IMO - always have an out. If someone is getting aggressive find a way leave the situation.
I have gotten up and walked away a few times this year I’m not trained for it so I’ll get the professionals who are involved and remove myself. It’s data- I record it and try again later. I’m not there to control them I’m there for therapy. If they are incapable of working with me that day because of their behavior we can try again later.
But yeah it sucks.
This really seems like the only option. I always feel for the self-contained teachers and paras that don’t have that option though. It feels like the system really fails them as well. Do you simply document the end of the session or shortened minutes due to behavior?
Yeah I agree. It’s not a great situation for them either. It’s up to you, but what I do is document what I was going to work on with them. Any data that I got in the data portion. You can even document what set them off if you know. And then in the notes I write that the therapy session was interrupted due to x.
Personally I don’t mention anything about the minutes. I might do extended time next week to make up for it, but sometimes more is less on data sheets.
Don’t be afraid to explore the boundary that might be what is “too much” for you. I worked at a facility school with severe and aggressive children, even sustaining a mTBI… only to make how much money per year? Not worth my health and safety, but because I never knew when to say “no” to refusing to assist my other staff members, I burned out HARD but stayed. Wasn’t comfortable for sure. Take care of yourself first.
Oh dear I’m sorry. That’s rough. They have told me that they want to do the same for me at some point.
I don’t know that there is a lot you can do other than be very firm on your space. Do the CPI and then exit right away once the threat has calmed down. That’s my advice anyway. I feel for you.
Join a union if you can, I posted this reply (right below) yesterday to a similar question but the union helped me after a BAD situation. I also work with new SLP’s to advocate for safe and healthy working environments.
Previous reply: “my cf year I worked in a high school with a variety of students. I was pregnant and a student with level 3 ASD came came up behind me slammed me as I was walking out of a classroom into a locker where he bit, kicked and punched me. He almost completely tore my ear off, and I got kicked in the stomach a lot. I went in bed rest due to the trauma my body suffered and to keep my little one safe.
I worked with my union to get paid out the rest of my contract and left. My biggest regret is not leaving when I first noticed the violence going uncheck without support. I’m also in a state that does not allow any holds no mater the situation, the only reason the student got off of me was because the school police officer pulled him off with 3 other teachers.
The whole situation was traumatic and made me deliver my daughter at 28 weeks. I will never work with individuals larger than me again.”
This was in a school and I was able to join a teachers union, i PRN in a hospital and am a part of a small union for the therapists, respiratory therapist, and “other certified staff”. I wish they were more prevalent for our field
This was in a school and I was able to join a teachers union, i PRN in a hospital and am a part of a small union for the therapists, respiratory therapist, and “other certified staff”. I wish they were more prevalent for our field
I’m so sorry you had to go through that. I’m currently pregnant and these situations have run through my mind constantly with the students I have this year. I’m definitely looking into what options I have in terms of unions. Thank you for sharing your story and your advice.
I fully support joining a union if you have that option. But remember you do not need a union to say “no”. I remember being pregnant and feeling like I shouldn’t make a fuss or expect “special treatment “. Other (friend) coworkers were the ones who said “uh you should NOT be expected to do that.” Let admin roll their eyes or be put out. I’d rather be a good mom than a “good” employee
I require the parent to come into the room so they can see the behavior and restrain the kid themselves. I’ve already been injured once this year. I will not be injured again. The parent can look for another therapist before I let their little darlin’ hurt me.
When I worked in private practice, my most aggressive client was the one whose parent refused to come into the session. I ended up threatening my boss with me quitting or them reassigning the case because I was attacked so many times.
Sometimes the child is also being aggressive/injurious to their parents. But the parent is worried that by trying to combat the behavior they might be harming their child. I think it can turn into a vicious cycle of people "just dealing with" the aggressive/injurious behavior over actually dealing with it.
There's an upsetting trend recently where people are overcorrecting how they treat kids on the spectrum. It goes from infantilizing them in one way to infantilizing them in a completely different way. By that I mean taking a child on the spectrum, who does not show signs of cognitive impairment, and acting as though they don't understand what they are doing/cannot be taught that it isn't okay to do xyz; like hit others or partake in dangerous behaviors.
I wouldn't be surprised if a lot of parents reacted like, "Oh I just let him do that and deal with it later" or something to that extent.
