Instructor: Certified PMAB Trainer, Scott Lepine
What is PMAB?
Cognitive Behavioral Theory
C.B.T.
Cognitive Thinking Errors
1.
POWER THRUSTING (“My way or the highway”)
2.
FALSE VIEW OF SELF (“I’m the best”)
3.
UNREALISTIC EXPECTATIONS (“Good things will come my way”)
4.
LACK OF PERSPECTIVE TAKING (“I’m the only one who counts”)
5.
VICTIM STANCE (“Blaming”)
6.
JUMPING TO CONCLUSIONS (“I wasn’t thinking”)
7.
FAILURE TO BE STRAIGHT (“Liar liar!”)
8.
AWFULIZING (“It’s all over!”)
Predisposing/Precipitating
Factors of Aggression
Summary
Communication During the
Aggression Cycle
THE CYCLE OF AGGRESSION
Physiological
PRE-CRISIS PHASE
RATIONALITY
Increased heart rate, blood pressure, lung capacity and metabolism
Gastrointestinal changes
Behavioural
Low level agitation / muttering to staff / more active
Clenched fists, staring, tensing of body
Suddenly outgoing or quiet
Psychological
Listens and responds to direction
Reasoning capacity remains
CRISIS PHASE: IRRATIONALITY
Physiological
Maximum heart rate, blood pressure, lung capacity.
Metabolism and physical strength
Gastrointestinal changes
Behavioural
High level agitation, shouting, swearing, punching, kicking
Dangerous to self and others
Psychological
Will not listen or respond to direction
No reasoning capacity
angry
POST-CRISIS PHASE: RATIONALITY
Physiological
heart rate, blood pressure, lung capacity, metabolism and physical strength return to normal state.
Gastrointestinal functions return to normal.
Behavioural
Level of agitation slowly recedes
Body relaxes, high levels of tiredness/crying
Talkative or reclusive
Remorseful or defiant
Psychological
Reasoning capacity returns
Willing to listen
Respond to direction
NOTE:
Aggressive acts never happen in isolation. They are always preceded and
followed by observable and recognizable behavioural and psychological
features.
Everyone in close proximity to the aggressive act is directly affected. Just as
the aggressor, behavioural, psychological and physiological changes occur
in those involved. The physiological feature may nor be recognized by staff
but affect the individual.
The behavioural, psychological and physiological in each phase will
directly influence the staff’s choice of effective management strategies and
techniques. There are no differences where the pre-crisis finishes and the
crisis begins.
CONTINUE:
Although the graphic suggest a continuity and predictability to the cycle, this is not
the actual fact because the cycle can be compressed into a space of a few minutes or
extended over the course of several days. The behavioural and psychological changes
can be occurring hours or even days before an aggressive act occurs, but the
physiological changes begin shortly before the crisis phase and can continue several
hours after the post-crisis.
During the crisis phase, the gradual build-up of such changes may not be a steady
one. During the crisis phase, staff needs to physically intervene in order to protect
the others. This risk of injury is greater during the crisis phase.
KNOWLEDGE OF THE CYCLE PROVIDES INFORMATION ON
WHEN/HOW/WHERE TO INTERVENE.
THE PROGRESSION FROM ONE STAGE TO THE NEXT CAN BE
PREVENTED!
Calming and Diffusing
Techniques
Calming Techniques
When to use:
In pre-crisis when the resident is willing to listen and
able to reason
Purpose:
To explore the situation
To get resident to discuss the problem
To reduce resident’s agitation
Open Questions
Listening Responses
Paraphrases
Stating Clear Expectations
Disarm Power Struggles
Timing Out
Humour
Distraction
Planned Ignoring
Reviewing Option, Choices and
Outcomes
Choices
Options
Information
Positive Reinforcement
Negotiate (Win/Win)
Defusing Techniques
When to use:
In crisis phase before verbal behaviour becomes violent
Crisis Phase
Purpose:
To de-escalate potentially violent situations without
violence occurring
Defusing
Defusing
Observation
Physical Presence
Light to Heavy
What to Say
Approach
Preparation
Summary
The Art of Paraphrasing
The Art of Paraphrasing
Involves using fresh words to state back what the
youth has just said.
The focus is on the situation or ideas rather than on
feelings.
The Art of Paraphrasing
Paraphrasing has two important purposes:
First, it allows youths to know and feel that you are hearing them
and that you want to try and understand.
Second, it usually prompts youth to continue expressing more
thoughts and feelings about their situation.
Be careful not to overuse paraphrasing, because it will seem
gimmicky, ingenuine, and may become annoying to the youth.
The Art of Paraphrasing
The Most Powerful Communication Tool
Definition:
Paraphrasing is a necessary backup system to
communication. It means to put the other person’s
MEANING into your WORDS and give it back. As
a power tool it does 14 things to improve your
communication power.
The Art of Paraphrasing
1. You can INTERRUPT someone and not generate resistance.
2. You can take CONTROL of the encounter.
3. You ‘get it right’ on the spot. We don’t’ always hear well.
4. The other can CORRECT you if you have mad en error.
Makes the other feel good, and is good for you.
5. It MAKES the other a better LISTENER. No one will listen
harder than to his OWN point of view.
6. It CREATES EMPATHY. The other will believe you are
trying to understand.
The Art of Paraphrasing
7. It often MAKES the other MODIFY his or her initial
statements (become more reasonable) because her or she gets to
hear his or her MEANING in different WORDS and tones.
8. It overcomes SONIC INTENION. People often think they have
said something to you because they have ‘heard’ themselves say
it in their mind. When you paraphrase, they hear what you have
heard, not what they THINK they have said.
9. It can CLARIFY for those who may be standing nearby.
10. It prevents METAPHRASE: the use of the ‘skewed phrase’. The
good paraphraser will never ‘put words into the other’s mouth’
The Art of Paraphrasing
11. Whenever you GIVE directions to others, insist THEY paraphrase
back to you your meaning, 8 out of 10 people misunderstand the
POINT of a verbal exchange. Protects you as manager/supervisor.
12. Whenever YOU take direction, it ensures you heard and interpreted
correctly the other’s MEANING, PARAPHRASE BACK. The other
may not have even said what he or she intended. Covers you from
making errors. Makes you EFFICIENT and EFFECTIVE.
13. It reinforces your own memory. The mind remembers what the mind
DOES. Your reports, written or oral, will be more concise and
accurate.
14. It generates ‘THE FAIR PLAY’ response. You have listened and made
an effort to understand the other. The other is almost forced
Physical Restraints
&
Legislative Expectations and
Residential Child Care
Experience
Excited Delirium and
Risk of Positional Asphyxia
Excited Delirium and Positional Asphyxia
Excited Delirium and Positional Asphyxia
http://blutube.policeone.com/police-trainingvideos/935602325001-excited-delirium/
Written Theory Test
GOOD LUCK!
Scott.lepine@parnipcas.org