was changing. And if we missed them, that's on us. It's not on the other

SPEAKER_00: 43:51

person. I want to talk about a couple of other things. One specific part that I found was just so enlightening for the team that I would train, all of it is, but just some specific highlights, is the communication piece. And talking about the difference between assertive and aggressive communication. I mean, it's all very relevant. But changing you statements to I statements. I found that just so important. And taking the word need out. Because so often, we just find ourselves 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 adults and then they just stare at you. And you're like... Oh, I guess you didn't actually need to do that. You're not going to spontaneously combust if you didn't do that. So it's interesting when I do my trainings now when you have different, you know, you've got people work with adults and work with kids and the ones that work with adults will look at the ones that work with kids and be like, yeah, tell my adults they need to do something and see what they do. But replacing it with the I statements, that was one of the other things that. I really highlighted, and the assertive communication, the empathetic I statement, helping somebody understand that you're on their team, I think is so important. Rather than just being this person that barks instructions down your neck, you need to do this, 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? How can the person that I'm working with think that we're on their team rather than we're just bossing them around as an outsider? Kim, I don't know if you want to speak to that, but that was the other part. The communication was just something that I found just so relevant to the demographic I worked with.

SPEAKER_02: 45:31

I think it's relevant to pretty much every demographic. And for me, again, it goes back to 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 an age-appropriate way, but it's like you're a human. It's just what we need to do with other people. But I think it's also important to realize that I statements are wonderful. I think they're essential, but it's also important that you can't put an I in front of a basically aggressive statement and it doesn't make it an I statement. So to say, you need to do this versus I need you to do this, those are equally aggressive. Because it's really still all about something that the other person has to do. The empathic I statements that you're talking about, Daniel, are critical in that they are about me. I want to help. I want you to feel better. I want to get you some food if you're hungry. I want you to be able to take a break.

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've always said is a good empathic I statement will connect me to my reason for doing the work. We've already talked about the fact that most people go into this work wanting to do good. They want to serve. They want to support. They want to help. So a good empathic I statement reminds 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 of this, people might think we're doing that for the other person. I'm using these statements so that they feel better. What you just said is it puts us in a mindset. and reminds us what we're there to do. It puts us in a less aggressive stance, more prepared to present empathy, to present assistance. I think that's really important because so much of this work, again, there's a locus of control. We want to be in control. We want to have instructional control. Control is a tricky word by itself. We're not talking about authoritarianism 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 and assertive communication that we're talking about is if I follow up my empathic I statement, my I statement that reminds me why I'm here and tells you why I'm here and I want to help, if I follow that up with a choice... And this is also an interesting piece. But this gives people back a level of control while also offering it to the person that you're working with. So I get to pick the choices I offer. That's my control. And I'm going to pick two choices that are perfectly reasonable and acceptable. And when I offer them, it gives the person that I'm working with the independence, the autonomy, the ability to make a choice. And so much of what we do in treatment environments is take choice away from people, which is also kind of ironic because our whole reason for treatment is to help make people more independent and capable, and that includes making choices. But if I can give two reasonable choices and give them the opportunity to select one, Like a huge win-win.

SPEAKER_00: 49:28

Kim, can I ask you a question then? Because I see this a lot, and it's actually not reinforcing the behavior, but I see this a lot with either the BCBA crowd or just people in general. They're like, well, because we talk about offering alternatives. Well, if I offer them an alternative, aren't they just getting away with it? Or aren't they learning that they 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 when you're done. But I would like to get your perspective on why you would say that is okay to do and they're not learning or they're not just getting away with it. Why can we offer them alternatives even if they're not doing the behavior that we want them 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 a trigger and if we're escalating, we've already talked about the fact that we've moved outside of the outside of the space of treatment. Now we're in an escalated, we're in that crisis phase and our focus is no longer about treatment and learning. Our focus is how do I keep this crisis from getting worse and get a person back to baseline so I can get them back to that other place of treatment and learning. So at that point, my goal is to say, if I've got someone who's escalating, The alternatives I offer are to bring them back to baseline. And that's my primary objective then. My primary objective is to get them back to a safe space so then they can go back into a place of treatment and learning. Does that make sense?

