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Sample Safety Plans

Sample 1

What are the issues?                                                                                  Date:

What the child/family can do to be safe?

Participants in the creation of this plan?

Safety Strategies When to put the strategy in place Person(s) responsible
Easiest Strategy (ie: self calming) this could be as simple as having a favorite stuffed animal, listening to a CD, etc.1)2)3)

More Difficult Strategy

1)

2)

3)

Special Instructions for Support Persons – this could include allergies, sensitivities, physical and mental health issues

 

Sample 2

Attachment to the IEP for (name).                                                             Date:

Developed by: (names of parent, teacher, principal, CYW, SERT, consultant, psychologist, etc.)

Shared with: (involved staff, parents)

Behaviour Triggers Prevention Strategies Interventions
Physical Aggression orVerbal Aggression- hitting- spitting

- throwing objects

- swearing

- negative self-talk

 

- Transitions- Being overwhelmed,frustrated- Anxious

- Close proximity of

others (i.e. line-ups)

- Changes in routines

- State of health & well-

being (is he/she ill?)

- Heightened sensory

stimulation

- Daily routines- Chunking of work- Take a break tickets- Recognize his/her

frustration

- Allow time for de-

escalation

- Give choices

- Limit dialogue

- Take time/space/break

- Appropriate social

skills need to be taught

directly.

- Safe Place to allow forde-escalation.- EA or CYW support- Remove other children

from the room if child

cannot be made to leave

room

- Call Emergency

Response Team

- If being physically

aggressive, parents to

be called in.

 

Inappropriate touching of others - Sensoryoverstimulation- Unaware that act isinappropriate - direct teaching ofappropriate skills - Safe place to talk orde-escalate

 

Sample 3

Attachment to the I.E.P. for student name

Date: current date

Reviewed and revised by: insert everyone who attends meeting here

Shared With:  Above parties, include any names as appropriate, Emergency Response Team

BEHAVIOUR

General:

  • Non-compliance where safety is at risk
  • Physical Aggression
  • Verbal Aggression

Specific:

  • Growling
  • Name calling/ swearing
  • Pushing furniture
  • Within personal space of others (female)
  • Gives unwelcome signs of affection (female)

-   Verbal – “I Love You”, “Mama”, or Physical – hugging/touching

  • Kicking
  • Leaving/running out of school boundaries

TRIGGERS

  • Writing tasks
  • Social Stress
  • Less structured social interactions
  • Transitions
  • Adult demands and pressures
  • Need for justice/ fairness issues
  • Using a “stern” tone of voice
  • Close proximity to others that is not initiated by student name
  • Telling student name “NO” vs. “Let’s think about this” or “STOP”
  • Loud noises
  • Punitive discipline

PREVENTATIVE STRATEGIES

  • Establish cueing system to indicate the need for breaks
  • Teach how to recognize the early warning signs to anger and frustrations

Student name may motion for staff to monitor him from outside the room (space)

  • Closely monitor social interactions to facilitate appropriate social connections
  • Teach social skills
  • Support and structure leadership opportunities
  • Use cooperative vs. competitive activities
  • Coach student name to “take space” during time of stress

Use MP3 player to block out loud noises

Sample Safety Plans (Example 3 continued)

  • Offer gum to help with stress relief
  • Prepare student name for upcoming transitions
  • Speak calmly using a gentle tone of voice
  • Avoid touching and reduce talking to a minimum once overloaded
  • Provide ample “wait time” for student name to process requests
  • Approach problem situations in a collaborative way and encourage student name to generate solutions (i.e. Dr. Ross Green – Collaborative Problem-Solving Approach)
  • When calm explain reasons for adult expectations
  • Use a scribe, AlphaSmart or tape recorder to reduce writing frustration
  • Encourage use of a manipulative (i.e. Stress ball) to assist in focusing
  • Facilitate goal setting as a way to reinforce successes and identify skill focus areas
  • Ensure student name is aware of school boundaries (leaving/running)
  • Establish two safe places with Student name that he is able to go to, to de-stress

-  within the school – designated room/spot

-  outside – primary area benches

INTERVENTIONS

  • Identify an appropriate in-class and out-of-class break location to provide student name with a safe, low stress location
  • Verbalize “student name, are you refusing?” during times of inflexibility/opposition
  • Allow “wait time” for student name to process information and requests
  • Provide Student name with a “wide berth” when he becomes stressed and do not try to de-escalate the situation through close proximity/touching

IN THE CASE OF ESCALATING BEHAVIOR, the following process will be followed:

  • ·     If CYW is not present, do an -ALL CALL – NORTEL 620,

       “Teacher name to location of incident”

  • Redirect behaviour by cueing a break.  Use Break Card to cue an out-of-class break
  • Directed inappropriate language dealt with by immediate withdrawal (2 mins.)
  • Involuntary noises/ language dealt with by using a visual template, which is attached to his/her desk  (three reminders then BREAK)
  • If student name does not respond to prevention strategies and outlined interventions or becomes physical with staff, remove class to an alternate safe area (P20) to allow Student name to de-escalate
  • Provide a “quiet down” reflection time for student name to compose himself after an escalation and provide positive support
  • Once calm, debrief the situation using visual template (CPRI Beaker) *see attachment*
  • Staff will continue to pursue student name as long as he is within school boundaries; once out of sight, police and parents are to be immediately notified

 

STAFF AVAILABLE TO SUPPORT SAFETY PLAN:

Enter names of teachers etc. available to help; Emergency Response Team

RESOURCES: List parents, reports, and other people who have helped, OSR Reports

 

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  • Coach student name to “take space” during time of stress
  • Use MP3 player to block out loud noises