Transcript Crisis Prevention Institute Non

Crisis Prevention Institute
Non-Violent Crisis
Intervention
Presenters:
Ellen Peden, M.C.E.S.A
Dan Simonds, Midland Public Schools
Before we begin, you should have the following:
•CPI Workbook
•Two Day Schedule
•Corporal Punishment Guidelines
•Participant Due Care Packet
•Post Vention Handout
Please make sure that you sign in on each day
Purpose of this Training
a.
Ensure the care and welfare, safety, and
security of your student and yourself.
b.
Teaches staff to recognize various stages of
a crisis situation.
c.
Teaches staff the most effective way to
respond to a crisis situation.
d.
Teaches you to sharpen your skills in
defusing a crisis before violence occurs.
e.
This training will make you feel more
confident about keeping yourself and others
safe when a person loses physical control.
Participant Introduction
•Who are you?
•Where do you work?
•What do you do?
•What do you do to take care of yourself?
•We can loose control Verbally and Physically
•Each require a different response from staff
•In this training you will be learning:
a. A set of strategies to use with people
who
are verbally acting out
b. A another set of strategies to use
with
people who are physically acting out
There are levels of behavior an individual experiences
when becoming agitated and there are also
appropriate
staff responses to each of those behavior
levels
Crisis Development Model
Anxiety
Defensive
Acting out person
Tension reduction
Supportive
Directive
Use of non-violent physical crisis int.
Therapeutic Rapport
“Previous Planning Prevents Poor Performance”
Behavioral Escalation Continuum
“As behavior excalates so does the intensity”
One of the goals of Nonviolent Crisis Intervention is to find
positive ways of dealing with crisis so that they are not
traumatic (or so that the degree of trauma is lessened)
Crisis can be a learning experience for everyone involved and
the results can lead to growth and change
The overall philosophy and goal of this training
is to provide the best possible
care
welfare
safety
security
for everyone involved in a crisis
Safety
Security
Care
Welfare
S
S
C
W
How CPI training assists with acting out behavior
•It is when people become agitated and begin to act
out that staff may have less confidence in their abilities
to handle the situation they encounter
•We are all agitated individuals at times most of us
have some skills to cope with that agitation
•Our role is to keep them and ourselves safe during
such episodes
•One way we can do this is to recognize the early
signs and to intervene early to head off difficult
behavior before it escalates.
Crisis Development Model
“When most of us think of a crisis, we probably think of
the moment when a person releases a great deal of verbal
or physical energy, such as yelling and swearing or
hitting and kicking. BUT almost every crisis begins long
before that moment.”
Crisis Development Model
•When we look at nonviolent crisis intervention we need to look
at how an individual loses control
Verbally or Physically
•We as staff need two options of intervention for these behaviors
-Verbal Intervention or De-escalation Techniques
-Use of Non-Violent Physical Intervention
•When we look at this model we look at behaviors student’s
go through during the escalation process and also the
intervention steps that staff can follow
•The CPI model is a way of understanding how a crisis
situation evolves through a series of changes and how our
response to each stage has an effect on the outcome
-Identifies a student’s behavior and the staff response
-If we determine a level it gives us an idea where to begin
-We do not have to go through all the levels
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Anxiety: is a noticeable increase or change in behavior
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Supportive: An empathic, nonjudgmental approach
attempting to alleviate anxiety
How we support depends on three things:
a. The type of support we are comfortable giving
Huggers, Listeners, Problem Solvers , Humor
b. The type of support the other person responds to
Students may need to cry, vent, be held, given space
c. The degree of rapport, if any that we share with the
student
Varies with each student
Recognize normal behavior
Observe anxiety through nonverbal behavior
Key Points: Anxiety/Supportive
•Recognize normal behavior
•Notice change in behavior (could be a sign of anxiety)
•Non-verbal signs could be a good indicator of a potential crisis
•This is the safest and best opportunity to prevent behavior
•Avoid overlooking signs of anxiety
•Be proactive-demonstrate a supportive response
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Defensive: The beginning stage of loss of rationality.
