De-Escalation & Safety Practices

Training Objectives: 1. Understand challenging behaviors. 2. Learn how to create a safe environment and demonstrate safe staff behaviors. 3. Understand the importance of managing YOUR own behavior. 4. Recognize the importance of observing and reading the consumer. 5. Learn techniques for effective incident management including recognizing triggers and signals, knowing when to call for help, de-escalation strategies, and maintaining physical safety.

Understanding Challenging Behaviors Individuals with developmental disabilities sometimes display challenging behavior, such as aggression or self-injury due to medical, psychiatric or neurological conditions. As care providers, we must ask ourselves: How do I maintain safety for all? How do I recognize the early warning signs that a person’s behavior may escalate? How can I intervene effectively before the person’s behavior becomes dangerous? If a person does become aggressive, how can I best control the situation?

Safety Habits – Create a Safe Environment DRESS FOR SAFETY: Appropriate clothing NO low cut or too short Enclosed, comfortable footwear Avoid loose items Jewelry Hair Scarves Glasses Perfumes

Safety Habits – Create a Safe Environment Minimize Clutter and Excessive Stimulation: Dangerous objects Objects that interfere with free movement Cluttered surfaces/unnecessary objects Loud noises Overly crowded places

Safety Habits – Create a Safe Environment KNOW WHERE YOU ARE: Stop and scan the environment. Know who is behind you at all times. Know where the exits are and if consumer becomes anxious, position yourself between both. Be aware of how and where you position your body (i.e. do not reach across or around consumers).

Safety Habits – Consumer Observation Carefully OBSERVE the consumer while respecting space. Watch for tension (facial, muscle). Changes in behavior (positioning, pacing). AWARENESS and reading the consumer is important! Always follow consumer’s Individual Support Plan (ISP) & any behavior plans!

Safety Habits – Staff Behavior MANAGE YOUR OWN BEHAVIOR Verbal Communication - What You Say (& When You Say It) Para-verbal Communication - How You Say It Non-verbal Communication – What Your Body is Saying BEHAVIOR INFLUENCES BEHAVIOR! NEVER PERSONALIZE! Leave your EGO at home! Treat with dignity and respect. Evaluate importance of what you are trying to accomplish.

Safety Habits – Staff Behavior Verbal Communication - What You Say (& When You Say It) Sometimes say nothing. Respect space. Positive, concise phrases. Use questions whenever possible. Praise appropriate behavior immediately. Try to withhold attention for challenging behaviors. Redirect, do not ignore person. Ask for desired behavior (i.e. “handshake please,” not “do not grab at me.”)

Safety Habits – Staff Behavior Verbal Communication - What You Say (& When You Say It) Verbal responses: Answer ‘information seeking questions’ with a rational response. Answer ‘challenging questions’ by sticking to the topic (redirecting), ignore the challenge (not the person). Be careful of violating rights. Use ‘when and then language,’ redirection, or share natural consequence. Use term ‘safe’ – “I need you to be safe by …….”

Safety Habits – Staff Behavior Para-verbal Communication - How You Say It Tone – firm but not condescending, impatient, or aggressive Volume – clear but not yelling Cadence – even, calm “Say what you mean, mean what you say, but don’t be mean when you say it.”

Safety Habits – Staff Behavior Non-verbal Communication – What Your Body is Saying Distance – 4-5 feet in front/behind; 3-4 feet to the side. Approach from side when possible. Movement – moderate pace = calm. Fast pace = threat/panic. Even in crisis situation, move slowly except for safety. Touch perception Can be perceived as threatening. Consider trauma history. Body language Posture, arms, chin, eye contact, face

Safety Habits – Staff Behavior Non-verbal Communication – What Your Body is Saying Safety Stance (Supportive Stance) Leg length away Wide base Thinking arms position Line of vision

Safety Habits – Staff Behavior Non-verbal Communication – What Your Body is Saying 6. Watch your cues! Calm facial expression – most of the time. Positive. Poker facial expression – if consumer becomes agitated.

