Steve Vitto diffusion, de esclation, & restraining at NSU
Upcoming SlideShare
Loading in...5
×
 

Steve Vitto diffusion, de esclation, & restraining at NSU

on

  • 612 views

training for NSU staff on October 4th, 20011

training for NSU staff on October 4th, 20011

Statistics

Views

Total Views
612
Views on SlideShare
612
Embed Views
0

Actions

Likes
0
Downloads
9
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • On the individual level, knowing why should always be our goal and effective treatment should be the result So how do we find out why? Through the process of functional assessment.

Steve Vitto diffusion, de esclation, & restraining at NSU Steve Vitto diffusion, de esclation, & restraining at NSU Presentation Transcript

  • ` NSU CRISIS PREVENTION TRAINING (CPI) BREAKING DOWN THE WALLS Strategies for Defiant & Aggressive Students Presented by: Steven Vitto, M.A., CCII., CTCI., MIBLSI Coach, Behavior Specialist, Muskegon Area ISD Certified Self Defense Instructor in TCI, CPI, Davereuz Emergency Intervention Training, N.A.P.P.I.
  • NONVIOLENT CRISIS INTERVENTION TRAINING PROGRAM CPI Presented by: Steven Vitto , M.A., CCII. Behavioral Specialist M.A.I.S.D. NSU, OCTOBER, 2011
  • Andrew
    • 11 years old
    Died from traumatic asphyxia and chest compression. Face-down restraint with arms crossed over chest.
  • Angie
    • 7 years old
    Stopped breathing after being placed in prone restraint position. Death being ruled a homicide  
  • Chase
    • 17 years old
    Asphyxiation by a prone restraint He was restrained for refusing to stop talking and not following instructions . According to an autopsy he died after suffocating on his own vomit.
  • Chris
    • 13 years old  
    Asphyxiation by prone restraint He was restrained 4 times … in his last 24 hours
  • Edith
    • 15 years old
    Restraint Asphyxia – She was looking at a family photograph when a male aide instructed her to hand over the "unauthorized" personal item. The dispute escalated into a face-down floor restraint
  • Gareth
    • 15 years old
    Died of asphyxiation by a prone restraint Restrained by three staff members on his 4th day at the facility
  • Jonathan
    • 13 years old
    Restrained in a van while staff were running errands. Though he was clearly having difficulties breathing they continued running their errands… for another 1½ hours .
  • Mark
    • 14 years old
    Asphyxiation while being forcibly restrained by 3 staff in a prone position
  • Travis
    • 13 years old
    The autopsy indicated he died because of the face-down on the ground restraint. Restrained 1½ hours.   Denied request for asthma meds.
  • Robert
    • 12 years old
    Asphyxiation while restrained after a dispute about his… missing teddy bear He was restrained for 10 minutes, face down on the floor. The staffer who restrained the boy left him lying, unresponsive, on the floor
  • Reality
    • 142 deaths in the US from 1988 – 1998 due to S/R, reported by the Hartford Courant (Weiss et al, 1998)
    • 111 fatalities over 10 years in New York facilities due to restraints (Sundram, 1994 as cited by Zimbroff, 2003)
    • At least 16 children (<18 y.o.) died in restraints in Texas programs from 1988 – 2002, reported by local media (American-Statesman, May 18, 2003 )
    • At least 14 people died and at least one has become permanently comatose while being subjected to S/R from July 1999 to March 2002 in California (Mildred, 2002 )
  • Reality
    • 50 to 150 deaths occur in the US each year due to S/R estimated by the Harvard Center for Risk Analysis (NAMI, 2003)
    • Federal Office of the Inspector General identified 42 of 104 (42%) SR deaths from 08/99 – 12/04 were not reported. (OIG, 2006)
  • The United States Government Accountability Office- Testimony Before the House of Representatives, 2009
    • Children with disabilities were more likely to suffer death as a result of seclusion and restraint.
    • These children were sometimes restrained and secluded even when they did not appear to be aggressive without parental consent.
    • Face down and other restraints that block air to the lungs can be deadly.
    • Teachers and staff in these cases were often NOT trained in the use of these techniques.
