Management and Treatment
When discussing severe challenging behavior, it is important to distinguish between management techniques and treatment.
Management refers to techniques focused on preventing challenging behavior and includes a variety of procedures such as:
- decreasing instruction time,
- interrupting challenging behavior, and
- the use of protective equipment to prevent injury.
Crisis management is a particular type of management that is more reactive and is not used preventatively but only after challenging behavior has escalated to crisis levels that present imminent risk to the individual or others. Both behavior management and crisis management are more short-term oriented and do not necessarily involve the use of individualized treatments. It is important to identify and weigh the risks of intervening in a crisis situation to employ crisis management, relative to the risks of not employing crisis management.
Treatment, in contrast, refers to proactive interventions, informed by functional behavior assessment (FBA), aimed at producing lasting behavior change, including those that prevent or reduce the occurrence of challenging behavior. Treatment is long-term oriented, applying techniques that:
- establish adaptive replacement behaviors,
- shape tolerance skills,
- arrange predictable routines, and
- extinguish old patterns of behavior.
This process requires careful assessment and training across many learning trials delivered over a period of weeks and/or months. There are also risks associated with assessment and treatment in terms of resources needed to develop effective intervention.
When developing an individualized treatment, it may be necessary to use management and/or crisis management techniques temporarily, but this is only acceptable if done while challenging behavior is being assessed and a treatment is developed. The use of management techniques, particularly crisis management in the absence of efforts to assess and treat challenging behavior does not represent appropriate care[22]. When an effective treatment is applied over time, management procedures can often be reduced to the extent they are used rarely and even eliminated[32-34].
For some individuals with more severe challenging behavior, however, use of both treatment and management techniques may be needed on an ongoing basis to increase safety and allow the individual to participate in school and community life.
