7 H, reserved. a: "-bited. Blue Card Blue Card con?rmation included. nonviolent crisis intervention a CPI specialized offering For Review ofthe Nonviolent Crisis intervention? Training Program care, welfare, safety, and securityf Find us. Fotlow us. View us. Learn more. facebook facebook.com/CPI.Training twitter-J ml? Tube youtube.com/crisisprevention crisisprevention.com SC 2005 CPI (reprinted 2012). All rights reserved. This work is protected by the copyright laws of the United States and other countries and remains the sow property of CPI. This work may not be reproduced in any manner without the express written permission of CPI. 7 Important information about your license to use teaching materials. . CPI hereby grants CPI Certified Instructors a perpetual, nonexcluswe. and nontransferable license to use this work in teaching this program to staff Within the Cert ?3 Mi. Base 0f EmPIOyment, as defined in the Instructor Manual. This license is site-specific to the Certified Instructor?s Base of Employment and includes the right to d322,; to program partiCipants for use during this training. Any other use of this work is strictly prohibited and will be considered a breach of this license and a VlOlatLS?ia" ot CPI. copyright laws. Certified Instructors are not agents (implied. apparent, or otherwise) or employees of CPI and do not have any authority to act for or on and Nonviolent Crisrs Intervention' are registered trademarks of CPI. Maintaining Safetg in the Nonviolent Crisis Intervention? Training Program The philosophy of this program is to provide the best Care, Welfare, Safety, and SecuritySM for the individuals in your charge, even in violent moments. The program has been designed to provide the same Care, Welfare, Safety, and SecuritySM for you as you learn the techniques and skills taught during this training. Please respect the Due Care guidelines outlined by your Certified Instructor during your training and recognize that this training is in a controlled environment to learn basic skills. While we cannot create ?reality," we can practice in order to prepare for real situations. The guidelines below are minimum standards for Due Care: - I will respect other participants as peers. I am responsible for the safety of others with regard to my actions. I am responsible for gauging myself with regard to any past/current injuries and my comfort level performing any given technique. If I have any concerns, I will see my Instructor at a break. - I will not engage in horseplay. - I will not teach other techniques. - In all role-plays/techniques, will act only on my Instructor's direction. - I will cooperate, not compete. I will take time to warm up and stretch before performing any physical activity, and I will drink plenty of fluids throughout the day. - I will be conscious of the space around me and always consider safety while practicing physical techniques. I must remember that there are others who are practicing near me. During physical exercises, any participant can ask to stop the activity at any time, for any reason. If, while practicing physical exercises, my partner asks me to stop the activity, I will take the request seriously and immediately discontinue the exemise. I will inform my Instructor prior to class of any injuries or limitations. I will report all injuries to my Instructor immediately. Please Read Carefully: As a participant in the Nonviolent practicing intervention strategies. . contact and include risk of injury. It is imp Instructor and the Due Care guidelines of the program. CPI makes no warranty or representation that the skills, techniques, and methods taught in this program comply with all local laws, rules, regulations, and ordinances that may be epphcabje to persons utilizing same. CPI's physical intervention techniques should be used only in a manner that comports with local laws. CPI assumes no liability for any bodily injury, loss, or damage caused by the misuse or incorrect application of the skills. techniques, and methods taught in this program, or by the illegal or inappropriate use of same, whether or not such injury, loss, or damage is foreseeable, Crisis Intervention? training program, you will be involved in You should understand that some of these methods involve physical ortant that you cooperate and follow the directions of your 2005 CPI (reprinted 2012). lntroduction Thank you for participating in this formal refresher of the Nonviolent Crisis Intervention" training program. This Key Point Refresher Workbook is designed to help improve your understanding of key program concepts, enhance your skills, and answer any questions you may have about how to apply the information to your workplace