THERAPEUTIC CRISIS INTERVENTION



THERAPEUTIC CRISIS INTERVENTION

POCKET GUIDE

There is a saying in Tibetan, “Tragedy should be utilized as a source of strength.” No matter what sort of difficulties, how painful experience is, if we lose our hope, that’s our real disaster.

Dalai Lama

Setting Conditions:- Anything that makes challenging behaviour more or less likely to occur.

Types of Setting Conditions - Organisational Culture, Environment, Personal, Programme Related, Relationships.

Staff may be able to avoid situations resulting in challenging behaviours by identifying and modifying setting conditions.

Emotional Competence - by understanding your own feelings, beliefs, strengths and limitations, this can help you to manage your emotions in stressful situations.

Most crises can be prevented by building therapeutic relationships, establishing activities to meet basic needs and having workers who are emotionally competent and skilled at managing the environment.

CRISIS AS AN OPPORTUNITY

A crisis occurs when a young persons inability to cope results in a change in behaviour.

The Goals of Crisis Intervention are :-

To Support - Environmentally and Emotionally to reduce stress and risk

To Teach :- Young People better ways to cope with stress

Recovery Phase

4 QUESTIONS WE ASK OURSELVES

IN A CRISIS

1. What am I feeling now?

2. What does this child feel, need or want?

3. How is the environment affecting the young person?

4. How do I best respond?

DE – ESCALATING THE CRISIS

Active Listening – Communicating that you understand to the young person through being respectful, empathic and validation.

Active Listening allows and encourages young people to talk out rather than act out.

Understanding Responses

Reflective - These mirror what the young person is saying or feeling e.g.- “I would be upset too if my visit had been cancelled”

Summarisation:- This helps both parties understand the meaning of what has been said e.g.- “so let me get this right your visit has been cancelled again and this is why you are upset”

Understanding responses help young people sort out what is happening to them and can help de-escalate potential crisis e.g. – “I am sorry you feel upset” or “I can see that you are angry”

The Conflict Cycle

The Conflict Cycle is described as the product of a young person’s stress fuelled by others reactions.

To help young people regulate their emotions, the worker must focus on the feelings driving the behaviour and provide a calming influence, avoiding a power struggle or becoming counter aggressive.

To break the cycle it is important to understand and recognise what is happening.

Breaking the Cycle

MANAGING CRISIS

Types of Aggression

➢ Reactive – Young people experience a loss of control and emotions drive their actions instead of reason. This may be triggered by frustration or stress and often are emotionally flooding.

➢ Proactive – This aggression is planned to achieve a goal and the young person is in control and reason dominates not emotion.

Model for Proactive Aggression

RESPONSES

Reactive Proactive

Safety Safety

Understanding & Support Containment & Negotiation

Remove / Reduce Stimulus Engagement & Reasoning

Teach Coping Skills Teach Appropriate Thinking, Values & Social Skills

Teach Self Regulation Skills Reward Socially Appropriate Behaviour not Anti-Social Behaviour

Anger Management

Non Verbal Communication and Behaviour

When dealing with young people who are on the verge of outburst, an awareness of and control over nonverbal aspects of communication is crucial. This means being aware of what the adult’s nonverbal behaviour means to young people and what young people’s nonverbal messages mean to adults. Carefully observing the nonverbal cues of the young person provides staff with valuable information e.g. is the aggression reactive or proactive.

Elements of a Potentially Violent Situation

To reduce the risk of a violent incident from occurring, remove any of the four elements.

Crisis Co – Regulation

At this phase of the crisis, staff need to depend on their assessment, behaviour support, relationship and communication skills.

What to think : - What am I feeling now?

What does this child feel, need or want?

How is the environment affecting the situation?

Use positive self talk.

What to do : - Take a deep breath.

Give the young person space and time.

What to say: - Speak calmly, assertively, respectfully.

Understanding Responses

What to do when it is over:- Allow time and space and prepare for LSI

Goals

➢ Return the young person to baseline

➢ Clarify the events

➢ Repair and restore the relationship

➢ Teach new coping skills

➢ Return the young person back into the routine

Steps to the LSI

I Isolate the Conversation

E Explore the Young Persons point of View

S Summarise the Feelings and Content

C Connect Feelings to Behaviour

A Alternative Behaviours Discussed

P Plan Developed / Practice new Behaviour

E Enter the Young Person back into the routine

SAFETY INTERVENTIONS

When young people do not respond to intervention techniques and become physically violent, it is important to professionally risk assess the situation using interventions which maintain safety.