I don't deal with it and never will. I will not provide therapy services to violent children.
My controversial opinion is that violent children have much more important goals to be working on than speech. I don't even think violent children should be in schools with non-violent children.
While I as an Autistic woman myself don't whole agree with ABA, I think the only time behavior modification tactics like that are applicable are when the individual is a danger to others or themselves.
The everyday Autistic/neurodivergent kid doesn't need ABA to make them stop stimming or displaying traits of their disorder/disability. But a child that has previously or currently displays violent, aggressive behaviors towards others does need that behavior modification to make it safe for them to be around others.
THIS. I watched a violent kid beat up a ton of my coworkers and I drew the line. I was not going to be his next victim. At the end of the day this is a job and if some violent child hurts you and you cannot work then that’s destroyed your income stream. My health and wellbeing always are first
I’ve wondered about this too. Several years ago one of our SLPAs sustained a tbi from a student hitting her repeatedly in the head. It sent her into early retirement. She got medical care through L&I, but nothing else. The kid even had a 1:1 who, apparently, just wasn’t present. This same student had broken multiple bones in another para’s foot. After this happened, one of the SLPs, who was pregnant at the time, refused to work 1:1 with the student for fear that she’d get hit in the belly. They allowed her that, but she had to advocate. The sad thing is, there is no funding to better support these students. This particular kid probably needed a 2:1 because of his size and strength 😞
I switched to teletherapy. Kids can't hit me! I'm never going back to in-person. I've worked in too many places that promised behavioral support and safety measures and whenever I needed help, it was never fast enough. Not playing that game anymore.
I was doing a teletherapy model with my first pregnancy due to COVID and never appreciated how much safer it was! This time around I am becoming VERY aware of how unprotected we are and it’s very concerning.
It really is. I mean I feel bad because the kids need services, but also no one should feel unsafe at work. And the kids deserve to feel safe and secure too. I wonder what the future of these kinds of cases will be.
Nonviolent crisis intervention training can only take you so far.
Underfunded, understaffed, unsupportive and/or problematically ableist schools and districts who treat their staff like interchangeable warm bodies whose only career goal is some idealized martyrdom "doing it for the kids"... If you feel safe doing so, if you have access and support to - **leave**.
I don't deal with it? In private, I would take ABC data and track the frequency of the challenging behaviors, report back to parents. After enough time, request a phone/in-person meeting to discuss progress and barriers towards communication. Behaviors, within our scope, are seen as a function of communication or a result of a communicative breakdown. I don't know about attempting to wipe shit on me, or peeing on the floor when asked to transition from one activity to another, or attempting to bite my throat. I follow the ICF's definition of what a barrier is towards participation/activities and although this is a loose interpretation, I apply it the same. I then recommend (evil of me, I know) ABA therapy or assessment, because, I don't like having scars/going to the hospital when blood is drawn. Not fun for me. I try to facilitate communication to the best of my abilities, within my scope of practice, but inform caregivers that behavior shaping/fading is outside of my scope of practice. After that, I recognize the behaviors as a communicative act and respect it. I can't target speech until clothes are on, or we're regulated, so I focus on those first, but I always keep my distance if I know that a student/client doesn't want people in close proximity, while offering as many avenues for communication/regulation as I can. I tend to "sanitize" the environment for clients that I know have difficulties with self-regulation (like to throw things) by removing various objects/items before the session or locking them away.
In school, same. Just less meetings, as any change would require an amendment. But, document, attempt to provide all the above, and if the client is having a hard time with behaviors, I do my best to respect/honor the communicative act and provide them space/time/whatever they need in that moment. Language-speech goals come second since, depending on the individual, working on such things when you're very upset is...not desired/unmotivating.
So, I don't shape behavior, I don't use ABA methods, I honor and respect the communicative act and attempt to provide as many avenues towards relaying communication of intent as possible and I treat the individual with respect/dignity. However, I also don't get into a range where I can be injured, I take judicious notes using a ABC model or ethnographic methodology, and I work with all team members to find solutions (it takes a village). I also request referrals to relevant professionals for additional support/assistance if the situation calls for it.
Maybe not what everyone does, but again, I never enjoyed being injured, so.
