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Applying a well-being approach to behaviours of concern

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"Most folks are as happy as they make up their minds to be."

Abraham Lincoln

1809-1865

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The Greek Philosophers

• Many Greek philosophers debated the concept of happiness (Plato, Aristotle, Epicurus).

• Hedonism was a philosophy that focused on maximisingpleasure and minimising pain.

• Epicurus viewed seeking pleasure as more of a journey, this included an honorable life.

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The Pursuit of Pleasure

• Freud argued that one of our basic drives was the pursuit of pleasure. The 'pleasure principle'

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The Emergence of Positive Psychology• Seligman & Csikzentmihayli (2000) argued that the old

psychological thinking was mostly focused on

negatives.

• "It concentrates on repairing damage within a disease model of human functioning. This almost exclusive attention to pathology neglects the fulfilled individual and the thriving community. The aim of positive psychology is to begin to catalyze a change in the focus of psychology from preoccupation only with repairing the worst things in life to also building positive qualities." (Seligman & Csikszentmihalyi, 2000).

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Positive Psychology

Positive psychology is concerned with the pleasant life, the

engaged life and the meaningful life.

(Carr 2011, pp2)

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Martin Seligman

• Seligman started his career conducting animal experiments (usually involving electric shocks see learned helplessness). He is now a leading guru in positive psychology.

• He is one of the most cited psychologists of the 20th Century.

• This is a major transformation and quite inspirational.

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Martin Seligman

• A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless. (Seligman 2000, pp5)

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Positive Psychology

• Positive Psychology research has identified certain skills and exercises that can boost our experience of positive emotions (Carr 2011).

• We can learn to feel them more strongly, and to experience them for longer. Cultivating positive emotions makes it easier to experience them naturally.

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Positive Psychology

• Positive psychology does reflect a change in emphasis.

• A recent review of 51 studies using positive psychological interventions found moderate gains.

• Generally, an emphasis on wellbeing rather than deviant labels is a major shift.

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Schickler, 2005

Well-being is multi -

dimensional

Well-being is more than

‘being well’

What is well-being?

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PERMA

• Positive emotions

• Engagement

• Relationships

• Meaning

• Accomplishment \ Achievement.

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Positive Emotion

• When someone asks you whether you are satisfied with your life, your answer depends heavily on the mood you are in.

• When you are feeling positive, you can look back on the past with gladness; look into the future with hope; and enjoy and cherish the present.

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Positive Emotions

• Feeling good helps us to perform better at work and study

• It boosts our physical health by strengthening the immune system.

• Feeling good is contagious. Seeing smiles makes us want to smile. Hearing laughter makes us feel like laughing.

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• Veenhoven and Hagerty (2006) found that in a European sample happiness increased between 1973 and 2002.

• They believed that these improvements were related to longevity rather than income.

• Happiness and wellbeing are complicated constructs. There are both cognitive (appraisal of life) with emotional experiences (Joy, contentment etc)

• How would you measure your happiness?

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Measuring happiness

• There have been many attempts to measure happiness.

• Fordyce (1988) developed a simple 2 item measure.

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In general how happy do you feel?

10 point scale ranging from 10= feeling ecstatic, joyous, fantastic to 0= utterly depressed or completely down

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On average what percentage of the time do you feel happy (or unhappy or

neutral?)

Scale is a percentage of time

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Question 1 = 6.9

Average score 54%

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Happiness in schools

• Do we apply the basic principles of happiness in education?

• What is the current view in Swedish schools?

• There has been an emphasis in developing resilience based approaches in schools (Seligman et al., 2009; Norrish et al., 2013)

• Groden et al (2011) discussed strategies to build resilience, optimism and self efficacy.

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Happiness

• How much of our happiness is determined by genetic factors and how much by the environment?

• 40% of happiness may be determined by intentional activities, 50% genetic and 10% life circumstances (Lyubomirsky, Sheldon & Schkade, 2005).