At this point an individual often becomes
belligerent and challenges authority.
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Directive:
An approach in which a staff member takes
control of a potentially escalating situation
by setting limits.
Setting Limits
-Setting limits is empowering
-Teaches accountability
-Gives the student a choice
-Helps keep our hands off people
-May prevent further intervention
Three keys that will assist us that our limits are reasonable
1.
Make limits clear, simple and understandable
2.
Be Concise
3.
Make sure limits are enforceable
Key Points: Defensive/Directive
•Recognize irrational behavior
•Maintain professionalism-don’t allow students to push buttons
•Give simple & clear instructions
•Limits must be enforceable
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Acting Out Person
Acting Out Person: The total loss of control which often
results in a physical acting out
episode.
May use necessary, reasonable physical force upon a pupil:
•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 cease from further disruption.
•To act in self defense or the defense of others.
•To prevent the infliction of harm on the pupil or another.
•To quell a disturbance that threatens physical injury to any person
•To obtain possession of a weapon or dangerous object upon or within
the control of the student.
•To protect property
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Acting Out Person
Nonviolent Physical Crisis
Intervention
Nonviolient Physical Crisis Intervention:
Safe, nonharmful control and restraint techniques used to
safely control an individual until he can regain control of
his behavior. These techniques should be utilized as a last
resort, when an individual presents danger to self and
others.
Key Points:
Acting Out Person/Nonviolent Crisis Intervention
•It is unlikely that the acting out student will respond to
a supportive or directive staff attitude. In fact this person
may not even hear the words spoken. Verbal intervention
may no longer be an option.
•Physical intervention is used as a last resort and
should never be used as a form of punishment.
•Ensure the care, welfare, security, and safety for the
student and yourself.
•Acting out behaviors should not be taken personally
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Acting Out Person
Nonviolent Physical Crisis
Intervention
Tension Reduction
Tension Reduction:
Decrease in physical and emotional
Energy which occurs after a person
has acted out, characterized by
regaining of rationality.
Behavioral Escalation Continuum
“A drop in normal behavior”
Characteristic of Tension Reduction
•Everyone eventually calms down.
•Decrease in physical and emotional energy.
•Often the student feels embarrassed, scared, confused
or remorseful.
•Can be a teachable reachable moment.
Behavior Labels
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Acting Out Person
Nonviolent Physical Crisis
Intervention
Therapeutic Rapport
Tension Reduction
Therapeutic Rapport: An attempt to reestablish
communication with an individual
who is in the tension reduction stage.
If we handled the crisis appropriately throughout the crisis
situation it can turn into a productive-learning experience
rather than that of a traumatic one.
-Therapeutic Rapport gives time for reviewing the crisis
situation or the true reason for the acting out behavior:
Why it happened
What led up to it
How can we help the individual deal with it
Can we help them alleviate what caused this behavior
How can similar crisis be avoided in the future
Can we teach them coping mechanisms or skills
How can we give them the human dignity that they
deserve
“We may not be able to eliminate all future crisis, but we can look for ways to
make them shorter, less intense, and less frequent”
Key Points:
Tension Reduction/Therapeutic Rapport
•Reduction of physical and emotional energy
•Can be a teachable moment by reviewing the crisis situation
•An opportunity re-establish trust and respect
Crisis development is an integrated experience
-What you say and what you do affects others and visa-versa
Anxious people
need
support
Defensive individuals
require
direction and limits
A person who loses control and acts out physically
needs
to
Someone to physically maintain control to prevent harm
themselves and others
A person experiencing tension reduction
needs
therapeutic rapport
Key Points:
Crisis Development Model
Crisis Development
Staff Attitude/Intervention
Anxiety
Supportive
Defensive
Directive
Acting Out Person
Nonviolent Physical Crisis
Intervention
Tension Reduction
Therapeutic Rapport
The CPI model is a way of understanding how a crisis situation evolves through
a series of changes and how our response to each stage has an effect on the
outcome.