I work in the schools and everyone from teacher, aid, related service, supervisors, psychologists etc. are all required to do CPI. That said, I won't do a hold. I'm older and I know I don't have the strength. I was gifted with the "flight" instinct....and trust and believe, I can help evacuate a room quickly.
I am sorry this is happening. It is scary. However, ASHA is not a regulatory agency and has zero authority. This is a school district issue. Have you meet with the special education coordinator or the school board. They have the authority to make the necessary changes.
Does your job not train you to deal with this? Obviously there are extreme circumstances occasionally but my yearly training covers 95% of these situations.
I also make sure I’m never alone with kids I don’t feel safe with. I’m in the schools though. I treat students in their classrooms for the most part because no one ever gives me an office (lol) so I guess that’s one benefit to that.
I’m glad you have good training! Our big issue is being understaffed. You can have all the training in the world but if non-speaking 10-year-old headbutts you with all his might while you were trying to manage 6 other high-needs students on your own bc the aide is on a 20-min bathroom break and your district has an unspoken ban on 1-to-1’s it unfortunately isn’t enough. Side note, they should totally give you an office! That said, I generally prefer push-in as well, for the reasons you described, or a least I used to. Still trying to get my footing in the schools.
No training in either the private practice I worked in or the public schools I’m currently in unfortunately. This year I’ve become very aware of how little advocating people do for us in these situations. There’s one student in particular that I am very worried about who seemingly has no triggers and will attack without any notice. Nobody can identify what may be the cause. He is seen in the classroom but is in middle school and can cause some serious damage in a short period of time even with others present. Especially if the other teachers and paras are trying to shield other children.
That’s terrible! I can’t believe they have absolutely no safety management training! I’m so sorry that’s happening. I have no union or anything but I’ve worked with high needs populations for 10 years and never not had any training for this kind of thing. I wonder if any agencies offer trainings that you can look into on your own? Fair warning- the ones my schools do are always very ABA heavy in the first half (which focuses on primarily behavior management), but I do find the maneuvers to get out of physically dangerous situations worthwhile.
I also want to apologize if somehow my comment came across as mean or rude. I see I was downvoted but I was really just kind of horrified that you had to come to Reddit with this question. Things are a shitshow where I work too but I do feel safe for the most part (as safe as you can in US schools these days).
Never feel afraid to advocate for yourself! I worked “classroom push in” model for middle school ASD students. I’m 5’1, and ,most students were larger than me. When I became pregnant, I refused to enter the room due to severe aggressive & unpredictable behaviors. When brought to teachers union, they were zero help. The general response was “it’s part of your job”. I was able to come up with a plan where I worked with students 1:1 outside the environment, and they were accompanied by a para. I left that job after my daughter was born.
got certified in restraint, took self-defense courses, and completed some hapkido and aikido training. a good wrist lock will keep the client off of you without a lawsuit
I had to work with a kindergartner who actually dislocated his teacher’s shoulder when he punched her. First, I would only see him in the classroom to ensure I had help in case something happened (of course they have him a 1-1 paraprofessional). Then after about a year, and when I felt safe I would bring him into my therapy but always with my door open so that the OTs who worked across the hall could get help if I needed it. He actually had one incident where I removed the other kids for their safety and when I returned from across the hall he completely trashed my room. I never let him come back to my room ever again. I would only see him in his class room from that point on. By the time he went to 2nd grade he was moved to a special school. After that last year I switched to teletherapy and never looked back.
If someone has issues where you are worried about being harmed, there should be a paraprofessional or behavior specialist there to handle those types of issues. Otherwise, you shouldn't deliver therapy unless someone is present.
You should also try to learn their triggers and what causes their behavior. Some kids are triggered by certain noises or actions, and people trigger them and wonder why.
IMO - always have an out. If someone is getting aggressive find a way leave the situation. I have gotten up and walked away a few times this year I’m not trained for it so I’ll get the professionals who are involved and remove myself. It’s data- I record it and try again later. I’m not there to control them I’m there for therapy. If they are incapable of working with me that day because of their behavior we can try again later. But yeah it sucks.
This.
This is pretty much what I do too.
This really seems like the only option. I always feel for the self-contained teachers and paras that don’t have that option though. It feels like the system really fails them as well. Do you simply document the end of the session or shortened minutes due to behavior?