  • The Research
    • Over 85% of restraints, management, seclusion, begin with students refusing to follow a staff direction.
    • How staff deal with this noncompliance plays a big part in whether the student’s behavior diffuses or escalates.
    • There is no research supporting the use of forced compliance as a behavioral change strategy.
    • There is a significant increase in children with ODD, ADHD, ASD, Social Maladjustment, Down Syndrome in our schools.
    • Staff need to be trained in how to deal with oppositional, defiant and aggressive behavior.
    • Most staff have little training in this area.
    • SUPPORTING STUDENT BEHAVIOR:
    • Standards for the Emergency Use of
    • Seclusion and Restraint
    • Nothing in this policy is intended to conflict with or limit the use of the “reasonable physical force” permitted in Act 451 of 1976, Section 1312(4), otherwise known as the Corporal Punishment Act.
  • Positive Behavior Supports
    • the most effective strategies for supporting positive
    • student behavior begin with meaningful instruction
    • provided by highly trained professionals in a safe
    • environment which promotes dignity for all students;
    • school-wide systems of positive behavioral support to
    • address challenging behavior will increase instructional
    • time for all; and
    • seclusion or restraint should be used only in an emergency and requires diligent assessment, monitoring,
    • documentation, and reporting by trained personnel
  • PBS emphasizes behavior that encourages learning by:
    • building relationships;
    • creating routines;
    • teaching skills/rules/expectations;
    • identifying replacement behaviors for behaviors that
    • interfere with learning;
    • making problem behavior less effective, efficient, and
    • relevant; and
    • making the desired behavior more functional and
    • adaptive.
  • A. Training Framework
    • A comprehensive training framework includes:
    • awareness training for the broader educational community,
    • including pre-service training for all teachers;
    • awareness training for substitute teachers; and
    • comprehensive training for key identified personnel
  • B. Training Components
    • All training must include:
    • proactive practices and strategies that ensure
    • the:
    • dignity of students;
    • conflict resolution;
    • mediation;
    • social skills training;
    • de-escalation techniques
  • C. Comprehensive Training for Key Identified Personnel A local educational agency (LEA) will identify sufficient key personnel to ensure that trained personnel are available for an emergency situation. Before using seclusion or restraint with students, key identified personnel who may have to respond to an emergency safety situation must be trained in:
    • proactive practices and strategies that ensure the
    • dignity of students;
    • conflict resolution;
    • social skills training;
    • de-escalation techniques;
    • positive behavior support strategies;
    • techniques to identify student behaviors that may
    • trigger emergency safety situations;
    • related safety considerations, including information
    • regarding the increased risk of injury to students and
    • staff when seclusion or restraint is used;
    • instruction in the use of seclusion and restraint;
    • types of seclusion;
    • types of restraint;
  • Discussion on Restraint
  • Continuum of School-wide PBS
  • Impact of School-wide PBS on Seclusion and Restraint
    • Implementation of a school-wide system will ensure that seclusion and restraint are used only as a last resort method.
      • Encourages learning by building relationships;
      • Teaches skills/rules/expectations;
      • Identifies replacement behaviors that interfere with learning;
      • Makes problem behavior less effective;
      • Makes desired behavior more functional and adaptive.
  • Are classroom response cost systems contributing to defiance and aggression?
    • Response to Intervention