The CPI Crisis Development model identifies the student’s behavior and the
staff attitude or response.
a. If we can determine a level--it gives us an idea where to begin
b. We do not have to go through all the levels
Break
Nonverbal behavior
• Despite our highly developed language
skills, as much as 80% of our
communication is estimated to be
nonverbal In the context of intervening
with a person experiencing anxiety, an acute
awareness of nonverbal messages becomes
essential
Proxemics (personal space)
• Proxemics or personal space varies
depending on who is approaching and what
the context of the situation is.
• Personal space on the average is 2-3 feet
• Personal space varies based on the level of
rapport
Proxemics exercise
Proxemics
Many factors effect the amount of
personal space one may need.
Gender, size, culture, background, authority,
appearance, hygiene, environmental moods,
eye-contact
Kinesics
(Body posture and motion)
Kinesics include: facial expressions,
gestures, posture, and movement.
The way we move and position our body in
relation to another person has a direct impact
on the message we deliver.
Supportive Stance
1. Communicates respect by honoring personal space
(2-3 feet is the recommended guideline)
2. Is nonthreatening, nonchallenging, and offers an escape
route (by standing off to the side).
3. Contributes to the staff’s personal safety if attacked
(provides a margin of safety of at least 2-3 feet).
By turning sideways you are keeping the most vulnerable
areas of your body, such as your groin, chest,stomach, knees
and shins, protected.
Tips for supportive stance
1. Keep hands close to the body
2. Palms up rather than palms down
3. Keep hands out in the open
Kinesics (body posture)
• Your body posture can
• escalate or deescalate
a situation
• increase or defuse
anxiety
• avoid the need for
higher level
intervention or invite
it
Kinesics
A staff member has the option during a potential
crisis to defuse the situation simply by taking the
time to
And
Check
Yourself
Key Points
• Personal space can
effect anxiety levels.
• Body posture and
motion effect anxiety
levels.
• Awareness of
nonverbal
communication can
de-escalate anxiety
PARA VERBAL COMMUNICATION
•Para verbal communication is “how we say what we say”.
•The manner in which we alter our tone, volume, and rate.
•“How does Para verbal communication assist us with
dealing with disruptive behavior?”
•People in crisis situations begin to lose rationality.
When this occurs, they respond to more basic levels
of communication.
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
THREE COMPONENTS OF PARA VERBAL COMMUNICATION
Tone: A sound of distinct pitch and quality
Volume: The amplification or loudness of a sound or
word(s).
Cadence: How fast or slow a message is delivered
We want to demonstrate control
We are not trying to control the
individual’s behavior but we are
telling our students that we have
professional control especially
over ourselves.
If we graph out an individual’s verbal behavior
in the defensive stage it would be erratic with
highs and lows
If the staff’s verbal behavior is similar,
what are we telling the student?
We have no more control than they do..so
how can we possibly help them?
7 simple words that we can keep in the same order
but we can make that statement say several things
I didn’t tell Tom you were incompetent
The words are the same but the meaning
is different
Paraverbal along with nonverbal
communication will help get our
messages through
Key Points
•“Para verbal communication is “how we say what we say”
-Your voice, including its tone, and rate of speech,
significantly affects the meaning behind your words.
•Think about how we sound
-This can contribute to how we can de-escalate a
behavior
-We don’t want to contradict Para verbals with nonverbals
-Nonverbal and Para verbal communication should be
consistent with the message you want to deliver.
•Coupled with non-verbal communication Para verbals
“package” your verbal intervention
Break
Key Points
1. Staff may not be able to control precipitating
factors, but they can control their own response
to the acting out behaviors which result.
2. A professional attitude must be maintained so that
we may control the situation without overreacting
or acting inappropriately
3. Staff need to find positive outlets for the negative
energy absorbed from acting out individuals
Questioning
Questioning
Questioning is one of the first behaviors we see in
a person who is escalating in the defensive level
There are two types of questions
that are apparent at this level
1. INFORMATION SEEKING
2. CHALLENGING
Information Seeking
1. A rational question seeking a rational response.
A legitimate question seeking information, clarification
or satisfying curiosity.
