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12/29/2015 1
Crisis Prevention Training
Senior Behavioral Health Salt Lake Behavioral Health 801 264- 6000 12/29/2015 2
Crisis Prevention Training
Goal: To provide the best care, welfare, safety and
security for the individuals in your charge, even in
violent moments.
Presented by: Nina Ferrell, MA Geriatric Outreach Coordinator Salt Lake Behavioral Health (801) 264-6000 Main (801) 419-7526 Cell
1. Systemic Steps Involved In
Planning for Behavioral Management
Society/Community Corporation Facility Staff Individual Patient 12/29/2015 3
2. Facility Based Risk Factors
Maslow Hierarchy of Needs Layout Color/design Ambiance Staff Training Recreation Staff Engagement 12/29/2015 4
3. Personal Influences
Age Culture Religion Size Gender History of Trauma Education History Socioeconomic Factors Mental Illness and Anger Management Coping Skills 12/29/2015 5
4. Safety Positions
CPI Supportive Stance
Kinetics
Proxemics
Para Communication
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CPI Development Model
Crisis Development/Behavior
- Anxiety
- Defensive
- Acting-Out Person (AOP) Total loss of control which often results in a physical acting-out episode Staff Attitudes/Approach
- Supportive
- Directive
- Intervention Nonviolent Physical Crisis Safe, non-harmful control and restraint techniques used to control an individual until he can regain control of his behavior. These techniques should be utilized as a last resort, when an individual presents a danger to self or others. 12/29/2015 11
CPI Development Model
Crisis Development/Behavior
- Anxiety
- Defensive
- Acting-Out Person (AOP) 4. Tension-Reduction Decrease in physical and emotional energy which occurs after a person has acted out, characterized by the regaining of rationality. Staff Attitudes/Approach
- Supportive
- Directive
- Nonviolent Physical Crisis Intervention (NPCI) 4. Therapeutic Rapport Attempt to reestablish communication with an individual who is experiencing Tension- Reduction. Building relationships with individuals in our care. 12/29/2015 12
Nonverbal Behavior
Proxemics : personal space
Kinesics : body posture and motion
CPI Supportive Stance
1. Communicates respect
2. Non-threatening/non-challenging
3. Staff personal safety/escape route
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Paraverbal Communication
Paraverbal Communication : The vocal part
of speech, excluding the actual words one
uses.
Tone : Try to avoid inflection of
impatience, condescension, etc.
Volume : Keep volume appropriate for
distance and situation
Cadence : Deliver your message using an
even rate and rhythm.
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CPI Verbal Escalation Continuum
1. Questioning
2. Refusal
3. Release
4. Intimidation
5. Intimidation Reduction
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Verbal Escalation Continuum
- Questioning
- Refusal
- Release
- Intimidation
- Tension Reduction
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Verbal Escalation Continuum
4. Intimidation : Individual is verbally and/or
nonverbally threatening staff in some
manner.
Hands-on approach at this time may trigger
physical acting-out behavior.
Intervention: A. Seek assistance and wait for team to intervene, if possible. B. Try to avoid individual intervention, as this is more likely to jeopardize the safety and welfare of both staff and the AOI. 12/29/2015 20
Verbal Escalation Continuum
5. Tension-Reduction : A drop in energy, which
occurs after every crisis situation, whether it
is after a low-level defensive behavior or after
intimidation.
Intervention :
Establish Therapeutic Rapport : reestablish
communication with the individual
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Setting Limits
Keys to Setting Limits When you set limits, you are offering a person choices, as well as stating the consequences of those choices. Offer positive choice and consequences first, then negative choices and consequence. You cannot force individuals to act appropriately. Trying to force a person to act in a certain way often results in a nonproductive power struggle. Simple/clear, reasonable and enforceable
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Verbal Intervention Tips
DO
Remain calm Isolate situation Be professional Enforce limits Listen Be aware of non-verbals Be consistent
DON ’ T
Overreact Get in a power struggle Make false promises Fake attention Be threatening Use jargon 12/29/2015 23
Empathic Listening
Empathic listening is an active process to
discern what a person is saying.
Remain nonjudgmental
Give undivided attention
Listen carefully to what the person is really
saying (focus on feelings not facts)
Allow silence for reflection
Use restatement to clarify messages
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Precipitation Factors, Rational
Detachment, and Integrated Experience
Precipitating Factors :
Internal or external causes of an acting-out behavior over which staff members have little or no control Loss of personal power Need to maintain self-esteem Fear Medications Attention-seeking Displaced anger Psychological/physiological causes
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Fear and Anxiety
Productive reactions to fear/anxiety include :
Increase in speed and strength – additional
adrenaline released into the bloodstream causes
an almost superhuman increase in speed and
strength.
Increase in sensory acuity – special alertness or
sharpness of our senses take place.
Decrease in reaction time – we take less time to
react than we would under normal circumstances.
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Fear and Anxiety
Ways to control fear and anxiety
Understand what makes us afraid. Use techniques to protect both ourselves and the acting-out individual in a crisis. Use a team approach – don’t respond alone. Learn nonviolent physical intervention techniques to manage acting-out individuals, if necessary. 12/29/2015 30
Philosophy of Nonviolent Physical
Crisis Intervention
Physical intervention should be used only as a last
resort when an individual is a danger to self or
others.
Even at those moments, conduct an assessment to
determine the best course of action to maintain the
care, welfare, safety and security of all involved.
There is risk involved in any physical intervention,
therefore, physical intervention should be considered
only in those moments where the danger being
presented by the acting-out individual outweighs the
risk inherent in physical interventions.
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Nonviolent Physical Crisis
Intervention Techniques
Nonviolent Physical Crisis Intervention techniques are designed to be non-harmful and allow for a Therapeutic Rapport to be reestablished with the individual who lost control. Key elements of Nonviolent Physical Crisis Intervention response include: Assessment of pain involved Attempts to calm down individual Individual not restrained on the floor, reducing risks of restraint related positional asphyxia and other injuries - Team interventions are used Used only as a last resort when someone presents a danger to protect not to punish – used By using physiological principles that do not rely on matching strength, staff involved are not in a “competitive” mindset The goal is to continually assess signs of tension opportunities to reestablish a therapeutic rapport with the individual.-reduction and use 12/29/2015 32
CPI Personal Safety Techniques
Two types of personal attacks:
1. Grab : control or destruction of a part of one’s
anatomy
2. Strike : a weapon coming in contact with a
target
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Personal Safety
Use physiological advantage by using:
The weakest point of the grab
Leverage
Momentum
Gain a psychological advantage by:
Staying calm
Having a plan
Using the element of surprise or distraction
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Postvention
The COPING Model for both Client and Staff
Perspectives
Control
Orient
Patterns
Investigate
Negotiate
Give
For More Information
Inpatient and Intensive Outpatient behavioral health services: Adults age 18 and over General Adult Crisis Stabilization Medical Detox and Chemical Dependency Treatment Geriatric Unit Men’s and Women’s Military Programs- Strong Hope Salt Lake Behavioral Health Hospital 3802 S 700 E SLC, UT 84106 (801) 264-6000 main 12/29/2015 (801) 419-7526 cell 38
