Law Enforcement Academy Asheville-Buncombe Technical Community College Asheville, North Carolina Crisis Intervention Team Training

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Law Enforcement AcademyAsheville-Buncombe
Technical Community CollegeAsheville, North
CarolinaCrisis Intervention Team Training

• De-Escalation Skills

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What is verbal de-escalation?

• Verbal de-escalation is used during potentially
  dangerous, or threatening, situation in an
  attempt to prevent persons from causing harm to
  us, themselves, or others.

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What is verbal de-escalation?

• De-escalation is another tool that officers have
  at their disposal to be judiciously applied in
  controlling a potentially volatile situation,
  rather than serving as a substitute for sound
  judgment and attentiveness to safety.
• De-escalation will not always work

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Effective Communication

• 70 of communication misunderstood
• Communication becomes more difficult when the
  persons ability to understand what you are
  saying and/or their ability to express their own
  thoughts or needs are compromised by their
  symptoms.

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Barriers to Effective Communication

• Barriers to communication are the things that
  keep the meaning of what is being said from being
  heard
• Pre-judging
• Not listening
• Criticizing
• Name-calling
• Engaging in power struggles
• Ordering
• Threatening
• Minimizing
• Arguing

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Effective Communication
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Non-Verbals

• It is very important to be able to identify
  exactly what you are communicating to others
  non-verbally
• You may be trying to de-escalate the situation by
  talking to the other person, but your body
  language may be saying something else. The
  consumer will react to want you are saying with
  your body language

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Non-Verbals

• Personal space
• Eyes
• Body Posture
• Voice
• Face

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Non-Verbals the key ones

• Remain calm
• Lower the volume of your voice

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What is a Behavioral Crisis?

• A crisis is a perception of an event or situation
  as an intolerable difficulty that exceeds the
  resources and coping mechanisms of the person
• Unless the person obtains relief, the crisis has
  the potential to cause severe behavioral
  malfunctioning.

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Behavioral Crisis

• 3 reasons that a consumer may be having a
  behavioral crisis
• Medical condition
• Substance use
• Psychiatric condition

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Behavioral Crisis

• The majority of encounters that you will have
  with consumers are because the symptoms of their
  illness are not under control. Most commonly,
  this occurs at the initial onset of illness,
  during a relapse (that can result for a variety
  of reasons) and when the person s using
  substances.
• The consumers behavior is usually a result of
  his or her illness, rather than being criminally
  motivated

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Avoid

• Maintaining continuous eye contact
• Crowding or cornering the consumer
• Touching the consumer unless you ask first or it
  is essential for safety
• Letting others interact simultaneously with the
  consumer
• Negative thoughts (God, this is another one of
  those homeless people.)

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Avoid

• Expressing anger, impatience or irritation
• Inflammatory language (You are acting crazy.)
• Feeling as though you have to rush or feeling
  like you are stuck if it takes time to get the
  consumer talking
• Intervening too quickly or trying too hard to
  control the interaction by interrupting or
  talking over the consumer.

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Avoid

• Saying You need to calm down.
• Shouting or giving rapid commands
• Arguing with the consumer
• Taking the words or actions of the consumer
  personally (They are symptoms of mental illness.)
• Lying, tricking, deceiving, threatening the
  consumer to get her to comply

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Avoid

• Asking why questions. Why questions are
  logic-based. Persons in crisis are not logical.
  Typically, what ever has worked in the past is
  not working now. Why questions put the consumer
  on the defensive. Ask open-ended questions.
• Forcing discussion

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Avoid

• Minimizing the consumers situation as a way to
  elicit conversation (Things cant be that bad,
  can they?)
• Suggesting that things will get better they may
  not
• Making promises that you may not be able to keep

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Avoid

• Commands such as drop the knife, or Get down
  on the ground might seem to be straightforward
  and easy to understand. When dealing with people
  who live with mental illness, however, officers
  need to take into account the types of barriers
  to effective communication that the brain
  disorder might create.
• Telling the consumer I know how you feel.