2. Do not assume that the person
understands why your directive is
being issued.
Intervention: Give them an
answer to their question.
Challenging Questions
These questions are to question authority
or to be evasive.
These questions: Challenge authority
are used to manipulate people and
situations, and are used to take
the focus off the student.
Intervention: Assist the student to refocus,
stay on the topic, (broken record technique),
negotiation (we’ll talk about that later).
Refusal
Questioning
Refusal
The next stage commonly observed in a person who
is verbally escalating is refusal
Characteristics of Refusal are:
1. Noncompliant behavior
2. Defiance
3. Tempting you to engage in a power struggle.
4. Button pushing
Interventions for Refusal
!. Ask the student “Why won’t you do that?”
2. Set Limits: Clear, Simple, Reasonable,and Enforceable
3. Allow time: We all need time to make a competent
decision, back off and release some pressure.
Release
Refusal
Questioning
Release
Acting out, emotional outburst, loss of rationalization
venting, screaming,swearing, High energy output
Interventions for Release,
1, Allow venting, if possible,
2.Remove audience or acting out individual from the area
3.When individual begins to calm down
state directives that are nonthreatening.
4.Use an understanding reasonable approach
5. Be prepared to enforce any limits you set.
Release
Intimidation
Refusal
Questioning
Intimidation
Characteristics are: Individual is verbally and/or
nonverbally threatening staff in some manner. Hands
on approach at this time may trigger physical acting out
behavior.
Interventions:
1. Seek assistance and wait for team to intervene, if possible.
2. Try to avoid individual intervention as this is more likely to
jeopardize the safety and welfare of both staff and student.
If a person displays aggressive behavior that jeopardizes the safety
of you, others or property, then, nonviolent physical intervention
may be used as a last resort.
Release
Intimidation
Therapeutic Rapport
Refusal
Questioning
Tension Reduction
There is a drop in energy that follows every crisis situation
Interventions: Establish therapeutic rapport-- reestablish
communication with the individual.
Release
Intimidation
Therapeutic Rapport
Refusal
Questioning
Verbal Intervention Tips and Techniques
Dos
1.
2.
3.
4.
5,
6.
Remain Calm
Isolate the situation
Enforce Limits
Listen
Be aware of nonverbals
Be consistent
Don’ts
Overreact
Get in a power struggle
Make false promises
Fake attention
Be threatening
Use jargon that confuses
the student.
EMPATHIC LISTENING
1. BE NONJUDGEMENTAL
2. GIVE UNDIVIDED ATTENTION
3. LISTEN CAREFULLY TO WHAT
THE PERSON IS REALLY SAYING
(FOCUS ON FEELINGS, NOT JUST
FACTS
4. ALLOW SILENCE FOR
REFLECTION
5. USE RESTATEMENT TO CLARIFY
MESSAGES
Lunch
Precipitating Factors
The internal or external causes of an acting out behavior
over which a staff member has little or no control.
We as staff have very little control over these factors
Behavioral Escalation Continuum
“Events and/or experiences that occur before the behavior ever begins”
Precipitating Factors
•“Antecedent of Behaviors”
•Precipitating factors come in many different forms.
(Insomnia or hunger or pain)
•Think of how your behavior changes when you don’t
get enough sleep or when you have a severe
headache.
•For a person with limited coping skills these factors
may be enough to cause an episode of acting out
behavior.
Understanding precipitating factors can positively
affect a staff person’s attitude and action
The list is endless because people are so different!
Peer Pressure
Hormonal Changes Displaced Anger
Lack of supervision/discipline
Substance Abuse
Physical Abuse Pain Communication Difficulties
Physiological
Death Low self-esteem
Lack of Sleep
Attention Seeking
Health
Divorce
Change Psychological Academics
Hunger Loss of personal power Money
•As staff members we have very little control over many
of these factors.
•Sometimes we don’t even know which factors are at
work in a given situation.