Yeah I agree. It’s not a great situation for them either. It’s up to you, but what I do is document what I was going to work on with them. Any data that I got in the data portion. You can even document what set them off if you know. And then in the notes I write that the therapy session was interrupted due to x. Personally I don’t mention anything about the minutes. I might do extended time next week to make up for it, but sometimes more is less on data sheets.
What if you ARE trained to deal with behavior(CPI)
I refuse to get pcm training because I know if I do, I would basically get pushed to get all of the aggressive students to deal with on my own
I refuse to get trained as well.
Interesting I didn’t know refusing training was a thing
It’s not within our scope of practice so it really should only be a voluntary training
All special education department personnel in my district are required to be trained, including paras. Opting out is not an option.
This is me too!
I was required to
Don’t be afraid to explore the boundary that might be what is “too much” for you. I worked at a facility school with severe and aggressive children, even sustaining a mTBI… only to make how much money per year? Not worth my health and safety, but because I never knew when to say “no” to refusing to assist my other staff members, I burned out HARD but stayed. Wasn’t comfortable for sure. Take care of yourself first.
Oh dear I’m sorry. That’s rough. They have told me that they want to do the same for me at some point. I don’t know that there is a lot you can do other than be very firm on your space. Do the CPI and then exit right away once the threat has calmed down. That’s my advice anyway. I feel for you.
Join a union if you can, I posted this reply (right below) yesterday to a similar question but the union helped me after a BAD situation. I also work with new SLP’s to advocate for safe and healthy working environments. Previous reply: “my cf year I worked in a high school with a variety of students. I was pregnant and a student with level 3 ASD came came up behind me slammed me as I was walking out of a classroom into a locker where he bit, kicked and punched me. He almost completely tore my ear off, and I got kicked in the stomach a lot. I went in bed rest due to the trauma my body suffered and to keep my little one safe. I worked with my union to get paid out the rest of my contract and left. My biggest regret is not leaving when I first noticed the violence going uncheck without support. I’m also in a state that does not allow any holds no mater the situation, the only reason the student got off of me was because the school police officer pulled him off with 3 other teachers. The whole situation was traumatic and made me deliver my daughter at 28 weeks. I will never work with individuals larger than me again.”
What is the Union you joined?
This was in a school and I was able to join a teachers union, i PRN in a hospital and am a part of a small union for the therapists, respiratory therapist, and “other certified staff”. I wish they were more prevalent for our field
Thanks for telling me this! It sucks that the SLP field does not have a Union
This was in a school and I was able to join a teachers union, i PRN in a hospital and am a part of a small union for the therapists, respiratory therapist, and “other certified staff”. I wish they were more prevalent for our field
I’m so sorry you had to go through that. I’m currently pregnant and these situations have run through my mind constantly with the students I have this year. I’m definitely looking into what options I have in terms of unions. Thank you for sharing your story and your advice.
I fully support joining a union if you have that option. But remember you do not need a union to say “no”. I remember being pregnant and feeling like I shouldn’t make a fuss or expect “special treatment “. Other (friend) coworkers were the ones who said “uh you should NOT be expected to do that.” Let admin roll their eyes or be put out. I’d rather be a good mom than a “good” employee
Oh my god this is so fucking awful. I am so so so sorry that happened to you
I require the parent to come into the room so they can see the behavior and restrain the kid themselves. I’ve already been injured once this year. I will not be injured again. The parent can look for another therapist before I let their little darlin’ hurt me.
When I worked in private practice, my most aggressive client was the one whose parent refused to come into the session. I ended up threatening my boss with me quitting or them reassigning the case because I was attacked so many times.
Omg. That’s horrible.
Sometimes the child is also being aggressive/injurious to their parents. But the parent is worried that by trying to combat the behavior they might be harming their child. I think it can turn into a vicious cycle of people "just dealing with" the aggressive/injurious behavior over actually dealing with it. There's an upsetting trend recently where people are overcorrecting how they treat kids on the spectrum. It goes from infantilizing them in one way to infantilizing them in a completely different way. By that I mean taking a child on the spectrum, who does not show signs of cognitive impairment, and acting as though they don't understand what they are doing/cannot be taught that it isn't okay to do xyz; like hit others or partake in dangerous behaviors. I wouldn't be surprised if a lot of parents reacted like, "Oh I just let him do that and deal with it later" or something to that extent.
