Transcript Advanced De-Escalation of Teens and Young Adults

Advanced De-Escalation of
Teens & Young Adults
CITI 2012
Emily L. Ribnik, M. Ed, PCC-S
Emily L. Ribnik, PCC-S
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Degrees in Psychology and Counseling
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Professional Clinical Counselor Licensed since 2008
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5 years experience in emergency mental health and risk assessments –
ages 6 to 90 years old
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CIT certified since 2007
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5 years experience teaching in CIT classes and presenting at CITI
conferences
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7 years experience working with first responders, veterans (Vietnam,
Desert Storm, Iraq, Afghanistan)
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Currently the mental health clinician for Kent State University at Stark – 1
of me and 4500 of them
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A.L.i.C.E. certified Instructor
Training Objectives
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Teens Today
Teens in Crisis and Types of Crises
Negotiation and De-escalation
Situation Specific Issues
Review of Priority Recommendations
Q/A
Where does de-escalation start?
Advanced de-escalation skills begin with
advanced, more refined ability to identify the
situation, and subject, that you are going to
de-escalate
Teens Today
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15 – 24 years old
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Age of onset for multiple severe mental health issues –
Bipolar, Schizophrenia, Psychotic features
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Referred to as Generation Me, the Tech Generation, and
Millennials
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Self-prioritize, zero tolerance for delay/wait, high emphasis on
relationships, tech savvy, saturated by media, multi-taskers
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More likely to question, challenge and confront commands or
directives that do not have an explanation – or what they feel is an
explanation
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Currently make up all the students from pre-K to traditional
Undergraduate and Master’s level college courses
Teens in Crisis
A real, or perceived, dramatic emotional or circumstantial
upheaval in one’s life…cause, or will appear to cause,
multiple negative changes and, although may build, will
occur suddenly and abruptly.
Same definition….
Different presentation
• Developmentally lack coping skills
• Associate external stimuli with emotional response
• Already less rational and more emotional before the crisis
• Easily escalates due to self prioritizing and zero tolerance for
delay/wait
– Specifically, this impacts the ability to have any future orientation…. At
all
• Act out quickly, emotionally and irrationally
• Although highly emotional, may tire out much faster than an adult
Impact on De-Escalation
With adults, you start with an advantage as a
police officer or authority figure.
You will not have this advantage with a teen.
o Faster, less predictable pace
o Faster reactive processing and response
o Very clear, straight forward agenda by teen
o More genuine reactions – typically have less skill in “masking” when in
crisis
o Teen will struggle to grasp or respond to future orientation, and will very
stubbornly emphasize the present
All of this impacts your physical set-up and approach
Types of Crises
Suicidal vs. Aggression
Either could escalate to a barricade or hostage
situation
Similar cause: a need not being met
The Four “Teen Needs”
1) Love and belonging
2) Power and importance
3) Fun and pleasure
4) Freedom and choice
Suicidal Behavior
Risk factors for suicidal ideation
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Mostly similar as adult risk factors
Fewer, less developed coping skills
Emphasis on relationships
Emotional reactions more closely linked to
perceptions
• Media saturation
• Privately suicidal can become publicly suicidal very
quickly, and NOT initiated by the teen
Suicidal Behavior
3 main factors in attempting/completing suicide:
1) Thwarted belonging
2) Real or perceived burdensomeness
3) Fearlessness
These factors are what you look for to find your hook
Aggressive Behavior
Why do teens become, or “turn to” being,
aggressive?
o Anger is empowering
o It may be the only (perceived) option left to
use in order to meet a need
Types of Aggressive Behavior
Emotional vs.
Deliberate Aggression
Emotional Aggression
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More common in teens
Loud and attention grabbing
Comes in waves
Typically does not have a plan or long-term agenda
Typically short-lived, but repetitious
Deliberate (or Planned) Aggression
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Less common, but more destructive
Has thought and agenda
“Simmering to a boil”
Specific outcome desired
Emotional Aggression can escalate to this, but
typically remains impulsive
De-escalation & Negotiating
with any Teen
• You will not have the advantage of automatic trust and
compliance from a teen just because you are a police
officer or authority figure – in fact, you may feel more
challenged and questioned which will be unusual for you
• Remove the audience – specifically limit media exposure
• This will include telling families and peers to not make contact
with the teen unless you are with them to supervise
Technology: Don’t fight it.. USE it!