realities. The Key Point Refresher Workbook is the tool your has selected to help build your confidence and reinforce the philosophy of providing the best possible Care, Welfare, Safety, and Security?. In your initial training, you learned how to: - Organize your thoughts about responding to agitated, disruptive, and assaultive individuals. - Focus on alternatives when a person loses control and becomes violent. - Use techniques to control your own anxieties during interventions and maintain the best possible professional attitude. - Use nonverbal, paraverbal, verbal, and physical intervention skills. - Work as a team to resolve disruptive and dangerous situations effectively, safely, and respectfully. To build on the foundation you already have in place, it is important to view Nonviolent Crisis Intervention? training as an ongoing process rather than a one-time event. By participating in this formal refresher course, you will have the opportunity to: - Develop a greater understanding of course concepts. - Problem solve and strengthen crisis intervention skills. - Receive additional supporting information. - Demonstrate ability and confidence in applying course content and to real-life . . dent CfiSiSInte,ye work experiences. ?09w Training a 42,, . The Nonviolent Crisis lntervention? Training Process Situationa, also includes opportunities to practice, participate Practice in content reviews, discuss policy decisions, review situational applications, and take part in :5 . rehearsals/drills. Staff are encouraged to "Q?VIOlent Interventlon Rehearsals participate in both formal and informal components of the Training Process on a regular basis. Thank you for your contribution to this effort. . Reviews training process Drills Policy Formal Discussions Refreshers .. 7 3 2005 CPI (reprinted 2012). All rights reserved. Keg REfreSher Copying prohibited. Pre-Test Name QT Date Title Facility Phone Facility Address Statel Province Zip/ Postal Code City Country Email 1. What is the philosophy of the Nonviolent Crisis Intervention? training program? ante, Lance/6:, smart 2. Complete the CPI Verbal Escalation ContinuumSM using the terms below. 2 @ntimida?on 3 flame.) gem .. mat ension Reduction @Refusai .. Mag. 3. When should you use Physical Crisis Interventions?? 3 5 ?anus-I- rexo Inurm Ac Wedwf or ecu-u 4. Match each CPI model to the appropriate definition: This model is used to guide staff through the process of establishing Therapeutic Rapport and staff debriefing after a crisis incident. a. The CPI Crisis Development ModelSM This model assists staff members to recognize a client?s behavior level and intervene early and appropriately. b. The CPI Verbal Escalation ContinuumSM? c. The CPI COPING Models? This model demonstrates defensive behaviors and staff interventions for each behavior. 2005 CPI (reprinted 2012). Crisis Development/ Behavior Levels Staff Attitudes/Approaches 1. Anxiety 1. Supportive Definition: A noticeable change or increase Definition: An empathic, nonjudgmental in behavior. approach. Examples: Examples: (We 0010 (new? 2. Defensive 2. Directive Definition: The beginning stage of loss Definition: An approach in which a staff member of rationality. takes control of a potentially escalating situation. Examples: Examples: gm ne?ms 96% 3. Nonviolent Physical Crisis 3. Acting?Out Person InterventionSM Definition: The total loss of rational control that Definition: Safe, nonharmful restraint positions to results in a physical acting-out episode. control an individual until he can regain control of his own behavior. Used only as a LAST RESORT: Examples: Examples: 4. Tension Reduction 4. Therapeutic Rapport Definition: A decrease in physical and Definition: An approach used to re-establish emotional energy. communication. Examples: Examples: co 2005 CPI (reprinted 2012). 6 Non-noun! Physical Cums Intervention" A Tia-panic Rapport gamm.mW 4, Tom-on Wm - life ?1 I Crisis Development/ Behavior Levels Staff Attitudes/Approaches 1 . Anxiety 1. Supportive A noticeable change or increase in behavior. An empathic. nonjudgmental approach. Proxemics: Personal space. An area surrounding the body, approximately 1.5 to three feet (depending on the context of the situation) in range. Personal space is considered an extension of self, and invasion can escalate anxiety. Examples: Kinesics: The nonverbal message transmitted by the motion and posture of the body. a; Examples: CPI Supportive Stances": Body positioned at least one leg-length away and at an angle. Reasons for using: . . . . the actual words one uses. Level 2 Crisis Development/ Behavior Levels .icn Exp.' \09' to I Supportwn I Anm?ly pivoldpmentl Bolt-war 2 Dolonuwo 2 Directive Parson 4 Tam-on 4 Rapport Staff Attitudes/Approaches t3 Milly/(ileum Plu?v. Al (luau Irinrummw- 2. Defensive The beginning stage of loss of rationality. 