When a person experiences a behavioral crisis, the way the Direct Support Professional (DSP) responds is very important. A behavioral crisis is when someone becomes a danger to their self or others. It can also include destruction of property. There are often warning signs that a crisis is coming, but crises can appear to happen suddenly. People who regularly experience behavioral crises around others may become unwelcome in public places. They may lose their jobs. They may be banned from public transportation. They may be at risk of institutionalization. They may also be targets of physical control by police or others in the community. DSPs should be prepared to prevent and respond to crises in homes, workplaces, community or medical settings.

How well a DSP handles behavioral crisis depends on several factors. You are more likely to accurately read the person’s signals of an approaching crisis if you are more familiar with the person you are supporting. When you have a professional relationship with the person you are supporting, you offer personalized support. Your training and perception of your role in crisis may also influence their response.

Training for DSPs

Service providers typically offer training, and even certification, in crisis prevention. However, the content is too often limited to protecting the person and DSP from an altercation. This approach is too narrow. DSPs need to learn preventative strategies. This includes reading a person’s behaviors and helping to prevent crisis. Resources to help learn these skills are provided in the Resource section below.

Too often opportunities are missed for redirecting and realigning the person’s focus, energies, and intentions before a crisis happens. New environments, interactions, and expectations can be difficult for people. The community can provide a lot of unpredictability. However, person-centered interventions — those requiring DSPs to really know a person — are widely available. These can be based in an individualized support plan. Person-centered practices can provide a framework for de-escalation. They help everyone to focus on similar goals. Supporting people in diverse, community settings can often test DSPs’ skills if they have had limited experience. It is important that you build relationships with people and support people toward their goals. You can also learn skills to identify and support the person when they have a crisis. A quick reference resource designed for DSPs and family members is provided in this issue. It is a guide for who to call if a person you support is in crisis.

Chart adapted and reprinted with permission from the course, "Introduction to Mental Health and Mental Illnesses: Lesson 5 – DSP Support Strategies," in the College of Direct Support, an online curriculum from the Research and Training Center on Community Living at the University of Minnesota, and Elsevier.

Working with and Training Law Enforcement

Law enforcement sometimes becomes involved when a person is in crisis. In everyday community life, the role of the DSP in de-escalation may sometimes be short circuited by other factors. At times, people misperceive the actions of the people you support. For example, neighbors hear a commotion down the block. Or, well-meaning citizens misinterpret an awkward scenario at a shopping mall or restaurant. They may call the police and describe what appears to them to be an altercation or threat. The next opportunity for de-escalating a crisis falls to law enforcement. Training police officers in working with people with intellectual and developmental disabilities (IDD) is important. Some police officers may have limited experience with people with disabilities, and they too may misinterpret what is happening with a person.

Great training programs for police officers exist. The Memphis Model is one program. This model started in 1987 as a result of the preventable death of a person with a mental illness after a misguided encounter with police. After this tragic event, the community of Memphis came together to educate law enforcement on mental health crisis. The 40-hour training covers recognizing mental health issues, crisis intervention, and de-escalation techniques. The goal is improving officer and community safety. Importantly, the model redirects people with disabilities away from the criminal justice system to the health and human service systems. Currently, there are over 2,500 communities in more than 40 states that offer a version of law enforcement training aligned with the Memphis Model.

Sadly, however, not every law enforcement training program includes training in disabilities. Typically, this only occurs when someone insists on IDD being addressed. There is also a shortage of people who are available to teach that model. In my experience as one of those professionals, providing this education to police officers leads to success in promoting and maintaining inclusion of people in their communities. Interestingly, there are also reports of police officers using the de-escalation training specific to people with IDD in other situations. Most notably, they use them in cases of domestic violence. These trainings support safe, healthy communities for everyone.

College of Direct Support on Crisis Intervention

The College of Direct Support (CDS) curriculum in the DirectCourse online training program offers courses that are specifically designed to help DSPs improve their knowledge and understanding of crisis prevention, intervention and resolution. The courses listed below are important for DSPs and other professionals who want to gain competence in preventing and responding to behavioral crises. Please explore the list below for more information on each of these courses.

CDS courses and lessons that may be helpful include the following:

• Positive Behavior Support. This course is an introduction to behavior as communication. It helps DSPs understand how to support people to communicate other ways other than challenging behavior.
• Functional Assessment. Functional assessment is a structured and comprehensive approach to understanding why a person engages in disruptive or harmful behaviors. This course teaches the value of careful and coordinated observation, asking good questions, and working with others to discover what’s behind behavior choices.
• Introduction to Mental Health and Mental Illness. This course provides the DSP specific strategies they can use in daily support such as active listening and validation. It includes information on building respectful relationships with those they support and information on how to deal with crisis situations related to mental health conditions.

DirectCourse is a trusted training program that is built on the latest research and delivered online via a powerful learning management system (LMS), and it is accredited by the NADSP. It gives you the ability to easily access, customize, track and assess training across your staff and teams. DirectCourse can help you train staff in ways that improves the lives of the people they support, while meeting compliance requirements and reducing liability. To learn more about DirectCourse visit www.directcourseonline.com