• Will find names or even cited events
• Look up information in recent posts, blog entries and photographs
• May help you find a supportive person in their life
• However, remember anything you say can and will be looked up by
the teen
• Limit media exposure
• Be in contact with your secondary via texts and images – you want
to avoid looking like you are multi-tasking
• Technology confiscation – ie. Cell phone
Visuals and Visibility
• Any hint at posturing can damage the rapport you are
building
• Be aware of jaw clenching, hiding your hands, and rigid
walking
• Slow down hand movements
• Try to limit how many people are visible to the teen – it is
another stimuli that you can reduce
Voice
• Aim for an even, real tone – a very low tone may be
perceived as anger or frustration
• Explain, Explain, Explain and Explain some more – it will
feel excessive to you
• Be careful of association statements and arguing
• corrections (“I didn’t say…), because regardless – that is what they
heard
• “I know how you feel” because you don’t – instead try to put out
stories and information that aligns with teen’s experience
Voice
• Say names and avoid pronouns
• Stay in the present – you could get stuck in the past,
and teens struggle with future orientation
• Ask their opinion and work towards them making
decisions and finding solutions
• Remember – de-escalation is about joining with the
person
Specific Situations
Some situations call for some additional advanced
skills, suggestions and recommendations.
• Suicidal
• Aggression
• Psychosis
Suicidal Behavior
• Rapport – needs to be doctor/patient, not friend
• Can give the impression that you are doing things for the teen you
don’t usually do
• Remember – this generation expects and wants to be treated like they
are “special”
• Can build rapport without becoming a friend
• The idea is to partner with the teen and allow them to feel they are
leading and that they are regaining some level of power/control that
they feel they have lost
Suicidal Behavior
• Identifying rank if it has benefits
– This is completely your call
– Remember, they can look it up anyway
– Can support the idea that you are in a position
to help them
Suicidal Behavior
• Set up multiple observers that can communicate with
each other
– Watch agitation level – reactive and escalating aggression
can happen if the teen feels forced, minimized, or has lost
face/control (or perceives any of this)
– Talk vs. behavior “dissonance” – if the teen talks calmly on
the phone, BUT is behaviorally aggressive/agitated when
not in contact, this could indicate
• the possibility of a vindictive suicide or suicide-by-cop
• The stronger possibility of an agenda
Suicidal Behavior
• Avoid trading/bargaining – offer choices instead or ask for
suggestions
• Instill hope
• Empathize and try to find a personal connection – even if
tenuous
– Do NOT state “I know how you feel”, this WILL sever everything
you have built because you have taken the feeling away from
them
Aggressive Behavior
• First, determine which aggression you are
dealing with
• If you don’t know, or don’t have enough
information, start with the skills for emotional
aggression – they will quickly show you if it is
deliberate aggression
Emotional Aggression
• Remember – a staple of this aggression is that it will come
in “waves”, so be prepared to adjust and “go with the flow”
• May take hostages – however, this will typically be a
reactive impulse
– The danger is that once they have a hostage, they will panic
because they didn’t want or plan to
Emotional Aggression
• Do not force a contact/conversation – it can escalate
the aggression
• Instead, consistently provide reassurance that you are
there and available when (not if) they want to talk
– Announce out loud (megaphone or building speaker) when
you are going to call – it allows them to decide whether
they want to talk to you at that time
– Allow silences
Emotional Aggression
• Literal Reflective Listening
– Allows venting, checking accuracy, being a “sound
board”
– Gives teen ability to hear what they said and think
about it
– Repeating exactly what was said sounds strange,
which can interrupt an behavior cycle
Emotional Aggression
• Literal Reflective Listening
– Long pauses or the teen asking why you are repeating
what they are saying is a signal of openness for
conversation
– Always use an explanation
• “I was repeating it to make sure I was hearing what you were
saying”
• “I wanted to repeat it to make sure I was understanding you”
Emotional Aggression
• Offer suggestions
– Only for the immediate situation – remember, they will struggle
to connect with future orientation
– Only after prompting the teen to provide acceptable options
– If the teen’s answer is “I don’t know”, that is typically a sign that
they are open to other suggestions and is your signal to provide
some
• “I don’t know” is often genuine – look at how they are acting
Emotional Aggression
• Agenda?
