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Crisis Prevention: Techniques for Behavioral Management and Nonviolent Intervention, Lecture notes of Acting

An in-depth look into the Crisis Prevention Institute's (CPI) training program, focusing on behavioral management and nonviolent intervention techniques. The training covers various steps involved in planning for behavioral management, the CPI development model, verbal and paraverbal communication, setting limits, and verbal escalation continuum. The goal is to offer the best care, welfare, safety, and security for individuals, even during violent moments.

Typology: Lecture notes

2021/2022

Uploaded on 09/12/2022

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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
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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

12/29/2015 6

12/29/2015 10

CPI Development Model

Crisis Development/Behavior

  1. Anxiety
  2. Defensive
  3. Acting-Out Person (AOP) Total loss of control which often results in a physical acting-out episode  Staff Attitudes/Approach
  4. Supportive
  5. Directive
  6. 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

  1. Anxiety
  2. Defensive
  3. 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
  4. Supportive
  5. Directive
  6. 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

12/29/2015 13

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.

12/29/2015 14

CPI Verbal Escalation Continuum

1. Questioning

2. Refusal

3. Release

4. Intimidation

5. Intimidation Reduction

12/29/2015 15

Verbal Escalation Continuum

  1. Questioning
    1. Refusal
  2. Release
  3. Intimidation
  4. Tension Reduction

12/29/2015 19

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

12/29/2015 21

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

12/29/2015 22

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

12/29/2015 24

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

12/29/2015 28

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.

12/29/2015 29

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.

12/29/2015 31

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

12/29/2015 33

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

12/29/2015 37

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