bunc de escalation

8/10/2019 Bunc de Escalation

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Law Enforcement AcademyAsheville-Buncombe Technical Community College

Asheville, North CarolinaCrisis ntervention Team Training!e"tember #$ % &ctober 1, #'1'

(e-Escalation !)ills


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Overview

1 days (12 hours) Lots of role-playing practice in small groups

Goal is for you to feel very confident in your ability to de-escalate odel ! "-L"#$ " ! engage (wed% pm) L"#$ ! listen& empathi'e& affirm& partner (thur% am) pecific strategies for consumers who are disoriented&

intoicated& suicidal& etc% (thur% pm)


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*ednesday $

*hat is de-escalation

"ffective communication

+on-verbals

,ehavioral crisis

"ngagement


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*hat is verbal de-escalation

.erbal de-escalation is used during

potentially dangerous& or threatening&

situation in an attempt to prevent persons

from causing harm to us& themselves& or

others


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Goals of .erbal /e-escalation

Open up clear lines of communication

,uild trust and validate the consumer0s

situation

Get the consumer taling about his

situation

Gathering the necessary information mae

a good resolution


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*hat is /e-"scalation

/e-escalation is less lie a recipe or formula

and more lie a fleible set of options%

+o single set of de-escalation sills wehave tried to put together a effective set of

sills by borrowing from multiple approaches

/e-escalation will not always wor


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*hat is de-escalation

,oth officer and consumer safety always remainparamount concerns in a crisis involving aperson with mental illness%

Once officers become silled in de-escalation&they do not simply abandon all the training andeperience that came before it%

/e-escalation is another tool that officers have

at their disposal to be 3udiciously applied incontrolling a potentially volatile situation& ratherthan serving as a substitute for sound 3udgmentand attentiveness to safety%


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"ffective 4ommunication

567 of communication misunderstood

"ffective communication is defined as

passing information between one person

and another that is mutually understood


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"ffective 4ommunication 4ommunication becomes more difficult when the

person0s ability to understand what you aresaying and8or their ability to epress their ownthoughts or needs are compromised by their

symptoms% *hen they can0t epress their needs& they

become more angry and frustrated more 9uiclyand more fre9uently

:our ability to engage a consumer inconversation and successfully resolve a conflictoften depends as much on how you say thewordsyou choose as much as the wordsthemselves%


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,arriers to "ffective 4ommunication

,arriers to communication are the things that eep themeaning of what is being said from being heard

$re-3udging +ot listening 4ritici'ing +ame-calling "ngaging in power struggles Ordering ;hreatening inimi'ing #rguing


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"ffective 4ommunication


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+on-.erbal


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$ersonal pace

$ersons with mental illness often develop and alteredsense of personal space% ;hey re9uire more space thanusual to feel comfortable and feel intensely threatened

when other people close in on them with no warning% they might interpret thatas an aggressive action

#nnounce intention ?< need some space& so < am goingto bac up%@


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"yes

One eyebrow raised ! sternness

"yes wide open ! surprise

# hard stare ! threatening gesture

4losing eyes longer than normal ! < am

not listening


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,ody $osture4hallenging postures that tend to threaten another

person and escalate the situation include Ainger pointing may seem accusing or

threatening houlder shrugging may seem uncaring or

unnowing Bigid waling may seem unyielding or

challenging Cse slow and deliberate movementsD9uic

actions may surprise or scare the other person


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.oice

;one - Csually unconscious

.olume - # raised voice could create fear

or challenges

Bate of speech - pea slowly > ;his is

usually interpreted as soothing


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Aace Eaw set with clenched teeth shows that

you are not open minded to listening to

his or her side of the story# natural smile is good% # fae smile

can aggravate the situation


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*hat is a ,ehavioral 4risis

# crisis is a perception of an event or

situation as an intolerable difficulty that

eceeds the resources and copingmechanisms of the person

Cnless the person obtains relief& the crisis

has the potential to cause severebehavioral malfunctioning%


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,ehavioral 4risis

4risis intervention is emotional first aid

which is designed to assist the person in

crisis to return to normal functioning% ;he focus of crisis intervention is what0s

happening here and howF


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,ehavioral 4risis

= reasons that a consumer may be having a

behavioral crisis

edical condition

ubstance use

$sychiatric condition 1) thought disorder

2) mood disorder =) aniety disorder H)

personality disorder


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,ehavioral 4risis

;he ma3ority of encounters that you will havewith consumers are because the symptoms oftheir illness are not under control% ost

commonly& this occurs at the initial onset ofillness& during a relapse (that can result for avariety of reasons) and when the person s usingsubstances%