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Emotions can be contagious

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People with ID and Autism

• Positive emotions are related to positive experiences.

• Many people with autism find distinguishing their own emotional states confusing as their world is often in chaos (Vermeulen, 2012).

• Some people with autism have difficulties recognising and expressing emotion (Gerland, 2013; Vermeulen, 2013.)

• There are some suggestions that this may be related to mirror neurons.

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Autism and ID

• The exercise you have just completed could be attempted by supporters to determine how happy they think the people they support actually are.

• How happy are the staff and supporters?

• Do they monitor their positive emotions?

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Three Good Things Exercise

• Three good things in life - Participants were asked to write down three things that went well each day and their causes every night for one week. In addition they were asked to provide a causal explanation for each good thing.

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Three great things that happened today at school

• You can see how Seligmans ideas can be translated to school/care environments

• For 1 week staff ending every shift have to write about 3 positive things that occurred in their day.

• You can also ask them to describe 3 things that made them smile.

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Three positive

things the

person did

What did they

do?

Why did this

happen?

What did I

learn?

1He paid me a

complimentDon’t know He can be kind

2He stayed calm

in the shop

Seemed very

relaxed

He can

surprise me

3

He really

laughed in the

kitchen

Staff member

cracked a joke

Sense of

humour

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Engagement

• Many activities such as running, computer games chess etc motivate us. If you have a job you love, you probably feel this way at work. We are most likely to fulfill our own unique potential when we are engaged in activities that absorb and inspire us.

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Engagement

• We don't thrive when we are doing nothing. We get bored and feel useless. But when we engage with our life and work, we become absorbed. We gain momentum and focus, and we can enter the state of being known as 'flow'.

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Flow

• Flow is a concept developed by Professor MihalyCsikszentmihalyi.

• Flow occurs when people are engaged in controllable but challenging tasks. Usually these activities require a considerable amount of skill (i.e. running, sailing stimulating conversation.)

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Flow

• Flow is characterised by people becoming absorbed in activities.

• Individuals have a heightened sense of control which reduces their anxiety.

• Flow tasks can become "autotelic". That is they become self motivating.

• These activities can be viewed as coping strategies.

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Flow and autism

• How does someone with autism achieve a form of flow.

• Special interests allow people to become absorbed in an area that gives them specialist knowledge and a sense of achievement.

• Repetitive tasks can achieve a sense of flow.

• These tasks can become absorbing and are an important part of peoples lives.

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John

• John is a young male with autism intellectual disabilities. He will often flap paper and then tear it when he is stressed. Often he does this in is own room. Some staff are trying to discourage him from doing this because they think it is linked to boredom. Although people reported that he seems more relaxed after doing this.

• They were advised by a psychologist to let him do this.

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Relationships

• We depend on the people around us to help us maintain balance in our lives. When we are alone, we lose perspective on the world, and we forget that others may be bearing greater burdens than our own.

• The quality of relationships is a key variable in therapeutic change processes. (Roth and Fonaghy, 2005)

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Relationships

• Seligman is very clear in his model that relationships that are positive greatly help with wellbeing.

• Humans are social animals. We have a need for connection, love, physical and emotional contact with others. We enhance our own well-being by building strong networks of relationships around us, with family, friends, coworkers, neighbours and all the other people in our lives.

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Social Support and Friendship

• Socially supportive relationships within families and close groups are associated with greater wellbeing health and longevity (Diener et al, 2008; Dickerson & Zoccola, 2009).

• People with autism struggle with these relationships as they can be confusing to them especially with contextual rules (Vermeulen 2012).

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People with Autism

• Loneliness is an issue for many people we support (Pitonyak, 2004).

• In the case of autism many of our accepted social supports are not always well received.

• People with autism may have difficulties relating to other individuals, but, this does not mean that they always like being alone.

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Meaning

• This is a slightly deeper concept.

• We get meaning from the concept of belonging to social groups and networks.