2. Directive An approach in which a staff member takes control of a potentially escalating situation. The CPI Verbal Escalation ContinuumSM 3. Release 4. Intimidation 2. Refusal 5W 1. Questioning Interventions: 1. Questioning Information-seeking: Challenging: 2. Refusal 3. Release 4. Intimidation 5. Tension Reduction Setting Limits: Keys 1. Simple and clear 2. Reasonable 3. Enforceable Empathic Listening: An active rocess to discern what a person is saying. 2005 CPI (reprinted 2012). vol.? Inn. I ?rms Development/Bahama! Sll" A?iludoo/Appum hon Level 3 LAglm Out 5?9va .- . 3 Nmzwulpnl/?hyarrdf 4 ?4 llmiumulu Hahn" tated EXpe, \?xg?g is ~t\e I Crisis Development/ Behavior Levels Staff Attitudes/Approaches 3. Acting-Out Person 3. Nonviolent Physical Crisis The total loss of rational control that results in Interventions? a physical acting?out episode. Safe, nonharmful restraint positions to 5- control an individual until he can regain a control of his own behavior. Used only as a LAST RESORT: g. . . Strike: A weapon coming In contact 1. Block (or deflect) the weapon. with a target. Examples: 2. Move the target. Grab: An attempt to control and/or 1. Gain a physiological advantage (1.3 destroy a part of one?s anatomy. by using: a. Examples: - a c. 2. To gain a advantage: a. b. 0. Team Intervention: Behaviors that may require physical Nonviolent Physical Crisis InterventionSM intervention as a LAST RESORT: is used as a last resort?92 2005 CPI (reprinted 2012). These CPI Classroom Model diagrams are intended as a point of learn these techniques reference and only represent a snapshot echniques should only be learned I of the process required to execute the technique. Accordingly, these . . I and practiced under the supervrsion of a Nonwolenr Crisis Intervention' Certified Instructor. Attempting to from the diagrams or descriptions may result in injury. CPI KICK BLOCK In any strike situation, you can remove the target or deflect the weapon by placing an object between the weapon and the target. The act of blocking or shielding is based on your natural response?a primal reflex to protect yourself from a strike. In this example, the bottom of the staff member?s foot is used to shield or block the oncoming kick. Attempt to move out of the way to maintain safety. CPI TWO-HAND WRIST GRAB RELEASE Gain a physiological advantage by using leverage and momentum to pull away from the weak area of the wrist grab (between the thumbs and four fingers). You can increase your momentum and leverage by using your free hand to assist in pulling away from the grab, maintaining a balanced stance, and using your body position to enhance your physiological advantage. At the same time, you can gain a advantage by using a verbal distraction or an element of surprise. Release and attempt to move out of the way to maintain safety. Trwia? ?ay. -4 CPI ONE-HAND WRIST GRAB RELEASE Gain a physiological advantage by using leverage and momentum to pull away from the weak area of the wrist grab (between the thumb and four fingers). You can increase your momentum and leverage by maintaining a balanced stance and using your body position to enhance your physiological advantage. At the same time, you can gain a advantage by using a verbal distraction or an element of surprise. Release and attempt to move out of the way to maintain safety. CPI ONE-HAND HAIR PULL RELEASE lmmobilize this grab by securing the person's hand to your head. By using one or both of your hands to immobilize the person?s hand, you can prevent further grabbing of hair and minimize injury. Move your head toward the person, leveraging the arm position to a 45-degree angle. The grip of the hair pull is levered . backward, reducing the strength of the grip and opening UP the weak point of the grab at the fingers. At the same time, YOU can gain a advantage by usrng a verbal distraction or an element of surprise. As your hair is released, attempt to move out of the way to maintain safety. 0 2006 CPI (reprinted 2012). 