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Therapeutic Crisis Intervention

Two goals of crisis intervention Support and Teach
Support in Crisis environmentally and emotionally reduce stress and risk
Teach in Crisis coach children on better ways to cope with stress
Stress Model of Crisis Baseline (agitation), Triggering Event (Aggression), Escalation , Outburst/Crisis (violence),Recovery (higher, no change, lower)
Recovery stage the last stage in the stress model of crisis. Higher (educateur), no change (firefighter), lower (abuser)
Conflict cycle stressful situation, young person's feelings, young person's behavior's, adult response
Ways to avoid conflict cycle Positive self-talk, Listen/validate feelings, Manage environment, Give choice/time to decide, Redirect to positive activity, Appeal to self-interest,Drop/change expectation
Four questions we ask ourselves in a crisis situation 1) What am I feeling now? 2) What does the child feel, need, or want? 3) How is the environment affecting the young person? 4) How do I best respond?
Setting condition anything that makes a challenging behavior more or less likely to occur (room too hot, medical issue, change in routine, trama)
Pain Based Behavior -impulsive outburst, -aggression, -running away, -self injury, -definace, -inability to regulate emotions, -trauma re-enactment
Behavioral Support Techniques -manage environment, -prompting, -caring gesture, -hurdle help, -redirection, -proximity, -directive statement, -time away
Goals of Emotional First Aid -provide immediate help and support, resolve immediate crisis, and keep child in program (Return to Baseline)
Strategies of Emotional First Aid drain off emotions (validate feelings, open ended questions), clarify events (reflective statements, summarize), maintain the relationship/ lines of communication, remind students of expectations/mediate if necessary
Help me Help Myself co-regulation
Co-regulation provide support/reduce stress and risk
Help me Help Myself Non-Verbal Stragegies -take a deep breath, -use protective stance, -step back, -give time, -sit down, -body language/facial expression
Help me Help Myself Verbal Stragegies -very little talk, -understanding responses (Ï can see...", "When you...", Ï know we...","I am sorry..."), -tone of voice
LSI Life Space Interview
Steps to LSI -Isolate the converstaion, -Explore childs point of view, -Summarize feelings and situation, -Connect feelings to behavior, -Alternative behaviors discussed, -Plan developed and practiced, -Enter child back into program
Goals of LSI -Return young person back to baseline, -Clarify events, -Repair and restore relationship, -Teach new coping skills, -Re-integrate child back to program
4 elements of a potentially violent situation 1) Trigger 2) Target 3) Weapon 4) Level of Stress/motivation (T-T-W-L)
Risk factors to be aware of before a restraint obesity, influence of drugs and alcohol, prolonged violent physical agitation, disease, hot humid environment, medication
When to avoid a restraint we are not in control (too angry), sexual stimulation is motivation, in a public place, child has a weapon, child has a medical condition, child has emotional problems, child is on medication
Physical Warning Signs during a restraint that a child is in Danger position of child, skin color, repiration, level of consciousness, level of agitation, range of motion or swelling of body parts
During a restraint you should NEVER.... never ignore warning conditions of asphyxia (suffocation) or fail to take action if there is a need to emergency medical treatment
Reactive Aggression expressive, loss of control and emotional flooding, and emotions are dominant
Proactive Aggression planned aggression, goal oriented, and cognitions (thoughts) are dominant
Ways to deal with Reactive Aggression safety, understanding and support, remove or reduce stimulus, anger management
Ways to deal with Proactive Aggression teach appropriate thinking, values, and social skills and reward socially appropriate behavior , not anti-social behavior
ICMP (individual crisis management plan) functional analysis of high risk behavior, strategy of intervening, tailored to child, periodic review and update
Created by: Catherine_R