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Conflict Resolution Training

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1 Conflict Resolution Training
For PSTS - Discuss reasons for CRT, Who the SMS are etc. Who our LSMS is and what he does. Where does the training come from. 1

2 Aims and Objectives Describe common causes of conflict
Describe two forms of communication Give examples of communication breakdown Explain 3 examples of communication models that can assist in conflict resolution Describe patterns of behaviour they may encounter during different interactions Explain the different warning and danger signs Give examples of impact factors Describe the use of distance when dealing with conflict Explain the use of “reasonable force” Describe different methods for dealing with possible conflict situations

3 Background to the training
Violence in mental health/learning disability settings is not new. Reliable data problematic, but there are concerns that problem is getting worse in some areas. Increasing demands from staff, unions and service users for safe and therapeutic services. Although the focus of this initiative is on violence by people with mental disorders directed towards staff, service users can also be victims. Violence by staff towards staff is also a serious problem.

4 Policy background NHS Security Management Service measures (2003)
Zero Tolerance (1999) National Audit Office report (2003) Blofeld inquiry into the death of David Bennett (2004) Delivering race equality in mental health care: An action plan for reform inside and outside services and the Government's response to the Independent inquiry into the death of David Bennett (2005) National Institute of Mental Health England (2004) National Institute of Clinical Excellence (2005) MHAC 11th Biennial report “In place of fear” ( ) 4

5 NHS Protect (Security Management Service)
Government body which has policy and operational responsibility for tackling violence across the NHS. Within SHFT Security Management Director – Huw Stone Non-exec SMD – Pam Charlwood Security Management Specialist – Dave White (Risk Team) Legal Protection Unit (LPU) Memorandum of understanding Supporting staff in pursuing sanctions for those service users who police can’t or won’t prosecute

6 What is Conflict & What Causes it?
In Groups discuss and write down what conflict means to you? What different types of conflict are there? What does it look like sound like etc? Are we always aware of conflict and who it is with. Think about wars, dissent, sedition, anarchy, student protests etc. Next group to shout out common causes of conflict. Write a list on flip chart, Make it fun Trainer Note- No single cause of conflict but there may be issues common to the group or society at large PSTS Cognitive theory of violence

7 What are the causes of violence and aggression?

8 Communication Breakdown
Below is a simple communication model. What things could stop the correct message getting across Transmitter Message Receiver Examples if people are struggling: Language differences-noise-weather-stress-alcohol-confused state-cultural differences-anger-stereotyping-jargon-emotional state-NVC not matching VC I think this would make a good flipchart fun exercise Link back to cultural awareness slide. Discuss how cultural mores may impact on communication Examples might include: language differences, confused state, stereotyping, background noise, cultural differences, jargon, weather conditions, too loud, emotional state, stress, too quiet, triggers, drugs and alcohol, anger, NVC not matching verbal contact. Ask group for personal experiences. Message

9 How do we communicate? COMMUNICATION NON-VERBAL VERBAL Words Tone
…..% of meaning is in the way the words are said Words …..% of meaning is the words that are spoken Body Language …..% of meaning is facial expression and body language Percentages are as follows 55% body Language 38% Tone etc 7% spoken word Body language and facial expressions do not always match up. Group to act out opposite body language and facial expressions. Just for fun! Instructor to give first examples

10 Cultural awareness People have different expectations of the services we provide. There are many factors that affect these expectations – language barriers, differing gestures, body language, modesty, religion, fear, anxiety and a lack of knowledge and understanding. Not all cultures have the same body language. Some people will not make eye contact when talking and some people will not shake hands as touching is not accepted. Invading personal space is accepted and common practice is some cultures. Some females may not even communicate without a chaperone or a husband present…

11 Transactional Analysis
In the 1950,s a Psychoanalyst, Eric Berne developed a theory which claimed we all have 3 basic ego states, which make up our personality. The model is useful for explaining why and how People think like they do People act like they do People interact / communicate with others.

12 Transactional Analysis
3 EGO STATES PARENT ADULT CHILD Nurturing Critical Adapted Free Draw on flip chart the picture of a person with the ego states in their various locations. It is thought that we return to these ego states when under stress.

