Nonviolent Crisis Intervention
St. Joseph’s Regional Medical Center
Center for Continuing Education
CPI
Crisis Prevention Institute
Unit I: Crisis Development
Model
How We Act Influence Others
Behavior Levels
Staff approach
1. Anxiety
1. Supportive
2. Defensive
2. Directive
3. Acting out
3. Nonviolent
person
physical crisis
intervention
4. Tension
4. Therapeutic
reduction
rapport
Exercises
• Proxemics
• Kinesics
Unit II: Nonverbal Behavior
Proxemics (Personal Space)
An area surrounding your body considered
an extension of self. US av: 11/2 – 3 ft
Factors that affect how much space we need:
Situation, attitude, illness, familiarity, safety,
hygiene, age, gender, etc.
Also extends to personal effects: purse,
room, drawers, etc.
Nonverbal Behavior
Kinesics (Body Language)
Nonverbal message we transmit through body
posture and motion
1. Facial Expressions: Smile, frown,
clenched jaw, eye contact.
2. Posture
3. Gestures: Close to own body, upward
motion, slow movements
4. Movement: Fast or slow
Supportive Stance
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•
•
Safety, offers an escape route
Non-challenging/ Non-threatening
Shows respect
Client
Staff
Unit III: Paraverbal
Communication
Definition
Vocal part of speech excluding the actual words we
use. (How we say what we say).
Elements
Tone: Avoid inflections of sarcasm, impatience,
disrespect, etc.
Volume: Keep volume appropriate to situation
Cadence: Rate and rhythm
Communication
I didn’t say
You were stupid
Verbal
Paraverbal
Nonverbal
Unit IV: Verbal Intervention
Verbal Escalation Continuum
3. Release
4. Intimidation
DEFENSIVE
5. Tension Reduction
2. Refusal
1. Questioning
Empathetic Listening
Definition: An active process to discern what
a person is saying
• Be nonjudgemental
• Give undivided attention
• Listen to facts and feelings
• Use restatement to clarify
• Allow silence for reflection
Unit V: Precipitating Factors
Definition: Internal and external causes of acting
out behavior over which staff have little or no
control of.
Examples
• Family issues
• Health
• History
• Financial issues
•
•
•
•
Attention seeking
Fear
Support system
Noncompliance
Reasons to Understand
Precipitating Factors
•
Proactive
•
Depersonalize
•
To not become a precipitating factor
Rational Detachment
Definition: The ability to stay in control of
our own behaviors and not take the acting
out behavior personally
• Control response
• Be professional
• Find positive outlets
Integrated Experience
Definition: The behaviors and attitudes of the
staff impact the behaviors and attitudes of
clients and vice versa.
Unit VI: Staff Fear and Anxiety
Universal Human Emotions
Unproductive
1. Freezing
2. Over-reacting
- Psychologically
Perceiving situation worst
than it is.
3. Act inappropriately
- Verbally
- Physically
Productive
1.  in speed and
strength
2.  in reaction time
3.  sensory acuity
Ways to Control Fear and
Anxiety
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•
•
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Know what makes you afraid
Don’t respond alone, team intervention
Know techniques to keep you and the
client safe
Learn physical interventions to manage
client if necessary
Unit VII: Personal Safety
Techniques
STRIKE
(A weapon coming in
Contact with target)
GRAB
(An attempt to
control/destroy
part of one’s anatomy
Kick
Punch
Thrown objects
Spit
Bite
Hair Pull
Choke
Principles of Personal Safety
STRIKE
1. Block the weapon
GRAB
1. Gain psychological
advantage
A. Stay calm
B. Have a plan
C. Element of
surprise or
distraction
Principles of Personal Safety
STRIKE
2. Move the target
GRAB
2.Gain
physiological advantage
A. Identify a weak point
B. Get leverage
C. Gain momentum
Unit VIII: Nonviolent Physical
Crisis Intervention
• Only to be used as last resort
• No floor restraints (prevent injury to client
such as accidental asphyxia).
• No element of pain
• Intent is to calm individual
• Team interventions
• Used to protect, not to punish
Team Intervention
Crisis Response Team
• 2-5 people per team
• Code as inconspicuous as possible
• Diversity
• Common goal: Care, Welfare, Safety, Security
1. Verbal de-escalation
2. Physical: last resort
Team Intervention
Team vs. Solo Intervention
Why team intervention?
• Safety: Two people can handle an acting out
individual more safely than one person can.
• Professionalism: Team members can lend
support to one another during a crisis situation.
This allows for staff to avoid perceiving the
acting-out behavior as a personal confrontation.
• Litigation: Having another person on the scene
provides a witness to the intervention.
Team Intervention
Team Leader
• The first person at the scene
• A team member with confidence and
competence in handling crisis situations
• A team member who has good rapport
with the acting-out individual
Team Intervention
Team Leader Duties
• Asses the situation. What steps are
necessary?
• Plan the intervention.
• Direct or cue the other team members.
• Communicate with the acting-out person.
To avoid confusion, only one person
should talk to the acting-out person.
Team Intervention
Auxiliary Team Member Duties
• Check:
* Physical and psychological status of the
disruptive individual.
* Safety of the environment/remove
dangerous objects.
• Address:
* What needs to happen to de-escalate the
crisis.
* Are there any safety concerns.
Team Intervention
•
•
Recognize:
* Additional additional assistance when
needed.
* Need to change intervention strategies.
Engage in:
* Verbal de-escalation with acting-out
individual. (if directed by team leader)
* Support to other team members.
Unit IX: Situational Role-Plays
Why do we use situational role-plays?
• Is safe, realistic practice
• Learning styles experiential
• Confidence
• Self-evaluation
Unit X: Postvention
Debriefing Process
Client
Control: Making sure client is calm and rational
Orient: Establish the basic facts, be nonjudgemental
Patterns: Past behavior, triggers
Investigate: Alternatives to inappropriate behavior
Negotiate: contract written or verbal
Give: Responsibility back to client, so he/she can
make own decisions.
Unit X: Postvention
Staff
Control: Calm and rational
Orient: Establish basic facts
Patterns: Staff response crisis (+ and -)
Investigate: What to do for next time to strengthen
the intervention
Negotiate: Agree to make changes
Give: Support and encouragement
Verbal Intervention
DO
• Remain calm
• Listen!!!
• Be supportive
• Watch paraverbals
• Directive, set limits
• Assist
• Be consistent
• Give choices
DON’T
• Over react
• Take it personally
• Invade their space
• Minimize
• Be defensive
• Get in power struggle
• Fake attention
• Be threatening
•
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