By Charlene N. Rivera-Bonet, Waisman Science Writer
With mouth wide open, slow speech, and exaggerated enunciation and cadence – aka whale talk – Josh Lapin, MSSW, director of Community TIES (Training, Intervention, and Evaluation Services) distracted his autistic client from an escalating moment of distress in the middle of a Target.
Lapin is recounting this story to family members, caregivers, and service providers of individuals with intellectual and developmental disabilities during a training on how to manage threatening confrontations.
Lapin recounts that he could sense the tension rising as his autistic client’s behavior started escalating after he had been triggered by something in the store. The client was frustrated and uncomfortable, and starting to get loud. Then Lapin remembered his client’s favorite scene from the movie “Finding Nemo” where the character Dory, a regal blue tang fish, communicates with humpback whales by “speaking whale.” This scene never failed to make his client laugh. So, in the middle of the store, feeling foolish but determined, Lapin started assuring his client that he was okay speaking in whale talk. His client responded with confusion at first, and then laughter. This distraction allowed Lapin to safely escort his client out of the store and away from the triggers.
Lapin, a behavioral consultant with more than 25 years of experience, has his share of scenarios where he’s had to deescalate a situation, or help a client calm down. Some more successful than others. He uses his experiences and expertise as part of Managing Threatening Confrontations— a training program offered by Community Outreach Wisconsin (COW) that teaches participants how to help individuals with intellectual and developmental disabilities maintain an adaptive lifestyle, and how to manage potentially threatening confrontations and challenging behaviors.
COW is a group of cutting-edge programs within the University Center for Excellence in Developmental Disabilities at the Waisman Center which includes Lapin’s program, Community TIES. TIES provides behavioral support to children, adolescents, and adults with intellectual and developmental disabilities living in Dane County, and their families. Their mission is to address behavioral, psychological, and emotional needs using therapeutic approaches that assure continued participation in supported community life.
Through Community Training, directed by Michael Truman, COW often pulls from the expertise of programs such as TIES to provide practical trainings on a broad range of topics related to intellectual and developmental disabilities such as health care, mental health, crises prevention, wellness, and how to support individuals with disabilities in the community. Trainings are open to the public and often include caregivers, families, self-advocates, program administrators, providers, and community members.
Training on managing threatening confrontations
Many of the individuals served by TIES present complex behavioral and mental health challenges that can take the form of aggression, self-injurious behavior, or property destruction. These behaviors can be rooted in frustration, unmet needs, or an inability to communicate in a typical way.
“There are so many variables that may cause someone to escalate,” Lapin says. “One of the more common triggers is pain (physical, and emotional). Undiagnosed physical ailments or unresolved trauma are very common triggers. Communication can be a trigger – if you are non-verbal or have limited verbal communication how do you effectively communicate with others? Transitions and lack of control or choice are all common triggers.”
Not all crises can be deescalated as quickly as the whale talk scenario with Lapin at Target. Sometimes these situations, despite best efforts, can escalate and create worrisome circumstances for everyone involved.
“Our guideline is always going to be safety,” Lapin says. The Managing Threatening Confrontations training is designed to help parents, caregivers, and service providers to effectively support individuals with intellectual and developmental disabilities who could experience the full range of behavioral escalation.
The training is divided into two sections, the first being a framework for understanding and recognizing the stages of behavior escalation, and positive action plans for each stage of the situation.
By sharing his experiences, example videos, roleplay, and a little bit of humor, Lapin guides the training participants through the different stages of behavioral escalation, and what to do, or what not to do for each one.
“I think the trick is how do we understand what a person looks like when they are having a good day and what pro-active reinforcement strategies can we put in place to help maintain an adaptive lifestyle,” Lapin says. He believes that positive relationships, like the one he held with his client, are vital for behavioral support. “You have that sense of what a good day looks like, what a challenging day looks like, and what supports are needed to help people maintain an adaptive lifestyle,” Lapin says.
For Laura Ogle, being reminded through this training that sometimes during behavioral escalation using fewer words, rather than lengthy discussions, is best, and how to use the correct language was beneficial. Ogle is a mother of three, and her youngest is a nine-year-old autistic boy with ADHD, dyslexia, dysgraphia (a learning disability), and oppositional defiant disorder.
This training was recommended to Ogle by her caseworker because of some recent instances of aggressive behaviors presented by her son. “Other than some fine motor skill issues related to the dysgraphia, he’s perfectly able-bodied and quite strong” Ogle says. She, however, has cerebral palsy, a physical disability. “I’m trying to make sure that I’m learning everything I can to de-escalate his behavior before it becomes violent. And if it does become violent, how to handle it better. So that we’re both in less danger,” Ogle says.
