1. De-Escalation and Pro-active Communication Skills
How to manage aggression and hostility and move the client forward when they are acting out.
A. Christine Furman MMHS
Director of Acute Care Services

2. What we are going to talk about:
Recognizing aggression and hostility
Communication Skills
Non-verbal Communication Skills
Diffusion Strategies
De-escalation techniques and skill

3. Why do people escalate and become aggressive or hostile?
Frustration
Feel that they have been treated unfairly
Feel that they have been humiliated
They are immature
There is a level of excitement they are reacting to
It works – it is a means to an end
It is part of their reputation
Aggression and Hostility may be symptoms of their mental illness

4. How do you know when someone is feeling hostile or aggressive?
They may stand taller
Their face may redden
Their voice may raise
They may breath faster
They may make prolonged, direct eye contact with you – stare you down
They may make exaggerated gestures
They may become very tense
They may begin to pace
They may clench their fists
They may clench their jaw and tighten their facial muscles
Behavior is different than normal

5. Communication Listening Speaking, and Hearing Observe, and Interpret
This is a two way process that includes:
Listening
Speaking, and
Hearing
As a staff member you will also need to:
Observe, and
Interpret

6. Some things that get in the way of effective communication are:
Background noise, and having to
speak loudly (are you having to yell?)
Inappropriate setting
Language barriers
Perception and Prejudice
Intrusion of personal space
Time constrains
Lack of encouragement

7. Twelve Roadblocks to Listening – Thomas Gordon, Ph.D.
Ordering, directing, or commanding
Warning or threatening
Giving advice, making suggestions, or providing solutions
Persuading with logic, arguing, or lecturing
Moralizing, preaching, or telling clients what they ‘should’ do
Disagreeing, judging, criticizing, or blaming
Agreeing, approving, or praising
Shaming, ridiculing, or labeling
Interpreting or analyzing
Reassuring, sympathizing, or consoling
Questioning or probing
Withdrawing, distracting, humoring, or changing the subject

8. Escalation Prevention Steps: Prevention Step #1
Staff need to be able to recognize early warning signals such as:
Behavior changes
Quiet people become agitated
Loud people become quiet
Commenting on the changes may open up conversation and minimize frustration or anger build up – giving the client an opportunity to diffuse the situation.

9. Prevention Step #2
Recognize that Anger is a normal emotion – we don’t always need to fix it or be afraid of it – unless the person becomes a danger.
Anger is not ‘normal’ when:
Anger is often used to get ones way
Anger is often used to get
attention
to escape a situation
to gain control of a situation
Anger is used to pump one’s self up when feeling small or insecure

10. Prevention Step #3
Staff need to remain in touch with their emotions when dealing with an angry client. If you become angry or defensive you will not be able to help the client. If you cannot manage your emotions and remain calm and objective, you will need to get help.

11. Prevention Step #4
Take a deep breath, and attempt to remind yourself of the following:
Avoid criticizing and finding fault with the aggressive person.
Avoid being judgmental with the aggressive person.
Use a calm, steady voice without and edge or sing song.
Do not become involved in the conflict.
Be able to try to see the situation from the angry person’s point of view.
Remember that your job is the health and safety of your client.
Have a plan.

12. What should staff do once a client has Escalated?
Take deeper breath
Appear confident – but not cocky
Remain calm
Show that you are listening
Speak slowly, gently and clearly
Avoid arguing and confrontation
Create space between you and the agitated person
Know how you are going to get out of the area

13. Adopt a non-threatening body posture
Use a calm, open posture – either sitting or standing
Reduce direct eye contact – do not stare
Allow the person adequate personal space
Keep both hands relaxed and visible
Avoid any sudden movements
Avoid and discourage an audience

14. De-Escalation Techniques
Explain your purpose or intention
Give clear, brief, assertive instruction
Negotiate options
Ensure that your non-verbal communication is non-threatening

15. De-Escalation Technique #1 Just Listen
Sometimes all it takes to de-escalate someone is a good ear and the time to allow the client to vent. Just listen to what they have to say and give them encouragement.

16. Technique #2 Acknowledgement
This is when you really listen and are able to relay back to them that you understand what they are feeling. “I understand that you are angry” “I see that you are frustrated” “You feel that you have been wronged”

17. Technique #3 Allow Silence
You don’t need to be the problem solver. It’s not your job to have all the answers. Give the client time to reflect, don’t fill the time with your thoughts and questions. Just be with them, calmly.

18. Technique #4 Apologize
If the situation was unjust or unfair – a sincere apology is powerful. It does not mean that you are accepting blame, it means you are acknowledging that something that occurred wasn’t right or fair.

19. Technique #5 Invite Criticism
Ask what you/we/the program could do better, be sincere. Don’t tell them why it won’t work or why it’s not a good idea, just listen and thank them for their input. This may intensify someone’s anger temporarily – but if you encourage them to continue and let them be heard the conversation tends to end on a more positive note.

20. Technique #6 Develop a Plan
You should have a plan at the ready, for example… a place for a time out, a meeting with a supervisor or case manager; however you will want to work out the options with the client.

21. Never Threaten
Once you have threatened or given an ultimatum all negotiations will cease and you will be in a win/lose situation. Try to keep options as open as possible.

22. Ultimate Plan for Safety
Do you have a plan if you can’t de-escalate a client?
Does your agency?
Does your agency have P&P regarding safety?
Do you have a way to summons others for help?