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Including the Child With Aggressive Behavior
                   at Church
                        Stephen Grcevich, MD
               President, Board of Directors, Key Ministry

Clinical Assistant Professor of Psychiatry, Northeast Ohio Medical University
         Senior Clinical Instructor, Child and Adolescent Psychiatry
           Case Western Reserve University School of Medicine


             ENGAGE Children’s Ministry Conference
        West Shore Evangelical Church, Mechanicsburg PA
                      November 10, 2012
Learning Objectives…
   Identify characteristics of kids who are
    predisposed to aggressive behavior
   Exploreapproaches for establishing ministry
    environments that reduce risk of aggression
   Reviewstrategies for intervening when kids are
    escalating toward or exhibiting aggression, and
    communicating with parents after aggressive
    behavior has occurred
   Discuss ministry strategies when the risk
    associated with a child’s aggressive behavior
    prevents inclusion at church
Subtypes of aggressive behavior:
Reactive aggression:                                  Predatory aggression
     Affect: fear, anger                                Affect: self-confidence
     Arousal level: high                                Arousal level: low
     Outcome: negative                                  Outcome: positive for self
     Impulsive                                          Controlled
     Reactive                                           Predatory
     Defensive                                          Offensive
     Overt                                              Covert
     Hostile                                            Instrumental
    Vitiello B, Stott DM. J Am Acad Child Adolesc Psychiatry 1997; 36(3) 307-315
Definition of maladaptive aggression:

   Aggressive behavior that occurs outside an
    acceptable social context

Maladaptive behavior is characterized by:


Intensity, frequency, duration and severity are disproportionate to its
   causes
May occur in absence of antecedent social cues
Behavior not terminated in expected time frame, or in response to
  feedback
Jensen P et al. J Am Acad Child Adolesc Psychiatry 2007; 46(3): 309-322
Traits associated with maladaptive
aggression:

   Difficulty with behavioral inhibition, emotional self-
    regulation
   Irritability/anxiety frequently predominant mood
   Misperception of social cues
   Misinterpretation of environmental risk
   Difficulty with communication
   Cognitive rigidity…propensity to get “stuck”
What situations at church may increase a child’s
risk for aggressive behavior?

   Initial visits to an unfamiliar church
   Transition times before/after children’s activities
   Chaotic, unstructured activities
   Kids transitioning from one area to another in building
   Excessive sensory stimulation
   Unfamiliar staff, volunteers
   Following high stimulation, high energy activities
   Evening activities (time course effects of medications,
    fatigue)
Environment shapes behavior!

The more sensory input a child has to process, the
  less mental capacity remains for self-control.
Consider…
 Visual input/clutter, lighting, use of color

 Use of pictures to assist in communication

 Effects of loud noise

 Touch…not everyone likes it

 Comfortable seating

 http://drgrcevich.files.wordpress.com/2011/11/inclusion-
  fusion-2011-harmony-welcomingenvironments.pdf
Space Planning & Sensory Issues

   Open check-in area with neutral tones and
    plotter images to reduce visual clutter
Space Planning & Sensory Issues

   Vineyard Student Union (middle school and
    senior high ministry)
Communication aides:

   Communication keys used to enhance volunteer name tags
    http://www.keyministry.org/wp-content/uploads/2012/07/PM-
    Appendix-3r-Sample-Communication-Key-and-Signage.pdf
Keys to Behavior Management

 Before
 During

 After
Before…
   Pray
   Create your classroom/respite culture
     Encouragement
     Expectations

   Plan proactively
     Physical   arrangement of the room
     Staffing
     Content  of the lesson
     Pace of the lesson
     “In the event of an emergency…”
During: First line strategies
   Proximity Control
   Distraction
   Hurdle Help
   Antiseptic Bounce
During: Next steps
   “Grandma’s Law”
   Emotional Labeling
   Watch YOUR language
   Managing other students for safety
During: General Rule of Thumb

   When a child/youth is demonstrating aggressive
    behavior that is predominantly impulsive in
    nature, decreasing the sensory stimulation in
    the environment is generally helpful
   When a child/youth is demonstrating aggressive
    behavior that is predominantly perseverative
    in nature, distracting the child as early as
    possible before the pattern escalates is
    generally helpful
After:

   Non-judgmental conversation
   Problem-solving
   Quiet
   Allow for “busy work”
   Re-join peers
   Communicate with parents
How can parents help?

