1. Nonviolent Crisis Intervention St. Joseph’s Regional Medical Center Center for Continuing Education CPI Crisis Prevention Institute

2. Unit I: Crisis Development Model How We Act Influence Others Behavior LevelsStaff approach 1. Anxiety1. Supportive 2. Defensive2. Directive 3. Acting out3. Nonviolent person physical crisis intervention 4. Tension4. Therapeutic reduction rapport

3. Exercises Proxemics Kinesics

4. Unit II: Nonverbal Behavior Proxemics (Personal Space) An area surrounding your body considered an extension of self. US av: 1 1/2 – 3 ft Factors that affect how much space we need: Situation, attitude, illness, familiarity, safety, hygiene, age, gender, etc. Also extends to personal effects: purse, room, drawers, etc.

5. Nonverbal Behavior Kinesics (Body Language) Nonverbal message we transmit through body posture and motion 1. Facial Expressions: Smile, frown, clenched jaw, eye contact. 2. Posture 3. Gestures: Close to own body, upward motion, slow movements 4. Movement: Fast or slow

6. Supportive Stance Safety, offers an escape route Non-challenging/ Non-threatening Shows respect Client Staff

7. Unit III: Paraverbal Communication Definition Vocal part of speech excluding the actual words we use. (How we say what we say). Elements Tone: Avoid inflections of sarcasm, impatience, disrespect, etc. Volume: Keep volume appropriate to situation Cadence: Rate and rhythm

8. Communication I didn’t say You were stupid Verbal Paraverbal Nonverbal

9. Unit IV: Verbal Intervention Verbal Escalation Continuum 3. Release 4. Intimidation DEFENSIVE 2. Refusal 5. Tension Reduction 1. Questioning

10. Empathetic Listening Definition: An active process to discern what a person is saying Be nonjudgemental Give undivided attention Listen to facts and feelings Use restatement to clarify Allow silence for reflection

11. Unit V: Precipitating Factors Definition: Internal and external causes of acting out behavior over which staff have little or no control of. Examples Family issues Attention seeking Health Fear History Support system Financial issues Noncompliance

12. Reasons to Understand Precipitating Factors Proactive Depersonalize To not become a precipitating factor

13. Rational Detachment Definition: The ability to stay in control of our own behaviors and not take the acting out behavior personally Control response Be professional Find positive outlets

14. Integrated Experience Definition: The behaviors and attitudes of the staff impact the behaviors and attitudes of clients and vice versa.

15. Unit VI: Staff Fear and Anxiety Universal Human Emotions UnproductiveProductive 1. Freezing1.  in speed and strength 2. Over-reacting2.  in reaction time - Psychologically Perceiving situation worst than it is. 3. Act inappropriately3.  sensory acuity - Verbally - Physically

16. Ways to Control Fear and Anxiety Know what makes you afraid Don’t respond alone, team intervention Know techniques to keep you and the client safe Learn physical interventions to manage client if necessary

17. Unit VII: Personal Safety Techniques STRIKE GRAB (A weapon coming in (An attempt to Contact with target) control/destroy part of one’s anatomy Kick Bite Punch Hair Pull Thrown objects Choke Spit

18. Principles of Personal Safety STRIKE GRAB 1. Block the weapon 1. Gain psychological advantage A. Stay calm B. Have a plan C. Element of surprise or distraction

19. Principles of Personal Safety STRIKE GRAB 2. Move the target 2.Gain physiological advantage A. Identify a weak point B. Get leverage C. Gain momentum

20. Unit VIII: Nonviolent Physical Crisis Intervention Only to be used as last resort No floor restraints (prevent injury to client such as accidental asphyxia). No element of pain Intent is to calm individual Team interventions Used to protect, not to punish

21. Team Intervention Crisis Response Team 2-5 people per team Code as inconspicuous as possible Diversity Common goal: Care, Welfare, Safety, Security 1. Verbal de-escalation 2. Physical: last resort

22. Team Intervention Team vs. Solo Intervention Why team intervention? Safety: Two people can handle an acting out individual more safely than one person can. Professionalism: Team members can lend support to one another during a crisis situation. This allows for staff to avoid perceiving the acting-out behavior as a personal confrontation. Litigation: Having another person on the scene provides a witness to the intervention.

23. Team Intervention Team Leader The first person at the scene A team member with confidence and competence in handling crisis situations A team member who has good rapport with the acting-out individual

24. Team Intervention Team Leader Duties Asses the situation. What steps are necessary? Plan the intervention. Direct or cue the other team members. Communicate with the acting-out person. To avoid confusion, only one person should talk to the acting-out person.

25. Team Intervention Auxiliary Team Member Duties Check: * Physical and psychological status of the disruptive individual. * Safety of the environment/remove dangerous objects. Address: * What needs to happen to de-escalate the crisis. * Are there any safety concerns.

26. Team Intervention Recognize: * Additional additional assistance when needed. * Need to change intervention strategies. Engage in: * Verbal de-escalation with acting-out individual. (if directed by team leader) * Support to other team members.

27. Unit IX: Situational Role-Plays Why do we use situational role-plays? Is safe, realistic practice Learning styles experiential Confidence Self-evaluation

28. Unit X: Postvention Debriefing Process Client Control: Making sure client is calm and rational Orient: Establish the basic facts, be non- judgemental Patterns: Past behavior, triggers Investigate: Alternatives to inappropriate behavior Negotiate: contract written or verbal Give: Responsibility back to client, so he/she can make own decisions.

29. Unit X: Postvention Staff Control: Calm and rational Orient: Establish basic facts Patterns: Staff response crisis (+ and -) Investigate: What to do for next time to strengthen the intervention Negotiate: Agree to make changes Give: Support and encouragement

30. Verbal Intervention DO Remain calm Listen!!! Be supportive Watch paraverbals Directive, set limits Assist Be consistent Give choices DON’T Over react Take it personally Invade their space Minimize Be defensive Get in power struggle Fake attention Be threatening

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