CRISIS PREVENTIONWhat does effective TCI implementation include?
Effective TCI implementation includes
leadership and programme support
clinical participation
supervision and post crisis response
training and competency standards
documentation and incident monitoring and feedback
CRISIS PREVENTIONDescribe conditions or settings that can affect behaviour
Anything that makes challenging behaviour more or less likely to occurfor example: Organisational culture (e.g. control orientated, poorcommunication)environment (e.
g. hot, crowded)Programme related (e.g. routine, staffing, activities)Personal(e.
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CRISIS AS OPPORTUNITYWhat are the three levels of recovery of the recovery phase?
Lower (Abuser) – we end up yelling or threatening
No Change (Fire Fighter)
Higher ((Educateur) = We want to be/get here
[image]
CRISIS AS OPPORTUNITYDescribe the skills building pyramid: self-awareness
Six levels.
LSI.Crisis co-regulation.Emotional first aid.Behaviour support techniques.Active listening crisis communication.Self-awareness (the four questions)[image]
CRISIS AS OPPORTUNITYWhat are the four questions we ask ourselves in a crisis situation?
What am I feeling now?
What is this young person feel, need, or want?
How is the environment affecting the young person?
How do I best respond?
CRISIS AS OPPORTUNITYHow do I best respond?
Provide environmental support by managing the environment to neutralise potential triggers.
Provide emotional support by engaging young person.Exercise self-control over on feelings.
Knowing Ourselves“What am I feeling now?”
Anger can undermine objectivity.Anger is an emotional and physical state.
Cognitive abilities are reduced.
Knowing OurselvesWhat are the effects of anger?
“When we after angriest, we are at our stupidest.” As anger increases, cognitive functioning decreases[image]
Knowing OurselvesDescribe the Feelings, Needs, and Behaviors Iceberg
Feelings and Needs are under the water andBehaviors are above the water [image]
Knowing OurselvesWhat does Assessing Behavior Mean?
All behaviour has meaning.
Behaviour reflects needs.
Trauma affects our children behave.
Knowing OurselvesPain-based behaviour includes?
Impulsive outbursts.Aggression.Running away.
Self injury.Defiance.In ability to regulate emotions.Trauma re-enactment.
Knowing OurselvesIdentifying a young person’s needs
What is this individuals child baseline behaviour? Is this typical behaviour?Is this normal or young person in this age?Does this behaviour reflect the child or family’s worldview?Is this a pain based behaviour related to past trauma?What feeling in the child expressing?
MANAGING THE ENVIRONMENTWhat would you examine the physical setting for?
Possible weapons.
Stimulating lights or noise levels.Crowding.Chaotic, messy, disorganised messages.
MANAGING THE ENVIRONMENTWhat questions should be asked about activities and routines?
Are they causing frustration, boredom or anger?Are they in adequately resource so that children cannot fully participate?Are they conducted in areas without enough space or equipment?Do they build on children’s strength or point out their weaknesses?Do they allow individuals (adult or child) to agitate others?
MANAGING THE ENVIRONMENT;Agency policy and procedures should be?
Clearly writtenCommunicated;Understood;Applied
COMMUNICATION;;;Nonverbal techniques include?
Silence.;Nods.;Facial expression.Eye contact.
CRISIS COMMUNICATION AND ACTIVE LISTENING;What does MEANING in emotional communication equal?
Facial expression = 55%+ Tone of voice = 38% + Words = 7%;[image]
CRISIS COMMUNICATION AND ACTIVE LISTENING;;What are Encouraging and eliciting techniques?
Open questions: “how did you respond?” “What happened next?”
CRISIS COMMUNICATION AND ACTIVE LISTENING;Understanding responses
Reflective responses:”you feel uncomfortable when your friends talk about school.””You’re angry about your visit being counselled. I be upset, too.”;Summarisation:”here’s what I hear you saying, you felt good at first, but now.
..”
CRISIS COMMUNICATION AND ACTIVE LISTENING;What is active listening?
Acting listening:-
Identifies and validates feelings.
Reduces defensiveness.
Promotes change.
Communicate that we care and understand.
It is an effective co-regulation strategy.
Help young people. “Talk out rather lacked out”
CRISIS COMMUNICATION AND ACTIVE LISTENING;Active listening is not
Throwing up roadblocks.
Arguing or blaming.
Giving permission.
Giving advice or solving the problem to the child.
Necessarily time-consuming.
BEHAVIOUR SUPPORT TECHNIQUES;What behaviour support techniques?
