Every day counselors, nurses, psychiatric technicians and others in the helping vocations are called upon to intervene in crisis situations which may become dangerous if not handled properly.  In most cases staff members receive comprehensive training that adequately prepares them for the realities of working with a potentially aggressive population.  This is also crucial for the well-being and therapeutic benefit of the population, as well.

This course will explore crisis intervention techniques, which can include verbal de-escalation and physical interventions.  Our focus will primarily be on positive and behavioral supports with a strong emphasis on prevention and verbal strategies rather than physical interventions. However, we will briefly explore restrictive measures such as seclusion, physical restraint, mechanical restraint and chemical restraint so that the learner will have been introduced to the concepts.  Use of physical force with this population predictably leads to resistance, and resistance to restraint as well as potential harm to the patient and staff.

Effective aggression control is relationship centered.  It is necessary to have an understanding of the source of the immediate problem, and then have the ability to use resources, relationships, rules and desired outcomes to manage behavior.  Staff must vigilantly safeguard the patient’s physical and emotional safety by utilizing professional judgment and skills during times of stress, by being at their best when patients are their worst: in crisis.

Lets look at:

• Levels of Behavior
• Definitions of aggression
• Warning signs of aggressive behavior
• Strategies for diffusion of aggressive situations
• Steps to take to reduce risk of aggressive behaviors
• Crisis Intervention Techniques
• Staff & Managerial Responsibility after the event

Please note that this course will use the terms patient and client interchangeably.

In any crisis development situation there are four distinct and identifiable behavior levels. The purpose of defining each level is to attempt to meet each level with the appropriate staff response to defuse or de-escalate the crisis development. The four levels model is not meant to oversimplify the complexities of the behavioral process, but rather functions as a workable guideline for the staff member who is intervening. Behavior is anything but neat and packaged. However, the following behavior patterns can be seen in most people who are escalating toward a potentially violent episode. For the purposes of this article, we will be using a typical example of a person waiting for a visitor in a waiting area of any human service setting. As we point out the four crisis development behavior levels, we will also be outlining the four staff responses or staff attitudes to each behavior level.

Four Behavioral Levels:

• Anxiety Level
• Defensive Stage
• Acting Out
• De-escalation