1 Communication and interaction training (CAIT): De-escalation skills Ian A. James, Roberta Caiazza & Associates Warning - DVD involves use of the ‘F’ word
1
Communication and
interaction training (CAIT):
De-escalation skills
Ian A. James, Roberta Caiazza
& Associates
Warning - DVD involves use of the ‘F’ word
Stepped Care Model
Step 4: Formulation-led interventionsIndividualised assessment, formulation and intervention (Specialist teams)
Step 3: Protocol-led interventionsInterventions tailored to specific presentations and needs
(Experienced practitioners/CPNs)
Step 2: Assessment and treatment of causesThorough assessment & good practice in care environment (Carers/GP)
Step 1: Recognition
Identification of difficulties, physical health & initial monitoring
(Carers/GP)
Treatment strategies
BtC
* Tranquilisation
& sedation to
reduce activity
Drug treatment for
a physical/mental
health cause
Environmental
modification
Care
practices
Psychological –
Reactive vs
Preventative
Carer-centred
Person-
focused
strategies
Magic bullet
4
AimsCarper 1978 – ‘Problem with nursing as a
practice discipline’
• Nurses know more than they can
communicate
• What nurses know has not been
communicated well
Help you become aware of what you do, and
enable you to articulate this! (Strength-
based relationship training)6
7
Vocalisation
AppearanceBehaviour
Mental health
Physical health
Social
Environment
Cognitive
abilities
Life story
Need
Medication
Functional
assessment
features
Personality
Background
status
Formulation Template (James, 1999)
Trigger
Therapies
11
Communication skills
Long List of do’s and don’t’s
12
Mac Model plus…….
13
Law enforcement
Emotions
• Sad
• Disgust
• Fear
• Surprise
• Anger
• Happy
14
R
MA
RAM Steps – scenarioR
• Reduce the feelings; Recognise &
empathise with the person’s situation
A
• Assess situation and need - ask questions;
Summarise situation.
M
• Give person what wants; if can’t do that
reach an acceptable alternative16
17
18
Customer service skills Three important rules
1. You cannot reason with an angry person. The first and only initial step is to reduce
his/her level of arousal so you can talk.
2. You may need to repeat these steps several times before the person calms down
3. You will need to practice the approach because it is a difficult skill to do well
4. R – reduce emotion; A – assess need; M –meet need.
Reducing emotion: Identify and reduce the emotional energy
Empathise with the person’s situation
Assess the need: Summarise his situation to show you understand him
Identify whether you can meet his need
Meeting the need: If possible, meet the need? If not, reach an acceptable alternative
Carer centred, Person focused
• Tolerate (changing carers’ perspectives)
• BANGS (rather be happy than right)
• Needs Hierarchy
– Meet need
– Simulate/Validate need
– Distract
– Therapeutic lie