13 Transactional Analysis
3 EGO STATES PARENT ADULT: You are right, I was wrong I think it might work what do you think? CHILD Nurturing: Don’t worry we can work it out Let me help you with that Come with me let's have a cup of tea Critical: Don’t do that again How many times do I have to tell you? Don’t slouch… Adapted: Why me? It’s not fair! If you loved me you would do it I’ll throw it away if you don’t want it Free: Yahoo! I’ve won BRILLIANT Just what I wanted Let’s Party Do simpsons exercise. Which of the Simpsons characters responds to which ego state. Laminated pictures of Simpsons, group to identify which is which of the ego states

14 Critical Parents display disciplinarian behaviour and make statements that are critical of others, “How many more times do I have to tell you”, “Sit up straight and look at me when I speak” Nurturing Parents display teaching, caring, supportive, loving and praising behaviour. “Don’t worry, we will sort it out” “Let me help you with that” “Come on, let’s go and have a cup of tea”

15 The adult ego state is characterised by mature, factual, logical and rational behaviour. It is the state that offers the least, or no conflict. Adults treat people with respect, the are approachable, reasonable, adaptable, rational and non-judgemental. “You were right to point the incorrect figure in my report, thank you” “ I think this could help us, what do you think?” “Can we try and avoid any misunderstanding?”

16 The adapted child may display behaviours that they have learned and can be manipulative and play on a persons emotions. “why me, its always me, never anyone else” If you loved me, you would do it for me” The Free child is characterised by behaviour that is instinctive, spontaneous, carefree and without boundaries. “Oh Brilliant! That’s fantastic, I can’t wait” “Let’s do it differently now, I’m a bit bored of this way!”

17 Lines of communication

18 Transactional analysis

19

20 Transactional analysis.
STATEMENT EGO STATE Look, I’ve shown you this over and over again. Now you go and do it! Critical parent How do you think the first presentation went? Adult I love it when the boss is on holiday, work is so much more fun, I’m going shopping! Free child Do you realise that I called you over an hour ago? Where have you been all this time? Critical parent I know I made a mess of that report. Please give me a chance to do it again- I know I can do it better. Please! Please! Adapted child I’m not sure I understand. Would you explain it to me again, please? Adult Don’t worry, never mind. It wasn’t really that bad. Nurturing parent Why aren’t you working? It looks bad if you’re just sitting around. Haven’t you got anything better to do? Critical parent You’re right. I have written it down incorrectly. Thanks for pointing it out Adult

21 Communication Models The C.U.D.S.A. Model C – Confront the situation
U – Understand each others situation D – Define the problems S – Search for and evaluate solutions A – Agree upon and implement the best solution

22 Communication Models The LEAPS Model: L – Listen; Listen actively
E – Empathise; Show understanding A – Ask; If you need more information P – Paraphrase; Put the facts into your own words S – Sum up; Condense the facts Useful in interviews and crisis resolution

23 Communication Models This 5 STEP APPEAL model is used to de-escalate conflict. It is useful when resolving a difficult situation or where a person refuses to comply with a request. SIMPLE APPEAL. To make a reasonable request of somebody. REASONED APPEAL. The reason / understanding as to why you are making the request. PERSONAL APPEAL. Appeal to their better nature, why do YOU want them to do it? FINAL APPEAL. The last chance to get the person to stop what they are doing. Offer alternatives / options / consequences. ACTION. Make sure you do what you said you are going to do, don’t make threats!

24 Attitude and Behavioural Cycle
Sometimes known as Betaris Box My Behaviour Your Behaviour My attitude Your attitude It is the role of the employee to break the cycle of negativity This session should also introduce to the delegate how individuals react in conflict situations and how their resistance or behaviour can progress from verbal resistance to physical assault Consider exercise, delegates to write down an example of this process they had recently witnessed, “The way we see them is the way we treat them and the way we treat them is how they often become” Zig Ziglar

25 Attitude and behaviour cycles
“ The way you see them is the way you treat them and the way you treat them is the way they often become” Zig Ziglar

26 Serious or aggravated resistance Aggressive resistance
Patterns of Behaviour Serious or aggravated resistance Aggressive resistance Active resistance Passive resistance Verbal Resistance Compliance Link to Betaris box and how behaviour can escalate.

27 Patterns of behaviour. Trigger Phase
An event or situation triggers an aggressive response within the individual Early warning signs can be easily missed The trigger may not be obvious and the persons response may seem to ‘come from nowhere’.

28 The Escalation Phase Anger and aggression begins to escalate. Stress and frustration increases. Person becomes overly focussed on the issue and less likely to respond to any rational intervention. The persons feelings need to be acknowledged

29 The Crisis Phase. As the person becomes increasingly physically, emotionally and psychologically aroused, control over aggressive impulses lessen and direct violence becomes likely. It is important to focus on the safety of yourself, the aggressor and anyone else who may be affected.

30 Agitation decreases, anxiety lessens, communication becomes possible.
The Recovery Phase. Agitation decreases, anxiety lessens, communication becomes possible. BEWARE! IT IS AT THIS POINT THAT MOST INTERVENTION ERRORS OCCUR. Adrenalin can remain effective for up to 90 minutes, causing heightened states of physical and emotional arousal, you may be at risk if you expect the person to be able to discuss the incident at this time.