SPEAKER_00: 51:08

I love it. Because learning isn't occurring away from baseline. So when people are like, well, aren't they just learning that? Well, no, because they're not learning because their computer wheel is spinning. We've got to get their computer wheel to stop spinning. I really like the way that you worded that, Kim. And also with the alternatives, we have to be thoughtful of alternatives. of our alternatives. That's a tongue twister. Thoughtful of our alternatives and maybe plan some of those out ahead of times because as we escalate, we might not be able to think about it. The alternative doesn't necessarily need to be, so if they're hypothetically tantruming about the iPad, the alternative doesn't necessarily need to be giving them the iPad. That's not what we're saying. We're not saying give in. We're saying what else can we offer them to get them back down to baseline? And that's where I think people, like you've talked about, Mike, with the blanket extinction piece and people just being stupid so linear of, well, if I give them anything, aren't I reinforcing them? No. As long as you don't give them that one thing, what other alternatives? Can we be less dense as practitioners and be like, well, it's either my way or the highway. 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 back down the baseline? Right.

SPEAKER_01: 52:19

Now, there is sort of a defining line here, right, in terms of, well, with regard to alternatives, at which point does... crisis management start offering fewer alternatives. Let's sort of get to that part. So we talked about the idea of restraint, which I think People erroneously equate immediately with crisis management. So you say proact, and oh, I'm going to get trained in proact. That means I'm going to learn how to do restraint. And they forget about all the other stuff we've just spent the last hour talking about, which, to your point, Kim, is the most important stuff. The restraint is the last resort. It's the last piece. But in all fairness, and please correct me if I'm wrong, it does then start... reducing the amount of alternatives that we can make available based on severity, I think is the word you used. And when we say severity, we're talking 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 offer change.

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 or six. Because that's like looking at that menu where you're going, I'm so hungry and I don't know what 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 or red? 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 move further 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, those empathic 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 the blue?

SPEAKER_03: 54:33

Yep.

SPEAKER_02: 54:35

It's really simple. And if they come back with something 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 that formula, if you will. I can still offer alternatives. And when we go back and talk about, and this is what you were saying, Daniel, The iPad no longer has to be part of this conversation at all. It's not about reinforcing. It's about saying, how do I bring 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 important because we talk about reducing energy. If somebody's escalating, the situation already has way too much energy. So anytime we're talking, we're adding energy. So we always talk about you want to be very intentional and specific with your communication because we don't want to just be talking just to talk. A lot of times people do that because filling air is comfortable to people, but that's adding energy. So if we're going to add energy, we want to be very strategic. I do have a question for you with the alternatives, Kim, because I do think it's a really important premise from Prague that we should at least spend a minute or two talking about, is the concept of self-control and controlling our own self. When people escalate, obviously we escalate as well. I wish I could have the visuals to reference because it's so nice to have those. But we escalate as well. And that's where I think some of the alternatives start to falter because we lose our own self-control. And now we're not thinking of how we can help the person, how we can meet their needs. Like you said, we're thinking about how we meet our needs. And that all comes from, like you say, a point of self-control and assessment. So could you maybe speak to that? Because we've talked about principles, and that's pretty much the first principle for all of our response strategies is self-control.

SPEAKER_02: 56:29

Yeah, I'd be happy to. I mentioned before that we have this early... portion of the training that speaks to professional development. As part of that were the observation skills that we've already addressed. Another piece of that is self-control. And understanding the role that you play, you as a professional, play in any crisis situation is critical to the management of that crisis situation. I think that's another thing that makes PROACT different is that a lot of programs will go in and start immediately talking about the kid's behavior or the other behavior, the client behavior, and that that needs to be managed. Well, I'm the only other person in 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 my interaction in that. And I think anyone who's spent much time in this field, if you ask them, have you ever seen someone who was very well-intentioned make a situation 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't have anything else. It takes a lot to think about those things, particularly when you're in a crisis situation. So having a level and a plan, a very clear plan for managing your own behavior through a crisis is critical to helping you to continue to think. That's the goal here. We've got to be able to think so that we can come up with those choices so that we can not escalate escalate more ourselves. I think you referenced the visual that ProAct uses, and I'm going to try a little bit to describe it here. Please do. Not so much the visual, but the process. Yes. For most people, when they interact with someone, it's going along fine. As something triggers the other person and their behavior escalates, they have one of those, whoa, now what am I going to do moments. And if that behavior continues to escalate, that escalating behavior is what triggers me away from my own baseline. Because I start thinking, what am I going to do? What's going to happen? How's this going to end? Are they going to throw something? Are they going to hit someone? Are they going to hurt something? What's going to happen? And my own blue dots in my head start spinning, and it interferes with my ability to think.

