North Carolina Interventions NCI

Philosophy To prevent and avoid the use of physical interventions If the physical interventions are needed, the interventions are to be used safely and only as a last resort.

History 1974 - Western Carolina Center (J. Iverson Riddle Center) recognized need to train staff in techniques for dealing with crises. 1980 - Murdoch Center Staff Development published the first illustrated guide - A Better Way-Protective Intervention Techniques. 1983 - Education & Training developed standardized , revised and published Basic Protective Intervention Techniques Manual 1984/1988 edition - Protective Intervention Course and implementation of Divisionwide policy for implementation and quality improvement. 2001 - Curriculum revised and standardized with further emphasis on prevention and alternatives as well as modification to some of the physical techniques to result in the NCI curriculum.

Why People Do What They Do? Part A Unit 1 NCI Why People Do What They Do? Part A Unit 1

Outside factors that affect behavior: Cultural Background Health Education Work experience Environment Finances

Inside Factors Personality Traits How You Think Individual’s Ability to Communicate Question: What you think is happening is more important than what is actually happening? True/False

Other factors that influence behavior Health Issues Stress Anger Lack of knowledge of the person - How can we learn more?

Building Positive Relationships Part A Unit 2 NCI Building Positive Relationships Part A Unit 2

Therapeutic Relationships Definition Friendship versus therapeutic relationship Strategies for a therapeutic relationship Safe Environment Whole Person - People First Orderly Routines Help people to learn what they want and to lead independent lives

Communication Ways you communicate Body Language Why people communicate Feedback Guidelines Active Listening Communication Roadblocks

Empathy Definition Strategies for showing empathy Learn to pay attention to how the other person feels Use positive verbal, body language, and active listening skills Reflect the person’s feelings/needs Encourage the person to continue

Decision Making & Problem Solving Part A Unit 3 NCI Decision Making & Problem Solving Part A Unit 3

Losses Freedom of Movement/ Spontaneity Privacy Dignity Limits on Personal Possessions Access to Family/friends Feelings based on losses and what the feelings may lead to

Ways to Empower People Encourage decision-making Teach Problem-solving Offering hope Offering choices Avoiding unnecessary confrontation Helping people make their own decisions Teach Problem-solving State the problem List options Evaluate options Choose and do Evaluate action

Assessing Risk for Escalating Behavior Part A Unit 4 NCI Assessing Risk for Escalating Behavior Part A Unit 4

Staff Attitudes & Behavior Ignoring people Expecting absolute obedience Telling rather than asking Making decisions for the person instead of with the person. Teasing or picking Not following through Making unreasonable and unenforceable consequences

Risk and Protective Factors Risk Factors Mental illnesses Mental Retardation Past history of violence Health problems Poor communication skills Poor support system Protective Factors Sense of Responsibility Problem solving abilities Good Self esteem Feeling of Control over one’s life Planning for future events Good social interpersonal skills Able to look for support from others

Environmental Factors Time Weather Space Resources Organizational Factors

Personal Factors Physical Emotional Hormone Imbalance Low Blood Sugar PMS Brain chemistry Drug/Alcohol Abuse Physical Ailments and Illness Diet Medication Emotional Hallucinations/Delusions Post Traumatic Stress Disorder Personality Disorders Psychotic brain syndromes

Assessing Cues for Escalating Behavior

Early Crisis Intervention Part A Unit 5 NCI Early Crisis Intervention Part A Unit 5

What you say: Voice tone/volume Giving reassurance Use “I” messages Get the facts Be clear and up front about the rules of the situation

How you say it: Use non-threatening body stance Give personal space Monitor yourself

Things to Consider: Self check On the spot problem solving Positive reinforcement Scheduling Arrangement of the environment Redirection Natural consequences

10 Questions to Consider Prior to Physical Intervention Can I handle this situation alone? Is there potential for danger for others? Is help readily available? Can I keep from getting angry? Is my appearance going to interfere with my ability to respond? Can I get others to a safe exit, if necessary?

10 Questions (cont.) Does this person have a history of hitting, biting, running away, etc? What is this person’s crisis plan? What is my agency’s policy regarding this type of intervention? Before I have to put my hands on, is there anything else that might be done to resolve this crisis appropriately without using physical intervention?

North Carolina Interventions NCI