;he consumer0s behavior is usually a result ofhis or her illness& rather than being criminallymotivated


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4onsumers typically will haveone of = feelings

#nger

Aear

adness8depression


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*hat you may be seeing % % %

Consumers Inner

Experience

Hostility, evasion Fear

Risk-taking Elation

Self-destructive behavior Depression

Odd, dangerous behavior Confusion

ery odd behavior !sychosis

"tte#pts at self-treat#ent$e%g% drugs&

Hopelessness, de#orali'ation


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,ehavioral 4risis

Given the low lielihood that emotional people in

crisis can succeed in rationali'ing alternatives&

law enforcement responses to emotional peoplein volatile situations cannot rely on convincing

people by maing a rational proposal to thin

differently% Bather& responders need to create a

stable and respectful environment within whichemotional individuals can tae comfort and

relief%


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"ngagement

,e aware of your setting personal safety first

ove to a safe place if necessary

#llow plenty of space $ersons with mental illnesses often can be

epected to process information slowly and to

have difficulty remembering things% ;his includes

understanding and remembering instructions

given by a police officer%


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"ngagement

,e aware that a uniform& gun& and

handcuffs may frighten the person with

mental illness so reassure consumer thatno harm is intended%

Bemain calm

:ou will liely have contact with theconsumer again how you treat him will be

important for establishing trust


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"ngagement

Inow when to act # person may be acting

dangerously& but not directly threatening

any other person or himself8herself%


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"ngagement

?


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#void

aintaining continuous eye contact

4rowding or ?cornering@ the consumer

;ouching the consumer unless you as first or itis essential for safety

Letting others interact simultaneously with the

consumer

+egative thoughts (?God& this is another one of

those homeless people%@)


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#void

"pressing anger& impatience or irritation


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#void

aying ?:ou need to calm down%@

houting or giving rapid commands

#rguing with the consumer ;aing the words or actions of the consumer

personally (;hey are symptoms of mental

illness%)

Lying& tricing& deceiving& threatening the

consumer to get her to comply


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#void

#sing why 9uestions% *hy 9uestions are

logic-based% $ersons in crisis are not

logical% ;ypically& what ever has wored inthe past is not woring now% *hy

9uestions put the consumer on the

defensive% #s open-ended 9uestions% Aorcing discussion


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#void

inimi'ing the consumer0s situation as a

way to elicit conversation (?;hings can0t be

that bad& can they@) uggesting that things will get better they

may not

aing promises that you may not be ableto eep


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#void

4ommands such as ?drop the nife&@ or ?Get

down on the ground@ might seem to be

straightforward and easy to understand% *hendealing with people who live with mental illness&

however& officers need to tae into account the

types of barriers to effective communication that

the brain disorder might create% ;elling the consumer ?< now how you feel%@


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#void

#sing a lot of 9uestions of the consumer in thebeginning% ;his is a natural tendency& however&this is generally not a good idea& especially earlyin the interaction%


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/O

pea in a calm& slow& clear voice :ou may need to repeat the consumer may be

distracted ,e patient give the situation time time is on

your side ;ry to reduce bacground noise and distractions

Cse ?and@ instead of ?but@ Obtain relevant information from informants


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/O

#llow the consumer to ventilate (?;ell me somemore about that%@

Cse ?please@ and ?than you@ often Bemain friendly but firm #s the consumer if she needs something Offer a cigarette& nutrition bar& warm clothing Aorecast #nnounce your actions and

movements


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/O

#ccept the consumer0s feelings& thoughts

and behavioral acceptance is not easy

when a consumer is behaving in a bi'arreor hostile manner

Bespect the dignity of the consumer

without regard to se& race& age& seualorientation


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Jot ,uttons

4onsumers will sometimes push a hot

button

*e all have them "ample ;he consumer calls you a ?pig@

or swears at you%

;his is +O; the time to demand respect


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1% /evelop a $lan

Decisions made ahead of time are

more likely to be rationale

Identify your hot buttons

Strategic visualization practice

what you would doHelps you gain confidence


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2% Cse $ositive elf-;al

You are not the target of the outburst

Never take anything personally

emember that most of us have been

irrational and said inappropriate things

when we are under e!treme stress


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=% Becogni'e :our Limits

"et someone else take over ifnecessary

Set a limit with the person# use an $I%statement# $I really want to help youbut I find it difficult because of yourname&calling# could you help me andstop the cursing so that I can work onhelping you' (hanks) I wouldappreciate it if you try'%


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;he Logic of /e-"scalation


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Bole-playing cenarios "veryone feels uncomfortable in role play

