November 2012 Managing Resistive Behaviour.

November 2012

Occupational Health & Safety Act Revision Bill 168

November Seminar Objectives: (1)To define the term “crisis.” (2)To define and articulate what constitutes “precipitating factors.” (3)To identify and articulate what constitutes “indicators of crisis.” (4)To identify and articulate the four (4) “stages of crisis.”

November Seminar Objectives: (5)To articulate and perform suggested “responses to crisis.” (6)To utilize effective strategies for “questioning challenges.”

November 2012 Crisis - Definition A circumstance or set of circumstances, perceived or real, internal or external, that causes personal change.

November Components of Crisis (1)Crisis is individually based. (2)Intensity of a crisis depends upon the individual’s ability to cope and manage circumstances. (3)Effects dependant upon the individual’s life experience. (4)Lack of personal control or power.

November Precipitating Factors of Crisis (1)Unwanted Change. (2)Effects of grief. (3)Effects of fear. (4)Emotional challenges. (5)Physical challenges.

November Precipitating Factors of Crisis (6)Financial challenges. (7)Relationship challenges.

November Indicators of Crisis (1)Screaming. (2)Yelling. (3)Profuse Sweating. (4)Fidgeting. (5)Skin Tone Change. (6)Heart Rate Increase. (7)Pacing Back and Forth. (8)Shaking / Adrenaline Surge.

November Indicators of Crisis (9)Nervousness. (10)Paranoia. (11)Kicking-Out. (12)Biting. (13)Throwing Items. (14)Punching (Self or Others). (15) Rude Remarks. (16) Spitting.

November Indicators of Crisis (17) Threatening. (18)Weight Loss. (19)Weight Gain. (20)Sleeplessness. (21)Bullying. (22)Self-Mutilation. (23)Loss of Personal Hygiene.

November Indicators of Crisis (24)Crying. (25)Remorse. (26)Nervous Laughter. (27)Inappropriate Humour.

November 2012

Indicators of Crisis The “Indicators of Crisis” may lead you to believe: (1)A person is in a crisis situation. (2)The level that the crisis situation has escalated to.

November The 4 Stages of Crisis There are four (4) basic stages to Crisis 1.The Anxiety Stage. 2.The Defensive Stage. 3.The Physically Acting-Out Stage. 4.The Tension Reduction Stage.

November 2012 The Anxiety Stage Anxiety is best described as any noticeable change in an individual’s perceived normal behaviour.

November 2012 The Defensive Stage The stage of crisis where an individual begins to lose their rational thought and becomes verbally or passively resistant.

November 2012 The Defensive Stage individual may become belligerent and begin to challenge you or the authority that you represent.

November 2012 The Physically Acting Out Stage The stage of crisis where an individual begins to lose physical control and starts to physically act out.

November 2012 The Physically Acting Out Stage This physical action may be directed toward oneself, against others, or against property.

November The Tension Reduction Stage The stage of crisis where the tension of the situation begins to diffuse and the individual begins to regain control, regaining some rational and cognitive thought.

November The Tension Reduction Stage The individual may show remorse and take some responsibility for their actions or behaviour.

November Responses to Crisis Anxiety Stage Defensive Stage Physically Acting Out Stage Tension Reduction Stage Supportive Response Directive Response Physical Restraint Response Restorative Interaction Phase

November Supportive Response - Steps 1.When observing signs of anxiety, respond with a display of a supportive attitude. 2. This includes “effective communication” that is intended to reduce the person’s anxiety level.

November Supportive Response - Steps 3. It is important to display empathy with the individual. 4. It is important to attempt to form a professional “rapport” with the individual.

November Directive Response - Steps 1. One should attempt to utilize communications that gains verbal control over the situation. 2. If the subject becomes argumentative, do not argue back with them.

November Directive Response - Steps 3. It is important to remain professional at all times and attempt to verbally manage the situation to a calmer climate.

November Physical Restraint Response 1. As the individual has lost control over their situation and has become physically active, it may become necessary to consider physical control options.

