Nonviolent Crisis Intervention

St. Joseph’s Regional Medical CenterCenter for Continuing Education

CPI

Crisis Prevention Institute

Unit I: Crisis Development Model

How We Act Influence OthersBehavior Levels Staff approach1. Anxiety 1. Supportive2. Defensive 2. Directive3. Acting out 3. Nonviolent person physical crisis

intervention4. Tension 4. Therapeutic reduction rapport

Exercises

• Proxemics

• Kinesics

Unit II: Nonverbal Behavior

Proxemics (Personal Space)An area surrounding your body considered

an extension of self. US av: 11/2 – 3 ftFactors 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.

Nonverbal Behavior

Kinesics (Body Language)Nonverbal message we transmit through body

posture and motion1. Facial Expressions: Smile, frown, clenched jaw, eye contact.2. Posture3. Gestures: Close to own body, upward

motion, slow movements4. Movement: Fast or slow

Supportive Stance

• Safety, offers an escape route• Non-challenging/ Non-threatening• Shows respect

Client

Staff

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

Communication

I didn’t say

You were stupid

Verbal

Paraverbal

Nonverbal

Unit IV: Verbal Intervention

Verbal Escalation Continuum3. Release

4. Intimidation DEFENSIVE 2. Refusal

5. Tension Reduction 1. Questioning

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

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

Reasons to Understand Precipitating Factors

• Proactive

• Depersonalize

• To not become a precipitating factor

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

Integrated Experience

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

Unit VI: Staff Fear and Anxiety

Universal Human EmotionsUnproductive Productive

1. Freezing 1. in speed and strength

2. Over-reacting 2. in reaction time

- Psychologically

Perceiving situation worst

than it is.

3. Act inappropriately 3. sensory acuity

- Verbally

- Physically

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

Unit VII: Personal Safety Techniques

STRIKE GRAB(A weapon coming in (An attempt toContact with target) control/destroy

part of one’s anatomy

Kick BitePunch Hair PullThrown objects ChokeSpit

Principles of Personal Safety

STRIKE GRAB1. Block the weapon 1. Gain psychological

advantage A. Stay calm B. Have a plan C. Element of

surprise or distraction

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

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

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

Team Intervention

Team vs. Solo InterventionWhy 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.

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

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.

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.

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.

Unit IX: Situational Role-Plays

Why do we use situational role-plays?

• Is safe, realistic practice

• Learning styles experiential

• Confidence

• Self-evaluation

Unit X: Postvention

Debriefing ProcessClientControl: Making sure client is calm and rationalOrient: Establish the basic facts, be non-judgementalPatterns: Past behavior, triggersInvestigate: Alternatives to inappropriate behaviorNegotiate: contract written or verbalGive: Responsibility back to client, so he/she can

make own decisions.

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

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

• This product was funded by a grant awarded under the President’s High Growth Job Training Initiative as implemented by the U.S. Department of Labor’s Employment & Training Administration.  The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non-commercial use only.