11 I These CPI Classroom Model diagrams are intended as a pornt of reference and only represent a snapshot of the process reqmred to execute the technique. Accordingly. these techniques should only be learned 3" I and practiced under the supervisron of a Nonwolcnt Intervention? Certified Instructor. Attempting to learn these techniques from the diagrams or descriptions may result in CPI TWO-HAND HAIR PULL RELEASE Use both of your hands to immobilize the person?s hands on your head. By securing the hands to your head, you can prevent further grabbing of hair and minimize injury. Move your head toward the person, leveraging the arm position to a 45-degree angle. The grip of the hair pull is levered backward. reducing the strength of the grip and opening up the weak point of the grab at the fingers. At the same time, you can gain a advantage by using a verbal distraction or an element of surprise. As your hair is released, attempt to move out of the way to maintain safety. CPI BACK CHOKE RELEASE Raise your arms straight up for leverage. (This may also create a distraction.) Lean away to extend the individual?s arms; this will weaken the grab. Create momentum by turning your shoulders and arms in a rotating motion away from the individual. Your shoulders will act as a lever while your momentum will assist in releasing the grab. Increase your advantage by using a verbal distraction or an element of surprise. Attempt to move out of the way to maintain safety. CPI FRONT CHOKE RELEASE Raise your arms straight up for leverage. (This may also create a distraction.) Lean away to extend the individual's arms; this will weaken the grab. Create momentum by turning your shoulders and arms in a rotating motion away from the individual. Your shoulders will act as a lever while your momentum will assist in releasing the grab. Increase your advantage by using a verbal distraction or an element of surprise. Attempt to move out of the way to maintain safety. CPI BITE RELEASE Avoid pulling away from the bite. Instead, lean into, or feed the bite, using the minimum amount of force necessary to cause the jaw of the person to open. Concurrently, use your finger in a vibrating motion to stimulate the person?s upper lip. This vibrating motion may result in a parasympathetic response that causes the mouth to open. At the same time, you can gain a advantage by using a verbal distraction or an element of surprise. Once the bite releases, attempt to move out of the way to maintain safety. 0 2005 CPI (reprinted 2012). 1 2 13 Notes: Pages removed detail Nonviolent Physical Crisis InterventionSM positions. .. . I on}: diagrams are intended as a pomt of reference and only represent a snapshot a '0 and practiced ur?guufh to Execute the technique Accordingly, these techniques only be learned er 0 of a Nonwo/ent Intervention? Certified Instructor. Attempting to learn these techniques from the diagrams or descriptions may result in Note: For more information on the risks of restraints, see pages 20?23. Figure Figure A CPI CONTROL POSITIONSM The CPI Children ?3 Control PositionSM is designed to be used with children. You should consider using this position only with individuals considerably smaller than yourself. Gain control of the child's arms from behind and cross the arms in front of the child. The arms should be positioned high on the child and secured by locking one arm under the other. This will prevent the child from slipping through and will minimize any pressure on the child's chest or abdomen. (Fig. A) Position yourself behind the child while maintaining close body contact and standing to one side. This position allows you to maintain a balanced stance while managing the child. (Fig. B) The auxiliary team member(s) will monitor for safety and assist, if needed. 2005 CPI (reprinted 2012). 4 9 The CPI Team Control PositionSM is used to manage individuals who have become dangerous to themselves or others. Two staff members hold the individual as the auxiliary team member(s) continually assess the safety of all involved and assist, if needed. During the intervention, staff members who are holding the individual should: These CPI Classroom Model diagrams are intended as a pomt of reference and only represent a snapshot I ca utl of the process requued to execute the technique. Accordingly, these techniques should only be learned and practiced under the supervi5ion of a Nonwolent Gusts Intervention Certified Instructor. Attempting to learn these techniques from the diagrams or descriptions may result in injury. Figure A CPI TEAM CONTROL POSITION5M Face the same direction as the acting-out person while adjusting, as necessary, to maintain close body contact with the individual. Keep their inside legs in front of the individual. (Fig. A) Bring the individual?s arms across their bodies, securing them to their hip areas. (Fig. B) Place the hands closest to the individual's shoulders in a C-shape position to direct the shoulders forward. (Fig. C) "Control Dynamics i? ta-quuce upper-body strength by controlling the arms as weapons. 0 2006 (~an 2012). 'suouisod smug [ears/{qd ?913p pertum 5;)de Pages removed detail Nonviolent Physical Crisis Intervention8M positions. 