SPEAKER_03: 59:14

Sure.

SPEAKER_02: 59:14

So that... And so we often say that the staff person, the professional, is one step behind the client in this whole crisis cycle. They've triggered and they're escalating. Their escalation triggers me. If they continue to escalate, my escalation goes higher because I become more concerned. Standardly, as we escalate, Our tendency is the classic fight or flight, which is why people want to control things. Their way of moving into that kind of fight response is to say, well, I'm going to shut this down now. And they become heavy handed, whether it's verbally or physically, they become heavy handed in that process. So understanding our role in making a situation better or worse is essential to us getting people back to baseline. Because what we have to do is say, if I'm not going to make it better, I don't want to make it worse. I need to control my own behavior so that I can think, I can offer the I statements, I can offer reasonable alternatives. So that when I say red or yellow and they say blue, I don't just get mad because they didn't pick

SPEAKER_03: 1:00:42

a

SPEAKER_02: 1:00:43

choice that

SPEAKER_03: 1:00:44

I

SPEAKER_02: 1:00:45

want. So that that doesn't further trigger me so that I'm thinking enough to say, yeah, no problem. That's fine.

SPEAKER_00: 1:00:52

Or like in the midpoint review example, like when we're trying to get the individual to walk through a different door and he finally does it, but he's like, you know, that's stupid or something. How do we not focus on the fact of them saying that they're stupid because we're stupid because we're away from self-control and focus on, hey, they're actually doing what we want them to do, right?

SPEAKER_01: 1:01:10

Those are my favorite examples when the client is actually doing what you want them to do, but they're not doing it exactly the way you want, and then people comment on that, right? So I turned in my effing homework. Well, let me correct you on the effing and forget about the fact that you turned in your homework.

UNKNOWN: 1:01:31

You turned in the homework, yes.

SPEAKER_01: 1:01:31

Yep. It's very easy for that to happen to anybody, yeah, for sure. Oh,

SPEAKER_02: 1:01:36

yeah. And that's also that thing, though, about we're traveling one step behind. Right. Because as they finally move beyond the crisis and say, fine, I've turned in the effing homework, I'm at the peak of mine, and I'm angry. And so I'm going to... focus on the wrong thing.

SPEAKER_01: 1:01:52

So that's to say, and I'd love both of your insights here, that's to say that in that escalation cycle, we, as the adult, as the professional, we are also going to face some level of escalation no matter what. Is that fair to say? So it's almost a process of then, to use that phrase we like to use, Dan, noticing our reaction and kicking in our response set such that we don't tip over into our own crisis. Am I getting that more or less correct?

SPEAKER_02: 1:02:27

Absolutely. Absolutely. That escalation is a normal physiological response. We can't stop it. All we can do is better manage

SPEAKER_01: 1:02:38

it.

SPEAKER_02: 1:02:38

And so we manage it through a plan for self-control.

SPEAKER_01: 1:02:41

So in that sense, baseline isn't necessarily flat. I mean, that's fair to say. It's a little bit of an up and down, a little bit of a slight escalation or excitement back down to baseline, back up, back down.

SPEAKER_00: 1:02:51

Yeah, think about it like a road, like a freeway, right? Like baselines, like the freeway, and then like self-control is maybe like the shoulders. So you've got the freeway, you're kind of in the

SPEAKER_01: 1:03:00

different lanes.

SPEAKER_00: 1:03:01

And then you've still got the shoulders, right, where you're not a baseline anymore, but you're in the different lanes. But you're not completely off the road. You're not in the ditch. Exactly. And then when you've lost self-control, you've completely moved away from it. Now you're completely off the road. So it's not like a one-lane road. It's like a freeway. And kind of like Kim was talking about, too, the reason that we're, because we're one step behind, what's so dangerous, and I know you alluded to it, I just wanted to reiterate it, is that we are so susceptible to make a situation worse after that individual is moving in the right direction. They're actually calming down. You've argued about the homework. They're like, fine, I'll do my effing homework. So they're actually in recovery.

SPEAKER_01: 1:03:38

But you're still pressing.

SPEAKER_00: 1:03:39

We're still, we're ready for that fight. And Kim, you mentioned, too, that because PROACT decreased curriculum is an approach rather than techniques. We always have to have kind of a level of thought of how we're going to implement that approach within that framework. So because of that, self-control is so important because within the product curriculum, there's never really a point of like, let's just turn our brain off and do this technique. It's always, let's figure out the most effective technique within the approach slash framework. So we have to have self-control to be able to do that. Would you agree with that, Kim?

