"Being a therapist is a calling. We don't often get to pick and choose our caseload. It is normal and it is okay to have a few students that cause you stress, a few that you would trade in a second, and even a few that you don't like. But, in the end, we are there because they need us. Try to put your job into a different perspective. Look at all that you do accomplish, and all of those parents and patients/students that are better because of your effort. Call upon your sense of professionalism and just do what you can for a difficult student. Know that all across the world, therapists, teachers, nurses, and counselors are also only doing what they can. We are humans, too. We have a life outside of our jobs. Focus on the time you give to that student that is difficult, then put it away until the next session. It is your responsibility to find a place in your career for difficult days, difficult students, etc. as well as for good days, sweet students, fast-learning students, etc."
I am rarely compelled to post on this forum but once in a blue moon, I do. Actually, one of the first few posts is how I got connected with BSILF!
Today, I felt compelled to post in response to the cry out for help and share what I've learned through my most trying year. I wrote:
I certainly agree with what everyone has shared and just wanted to add on.
I, too, strongly urge anyone working with individuals with aggressive behaviors to attend the Nonviolent Crisis Intervention (NCI or CPI) training programs. As the previous poster said, restraint is used only as a last resort, but by being professionally trained to restrain protects us from any litigation, so long as we adhere to the NCI procedures. Without being certified in NCI (2-day training), one is not to restrain anybody (unless they aren't afraid of getting hurt and being sued). In addition, the training (lightly) prepares you on how to prevent aggression or de-escalate the situation once it has occurred with behavioral techniques.
You mentioned that the student's aggressive acts had decreased from 15-20 to 3, but are now increasing again. Does anyone know what changed? E.g., environment, routines, adults, home situations, medication. Does your district have a Board-Certified Behavior Analyst (BCBA) that you can collaborate with? They are trained to conduct a functional behavioral assessment (FBA) to determine the function of a behavior. Results and behavioral recommendations are then worked into the Behavior Support Plan. (This is moreso an effective but long-term procedure that involves interviews, collecting data, experimenting, etc.)
When I first worked with my most aggressive student (head butt, scratch, hit hard, and pulled my hair once), I had to experiment a lot and consistently do certain things with blind faith. I know every child is different, but what worked for me was a multitude of strategies:
- visual supports -- can't stress this enough. Also using the Pre-Mack Principle with visuals: "First...Then..." [First, (picture representing speech time -- same picture used on their visual schedule), then (picture of taking a walk -- a reward he chose)].
- give him choices of order of speech activities and rewards.
- environmental arrangements: e.g., I sat across from him with enough room behind me to spare if he leaned over the table to try to hit me. If necessary, the paraeducator sat behind him so that he couldn't get out of his chair to come around to attack me. e.g., Working in a secluded area (e.g., use wall/room dividers so there are less visual distractions and somewhat less auditory stimuli).
- using a prompting hierarchy and giving the student enough time to respond before prompting again (generally 5 seconds before repeating stimuli + additional prompt...if we don't give them enough time to respond, some of them get auditorally bombarded which can lead to frustration and aggression).
- working with OT to incorporate sensory strategies or breaks. E.g., give student a 3-5 minute sensory break before speech or incorporate mini-sensory breaks in speech sessions.
- Working with the child during his snack time. While working on language (requesting, labeling) with the use of his own snacks as reinforcers, the student establishes that you are the Provider of Goodies...and theoretically/ideally will not want to sabotage that relationship. This really worked well for two of my most aggressive kids. Once I was fit into their routine (twice a week) by providing their snacks, they somewhat generalized their "good" behavior to the speech setting. (Clarification: the parents pack the students their snacks and lunches; I just hold onto their snacks and have them request for it with "good" behavior, such as "quiet sitting," and appropriate language.)
Because your student is young, you might even just begin with "quiet sitting" -- getting him to sit for 5 seconds (if that, or longer if he can) with quiet hands, quiet feet, and quiet mouth and incrementally increasing the time. After all, we need our kiddos to be able to attend before we can really work on other things.
I work with middle school students with severe autism and I can't stress enough how important it is for us to get the behaviors down while they are young (even though we are not behavioral therapists...but we implement a lot of behavioral techniques, whether we know it or not). Once they're in middle school and high school, they are so big and strong (even the small, skinny ones) and what with hormones, the aggression can really get outta hand and will take even more energy, time, and people to work with one kid.
On a less serious note, the main student that I based this post on...has totally become my favorite!I've been working with him for a year and for the first new months (fresh out of grad program, thinking, "I didn't learn how to work with these kids nor did I sign up for this!"), I dreaded seeing him 3 x 30 min/week because of the behaviors and unsupportive, untrained staff. After many consultations with other professionals, lots of trainings on visual supports, numerous trial-and-error, and consistency with blind faith, he rarely displayed any behaviors around me after a few months. Actually, it's a 180 from him hating speech (and/or me) to now literally making a bee-line towards me whenever I enter the room (and tries to smell or kiss me...which is something else I am working on avoiding now!).
After feeling like I did something good by sharing what I've learned with J320, I looked at my profile:
Group: members
Posts: 13
Joined: 12-July 07
Member No.: 737
13 posts in 1.5 years? That's it?!? I bet 2 of those 13 were in response to BSILF's same post. Dang, I'm lame.
Happy New Year!