7th?? CPI Classroom Model diagrams aw as a point ol rvarumtu and only represent a snapshot I ca utl Ill? DIUCUSH to mouulu the technique. Accordingly. those techniques ShOuld only be lumnud and maimed tho supuwmion of .1 0,5,5 litre/i'viillofl' Instructor. Attempting to lht?s?v techniques liom the diagrams or dosenphons may rosull in injury. CPI TRANSPORT POSITIONSM The CPI Transport PositionSM will assist you in safely moving an individual who is beginning to regain control. Prior to moving an individual, assist the person into a more upright position and remove your hand from the individual's shoulder. Reach under the individual?s arm to grab your own wrist. This cross-grain grip better secures the individual between staff during transport. Remove your leg from directly in front of the individual prior to transport while maintaining close body contact. It is not recommended to transport an individual who is struggling. If necessary, return to the CPI Team Control PositionSM if the individual's and/or staff's safety is at risk. -C 2005 CPI (reprinted 2012). 1 6 Model diagrams am intended as a pounl of reference and Only re re i 3 mi, COfdlneg. these techniques should onleni a ?nipshm TIu?so CPI Classroom PXUCUI Mum?s}. ruquvn (1 Int . I U, S?Lill?llt?l?d undvr tho 01 Crisis Intervention Certi?ed InsIructory b? Icarned I . . i I un thuqu Irum the diagl?ln3 0" descriptions may AItamming I0 CPI INTERIM CONTROL The CPI Interim Control PositionSM is a temporary control position that allows you to mai the indmdual?s arms, if necessary. for a short time. ntain control of both of ase the cross-grain Starting from the CPI Transport Positions?, maintain control of the individual?s arm. bUt rele p15 to G?p- Use your free arm to reach across and gain control of the opposite arm. (Fig. A) If the individual a?em "39 your free arm to block, and safely move away. (Fig. B) 17 2005 (reprinted 2012). Level 4 I I I Crisis Development/ Behavior Levels 4. Tension Reduction A decrease in physical and emotional energy. Individual must be back in and control. Establish the basic regarding what happened. Look for patterns of to the Investigate inappropriate behavior. Aim for reaching an agreement about behaviors and consequences. Give along with support and encouragement. Why is Postvention important for the individual? Control Orient Patterns Investigate Negotiate Development/Behavior Levels . Amman/App he, I ArmwlInnuun-m: Puma? fie I Staff Attitudes/Approaches 4. Therapeutic Rapport An effort to re-establish communication between the individual and staff. All must be back in control before discussing the incident. Establish the facts regarding what happened. Identify any patterns in the ways staff to crisis situations. Look for ways to improve interventions. Agree to changes that will improve future efforts to and respond to crises. Offer and encouragement to each other. Why is Postvention important for the staff? 18 .c 2005 CPI (reprinted 2012). 0802 1, ?3 nonviolent crisis intervention a CPI specialized offering Understanding the Risks of Restraints 2005 CPI (reprinted 2012). Understanding the Risks of Restraints The Nonvrolont Crisrs Intervention" training program focuses on prevention and the creation of restraint-tree envrronments through a commitment to Care. Welfare, Safety, and Securr'ty??. While considered a last resort, physical intervention procedures are taught as part of the program to provide staff with skills and confidence to safely manage emergency situations. Any physical intervention should be used only when all other options have been exhausted and when an individual is a danger to self or others. Even in those moments, an assessment is still necessary to determine the best course of action to maintain the Care, Welfare, Safety, and SecuritySM of all. Dangers of Restraints The events leading up to a crisis situation and the struggling that occurs during a restraint can result in a lot of stress for the individual being restrained. This negative stress is sometimes called distress. Consequently, it is not unusual for a restrained individual to show signs of distress, both physically and emotionally. Always keep in mind that the acting-out person might have health problems. Therefore, everyone being restrained should be considered at risk. It is also important to understand that in some cases, restrained individuals have gone from a state of no distress to death in a matter of moments. Policies and procedures should reflect how staff can monitor these signs of distress and identify what protocol should be followed. There is also a danger in using restraints. Being restrained can be a frightening? even traumatic?experience. Restraints can interfere with the relationship between caregivers and the person being restrained. In fact, if people are restrained too often, they may begin to feel that they have no control over their lives. 