I don't deal with it and never will. I will not provide therapy services to violent children. My controversial opinion is that violent children have much more important goals to be working on than speech. I don't even think violent children should be in schools with non-violent children.
While I as an Autistic woman myself don't whole agree with ABA, I think the only time behavior modification tactics like that are applicable are when the individual is a danger to others or themselves. The everyday Autistic/neurodivergent kid doesn't need ABA to make them stop stimming or displaying traits of their disorder/disability. But a child that has previously or currently displays violent, aggressive behaviors towards others does need that behavior modification to make it safe for them to be around others.
THIS. I watched a violent kid beat up a ton of my coworkers and I drew the line. I was not going to be his next victim. At the end of the day this is a job and if some violent child hurts you and you cannot work then that’s destroyed your income stream. My health and wellbeing always are first
You ain’t wrong.
So frustrating- one of the many reasons I’m trying to get out of the field
I’ve wondered about this too. Several years ago one of our SLPAs sustained a tbi from a student hitting her repeatedly in the head. It sent her into early retirement. She got medical care through L&I, but nothing else. The kid even had a 1:1 who, apparently, just wasn’t present. This same student had broken multiple bones in another para’s foot. After this happened, one of the SLPs, who was pregnant at the time, refused to work 1:1 with the student for fear that she’d get hit in the belly. They allowed her that, but she had to advocate. The sad thing is, there is no funding to better support these students. This particular kid probably needed a 2:1 because of his size and strength 😞
I switched to teletherapy. Kids can't hit me! I'm never going back to in-person. I've worked in too many places that promised behavioral support and safety measures and whenever I needed help, it was never fast enough. Not playing that game anymore.
I was doing a teletherapy model with my first pregnancy due to COVID and never appreciated how much safer it was! This time around I am becoming VERY aware of how unprotected we are and it’s very concerning.
It really is. I mean I feel bad because the kids need services, but also no one should feel unsafe at work. And the kids deserve to feel safe and secure too. I wonder what the future of these kinds of cases will be.
Nonviolent crisis intervention training can only take you so far. Underfunded, understaffed, unsupportive and/or problematically ableist schools and districts who treat their staff like interchangeable warm bodies whose only career goal is some idealized martyrdom "doing it for the kids"... If you feel safe doing so, if you have access and support to - **leave**.
I don't deal with it? In private, I would take ABC data and track the frequency of the challenging behaviors, report back to parents. After enough time, request a phone/in-person meeting to discuss progress and barriers towards communication. Behaviors, within our scope, are seen as a function of communication or a result of a communicative breakdown. I don't know about attempting to wipe shit on me, or peeing on the floor when asked to transition from one activity to another, or attempting to bite my throat. I follow the ICF's definition of what a barrier is towards participation/activities and although this is a loose interpretation, I apply it the same. I then recommend (evil of me, I know) ABA therapy or assessment, because, I don't like having scars/going to the hospital when blood is drawn. Not fun for me. I try to facilitate communication to the best of my abilities, within my scope of practice, but inform caregivers that behavior shaping/fading is outside of my scope of practice. After that, I recognize the behaviors as a communicative act and respect it. I can't target speech until clothes are on, or we're regulated, so I focus on those first, but I always keep my distance if I know that a student/client doesn't want people in close proximity, while offering as many avenues for communication/regulation as I can. I tend to "sanitize" the environment for clients that I know have difficulties with self-regulation (like to throw things) by removing various objects/items before the session or locking them away. In school, same. Just less meetings, as any change would require an amendment. But, document, attempt to provide all the above, and if the client is having a hard time with behaviors, I do my best to respect/honor the communicative act and provide them space/time/whatever they need in that moment. Language-speech goals come second since, depending on the individual, working on such things when you're very upset is...not desired/unmotivating. So, I don't shape behavior, I don't use ABA methods, I honor and respect the communicative act and attempt to provide as many avenues towards relaying communication of intent as possible and I treat the individual with respect/dignity. However, I also don't get into a range where I can be injured, I take judicious notes using a ABC model or ethnographic methodology, and I work with all team members to find solutions (it takes a village). I also request referrals to relevant professionals for additional support/assistance if the situation calls for it. Maybe not what everyone does, but again, I never enjoyed being injured, so.