Options for dealing with physical violence include:-

The goal of physical intervention is safety

The immediate purpose of restraint is to provide minimum control to ensure maximum safety.

The following criteria must be met to use physical restraint:-

➢ Agency policies and procedures allows it.

➢ Individual Crisis Management Plan is in place.

➢ Staff’s professional risk assessment notes that a physical restraint is less risky that the young persons behaviour.

Physical Restraint is NOT used to:

Situations where Restraint should be avoided are:

➢ When staff cannot control the young person safely using restraint techniques.

➢ When staff can’t remain calm and in control.

➢ The young person is threatening staff with bodily injury and appears capable of doing so

➢ If sexual stimulation is the motivation.

➢ When in a public place.

➢ When a weapon is involved.

➢ If a young persons medical condition could be aggravated by restraint.

➢ If re - traumatisation may occur.

➢ If the young person is on medication which may have an effect on their cardiovascular or respiratory system.

Risk Factors to consider when using restraint:

➢ Obesity

➢ Influence of alcohol or drugs

➢ Prolonged violent physical agitation

➢ Underlying natural disease

➢ Hot humid environment

➢ If young person is taking certain medication

WARNING SIGNS

✓ The young person states they can not breathe.

✓ Breathing is laboured, rapid or abnormal.

✓ The young person makes grunting sounds.

✓ The young person vomits.

✓ The young person turns a dusky purple colour.

✓ The young person goes limp and ceases to breathe

RECOMMENDATIONS TO REDUCE THE RISKS

➢ Never place weight or pressure onto the chest, stomach, back or neck

➢ Do not restrain once there are no risks involved

➢ Never place young persons arms behind their back.

➢ Never bend a young person forward or apply pressure when in a seated restraint.

➢ Never place anything over or near the face, mouth or nose.

➢ Never ignore the warning signs.

➢ Never allow the young person to continue lying or sleeping on the floor after a restraint.

➢ Do not use restraint techniques to children under five years of age.

DOCUMENTATION

All physical interventions need to be documented using the L.C.C restraint information recording form and recorded in the incident log, the young persons file and where the police are involved Ofsted notified.

Where identified in the LSI the young persons ICMP and risk assessments updated.

If you have any queries, please contact the TCI team on 0113 39 52129

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Crisis Intervention

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Behaviour Support Techniques

Behaviour Support techniques enable us to use a range of techniques at the first sign of distress. It helps young people manage their stress and emotions to de-escalate potential crisis situations.

➢ Redirection and Distractions

➢ Proximity

➢ Directive Statement

➢ Time Away

➢ Managing the environment

➢ Prompting

➢ Caring Gesture

➢ Hurdle Help

My Pony Can Hurdle Real Practitioners During Training

(Mnemonic for remembering the above BST’s

Emotional First Aid

This is a quick intervention designed to get the young person through a tough situation and continue in the activity where they are learning important skills.

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Goals for Emotional First Aid

1. Provide immediate help and support to reduce emotional intensity

2. Resolve the immediate crisis

3. Re-enter the child back into the routine

Strategies for Emotional First Aid

➢ Drain off emotions

➢ Clarify the events

➢ Maintain the relationship

➢ Remind the young person of expectations.

➢ Listen and validate the young persons feelings.

➢ Manage the environment.

➢ Give choices and the time to decide what to do next.

➢ Redirect to a positive activity.

➢ Appeal to the young persons self interest.

➢ Drop or change the expectation.

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Types of Non Verbal Communication

Silence

Nods

Facial Expression

Eye contact

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Types of Non Verbal Behaviours

Eye Contact, Body Language, Personal Space, Cultural Issues, Height and Gender.

➢ Weapon

➢ Stress or Motivation

➢ Trigger

➢ Target

The Life Space Interview ( LSI)

➢ Maintain a safe distance

➢ Use protective stance

➢ Leave the situation and get assistance.

➢ Use physical restraint techniques.

➢ Eliminate one or more of the elements of the violent situation

➢ Make a directive statement.

➢ Use protective interventions

Inflict Pain or Harm

Punish or Discipline

Demonstrate Authority

Enforce Compliance

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