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
Crisis
Intervention
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.
2
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
3
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?
4
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 deescalate potential crisis e.g. – “I am sorry you feel
upset” or “I can see that you are angry”
5
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
 Managing the environment
Distractions
 Prompting

Proximity
 Caring Gesture
 Directive Statement
 Hurdle Help
 Time Away
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.
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




6
Drain off emotions
Clarify the events
Maintain the relationship
Remind the young person of expectations.
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
 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
7
expectation.
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
8
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
9
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.
Types of Non Verbal
Communication
Silence
Nods
Facial Expression
Eye contact
Types of Non Verbal
Behaviours
Eye Contact, Body
Language, Personal
Space, Cultural Issues,
Height and Gender.
10
Elements of a Potentially Violent Situation
To reduce the risk of a violent incident from occurring,
remove any of the four elements.
 Trigger
 Target
 Weapon
 Stress or Motivation
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
11
The Life Space Interview ( 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
12
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: Eliminate one or more
of the elements of the
violent situation
 Make a directive
statement.
 Use protective
interventions
 Maintain a safe distance
 Use protective stance
 Leave the situation and
get assistance.
 Use physical restraint
techniques.
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.
13
Physical Restraint is NOT used to:
Demonstrate Authority
Enforce Compliance
Inflict Pain or Harm
Punish or Discipline
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:






14
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.
15
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
16