Crisis Development Model
Individual Behavior Staff Attitude
- Anxiety 1. Supportive
- Defensive 2. Directive
- Acting Out 3. Non-Violent Crisis Intervention
- Tension Reduction 4. Therapeutic Rapport
Anxiety
A noticeable increase or change in behavior
Supportive
An empathic, non-judgmental approach attempting to alleviate. (Listening, take a break)
Defensive
Beginning stage of loss of rational. (Belligerent, Challenging)
Directive
Staff takes control of the potential escalation. (Timer, Walk)
Acting-Out Person
Total loss of control.
Nonviolent Crisis Intervention
Restraint is last resort
Tension Reduction
Decreases in emotional and physical energy that occurs after a person acts out, regaining rational.
Therapeutic Rapport
Crying, falling asleep, apologizing, hugging.
Proxemics
1 1/2-3 feet space (depends on size, gender, cultural)
Paraverval Communication
Tone, Volume, Candance
Verbal Escalation Continuum
Question, Refusal, Release, Intimidation, Tension Reduction
Questioning
Information seeking
Challenging- questioning authority, evasive, attempting to draw staff in
Questioning interventions
give arational response
stick to the topic, ignore the challenge
Refusal
non-compliance, loss of rational
Refusal Interventions
set limits- First…Then
Release
verbal acting out and emotional outburst
Release interventions
allow student to act out, remove audience
Intimidation
verbal/nonverbal
Intimidation Intervention
seek assistance, avoid hands on, take it serious
Tension Reduction
A drop in energy, low level defensive
Verbal Intervention Techniques
calm, isolate situation, enforce limits, listen, be aware of non verbal, consistant
Empathic Listening
active process to discern what the person is saying.
non-judgmental, undivided attention, listen carefully, allow silence, restate to clarify
Unproductive Response
freezing, over reacting, responding inappropriately
Productive Response
increase speed in strength, increase awareness, decrease reaction time
Strike
a weapon coming in contact with a target (hit, kick, throw)
Grab
the control or destruction of a part of one’s anatomy
CPI Principals’ of personal safety
Block and Move
Precipitating Factors
internal/external cause of acting out-staff has no control of
Rational Detachment
stay professional, don’t take it personal
Integrated Experience
the concept the behaviors and attitudes of staff impact the behaviors and attitudes of those in their care- visa-verse
Precipitating factors Can
prevent behaviors, recognize staff is not the case, avoid becoming the cause.
CPI Purpose
Care, Welfare, safety, security of all
4 Behavior Levels
- Anxiety
2.Defensive - Acting Out Person
- Tension Reduction
Staff Attitude and Approach to Anxiety
Be Supportive
an emphatic non-judgemental attempt to alleviate anxiety
Staff Attitude and Approach to Defensive
directive-attempt to control the situation and begin to set limits
Staff Attitude and Approach Acting Out Person
non-violent physical crisis intervention
Staff Attitudes for Tension Reduction
therapeutic rapport decrease in energy regaining of rationality
integrated Experience
we can set the tone for whether or not the behavior escalates or de-escalates
non-verbal-proxemics (personal space)
area surrounding your body considered an extension of self. 1 1/2 to 3 feet (typically) culture, height, gender, age, status, appearance, and familiarity.
kinesics (body language)
non-verbal message transmitted by motion and body posture. Factors: eye contact, facial expressions send a very strong message gestures, how we stand
(stance) hands
3 reasons for using the CPI supportive stance
safety
less threatening
communicates respect
components of the communication pyramid
verbal communication, para verbal coomunication, and non-verbal communication
what is paraverbal communication
how we say what we say
three components of paraverbal communication
tone
volume
cadence
total voice control
what is the verbal escalation continuum?
the kite
- Questioning
- Refusal
- Release
- Intimidation
- Tension-Reduction
what is questioning
information-seeking
what is an intervention for questioning
give a rational response
redirect
what is refusal?
non-compliance
what is an intervention for refusal
set limits
give options
what is release
high energy outburst
intervention for release
let it happen
isolate the situation
what is intimidation
verbal or non verbal threats
intervention for intimidation
take it seriously
get help
document
what is tension reduction
decreased energy and regaining rationality
what is an intervention for tension reduction
therapeutic rapport
3 keys to setting limits
- keep it simple
- reasonable
- enforceable
what is empathetic listening
active process to discern what a person is really saying
5 things to do during active listening
- give un-divided attention
- be non-judemental
- listen for feelings
4.allow for silence - restate to clarify
what are precipating factors
the internalor external causes for behavior over which staff has little or no control
rational detachment
the ability to stay in control of our own behavior and not take the student’s behavior personally
intergrated experience
the concept that attitudes and behaviors of staff impact and influence the attitudes and bahaviors of students and vice versa
3 unproductive reactions to fear and anxiety
- freezing
- over-reacting
- responding inappropriately
3 productive responses to fear and anxiety
- increase in speed & strength
- increase in sensory acuity
- decrease in reaction time
definition of a strike
a weapon coming into contact with a target
examples of strikes
kicking
punching
throwing
definition of grab
an attempt to control or damage part of one’s body
examples of grabs
biting
scratching
hair pulling
principles of personal safety regarding strikes (name two)
- block or deflect
- move the targey
principles of personal safety regarding grabs. Name 2
- gain physiological advantage
- gain psychological advantage
Name the 3 control dynamics
- reduce upper body strength by conrolling arms as weapons
- reduce lower body strength by managing the back incline
- reduce mobility by close body contact
what should you consider when putting together a crisis team?
