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Crisis Prevention Intervention (Refresher)
10
Crisis Prevention Intervention
Refresher
CPI
NON-VIOLENT CRISIS INTERVENTION
Q.T.I.P
Quit Taking It Personally
“All behavior is a form of communication, and escalating behavior is the communication of increasing distress.What if, instead of seeing a person as challenging, you view them as a person in distress? Think of their words and actions as the communication of that distress.Fear and anxiety play a large role in a person’s escalating behaviors. It’s important to consider the reasons why a person’s behavior may escalate” (CPI, 2020)
Decision Making and De-escalation
Staff behavior should be proportionate to student behavior.
We want to avoid an under-reaction or over-reaction
Making Effective Decisions
Risk
Assess the risk of a situation
-Is the student putting his/herself or others in imminent danger?
-Do I feel safe?
-If I do nothing, what will happen?
-What will happen if I engage verbally and/or physically?
-What are my other options?
Decision Making Matrix
Severity
Likelihood
Top 10 De-Escalation Techniques
1. Be Empathetic and Non-Judemental
-Validate emotions/thier reality
4. Avoid Overreacting
-Stay calm, rational, professional
7. Set Limits
-Set clear, simple and enforceable limits
2. Respect Personal Space
- 1.5ft-3ft of space
-Decrease Anxiety
5. Focus on Feelings
-Listen to a persons real message
-Summarize back to them
De-Escalation Tips
8. Choose Wisely on What You Insist Upon
-Decide what are negotiables and non-negotiables
-Be flexible
9. Allow Silence for Reflection
-Stop the Verbal Purge
3. Use Non-threatening Nonverbals
-Loss of Control=decreased ability to process
-Limit Language
- Use gestures,facial expressions, movements, tone of voice.
6. Ignore Challenging Questions
-Answering questions=power struggle
-Redirect student to problem solving
-Information Seeking vs. Challenging
10. Allow Time for Decisions
-Rushing=Increased Anxiety
-Allow Time to Process
Disengagements
-Lowest level of physical management staff will engage in with students
-DOES NOT require CPI documentation
Dis-engagements and Escorts
Blocking Strikes and Kicks
Blocks
-Therapeutic stance
-Non-threatening
-Provides an 'out'
-Hands open and out to block
-Body moving away from the student
-Be aware of proximity
-Call for help
Hold and Stabilize
1.Wrist
2.Clothing
3.Hair
4.Neck
5.Body
6.Bite
Hold and Stabilize
-'Go to' when grabbed by a student
-Allows for a seamless progression to disengage if behavior escalates/continues
-Limits the range of motion
-Remain calm, downplay the situation
-Use verbal cues to direct student to let you go
-'First-Then', 'If-Then'
-Call for help
Push-Pull
-Moving two things in opposite directions
Push-Pull
Clothing
-Hold and stabilize
-One hand supporting student wrist, one hand on your clothing
-Move student hand one direction and your clothing in the opposite direction
Neck
-Hold and stabilize
-Move student body one direction and your body in the opposite direction
-Momentarily hold on to student wrists to maintain safety
Wrist
-Hold and stabilize
-Move student arm in one direction and your arm in the opposite direction
Push/Pull
(Hair, Body, Bite)
Hair
-Hold and stabilize
-Use a flat hand to push away student hand
-Move head in opposite direction
Body
-Hold and stabilize
-Place two hands on one of the students' arms
-Push student arm away, move your body in the opposite direction
Bite
-Hold and stabilize
-Pull individual close to your body
-Pivot to the side (student becomes unbalanced)
Lever
-Using the weak-point to our advantage to disengage
Lever
Clothing
-Hold and stabilize
-Rotate around the fixed point/weak point (wrist)
Hair
-Hold and stabilize
-Bend at the weak point (wrist)
Wrist
-Hold and stabilize
-Rotate your wrist around the weak-point (meeting point of students' thumb and fingers)
Lever
Body/Neck
Neck
-Hold and stabilize
-Raise one or two arms
-Spin towards student arms (be a ballerina)
Body
-'Hulk out' (push out elbows)
-Creates space
-One hand on the outside, one on the inside
-Put pressure on the weakpoint (hands meet)
Escorts
'Momentary periods of physical restriction by direct person-to-person contact, without the aid of material or mechanical devices, accomplished with limited force and designed to:
1) prevent a student from completing an act that would result in potential physical harm to himself, herself, or another or damage to property
2) remove a disruptive student who is unwilling to leave the area voluntarily' (ISBE, 2020).