SPEAKER_02: 1:04:13

Absolutely. Which I think takes us all the way back to one of the things that we started the conversation with, which is a lot of people really like techniques because techniques takes the thinking out of the process.

SPEAKER_00: 1:04:26

Yep. And the blame, right?

SPEAKER_01: 1:04:28

Well, I did it that way and it didn't work, so it had to be the technique.

SPEAKER_02: 1:04:32

Right. It becomes simply an implementation process. I did what you told me to do and it didn't work. And what we're saying is... We want to think about things because we've got a lot of ways to make this work and our primary objective is to serve our clients, to take care of that client.

SPEAKER_00: 1:04:52

I want to talk a little bit because I would be remiss if we didn't just at least touch on the restraint piece. Yes. And I want to talk about that because I don't know why, but sometimes, at least in my experience and some of the places where I've trained as well, people come into PROACT thinking it's going to be the restraint class and they leave with a very different realization. But, you know, I think it's only four hours of the 18 hours if they choose to go through the restraint course, which is a totally separate curriculum. You can be PROACT certified and not be restraint certified. The product training's 14 hours, the restraint's four. I have a question for you and please go down whatever roads you want with this, Kim. Our goal is to reduce the risk of restraint. What are your thoughts on why we include restraint and how teaching restraint is either useful or applicable in reducing the use of restraint. Like why if our goal is to reduce restraint, do we teach restraint?

SPEAKER_02: 1:05:56

Oh, well, that's an excellent question. So our goal is to reduce or avoid the restraint. And that's why we spend about 80% of this whole curriculum on teaching. ways to do that on things like observation, on self-control, on understanding the assault cycle, on being able to observe when someone's been triggered and escalating, how to identify a thoughtful, empathic I statement, how to give reasonable and choices that people... So that's why we spend all that time doing that.

UNKNOWN: 1:06:35

Okay.

SPEAKER_02: 1:06:36

There are... And so... So I feel like that's where we put our energy. So then the question is, why do we teach restraint at all? Because there are situations that occur, and people make decisions. I think what PROACT does is it very clearly says, here are the parameters for even considering restraint. When we go back and talk about those levels of dangerousness or the levels of risk and the high, medium, and low, restraint doesn't figure into low and restraint doesn't figure into medium. Restraint is only considered an option, and not the only option, but it's only considered an option when you get to high levels of immediate physical risk. And And we've already spoken about the fact that things go wrong. That sometimes treatment plans that we write aren't as effective as we want them to be, or something's changed, or that something occurred. So when something happened, we can always say that if we get into that immediate risk of serious injury, and when I talk about serious injury, I'm talking about a time when people can be significantly injured when you're going to need medical intervention. If we can reduce the risk of serious 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 significant amount of injury. So to not know how to manage a restraint and not know about reducing circulation, to not understand positional asphyxia, to not understand the risk of choosing restraint would be irresponsible. So that's why we teach it.

SPEAKER_00: 1:08:48

That makes a lot of sense. And it's also potentially another tool. Like you said, people, when they don't have tools, they start kind of doing all sorts of things. And a lot of times people that don't have the tools actually do restraint not realizing that it is restraint. And then they do it improperly and there's a lot of consequences. You know, hundreds of people die every year from restraints and likely improper restraints. You said something, Kim, it's actually changing in my vocabulary. I used to say, you would catch me sometimes say the term that we had to restrain. And that's something that is now repulsive to me. It's we chose to restrain. And I do think that, you know, restraint, it's interesting because the last person we had on the podcast, talked about some ABA companies not taking very high behavior, for lack of a better term, highly impacted people that have very dangerous behaviors because they didn't know how to do restraints and didn't have that tool in their toolbox to deal with them. So restraint could be a potential tool to help with individuals, and it is a shame to not have that tool and not be able to serve these individuals who greatly need it. One thing the product does do and does put in great context of, hey, this is a very specific tool, and we're going to give you the parameters in which you can use it and the parameters of how to use it as well. So from my experience, and again, this is just my experience, it actually minimizes its use and maximizes its effectiveness when chosen to be used. Kim, would you agree with that? Did I say that correctly?