• Living a meaningful life is, in essence, related to attaching oneself to something larger than oneself. It instills the sense that there is a larger purpose to life, and being a part of it confers meaning. Having such connections with something bigger is also an effective barrier against depression.

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Meaning

• Friendships and social supports are important for people with autism as they also provide some meaning.

• Meaning can also arise out of belonging to a group (sometimes these relationships focus on special interests)

• The word of caution is that people with autism may view relationships differently from neurotypical people.

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Achievement\Accomplishment

• What use are goals and ambitions if we never reach them? To achieve well-being and happiness, we must look back on our lives with a sense of accomplishment: 'I did it, and I did it well'.

• There is evidence that being goal driven is an important part of wellbeing ( ).

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Achievement\Accomplishment

• Past successes make us feel more confident and optimistic about future attempts.

• Goals are a focus of self discovery (see Maslow).

• Achieving goals helps self esteem and self worth.

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Promoting Achievement

• Who chooses the goals?

• Let the person select what is meaningful for them.

• Avoid making the assumption that what I like is what everyone likes.

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The PERMA focus

• There are some areas that are less well emphasized in the PERMA model.

• Exercise is kind of implied as important, but we on the Atlass programme would rate it very highly indeed.

• Some variables would appear to be very important such as Empathy.

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Empathy and double empathy

• Many advocates of Theory of Mind argue that people with autism lack empathy. Due to the fact that they struggle taking the perspective of others and have difficulty reading emotions.

• Our experience is that many people can understand empathy but are relatively poor at expressing feelings.

• Empathy is different from sympathy.

• Milton (2012) referred to a double empathy problem where carers also struggle to empathise with people with autism. Encouraging empathy is a key positive component. "he has feelings like me".

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Promoting Empathy

• Strategies for promoting empathy involve trying to "walk a mile in the persons shoes".

• Understand the chaos the person experiences.

• Focus on trauma and stress.

• Who does the person connect with.

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Optimism

• Optimism is viewed as a thinking style rather than a personality trait as such (Peterson & Steen, 2009).

• Optimists tend to focus on external factors especially in situations of failure.

• They tend to believe that they can also alter events in the future.

• Some researchers believe that optimism can be developed in people (Seligman, 2011).

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Physical Health

• Subjective ratings of happiness appear to correlate with health, but, more objective ratings tend not to (Diener, 1999)

• There is evidence that positive emotional experiences and a positive outlook may have an positive impact on the immune system and increase longevity (Steptoe, 2009). (see the Nun study as an example).

• Health issues are more common in people with autism and ID

• Poorer primary care is also more likely especially if the person is challenging.

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Perception of Control

• The more control we perceive we have over our life the better are our health and wellbeing outcomes.

• Giving people choice and control is good from a wellbeing perspective.

• Focus on what you can change rather than on what you cannot. "We need more staff!"

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Applying A Wellbeing Model

• The model applies not just to individuals but, also to environments.

• Service cultures can become positive or negative especially if individuals are perceived of as challenging and difficult..

• What are the ways we can promote a positive culture?

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Promoting Positive Cultures

• Leadership: Managers need to lead from the front.

• Role modelling: People need to see you demonstrating positive interactions.

• Inject humour: Pitonyak (2004) suggested that having fun is a natural part of the process of change.

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Promoting Positive Cultures

• When you look at a service ask yourself do the service users have fun?

• Do the staff/supporters have fun.

• List the activities that demonstrate people appear to smile and consider doing more of them

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Promoting Positive Cultures

• Positive recording: We tend to focus on recording negative encounters. Positive recording days and weeks can help to encourage a more positive outlook.

• Positive recording forces view the positives things in the day

• It keeps people in the present.

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Promoting Positive Cultures

• Go with the flow: "flow" type activities. Do not discourage repetitive activities, promote them.

• Positive goals: Give people goals that they can look forward to.

• Optimistic thinking: This needs to be a focus especially if a person has been challenging.

