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

2. 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

3. 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

4. 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

5. Image from Conscious Discipline

6. Escalational commitment
Image from modernman.com

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

8. 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”

9. 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

10. 4 step Crisis intervention model
Call For Help
Cleveland Mobile Crisis National TALK (8255) (national suicide lifeline) (Cleveland Rape Crisis Center) National HOPE (4673) HELP (4357) (Cleveland Domestic Violence Hotline National
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

11. 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.”

12. 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: Deane, M. W., Steadman, H. J., Borum, R., Veysey, B., & Morrissey, J. (1999). Emerging partnerships between mental health and law enforcement. Psychiatric Services,