SPEAKER_02: 1:10:25

Yeah, I think you're right. I think if restraint is taught well and the risks associated with it, and those risks go far beyond, of course, the physical. There are significant physical risks, but then there's other things. There's the trauma risk.

SPEAKER_01: 1:10:38

I

SPEAKER_02: 1:10:40

think we also, it's important to recognize that there's physical and trauma risks to the staff as well. But if we... If we understand the risks, and the reason we talk about choosing to restrain is because if there's been a choice to restrain, I also, as the staff, am going to own that. I'm going to own the outcome of that. Whether or not I choose it consciously, but I, as the staff, own the outcome of the restraint.

SPEAKER_00: 1:11:13

Which could be death.

SPEAKER_02: 1:11:15

Pardon me?

SPEAKER_00: 1:11:15

I said, which could be death. That could be the outcome of the

SPEAKER_02: 1:11:18

restraint. Which could be, right. So I think when it's taught with an understanding of these are the risks, these are the only reasons you would consider, understand the risks, make the choice responsibly, People do tend to do it less. They do find other ways of managing behavior. I think when restraint is just taught as a casual exercise, people don't think about the risks, and it doesn't even occur to them that anything bad could happen. It's just the next step.

SPEAKER_01: 1:11:51

I spent at least a year in my early professional career at a place that the moment I walked in and spent one day there, realized that they were... overly using restraint as a means of controlling behavior. I'm happy to say that I only got into one situation with restraint that entire year I was there, but I really love the way you just pitched that and I think it's very important for people to consider that because you 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 important part of it, but it's a small percentage of it if you're doing the whole process the way it's supposed to be done. Super, super important. We have easily covered our time. We're in no rush here. I know there's a couple things we want to get to, but just letting us know that we're somewhere near the end. We'll see. We've got some good segues to entertain here. Dan, you had something

SPEAKER_00: 1:12:51

you wanted to jump in with? I did. Just like, you know... the non-restraint pieces are at least 80% of the product curriculum. The non-restraint pieces have been at least 80% of this podcast, which is appropriate. I did have one other thing to talk about, but before that, Kim, anything else on the restraint piece? Because I know that's an emotional piece for people and kind of a hot-button topic, and I want to make sure that all of the thoughts or points that you wanted to make on restraint have been covered. Is there anything else on that that you wanted to... speak on?

SPEAKER_02: 1:13:24

No, I think I just would share this one little experience I had with a group a number of years ago. This was an organization, a health care organization that had adopted PROACT as its system for managing crisis behavior. And I went and met with them, a group of them, about a year, year and a half after they first introduced the content of PROACT content. And they said, you know, we're not really using Proact anymore because we don't do restraint.

SPEAKER_03: 1:13:57

And

SPEAKER_02: 1:13:58

I said, oh, well, really? That means you're using Proact all the time because you're not doing restraint. Yeah. And so that was a... It's, again, people do just fall into that pattern of thinking that... that that's what we do. But we do so many other things.

SPEAKER_00: 1:14:16

One of the gentlemen who I used to go to my recertification classes with was the director at the Tascadero State Mental Hospital up here in California. And I remember I went to probably four recertification trainings with him over the last 15 years. And in the beginning, they were doing hundreds of restraints a year. And by the end, not even the end, by like the middle, they were down to like two or three. And these are some of the most impacted people in the state of California. Just by focusing on the PROAC part not the restraint part like we talk about you don't get better at reducing restraints by doing restraints so there's so much power and if we're talking about the highest uh you know impacted people in the state it's very feasible with the right uh you know culture and organizations with the right primary plans and things like that to see similar um effects wherever um you may be implementing this curriculum um kim i wanted to talk you have oh god please

SPEAKER_02: 1:15:11

I was just going to say, because it's not the people, it's not the client or the patient group at that hospital that changed. It was the staff.

SPEAKER_00: 1:15:19

That's a great point. Yeah, that's a great point. It goes with that. Well, we just have to restrain these clients. No, we chose, it's us that chose to restrain them, not the clients.

SPEAKER_01: 1:15:29

I think what you just said there is monumental. If I think about parent education in our day-to-day work, parents are often coming to us. They want their... child's behavior to change immediately and the answer is well what are you going to do about your behavior around your child and i think that that what you just said there about the hospital staff highlights that they the patient stayed the same the staff changed their ways that's fact that's fantastic

SPEAKER_00: 1:15:55

yeah kim you have a really good uh or at least i enjoyed a lot um kind of mantra or question or saying and you talk about the difference between a groove and a rut I feel like that's one of your questions or sayings. Could you speak to that a little bit? Because I think that's so relevant to us in the ABA field.

