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what are the core values of CPI ✔✔Care, Welfare, Safety, and Security for all involved. Core value of CPI- CARE ✔✔demonstrate respect, maintain dignity, and being nonjudgmental and empathetic. Core value of CPI- WELFARE ✔✔provide emotional and physical support and always consider the client's best interest. Core value of CPI- SAFETY ✔✔protect human rights and reduce and manage risks. Core value of CPI- SECURITY ✔✔maintain a safe, effective, and therapeutic relationship that relies on collaboration. Aggression ✔✔the outward expression of anger. Yelling, grunting, verbalizing.... Violence ✔✔the physical expression of anger. throwing desks at people. Punching....
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Key Learning Objective of CPI ✔✔Identify behaviors that indicate an escalation toward aggression and violent behaviors. Take measures to AVOID escalation and to decelerate the crisis situation. Crisis Development Model ✔✔Behavior levels and the staff attitudes/approaches in response. The ANXIETY behavior level ✔✔individual demonstrates changes in behavior. wringing hands, sweating, rocking, talking rapidly. The DEFENSIVE behavior level ✔✔individual is starting to lose rationality. Responses are disproportionate. sewaring, posturing, throwing items off table. The RISK behavior level ✔✔individual is demonstrating behaviors that put himself or others at risk. May become physically violent or throw things at others. The TENSION REDUCTION behavior level ✔✔individual demonstrates a decrease in emotional and physical energy. Increase in RATIONALITY. RELAXED Staff Attitude/Approach to ANXIETY ✔✔Supportive Supportive approach in response to an individual's anxiety ✔✔Offer support, empathy, and tools you may know that will help them to become calm. Ask and listen to what the person has to say.
Nonverbal communication that can help prevent escalation or promote de-escalation of crisis situations. the "ics words" ✔✔proxemics, kinesics, and haptics nonverbal communication- proxemics ✔✔personal space one allows is a form of non-verbal communication to help deescalate crisis situations. nonverbal communication- kinesics ✔✔a person's body movements such as posture, eye contact, hand movements, eyebrow movements can help to deescalate or decelerate crisis situations. nonverbal communication-haptics ✔✔communication through touch or refraining from touch can help to decelerate a crisis situation. Supportive Stance- Nonverbal Communication ✔✔the staff member is a legs length away and turned with legs at a wide stance. Reasons for SUPPORTIVE STANCE ✔✔ 1 - Communicates respect, 2 - non-threatening, 3 - maintain safety Supportive stance includes what three Ps ✔✔Position, proximity, and posture position ✔✔where you are in relation to the individual
posture ✔✔how you hold and move your body proximity ✔✔distance between individuals Paraverbal and Verbal Communication affects on what listener hears. ✔✔T, V, C What are the paraverbal components that affect a verbal message. ✔✔Tone, Volume, Cadence Verbal Interventions for the Defensive level of Crisis. ✔✔It does not have to go in order. QRRIT. Questioning, Refusal, Release, Intimidation, Tension Reduction. (Kite graphic Defensive level of Crisis ✔✔QRRIT Verbal intervention for Defensive QUESTIONING ✔✔give a rational response. They are information SEEKING or QUESTIONING AUTHORITY. Give a rational answer if information seeking. If questioning authority just stick to topic and set limits. Stay on topic and avoid being drawn in. Verbal intervention for Defensive REFUSAL ✔✔this can be verbal or nonverbal noncompliance. set limits. use the 5 step approach
2 - reasonable and realistic 3 - enforceable "Interrupt and Redirect" Example of Limit setting ✔✔get the person's attention and redirect them to desired activity/outcome. "When and then, first-then" Example of limit setting ✔✔state expectation and positive outcome. Example, When you get up we will be able to start our game. "If and Then" Example of Limit setting ✔✔Tell them the desired outcome and then the positive consequence. Then give the negative outcome and the negative consequence. For example, "If you use a tissue then you can use my ipad. If you do not use a tissue you you can not use my ipad." Empathic Listening ✔✔an active process to discern what a person is saying. Five Keys to Empathic Listening ✔✔ 1 - be NONJUDGMENTAL 2 give UNDIVIDED attention 3 LISTEN carefully focusing on FEELINGS and FACTS
- allow SILENCE for reflection
- RESTATE and REPHRASE
Precipitating Factors ✔✔Factors that influence behavior. like temperature, environmental noises, feelings about holidays, scents How can understanding precipitating factors help staff? ✔✔-DE-PERSONALIZE the situation (don't take behavior personal)
- BE PROACTIVE in prevention (get a fan ahead of time if it's hot)
