De-Escalation Training

Welcome to Sojourner Recovery Services’ on-line training on De-Escalation. Below you will find some general information on this subject as well as agency guidelines on de-escalation. This is not intended to be a comprehensive training and further training may be required. If you have questions or concerns, please contact your supervisor or an administrator.

Purpose:

The purpose of this training is to provide education and instruction on how to identify and de-escalate an agitated client while keeping yourself and others safe.

Introduction:

Substance-abusing clients’ behaviors may become escalated when they are presented with feelings, circumstances or situations with which they are unable to cope. While in treatment, they will learn healthy ways to deal with these; however, at times they may react in the manner in which they have coped in the past.

Identifying the Escalated Client

Some common signs that a client has become escalated:

-Raised Voice -High-pitched Voice

-Rapid Speech -Pacing

-Excessive Sweating -Balled Fists

-Excessive Hand Gestures -Erratic Movements

-Fidgeting -Aggressive Posture

-Shaking

Effective de-escalation techniques feel abnormal. We are intuitively driven into “fight or flight” mode when scared. However, in de-escalation, we can do neither. We must appear centered and calm even when we are terrified. Therefore these techniques must be practiced before they are needed so that they can become “second nature”.

When under stress, people tend to hold their breath or breathe shallowly. Practice slow, deep diaphragmatic breathing when confronted by stressful situations to decrease your own level of arousal. Also use positive affirmations or self-talk. It is a fact that our thoughts trigger emotions and are triggered by our communication with ourselves. Stay positive when under attack by maintaining a win-win attitude.

De-Escalation Techniques

Non-Verbal De-Escalation: It is said that approximately 65 percent of communication consists of non-verbal behaviors. Of the remaining 35 percent, inflection, pitch, and loudness account for more that 25 percent, while less that seven percent of communication has to do with what is actually said.

Appear calm, centered, and self-assured even if you don’t feel it. Your anxiety can make the client feel anxious and unsafe which can escalate aggression.

Maintain limited eye contact. Loss of eye contact may be interpreted as an expression of fear, lack of interest or regard, or rejection. Excessive eye contact may be interpreted as a threat or challenge.

Maintain a neutral facial expression. A calm, attentive expression reduces hostility.

Keep a relaxed and alert posture. Stand up straight with feet about shoulder width apart and weight evenly balanced. Avoid aggressive stances.

Minimize body movements such as excessive gesturing, pacing, fidgeting, or weight shifting. These are all indications of anxiety and will tend to increase agitation.

Position yourself for safety:

· Never turn your back for any reason

· Maintain a distance of at least two arms’ length between yourself and the agitated party. This will allow you reaction time from attacks such as grabs, strikes, and lunges.

· Angle your body about 45 degrees in relation to the individual. This stance not only reduces your target size in the event of an attack, but also prepares you to escape when necessary.

· Place your hands in front of your body in an open and relaxed position. This gesture appears non-threatening and positions your hands for blocking if the need arises. Avoid crossed arms, hands in the pockets, or arms behind the back since it can be interpreted as negative body language as well as putting you at tactical disadvantage if an attack occurs.

· If possible, casually position yourself behind a barrier such as a sofa, desk, large chair, counter, table, or other large object.

· Position yourself closer to the room entrance than the escalated client if indoors.

· If you have time, remove necktie, scarf, hanging jewelry, religious or political symbols before you see the client (not in front of him/her).

Always be at the same eye level. Encourage the client to be seated, but if he/she needs to stand, stand up also.

Do not point or shake your finger.

Do not touch even if some touching is generally culturally appropriate and usual in your setting. Cognitive disorders in agitated people allow for easy misinterpretation of physical contact as hostile and threatening.

Verbal De-Escalation: Once non-verbal tactics are in place, verbal de-escalation can be a logical next step in dealing with an agitated client. Remember, reasoning with an enraged person is not possible. The first and only objective in de-escalation is to reduce the level of client arousal so that discussion becomes possible. The following are general guidelines for verbal de-escalation:

1. Remember that there is no content except trying to calmly bring the level of arousal down to a safer place.

2. Use a modulated, low monotonous tone of voice (our normal tendency is to have a high-pitched, tight voice when scared).

3. Do not get loud or try to yell over a screaming person. Wait until he/she takes a breath, then talk. Speak calmly at an average volume.

4. Do not be defensive even if comments or insults are directed at you. They are not about you. Do not defend yourself or anyone else from insults, curses, or misconceptions about their roles or behaviors.

5. Be very respectful even when firmly setting limits or calling for help. The agitated individual is very sensitive to feeling shamed and disrespected. We want him/her to know that it is not necessary to show us that they should be respected. We automatically treat them and all clients with dignity and respect.

6. Respond selectively. Answer only informational questions no matter how rudely asked, (e.g. “Why do I fill out these g-d forms”?) This is a real information-seeking question. Do not answer abusive questions (e.g. “Why are all counselors’ assholes”?). This sort of question should get no response whatsoever.

7. Be honest. Lying to a client to calm them down may lead to future escalation if they become aware of the dishonesty. However, do not volunteer information which may further upset the client.

8. Explain limits and rules in an authoritative, firm, but respectful tone. Give choices, where possible, in which both alternatives are safe ones (e.g. “Would you like to continue our meeting calmly or would your prefer to stop now and come back tomorrow when things can be more relaxed.”).

9. Empathize with feelings but not with the behavior (e.g. “I understand that you have every right to feel angry, but it is not okay for you to threaten me or my staff.”).

10. Suggest alternative behaviors where appropriate (e.g. “Would you like to take a break and have a cup of coffee or some water?”).

11. Do not solicit how a person is feeling or interpret feelings in an analytic way.

12. Do not try to argue or convince.

13. List consequences of inappropriate behavior without threats or anger.

14. Represent external controls as institutional rather than personal.

15. Trust your instincts. If you assess or feel that de-escalation is not working, STOP! Tell the person to leave, escort him/her to the door, call for help or leave yourself and call the police.

There is nothing magical about talking someone down. You are simply transferring your own sense of calm and respectful, clear limit setting to the agitated person in the hope that he/she actually wishes to respond positively to you respectful attention. Do not be a hero and do not try de-escalation when a person has a weapon. In that case, simply cooperate.

Sources:

Massachusetts Chapter-National Association of Social Workers

Texas Dept of Health-Bureau of Emergency Management

Quiz Instructions:

1. Click on the link below to access the quiz

2. Print the page

3. Complete the quiz

4. Submit the completed quiz to your supervisor

De-Escalation Training Quiz