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Promoting Positive Cultures

• Promote risk taking: Stressed staff tend to focus on the bad things that can happen in the future.

• They start to see risks in even the most simple activities.

• Generate low risk activities.

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Making a Connection

• Activities that are shared can help us "connect" with people.

• Focus on having a fantastic day (see Pitonyak 2004)

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Promoting Wellbeing

• Greater control

• Increase exercise

• Encourage flow activities

• Concentrate on modelling wellbeing.

• Wellbeing needs to be modelled by managers.

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Happiness.

• Happiness does not depend on any external conditions. It is governed by our own mental attitude. (Dale Carnegie 1888 to 1955)

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Patch Adams

• The reason adults should look as though they are having fun, is that it gives kids a reason to grow up

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Managing behaviours

"When a person is drowning that is not the best to teach them how to swim. "

(David Pitonyak)

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Good behaviour management

“It is a mistake to think that once an intervention is underway, you no longer

need to worry about serious outbursts and the necessity for crisis management”

(Carr et al. 1994, p.14).

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What we believe?

“Peoples’ levels of motivation, affective states and actions are based on what they believe,

than in what is objectively true”

(Bandura, 1997, p21).

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Stress is key

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Lazarus & Folkman (1984)

• Described a transactional model of stress emphasizing interaction between an individual and his/her environment.

• Stress occurs when the demands of stressors outweigh coping responses and there is a clear interaction between environmental and physiological events. Implicit in this model is the cognitive appraisal of threat.

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Stress and Coping

• Lazarus & Folkman (1991) linked stress and coping.

• Coping strategies are a critical variable in this model.

• In this model individuals with high levels of stress , but with high levels of coping responses do OK.

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Stress as a transaction

• Psychological—Perceived Threat• Demands exceed ability to cope

• Experience of stress

• Biological—CNS Activation

» and/or Physiological response

• e.g., BP, HR, Skin Conductance,

• HR variability, Cortisol

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What is stress appraisal?

Primary Appraisal– Is this a threat

Threat (potential for harm)

Harm/loss (damage done)

Challenge (opportunity for growth, mastery, gain)

Secondary Appraisal-- Can I cope with it?

Problem-focused coping

Emotional-focused coping

Lazarus, R. S., & Folkman, S. (1984) Stress, appraisal & coping.

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Stress hormones are key in our fight or flight response

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Threat

• The problem is: threat also causes cortisol secretion – and disturbs the 24 hour rhythm.

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Threat in humans

• In humans the threat is usually psychological- not physical.

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Melatonin/Cortisol Relationship

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Cortisol Levels Throughout the Day

0 2 4 6 8

10 12

14 16 18

4AM 6AM 8AM 10AM Noon 2PM 4PM 6PM 8PM 10PM Mid 2AM

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The Solution: Cortisol Management

• You can control cortisol levels via:

1. Stress Management Techniques

2. Relaxation

3. Being mindful

4. Support systems

5. Coping styles

6. Exercise

7. Nutrition

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Arousal Regulation

• Many individuals may struggle to regulate their internal arousal state.

• McDonnell et al. (2015) proposed that physiological arousal mediates many behaviours of concern.

• Individuals are attempting to achieve a level of arousal homeostasis.

• Some behaviours may reflect a level of under arousal (catatonia, low motivation).

• Some behaviours may reflect over arousal (ADHD, SIB).

• Many behaviours may be reflective of a fluctuating arousal state.

• Arousal regulation is something we all strive to achieve in our daily interactions.

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Stress and Arousal

• A number of people with ASD who present with challenging behaviours may experience either constant or intermittent states of hyperarousal. Dunn (2001) in her model of sensory experiences argued that people often experience modulation of sensory input.

• The mixed results of empirical studies on hyperarousal may be accounted for by individuals who’s arousal level fluctuates on a regular basis. This model suggests that there is a transaction between the persons internal state of arousal and the interaction with environmental stressors. (McDonnell et al, 2014)

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Other Mechanisms (Changing perceived control)

• Changes in staff behaviour ma occur because they perceive the person with autism to be less in control of their behaviour.

