THE NADD COMPETENCYBASED DSP CERTIFICATION PROGRAM Lesson 3

THE NADD COMPETENCY-BASED DSP CERTIFICATION PROGRAM Lesson 3 Crisis Prevention and Intervention

NADD-DSP Competency Standard #3 Crisis Prevention and Intervention is one area of competency in the NADD DSP Certification program. Below is the full list of all the areas in the DSP competency set. – Competency Standard 1: Assessment and Observation – Competency Standard 2: Behavior Support – Competency Standard 3: Crisis Prevention and Intervention – Competency Standard 4: Health and Wellness – Competency Standard 5: Community Collaboration and Teamwork PLUS…Application and commitment to the Code of Ethics

Educational Objectives Participants will be able to recognize why people with IDD/MI are more likely to experience conditions that can lead to a crisis. Participants will be able to identify safe and effective crisis prevention and intervention strategies. Participants will be able to discuss how proactively managing their own stress can lead to more effective and positive support approaches.

Benchmark 3 A: Knowledge and Use of Crisis Prevention Strategies The qualified DSP recognizes great toll that crisis takes on individuals supported. He/she works to help each person reduce the risk of repeated crisis. The DSP implements daily strategies that reduce the likelihood of crisis. This includes supporting a health and safe environment. This includes helping the person learn new skills and abilities that prevent crisis. It is includes being aware of early signs of building crisis or triggers for each person and taking early steps to avert crisis.

The Big Picture: reducing crises l l l Establishing Environments that reduce/prevent crisis Behaviors are viewed as indicators where assistance is needed Support ongoing wellness and relaxation opportunities for all individuals, with extra emphasis on mental health supports for those with a psychiatric diagnosis Activities are engaging, supportive, interactive, personcentered, choice-driven, safe Provide immediate crisis prevention and response services in the community.

Factors that can Precipitate a Crisis • • The exacerbation of one’s mental illness Environmental stressors Psychological factors Interpersonal stressors (staff, roommates, coworkers) • Physical stressors (illness, pain) • Trauma • Any or a combination of the above Cheplic, 2016

Understanding Behavior: The Key to Crisis Prevention Many people with IDD/MI have trouble with challenging behavior. However, for a subset of people their mental health status or other needs may create a situation in which crisis behaviors are seen. A behavioral crisis is a situation where the person’s behavior puts him/her or others at risk of immediate and serious physical harm or death. The qualified DSP recognizes that most crises can be prevented or interrupted before harm occurs.

Activity Adjust daily support and expectations in order to prevent crisis when there are signs of increased needs of individuals at risk for crisis. Kyle was fired from his job yesterday. At breakfast, he tells his roommate he is going to get even with his boss when the time is right. What are your next steps?

Crisis Prevention • Use behavior and health information to help prevent or prepare for a crisis • describe how to recognize patterns of escalating behaviors or symptoms and ways to intervene as early as possible

Benchmark 3 B: Knowledge and Use of Crisis Intervention Strategies The qualified DSP uses safe and effective crisis intervention strategies when necessary. He/she is aware of the specific needs and triggers of individuals supported and works with each person individually. In a crisis, the qualified DSP is able to stay calm and work well with the person and others. He/she is able to work effectively with emergency response personnel. .

Crisis Intervention Activity Jorge, who has an anxiety disorder, is looking forward to an evening out with his Mom. She planned to pick him up at 5: 00. It’s 5: 15 and he is pacing by the window, pulling on the curtain. At 5: 30 he starts to yell and bang on the glass. When his roommate asks if he is going out, Jorge throws the TV remote at her. Her mouth is bleeding.

In the Midst of Crisis l Mistakes/dangers in a crisis: assess incorrectly, respond inappropriately, overreact, threat, lecture, order, impose consequence rather than let people evaluate them, allow people to get hurt physically or emotionally. l During crisis – anxiety, instability internally or in environment, prevent person from effectively using skills - but WE CAN l Opportunities in a crisis: prevent behavior based on why the behavior happens, model and coach calming techniques, help people evaluate options and outcomes, make positive change, exercise decisionmaking ability and self-control.

Response: When Incidents Do Occur l l Respond positively: focus on the reason for the behavior – Finding a way to get what they want/need usually helps someone calm down quicker – What does this person need right now? Attend to needs of other individuals – – Give others some attention Prevent others from escalating or getting hurt

Verbal De-Escalation Strategies § § § § Use a calm tone of voice Use reflective listening Avoid threatening punishment Avoid power struggles Do not ignore escalations of behaviors that could lead to severe behaviors Change staffing if necessary Affirm that you understand Mc. Gilvery & Sweetland, 2011

More Verbal De-Escalation Strategies § § Change the subject if it appears to agitate the person more to talk about it Change aspects of the environment. Set limits by reminding the person of the choices and outcomes but do so in a firm, fair manner and with a non-emotional tone of voice. Remind the individual of the undesirable consequences that can occur if he or she engages in the problem behavior. Mc. Gilvery & Sweetland, 2011

Benchmark 3 C: Documentation and Communication of Crisis Situations The qualified DSP recognizes that effective and complete documentation of crisis events is useful. It will guide future decisions regarding prevention and response in crisis. He/she follows all employer documentation guidelines as well as the state documentation requirements. The qualified DSP is familiar with and skilled at following each individual’s treatment plan. He/she communicates with the treatment team as indicated.

Components of a Crisis Prevention Plan A Crisis Prevention Plan is intended to be an informative and helpful planning tool for individuals, families, and providers to aid in the early detection of and effective intervention during an emergent situation

Documentation of Crisis Info Document and communicate observations regarding the coping skills identified in treatment and behavior support plans in accordance with agency policy and state guidelines. Identify and documental health symptoms to be monitored according to the individual’s treatment plan. Recognize and document changes in behavior, including responses to specific interventions

Individual Response Planning Outline the appropriate actions to address the issues at the earliest possible stage of the crisis unfolding. The plan should also include appropriate intervention strategies that are effective when dealing with problem behavior.

Benchmark 3 D: Managing Stress and Burnout The qualified DSP recognizes that supporting people who experience significant or frequent crisis is a challenging job. The DSP recognizes that these experiences affect their own mental health and well-being. The DSP knows that burnout and stress can reduce effectiveness. In order to maintain a positive and effective approach to support, the DSP must be skilled at recognizing and attending to his or her own needs.

Best Practices in Crisis Reduction Building a Tool Kit l l l Teach individual to identify and label feelings Gain a understanding of how feelings and behaviors contribute to larger crises Learn to recognize feelings in oneself Use visual tools or cues to help individuals learn to recognize the feelings Practice monitoring those feelings

Stress and Burnout The DSP knows that burnout and stress can reduce effectiveness. In order to maintain a positive and effective approach to support, the DSP must be skilled at recognizing and attending to his or her own needs

Stress and Burnout Activity l What causes stress in your life? l What things are stressful at your job? l What are good/bad response? Discussion: How can we be more prepared for a “crisis” on the job when we manage our own stress?

Best Practices in Crisis Reduction Least Restrictive and Person Centered § § Supports people in lifestyle choices that reduce vulnerabilities (exercise, sleep, food, therapy, support group, family time, relaxation, etc. ). Supports the person in identifying and learning alternative coping skills and for how to avoid or reduce triggers to crisis. Adjust daily support and expectations in order to prevent crisis when there are signs of increased needs. Remember that mental health challenges make people vulnerable.