    • Are we using evidenced based classroom behavior management systems at the universal level? Are classroom response cost systems evidenced based? Is there a balance, better yet, an overbalance of Positive Incentives and Feedback for Desired Behavior?
    • When universal consequences (e.g., Classroom Response Cost System) are not effective, or when they trigger an escalation of behavior, do we differentiate our approach?
    • Are we over-relying on classroom response cost systems to manage student behaviors?
  • Awareness of Potential for Violence
    • Early Warning Signs
    • (threatening,heightened anxiety)
    • Other Indicators
    • (ADD/ADHD,EI,CD,ODD,etc.)
    • Brain Development: “The Amigdila”
  • ATTACHMENT DISORDER OPPOSITIONAL DEFIANCE DISORDER CONDUCT DISORDER ATTENTION DEFICIT HYPERACTIVITY DISORDER EMOTIONAL IMPAIRMENT ANXIETY DISORDERS FETAL ALCOHOL SYNDROME ASPERGERS SYNDROME COGNITIVE IMPAIRMENT Conditions Effecting Behavior
  • OPPOSITIONAL DEFIANCE DISORDER
  • Where it Comes From…
    • Aggressive behavior is learned and maintained in a manner similar to other behaviors.
    • Three important factors to consider include modeling, positive reinforcement, and negative reinforcement.
    • Aggressive students often exhibit deficits in social information processing-I.e. often misinterpreting social cues and misassigning hostile intent to others
  • Understanding Aggressive Behaviors
    • Reactive Aggression
      • Affective or expressive aggression
      • Loss of control and emotional flooding
      • Emotions are dominant
    • Proactive Aggression
      • Instrumental or operant aggression
      • Goal oriented
      • Cognitions are dominant
    TCI TRAINING [11]
  • Traumatic or not???
  • Scott
    • An explanation of the diagram can be found on the slides that follow.
  • The Conflict Cycle
  • RAPID ASSESSMENT
    • THE ENVIRONMENT
    • THE AGITATED INDIVIDUAL
    • YOU
  • The number one reason student’s loose control…
    • Perception of being treated unfairly
  • Learn the student’s triggers Contra-Indicated Behaviors Strategies for the Oppositional Student
    • Ultimatums
    • Strict Boundaries: Drawing the Line in the Sand
    • Counts, Warnings, Threats
    • Being touched
    • Prolonged Eye-Contact
    • Infringing on Personal Space
    • Social Disapproval
    • Judgmental Responses
    • Response Cost and Punishment
    • Strict Boundaries or Contracts
  • Myth
    • “You only hurt the ones you love…”
  • MODELING
  • THE CPI WORKBOOK
    • Due Care for Participants (page 5)
    • Program Objectives (page 6)
    • Integrated Experience (page 7)
    • Care, Welfare Safety, and Security
  • Stages of Crisis Development
    • STAGE 1.
    • 1. ANXIETY
    • APPROPRIATE STAFF RESPONSE:
    • SUPPORTIVE
    Page 7
  • Reduce agitation in a demand situation….
    • 1. Communicate concern
    • 2. Allow the student time and a place to calm
    • 3. Give student choices and options
    • 4. Consider history student and knowledge of what is calming for them
    Page 7
  • STAGE 2.
    • 2. DEFENSIVE
    • (refusing, arguing, name-calling, threatening)
    • APPROPRIATE STAFF RESPONSE:
    • DIRECTIVE
    • (setting limits, giving choices)
    Page 7
  • DEFENSIVE STAGE
  • STAGE 3
    • 3. ACTING OUT PERSON
    • APPROPRIATE STAFF RESPONSE:
    • NONVIOLENT PHYSICAL CRISIS INTERVENTION
  • ACTING OUT PERSON
  • Reactive = Traumatic
  • Proactive = Goal Oriented
  • Stage 4
    • 4. Tension Reduction
    • APPROPRIATE STAFF RESPONSE:
    THERAPEUTIC RAPPORT
  • Proxemics/Kenesics
    • The invisible bubble
    • Nonverbal communication
    • Triggers
    Page 8
  • SUPPORTIVE STANCE
    • Three reasons for using the supportive stance:
    • 1. HONORS PERSONAL SPACE
    • 2. ESCAPE ROUTE
    • 3. NONTHREATENING
    Page 8
  • Paraverbal
    • Tone
    • Volume
    • Cadence
  • THE DEFENSIVE STAGE
  • Remember your goal during the Defensive Stage
    • DIFFUSE AND DE-ESCALATE
    • STATE CALM AN PROFESSIONAL
    • AVOID EMOTIONAL AND JUDGMENTAL RESPONSES
    • REMEMBER YOUR TRIGGERS
    • OBTAIN BACK UP SUPPORT
    • ISOLATE WHENEVER POSSIBLE
    • DON’T TAKE THINGS PERSONALLY
  • Student Arguing with Staff The F.A.S.T.
  • Withdrawing from Power Struggles The F.A.S.T. Program
  • THE VERBAL ESCALATION CONTINUUM