• Coping can include the ability to control ones own life.

• The Whitehall studies of civil servants repeatedly found that mortality rates from diseases such as coronary heart disease were lower in individuals who were at the top of the work hierarchy. (Marmot et al, 1978: Marmot et al 1991).

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Stress and perceived control

• Stress alone is not the main variable but our ability to have control over our daily lives.

• We have long advocated giving more choice and control and choice to people with intellectual disabilities (Wolfensberger, 1983, Chan et al, 2011).

• Can we measure perceived control?

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Controllability Beliefs Scale (Dagnan et al. 2012)

• They are trying to wind me up• They can’t help themselves • They are doing it deliberately • They know what they are doing • They have no control over their behaviour • They could stop if they wanted • They are trying to manipulate the situation • They can think through their actions • They don’t mean to upset people• They are in control of their behaviour• They mean to make me feel bad• They have chosen to behave in this way• They are not to blame for what they do• They know the best time to challenge • They don’t realise how it makes me feel

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Challenging behaviours as panic reactions

• Many people with intellectual disabilities and challenging behaviours show signs of panic in specific situations.

• Behaviours may be interpreted as deliberate by carers in these situations.

• Similarities have been drawn between the symptoms of post traumatic stress disorder and some individuals who present with challenging behaviours (Pitonyak, 2004).

• Panic reactions can often lead to people needing to escapefrom situations.

• Panic responses do not appear to habituate rapidly. • Individuals are not always allowed by carers to escape from

situations.

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Manage my stress first?

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How can mindfulness training alter behaviour?

• As caregivers increase their mindfulness, they may become more responsive to each moment of their interactions with the individuals in their care. (Singh et al, 2010).

• This is arguing that interactions between carers and staff may alter after training.

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Mindfulness

• Singh et al (2006) investigated mindfulness training for staff and its impact on aggressive behaviours of staff.

• Behavioural training was used as a comparison.

• They found staff interventions for aggression reduced from baseline after behavioural training, but greater impact after mindfulness training

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Mindful carers

• Singh et al (2010) reported the impact of mindfulness training on 3 carers.

• Observations of their 5 children were recorded at baseline, mindful training and mindful practice over a 30 to 35 week period.

• Singh argued that all 5 children showed reduction in non compliant behaviours.

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Physical exercise for carers

• There are relatively obvious benefits of regular exercise in reducing anxiety (Petruzello, Landers, Hatfield, Kubitz & Salazar, 1991).

• Exercise can reduce and stabilise cortisol levels over time (McCreadie &McDonnell 2013).

• McGimsey and Favell (1988) found that when severely aggressive and hyperactive clients were exposed to two daily periods of jogging and strenuous activities there was a systematic reduction in problem behaviour for 8 of the 10 participants to levels considered not a problem or only an occasional problem.

• Do we consider the physical fitness levels of staff who work with people who challenge?

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Reflective practitioners

• By focussing on their own behaviour carers may make a connection to the fact that they are part of the problem and as such part of the solution.

• A key variable in this may be reflective practice (Schon 1987).

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Concept of Arousal

• Arousal is not a new construct the concept of arousal related to learning was discussed at the beginning of the 20th Century (Yerkes and Dodson, 1908).

• Although criticised the construct is viewed as having utility (Pfaff, 2005).

• The construct is difficult to define as there may well be a number of regulatory mechanisms in the brain.

• Physiological arousal can be strongly linked to the construct of stress. McDonnell et al, 2014).

• Arousal and stress are considered to be important in the regulation of emotion (Reich & Zautra, 2002).

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Low arousal approaches-Definition

“

attempts to alter staff behaviour by avoiding confrontational situations and seeking the

least line of resistance.“

(McDonnell, Reeves, Johnson & Lane, 1998, p164)

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History of low arousal approaches

• I first used the term circa 1990.