Behaviour support techniques are:-;
Managing environment.
Prompting.
Caring gesture.
Hurdle help.
Redirection and distractions.
Proximity
Directive statements.
Time away
EMOTIONAL FIRST AID;Adults can help children by?
Seeing the incident from the child’s perspective.
Helping children see the connection between feelings and behaviour.
Encouraging children to be responsible for their actions.
CRISIS COMMUNICATION AND ACTIVE LISTENINGWhat are the goals of emotional first aid?
To provide immediate help and support to reduce emotional intensity (co-regulation).
To resolve the immediate crisis.
To keep the child in the programme / activity
CRISIS COMMUNICATION AND ACTIVE LISTENINGWhat are the strategies are emotional first aid?
Drain off emotions.
Clarify events.
Maintain a relationship and lines of communication.
Remind a child of expectations immediate situation if necessary.
CRISIS COMMUNICATION AND ACTIVE LISTENINGWhat should the worker ensure that the child understands?
That the child believes they have the ability to successfully participate in activity.
But there will be time to talk again later if needed.
THE CONFLICT CYCLEWhat are the four elements of the conflict cycle?
Stressful situation/incident.
Young Persons feelings.
Young person’s behaviour.
Adults response
[image]
CONFLICT CYCLE;How can we avoid a conflict cycle?
We can avoid a conflict cycle by:-
Using positive self talk.
Listening and validating feelings.
Managing the environment (e.g.
removing others).
Giving choices and the time to decide.
Redirecting young person to another positive activity.
Appealing to young persons self-interest.
Dropping or changing the expectation
;
MANAGING AGGRESIVE BEHAVIOUR;What are the 2 Types of Aggressive Behaviors?
1. Reactive Aggression2. Proactive Aggression
MANAGING AGGRESIVE BEHAVIOUR;What is Reactive Aggression mean and what does it look like?
;;
Affective or expressive aggression
Loss of control and emotional flooding
Emotions are dominant
MANAGING AGGRESIVE BEHAVIOUR;What is Proactive Aggression and what does it look like?
;;1. Instrumental or operant aggression2. Goal Oriented3. Cognitions are dominant (Thinking is dominant)
MANAGING AGGRESIVE BEHAVIOUR;What are the features of reactive aggression?
Facial features;;;;;;;;;; wide-eyed red-faced (pale if afraid).Actions;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;; disorganised, impulsiveTone of voice;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; angry, loud, shrillEmotions;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;highly aroused
MANAGING AGGRESIVE BEHAVIOUR;What are the features of proactive aggression?
Facial features;;;;;;;; ;;;;; impassive staring smiling or smirking Actions;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;; deliberate, methodicalTone of voice;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; firm, calm, menacingEmotions;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;apparently controlled
MANAGING AGGRESIVE BEHAVIOUR;what are the immediate response priorities reactive and proactive aggression?
;REACTIVE;;;;;;;;;;;;;;;;;;;;;;;; PROACTIVE;safety;;;;;;;;;;;;;;;;;;;;;;;;;safety;understanding and support;;;;;;;;;;;;;;;;;;;;;; containment and negotiation;remove or reduce stimulus;;;;;;;;;;;;;;;;;;;; ;engagement and reasoning
MANAGING AGGRESIVE BEHAVIOUR;what are the ongoing response priorities reactive and proactive aggression?
REACTIVE;;;;;;;;;;;;;;;;;;;;;;;; PROACTIVETeach coping skills;;;;;;;;;;;;;;;;;;;;Teach appropriate;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; thinking,;values, and social;;;;;;;;;;;;;;;;;;;;;;;;;;; skills;teach self regulation skills;;;;;;;;;;;;;;;;;;;;;;;;reward sociallyappropriate;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;behaviour, not antisocial;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; behaviour;;;;;;;;;;;;;;;;;;;;anger management;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
MANAGING AGGRESIVE BEHAVIOUR;What is an individual crisis management plan?
;;Functional analysis of high risk behaviour.
Strategy intervening tailored to the young person.Periodic review and update
MANAGING AGGRESIVE BEHAVIOUR;
;
What are non-verbal behaviors?
1. Eye contact2. Body language3. Personal Space4. Height Differences5. Gender Differences6. Cultural Differences
ELEMENTS OF A POTENTIALLY VIOLENT SITUATION;What are the elements of a potentially violent situation?
;
A potential triggered violence.
A target.
A weapon.
