Nonviolent Crisis Intervention St. Joseph’s Regional Medical Center Center for Continuing Education CPI Crisis Prevention Institute

Unit I: Crisis Development Model

How We Act Influence Others

Behavior Levels

1. Anxiety

Staff approach

1. Supportive 2. Defensive 3. Acting out person 4. Tension reduction 2. Directive 3. Nonviolent physical crisis intervention 4. Therapeutic rapport

• Proxemics • Kinesics Exercises

Unit II: Nonverbal Behavior

Proxemics (Personal Space)

An area surrounding your body considered an extension of self. US av: 1 1/2 – 3 ft

Factors that affect how much space we need:

Situation, attitude, illness, familiarity, safety, hygiene, age, gender, etc.

Also extends to personal effects: purse, room, drawers, etc.

Nonverbal Behavior

Kinesics (Body Language)

Nonverbal message we transmit through body posture and motion 1. Facial Expressions: Smile, frown, clenched jaw, eye contact.

2. Posture 3. Gestures: Close to own body, upward motion, slow movements 4. Movement: Fast or slow

Supportive Stance • • • Safety, offers an escape route Non-challenging/ Non-threatening Shows respect Client Staff

Unit III: Paraverbal Communication

Definition

Vocal part of speech excluding the actual words we use. (How we say what we say).

Elements

T

one: Avoid inflections of sarcasm, impatience, disrespect, etc.

V

olume: Keep volume appropriate to situation

C

adence: Rate and rhythm

Communication

I

didn’t

say You

were

stupid

Verbal Paraverbal Nonverbal

Unit IV: Verbal Intervention

Verbal Escalation Continuum

3.

Release

4.

Intimidation

DEFENSIVE

2.

Refusal

5.

Tension Reduction

1.

Questioning

Empathetic Listening • • • • • Definition: An active process to discern what a person is saying

Be nonjudgemental Give undivided attention Listen to facts and feelings Use restatement to clarify Allow silence for reflection

Unit V: Precipitating Factors

Definition

: Internal and external causes of acting out behavior over which staff have little or no control of.

Examples

• Family issues • Health • History • Financial issues • Attention seeking • Fear • Support system • Noncompliance

• Reasons to Understand Precipitating Factors Proactive • Depersonalize • To not become a precipitating factor

Rational Detachment Definition: The ability to stay in control of our own behaviors and not take the acting out behavior personally • • •

Control response Be professional Find positive outlets

Integrated Experience Definition: The behaviors and attitudes of the staff impact the behaviors and attitudes of clients and vice versa.

Unit VI: Staff Fear and Anxiety

Universal Human Emotions

Unproductive

1. Freezing

Productive

1.  in speed and strength 2.  in reaction time 2. Over-reacting - Psychologically Perceiving situation worst than it is.

3. Act inappropriately - Verbally - Physically 3.  sensory acuity

• • • • Ways to Control Fear and Anxiety Know what makes you afraid Don’t respond alone, team intervention Know techniques to keep you and the client safe Learn physical interventions to manage client if necessary

Unit VII: Personal Safety Techniques

STRIKE

(A weapon coming in Contact with target)

GRAB

(An attempt to control/destroy part of one’s anatomy

Kick Punch Thrown objects Spit Bite Hair Pull Choke

Principles of Personal Safety

STRIKE

1. Block the weapon

GRAB

1. Gain psychological advantage A. Stay calm B. Have a plan C. Element of surprise or distraction

Principles of Personal Safety

STRIKE

2. Move the target

GRAB

2.Gain physiological advantage A. Identify a weak point B. Get leverage C. Gain momentum

Unit VIII: Nonviolent Physical Crisis Intervention • Only to be used as last resort • No floor restraints (prevent injury to client such as accidental asphyxia).

• No element of pain • Intent is to calm individual • Team interventions • Used to protect, not to punish

Team Intervention

Crisis Response Team

• 2-5 people per team • Code as inconspicuous as possible • Diversity • Common goal: Care, Welfare, Safety, Security 1. Verbal de-escalation 2. Physical: last resort

Team Intervention

Team vs. Solo Intervention

• • • Why team intervention?

Safety: Two people can handle an acting out individual more safely than one person can.

Professionalism: Team members can lend support to one another during a crisis situation. This allows for staff to avoid perceiving the acting-out behavior as a personal confrontation.

Litigation: Having another person on the scene provides a witness to the intervention.

Team Intervention • • •

Team Leader

The first person at the scene A team member with confidence and competence in handling crisis situations A team member who has good rapport with the acting-out individual

Team Intervention • • • •

Team Leader Duties

A

sses the situation. What steps are necessary?

P D

lan the intervention.

irect or cue the other team members.

C

ommunicate with the acting-out person. To avoid confusion, only one person should talk to the acting-out person.

Team Intervention • •

Auxiliary Team Member Duties

C

heck: * Physical and psychological status of the disruptive individual.

* Safety of the environment/remove dangerous objects.

A

ddress:

*

What needs to happen to de-escalate the crisis.

* Are there any safety concerns.

Team Intervention • •

R

ecognize: * Additional additional assistance when needed.

* Need to change intervention strategies.

E

ngage in: * Verbal de-escalation with acting-out individual. (if directed by team leader) * Support to other team members.

Unit IX: Situational Role-Plays Why do we use situational role-plays?

• Is safe, realistic practice • Learning styles experiential • Confidence • Self-evaluation

Unit X: Postvention

Debriefing Process Client

C

ontrol: Making sure client is calm and rational

O

rient: Establish the basic facts, be non judgemental

P

atterns: Past behavior, triggers

I

nvestigate: Alternatives to inappropriate behavior

N

egotiate: contract written or verbal

G

ive: Responsibility back to client, so he/she can make own decisions.

Unit X: Postvention

Staff

C

ontrol: Calm and rational

O

rient: Establish basic facts

P

atterns: Staff response crisis (+ and -)

I

nvestigate: What to do for next time to strengthen the intervention

N

egotiate: Agree to make changes

G

ive: Support and encouragement

Verbal Intervention

DO

• Remain calm • Listen!!!

• Be supportive • Watch paraverbals • Directive, set limits • Assist • Be consistent • Give choices

DON’T

• Over react • Take it personally • Invade their space • Minimize • Be defensive • Get in power struggle • Fake attention • Be threatening

•

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