Module 1: The Crisis Development Model

Question 1

1

Answer 1

There are a number of ways people can express themselves and it cannot always be easy to recognise the emotions underlying the behaviours.

When someone is distressed they may communicate this through their behaviour. If their needs are not met, then their distress may increase.

Question 2

2

Answer 2

The crisis development model looks at the 4 levels of an escalating crisis and identifies approaches for each level in order to prevent or de-escalate a crisis moment. So on the left-hand side of the table you will see the behaviour and on the right-hand side you will see the way in which a staff member should approach that behaviour when displayed.

You cannot manage how an individual escalates or de-escalates. However, you can manage how you respond and it can have a large impact on the outcome of the potential crisis.

Question 3

3 (Anxiety)

Answer 3

So the first behaviour is Anxiety and it is defined as a change in typical behaviour. If you don’t know the individual very well you may not know their normal behaviours and in that case, you should be looking to see if anything indicates that there is something troubling the person. Behaviours start to escalate when a person’s needs are not being addressed.

Question 4

4 (Anxiety)

Answer 4

Q: What behaviours do you demonstrate when you are anxious or any of the service users/patients/children you work with?

They appear as nervous behaviours. Such as: Pacing fidgeting, sighing and clenching fists.

Question 5

5 (Supportive)

Answer 5

Early intervention is key in preventing a situation from escalating. When someone is displaying behaviours at the anxiety level, we would take a supportive, empathic and non-judgemental approach.

The person in distress may just need to hear things such as: Is everything okay? Is there anything I can help you with? It is important to listen and validate them when you demonstrate support. This could help to reduce the anxiety level.

Question 6

6 (Defensive)

Answer 6

The second level of the CDM is where the individual’s behavior changes in a way that they begin to lose rationality and challenges someone. It is protecting oneself from a real or perceived challenge.

Question 7

7 (Defensive)

Answer 7

Q: What behaviours do you think are common when someone is at this defensive stage of behavior:

A: Shouting, Refusal, Who are you to tell me what to do? Threatening behaviour.

Question 8

8 (Directive)

Answer 8

In this case being supportive may not help to de-escalate the behaviour. In this case we need to provide clear direction or instruction, which is called being directive.

We give the individual simple and reasonable choices which is called limit setting. As the individual may be thinking with their emotional brain, it gives them a clear choice in changing their behaviour in a positive way.

Question 9

9 (Risk Behaviour)

Answer 9

The 3rd behaviour is risk behaviour. Where behaviour continues to escalate due to an individual’s distress increasing, they may begin to demonstrate physical behaviour that poses a risk to themselves or others around them.

Question 10

10 (Risk Behaviour)

Answer 10

When risk behaviour is presented it means that the individual presents an imminent or immediate risk of harm to themselves or others. It may be impulsive or deliberate. Examples of risk behaviour include, but are not limited to: kicking, striking, biting, throwing objects and injuring themselves.

Question 11

11 (Safety Interventions)

Answer 11

When someone is presenting risk behaviours, we should be looking to apply safety interventions. These are non-restrictive interventions that enable staff to respond by considering effective verbal interventions, making the environment safe, or even moving to a place of safety.

Question 12

12 (Safety Interventions)

Answer 12

Examples of non-restrictive interventions include:
Removing items that could be dangerous.
Removing the person in distress.
Removing bystanders.
Asking another member of staff to help.
Calling for help.
Physical disengagements.

Question 13

13 (Safety Interventions)

Answer 13

In some cases, restrictive interventions may have to be used as a last resort. They should only be used if you are fully trained to do so and have full confidence in what you are doing. Restrictive intervention is defined as any physical, chemical, environmental, or mechanical intervention used to restrict a person’s liberty of movement.

Question 14

14 (Tension Reduction)

Answer 14

The final level of the CDM is tension reduction where an individual will experience a decrease in physical and emotional energy. The person begins to regain calm and reflect on their behaviour. This can occur after any level of a crisis.

Question 15

15 (Tension Reduction)

Answer 15

There can be physical signs of this, such as: relaxing posture, decrease in heart rate, change in breathing rate, reduced muscle tension.
There may also be emotional signs such as: withdrawal, guilt, sadness, fear, anxiety, remorse and embarassment.

Question 16

16 (Therapeutic Rapport)

Answer 16

In this case the approach you would take is to use therapeutic rapport. This involves re-establishing the relationship and you must be sure to address any physical or emotional needs of the individual.
The goal is always to help the individual achieve tension reduction when they are in distress. Every individual will have their own individual behaviours and may escalate faster or slower than others, but you should always try to re-establish that relationship once they have their composure.

Question 17

17

Answer 17

The idea of integrated experience is key here as shown at the top of the model. As behaviour influences behaviour, it shows your behaviour influences the individuals behaviour in turn and moves them through the different levels of the model. Integrated experience is something we will have a look at a little further down the line in greater detail.