November Physical Restraint Response 2. This involves the use of techniques that manage the physical actions of a subject and provide an element of safety for all involved persons.

November Restorative Interaction Response 1. In order to bring about tension reduction, begin “Restorative Interaction” as soon as you arrive at the situation.

November Restorative Interaction Response 2. One should use words (communications) that is designed and intended to de-escalate the tension of the situation and maintain safety for all persons involved.

November Interaction with the “Defensive Stage” 1. The “defensive stage” is challenging to manage. 2. You should realize that verbalization is not personally directed towards you.

November Interaction with the “Defensive Stage” 3. The “defensive stage” is verbal in nature and displays four (4) stages of verbal escalation.

November Interaction with the “Defensive Stage” Stage #1: Questioning Stage #2: Refusal Stage #3: Venting Stage #4: Threatening

November Interaction with the “Defensive Stage” 4. The categories are escalating but do not have a divisible line between each. 5.You may experience one or a combination of the stages.

November Interaction with the “Defensive Stage” 6. You must remain aware and always maintain or obtain appropriate distance.

November Stages of Verbal Escalation Questioning Phase During the Questioning Phase, there are two types of questions. 1.Information Type Questions. 2.Challenging Type Questions.

November Stages of Verbal Escalation Information Type Questions 1. Subjects often ask open or closed information type questions. 2. The subject requires information to enable the decision making process to kick in.

November Stages of Verbal Escalation Information Type Questions 3. If the subject requires information they will ask questions of you. 4. If you know the answer to the question, you should always be honest and truthful with your response.

November Stages of Verbal Escalation Challenging Type Questions 1. Challenging type questioning may be used by a subject to put you on the defensive. 2. This may alter your intended goal or strategy.

November Stages of Verbal Escalation Challenging Type Questions There are essentially two types of Challenging Questions. 1. Illegitimate. 2. Legitimate.

November Stages of Verbal Escalation Goals - Effective Communications 1. To Instill Professionalism. 2.To Obtain Management of the Incident. 3.To De-escalate the Incident. 4.To Create Positive Witnesses. 5.To Create Subject Accountability. 6.To Allow for Justification of Your Actions.

November Responses to Illegitimate Challenges 1.To Deflect the Challenge. 2.To Sidestep the Challenge.

November Deflect the Challenge The theory behind the use of deflection is to allow the subject their dignity. The right to think, have an opinion and to voice that opinion is important to us all.

November Deflect the Challenge Examples -I can appreciate why you say that, but… - That may be so, but I’m sorry you feel that but...

November Deflecting the Challenge These phrases display “empathy” for subject’s position. Permit you to “direct the conversation” back to the issues at hand.

November Sidestep the Challenge The Sidestep is very similar to the Deflection process except that you do not acknowledge the original comments of the subject and go on about your task.

November Sidestep the Challenge You require to be directive and put forward the reason for your interaction. Explain why you are here and make good use of effective communications.

November Sidestep the Challenge You are being professional. You are being sensitive and are creating positive witnesses. You are creating a position of safety for all persons present.

November Refusal Phase 1)The next phase of the Defensive Stage of Crisis is the subject’s refusal. 2)This may be a very frustrating s tage in the Crisis. Many expect that the subject should or will obey our commands.

November Refusal Phase 3)When a subject refuses to comply, the management of the situation changes momentarily. 4)What occurs with change and loss of power? A Crisis.

November Refusal Phase (5)When the power or authority changes sides during an interaction, who enters a Crisis? You or the participant? You

November Refusal Phase 6)This stage of the crisis can be brief, unless you don’t have a coping or directive mechanism ready to use. 7)What techniques will work in this situation to ensure you regain control, de-escalate the situation and make the subject responsible for their actions?

November Refusal Phase 8)For the subject who is displaying passive resistance and refusing to obey requests, try to utilize the technique of “Setting Limits”.

November 2012 Managing Resistive Behaviour.