An Escort is NOT a hold or restraint.
**DOES NOT require CPI Documentation**
Physical Holds and Restraints
Physical Holds and Restraints
Used as a last resort
May not be sustained for more than 15 minutes at a time
-Why am I holding onto this student?
-Are there alternatives? (weighted blanket/sensory items)
-Have we tried disengaging?
When engaging in a hold...
-Limit verbal interactions with student
-One staff should be taking the lead (typically 1st on scene)
-Directives should be short/concise and focused around having a safe body
-Processing SHOULD NOT begin until student is displaying SAFE behaviors and is out of the hold/restraint
Things to consider...
-Personal comfortability and appropriate engagement (Am I able to be therapeutic? Are my team members engaging therapeutically?)
-If not, speak up and get switched out ('You have a phone call from a parent', 'I have a meeting I have to get to')
-Is there an appropriate amount of staff?
-Too many staff can escalate student behaviors
-Too little staff increases risk levels
If hold becomes 'unsafe' (incorrect, not being used properly) or a teammember is feeling uncomfortable, DISENGAGE then REENGAGE.
Seated Holding
Low
Medium
High
Seated Holding
-Wide stance
-Body in
-Inside arm holding wrist in 'T-Rex' arm position
-Outside hand caps fist
-Two staff sitting on either side of the child
-Hands lightly placed on top of wrists
-Provide verbal support/use haptics
-Stance widens and body moves in (limit range of motion)
-Inside hand through individuals arms, supporting wrist
-Outside arm supporting at or slightly above elbow
Standing Holding
High
Low
Medium
Standing Holding
-1:1
-Both arms supported at or slightly above the elbow
-Body in, wide stance
-2:1
-Inside hand supporting wrist. Arms pulled up in 'T-rex' position
-Outside hand caps fist
-Body in, wide stance
- Does not have to be in sync (One in high/one medium)
-2:1
-Outside hand placed at or slightly above the elbow
-Inside hand supporting wrist
-Body in, wide stance
Team Control Position 'The C'
Team Control Position
-Step forward together, feet side by side, not crossing
-Body pivots to the side (facing away from teammate)
-Squat position, body snug into students'
-Inside hand supports shoulder, outside hand supporting wrist. Student wrist facing ceiling
-Student arm draped across waist like a seatbelt
-Starts with medium level standing hold
-Make sure to communicate with your teammate!
-Team members need to be in sync (head nod, call out 'C')
-Be aware of proximity to furniture/walls/tables ect.
-3rd person can assist with modifying/creating space (move chairs, tables, ect.)
Children's Control Position
Should ONLY be used on individuals who are SMALLER and WEAKER
Low
Medium
High
Children's Control Position
-1:1
-Body pivoted to the side (maintains safety/comfortability)
-Hands through students arms, supporting wrists at the hip
-Body in, wide stance
-Option to lean back
-1:1
-Body pivoted to the side
-Cross arms, support student wrists, pull wrists into students armpits
-Body in, wide stance
-Option to lean back
-1:1
-Both arms supported at or slightly above the elbow
-Body in, wide stance
Post Crisis
Post-Crisis
and CPI Documentation
When the student displays a calm/safe body...
1. Start building rapport
-Validate student emotions/assess needs (water, tissues, food, blanket, quiet environment)
-If a student verbalizes they are hurt or if there are visible injuries, seek out a nurse to assess the student
-Give student time, space and quiet. Don't rush.
2. Process the situation with the student
-Discuss the situation, brainstorm ways decision making can be altered in the future
-Give consequences
-Reestablish boundaries (What are the expectations of the student?)
-Set the student up for success (Review schedule, use positive phrasing/be encouraging)
3. Fill Out CPI documentation
When students are in crisis, staff are in crisis
CPI Documentation
Control- is the staff back under physical/emotional control? How was it determined staff were back under physical/emotional control?
Orient-Using the physical intervention form as a reference, what were the basic facts? Allow each team member to share their perspective.
Patterns-Discuss behavioral patterns and or triggers to behavior in the past.
Investigate-Discuss possible replacement behaviors/alternative plans as a group. If the student has an FBA/BIP, use this document as a reference at this time
Negotiate-As a team, negotiate/decide any changes that will take place (proactive or reactive). List any changes in responsibilities for team members or other staff members. Document changes in the FBA/BIP
Give-Discuss how support was provided to the team and discuss the positives that can be pulled from the experience/process.