Proactive
Interventions
1. Crisis Prevention
2. Verbal Intervention
Prevention
•In Part 1, we will cover:
• Decisions in Crisis
• Deliberate Aggression
• Emotional Crisis
Part 1:
Making
Decisions
in Crisis
CRISIS!
Immediately
Dangerous?
Not Immediately
Dangerous?
Deliberate?
Emotional?
CORRECTIVE RESPONSE
COUNSELING RESPONSE
1.
Remind, warn or confront
1.
Give space
2.
Remove verbally
2.
Listen actively
3.
Restrain physically
3.
Therapeutic Problem Solving
Part 2:
Deliberate
Problems
Deliberate Misbehavior
“Purposeful attempt to
meet one’s own needs at
the expense of others.”
Cues to
Deliberate Problems
•
•
•
•
Usual behavior
Peer reinforcement
Calm body language
No outside stress
Glasser’s Social Needs
According to Dr. William Glasser, Psychiatrist
(developer of Reality Therapy and Choice
Theory), we have four basic social
needs.
We each learn to meet these needs in different
ways through our experiences with
individuals, social groups, and society.
Glasser’s Social Needs
Belonging Importance
Fun
Freedom
Social Needs
How do YOU meet YOUR social
needs?
Socially Appropriately
Or
Inappropriately
Aggression
Can aggression fill social needs?
Inappropriate Ways to Fill Needs?
Belonging
Importance
Class clown,
neediness & whining,
giving in to peer
pressure…
Defying authority,
breaking rules,
intimidating others…
Fun
Freedom
Off-task chatter,
running in halls,
teasing others…
Refusal to work,
roaming hallways,
running away, using
drugs or alcohol…
Meeting Needs
Prosocially
What opportunities do (or could)
patients have to meet these needs
prosocially?
Give examples of positive activities that meet
these needs.
Fun = Playing video games, TV, Board Games…
Prosocial ways to allow
BELONGING
1. Build strong caring
relationships
2. Allow healthy contact
with parents/family
3. Create and facilitate
social activities
Prosocial ways to allow
IMPORTANCE
1. Provide genuine
leadership/decision Making
opportunities
2. Give praise and
encouragement
3. Recognize actual
accomplishments
Prosocial ways to allow
FUN
1. Allow free time to play and
socialize normally
2. Integrate music, art,
sports, and activities
3. Be fun with Patients!
Prosocial ways to allow
CHOICE
1. Allow choices when
possible
2. Encourage responsible
freedom of expression
3. ASK, don’t TELL, whenever
possible
Part 3:
Emotional
Crisis
Emotional Crisis
“Impulsive over-reaction
to overwhelming stress
or misperceptions.”
Cues to
Emotional Crisis
•
•
•
•
Unusual behavior
Intense body language
Irrational statements
Outside stress
Adult
Reactions
in Crisis
ADULT ANGER TRAP #1
STRESS
Leftover stress from other
home or work problems…
makes it easy to overreact
angrily to a minor situation.
ADULT ANGER TRAP #2
INADEQUACY
We feel helpless trying to
manage a challenging situation…
then turn embarrassment to
anger.
ADULT ANGER TRAP #3
FEAR
We feel a natural shock or
fear in response to a
threatening situation…
then turn anxiety into anger.
ADULT ANGER TRAP #4
VALUES
VIOLATION
A core value is violated by a
patient’s behavior, sparking
feelings of righteous anger.
ADULT ANGER TRAP #5
AUTHORITY
CHALLENGE
We engage in an angry
power struggle to establish
dominance over a defiant
patient.
Understanding Ourselves
3. At my
worst…
2. My
warning
signs…
1. Stresses in
my life….
4. To calm
down…
Breaking the
the
1.1. Breaking
Conflict Cycle
Remember that the patient’s past experiences
give him/her a different way of perceiving
events than you have.
However unreasonable this perception seems to
you, it is very REAL to him/her. By knowing
his/her past and his/her patterns, you can
predict potential stress.
2. Breaking
Breaking the
the
2.
Conflict Cycle
Remember that during conflict, the patient’s
irrational beliefs trigger strong feelings and
explosive behaviors, which cause problems
with adults, peers, rules and learning.
Look for unusual behaviors under “normal
circumstances” for early clues of crisis.
3. Breaking
Breaking the
the
3.
Conflict Cycle
Remember that during conflict, a patient is his
own worst enemy: he will defend, deny, blame,
rationalize, and regress from owning his feelings
or having responsibility for his behaviors.
Don’t try to reason with him when you can see he
is highly agitated. Back off, and give him time to
cool off if you can.
1. Breaking the
Conflict Cycle
Remember that outside stress makes it harder for
you to tolerate the situational stress of a conflict.
Be aware of the stressors acting on you, and be
able to tell what you are reacting to in a crisis.
Reduce your stress when you can before entering
“hot” situations.
2. Breaking the
Conflict Cycle
Remember that everyone has sensitive issues
that set them off.
Know your emotional “hot spots” -- you can
bet the patients know them!
3. Breaking the
Conflict Cycle
Remember that anger is a natural response to
hostility and threats.
Admit to yourself when you are mad or
overwhelmed in a crisis. Take a deep breath
and slow down.
4. Breaking the
Conflict Cycle
Remember to catch yourself using sarcasm,
belittling comments, or accusations.
Try to see the problem through the patient’s
eyes. Apologize if necessary, without
expecting an apology in return.
5. Breaking the
Conflict Cycle
Remember that it is okay to ask for and offer
help to colleagues in crisis.
Talk about problems after they happen, and plan
for them before they occur. Staff support relieves
stress!
KEY POINT #1
Understanding aggressive behavior:
There are two distinct sources of
aggressive behavior:
A. Deliberate needs-fulfilling behavior
B. Emotionally-driven impulse behavior
KEY POINT #2
Understanding crisis:
Crises do not “just happen.” They follow
an escalation pattern and can often be deescalated if we use the appropriate skills
during each phase of crisis.
KEY POINT #3
Understanding prevention:
Prevention requires an awareness of the
patient and ourselves. Be aware of:
A. Patient's verbal and non-verbal cues.
B. Our own personal issues and emotions.
KEY POINT #4
Our goal in crisis:
Our goal is always to de-escalate behavior
as safely as possible. This requires a cool
head, an awareness of the choices, and the
skills to implement them.
End