CPI Training
The TENSION REDUCTION behavior level
individual demonstrates a decrease in emotional and physical energy. Increase in RATIONALITY. RELAXED
The ANXIETY behavior level
individual demonstrates changes in behavior. wringing hands, sweating, rocking, talking rapidly.
How can understanding precipitating factors help staff?
-DE-PERSONALIZE the situation (don't take behavior personal) -BE PROACTIVE in prevention (get a fan ahead of time if it's hot) - AVOID becoming a precipitating factor. (don't wear perfume...)
Unproductive responses due to Staff Fear and Anxiety
-freeze -overreact - respond inappropriately
Productive responses to Staff fear and anxiety
-increased speed and strength -increased sensory acuity - decreased reaction time
Reasons for SUPPORTIVE STANCE
1- Communicates respect, 2- non-threatening, 3- maintain safety
Maximizing Productive Responses to Staff Fear and Anxiety(1-4)
1- learn to keep yourself safe 2- learn to keep the individual safe 3- use a team approach 4- understand what makes you afraid and drives your decisions.
Keys to LIMIT SETTING
1- offer simple/clear choices and consequences 2- reasonable and realistic 3- enforceable
Five Keys to Empathic Listening
1-be NONJUDGMENTAL 2 give UNDIVIDED attention 3 LISTEN carefully focusing on FEELINGS and FACTS 4. allow SILENCE for reflection 5. RESTATE and REPHRASE
3 Reasons for team interventions
1. SAFETY for everyone 2. Maintenance of PROFESSIONALISM 3. LITIGATION
Decision making is based on what?
1. The LIKELIHOOD and SEVERITY of a RISK. Risk assessment! 2. reasonable and proportionate 3. last resort and least restrictive 4. risk of doing nothing 5. human rights 6. Legal and professional considerations
5 step approach to limit setting for the refusal level of defensive behavior.
1. explain WHICH behavior is inappropriate. 2. explain WHY the behavior is inappropriate 3. give reasonable choices and consequences 4. Allow Time 5. Follow Through with consequences
Medium level holding
A team of two staff reacts in unison and sits on either side of the individual and places their outer-most hand above the person's elbow and then their inner-most arm along the inside of the individual's arm and their hand over the wrist of the individual. At the same time they move to a supportive seated stance and put their outer-most leg out to the side to provide stability while their inner-most leg is up against the individual's.
higher-level holding
A team of two staff reacts in unison and sits on either side of the individual and places their outer-most hand above the person's elbow and then their inner-most arm along the inside of the individual's arm and their hand over the wrist of the individual. At the same time they move to a supportive seated stance and put their outer-most leg out to the side to provide stability while their inner-most leg is up against the individual's. They then move to pull their inner most arm back to hold the person's arm above the elbow while pulling up and back with their other hand over the individual's fist.
Physical Skills Review SEAT
Assess whether our holding is SAFE, EFFECTIVE, ACCEPTABLE, and TRANSFERABLE
Crisis Development Model
Behavior levels and the staff attitudes/approaches in response.
Key Principles for Holding Skills in addition to the 3 Ps
Biomechanical benefit -outside inside. place arm along the outside of their elbow and then your hand toward the inside. - limit range of motion
Auxiliary Team Member Duties "C.A.R.E."
C- CHECK- on the physical and psychological status of the indiv and staff. -on the safety of the environment. A- ADDRESS- what needs to happen to deescalate the crisis. - Are their safety concerns? Are holding principles being utilized safely? R- RECOGNIZE- additional assistance needed. The need to change intervention strategies E- ENAGE in- verbal deescalation if the leader asks you to. Support other team member and look for her cues. BARE MINIMUM IS TO CARE ABOUT THE INDIVIDUAL IN CRISIS.
What are the core values of CPI
Care, Welfare, Safety, and Security for all involved.
Directive approach in response to an individual's defensive behaviors
DECELERATE an escalating Behavior. Offer choices. set limits, give opportunities, remain calm. Use visuals, reduce conversation, and utilize first/then strategies. MANAGE the environment to REDUCE risk.
Staff Attitude/Approach to Defensive Behaviors
Directive
The PHYSICAL INTERVENTION approach to risk behaviors
Disengagement and or holding strategies to manage a risk behavior. Continuously assess the behaviors and risks. Use least restrictive responses. Response must be proportionate and reasonable. EX. barriers, removing others from the classroom....
Precipitating Factors
Factors that influence behavior. like temperature, environmental noises, feelings about holidays, scents
Principles of holding in a standing position- low level
Have one person take the lead and another staff member stand by for support. put your body along the individual's side and put your arm around them so that each of your hands it is the person's elbows. Apply stabilization and tell the person what you want them to do or what you are there for.
Key Learning Objective of CPI
Identify behaviors that indicate an escalation toward aggression and violent behaviors. Take measures to AVOID escalation and to decelerate the crisis situation.