Level of stress or motivation
ELEMENTS OF A POTENTIALLY VIOLENT SITUATION;How do you remove the potential triggered violence?
Never touching and angry and potentially violent person.
Avoiding any aggressive moves and provocative statements.
Avoiding the conflict cycle and counter aggression.
Removing others who might trigger the violence.
-; BODY LANGUAGE IS CRITICAL –
ELEMENTS OF A POTENTIALLY VIOLENT SITUATION;Remove the target by
;;
Asking the targeted person to leave.
It’s you, reminding young person of your relationship only when the situation and asking a “neutral” staff to manage incident.
– THE TARGET MAY SHIFT DURING THE EPISODE –
ELEMENTS OF A POTENTIALLY VIOLENT SITUATIONHow would you avoid the weapon?
Discreetly removing objects.
Manoeuvering away from weapons.
Staying a safe distance away
ELEMENTS OF A POTENTIALLY VIOLENT SITUATIONHow would you decrease the level of stress or motivation?
Usual relationship.
Actively listen to identify feelings.
Remove the audience.
Using co-regulation strategies (reactive aggression).
Offering alternative, nonaggressive ways to achieve goals (pro active aggression)
HELP ME HELP MYSELF : CRISIS CO-REGULATIONWhat is the objective of crisis co-regulation?
To provide support in a way that reduces stress and risk
HELP ME HELP MYSELF : CRISIS CO-REGULATIONWhat should I think (self-awareness)
Ask yourself the four questions
1. What am I feeling now? 2. What does this young person feel, need, or want?3. How is the environment affecting the young?4.
How do I best respond? Use positive self talk
HELP ME HELP MYSELF : CRISIS CO-REGULATIONWhat should you do? (non-verbal strategies)
Take a deep breath.
Use protective stance.
Step back.
Give the situation time.
Sit down if appropriate.
-remember the importance of body language and facial expression-
HELP ME HELP MYSELF : CRISIS CO-REGULATIONWhat should you say? (Verbal strategies)
“I can see….
” (validate feelings.)
“When you….” (encourage positive behaviours).
“I know we.
..” (emphasise desirable outcomes).
“I am sorry…” (offer an apology).
– remember the importance of tone of voice –
HELP ME HELP MYSELF : CRISIS CO-REGULATIONWhat to do when it’s over
;;
It’s over when the.
…….
…..
Prepare to discuss the situation in an LSI
THE LIFE SPACE INTERVIEWThe life space interview (LSI) is?
A therapeutic, verbal strategy to intervene with the young person. “The clinical exploitation of life events” – Fritz Redl
THE LIFE SPACE INTERVIEWWhat are the goals of the LSI?
Return the young person to normal functioning.
Clarify events.
Repair and restore the relationship.
Teach new coping skills.
Reintegrate young person back into the programme.
THE LIFE SPACE INTERVIEWWhat are the steps to the LSI
I – Isolate the conversation.E – Explore young person’s point of view.
S – Summarise the feelings and content.C – Connect feelings to behaviour.A – Alternative behaviour is discussed.
P – Plan developed/practice new behaviour.E – Enter young person back into the routine
THE LIFE SPACE INTERVIEW;I verbiage in I ESCAPE
;”I’d like to talk to you” or “Lets go ….and sit down..
..”
THE LIFE SPACE INTERVIEW;The verbiage for E in I ESCAPE:
;;E = “What was happening?” “And then what happened?” “So you felt.
…” I was worried when…
.”
THE LIFE SPACE INTERVIEWThe verbiage for S in I ESCAPE:
“Let’s make sure I got this straight.”
THE LIFE SPACE INTERVIEWThe verbiage for the C in I ESCAPE
“So, when you feel….
. you….?”
THE LIFE SPACE INTERVIEWThe verbiage for the A in I ESCAPE:
“Let’s think of some different ways you could.
…”
THE LIFE SPACE INTERVIEWThe verbiage for the P in I ESCAPE:
“You’ve got some good options.””Let’s make a plan.” “Let’s now practice/rehearse”
THE LIFE SPACE INTERVIEWThe verbiage for the last E in I ESCAPE:
“Here’s what’s happening now.
..” “Do you think you are ready to go back?”
SAFETY INTERVENTIONSOptions to handle physical violence are? (5)
1. Eliminate one of the elements of the violent situation. 2. Make a directive statement that clearly communicates that the violence must stop 3. Use releases and maintain a safe distance with a protective stance 4.