• First published the term in the early 1990s (McDonnell, McEvoy and Dearden (1993)

• Case study published in 1998 (McDonnell et al 1998) on an adult with intellectual disabilities and challenging behaviour.

• Concept reformulated to include cognitive aspects (McDonnell, Waters and Jones 2002; McDonnell, 2009, McDonnell 2010)

• Low arousal construct further developed in Scandanavia (Heilskov Elven, 2010).

• Application to families (Woodcock and Page 2010)

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Development of the construct

• Trauma informed behaviour management (McDonnell, 2010).

• Strengthened the idea of reflective practice (McDonnell, 2010)

• Construct to include emotional contagion (Heilskov Elven, 2010)

• Reflective practice (Schon, 1987, McDonnell 2010)

• Homeostatic model of arousal and behaviour (McDonnell et al, 2014)

• The current construct is much broader than the original collection of crisis management strategies

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Reflective practice

• Reflective practice is considered to be the cornerstone of behaviour management strategies such as low arousal approaches (McDonnell, 2010).

• There is a clear link with mindfulness.

• Staff need to understand their own contribution to challenging behaviours.

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Reflective practice

• Many of the central principles of a low arousal approach are based on non violent philosophies such as Buddhism and Quaker beliefs.

• There are also strong influences of mindfulness in the approach in particular the role of reflective practice.

• Before you attempt to change or manage another person you need to reflect on your own behaviour.

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Trauma informed behaviour management

• McDonnell (2010) identified trauma informed as a construct that is part of the low arousal approach.

• Viewing an individual as stressed and traumatised is a core component.

• If a persons behaviours that challenge are rationalised by carers as being strongly associated with trauma, this should mediate the need for controlling responses.

• Individuals who have received high levels of restraint and other restrictive practices can viewed as ‘victims’ of trauma.

• Avoiding retraumatising people is key to a trauma informed approach.

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Challenging negative statements and assumptions

• The reflective process requires colleagues to provide both positive and negative feedback. Challenging thoughts and altering beliefs is an integral part of Cognitive Behaviour Therapy (see Beck, 1974).

• Gently challenging colleagues about their practice is a critical component of the approach.

• It can be difficult to do in practice!

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Staff behaviour (Attribution)

• Attempts have been made to explain staff behaviour in care environments from a cognitive behavioural perspective (Dagnan, Trower & Smith, 1998).

• Attribution models stress that staff perceptions of a situation mediate their behavioural responses. Staff may have negative thoughts about working with a particular individual in a service setting ‘Oh god, I’m not working with him again’ which directly affect their deeper held beliefs such as ‘I can’t cope with stress’.

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Staff behaviour (Expectations)

• It is not unusual for staff to catastrophiseevents, often this is typified by predictions about negative future outcomes:

• ‘It is only a matter of time before I really get badly hurt’

• ‘he is a ticking bomb’. • In addition if the person is perceived as in

control of their behaviour (‘He’s manipulative’ or ‘she know’s hat she is doing’

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Crisis management is not about reinforcement

• Because we ask people in low arousal approaches supporters often perceive this as 'giving in'

• In a crisis our goal is to reduce stress and not to teach a person.

• The more stressed people become the less they process.

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We are part of the problem

• The vast a majority of challenging situations are inadvertently triggered by supporters.

• We are often unaware that we can trigger situations.

• Reflective practice is a cornerstone of low arousal approaches.

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Video Exercise- Gerald Part 1

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Video Exercise- Gerald Part 2

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Make fewer requests

• A request does not have to be unpleasant.

• Sometimes consider making a request visual rather than verbal.

• Allow people time to process requests.

• As a rule the more stressed people become the more the longer their delays in processing.

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Bo Elven- Demands

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Choices not boundaries

• In a crisis or 'meltdown' choices can empower people.

• 'Give people choices rather than adding boundaries and rules'

• Getting rid of unnecessary boundaries and rules is also important.

