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
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.
CRISIS AS AN OPPORTUNITY
A crisis occurswhen 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
Recovery Phase
4 QUESTIONS WE ASK OURSELVES
IN A CRISIS
- What am I feeling now?
- What does this child feel, need or want?
- How is the environment affecting the young person?
- How do I best respond?
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 saide.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 de-escalate potential crisis e.g. – “I am sorry you feel upset” or “I can see that you are angry”
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
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
RESPONSES
ReactiveProactive
SafetySafety
Understanding & SupportContainment & Negotiation
Remove / Reduce StimulusEngagement &Reasoning
Teach Coping SkillsTeach Appropriate Thinking, Values & Social Skills
Teach Self Regulation SkillsReward Socially Appropriate Behaviour not Anti-Social Behaviour
Anger Management
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.
Elements of a Potentially Violent Situation
To reduce the risk of a violent incident from occurring, remove any of the four elements.
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
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
IIsolate the Conversation
EExplore the Young Persons point of View
SSummarise the Feelings and Content
CConnect Feelings to Behaviour
AAlternative Behaviours Discussed
PPlan Developed / Practice new Behaviour
EEnter the Young Person back into the routine
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 interventionswhich maintain safety.
Options for dealing with physical violence include:-
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.
Physical Restraint is NOT used to:
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:
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 ornose.
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.
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
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