2005 CPI (reprinted 2012). There may be times when other continuing verbal intervention obljlectsf, using Personal Safety Techniqu ailgemus . ml, ca ing or urther aSSistanoe Would e5 I and possibly prevent any Physical InteWErZECede and On. St - rategms? Su emovin Lh as Remember that there are risks involved intervention. Therefore, physical intervenl: a be considered only when the danger prelon Sh acting-out individual outweighs the risks Zente intervention. Specific laws or regulations ph use of restraints. Be sure to check your faciali policies and procedures for applicable rulesl by lhe QOVern y?s For these reasons and others, restraints should be used only when a person ?s behavior is MORE dangerous than the danger of using restraints. Some restraints are more dangerous than others. For example, facedown (prone) floor restraints and positions in which a person is bent over in such a way that it is difficult to breathe are extremely dangerous. This includes a seated or kneeling position in which the person being restrained is bent over at the waist and any facedown position on a bed or mat. Restraint-related positional occurs when the person being restrained is placed in a posmon in which he cannot breathe properly and is not able to take in enough oxygen. Death can result from lack of oxygen and consequent disturbance In the of the heart. Staff members must be especially careful ?0:31:58 their own bodies in ways that restrict the r53?; or person?s ability to breathe. This include?1 3 en lying across a person?s back or Stomfsure to the someone is lying facedown, even Pie?,S ability to arms and legs can impact that perSO breathe effectively. Examples of High-Risk Positions for Restraint-Related Positional Illustrations are based on information from various individuals and resources. See Additional Resources and References. All of these positions may interfere with a person?s ability to breathe. While they are different, these positions share a common factor: When forcefully maintained, each of them could prevent the diaphragm (the largest muscle of respiration) from working. If the diaphragm is not allowed to move down into the abdomen, breathing is seriously restricted. In fact, when a forcefully maintained position hinders both chest and abdomen movement?the result can be fatal. When confronted with an emergency situation, always consider the option of disengaging. If the person is not a danger to self or others while on the floor, staff may make the decision to move away and give a clear directive. ?9 2005 CPI (reprinted 2012). 22 Reducing the Risks of Restraints There are ways to minimize risks involved in any physical intervention. The very best way to av0id injury is to avoid the need to restrain in the first place. Get to know the people in your care. Be aware of changes in their behavior that can be warning signs of anxiety. Intervene early. Learn to set limits effectively. Avoid being drawn into power struggles. Work as hard at learning verbal intervention skills as you do at learning physical intervention skills. Treat everyone with dignity and respect. Staff members should be trained in and regularly practice safer ways of restraining. The physical intervention procedures taught in the Nonviolent Crisis Intervention? training program are designed to maximize safety and offer a safer alternative to techniques that involve the floor to restrain an individual. A physical restraint is an emergency procedure comparable to CPR or first aid. As with any emergency response procedure, staff members need to practice these skills on a regular basis. Educate yourself and others on the risks and dangers of using restraints. Some restraints are more dangerous than others. By choosing safer restraint techniques, you and your facility can reduce the possibility of serious injury and even death. in particular, you should avoid positions that can lead to restraint-related positional 0 2005 CPI (reprinted 2012). CPl?s Nonviolent Physical Crisis In techniques are designed for safety Therapeutic Rapport to be Fe-esta individual who has lost control. Ke Non violent Physical Crisis Interv responses include: te?Ventionsv a'nd allOW fOr bl'Sh?id with th: elements of enilonSM - No element of pain is involved - The intent is to calm the individual - The intent is to keep the individual off th floor, thus reducing risks of restraint- . . . rel posmonal and other injurie ated 3. Team interventions are used when neces sary - Nonviolent Physical Crisis InterventionSM is used only as a last resort when someone presents a danger. - Non violent