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OVERT - Classroom Version
Transcript of OVERT - Classroom Version
Please speak with an instructor if you have any physical limitations that will prevent you from participating fully in our physical exercises.
If your condition is temporary, please come back at a time when you are able to practice the techniques with the class.
If you are unable to practice and demonstrate more than 2 of the activities, we will notify Occupational Health (and from there your manager and HR).
At the end of the class, you should be able to:
-Understand the importance of effective communication techniques in the prevention and diffusion of potentially violent situations.
-Use a team approach to diffuse hostile situations.
-Describe the concept of perceived threat
-Demonstrate techniques for evading physical holds.
of the warning signs is the key to preventing or mitigating workplace violence.
Prevention, Intervention and Response
Type II & III Violence:
An "action point" is the moment when an individual recognizes that a person may be on the path toward committing some type of violent act in the workplace and subsequently
to prevent it.
Prevention, Intervention, or Response?
Violence by non-employees or service recipients is often
Most strategies to curtail type I & IV violence are
Type I and IV Violence:
There are often warning signs that precede
instances of Type II and III
A two-way process of sending and receiving of messages.
Sending a message that is understood
Understanding the message that is sent
Sometimes the meaning is in
the verbal message was sent (or received).
This is called "Paralanguage"
Is it important to identify Communication Barriers when attempting to deescalate? Why or why not?
Walls, Glass, Counters,
Not just language!
Can be expressions, slang words, medical terminology, and other jargon.
Differences between masculine and feminine styles of communication.
Shyness, narcissism, mistrust,
perception of authority
Different views, ideas, or values
Ethnic, religious, and social differences
Inability to control emotions.
To put something in place to reduce a risk is
An action that changes the course of something is
A physical or verbal reaction to something is
ACTION POINT =
A "flash point," is the moment when violence occurs. It too late for an intervention or preventive strategy.
FLASH POINT =
Intervention during the
Communication as a deescalation tool
Assault & Battery
Least Restrictive Method
Equal Level of Force
If you are being assaulted or battered you have the legal right to protect yourself.
respond with a lower or equal level of force
The force you use must be considered "reasonably necessary" under the circumstances,
EXCESSIVE FORCE IS NEVER AUTHORIZED!!!
So what is "Reasonably Necessary"?
Is your response reasonably necessary?
Protection of self or others
Least restrictive method
Least restrictive method of restraint
Intervention during the "Action Point"
The 10 principles of
Respect Personal Space
Do not Provoke
Listen to What the Person Is Saying
Agree to Disagree
Lay Down the Law and Set Clear Limits
Debrief the person and staff
Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup
Janet S Richmond, MSW,* Jon S Berlin, MD,† Avrim B Fishkind, MD,‡ Garland H Holloman, Jr, MD, PhD,§ Scott L Zeller, MD, Michael P Wilson, MD, PhD,¶ Muhamad Aly Rifai, MD, CPE,# and Anthony T Ng, MD, FAPA**
Occupational Violence Education and Reduction Training
Any type of restraint on a patient must be
The following must be documented by the attending physician:
The reason for restraints.
What measures have been taken to avoid restraints.
The type of restraints being employed and why.
A plan for removal of the restraints.
A response that is deemed prudent and sensible under the prevailing circumstances.
Reasonably Necessary is:
We legally may not restrict someone’s freedom any more than we must.
Use the minimum amount of force to necessary to maintain a safe environment.
Least Restrictive Method
Protection of self
If you are being battered, you have the legal right to defend yourself.
Your actions must be reasonably necessary under
Protection of Others
If a person is attempting to cause physical harm or threatening to kill someone the
has a legal responsibility to either detain that patient for medical evaluation, or notify law enforcement.
Immediate (expires within 10-30 minutes)
Imminent Danger is....
The legal criteria that must be met before you engage in self defense or the defense of others.
of all emotional information and more than
of the total information in spoken English is communicated
In almost all cases, verbal
de-escalation must be attempted prior to the use of restraints.
Are these examples of restraint?
Grabbing an arm
Holding someone down
Seclusion in an isolation room
The use of behavior modifying medication
Detaining a person for observation
de-escalate the agitated person.
and assists in the event of physical violence.
may set a tone of anger which could create fear or challenges.
voice may set a tone of anticipation or uncertainty which may promote excitement or disruption.
Speak slowly -- This is usually interpreted as soothing.
voice is one of calm and firmness which promotes confidence in both parties.
What do these non-verbal actions say to you?
Jaw set with clenched teeth
A fake smile
Hands on Hips
An assault is an unlawful attempt, coupled with a present ability, to commit
on the person of another.