Leave the situation and get assistance
5. Employ physical restraint techniques (if indicated on the ICMP)
SAFETY INTERVENTIONSWhat is the goal of physical intervention?
To ensure safety
SAFETY INTERVENTIONSWhat is the definition of Physical Restraint?
Physical Restraint: The use of staff members to hold a young person in order to contain acute physical behavior Acute Physical behavior: Behavior likely to result in physical injuryThe young person, other clients, staff members, or others are at imminent risk of physical harm
SAFETY INTERVENTIONSphysical restraint should only be used when?
Physical restraint should only be used when: (all criteria must be met) 1. Agency policies and state regulations approve restraint 2. The young person’s ICMP indicates it ;3.
Our professional judgement indicates it
SAFETY INTERVENTIONS;Physical restraint is not used to?
;;1 at 480. Demonstrate authority 2. Enforce compliance 3. Inflict harm or pain 4. Punish or discipline
SAFETY INTERVENTIONS;What are the basic principles of physical intervention?
;;A maximum amount of caring and a minimum amount of force with the goal of de-escalating the situation by reducing stimulation
SAFETY INTERVENTIONS;What is the letting go process in a physical restraint?
;1. Is a gradual test of a young person’s self-control 2. States what is expected of the young person 3.
Is directed by the team leader
4. Is supportive of the young person
LIFE SPACE INTERVIEWSWhat are the Poential Pitfalls of an LSI?
1. Person refuses to talk
convey calm support and sanction silence.
Ask a focused question
reschedule LSI
2.
Young person gets off subject
allow exploration and relate it to incident.
Focus on issue at hand
3. Worker or young person wants to just “fix it”
don’t interrupt a young person’s thought process.
Don’t develop a plan for young person.
SAFETY CONCERNS;Do not use physical restraint when?
We cannot control young person safely.
We are not in control or are too angry.
Sexual stimulation is the motivation.
We are in a public place.
Young person has a weapon.
Young person’s medical condition prohibits it.
Young person has emotional problems risking retraumatisation.
Young person is on medication is perfect his or her system
SAFETY CONCERNSWhat are the definitions of asphyxia?
Asphyxia: the deprivation of oxygen to living cells.Positional asphyxia: fatal respiratory arrest, in which the ability to breathe is compromised by the position of the body in relationship to its immediate surroundings
SAFETY CONCERNSWhat are the predisposing risk factors of asphyxia?
Obesity.
Individuals under the influence of alcohol or drugs.
SAFETY CONCERNSWhat are the warning signs of asphyxia?
Due to neck compression: Goes limp and ceases to breathe spontaneously Due to respiratory interference: States he or she can’t breathe.Restoration is laboured, rapid or abnormal.May make grunting noises. Vomiting or turning a dusky purple colour, especially of the face.Goes limp and ceases to breathe
SAFETY CONCERNS;What should you monitor during a restraint?
Position of child and staff (appropriate restraint being applied).
Skin colour.
Respiration (no breathing problems).
Level of consciousness (is responsive).
Level of agitation (overexertion).
Range of motion and/or swelling in extremities.
SAFETY CONCERNS;What are the;recommendations to reduce the risk of injury or death?
Never place weight a young person’s chest or back.
Never put pressure on the young person’s neck.
Never placed a head in a position because of a neck to be compressed.
Never allow young person to stay in the prone or supine position once he or she is no longer a safety risk-get person up and in a seated position.
Never place a young person’s arms behind his or her back when that person is in a prone position.
Never bend, a child forward in the small child or seated restraint.
Never place anything over or near the young person’s face, mouth, or knows that can be inhaled or conform to the contours of the face.
Never ignore any of the warning signs appending asphyxia.
Never failed to take immediate action if there is a need for an emergency medical treatment.
Never restrain a child in the prone position on a mattress or surface that can conform to the contours of the face.
Never use these restraint techniques on children under five years of age.
SAFETY CONCERNS;Following a restraint what documentation should be kept?
Who, what, when, where?
What were the antededents?
What did staff do to de-escalate situation?
If physical contact, who did what (be specific)?
How long did the restraint last?
Staff/child injuries? Medical attention?
What plan was developed in the Life Space Interview?
Debriefing of staff?
Was follow-up needed? What is the family notified?
MANAGING AGGRESIVE BEHAVIOUR;All of the physical intervention techniques used in TCI are based on the priniples of ?
;;(a) a maximum amount of caring with minimum amount of force;(b) the goal of de-escalating the situation by reducing stimulation
