Nonviolent Crisis Intervention St Josephs Regional Medical Center

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

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

Unit I: Crisis Development Model How We Act Influence Others Behavior Levels Staff approach

Unit I: Crisis Development Model How We Act Influence Others Behavior Levels Staff approach 1. Anxiety 1. Supportive 2. Defensive 2. Directive 3. Acting out 3. Nonviolent person physical crisis intervention 4. Tension 4. Therapeutic reduction rapport

Exercises • Proxemics • Kinesics

Exercises • Proxemics • Kinesics

Unit II: Nonverbal Behavior Proxemics (Personal Space) An area surrounding your body considered an

Unit II: Nonverbal Behavior Proxemics (Personal Space) An area surrounding your body considered an extension of self. US av: 11/2 – 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.

Nonverbal Behavior Kinesics (Body Language) Nonverbal message we transmit through body posture and motion

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

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

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

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

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

Unit IV: Verbal Intervention Verbal Escalation Continuum 3. Release 4. Intimidation DEFENSIVE 5. Tension

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

Empathetic Listening Definition: An active process to discern what a person is saying •

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

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 • Health • History • Financial issues • • Attention seeking Fear Support system Noncompliance

Reasons to Understand Precipitating Factors • Proactive • Depersonalize • To not become a

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

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

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 Emotions Unproductive 1. Freezing 2. Over-reacting

Unit VI: Staff Fear and Anxiety Universal Human Emotions Unproductive 1. Freezing 2. Over-reacting - Psychologically Perceiving situation worst than it is. 3. Act inappropriately - Verbally - Physically Productive 1. áin speed and strength 2. âin reaction time 3. ásensory acuity

Ways to Control Fear and Anxiety • • Know what makes you afraid Don’t

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 (A weapon coming in Contact with target) GRAB

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

Principles of Personal Safety STRIKE 1. Block the weapon GRAB 1. Gain psychological advantage

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

Principles of Personal Safety STRIKE 2. Move the target GRAB 2. Gain physiological advantage

Principles of Personal Safety STRIKE 2. Move the target GRAB 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

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

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 Intervention Why team intervention? • Safety: Two people can

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.

Team Intervention Team Leader • The first person at the scene • A team

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? •

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

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 assistance when needed. * Need to change

Team Intervention • • Recognize: * 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

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 Process Client Control: Making sure client is calm and rational

Unit X: Postvention Debriefing Process Client Control: Making sure client is calm and rational Orient: Establish the basic facts, be nonjudgemental 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.

Unit X: Postvention Staff Control: Calm and rational Orient: Establish basic facts Patterns: Staff

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

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

• 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.