De-Escalation Techniques: Coping with Students & Clients, Coping with Our Lives
By BA Laris, MPH | April 10, 2018
Program Manager, ETR
The news and my social media feed keep screaming at me. FINANCIAL CRISIS! POLITICAL CRISIS! ENVIRONMENTAL CRISIS! PERSONAL CRISIS!
It feels like everyone is facing a catastrophe. This barrage of uncertainty is highly distressing (especially for this “the glass is always half-full” ETRian). I began to wonder what Merriam-Webster has to say about “crisis” to see if maybe I could convince myself that people were misusing the word…
An unstable or crucial time or state of affairs in which a decisive change is impending; especially one with the distinct possibility of a highly undesirable outcome.
Pretty spot-on. We are facing crises.
What Do I Do?
So, given this expression of crisis all around me, I asked myself, “What can I do?”
What are some tools or strategies that can help me and others cope? How can we protect our own capacity and ability to effect positive change in the world? And how can we support service providers and educators who are experiencing the ripple effect of these crises in the reactions and behavior of clients, students, patients and community members?
Thanks to a timely training request from Empower “U”, Inc. Community Health Center, I had the chance to compile tools and strategies to address exactly this issue. Empower “U” is a community health center in Miami, Florida. Their prevention and clinic teams told us that every day, clients walk in feeling agitated and anxious. They frequently escalate out of control when they interact with staff.
ETR’s Community Impact Solutions Program team (CISP) offers a range of capacity-building resources for HIV programs across the nation (check out the collection of free online courses and recorded webinars at our website). In response to the request from Empower “U”, we developed and delivered a full-day training on crisis de-escalation.
We shared three key ideas during the training. These are principles I think we can apply to all kinds of situations—with clients, students, co-workers or even family members. I also think we can use them in an adapted way in our interactions with the daily news cycle or our social media feeds—they can help us keep ourselves from escalating our anxiety to a point of destructive outbursts or non-productive paralysis.
The key ideas are:
- Understand the causes of escalation.
- Understand the Violent Behavior Cycle (based on the work of Kaplan and Wheeler).
- Identify and master de-escalation techniques that can keep interactions from becoming crises.
Understand the Causes of Escalation: Conduct an Escalation Assessment
As a service provider, the first step in de-escalating a potentially dangerous or crisis situation is to conduct an assessment of the situation, focusing on three critical components:
- Self. What are you, as a provider or educator, thinking, feeling and doing? For example, are you paying attention to the other person’s body language? Are you allowing yourself to be drawn into a power struggle? Are you experiencing strong emotions yourself (fear, anger, doubt)?
- The Client/Patient/Student. What is this person thinking, feeling and doing? Do they think they are not being heard? Do they feel threatened, frightened, helpless, powerless or wronged? Is their body language showing increased signs of agitation?
- The Environment. Is this setting noisy, crowded or confined in some way? Are there ways the individual could harm themself or others? Are weapons present? Are there others nearby who can assist you if necessary?
Understanding the Violent Behavior Cycle: Know the 5 Phases
The next step in de-escalating a situation is to understand five phases of the Violent Behavior Cycle. There is no standard timeline for this cycle. It is difficult to know when a person will shift from one phase to the next. Recognizing the indicators of each phase can help you understand the appropriate intervention approach.
Post Crisis Depression Phase
The early warning phase. Something happens that makes the person afraid or frustrated. They can manage this state without hostility or aggressive behavior, but may be uncomfortable, angry or agitated.
The person will indicate movement toward a loss of control. Mentally and physically, they are preparing for a fight.
The person loses control and reacts to the environment. There may be outbursts or violent behavior. Others may be threatened or harmed.
After the outburst occurs, the person may:
After the event, the person may feel/express:
They may isolate themselves or disconnect from others.
There is no single response to the Violent Behavior Cycle that will be appropriate for all situations. There is also no situation that calls for only one response. This is why it’s important to continuously add to your own “De-Escalation” toolbox. Having a range of options will help you feel confident and maintain your calm when faced with crisis situations.
In a crisis situation, you’ll need to do your escalation assessment, determine what phase the person is in, then choose an intervention that matches the circumstances. Think about the following suggestions as possibilities. Practice them in a safe place (e.g., with colleagues, in a training, in the mirror). Make the techniques your own so you’ll be comfortable using them when they’re needed.
- Align with the person. Find a point of agreement—get to a yes. Yes, you can understand they’re frustrated. Yes, what they’re going through sounds scary. Even yes, it’s a mighty hot day out there.
- Give them space. Stand 2-3 feet away if possible. If you need to move closer to provide care, explain what you’re doing so they are less likely to feel threatened.
- Engage supportively. Listen to their story with full attention. Don’t change the subject or interrupt. Give them the chance to say what they need to say.
- Monitor your voice tone. Keep your tone measured and calm. You might slow your pace a bit. Remember to breathe.
- Project a supportive attitude. In your voice, manner and behavior, communicate, “I have time for you. You are an important person.”
- Protect yourself at all times. You may need to set limits—calling for assistance or moving out of the area, for example. Let the person know what you’re doing. Don’t respond to challenging questions or insults. Avoid power struggles.
- Know how to retreat. Sometimes a change in listeners can help. (“It seems we are not understanding each other, so let me have Ms. Evans talk with you. Maybe she can help us both.”)
De-Escalating Life Crises
These are some of the tried-and-true techniques that can be used in de-escalation with clients or students caught up in the Violent Behavior Cycle. What about those crises that are affecting all of us these days? Are any of these strategies relevant?
This could be an interesting discussion with students in a health education class or among friends over Friday dinner. For me, some of the strategies definitely resonate. Staying calm, allowing space, setting limits and knowing how to retreat (“No more Facebook tonight!”) have helped me stay more focused on the things that are most important to me. When I’m focused, I still have energy to be engaged with my family, my job, my service work and the political and social causes that are important in my life. I’m less likely to be distracted by an onslaught of crises that are simply too numerous for anyone to take on.
Interested in More?
If you are interested in more information and would like to see if the CISP team can provide this or a similar training for your organization, please contact me. I’d love to talk with you.
BA Laris is a Program Manager at ETR. She can be reached at firstname.lastname@example.org.