The second part of the training teaches techniques of passive self-protection, which is meant to keep everyone safe in the case of behavioral escalation. Participants lined up facing each other as Hedy Burke, a behavior consultant with Community TIES, went over different scenarios and protective measures. Each row took turns practicing what they learned in slow motion.
Debi Meng, whose 17-year-old grandson, Jonathan, is on the autism spectrum, non-verbal, and visually impaired, struggles with challenging behavior most mornings as she gets him ready for school. Meng mentions that although Jonathan enjoys going to school, the process of getting up and getting dressed leads to confrontations more often than not, which is what brought her to the training. “He’s getting more and more aggressive and growing and getting strong, so I need strategies to keep myself safe. I’m getting older and he’s getting stronger,” Meng says.
The training was also recommended to Andrea Silvis after several incidents where her 15-year-old autistic son ran away, once toward Whitney Way, one of the busiest streets in Madison. “He’s not really aggressive, but just trying to get him to comply when he is in that state. I’m trying to look for strategies to help with that because he is pretty big too,” Silvis says.
Silvis’ son recently became part of the TIES program, through which they are developing a police plan, and a behavioral plan to go between school and home. Like Silvis’s son, all TIES participants receive behavioral support and developed behavioral plans to provide guidance for caregivers for both avoiding worrisome situations, and knowing what to do when those situations arise.
For both Meng and Silvis, the training’s focus on managing their own state-of-mind and staying positive was the most helpful. Meng referenced the Q-TIP acronym – quit taking it personal. “Because a lot of times, I feel like he’s attacking me. Well, he’s not,” Meng says. “A lot of times all of his behaviors are just because he’s frustrated. I have to really remember that he’s not attacking me personally. It’s his own frustration.”
In addition to family members and caregivers, service providers also attended the training. Sara Flugum is a director of programming at Rise Wisconsin, an organization that seeks to support families and communities, specializing in early child development, school readiness, respite, and wraparound mental health support for youth and adults up to age 35. As a director, something that stood out to her is the need to communicate well and work as a team alongside families. “What does it mean to have consultation with one another, debrief about tough situations, and then strategize moving forward,” Flugum says.
Covering multiple areas of need
Although Managing Threatening Confrontations is the most popular of the COW trainings, it is just one of many different trainings offered to the community. These trainings are developed and offered by COW staff who have extensive experience and knowledge in supporting people with disabilities. But they are also influenced by community needs. “We also take a lot of feedback from the community,” Truman says. “Some of our trainings have been because people have said, ‘We would really love to learn about this.’ We’ve worked to put together trainings that address those needs.”
For example, the Sensory Regulation & Self Care training teaches practices to help reduce stress and manage upsets and dysregulations. It is offered to individuals with disabilities and people who support them. Through Autistic Flourishing: Fostering Happy, Healthy Brains and Bodies, attendees explore how to be an ally and foster genuine happiness, health, and flourishing across the lifespan of autistic individuals. Lastly, Power and Control: Learning to Use it Respectfully teaches caregivers to recognize power dynamics, identify how they may be exerting power and control, and how to avoid or de-escalate power struggles.
For health-focused trainings, Community Training partners with COW’s Wellness Inclusion Nursing (WIN) program, where nurses serve as consultants focused on restoring, maintaining, and promoting maximal health and independence for adults and children with disabilities. WIN offers both in-person and virtual learning opportunities. Some examples of these trainings include understanding physical pain and how to tell others about it, safe medication administration, and how to take proper skin care. “There’s so much expert knowledge and information freely available through the practicing nurses, the psychiatry clinic, and the behavior support specialists. [Community Training] definitely wouldn’t be the same program if we weren’t able to tap into those folks regularly to provide training,” says Rachel Weingarten, former director of COW’s Community Training.
Truman and the Community Training team have new programming opportunities on the horizon. In association with Dane County Department of Human Services, they are working on putting together a cultural competency series. “It will look at various communities that we serve, and think about how culture might impact the way we deliver services to them,” Truman says. They are also working alongside the Department of Health Services to offer the Managing Threatening Confrontations training virtually, and statewide.
A full list of upcoming trainings can be found here.
“Through the COW trainings, we aim to provide a resource to the community,” Lapin says. “We hope to empower caregivers and help those with intellectual and developmental disabilities be active and full members of their community.”
- Learn more: Community TIES: Milestones
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