   Do share information with ministry team about techniques
    shown to help prevent/reduce aggression
   Do administer medication shown to help reduce frequency,
    severity of aggressive behavior during church activities
    (with approval of treating physician)
   Do be aware of the concern that aggressive behavior
    presents with largely untrained volunteers
   Doconsider keeping your child home when he/she exhibits
    aggression that you can’t successfully manage at home
What if a child/youth presents too great a
risk of severe aggression to attend church?
   Support the rest of the family in attending church,
    participating in discipleship activities
   Relational (home-based) respite
   Paid in-home child care/buddies with specialized training
   Scheduling church activities when child care available
   Whose responsibility is the child’s spiritual development?
   Church as resource provider to parent?
Conclusions:
   Kids with reactive aggression can generally be included
    in existing church programming
   Churches may reduce risk of aggression behavior by
    designing friendly ministry environments
   Providing teachers and group leaders adequate training
    to identify and intervene in potentially risky situations
   Ensure sufficient staffing at times of enhanced risk
   Traditional church may not be the “least restrictive
    environment” for some children/youth especially prone
    to aggressive behavior
Provides FREE training,
consultation, resources and
support to help churches serve,
welcome and include families of
kids with hidden disabilities
Stay in Touch!
Key Ministry Website: http://www.keyministry.org


Church4EveryChild…Steve’s Key Ministry Blog: http://drgrcevich.wordpress.com
Diving For Pearls…Katie Wetherbee’s Blog: http://katiewetherbee.wordpress.com
A Reckless Pursuit…Harmony Hensley’s Blog: http://arecklesspursuit.wordpress.com



             http://www.facebook.com/drgrcevich
             http://www.facebook.com/pages/Key-Ministry/116940088329098


              http://twitter.com/#!/drgrcevich
              http://twitter.com/#!/KeyMinistry
Questions?

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Including the Child With Aggressive Behavior at Church