- AVOID becoming a precipitating factor. (don't wear perfume...) Rational Detachment ✔✔ability to manage your own behavior and attitude Examples of Rational Detachment ✔✔STAY CALM maintain PROFESSIONALISM QTIP find POSITIVE OUTLETS for NEGATIVE ENERGY Integrated Experience ✔✔behavior influences behavior. look at how you affect your rational detachment. What strategies do you use at home and at work to help you get regulated. You are a role model!!! Unproductive responses due to Staff Fear and Anxiety ✔✔-freeze
- overreact
- respond inappropriately
Risk ✔✔the CHANCE of a BAD CONSEQUENCE. We need to constantly assess this objectively. Consider the following two variables when considering risk ✔✔Likelihood=CHANCE an event or behavior will occur. and Severity= the level of HARM that may occur LOW RISK ✔✔unlikely event or behavior with a high severity of harm. HIGHER RISK ✔✔Very likely event with a high severity of harm. 3 Ratings of harm ✔✔low harm, minor harm, major harm What should you assess the risk of? ✔✔the behavior as well as the responses to the behavior. Compare which has a greater risk. 3 Reasons for team interventions ✔✔1. SAFETY for everyone
- Maintenance of PROFESSIONALISM
- LITIGATION
Who is the Team leader ✔✔may be first on the scene best rapport with client confident and competent in abilities Auxiliary Team Member Duties "C.A.R.E." ✔✔C- CHECK- on the physical and psychological status of the indiv and staff. - on the safety of the environment. A- ADDRESS- what needs to happen to deescalate the crisis. - Are their safety concerns? Are holding principles being utilized safely? R- RECOGNIZE- additional assistance needed. The need to change intervention strategies E- ENAGE in- verbal deescalation if the leader asks you to. Support other team member and look for her cues. BARE MINIMUM IS TO CARE ABOUT THE INDIVIDUAL IN CRISIS. TEAM LEADER and MANAGER Duties P.D.C.S.L.P ✔✔Planning- use situations as learning opportunities and consider known precipitating factors Decision Making- let the team know what is going to happen and what is going on. Communicate needs of individual and staff. Safety- make sure there is care, welfare, safety, and security for all.
The physical intervention/disengagement with a low level hold ✔✔stand in a supportive stance and stabilize the individual's hand at wrist and ask that they please let go. The physical intervention/disengagement with a medium level hold ✔✔stand at a supportive stance and hold their wrist and then pull it away while pushing your's out of their grip in the direction of their thumb. The physical intervention/disengagement with a high level hold ✔✔stand at a supportive stance and hold their wrist and pull their hand away while you turn your arm to leverage it away in the direction of the person's thumb. The physical intervention/disengagement with a lower level risk grab of clothing. ✔✔stand in a supportive stance and place your hands on the person's arm and wrist and hold and stabilize while getting the person;s attention and asking them to please to let go. The physical intervention/disengagement with a medium risk grab of clothing. ✔✔Stand in a supportive stance and place your hand on the person's wrist and the other hand on your shirt and pull your shirt while pushing their hand away. The physical intervention/disengagement with a higher risk grab of clothing ✔✔Stand in a supportive stance and place both of your hands on the person's wrist and pull them in while you bend down toward them forcing their hand to move back and release the shirt.
Physical intervention/disengagement for low level hair pull ✔✔Stand at a supportive stance and hold and stabilize their hand and ask for them to let go of your hair. Physical intervention/disengagement for medium level hair pull ✔✔Stand at a supportive stance and hold and stabilize the person's wrist and then put your hand like a wedge and slide your hand between your hair and slide it down. Physical intervention/disengagement for high level hair pull ✔✔Stand at a supportive stance and stabilize their hand with both of your hands and move toward them in a downward motion of your head to apply pressure to their wrist resulting in their release of your hair. Physical intervention/disengagement for neck grab low level ✔✔Stand at a supportive stance and stabilize their hands with both of your hands and request that they release your neck. Physical intervention/disengagement for neck grab medium level ✔✔Stand at a supportive stance and hold their wrists and push them away while moving yourself back. Physical intervention/disengagement for neck grab high level ✔✔Stand at a supportive stance and then as the person grabs for the neck grab one wrist and put the arm up that is closest to the individual and pivot across their reach to disengage their hands. Your stance will shift at the same time.