    • Questioning
    • Refusal
    • Release
    • Intimidation
    • Tension Reduction
    Page 9
  • QUESTIONING
    • ANSWER THE QUESTION
    • PLANNED IGNORING
    • ADEQUATE RESPONSE TIME
    • ALLOW SPACE AND TIME
    • DO NOT ARGUE
    • RESTATE THE LIMIT
  • REFUSAL
    • DON’T ARGUE
    • SET LIMITS
    • EVALUATE HISTORY
    • CONSIDER CALLING FOR HELP
    • RESPONSE TIME
    • ENFORCE LIMITS
  • RELEASE OR NAMECALLING
    • REMAIN CALM AND PROFESSIONAL
    • DON’T TAKE COMMENTS PERSONALLY EVEN IF THEY HURT
    • ALLOW VENTING
    • ISOLATE IF POSSIBLE
    • SET LIMITS
    • CONSIDER CALLING FOR ASSISTANCE
  • INTIMIDATION OR THREATENIN G
    • DON’T RUN
    • TAKE THREATS SERIOUSLY
    • STAY CALM & PROFESSIONAL
    • DO NOT RESOND TO THREATS
    • STATE LIMITS
    • DIRECT TEAM
    • ASSESS ENVIRONMENT
    PAGE 9
  • SETTING LIMITS
    • KEYS TO SETTING LIMITS
    • 1. SIMPLE, REASONABLE, ENFORCEABLE
    • 2. DO’S AND DON’TS
    • 3. WHEN TO CALL FOR HELP
  • Setting Limits
    • Present the expected behavior and logical consequence as a decision and place responsibility on the student.
    • Always lead with the positive outcome that will occur if the student make the choice to calm down or follow directions.
    • Allow a few seconds for the student to decide.
    • Withdraw from the student and attend to other students. Limit direct eye-contact.
    • Follow though with limits established.
  • THE THREE DON’TS
    • Avoid touching the person
    • (verbal = verbal)
    • Avoid Ultimatums
    • Avoid crowding or trapping
  • SHANE
  • How to get someone to leave
    • Consider focus of anger
    • Problem or solution
    • Remember your goal
  • How to avoid physical contact
    • Remove triggering stimulus
    • Calmly explain limits
    • Select a staff (or peer) who has a calming influence
    • Select a novel or neutral party
    • Bait to open area
    • Remove other students
    • Call home or police
  • Verbal Intervention Tips
    • DO
    • Remain calm
    • Isolate the situation
    • Enforce limits
    • Listen
    • Be aware of non-verbals
    • DON’T
    • Overreact
    • Get in a power struggle
    • Make false promises
    • Fake Attention
    • Be threatening
  • EMPATHIC LISTENING
    • 1.Be nonjudgmental
    • 2.Give Undivided Attention
    • 3.Listen Carefully to what the person is really saying
    • 4. Allow silence for reflection
    • 5. Use re-statement to clarify messages
    PAGE 10
  • PRECIPITATING FACTORS FUNCTIONAL ASSESSMENT
  • Functional Assessment
    • Identifies triggers
    • (sets the stage for evidence based practice)
    • Identifies Approach Concerns
    • Makes a Hypothesis About Motivation
    • Helps to Establish Preventative Strategies
  • SHANE
  • “ If you know why, you can figure out how….” W. Edward Deming
  • SHANE’S MOTIVATION
  • RATIONALE DETACHMENT OUR ABILITY TO MAINTAIN A THERAPEUTIC APPROACH
  • “The Clean Slate”
  • Integrated Experience
    • Recognizing your part in the Conflict Cycle
    • Staying Calm and Professional
  • FEAR
  • Staff Fear
    • Unproductive responses
    • Productive Responses
  • STAGE 3.
    • AGGRESSIVE/DESTRUCTIVE
    • APPROPRIATE STAFF RESPONSE:
    • NONVIOLENT PHYSICAL
    • INTERVENTION
  • REASONABLE FORCE
    • MICHIGAN SCHOOL CODE
    • CORPORAL PUNISHMENT
    • DOCUMENTATION
    • SELF DEFENSE
  • Exercise Great Caution
  • What is not reasonable force.
    • Deliberate infliction of pain.
    • Forced exercise or uncomfortable position.
    • Dragging someone who is noncompliant but not dangerous or in danger.
    • Not using safe physical management techniques.
    • There are three possible outcomes of crisis:
    • Staff student relationship is improved
    • The staff student relationship is unchanged
    • The staff student relationship is damaged
  • STAGE 3.
    • AGGRESSIVE/DESTRUCTIVE
    • APPROPRIATE STAFF RESPONSE:
    • NONVIOLENT PHYSICAL
    • INTERVENTION
  • TERMS
    • What is restraint?
    • What is physical management?
    • What is physical assistance?
    • What is a physical escort?
    • What is mechanical restraint?
    • What is seclusion?
    • What is time-out?
    • What is an emergency?