-2 to 5 people per acting out person
consider how your team is called
consider the physical location of your team
consider who will be on the team
Name 3 reasons to use a team instead of solo intervention
- safety
- professionalism
- litigation
three characteristics of team leader
- 1st person on the scene
- confident and competent
best rapport with client
Name the team leader duties
- assess the situation
- plan the intervention
- direct the team
- communicate with the client
Auxiliary Team Member Duties
C-A-R-E
- Check for the safety of the environment
- Address safety issues
- Recogize if the intervention needs to be changed
- Engage and support
what is the CPI COPING Model (strategy for therapeutic rapport)
C-control physically and emotionally
O-orient to the facts/ non-judgemental
P-pattern-triggers and trends
I-investigate alternatives/provide resources
N-negotiate the contract or changes
G-give support and responsibility
3 steps for facilitating through lecture
- term
- definition
- example ( mine and participants)
3 steps for facilitating through activities
- demonstrate/describe
- participate/practice
- explain/expand
ways to respond to participants questions
redirect
deflect
give a rational response
parking lot
ways to maintain safety during training
following due care guidelines
training room considerations-enough space, safe, discuss personal injuries
practicing of physicals
why do we use non violent crisis intervention
to promote the care, welfare, safety, and security of all of our students
Due Care Guidelines
take responsibility for Care, Welfare, Safety, Security of themselves and others and adhere to the following:
- I am responsible for the safety of others with regards to my actions.
- I will respect other participants as peers
Core Values Words
Care, Welfare, Safety, and Security.
How do the core value words fit with my own values
The core values of CPI ( Care, Welfare, Safety, and Security) fit with my core values of integrity, acceptance, honesty, compassion, respect, equality, and trust as they will provide a foundation for integrity in my decision making process when following the principle of CPI.
Crisis Development Model/Behavior Levels
- Anxiety
- Defensive
- Risk Behavior
- Tension Reduction
Crisis Development Model Staff Approaches to Behaviors
- Anxiety <-> Supportive
- Defensive<-> Directive
- Risk Behavior <-> Physical Intervention
- Tension Reduction<-> Therapeutic Rapport
Supportive Approach for helping Anxiety level
An empathic, nonjudgmental approach. Listen and allow time
Directive Approach for helping Defensive Level
Decelerating an escalating behavior. Take control of a potentially escalating behavior.
Physical Intervention for Risk Behavior
Disengagement and/or holding skills to manage risk behavior.
Integrated Experience with the Crisis Behavior Model
Behavior influences behavior
Nonverbal Communication PKH
Proxemics
Kinesics
Haptics
Proxemics
personal space.
Kinesics
body language
Haptics
communication through touch
Nonverbal Communication: Supportive Stance
Reasons for using it:
It communicates respect.
non-threatening
Maintains safety
How can we modify our supportive stance?
remain at an angle and one-leg length away. If the person is sitting you can squat or kneel down and still maintain a supportive stance. Posture-get to their level.
What are the 3 Ps of non-verbal communication
Position, Posture, Proximity
How can you modify the 3 Ps to support a person.
Position is where you are in relation to others and you can stand, kneel, or sit to the side of an individual at an angle places you in a safer position.
Posture is how you hold and move your body. Standing, sitting, kneeling. Also the way you move your hands, arms, head, eye contact…. Adopting a posture with legs shoulder width apart helps you to remain balanced and nonthreatening.
Proximity is the distance between people. Consider gender, relationships, activity. remain at least one arms length away.
Paraverbals
tone
volume
cadence
Verbal Escalation Model
Questioning
Refusal
Release
Intimidation
Tension Release
Staff approach for the Questioning level of Defensive Behavior
Provide a rationale answer for a rationale question.
Staff approach for the Refusal level of Defensive Behavior
Set reasonable limits
Staff approach for the Release level of Defensive Behavior
allow venting and possibly move student or audience.
Staff approach for the Intimidation level of Defensive Behavior
Take all threats seriously and avoid physical interventions unless there is no safer alternative.
Keys to Limit Setting SRE
Simple/clear
Reasonable
Enforceable
Empathic Listening 5 characteristics
1-NONJUDGMENTAL
2-undivided attention
3-allow silence for reflection
4-listen for feelings and facts
5-restate and paraphrase
Precipitating Factors
factors that influence behavior
Rational Detachment
Ability to manage your own behavior and attitude
Integrated Experience
behavior of student influences behavior of staff and vice versa
Maximizing Productive Responses
- Learn to keep yourself safe and learn to keep the individual in crisis safe.
- Use a team approach
Use of the Decision Making Matrix
It is to assess RISK Behavior
The Decision Making Matrix rates
severity (up)
likelihood (across)
Physical Interventions-Disengagement Skills
Position
Posture
Proximity
biomechanical benefit
HOLD/STABILIZE
PULL/PUSH
LEVER
Physical Skills Review- SEAT
Safe
Effective
Acceptable
Transferable
Key Principles for HOLDING SKILLS
P, P, P
Mechanical Benefit
OUTSIDE/INSIDE
LIMIT RANGE OF MOTION
When does POSTVENTION OCCUR
in the Tension Reduction behavior level
The COPING Model
Control- of emotion/physical
Orient- self to facts
Patterns- look for triggers
Investigate- alternative to behaviors
Negotiate- future approaches, expectations, behaviors (Behavior Mapping)
Give- control back, provide support and encouragement.
Facilitation Formulas
Declarative knowledge-> knowing WHAT
TERM->DEFINITION-> EXAMPLES
Procedural knowledge-> knowing HOW
DEMONSTRATE->PARTICIPATE->EXPLAIN