Transferable ? Physical INterventions-Disengagement Continuum- RESPONSE ✔✔R-Response= down play and relax E- Explain And Ask S- State or Tell P- Prompt, gesture, sign O- Option to use physical intervention N- Nurture recovery S- Support E- Engage and Learn Key Principles for Holding Skills in addition to the 3 Ps ✔✔Biomechanical benefit
- outside inside. place arm along the outside of their elbow and then your hand toward the inside.
- limit range of motion Low level holding ✔✔physical intervention necessary to use as a guide or physical prompt to provide MINIMAL support to limit range of movement in relation to low risk behaviors. Physical Skills Review SEAT ✔✔Assess whether our holding is SAFE, EFFECTIVE, ACCEPTABLE, and TRANSFERABLE
Low level seated holding ✔✔a team of two staff reacts in unison and sits on either side of the individual and places their arms along the outside of the individual's elbow and drapes the hand on that same side of their body over the individual's arm with fingers toward the inside. The legs are used to also provide support on the outside of the individual's legs Medium level holding ✔✔A team of two staff reacts in unison and sits on either side of the individual and places their outer-most hand above the person's elbow and then their inner-most arm along the inside of the individual's arm and their hand over the wrist of the individual. At the same time they move to a supportive seated stance and put their outer-most leg out to the side to provide stability while their inner-most leg is up against the individual's. higher-level holding ✔✔A team of two staff reacts in unison and sits on either side of the individual and places their outer-most hand above the person's elbow and then their inner-most arm along the inside of the individual's arm and their hand over the wrist of the individual. At the same time they move to a supportive seated stance and put their outer-most leg out to the side to provide stability while their inner-most leg is up against the individual's. They then move to pull their inner most arm back to hold the person's arm above the elbow while pulling up and back with their other hand over the individual's fist. Principles of holding in a standing position- low level ✔✔Have one person take the lead and another staff member stand by for support. put your body along the individual's side and put your arm around them so that each of your hands it is the person's elbows. Apply stabilization and tell the person what you want them to do or what you are there for.
medium level standing children's hold ✔✔Stand behind the child and wrap your arms inside theirs and hold their hands in front of them at their waist. higher level standing children's hold ✔✔Stand behind the child with one leg behind the other. wrap and tuck the child's arms across their chest and lean them back on to your front leg for support. Postvention ✔✔addressing emotions and behaviors associated with the crisis event. The COPING Model= ✔✔a model that guides you through the process of establishing Therapeutic Rapport with an individual after a crisis incident. We do this for the individual and the staff at separate times. The COPING MODEL- for indiv C= ✔✔Control- emotional and physical. Can tell by body language. non-crying. ready to talk. ask "are you ready to talk?" The COPING MODEL - for indiv O= ✔✔Orient- yourself to the basic facts. Listen to them and get their perspective. Ask open-ended questions. What? Who? When? Where?
The COPING MODEL - for indiv P= ✔✔Patterns- look for triggers. Indentify precipitating factors. Help people see the connections. Guide individual to see the pattern. Maybe it's with a particular staff member or at a particular time... The COPING MODEL - for indiv I= ✔✔Investigate alternatives to behavior. What can we do differently? Make this a collaborative effort. Get their idea of what can be done differently. Process through cause and effect. Talk them through the decision making matrix. The COPING MODEL - for indiv N= ✔✔Negotiate future approaches, expectations, behaviors. Come up with a plan A, B, and C. Practice and role-play behaviors. Consider outcomes/consequences to the behavior. The COPING MODEL - for indiv G= ✔✔Give control back- provide support and encouragement. Give Affirmation and validation. We appreciate that you were able to talk about this. Express a fresh start attitude. The COPING MODEL - for staff C= ✔✔control for the staff. Staff is under emotional and physical control. took a break. Time to collect thoughts and notes about the event. The COPING MODEL - for indiv O= ✔✔Orient self to basic facts. get all perspectives from everyone who is involved. Documentation and reports. Include information from the indiv in crisis.
