De-Escalation and Pro-active Communication Skills How to manage aggression and hostility and move the client forward when they are acting out. A. Christine.

De-Escalation and Pro-active Communication

Skills

How to manage aggression and hostility and move the client forward when they are acting out.

A. Christine Furman MMHSDirector of Acute Care Services

Recognizing aggression and hostility

Communication Skills

Non-verbal Communication Skills

Diffusion Strategies

De-escalation techniques and skill

What we are going to talk about:

Frustration Feel that they have been treated unfairly Feel that they have been humiliated They are immature There is a level of excitement they are

reacting to It works – it is a means to an end It is part of their reputation Aggression and Hostility may be

symptoms of their mental illness

Why do people escalate and become aggressive or hostile?

They may stand taller Their face may redden Their voice may raise They may breath faster They may make prolonged, direct eye contact with you –

stare you down They may make exaggerated gestures They may become very tense They may begin to pace They may clench their fists They may clench their jaw and tighten their facial muscles Behavior is different than normal

How do you know when someone is feeling hostile or aggressive?

This is a two way process that includes: Listening Speaking, and Hearing

As a staff member you will also need to: Observe, and Interpret

Communication

Background noise, and having to speak loudly (are you having to yell?)

Inappropriate setting Language barriers Perception and Prejudice Intrusion of personal space Time constrains Lack of encouragement

Some things that get in the way of effective communication are:

1. Ordering, directing, or commanding

2. Warning or threatening

3. Giving advice, making suggestions, or providing solutions

4. Persuading with logic, arguing, or lecturing

5. Moralizing, preaching, or telling clients what they ‘should’ do

6. Disagreeing, judging, criticizing, or blaming

7. Agreeing, approving, or praising

8. Shaming, ridiculing, or labeling

9. Interpreting or analyzing

10. Reassuring, sympathizing, or consoling

11. Questioning or probing

12. Withdrawing, distracting, humoring, or changing the subject

Twelve Roadblocks to Listening – Thomas Gordon, Ph.D.

Staff need to be able to recognize early warning signals such as:

• Behavior changes

• Quiet people become agitated

• Loud people become quiet

Commenting on the changes may open up conversation and minimize frustration or anger build up – giving the client an opportunity to diffuse the situation.

Escalation Prevention Steps:Prevention Step #1

Recognize that Anger is a normal emotion – we don’t always need to fix it or be afraid of it – unless the person becomes a danger.

Anger is not ‘normal’ when: Anger is often used to get ones way Anger is often used to get

attention to escape a situation to gain control of a situation

Anger is used to pump one’s self up when feeling small or insecure

Prevention Step #2

Staff need to remain in touch with their emotions when dealing with an angry client. If you become angry or defensive you will not be able to help the client. If you cannot manage your emotions and remain calm and objective, you will need to get help.

Prevention Step #3

Take a deep breath, and attempt to remind yourself of the following:• Avoid criticizing and finding fault with the aggressive

person.

• Avoid being judgmental with the aggressive person.

• Use a calm, steady voice without and edge or sing song.

• Do not become involved in the conflict.

• Be able to try to see the situation from the angry person’s point of view.

• Remember that your job is the health and safety of your client.

• Have a plan.

Prevention Step #4

Take deeper breath Appear confident – but not cocky Remain calm Show that you are listening Speak slowly, gently and clearly Avoid arguing and confrontation Create space between you and the agitated

person Know how you are going to get out of the area

What should staff do once a client has Escalated?

Use a calm, open posture – either sitting or standing

Reduce direct eye contact – do not stare Allow the person adequate personal space Keep both hands relaxed and visible Avoid any sudden movements Avoid and discourage an audience

Adopt a non-threatening body posture

Explain your purpose or intention Give clear, brief, assertive instruction Negotiate options Ensure that your non-verbal

communication is non-threatening

De-Escalation Techniques

Sometimes all it takes to de-escalate someone is a good ear and the time to allow the client to vent. Just listen to what they have to say and give them encouragement.

De-Escalation Technique #1 Just Listen

This is when you really listen and are able to relay back to them that you understand what they are feeling.

“I understand that you are angry”“I see that you are frustrated”“You feel that you have been wronged”

Technique #2 Acknowledgement

You don’t need to be the problem solver. It’s not your job to have all the answers.

Give the client time to reflect, don’t fill the time with your thoughts and questions. Just be with them, calmly.

Technique #3 Allow Silence

If the situation was unjust or unfair – a sincere apology is powerful. It does not mean that you are accepting blame, it means you are acknowledging that something that occurred wasn’t right or fair.

Technique #4 Apologize

Ask what you/we/the program could do better, be sincere. Don’t tell them why it won’t work or why it’s not a good idea, just listen and thank them for their input. This may intensify someone’s anger temporarily – but if you encourage them to continue and let them be heard the conversation tends to end on a more positive note.

Technique #5 Invite Criticism

You should have a plan at the ready, for example… a place for a time out, a meeting with a supervisor or case manager; however you will want to work out the options with the client.

Technique #6 Develop a Plan

Once you have threatened or given an ultimatum all negotiations will cease and you will be in a win/lose situation. Try to keep options as open as possible.

Never Threaten

• Do you have a plan if you can’t de-escalate a client?• Does your agency?• Does your agency have P&P regarding

safety?• Do you have a way to summons others

for help?

Ultimate Plan for Safety