ACTIVITY BREAK Stand up and find a partner! Distance Posturing Touch perception Safety Stance

Incident Minimization Concepts to know: Triggers and signals Calling for help Designate a lead Safety during de-escalation De-escalation strategies Physical safety

Incident Minimization Detecting Antecedents and Predicting Behavior: Antecedents – whatever happens before a behavior. Triggers (environmental) Signals (behavioral) PAY CLOSE ATTENTION = early detection = earlier intervention If you start to wonder if it’s time to call for help…IT IS!!

Incident Minimization Leadership during incidents: TEAMWORK One lead staff only. Leader’s job is to: Decide what to do. Direct the other staff. Leader is on the only person who speaks to consumer, unless leader delegates the role.

Incident Minimization – De-escalation De-escalation Goals: Maintain safety of all. Avoid making situation worse or consumer more agitated. Decrease crisis behavior. Try not to reinforce crisis behaviors. If the consumer has a written behavior plan, always follow the plan!

Incident Minimization – De-escalation Safety During De-Escalation Call for help Move other consumers away Identify leader Remove potential weapons Safety Stance Stay between consumer and exit Talk quietly, if need to talk at all

Incident Minimization – De-escalation DE-ESCALATION STRATEGIES Help Prompt Wait

Incident Minimization – De-escalation HELP STRATEGY Safety Stance. Ask what the consumer wants. Allow time for process of request. Repeat, if necessary. If request if made, praise. Comply if able. If becomes more agitated, stop.

Incident Minimization – De-escalation PROMPT STRATEGY Safety Stance. Prompt the desired behavior in calm, neutral voice. Allow 10 seconds for process of request. Repeat, if necessary. Praise any compliance. If noncompliant, stop.

Incident Minimization – De-escalation WAIT STRATEGY Remove others and potential weapons. Monitor safely. Avoid reinforcing behavior (i.e. don’t talk/respond, no eye contact). When behaves more calmly, can use PROMPT or HELP strategies.

Incident Management – Physical Safety PROTECTIVE STANCE Begin in Safety Stance. Turn your stance to protect yourself, if consumer comes towards you. Hands in front of your face, palms out, fingers together. Use forearms for blocks. Hands close to your head. Do not grab!

Incident Management – Physical Safety SAFETY SHUFFLE Start from Protective Stance. Call for assistance! Move your rear foot back first. Shuffle front foot close to back foot. Repeat to maintain safe distance. If necessary, move unpredictably away from consumer’s midline. Never turn your back or get backed into a corner!

Incident Management – Physical Safety HAIR PULLING Push consumer’s hand against head. Do not pull away. Call for help. Communicate – “please let me go” Until help arrives, wait it out. Reminder: wear longer hair up

Incident Management – Physical Safety BITE Push into bite. Call for help. Communicate – “please stop biting me” Until help arrives, wait it out.

Incident Management – Physical Safety GRAB Push into the grab by holding and stabilizing consumer’s wrist. Call for help. Communicate – “please let me go” Wait out. If safely able without hurting self or consumer, can pull limb away at weakest point.

ACTIVITY BREAK Stand up and find a partner! Safety Stance Protective Stance Safety Shuffle Hair Pulling Bite Grab

Training Re-cap Create a Safe Environment Consumer Observation Detecting Antecedents and Predicting Behavior Manage YOUR behavior – verbal, para-verbal, non-verbal, cues De-escalation Goals Safety During De-Escalation De-Escalation Strategies – Help, Prompt, Wait Physical Safety – Safety Stance, Protective Stance, Safety Shuffle, Hair Pulling, Bite, Grab

References page Safety Care, Quality Behavioral Solutions to Complex Behavior Problems™. https://www.qbscompanies.com/Safety-Care. cpi, nonviolent crisis intervention. https://www.crisisprevention.com/.