Verbal Interventions for the Defensive level of Crisis.
It does not have to go in order. QRRIT. Questioning, Refusal, Release, Intimidation, Tension Reduction. (Kite graphic
Consider the following two variables when considering risk
Likelihood=CHANCE an event or behavior will occur. and Severity= the level of HARM that may occur
Supportive approach in response to an individual's anxiety
Offer support, empathy, and tools you may know that will help them to become calm. Ask and listen to what the person has to say.
Staff Attitude/Approach to Risk Behaviors
Physical Intervention
TEAM LEADER and MANAGER Duties P.D.C.S.L.P
Planning- use situations as learning opportunities and consider known precipitating factors Decision Making- let the team know what is going to happen and what is going on. Communicate needs of individual and staff. Safety- make sure there is care, welfare, safety, and security for all. Look for signs of distress Postvention approaches, therapeutic rapport, debrief with staff and the person.
Supportive stance includes what three Ps
Position, proximity, and posture
Key Principle for Physical Interventions- three Ps
Posture, proximity, position
Defensive level of Crisis
QRRIT
Physical INterventions-Disengagement Continuum- RESPONSE
R-Response= down play and relax E- Explain And Ask S- State or Tell P- Prompt, gesture, sign O- Option to use physical intervention N- Nurture recovery S- Support E- Engage and Learn
Decision-Making Matrix is what type of matrix?
Risk-Assessment Matrix
Examples of Rational Detachment
STAY CALM maintain PROFESSIONALISM QTIP find POSITIVE OUTLETS for NEGATIVE ENERGY
Physical intervention/disengagement for medium level hair pull
Stand at a supportive stance and hold and stabilize the person's wrist and then put your hand like a wedge and slide your hand between your hair and slide it down.
Physical intervention/disengagement for low level hair pull
Stand at a supportive stance and hold and stabilize their hand and ask for them to let go of your hair.
Physical intervention/disengagement for neck grab medium level
Stand at a supportive stance and hold their wrists and push them away while moving yourself back.
Physical intervention/disengagement for high level hair pull
Stand at a supportive stance and stabilize their hand with both of your hands and move toward them in a downward motion of your head to apply pressure to their wrist resulting in their release of your hair.
Physical intervention/disengagement for neck grab low level
Stand at a supportive stance and stabilize their hands with both of your hands and request that they release your neck.
Physical intervention/disengagement for neck grab high level
Stand at a supportive stance and then as the person grabs for the neck grab one wrist and put the arm up that is closest to the individual and pivot across their reach to disengage their hands. Your stance will shift at the same time.
The physical intervention/disengagement with a higher risk grab of clothing
Stand in a supportive stance and place both of your hands on the person's wrist and pull them in while you bend down toward them forcing their hand to move back and release the shirt.
The physical intervention/disengagement with a medium risk grab of clothing.
Stand in a supportive stance and place your hand on the person's wrist and the other hand on your shirt and pull your shirt while pushing their hand away.
Staff Attitude/Approach to ANXIETY
Supportive
Paraverbal and Verbal Communication affects on what listener hears.
T, V, C
"If and Then" Example of Limit setting
Tell them the desired outcome and then the positive consequence. Then give the negative outcome and the negative consequence. For example, "If you use a tissue then you can use my ipad. If you do not use a tissue you you can not use my ipad."
Staff Attitude/Approach to TENSION REDUCTION
Therapeutic Rapport
Verbal Intervention for Defensive RELEASE
This is an emotional or verbal outburst. May be a tantrum/flipping desk/yelling/venting. Intervention- allow venting. Remove the audience or the person.
What are the paraverbal components that affect a verbal message.
Tone, Volume, Cadence
HIGHER RISK
Very likely event with a high severity of harm.
Physical Skills Review- SEAT
Was the physical intervention Safe Effective Acceptable Transferable ?
Physical intervention/disengagement for a body "hug" from behind that with a high risk
You lean over with a wide stance while making your shoulders as big as possible and lean forward while you thread one hand through the person's arms and turn to the side and leverage your way out of their grasp
nonverbal communication- kinesics
a person's body movements such as posture, eye contact, hand movements, eyebrow movements can help to deescalate or decelerate crisis situations.
Low level seated holding
a team of two staff reacts in unison and sits on either side of the individual and places their arms along the outside of the individual's elbow and drapes the hand on that same side of their body over the individual's arm with fingers toward the inside. The legs are used to also provide support on the outside of the individual's legs
Strikes
a weapon (body part or object) making contact with a target
Rational Detachment
ability to manage your own behavior and attitude
Empathic Listening
an active process to discern what a person is saying.
nonverbal communication-haptics
communication through touch or refraining from touch can help to decelerate a crisis situation.
How to make decisions
based on fact, objectivity, and what is in the staff and individuals best interest. Respond to risk behaviors has to be proportionate and reasonable.