    • What is imminent danger?
  • Use of Emergency Restraint
    • A behavior that requires immediate intervention constitutes
    • an emergency. Emergency restraint must be used
    • only under emergency situations and if essential. An
    • emergency that may require the use of restraint includes
    • behavior that: poses an imminent risk to the safety of an
    • individual student; poses an imminent risk to the safety of others; or is otherwise governed by T he Revised School
    • Code , 1976 PA 451, otherwise known as the Corporal Punishment Act.
  • Physical Restraint involves direct physical contact
    • that prevents or significantly restricts a student’s movement. Restraint is a last resort emergency safety
    • intervention. Restraint is an opportunity for the student to regain self-control. This policy on physical
    • restraint is not intended to forbid actions undertaken: to break up a fight; to take a weapon away from a student; as the brief holding by an adult in order to calm or comfort; as the minimum contact necessary to physically escort a student from one area to another;
    • to assist a student in completing a task/response if the student does not resist or resistance is minimal in intensity or duration; or
    • to hold a student for a brief time in order to prevent an impulsive behavior that threatens the student’s immediate safety (e.g., running in front of a car).
  • Mechanical Restraint
    • means the use of any device, article, garment, or material attached to or adjacent to a student’s body that restricts normal freedom of movement and that cannot be easily removed by a student.
    • Mechanical restraint does not include:
    • an adaptive or protective device recommended by
    • a physician or therapist (when it is used as
    • recommended); or safety equipment used by the general student population as intended (for example, seat belts, safety harness on school transportation).
    • An LEA must ensure that substitute teachers are informed of all local emergency procedures, including the emergency use of seclusion and restraint.
  • REASONABLE FORCE
    • MICHIGAN SCHOOL CODE
    • CORPORAL PUNISHMENT
    • DOCUMENTATION
    • SELF DEFENSE
  • Use of Physical Force under the Corporal Punishment Statute
    • In maintaining order and control, a person may use physical force upon a student:
      • To restrain or remove a pupil whose behavior is interfering with the orderly exercise and performance of school functions if the pupil has refused to comply
      • For self-defense or defense of another
      • To prevent a student from inflicting harm on self
      • To quell a disturbance that threatens physical injury
      • To obtain possession of a weapon or other dangerous object
      • To protect property
    • Trigger = a pattern of behavior requiring the use of restraint
    • Documented steps for EIP:
      • Detail the emergency plan
      • Ask if a known medical condition contraindicates restraint
      • Conduct peer review by knowledgeable staff
    Emergency Intervention Plan (EIP) for Restraint
  • Duration
    • Seclusion:
      • No longer than needed to allow student to regain control
      • Elementary = no more than 15 minutes
      • Middle / High School= no more than 20 minutes
      • If more time is needed, add support staff and document to explain time extension
    • Restraint:
      • No longer than needed to allow student to regain control, but generally no longer than 10 minutes
      • If more time is needed, add support staff and document to explain time extension
  • Documentation and Reporting
    • Seclusion:
      • Document each use of seclusion and reason for use
      • Document in writing and report immediately to building administrator
      • Verbally report to parent/guardian immediately or ASAP
      • Provide written report to parent within 24 hours
    • Restraint:
      • Document each use of seclusion and reason for use
      • Document in writing and report immediately to building administrator
      • Verbally report to parent/guardian immediately or ASAP
      • Provide written report to parent within 24 hours
  • Best Practice