This includes verbal threats that place another in
of an offensive and imminent bodily contact (a battery).
A battery is any willful and unlawful use of force or violence upon the person of another.
A victim must be physically touched for a battery to occur.
Becoming skilled at verbal de-escalation requires:
Practice, Communication skills,
and an understanding of your:
-tendency to retaliate
-tendency to become defensive
Choke from front
Choke from behind
Headlock Choke (lift technique)
Headlock Choke (shoulder drop technique)
General principles with Biting
Biting on the arm
Biting a finger
Biting the shoulder or back
Two-Handed Grab (on one arm)
Two-Handed Grab (one hand on each arm)
Fingernails dug into the arm
Your goal is to escape to safety
Turn an attacker’s attention inward
Move in rather than pulling away
Activate your larger muscles
Weak points in a grasp
Angles that will force release
Bear Hug – front over arms
Bear Hug – front under arms
Bear Hug – behind over arms
Bear Hug – behind under arms
General principles with Hair Pulling
Hair pulling – top from the front
Hair pulling – top from the back
Hair pulling – ponytail or from behind
Plant your feet apart, with one foot forward and your knees slightly bent. This will lower your center of gravity and increase your balance.
Before doing anything physical, try to talk the aggressor into letting you go.
As soon as you feel a grip releasing, continue the motion to make your escape.
All of these physical maneuvers are evasive. Your goal is always your personal safety.
Compliancy-based means we are trying to create a release-response
Give enough resistance as the attacker to understand the efficacy of the maneuver without hurting your partner.
A Code Gray is used to alert hospital staff to a disruptive or potentially violent employee, patient, visitor, or other service recipient.
Rate & Pitch
The key is to preventing this type of violence is to intervene
before the person becomes violent.
When approaching an agitated person, maintain at least 2 arm’s lengths of distance.
Do not touch the person.
Both parties should be able to exit the room without feeling the other is blocking the way.
Attempt to identify and resolve possible barriers to communication.
Stand at an angle and minimize eye contact.
Maintain a calm demeanor and voice.
Keep a neutral facial expression.
Keep your hands visible.
Let the person know you are and why you are there
how they would like to be addressed.
Give options & choices
Give the person time to process what has been said.
Allow the person to respond before providing additional information.
Persistently repeat your message to the person until it is heard.
Actively listen to the patient and
with his/her position
Do not make assumptions regarding why the person is agitated -ASK THEM
Communicate your desire to understand
to determine unspoken needs.
Acknowledge the person is having difficulty conforming to what is expected of him/her.
Is their behavior a symptom of a medical issue? Personality disorder?
Empathize vs. Sympathize
Try to imagine how the person’s beliefs could be true
Make an attempt to understand what he/she is saying by asking questions
Do not dismiss the persons concerns or contribute to delusions
Use the "fogging" technique to find something about a person’s position with which you can agree.
Tell the person that injury to them self or others is unacceptable and they may be arrested if he assaults or batters anyone.
Present consequences, which are:
Clearly related to the specific behavior
Be prepared to follow through with the consequences you have given.
Do not give idle threats or discuss consequences that are not directly related to the behavior.
Propose alternatives to violence.
Offer things that will be perceived as acts of kindness
Give choices that may stall aggressive behaviors.
Do not deceive by promising something that cannot be provided.
Give two examples of
and two examples of
in a clinical setting.
What are people
saying when they communicate?
Words don't always matter!
What's your name?
What would you like me to call you?
I'm here to help
I need your help
Do you want?
Would you like?
That may be but...
I understand however...
I see your point and...
You seem upset
Are you upset
I can't understand you
I want to understand you
You need to calm down right now
I know you're doing your best to be calm right now
Class Discussion Questions:
Describe at least 3 warning signs that may signify an "Action Point" .
Do you believe use of communication and intervention techniques can prevent violence from occurring? Why or why not?
Class discussion question:
Agree with the truth
"That's true, you have been waiting for a long time"
Agree with the principle
You know, you're right. Nobody should have to wait to be seen when they have a sick child."
Agree with the odds
"I agree. If we weren't so busy you would probably not have to wait as long."
Fogging involves agreeing with any truth that may be contained within statements, even if critical.
By not responding in the expected way, (being defensive or argumentative), the other person will cease confrontation as the desired effect of their words is not being achieved.
I've been waiting here for an hour! My daughter is sick and I want her seen RIGHT NOW!
When a CODE GREY is called, the team leader MUST establish
and who will be doing the talking
Contact vs. Cover
Response during the
Use of force and self defense
Escaping the Flash Point: