De-Escalation & Safety Practices

Training Objectives:

1. Understand challenging behaviors.

2. Learn how to create a safe environment and demonstrate safe staff behaviors.

3. Understand the importance of managing YOUR own behavior.

4. Recognize the importance of observing and reading the consumer.

5. Learn techniques for effective incident management including recognizing triggers and signals, knowing when to call for help, de-escalation strategies, and maintaining physical safety.

Understanding Challenging Behaviors

Individuals with developmental disabilities sometimes display challenging behavior, such as aggression or self-injury due to medical, psychiatric or neurological conditions.

As care providers, we must ask ourselves:

How do I maintain safety for all?

How do I recognize the early warning signs that a person’s behavior may escalate?

How can I intervene effectively before the person’s behavior becomes dangerous?

If a person does become aggressive, how can I best control the situation?

Safety Habits – Create a Safe Environment

DRESS FOR SAFETY:

NO low cut or too short

Jewelry

Hair

Scarves

Minimize Clutter and Excessive Stimulation:

______objects

Objects that interfere with ______

Cluttered surfaces/unnecessary objects

Loud noises

Overly ______places

KNOW WHERE YOU ARE:

  1. Stop and scan the ______.
  2. Know who is behind you at all times.
  3. Know where the ______are and if consumer becomes anxious, position yourself between both.
  4. Be aware of how and where you position your ______(i.e. do not reach across or around consumers).

Safety Habits – Consumer Observation

Carefully ______the consumer while respecting space.

Watch for ______(facial, muscle).

Changes in ______(positioning, pacing).

AWARENESS and reading the consumer is important!

Always follow consumer’s ______(ISP) & any behavior plans!

Safety Habits – Staff Behavior

MANAGE YOUR OWN BEHAVIOR

  1. ______Communication - What You Say (& When You Say It)
  2. ______Communication - How You Say It
  3. ______Communication – What Your Body is Saying

 BEHAVIOR INFLUENCES BEHAVIOR!

 NEVER PERSONALIZE!

 Leave your ______at home! Treat with dignity and respect.

 Evaluate importance of what you are trying to accomplish.

Verbal Communication - What You Say (& When You Say It)

  1. Sometimes say nothing. ______.
  2. Positive, concise phrases.
  3. Use ______whenever possible.
  4. Praise appropriate ______immediately.
  5. Try to withhold attention for challenging behaviors. Redirect, do not ______person.
  6. Ask for ______behavior (i.e. “handshake please,” not “do not grab at me.”)
  7. Verbal responses:

Answer ‘information seeking questions’ with a rational response.

Answer ‘challenging questions’ by sticking to the topic (redirecting), ignore the challenge (not the person).

  1. Be careful of violating ______. Use ‘when and then language,’ redirection, or share natural consequence.

Use term ‘______’ – “I need you to be safe by …...”

Para-verbal Communication - How You Say It

  1. ______– firm but not condescending, impatient, or aggressive
  2. ______– clear but not yelling
  3. ______– even, calm

“Say what you mean, mean what you say, but don’t be mean when you say it.”

Non-verbal Communication – What Your Body is Saying

  1. ______– 4-5 feet in front/behind; 3-4 feet to the side.

 Approach from side when possible.

  1. ______– moderate pace = calm. Fast pace = threat/panic.

 Even in crisis situation, move slowly except for safety.

  1. ______

Can be perceived as threatening. Consider trauma history.

  1. ______

Posture, arms, chin, eye contact, face

  1. ______(Supportive Stance)

Leg length away

Wide base

Thinking arms position

Line of vision

  1. Watch your ______!

Calm facial expression – most of the time. Positive.

Poker facial expression – if consumer becomes agitated.

Incident Minimization

Concepts to know:

 Triggers and signals

 Calling for help

 Designate a lead

 Safety during de-escalation

 De-escalation strategies

 Physical safety

Detecting Antecedents and Predicting Behavior:

Antecedents – whatever happens before a behavior.

______(environmental)

______(behavioral)

PAY CLOSE ATTENTION = early detection = earlier intervention

If you start to wonder if it’s time to call for help…IT IS!!

Incident Minimization – De-escalation

Leadership during incidents:

  1. ______
  2. One ______staff only. Leader’s job is to:

Decide what to do.

Direct the other staff.

Leader is on the only person who speaks to consumer, unless leader delegates the role.

De-escalation Goals:

  1. Maintain ______of all.
  2. Avoid making situation worse or consumer more agitated.
  3. Decrease ______behavior.
  4. Try not to reinforce crisis behaviors.
  5. If the consumer has a written behavior plan, ______follow the plan!

Safety During De-Escalation

Call for ______

Move other ______away

Identify ______

Remove potential ______

Safety Stance

Stay between ______and ______

Talk quietly, if need to talk at all

DE-ESCALATION STRATEGIES

  1. Help
  2. Prompt
  3. Wait

HELP STRATEGY

  1. Safety Stance.
  2. Ask what the consumer wants.
  3. Allow time for process of request.
  4. Repeat, if necessary.
  5. If request if made, praise. Comply, if able.
  6. If becomes more agitated, stop.

PROMPT STRATEGY

  1. Safety Stance.
  2. Prompt the desired behavior in calm, neutral voice.
  3. Allow 10 seconds for process of request.
  4. Repeat, if necessary.
  5. Praise any compliance.
  6. If noncompliant, stop.

WAIT STRATEGY

  1. Remove others and potential weapons.
  2. Monitor safely.
  3. Avoid reinforcing behavior (i.e. don’t talk/respond, no eye contact).
  4. When behaves more calmly, can use PROMPT or HELP strategies.

Incident Management – Physical Safety

PROTECTIVE STANCE

  1. Begin in Safety Stance.
  2. Turn your stance to protect yourself, if consumer comes towards you.

Hands in front of your face, palms out, fingers together. Use forearms for blocks. Hands close to your head. Do not grab!

SAFETY SHUFFLE

  1. Start from Protective Stance.
  2. Call for assistance!
  3. Move your rear foot back first.
  4. Shuffle front foot close to back foot.
  5. Repeat to maintain safe distance.
  6. If necessary, move unpredictably away from consumer’s midline.Never turn your back or get backed into a corner!

HAIR PULLING

  1. Push consumer’s hand against head. Do not pull away.
  2. Call for help.
  3. Communicate – “please let me go”
  4. Until help arrives, wait it out.

Reminder: wear longer hair up

BITE

  1. Push into bite.
  2. Call for help.
  3. Communicate – “please stop biting me”
  4. Until help arrives, wait it out.

GRAB

  1. Push into the grab by holding and stabilizing consumer’s wrist.
  2. Call for help.
  3. Communicate – “please let me go”
  4. Wait out.
  5. If safely able without hurting self or consumer, can pull limb away at weakest point.

Training Re-cap

  1. Create a Safe Environment
  2. Consumer Observation
  3. Detecting Antecedents and Predicting Behavior
  4. Manage YOUR behavior – verbal, para-verbal, non-verbal, cues
  5. De-escalation Goals
  6. Safety During De-Escalation
  7. De-Escalation Strategies – Help, Prompt, Wait
  8. Physical Safety – Safety Stance, Protective Stance, Safety Shuffle, Hair Pulling, Bite, Grab

References page

Safety Care, Quality Behavioral Solutions to Complex Behavior Problems™.

cpi, nonviolent crisis intervention.

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