    • If you are going to put your hands on a student to move them against their will, or to inhibit their movement, it should only be when that student is presenting a physical danger to others, or is severely disrupting the school environment.
  • PERSONAL SAFETY TECHNIQUES
    • Strike-a weapon coming in contact with a target
    • Grab-obtaining control over part of someone's anatomy and trying to injure or destroy it.
    • CPI’s Principals of Personal Safety
    • Strike
    • 1.move
    • 2.block
    • Grab
    • 1.Weak point
    • 2.Momentum
    • 2.Leverage
    Page 13
  • Personal Safety Techniques
    • Supportive Stance
    • Danger Zone> Safety Zone
    • Deflecting a punch
    • Kick Block
    • One Hand Wrist Grab Release
    • Two Hand Wrist Grab Release
    • Two Hands or Two Arms
    • Front and Back Choke
    • Bar Arm Choke
    • Hair pull Release
    • Bite Release
  • Nonviolent Crisis Intervention
    • CPI Children’s Control Position
    • TCI – Seated child basket wraps
    • Deveruex Two Arm Control Safety Position
    • Daveruex Bear Hug Control Position
    • CPI Transport Position
    • CPI Interim Control Position
    • Daveruex Basket Wrap Assist
    • Daveuex Carry
    • Prone and Supine Restraint Concerns
  • Team Interventions
    • Crisis Response Team
    • Team versus Solo
    • 1. Professionalism
    • 2. Safety
    • 3. Documentation
    • Team Leader
    • 1. Confident
    • 2. Competent
    • 3. Knows the AOP
    Page 19
  • Team Leader Duties
    • Assess the situation
    • Develop a Plan
    • Direct the Team
    • Communicate with the AOP
    • The Letting Go Process
  • Auxiliary Team Members
    • 1. Check
    • 2. Address
    • 3. Recognize
    • 4. Engage
  • STAGE 4
    • TENSION REDUCTION (CALMING)
    • APPROPRIATE STAFF RESPONSE
    • THERAPEUTIC RAPPORT
    • (OBJECTIVE PROCESSING)
  • Therapeutic Rapport
    • POSITIVE BEHAVIORAL SUPPORTS
    • THE C.O.P.I.N.G. MODEL
    • ANGER REPLACEMENT TRAINING
    • LIFE SPACE CRISIS INTERVENTION
  • C.O.P.I.N.G. PROCESSING WITH STUDENT
    • C ONTROL-BACK IN THE DRIVER’S SEAT
    • “ A CLEAN SLATE”
    • O RIENTING- WHAT HAPPENED/DEBRIEFING
    • P ATTERNS- IS THERE A RECOGNIZABLE
    • PATTERN?
    • I NVESTIGATING- WHAT IS REALLY GOING ON?
    • N EGOTIATING- LET’S CHOOSE A BETTER WAY.
    • CONFRONT IRRATIONAL BELEIFS
    • G IVING-
    • DIGNITY
    • CARING
    • SUPPORT
  • C.O.P.I.N.G. MODEL DEBRIEFING WITH STAFF
    • C ONTROL-ARE YOU ALRIGHT??
    • O RIENTING- WHAT HAPPENED? DOCUMENTATION AND DEBRIEFING
    • P ATTERNS- IS THERE A RECOGNIZABLE
    • PATTERN?
    • I NVESTIGATING- WHAT IS REALLY GOING ON?
    • CAN WE PREVENT THIS FROM
    • HAPPENING AGAIN
    • N EGOTIATING- LET’S CHOOSE A BETTER WAY.
    • G IVING
    • CARING
    • SUPPORT
    • COOLABORATION
    • There are three possible outcomes of crisis:
    • Staff student relationship is improved
    • The staff student relationship is unchanged
    • The staff student relationship is damaged
  • Debriefing
    • Seclusion:
      • Followed by debriefing with the parent and student to explore
        • Triggers
        • Whether behavior will occur again
        • What, if any, follow-up is needed
    • Restraint:
      • Followed by debriefing with the parent and student to explore
        • Triggers
        • Whether behavior will occur again
        • What, if any, follow-up is needed
  • Reoccurring Behavior – Should a pattern of behavior
    • emerge, or be anticipated, which may require the
    • use of emergency seclusion, the school personnel
    • must:
    • conduct a functional behavioral assessment;
    • develop or revise a positive behavior support plan
    • (PBS) to facilitate the reduction or elimination of
    • the use of seclusion;
    • develop an assessment and planning process conducted
    • by a team knowledgeable about the student,
    • including:
    • the parent;
    • the student (if appropriate);
    • people responsible for implementation of the
    • PBS; and
    • people knowledgeable
  • The Problem with Assumptions
  • Thanks for Being Here!!
    • Any Questions any time, please call me at 231=767-7279
    • or write me at
    • [email_address]