Aeedbac will be constructive

cenarios are derived from real-lifeeperiences

*e will be woring as a team to assist one

another in sill development

mall groups = rolesDLaw enforcement&

consumer& observer


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;hursday #

Listen

"mpathi'e

#ffirm

$artner

*hat


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L ! Listen

ilent and listen are spelled with the same

letters

Listen twice as much as you tal that0swhy you have 2 ears and 1 mouth

*hat is the difference between listening

and hearing


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;he 4hinese symbol for listen

eyes& ear& heart


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Listen

Listen for the total meaning

Aocus on what the consumer is telling you

,loc out distractions


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Listen


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;echni9ues that how :ou #re

Listening1% inimal encouragers

2% Beflecting

=% #s open-ended 9uestions (?4an you tell

me more about that%@


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inimal "ncouragers

inimal encouragers are brief statements that canbe either nonverbal& such as a positive nod of thehead& or simple verbal responses such as Oay&

Ch-huh& < see& < am listening% inimal encouragers demonstrate to the consumer

that you are listening and paying attention& withoutstalling the dialogue or creating an undueinterruption% "specially early in the encounter&

consumers need these types of encouragers to feelthat the officer is really attending to them andlistening to what they are saying%


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Beflecting

*hereas minimal encouragers provide initial

confirmation that you are listening& reflecting adds

another dimension to the communication% Jere&

you provide the consumer with evidence that you

are listening by actually repeating what he or she

has said% Often the reflecting response will simply

consist of the last few words the consumer says%

;hese statements should be brief and used in

such a way as not to interrupt the consumer%


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Beflecting

Bepeat the last few words that the

consumer said

"ample ?< am tired of everyone notlistening to me and it mae me angry%@

?Eim& it maes you angry%@


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Open-"nded uestions

Open ended 9uestions allow you to getmore information

Open ended 9uestions enable us toassess the consumer0s level ofdangerousness

Open ended 9uestions allow you toassess whether the consumer is in touchwith reality


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pecific uestions ;hat :ou ay *ant :ou

#s& *hen #ppropriate /oes the consumer need something (e%g%&

hungry& thirsty)


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edication

entioning ?medication@ must be given carefulthought%


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" ! "mpathy

1% "motion labeling

2% $araphrasing


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"motional Labeling


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"motional Labeling "amples

:ou seem to be % % % %


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$araphrasing

$araphrasing is similar to reflecting ecept

that now you begin to communicate that

you are trying to understand theconsumer0s entire message by putting

what the consumer has said into your own

words%


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$araphrasing

,uilds rapport between officer andconsumer

Jelps the officer refine the assessment ofthe crisis $rovides information that lays the

groundwor for an eventual resolution ofthe crisis

4ommunicates that you are listening andunderstanding


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$araphrasing "amples

4onsumer < don0t now what < am going

to do% y family doesn0t want me here%

4


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$araphrasing "amples

*hat < hear you saying is % % % %


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# ! #ffirm

:ou need to now what the consumer is upsetabout

:ou may have a tendency to go to the solutionstep without really identifying what the issue is

with the consumer% :ou should not assume thatyou now why the consumer is upset% :oushould as and let the consumer tell you whatthe problem is before looing at possiblesolutions%

#fter getting the information that you need& steerthe conversation toward a resolution by affirmingthe consumer0s situation


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#ffirm "ample

?Oay& let me mae sure < understand you&

:ou0ve told me that people are bothering

you and that your case manager is nothelping you% ;hat your meds are hurting

you because they mae you feel sic% /id

< understand you correctly%@


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$ ! $artner

#lso ?plan&@ ?problem-solve@

Goal is to find a resolution and return to

pre-crisis state% :ou are looing to find the combination

that will unloc the crisis%


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$artner

:ou can as the consumer what shethins will resolve the problem

Loo for alternatives withthe consumer ;ry to have 2 or more options "mpower the consumer to choose


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$artner

$utting yourself in the consumer0s shoes willhelp you find a solution

/on0t force particular points of discussion

;ry to get agreement on a course of action%Bepeat what the plan is and what is epected%

eet reasonable demands when possible

Beach for small concrete goals


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$artner


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$artner


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*hat


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*hat


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*hat


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*hat


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*hat


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*hat


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*hat


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*hat


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Aive pecial trategies

1% #ssertive


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1% #ssertive


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;hree tep #ssertive


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"amples ?Eac& < understand that you are upset and that

you feel lie no one is listening to you or doingenough to help you% ,ut you and < need to letthese people get bac to wor here& so we are

going to have to get out of this waiting room%


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4hoice


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2% 4orrective #ction ###


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=% Beducing timuli

Bemove the audience or move the

consumer to a private space

;urn off flashing lights


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K $ro active "ngagement


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K% $ro-active "ngagement

of 4onsumers

any of you will interact with the same

consumer on repeated occasions so you will

get to now him or her%


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$ro-active "ngagement of

4onsumers

/rop by the consumer0s residence% #s if there is

anything you can do to help% (e%g% call the case

manager to try to access a resource for the

consumer%)