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Avoid

• Asking a lot of questions of the consumer in the
  beginning. This is a natural tendency, however,
  this is generally not a good idea, especially
  early in the interaction. In de-escalation,
  encouraging the consumer to continue talking is
  more effective than asking a lot of questions. It
  will help continue the dialogue and will provide
  the consumer with opportunities to give
  information that will help to resolve the crisis.

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DO

• Speak in a calm, slow, clear voice
• You may need to repeat the consumer may be
  distracted
• Be patient give the situation time time is on
  your side
• Try to reduce background noise and distractions
• Use and instead of but
• Obtain relevant information from informants

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DO

• Allow the consumer to ventilate (Tell me some
  more about that.
• Use please and thank you often
• Remain friendly but firm
• Ask the consumer if she needs something
• Offer a cigarette, nutrition bar, warm clothing
• Forecast Announce your actions and movements

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Hot Buttons

• Consumers will sometimes push a hot button
• We all have them
• Example The consumer calls you a pig or swears
  at you.
• This is NOT the time to demand respect

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Use Positive Self-Talk

• Identify your hot buttons
• You are not the target of the outburst
• Never take anything personally
• Remember that most of us have been irrational and
  said inappropriate things when we are under
  extreme stress

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Recognize Your Limits

• Let someone else take over if necessary
• Set a limit with the person use an I
  statement I really want to help you but I find
  it difficult because of your name-calling could
  you help me and stop the cursing so that I can
  work on helping you. Thanks, I would appreciate
  it if you try.

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The Logic of De-Escalation

• If you take a LESS authoritative, LESS
  controlling, LESS confrontational approach, you
  actually will have MORE control.
• You are trying to give the consumer a sense that
  he or she is in control.
• Why? Because he or she is in a crisis, which by
  definition means the consumer is feeling out of
  control. The consumers normal coping measures
  are not working at this time.

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De-Escalation Model E-LEAP

• Engage
• Listen
• Empathize
• Agree
• Partner
• The LEAP Model was developed by Xavier Amador,
  Ph.D.

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E-ENGAGE

• An introduction promotes communication
• Hi, my name is Doug (or Deputy Smith). I am a
  officer with the Sheriffs Department.
• Can you tell me your name?
• State what you see/know (I can see youre
  upset.)
• State or convey that you are there to help.
• Be prepared to explain the reason you are there
• (e.g., a neighbor called to say someone is upset)

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Introduce Yourself

• How many of you can have someone tell you her
  name, and within a few seconds you have already
  forgotten it
• Make a point of immediately starting to use the
  consumers name that will help you remember it
• Use the consumers name often

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Introduce Yourself

• Get out of here you damn cop!
• Dont take the bait and turn confrontational

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L LISTEN to the persons story

• Silent and listen are spelled with the same
  letters
• Listen twice as much as you talk thats why you
  have 2 ears and 1 mouth
• What is the difference between listening and
  hearing?

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LISTEN to the persons story

• It is important understand and remember that what
  the consumer is saying or believing may be real
  or imagined. Since mental illness is a brain
  disease, thinking is what is most affected by
  mental illness. Sometimes their thoughts are
  disconnected and youll hear this in their
  speech, which can be difficult to follow and make
  sense of.

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Techniques that Show You Are Listening

• Minimal encouragers
• Reflecting
• Ask open-ended questions (Can you tell me more
  about that.

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Minimal Encouragers

• Minimal encouragers are brief statements that can
  be either nonverbal, such as a positive nod of
  the head, or simple verbal responses such as
  Okay, Uh-huh, I see, I am listening.
• Minimal encouragers demonstrate to the consumer
  that you are listening and paying attention,
  without stalling the dialogue or creating an
  undue interruption. Especially early in the
  encounter, consumers need these types of
  encouragers to feel that the officer is really
  attending to them and listening to what they are
  saying.