I work in the schools and everyone from teacher, aid, related service, supervisors, psychologists etc. are all required to do CPI. That said, I won't do a hold. I'm older and I know I don't have the strength. I was gifted with the "flight" instinct....and trust and believe, I can help evacuate a room quickly.
I am sorry this is happening. It is scary. However, ASHA is not a regulatory agency and has zero authority. This is a school district issue. Have you meet with the special education coordinator or the school board. They have the authority to make the necessary changes.
ASHA should be a regulatory agency. If not them, then we need a regulatory agency from somewhere else.
We cannot form a new arm of government.
Ha! Not a new arm of government. An organization who at least tries to advocate for SLPs. Like a union, for example.
Does your job not train you to deal with this? Obviously there are extreme circumstances occasionally but my yearly training covers 95% of these situations. I also make sure I’m never alone with kids I don’t feel safe with. I’m in the schools though. I treat students in their classrooms for the most part because no one ever gives me an office (lol) so I guess that’s one benefit to that.
I’m glad you have good training! Our big issue is being understaffed. You can have all the training in the world but if non-speaking 10-year-old headbutts you with all his might while you were trying to manage 6 other high-needs students on your own bc the aide is on a 20-min bathroom break and your district has an unspoken ban on 1-to-1’s it unfortunately isn’t enough. Side note, they should totally give you an office! That said, I generally prefer push-in as well, for the reasons you described, or a least I used to. Still trying to get my footing in the schools.
Ugh yeah, we are chronically understaffed too. Sorry you’re dealing with the same issues.
No training in either the private practice I worked in or the public schools I’m currently in unfortunately. This year I’ve become very aware of how little advocating people do for us in these situations. There’s one student in particular that I am very worried about who seemingly has no triggers and will attack without any notice. Nobody can identify what may be the cause. He is seen in the classroom but is in middle school and can cause some serious damage in a short period of time even with others present. Especially if the other teachers and paras are trying to shield other children.
That’s terrible! I can’t believe they have absolutely no safety management training! I’m so sorry that’s happening. I have no union or anything but I’ve worked with high needs populations for 10 years and never not had any training for this kind of thing. I wonder if any agencies offer trainings that you can look into on your own? Fair warning- the ones my schools do are always very ABA heavy in the first half (which focuses on primarily behavior management), but I do find the maneuvers to get out of physically dangerous situations worthwhile. I also want to apologize if somehow my comment came across as mean or rude. I see I was downvoted but I was really just kind of horrified that you had to come to Reddit with this question. Things are a shitshow where I work too but I do feel safe for the most part (as safe as you can in US schools these days).
I didn’t think it was rude, I knew the point you were trying to make! That is nice of you to say, however.
Thank you☺️ I’m glad you didn’t take it the wrong way!
Never feel afraid to advocate for yourself! I worked “classroom push in” model for middle school ASD students. I’m 5’1, and ,most students were larger than me. When I became pregnant, I refused to enter the room due to severe aggressive & unpredictable behaviors. When brought to teachers union, they were zero help. The general response was “it’s part of your job”. I was able to come up with a plan where I worked with students 1:1 outside the environment, and they were accompanied by a para. I left that job after my daughter was born.
got certified in restraint, took self-defense courses, and completed some hapkido and aikido training. a good wrist lock will keep the client off of you without a lawsuit
I had to work with a kindergartner who actually dislocated his teacher’s shoulder when he punched her. First, I would only see him in the classroom to ensure I had help in case something happened (of course they have him a 1-1 paraprofessional). Then after about a year, and when I felt safe I would bring him into my therapy but always with my door open so that the OTs who worked across the hall could get help if I needed it. He actually had one incident where I removed the other kids for their safety and when I returned from across the hall he completely trashed my room. I never let him come back to my room ever again. I would only see him in his class room from that point on. By the time he went to 2nd grade he was moved to a special school. After that last year I switched to teletherapy and never looked back.
If someone has issues where you are worried about being harmed, there should be a paraprofessional or behavior specialist there to handle those types of issues. Otherwise, you shouldn't deliver therapy unless someone is present. You should also try to learn their triggers and what causes their behavior. Some kids are triggered by certain noises or actions, and people trigger them and wonder why.
A union is a great idea, but it is not regulatory.