SPEAKER_02: 1:16:18

Yeah, I mean, I would be happy to. And I do think it actually fits with a lot of, it can fit in with a lot of life practices. But oftentimes as we learn new things, try new things, we work hard to develop an understanding of them and in that process we figure out how to how to do it more effectively to do it more efficiently to do it to do something that engages others as we develop our practice we can spend more time on the other because we know what we're doing and that feels comfortable and we do that for a while and the challenge in life um is to not allow you know and we we use that term sometimes it's like i've got it i've got this group i'm in a group i know what i'm doing now but the question i think that we always have to ask ourselves is when does that group become a rut when i have something figured out then and i don't want to change what i do because it would require more thinking it would require me to come up with a new process or a new alternative or to step outside of my comfort zone. And everybody likes to be comfortable. So the idea isn't that good people never get into a rut. That's not what we're talking about here. It's just, as I see it, it's about lifelong learning. I'm an educator. That's what matters to me. And when I find myself too much in a pattern, I have to check and say, am I paying attention to all of the other things in my environment? Am I paying attention to the people? Am I paying attention to the new understanding, to the research? Am I paying attention to, if I'm in a treatment environment, am I paying attention to my colleagues? Am I paying attention to the parents of this child that I'm working with? Am I paying attention to the siblings of the child that I'm working with? And how do I take all of that in and find a new groove? it's just my way of saying don't get too comfy because If you get too comfy, there's a lot of things you might be missing.

SPEAKER_00: 1:18:52

I love that. At our previous company, we went through that, the one that Mike and I were leading, I don't know, five, six years ago. We were kind of looking and saying, okay, the way we're doing things is working. Can we do it better? We came up with some ways that we thought could be better. When people are in the groove slash rut, it can be very daunting. People can take it very personally, the change, and not want to change. We lost a lot of staff that when we were suggesting their groove was a rut, they were insisting it was a groove. And then with Proact as well, I mean, it was started 50 years ago now and it's gone through a name change. So I imagine if we were in the same groove that we were in in 1975, Proact would not be nearly as applicable and efficient and dignified as it is today.

SPEAKER_02: 1:19:43

Nope, it'd be a big rut.

SPEAKER_01: 1:19:46

Well, we've covered a lot of ground. This might be a good stopping point. We could talk with you forever, Kim. So thank you for your time. This has been extremely educational. Love to have you back at some point. We could find a different groove to discuss. But thank you so much for your time and for your patience with us. I am excited for our listeners to be able to take you in and all your knowledge that you shared with us today. So we're very appreciative.

SPEAKER_00: 1:20:13

Anything that you would like to add in conclusion, Kim?

SPEAKER_01: 1:20:16

Yeah, any closing thoughts?

SPEAKER_02: 1:20:18

No, no closing thoughts other than how much I appreciate what you do. It was fun to be here.

SPEAKER_00: 1:20:22

And on our end, you've never heard us promote any product. I've taught PROACT to my ABA companies over the last, I think, 15 years. I can't speak highly enough. I've said this, not just because Kim's on here, that if you can give your staff one training, give them the PROACT training. It teaches people how to think. The number one thing that direct staff is concerned about is this kid's tantruming. How do I get this Kid to Stop Tantruming. The product will give you great framework and approaches to how to deal with that. The idea that it's part of the

SPEAKER_01: 1:20:55

basic training for any ABA agency, I think a lot of us have moved away from it based on time and expense or whatever you want to call it. I think you're right. I think it just needs to be integral, part of the basic. You come in for your week of training and RBT certification and somewhere early in your tenure, you have to get that PROAC training for sure. I agree.

SPEAKER_00: 1:21:14

Please, please, please. We'll have links in our description and everything if you want to check them out. I just can't speak highly enough about the curriculum. I've seen it make a huge, huge difference in the impact of the people we serve.

SPEAKER_01: 1:21:27

I'd like to do a little closing here, some closing points. We're saying respond, don't react, play close attention, always, and then we say always analyze responsibly. Thank you so much. Cheers.

SPEAKER_02: 1:21:41

Thank you.

SPEAKER_01: 1:21:43

ABA on Tap is recorded live and unfiltered. We're done for the day. You don't have to go home, but you can't stay here. See you next time.