Integrated Experience
behavior influences behavior. look at how you affect your rational detachment. What strategies do you use at home and at work to help you get regulated. You are a role model!!!
Verbal Intervention of the TENSION REDUCTION PHASE of Defensive behaviors.
decrease in physical and emotional energy. Establish a therapeutic rapport.
Core value of CPI- CARE
demonstrate respect, maintain dignity, and being nonjudgmental and empathetic.
proximity
distance between individuals
"Interrupt and Redirect" Example of Limit setting
get the person's attention and redirect them to desired activity/outcome.
Verbal intervention for Defensive QUESTIONING
give a rational response. They are information SEEKING or QUESTIONING AUTHORITY. Give a rational answer if information seeking. If questioning authority just stick to topic and set limits. Stay on topic and avoid being drawn in.
Physical Interventions-Disengagement Skills involve one or more of the following techniques=
hold and stabilize pull/push lever
Physical Intervention/disengagement for a lower level bite (medium really)
hold their head and stabilize at the crown of the head while asking them to release.
Physical intervention/disengagement for a medium high level bite
hold their head at the crown and push your arm toward their mouth.
posture
how you hold and move your body
The RISK behavior level
individual is demonstrating behaviors that put himself or others at risk. May become physically violent or throw things at others.
The DEFENSIVE behavior level
individual is starting to lose rationality. Responses are disproportionate. sewaring, posturing, throwing items off table.
Grabs and Holds
individual maintains physical contact without consent.
3 Ratings of harm
low harm, minor harm, major harm
Core value of CPI- SECURITY
maintain a safe, effective, and therapeutic relationship that relies on collaboration.
Who is the Team leader
may be first on the scene best rapport with client confident and competent in abilities
nonverbal communication- proxemics
personal space one allows is a form of non-verbal communication to help deescalate crisis situations.
Low level holding
physical intervention necessary to use as a guide or physical prompt to provide MINIMAL support to limit range of movement in relation to low risk behaviors.
Physical Interventions- DISENGAGEMENT SKILLS are a response to=
physical risk behavior
Core value of CPI- SAFETY
protect human rights and reduce and manage risks.
Core value of CPI- WELFARE
provide emotional and physical support and always consider the client's best interest.
Nonverbal communication that can help prevent escalation or promote de-escalation of crisis situations. the "ics words"
proxemics, kinesics, and haptics
Physical intervention/disengagement for a body "hug" from behind with low level risk
put your hands on the person's wrists and provide stabilization while requesting that they let go of you.
THe approach of THERAPEUTIC RAPPORT in response to an individual's tension reduction.
re-establish communication. Express you still care about the individual. Debrief after the crisis with the individual and the staff separately. Provide coping skills
Warning Signs of distress
shallow breathing, grunting, clod extremities, vomiting, diarrhea, headache, confusion, pain, discoloration,
The physical intervention/disengagement with a high level hold
stand at a supportive stance and hold their wrist and pull their hand away while you turn your arm to leverage it away in the direction of the person's thumb.
The physical intervention/disengagement with a medium level hold
stand at a supportive stance and hold their wrist and then pull it away while pushing your's out of their grip in the direction of their thumb.
The physical intervention/disengagement with a lower level risk grab of clothing.
stand in a supportive stance and place your hands on the person's arm and wrist and hold and stabilize while getting the person;s attention and asking them to please to let go.
The physical intervention/disengagement with a low level hold
stand in a supportive stance and stabilize the individual's hand at wrist and ask that they please let go.
Physical intervention/disengagement for a body "hug" from behind with a medium level risk
stand in a wide stance and lean over as youput your hands on the person's wrist and push it away at the same time you pivot in the direction of that hand
"When and then, first-then" Example of limit setting
state expectation and positive outcome. Example, When you get up we will be able to start our game.
Risk
the CHANCE of a BAD CONSEQUENCE. We need to constantly assess this objectively.
What should you assess the risk of?
the behavior as well as the responses to the behavior. Compare which has a greater risk.
Aggression
the outward expression of anger. Yelling, grunting, verbalizing....
Violence
the physical expression of anger. throwing desks at people. Punching....
Supportive Stance- Nonverbal Communication
the staff member is a legs length away and turned with legs at a wide stance.
Verbal intervention for Defensive REFUSAL
this can be verbal or nonverbal noncompliance. set limits. use the 5 step approach
LOW RISK
unlikely event or behavior with a high severity of harm.
Verbal Intervention of Defensive INTIMIDATION
verbally or nonverbally. do the following: 1- take threats seriously (back up with hands up in front of you) 2- seek assistance. Consider intent and capacity to follow through. 3- Validate and listen to them 4 Document what the threat was and the actions they made. 5. AVOID PHYSICAL INTERVENTION unless there is no safe alternative.
position
where you are in relation to the individual