•Sometimes we are seen as a safe and convenient target
for the person who is disruptive or even assaultive.
•KNOWING THESE BEHAVIORS AND THE BIG
PICTURE ALLOWS US TO SHOW SOME COMPASSION,
HOWEVER THIS DOES NOT JUSTIFY BEHAVIOR
Knowledge of Precipitating factors assist us in
building a positive staff attitudes
1. Prevent acting out behavior by being proactive
2. Depersonalize crisis situations
3. Avoid becoming a precipitating factor ourselves
(Rational Detachment)
Behavioral Escalation Continuum
“Events and/or experiences that occur before the behavior ever begins”
Being Proactive
Attempting to eliminate or elevate precipitating factors
1. Knowledge of Precipitating Factors allows us to anticipate when
a
student might become agitated
2. This anticipation allows us to be prepared
3. By feeling prepared staff will feel more confident and less desperate
4. Allows staff to understand where the student is coming from or
their
aggression
5. Assists us in depersonalizing the situation
Depersonalizing
Understanding precipitating factors can help us
recognize that we are seldom the cause of acting out
behavior
1. We are seldom the cause of acting out behavior
2. We want to avoid taking an acting out behavior as a personal attack
3. Another name for depersonalizing is rational detachment
Rational Detachment
The ability to stay in control of one’s behavior and
not take acting out Behavior personally
1. The ability to control your own feelings
2. The ability to stay calm, objective and professional
3. We can prepare to rational detach ourselves from stressful situations
by taking good care of ourselves
QuickTime™ and a
Cinepak decompressor
are needed to see this picture.
Key Points
1. Staff may not be able to control precipitating
factors, but they can control their own response
to the acting out behaviors which result.
2. A professional attitude must be maintained so that
we may control the situation without overreacting
or acting inappropriately
3. Staff need to find positive outlets for the negative
energy absorbed from acting out individuals
UNIT IV: STAFF FEAR AND ANXIETY
Fear and anxiety are universal
emotions.
Our response to them is both
psychological and physiological
Nonproductive reactions to fear/anxiety include:
A. Freezing- inability to react to a situation (i.e. stage fright)
B. Overreacting
1. Perceiving that a situation is worse than it really is
C. Responding Inappropriately
1. Verbally-saying things that are not pertinent to the situation,
using obscene or vulgar language
2. Physically- striking out at someone, not being able to control
our actions.
Productive reactions to fear and anxiety include:
1.
2.
Increase in speed and strength
additional adrenaline in the bloodstream
can induce super human strength.
Increase in sensory acuity- special
alertness or sharpening of our senses.
3. Decrease in Reaction Time we respond
more quickly, than in normal situations.
Ways to control fear/Anxiety
• 1. Understand what
makes us afraid.
• Learn techniques to
protect everyone.
• Use a team approach,
don’t respond alone.
• Learn techniques to
control acting out
individuals.
Fear and Anxiety
• Our goal is not to
make you fearless, but
to use the energy
produced from fear in
a positive way by
improving our
responses to crisis
situations.
Break
DUE CARE FOR PARTICIPANTS
* We will treat each other as peers.
* We are all responsible for each other’s safety.
any
* You are responsible to gauge for yourself
past/current injuries and your comfort level. If
you have any concerns, please see us.
* Horseplay will not be tolerated.
my
* In all exercises, you will act only on
command/direction.
* You must report all injuries to me immediately.
* Cooperate, don’t compete. (No points for style).
* Take off all jewelry.