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;hursday $

.erbal


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Beview of ;erms

;hought /isorder ! usually a reference to apsychotic disorder

$sychotic ! out of touch with reality ofteneperiencing delusions or hallucinations

/elusion ! false belief Jallucination ! false sensory perception (most

common is auditory) ania ! # manifestation of bipolar disorder

(manic depression)& characteri'ed by profuseand rapidly changing ideas& eaggeratedseuality& gaiety& or irritability& and decreasedsleep


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uicide #sing about suicide ?ometimes when people have

been feeling down for a long time& they begin havingthoughts that they would rather be dead& are you havingany feelings lie that@

?Jave you ever tried to hurt yourself before@ ?*hen and what did you do@ ?/o you have a plan now@ ?/o you have any weapons that you could use to hurt

yourself@

how support and interest ,e non-3udgmental and accepting Offer help that is available #ssess availability of supports


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uicide ;hreatening Jarm

Aocus on the anger or fear that is causingthe threats

Bepeat that you are here to help and eepeverybody safe Get the names of significant others (even

pets)& as a way to mae a personalconnection and eep the consumergrounded


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uicide #ttempt

.erbal communications should focus on

providing hope for the consumer during a time

when he is feeling hopeless%

Generally& helpful comments to mae during

9uestioning include ;hese feelings will not last

forever& even though it may seem lie it now%

;here is help available% any other people havefelt this way and have gotten better%


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uicide #ttempt

Cnhelpful comments include clichMs such as&

;here0s a silver lining in every cloud& or

comments about all that they have& :ou have a

nice home& family who loves you& who will taecare of your ids% #nd finally comments about

yourself& < felt the same way once or a friend of

mine felt this way once% ;hese types of unhelpfulcomments only elicit more profound feelings


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Jomelessness H67 of homeless persons have a mental

illness ;he ways in which homeless people dress

may seen bi'arre to other people ental health professionals may refer to a

homeless person0s choice not to taemedications as noncompliance& but to a

homeless person the decision not to taesedating psychiatric medications maymae good sense%


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;hought /isorder

;he = possible responses to a person who losescontact with reality& and are either hallucinating ordelusional& are

#%#gree with them

,%/ispute them& or

4%/efer the issue

*hich is the appropriate response #& , or 4


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;hought /isorder ;he engagement goal is to validate the consumer0s

situation and how frightened and anious he must feelwithout agreeing with their hallucinatory8delusionaleperience%


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Jallucinations


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Jallucinations

#s if they are hearing voices ?*henpeople are stressed or scared& they may

hear or see things& is that happening to

you%@#s& ?are the voices telling you to do

something& what@

$eople who are abusing substances orare in withdrawal may see things or feel

things crawling on them


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Jallucinations


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Jallucinations

Jallucinations8voices that are commandoriented involving religion& good versusevil& or are declaring self-harm are higher-ris than non-religious& non-confrontational hallucinations%

;his can lead to dangerous behavior

because many persons will obey thecommand%

4onfused8/isorgani'ed peech


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$eople with a variety of mental illnesses

may eperience confusion schi'ophrenia&

bipolar& neurological disorders& traumatic

brain in3ury& people who are actively usingor withdrawing from substances

Ieep interactions brief and to the point



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*hen it is difficult to understand the

consumer& say so and as for clarification%


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#gitation& #niety& Aears

"ncourage = slow deep breaths


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$eople *ho #re


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$;/ Alashbacs ome people with post traumatic stress disorder

eperience flashbacs% /uring a flashbac& theperson is eperiencing the traumatic event% oall the senses and thoughts are in the moment%


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Bapid peech 8 ania

ome people tal rapidly when they arestressed or scared% $eople who are manicoften tal very rapidly

"ncourage the person to slow down& taedeep breathes%

?< want to understand what you are saying&

but you are taling really fast% Let0s taesome deep breaths together%@

# l d t


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#cnowledgements

;his material was adapted from numerous sources&including

emphis 4


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;han you for going the etra

mile to help people with mental

illnessF

bunc de escalation

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