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Slow movements down

• The more aroused people become the more they become aware of signals of threat.

• Even relatively slow movements may appear very fast.

• A support staff needs to slow their movements down as this may reduce perceived threat.

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Allow the person to escape

• People who are in a state of heightened arousal often want to escape from situations.

• Sometimes carers do not always support this.

• Teaching people symbolic methods of stating that they want to stop an activity is essential.

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Andrew McDonnell- Planned Escape

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Seeing the person as traumatised

• Viewing people as traumatised and stressed often can dictate what people need to do in a crisis situation.

• It is essential that we consider ourselves as active agents in this process.

• Supporters can concentrate on regulating their own arousal levels.

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Avoiding punitive consequences

• A low arousal approach by definition involves reducing boundaries for people.

• It is a myth that the approach focuses on no boundaries at all.

• People who are stressed are often not processing what we are saying.

• Avoiding punitive consequences is important as we need to avoid re-traumatising people.

• We try to avoid consequential based learning.

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Allow property destruction

• People matter more than property.

• If a person breaks an object do not intervene, especially if the is no immediate risk to other people.

• If we mean this then many situations that even involve restraint can be avoided.

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Low Arousal: Practice

• The early papers outlined five key principles.

1. Stay calm. Or more correctly give the appearance of being calm. Staff members need to control their breathing and avoid sudden movements and increases in the pitch of their voice. There is a commonly used phrase ‘do not pour fuel on an open fire’. In a conflict situation a staff member should be appear calm and not increase arousal in a conflict situation; especially when the service user they are managing is hyperaroused.

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Low Arousal: Practice

2. Avoid physical contact. Human touch can have both calming and excitatory effects. When a service user is hyperaroused it is possible that physical contact may increase this further. Touch should be intermittent.

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Low Arousal: Practice

3. Be aware of your own bodily reactions. It is the experience of the author that staff members in these situations are not aware that their own body language often communicates fear and distress. Individuals may perspire or stare at a service user (also physiologically arousing). Aggressive postures such as folding arms should be avoided.

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Low Arousal: Practice

4. Keep your distance. Everyday social interactions tend to take place at a social distance of three to six feet. Research has demonstrated that close proximity to individuals who are angry or aroused may increase the likelihood of interpersonal violence.

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Low Arousal: Practice

5. Respond in a non-violent manner. This is as much a moral as well as a pragmatic approach. Essential to the approach is the view that violent acts elicit violent responses, thus creating behavioural response chains that increase the likelihood of violence.

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Fools Rush In

• Good crisis management avoids people trying to stop behaviours ( as it is often too late).

• Always consider the fact that we can all be 'fools' at time.

• Every crisis situation is a learning opportunity.

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Challenging our beliefs

• Low arousal approaches often challenge our own views of our roles.

• It often our own beliefs that make us intervene too early with people who are stressed.

• Standing back sometimes is difficult.

• We have to stop ourselves 'tinkering with behaviours'

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The physical management of behaviours

• We accept that there are times when a person may need to be redirected. Sometimes it is important for people to know how to keep people safe.

• The evidence base for crisis management training is extremely poor (McDonnell, 2010).

• Most training providers around the world talk about using physical interventions as a last resort. In reality children are often exposed to situations where restraint is used.

• Studio 3’s approach is to avoid using physical interventions however there are some guiding principles.

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Physical interventions- Guiding Principles

• If you are a parent or family member, always ask how your child will be managed in a crisis.

• Methods should be able to be carried out in a public area with people watching.

• Avoid traumatising restraint holds (face down, face up).

• For younger children avoid one person holds (basket holds etc.)

• Physical management should be momentary in nature.

• Training programmes need to be limited in terms of the quantity of physical interventions taught.

• Have you ever had any physical interventions training?

• How much did you remember?

Atlass Masterclass

Further information

• For more information, please contact Studio 3 at info@studio3.org

• You can follow Professor McDonnell on Twitter @ andylowarousal