Personal Safety Techniques
There are two types of personal attacks:
A STRIKE & A GRAB
Strike: a weapon coming in contact with a target
Examples: hit, punch, kick, shove, spitting,
throwing objects, use of weapons
Grab: any strike that holds on
the control or destruction of a part of one’s anatomy
Examples: wrist grab, hair pull, chokes, bites,
pinching, tackle
“Every attack usually falls in these two categories (strike/grab)”
“Being able to identify a strike or a grab can lead to how one will react”
Principles of Personal Safety
A. Strike
1. Block (or deflect) the weapon.
2. Move the target
These are natural, instinctive responses to a strike
Principles of Personal Safety
B. Grab
1. Gain a physiological advantage by using the following:
a. The weak point of the grab
b. Leverage
c. Momentum
2. Gain a psychological advantage by remaining in control of
your behavior. Do this by:
a. Stay calm
b. Have a plan (knowing what to do when)
c. Using an element of surprise or distraction
In contrast to a strike, these may not be natural,
instinctive responses. Our instinctive response to a
grab usually is to pull away which is not as effective
and may increase injuries.
Video: “Reading, WRiting, and Weapons”
End Of Day 1
Video: “the disRuptiVe adolescent”
DUE CARE FOR PARTICIPANTS
* We will treat each other as peers.
* We are all responsible for each other’s safety.
any
* You are responsible to gauge for yourself
past/current injuries and your comfort level. If
you have any concerns, please see us.
* Horseplay will not be tolerated.
my
* In all exercises, you will act only on
command/direction.
* You must report all injuries to me immediately.
* Cooperate, don’t compete. (No points for style).
* Take off all jewelry.
Break
TEAM CONTROL DYNAMICS
Reduce Upper Body Strength by controlling arms as weapons
A. Turning Palms Up
B. Raising Arms above the shoulders
C. Anchoring Arm on Hip
Reduce Lower Body Strength by controlling the back incline
A. Lowering shoulders below hips
Reduce Mobility by Close Body Contact
Video: “team inteRVention”
TEAM LEADER DUTIES
1.
Assess the situation
a.
b.
c.
d.
e.
f.
What level of intensity/How dangerous is
How many
Who is involved
Bystanders
Any weapons
Is outside help necessary
2.
Plan the intervention
a. One that is willing to make a decision
-What to do
-Who to contact
3.
Direct or cue the other team members
4.
Communicate with the acting out individual
Quic kTime™ and a
dec ompr es sor
are needed to s ee this pic ture.
“You may not get it right the first time
but keep practicing until you feel comfortable”
Lunch
Postvention
During a crisis a tremendous amount of energy is built
up, then expended by the acting out person. This high level
of energy can not last forever and finally dissipates, and the
individual begins to calm down.. This final behavior level
is called Tension Reduction.
Postvention is reestablishing a relationship with the person that
has acted out. Another name for this is establishing
Therapeutic Rapport
This is the final step of providing an individual with care, welfare,
safety and security.
The second part of postvention involves the Tension Reduction
that is experienced by staff members- who have also expended
a great deal of energy during the crisis. Debriefing allows
staff members to discuss both the facts and their feelings.
Postvention leads to a focus on prevention
It gives the staff an opportunity to focus on
What happened? How did the staff respond?
How could the intervention have been better
handled? How can we prevent this situation?
The CPI COPING MODEL
Control
Orient
Patterns
Investigate
Negotiate
Give
Control
Make sure that staff and the person who
acted out are back under emotional and
physical control
Orient
Orient yourself to the basic facts. What
happened? Be nonjudgmental; listen to
the perspective of the acting out person
Patterns
Look for patterns of past behavior
Investigate
Investigate alternatives to the inappropriate
behavior and resources that could be helpful in
making behavioral changes
Negotiate
Negotiate a contract with the acting out
individual. Make sure that the person understands
what she can do instead of displaying inappropriate
behavior.
Give
Return control to the person that is
acting out. Give her back the
responsibility to control her own
behavior, along with your support and
encouragement
COPING, FOR STAFF
CONTROL
Be sure that the staff members are back in
control before discussing the incident
Orient
Establish the basic facts of the incident
team members may have arrived at different
points in the intervention and may have
observed and hear events differently
Patterns
Review the staff response to the crisis situations.
Are there patterns in the way the team responds?
Investigate
Look for ways to strengthen individual
and team responses to crisis situations
Negotiate
Agree to changes which will improve
future interventions
Give
Provide one another with support
and encouragement. Express trust and
confidence in fellow team members
Break
Role Play