Physical Crisis InterventionSM is used to protect?not to punish. The goal is for staff to continually assess for signs of Tension Reduction and identify opportunities to re-establish a Therapeutic Rapport with the individual. Remember, the best way to eliminate the dangers of restraints?to you and to those in your care?is to eliminate the need for restraints at all. A Glossary of CPI Terms Acting-Out Person?the total loss of control, which results in a physical acting-out episode. It is the third level in the CPI Crisis Development Model?. Individuals in this level are presenting a danger to themselves or others. Anxiety?a noticeable increase or change in behavior. A nondirected expenditure of energy: pacing, finger drumming. wringing of the hands, or staring. It is the first level in the CPI Crisis Development Models?. Challenge Position?a body position in which one individual is face-to-face, toe-to-toe, and eye-to?eye in relation to another individual. This position is often perceived as a challenge and tends to escalate a crisis situation. CPI Classroom Model?a standardized way of demonstrating personal safety and Nonviolent Physical Crisis InterventionSM methods in order to show the application of basic principles. CPI COPING ModeF"-a model that staff members can use to guide them through the process of establishing Therapeutic Rapport with an individual after a crisis incident. The CPI ModelSM can also be used as a way to structure a staff debriefing. CPI Crisis Development series of recognizable behavior levels an individual may go through in a crisis. and corresponding Staff Attitudes/Approaches used for crisis intervention. Defensive Level-the beginning stage of loss of rationality. At this stage, an individual often becomes belligerent and challenges authority. It is the second level in the CPI Crisis Development Mode/5M. Directive Staff Attitude/Approach-an approach in which a staff member takes control of a potentially escalating situation. It is the recommended Staff Attitude/Approach to an individual at the Defensive level. Empathic Listening?an active process to discern what a person is saying. Integrated Experience?the concept that behaviors and attitudes of staff impact behaviors and attitudes of indIVIduals and vice versa. Kinesics-the nonverbal message transmitted by the motion and posture of the body. Limit Setting?~a verbal intervention technique in which a person is offered choices and consequences. Limits should be clear, simple, reasonable, and enforceable. Nonviolent Crisis Intervention" Program?a safe. nonharmful behavior management system designed to and staff in maintaining the best possible Care, Welfare, Safety, and . SecuritySM for agitated or out-of?control indiwduals even unng their most violent moments. Nonviolent Physical Crisis lntervention5?? used only as a last resort when a person is a danger to self or others. This involves the use of safe, nonharmful control and restraint positions to safely control an individual until he can regain control of his behavior. Paraverbal Communication?the vocal part of speech, excluding the actual words one uses. Three key components are tone, volume, and cadence of speech. Precipitating Factors?the internal or external causes of an acting-out behavior over which a staff member has little or no control. Proxemics-personal space. An area surrounding the body. approximately 1.5 to three feet in range, which is considered an extension of self. Rational Detachment?the ability to stay in control of one's own behavior and not take acting-out behavior personally. Restraint-Related Positional fatal condition that occurs when the position of a person?s body interferes with respiration and results in or suffocation. Supportive Staff Attitude/Approach?an empathic, nonjudgmental approach attempting to alleviate anxiety. It is the recommended Staff Attitude/Approach to an individual at the Anxiety level. CPI Supportive StanceSM?the suggested body position for a staff member to maintain when intervening with a potentially out-of-control or acting-out individual. The CPI Supportive Stances'? is maintained by keeping a distance of one leg-length from the person and by remaining at an angle. Tension Reduction?a decrease in physical and emotional energy that occurs after a person has acted out, characterized by the regaining of rationality. It is the fourth level in the CPI Crisis Development Model?. Therapeutic Rapport?an approach used to re-establish communication with an individual who is experiencing Tension Reduction. Training Process?a format for identifying ongoing learning opportunities to ensure training concepts expand upon course content through practical application. In addition to initial training, components include Formal Refreshers, Reviews. Policy Discussions, Practice. Situational Applications. and Rehearsals/ Drills. CPI Verbal Escalation ContinuumSM-a model demonstrating a variety of defensive behaviors that are often seen when individuals are in the Defensive level of the CPI Crisis Development Mode/3M. This model includes suggested staff interventions for each behavior. 