Crisis De-Escalation Basics Patricia Napolitano, mSW, LISW Cuyahoga County Court of Common Pleas Crisis Intervention behavioral health specialist

Individuals in crisis Largely feel unheard Central Nervous System is in fight/flight/freeze/faint mode Require calm intervention that soothes and attempts to help the person vocalize complaints May require police response May require medical response May result in the person leaving on their own

Crisis Intervention Team (CIT) model is a police-based training and intervention program. Ohio CIT Programs Goals are to Increase Safety for officers and persons with mental illness Divert persons with mental illness away from the criminal justice system 2006 study in Akron found that there was an increase in the number of calls identified as mental health-related, and increase in CIT officers transporting to the hospital for evaluation, but no change in arrest rate. 1999 study indicates 10% of police contacts with the public involve persons with mental illness. Difficulty in studying CIT Officers participate voluntarily Department personnel assignments are internal Record keeping does not track health information CIT Outcomes in Chicago – 2010 Increased linkage to mental health services Improving safety in calls Improve outcomes for officers and clients Deane et al 1999 Teller et al 2006

Communication ACES study; Factors of Household Dysfunction and Abuse are strongly correlated with antisocial behaviors and criminal justice involvement in teen and adult years Deficiencies in social communication Impulsive Cognitive Style Independence Rigidity of Ideas Tendency towards social distrust and suspicion Focus on communication strategies Moreno-Manso et al 2016

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Escalational commitment Image from modernman.com

Agitated Client Suicidal Client Homicidal Client Clients in distress Physical Distress Fear Response Suicidal Client Emotional Distress Hopelessness Homicidal Client

4 step crisis intervention model 1. Rapport Building Reflective Listening 2. Information Gathering Focusing on the here and now Using risk tools Assessing lethality, strengths, and needs 3. Assessment Determine level of immediate service need Plan for face to face contact if necessary 4. Problem Solving Implement and Evaluate “Help me understand….” “It is surprising to hear you say…” “When you said…. I felt…” Simple rephrasing siding with client emotion “When he said go away, you felt like he didn’t care at all”

4 step Crisis Intervention model Information Gathering Prompts “How much has this bothered you in last 24 hours?” “Who lives with you?” “What part of this is bothering you the most” “When was the last time you dealt with something like this? How did you do it?” 1. Rapport Building Reflective Listening 2. Information Gathering Focusing on the here and now Using risk tools Assessing lethality, strengths, and needs 3. Assessment Determine level of immediate service need Plan for face to face contact if necessary 4. Problem Solving Implement and Evaluate

4 step Crisis intervention model Call For Help 216-623-6888 Cleveland Mobile Crisis National - 800-273-TALK (8255) (national suicide lifeline) 216-619-6194 (Cleveland Rape Crisis Center) National - 800-656 HOPE (4673) 216-391-HELP (4357) (Cleveland Domestic Violence Hotline National - 800-799-7233 Rapport Building Reflective Listening 2. Information Gathering Focusing on the here and now Using risk tools Assessing lethality, strengths, and needs 3. Assessment Determine level of immediate service need Plan for face to face contact if necessary 4. Problem Solving Implement and Evaluate

4 step Crisis Intervention model 1. Rapport Building Reflective Listening 2. Information Gathering Focusing on the here and now Using risk tools Assessing lethality, strengths, and needs 3. Assessment Determine level of immediate service need Plan for face to face contact if necessary 4. Problem Solving Implement and Evaluate Avoid Power Struggles Make the Client set the Most Important goal Invite the client to set as much of the plan as possible Give multiple options in brainstorming, not just an obvious right or wrong one Discuss whether options are possible or not Make the client the expert “You are probably in the best place to make a decision, it’s your life.”

References Moreno-Manso, J., Garica-Baamonde, M. E., Blazquez- Alonso, M., Pozueco-Romero, J. M., Godoy-Merino, M. J. (2016). Social Communication Disorders and Social Cognitive Strategies and Attitudes in Victims of Child Abuse. Journal of Child and Family Studies. 25: 241-250 Deane, M. W., Steadman, H. J., Borum, R., Veysey, B., & Morrissey, J. (1999). Emerging partnerships between mental health and law enforcement. Psychiatric Services, 50. 99-101