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Reflecting

• Whereas minimal encouragers provide initial
  confirmation that you are listening, reflecting
  adds another dimension to the communication.
  Here, you provide the consumer with evidence that
  you are listening by actually repeating what he
  or she has said. Often the reflecting response
  will simply consist of the last few words the
  consumer says. These statements should be brief
  and used in such a way as not to interrupt the
  consumer.

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Reflecting

• Repeat the last few words that the consumer said
• Example I am tired of everyone not listening to
  me and it make me angry.
• Jim, it makes you angry.

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Open-Ended Questions

• Open ended questions allow you to get more
  information
• Open ended questions enable us to assess the
  consumers level of dangerousness
• Open ended questions allow you to assess whether
  the consumer is in touch with reality

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Specific Questions That You May Want to Ask,
When Appropriate

• Does the consumer need something (e.g., hungry,
  thirsty)
• Is the consumer receiving services
• Where is the consumer receiving services
• Does the consumer have a case manager
• Is the consumer taking medication
• When did the consumer last take his or her
  medication

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Medication

• Mentioning medication must be given careful
  thought.
• In some cases, the topic is best left to mental
  healthcare providers after the consumer has
  calmed down.
• In other situations, the consumer may want to
  talk about his or her medication.
• Also, many consumers have had negative
  experiences with therapists and dont want to
  talk about it their counselor.

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E EMPATHIZE

1. Emotion labeling
2. Paraphrasing

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Empathy

• What is the difference between empathy and
  sympathy?
• Feeling sorry versus trying to understand what it
  is like to be in their shoes.
• Being sincere and real will convey understanding
• Its hard to stay angry and aroused when someone
  empathizes

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Emotional Labeling

• In emotional labeling, you again take listening
  to a higher level by trying to help the consumer
  identify feelings.
• This is different from telling the consumer
  what he or she is feeling because your statement
  is based on what the consumer has been
  communicating through his or her words and
  behavior.
• If you have used your listening skills well, it
  will often be rather easy to provide an emotional
  label to assist the consumer.

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Emotional Labeling Examples

• You seem to be . . . .
• It seems to me like you feel . . . .
• If I were in your situation, I think Id feel . .
  .

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Paraphrasing

• Paraphrasing is similar to reflecting except that
  now you begin to communicate that you are trying
  to understand the consumers entire message by
  putting what the consumer has said into your own
  words.

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Paraphrasing

• Builds rapport between you and consumer
• Helps you refine the assessment of the crisis
• Provides information that lays the groundwork for
  an eventual resolution of the crisis
• Communicates that you are listening and
  understanding

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Paraphrasing Examples

• Consumer I dont know what I am going to do. My
  family doesnt want me here.
• You Youre not sure where you can stay for
  awhile, but home doesnt seem like the best place
  right now.

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Paraphrasing Examples

• What I hear you saying is . . . .
• If I am hearing you right . . . .
• Let me see if I understand what you are saying .
  . .
• These types of statements also summarize what has
  been said in the communication.

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A AFFIRM

• You need to know what the consumer is upset about
• You may have a tendency to go to the solution
  step without really identifying what the issue is
  with the consumer. You should not assume that you
  know why the consumer is upset. You should ask
  and let the consumer tell you what the problem is
  before looking at possible solutions.
• After getting the information that you need,
  steer the conversation toward a resolution by
  affirming the consumers situation

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Affirm Example

• Okay, let me make sure I understand you, Youve
  told me that people are bothering you and that
  your case manager is not helping you. That your
  meds are hurting you because they make you feel
  sick. Did I understand you correctly.

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P PARTNER to address the persons need

• Goal is to find a resolution and return to
  pre-crisis state.
• You are looking to find the combination that will
  unlock the crisis.

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Partner

• You can ask the consumer what she thinks will
  resolve the problem
• Look for alternatives with the consumer
• Try to have 2 or more options
• Empower the consumer to choose
• If one approach doesnt work, throw another
  lure

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Partner

• Putting yourself in the consumers shoes will
  help you find a solution
• Dont force particular points of discussion
• Try to get agreement on a course of action.
  Repeat what the plan is and what is expected.
• Meet reasonable demands when possible
• Reach for small concrete goals
• Its never too late to reassess and change a plan

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Partner

• If repeated attempts fail, set firm limits and
  tell the consumer that you are worried about his
  safely and you want to help him.
• Ask if there is a family member you could talk
  to.
• State your expectations by linking to safety
  issue I need to make sure that everyone stays
  safe.