2005 CPI (reprinted 2012). 24 gnu. Additional Resources and References Allen, D., Tynan, H. (2000). Responding to aggressive behavior: Impact of training on staff members? knowledge and confidence. Mental Retardation, 38(2). Allen, J. D. (1997). Who's driving this bus anyway? Empowering drivers. School Business Affairs, 63(1). American Academy of Family Physicians. (1997). Use of physical restraints in children. American Family Physician, 55(6). American Association, American Nurses Association, National Association of Health Systems. (2003). Learning from each other: Success stories and ideas for reducing restraint/seclusion in behavioral health [Electronic version]. Arlington, VA and Washington, D.C.: Authors. Retrieved from Bair, B., Toth, W., Johnson, M. A., Rosenberg, C., Hurdle, J. F. (1999). Interventions for disruptive behaviors: Use and success. Journal of Gerontological Nursing, 25(1). Birdwhistell, R. (1970). Kinesics and context: Essays on body motion communication. Philadelphia, PA: University of Press. Brendtro, L. K. (2004). From coercive to strength-based intervention: Responding to the needs of children in pain [Electronic version]. Lenox, SD: The International Child and Youth Care Network. Retrieved from British Institute of Learning Disabilities. (2001). BILD code of practice for the use of physical interventions. Kidderminster, UK: Author. Burgoon, J. K., Jones, 8. B. (1976). Toward a theory of personal space expectations and their violations. Human Communication Research, 2, 131 ?146. Burgoon, J. (1993). Interpersonal expectations, expectancy violations, and emotional communication. Journal of Language and Social 12, 30?48. Chou, K., Kaas, M., Richie, M. (1996). Assaultive behavior in geriatric patients. Journal of Gerontological Nursing, 22(1 1). Cooper, A., Anthony, R., Saxe-Braithwaite, M. (1996, June). Verbal abuse of hospital staff. The Canadian Nurse, 92(6). DattiIIo, F., Beck, A., Freeman. A. (2000). Cognitive-behavioral strategies in crisis intervention (2nd New York: Guilford Publications. De Becker, G. (1997). The gift of fear: Survival signals that protect us from violence. Boston: Little, Brown Co. Ekman, P., Friesen, W. V., Ancoli, S. (1980). Facial signs of emotional experience. Journal of Personality and Social 39, 1 1 25?1 1 34. Epstein, M., Atkins, M., Cullinanl D., Kutash, K., and Weaver, R. (2008). Reducing behavior problems in the elementary school classroom: A practice guide (NCEE #2008-012). Washington, D.C.: National Center for Education Evaluation and Regional Assistance, Institute of Education Sciences, U.S. Department of Education. Retrieved from Fletcher, K. (1996). 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Journal of n! and aggressmn manageme Keg Point Refresher Participant Evaluation Please indicate your response to each of the following items by circling the number that most appropriately expresses your opinion, using a scale of 5 (strongly agree) through 1 (strongly disagree). 5 strongly agree; 4 agree; 3 neither agree nor disagree; 2 disagree; 1 strongly disagree. How would you rate the Key Point Refresher program? Did the Instructor effectively review and facilitate practice 5 4 3 2 1 of safe physical intervention procedures to be used as a last resort? Did this refresher course help you build upon information 5 4 3 2 1 and skills learned in the Nonviolent Crisis Intervention? training program? Was the Instructor able to apply the course content variety of examples? 5 4 3 2 1 Did this refresher course give you more confidence to manage physically dangerous situations safelyDid the Instructor stimulate interest in the subject matter? 2 1 Was the philosophy of Care, Welfare, Safety, and Security/SM emphasized throughout every aspect of the program? 5 4 3 2 1 Which parts of the Key Point Refresher program were most helpful to you? How do you think the content could be improved? or the Instructor: Additional comments on the program, teaching methods, and/ we use comments from program participants in our promotional materials. If you?d agree to allow us to From time to time, . us permission by Signing here: share your comments, please giv Thank you for your input. It is both valuable and necessary in maintaining the quality of the program, 0 2005 CPI (reprinted 2012). 26 Jar