– Typically, one will not exist due to impulsivity of the
aggression – which you can work to your advantage
• Can be used to help with releasing hostages because “that wasn’t
planned – we don’t have to keep going in that direction”
– “Unknown agenda”
• This is the idea that although they do not have a conscious
agenda, they need to express or release the emotions
• Once this expression or release has completed – remember the
waves – the aggressive behavior is also completed
Deliberate Aggression
• Remember – there is a reason and agenda behind the aggression
– Seen more in shooters and hostage takers
– Meeting their real or perceived “unmet need” is the agenda/goal
– Genuine agenda – work WITH it, not against it if possible
– The agenda = your hook
– Clearest indicator that it is Deliberate Aggression
Deliberate Aggression
• Techniques are progressively more direct
– Remind – subtle, verbal hint that the behavior is not
acceptable
– Warn – State consequences if there is not compliance
– Confront – Clearly, firmly state the situation/behavior
and an instruction
Active Shooter
What’s their agenda?
• Power and importance
• Mass media attention, historical significant, get in to
Wikipedia
• Hurt or kill a specific person
• High body count
• “Beat Columbine”
Active Shooter
Response
– Minimize loss of life and availability of targets
– A.L.i.C.E.
– Most law enforcement follow “first response” or “solo
engagement”
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An individual officer/responder will enter and attempt to engage/eliminate the threat (shooter). They
will not wait for backup, SWAT, approval, or medical response preparedness
– Law enforcement response will focus on the shooter, not aiding
others present
– Do not expect negotiations or de-escalation
Psychosis
• Reduce stimuli as much as possible – including your
own movements and gesticulations
• Emphasize participation, choice and decision-making
• Expect non-linear communication
• Hallucinations
– Possible visual signs – shaking head a lot, hitting head, eye
darting, sudden looking around, excessive jumpiness,
talking to self (could also be stress)
Psychosis
• Delusions
– May initially appear to be assumptions or
generalizations
– Find “work-around”
– Monitor for incorporation
Priority Recommendations
• Social Media
– Have a non-personal log in for common sites
(Facebook, Twitter, MySpace)
– Ask family and peers if there is another site that
teen uses (ie. My Yearbook)
– Specifically tell family and peers to NOT message
teen during the negotiation
– Consider options for cutting off access if possible –
turning off power, turning off wi-fi
Priority Recommendations
• Significant reduction of ALL stimuli
– This could include social media to cut out
“audience” factor
– Look at privacy options
– Stimuli includes lights, sirens, number of people,
etc.
– If possible, keep media the farthest back
– Rope off as large an area as possible
Priority Recommendations
• Use technology - Utilize text and image messages on
your phones so it does not overtly appear you are
multi-tasking
• Use names – try to avoid pronouns
• Use explanations – it will feel excessive, but this is a
primary thing in de-escalating teens
• Remain in the here and now – teens will struggle to
connect with future orientation
Priority Recommendations
• Remember – Anger is empowering and
aggression may be the last (perceived) option
– Identify the type of aggression
– One of their needs is not being met
– Identifying which need will give you your hook for
negotiation and de-escalation
Readings & Information
Why People Die by Suicide – Dr. Thomas Joiner, specifically Ch 2 about acquiring fearlessness
De-Escalating Juvenile Aggression – Jeffrey S. Golden, J.D. (www.policechiefmagazine.com – May 2004
Archives)
Classroom De-Escalation – An Unnatural Act! – www.keepschoolssafe.org
A.L.i.C.E. Trainings – www.responseoptions.com
Active Shooter: How to Respond – U.S. Department of Homeland Security 2008, www.dhs.gov
Guide for Preventing and Responding to School Violence – Bureau of Justice Assistance and International
Association of Chiefs of Police, www.theiacp.org
Why Teens Kill: Warning Signs, Causes, Triggers and Prevention – Phil Chalmers, www.philchalmers.com
Emily L. Ribnik, M. Ed, PCC-S
[email protected]
Office: 330-244-5048
Cell: 330-990-6963
6000 Frank Avenue NW
North Canton, OH 44720