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Partner

• In your attempts to resolve an escalating
  situation you may be tempted to use bargaining,
  deal-making, or saying/promising anything to gain
  compliance.
• They are not recommended as they ultimately
  violate trustwhich is important in your repeated
  encounters with people.

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Resolution

• Can it be informally resolved?
• Is an evaluation needed?
• Are commitment criteria met?
• Was a crime committed?

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What Ifs

• What if the consumer asks you a long-term
  question?
• Say that you dont know the answer but that you
  and the consumer can handle the immediate
  situation

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What If

• The consumer says that theres nothing you can do
  to help?
• Say that youre not sure what you can do, but
  that you want to work with the consumer to figure
  out something

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What If

• The consumer will not engage problem-solving and
  is distracted?
• Say Stay with me, Frank. Lets work on this
  together. Id like for you to stop for a minute
  and take a deep breath with me. Like this. Thats
  good. Thank you, Frank.

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What If

• The consumers moves too close you?
• Say I need some space, Jim, so I am going to
  back up.

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What If

• The consumer is talking so loudly it is
  disruptive?
• Drop the volume in your own voice and say, Jim,
  I am having a hard time understanding you because
  of how loud your voice is.

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What If

• You think the consumer might become aggressive?
• If possible, bring in another trained person.
• There is less chance of aggression if two people
  are talking to one person.

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What If

• The consumer will only respond non-verbally, like
  with a head nod
• Respond positively

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What If

• The consumer remains unresponsive?
• Simply validate the consumer by stating what you
  observe about their situation
• You look really sad you must be really hurting
  right now.

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Special Strategies

1. Assertive Intervention
2. Corrective Action
3. Reducing Stimuli
4. Reducing Arousal

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1. Assertive Intervention

• Can be used when
• The consumer is uncooperative or unresponsive to
  directives that they are expected to follow.
• The consumer is violating rules which serve to
  maintain security

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Three Step Assertive Intervention

1. Empathy statement A statement that lets the
   consumer know that you understand where he or she
   is coming from and how he or she likely feels.
2. Conflict statement A statement that describes to
   the consumer that you have a conflict that needs
   to be addressed.
3. Action statement A statement that lets the
   consumer know what you want him or her to do.
   This statement can be in the form of a request.

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Examples

• Jack, I understand that you are upset and that
  you feel like no one is listening to you or doing
  enough to help you. But you and I need to let
  these people get back to work here, so we are
  going to have to get out of this waiting room.
  Id like you to walk with me down the hallway to
  an empty room so you and I can talk.
• It looks to me like you are pretty upset, and
  Im here to help you. But I am afraid someone is
  going to get hurt by those stones. So Id like
  you to stop tossing them and step up here on the
  curb so I can talk to you and try to understand
  what is going on with you today.

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Choice

• If possible, offer a choice
• Joe, I want you to stop throwing the stones or,
  if you prefer, step over here with me on the
  grass and throw them in the grass while we talk.
  What is best for you?
• This helps the consumer save face.
• Everyone reacts better to a choice versus being
  told what to do.

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2. Corrective Action AAA

• If you make a mistake (and you will) and the
  consumer escalates
• Acknowledge Jim, I can see that mentioning your
  medication is a real sore point.
• Apologize Im sorry to have upset you. I didnt
  mean to.
• Try Again I want to help, not upset you, so
  lets try something else.

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3. Reducing Stimuli

• Remove the audience or move the consumer to a
  private space
• Turn off flashing lights

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4. Reducing Arousal

• Encourage the consumer to take 3 deep breaths
  you can do this with the consumer. Lets take 3
  deep breaths like this then demonstrate and do
  it with the consumer.