  • 1. Including the Child With Aggressive Behavior at Church Stephen Grcevich, MD President, Board of Directors, Key Ministry Clinical Assistant Professor of Psychiatry, Northeast Ohio Medical University Senior Clinical Instructor, Child and Adolescent Psychiatry Case Western Reserve University School of Medicine ENGAGE Children’s Ministry Conference West Shore Evangelical Church, Mechanicsburg PA November 10, 2012
  • 2. Learning Objectives…  Identify characteristics of kids who are predisposed to aggressive behavior  Exploreapproaches for establishing ministry environments that reduce risk of aggression  Reviewstrategies for intervening when kids are escalating toward or exhibiting aggression, and communicating with parents after aggressive behavior has occurred  Discuss ministry strategies when the risk associated with a child’s aggressive behavior prevents inclusion at church
  • 3. Subtypes of aggressive behavior: Reactive aggression: Predatory aggression  Affect: fear, anger  Affect: self-confidence  Arousal level: high  Arousal level: low  Outcome: negative  Outcome: positive for self  Impulsive  Controlled  Reactive  Predatory  Defensive  Offensive  Overt  Covert  Hostile  Instrumental Vitiello B, Stott DM. J Am Acad Child Adolesc Psychiatry 1997; 36(3) 307-315
  • 4. Definition of maladaptive aggression:  Aggressive behavior that occurs outside an acceptable social context Maladaptive behavior is characterized by: Intensity, frequency, duration and severity are disproportionate to its causes May occur in absence of antecedent social cues Behavior not terminated in expected time frame, or in response to feedback Jensen P et al. J Am Acad Child Adolesc Psychiatry 2007; 46(3): 309-322
  • 5. Traits associated with maladaptive aggression:  Difficulty with behavioral inhibition, emotional self- regulation  Irritability/anxiety frequently predominant mood  Misperception of social cues  Misinterpretation of environmental risk  Difficulty with communication  Cognitive rigidity…propensity to get “stuck”
  • 6. What situations at church may increase a child’s risk for aggressive behavior?  Initial visits to an unfamiliar church  Transition times before/after children’s activities  Chaotic, unstructured activities  Kids transitioning from one area to another in building  Excessive sensory stimulation  Unfamiliar staff, volunteers  Following high stimulation, high energy activities  Evening activities (time course effects of medications, fatigue)
  • 7. Environment shapes behavior! The more sensory input a child has to process, the less mental capacity remains for self-control. Consider…  Visual input/clutter, lighting, use of color  Use of pictures to assist in communication  Effects of loud noise  Touch…not everyone likes it  Comfortable seating  http://drgrcevich.files.wordpress.com/2011/11/inclusion- fusion-2011-harmony-welcomingenvironments.pdf
  • 8. Space Planning & Sensory Issues  Open check-in area with neutral tones and plotter images to reduce visual clutter
  • 9. Space Planning & Sensory Issues  Vineyard Student Union (middle school and senior high ministry)
  • 10. Communication aides:  Communication keys used to enhance volunteer name tags http://www.keyministry.org/wp-content/uploads/2012/07/PM- Appendix-3r-Sample-Communication-Key-and-Signage.pdf
  • 11. Keys to Behavior Management  Before  During  After
  • 12. Before…  Pray  Create your classroom/respite culture  Encouragement  Expectations  Plan proactively  Physical arrangement of the room  Staffing  Content of the lesson  Pace of the lesson  “In the event of an emergency…”
  • 13. During: First line strategies  Proximity Control  Distraction  Hurdle Help  Antiseptic Bounce
  • 14. During: Next steps  “Grandma’s Law”  Emotional Labeling  Watch YOUR language  Managing other students for safety
  • 15. During: General Rule of Thumb  When a child/youth is demonstrating aggressive behavior that is predominantly impulsive in nature, decreasing the sensory stimulation in the environment is generally helpful  When a child/youth is demonstrating aggressive behavior that is predominantly perseverative in nature, distracting the child as early as possible before the pattern escalates is generally helpful
  • 16. After:  Non-judgmental conversation  Problem-solving  Quiet  Allow for “busy work”  Re-join peers  Communicate with parents
  • 17. How can parents help?  Do share information with ministry team about techniques shown to help prevent/reduce aggression  Do administer medication shown to help reduce frequency, severity of aggressive behavior during church activities (with approval of treating physician)  Do be aware of the concern that aggressive behavior presents with largely untrained volunteers  Doconsider keeping your child home when he/she exhibits aggression that you can’t successfully manage at home
  • 18. What if a child/youth presents too great a risk of severe aggression to attend church?  Support the rest of the family in attending church, participating in discipleship activities  Relational (home-based) respite  Paid in-home child care/buddies with specialized training  Scheduling church activities when child care available  Whose responsibility is the child’s spiritual development?  Church as resource provider to parent?
  • 19. Conclusions:  Kids with reactive aggression can generally be included in existing church programming  Churches may reduce risk of aggression behavior by designing friendly ministry environments  Providing teachers and group leaders adequate training to identify and intervene in potentially risky situations  Ensure sufficient staffing at times of enhanced risk  Traditional church may not be the “least restrictive environment” for some children/youth especially prone to aggressive behavior
  • 20. Provides FREE training, consultation, resources and support to help churches serve, welcome and include families of kids with hidden disabilities
  • 21. Stay in Touch! Key Ministry Website: http://www.keyministry.org Church4EveryChild…Steve’s Key Ministry Blog: http://drgrcevich.wordpress.com Diving For Pearls…Katie Wetherbee’s Blog: http://katiewetherbee.wordpress.com A Reckless Pursuit…Harmony Hensley’s Blog: http://arecklesspursuit.wordpress.com http://www.facebook.com/drgrcevich http://www.facebook.com/pages/Key-Ministry/116940088329098 http://twitter.com/#!/drgrcevich http://twitter.com/#!/KeyMinistry