De-escalation of individuals who have become emotionally upset and potentially disruptive or dangerous is a skill and, in some respects, an art form. For staff who work in education or youth service, calming a youth who is upset is a must-have skill. Some individuals are blessed with communication instincts that allow them to move easily into these situations and achieve success, while others must learn the fundamentals of interrupting and calming negative emotional energy.
Every crisis behavior incident is an individualized event that requires individualized intervention. The children and youth in care have substantial variance in their cognitive and social maturity, communication skills, strengths and limitations. They require an individualized approach with a common goal – de-escalation. The emphasis on de-escalation has evolved over time.
Events leading to the de-escalation emphasis
In the late 1960’s, the beginning of my career, there was little training available for staff. Students and youth in care were perceived as individuals to be seen but not heard. When non-compliant behavior occurred, it was treated harshly.
Concerns regarding harsh treatment of youth in facilities and with the use of corporal punishment in schools stimulated advocacy for reform. Some landmark cases (PARC v Pennsylvania, Halderman v Pennhurst, andIngram v Wright) prompted protection legislation, the development of government oversight agencies and the promulgation of standards and regulations aimed at curtailing abusive treatment. Around the same time, Ranae Hanson authored The Institutional Abuse of Children & Youthwhich exposed abuse of a variety of populations via organizational culture.
In the 1980s, when service organizations began to be held accountable for intervention practices, it became clear there was a need for a more humanistic approach and methodology to respond to youth exhibiting harmful behaviors. While crisis intervention training curriculums were initially focused on non-abusive emergency interventions, over time training vendors began to provide more comprehensive content that included prevention and de-escalation material.
In the 1990’s, juvenile justice practitioners experienced an increase in incarceration linked to a national spike in violent crime. More juvenile facilities were built with high emphasis on security and an increased emphasis in training for physical encounters. At the same time, service agencies were subjected to a higher level of oversight regarding the use of physical intervention skills. A policy tipping point occurred in 1998 when the Hartford Courant newspaper published a series of articles exposing tragic outcomes related to the use of physical intervention in facilities serving young people. These articles prompted substantial advocacy to establish governance on the use of physical restraint in caregiving services. The advocacy lead to the initiation of guidelines for behavior management by numerous professional associations.
In 2000, the Children’s Health Act was the first federal legislation passed that addressed the use of “Restrictive Interventions” in health care programs. These were limited to programs accepting federal funds. In 2003, the Substance Abuse and Mental Health Services Administration (SAMHSA) initiated a movement to eliminate the use of seclusion and restraint in behavioral health programs. This movement was modeled on the previous success in restraint reduction of its Director, Charles Curie, when he worked in the Pennsylvania State Hospital system.
As the movement progressed, the identification of prone position restraints (face down) as being highly associated with tragic outcomes mobilized the restraint elimination advocacy. This resulted in prone positions being prohibited in many states, including Pennsylvania. At the same time, the continued development of regulatory governance at the local, state and national levels increased in specificity and in scope.
There has been substantial reduction in the use of restrictive interventions throughout the field. Emergency intervention skills training will remain necessary. However, the effort to increase the prevention and de-escalation skill development of staff will continue to minimize this need.
The power of relationship building
The most salient tool we have when working with other human beings is our ability to form a positive relationship. Relationship building is a prevention strategy, and de-escalation is always less difficult when a positive relationship has been established. It is a key element in developing a safe and secure operating environment, and when combined with a consistent structure and organized student/client based programming in classrooms and care centers, positive personal rapport (relationships) provides a sense of certainty for individuals that reduces personal anxiety. When anxiety levels are reduced, there are fewer behavior incidents.
Sometimes, though, the needs of our service population exceed the impact of these efforts. In addition, in every population there is a small number of individuals who are associated with a large number of crisis behavior interventions. I refer to these individuals as “the fabulous 5%.” These special individuals require Individual Behavior Support Plans that use functionally assessed information on the prompts and reinforcements that stimulate and sustain their behavior and ideally provide the pathway to achieve alternative behaviors. This process can equip staff with strategically developed, individually focused de-escalation strategies.
Key Skill – Assessment
While preferred, the functional behavior assessment (FBA) approach is not always available. For staff, the challenge of everyday behavior by the remaining 95% of our populations is ever-present. So, they must become equipped and proficient with generic de-escalation skills – including how to assess the situation quickly and completely:
- First, the intervening staff must assess the environment. Who and what is in the immediate environment can be critical for a successful intervention. This would include, but not be limited to, support resources, peer group observers, problematic structure, etc.To be successful, staff may need to address some of these environmental variables – by, for example, changing the location or removing the peer audience.
- Second, staff must assess the individual. Ideally, staff will have a working knowledge and established rapport with the clients in their care. When this is not the case, they must assess the individual’s characteristics, their level of negative energy, verbal and non-verbal communication and potential for aggression.
- Third, staff must assess themselves. The most common error in dealing with escalating individuals is the human instinct for counter-aggression. When these events occur, the intervening staff will often mirror the behavior of the escalating individual. This reflection is prompted by a self-protective instinct that must be professionally controlled. Escalating individuals are astute in triggering counter-aggressive responses by using verbal insults, non-compliant behavior and value-latent remarks. Staff must develop immunity to these actions, not allowing them to affect their response.
After assessment, the key to successful de-escalation is finding a way to interrupt the flow of negative energy. Literally, staff must coax the individual to “slow down,” change direction and focus. How do we do this?
Interrupting Negative Energy
In these situations, communication regarding staff intention occurs before any words are spoken. The physical approach with an escalating individual is critical. Movement, demeanor and gestures must be non-threatening; “calm” and “confident” are the words that should describe the initial contact.
To this approach we add the use of active listening and verbal invitations of assistance and problem solving. Staff must hear the individual’s emotion and respond in an empathetic reflective manner: “I know you are upset, how can I assist?”Breaking the flow of negative energy that is driving the escalating behavior requires the intervening staff to find an opportunity to request a change in a behavior that is a symptom of their emotional energy. This may be a simple request to reduce the speed of their speech: “I would like to understand…can you slow down?”Or, requesting an environmental change to reduce audience pressure: “Let’s walk to where you can have some privacy.”
When there is a compliant reaction to such intervention, the energy flow is reduced and there is a pause in the escalation. At this point, staff will continue to provide verbal problem-solving assistance. Once dialogue is initiated, the key is to keep the focus on collaborative problem solving. Too often, this is when staff engage in judgmental condemnation of the initial behavior. They must remain focused on the immediate task of de-escalation; concerns regarding behavior compliance issues can be initiated at a later time. Staff skilled in de-escalation will model the behavior they seek by speaking slowly and with a calm demeanor and tone. Of course, there are individuals who lack the capacity for verbal resolution. Here, there is need for the FBA process to assist with the de-escalation and the development of alternative behaviors.
In Safe Crisis Management®, successful de-escalation leads to a collaborative problem-solving conversation that explores motivation, examines alternative behaviors and allows the individual to return to a regular program. This process can be an art form when staff communicates genuine concern for the individual.