31 Post Crisis Depression Phase.
The persons behaviour will usually regress below their baseline behaviour. Mental and physical exhaustion is common and the persons behaviour will ‘dip’ below their normal base line behaviour. They may become tearful and withdrawn or ashamed.

32 Warning and Danger Signs
Warning signs Direct, prolonged eye contact Facial colour may darken Head is back Subject stands tall Subject kicks the ground Large movements close to people Breathing rate accelerates Behaviour may stop/start abruptly Danger Signs Fists may clench and unclench Facial colour may become paler Lips tighten over teeth Head drops to protect throat Eyebrows droop to protect the eyes Hands raise above the waist Shoulders tense Stance moves from square to sideways Stare is now at intended target Lowering of body to launch forward Talk through confrontation i.e. making self big to win fight before it has started moving through to the fighting stance getting smaller, minimising target ready to rumble. Discuss how a lot of the things that happen are physiological and to an extent the person has no or limited control over them. Possibly discuss Kaplan and Wheeler Assault cycle

33 Impact factors People Objects Places Sex-Age-Size-Build Alcohol
Excessive Noise Specialist Knowledge Drugs Safe exits/Layout Skill-Boxing/Martial Arts Potential weapons (that could be used to cause injury) Public or private premises Mental State Offensive Weapons Deliberately made to cause injury Being in a position of disadvantage Numbers Present Items of value Slip/Trip Hazards Tiredness or exhaustion (Physical or Mental) Time of day Imminent danger Impact factors is like carrying out a mini risk assessment. Discuss Reaction Gap The distance we should adopt when dealing with conflict. It is the distance between the extremities of your reach and that of your opponents including any weapons. Fighting Arc – Draw on flipchart to explain

34 Distances Exercise to demonstrate personal space, link back to last slide and reaction gap. Discuss how distances expand as we become angry. Further discuss how when care giving we may have to enter further into peoples personal zones than either they or us feel comfortable with. What can we do to make the person feel less uncomfortable with that. Discuss if opportunity presents itself.

35 The Fighting Arc Offside Positioning 90º The “Fighting Arc” is the
area in which people can fight successfully. It covers a 90º degree angle in front of the body. Offside Positioning By positioning yourself in the “offside position” you will make it more difficult for him / her to attack you

36 What is Assault? Physical assault Non-Physical Assault
The intentional application of force by one person to another, without lawful justification, resulting in physical injury or personal discomfort Eisener v. Maxwell 1951, Kaye v. Robinson 1991 Non-Physical Assault The use of inappropriate words or behaviour causing distress and/or constituting harassment Physical and non-physical assaults should be documented in the service users notes and on an incident form and physical assaults referred to the police.

37 What to do when it doesn’t work?
Flight This is always your preferred option, and it is safer. Never stay in a situation in which you feel uncomfortable; remember, even if your job role means that you work with a duty of care that duty starts with you! Unfortunately fight may be you only option. If it is, you should be aware of the limitations and legal requirements; the following laws are relevant if you have to protect yourself legally Property is not worth being attacked for!!!!

38 Reasonable force The Criminal Justice and Immigration Act 2008 provides a statutory defence: ‘A person may use such force as is reasonable in the circumstances in the prevention of a crime… Any force must be absolutely necessary and proportionate to that which it seeks to prevent. 38

39 Using Reasonable Force
The law states that any use of force must be : Necessary Was there any need to use force at all? In proportion to that which it seeks to prevent Was the level of harm suffered reasonable compared to what would have happened if no forcible intervention had been made? Carried out because of an “honestly held belief” ‘The test to be applied for self defence is that a person may use such force as is reasonable in the circumstances as he honestly believed them to be in the defence of himself or another.’ Reasonable Discussed on next slide 39

40 Assessing reasonableness
In all cases, surrounding circumstances will aid the decision with regard to pursuit of criminal proceedings. The assailant’s height, build, gender, level of threat, use of weapon, intent to harm. The victim’s height, build, gender, alternative courses of action available, location circumstances, e.g. action deemed suitable in response to a threat in a pub may not be considered appropriate in a care home. Additionally, the interpretation of reasonable force depends on several further factors which are decided upon in the courts – The gravity of the crime you were trying to prevent whether it was possible to prevent it by non-violent means whether you were ready to try those means first 40

41 A note about weapons If anyone is armed with a weapon DO NOT approach them Instead secure the area, removing any other service users and staff members and call the police only staff with proper training and protective equipment should approach armed assailant

42 Assessing reasonableness
A member of the public strikes a man who attempts to steal her bag. The thief tells the police that he was assaulted….Was the action taken “reasonable”? 42

43 Any thoughts? A CPN who has recently been appointed is alone with a male service user in his home. He threatens to kill her but as he is between her and the door she cannot escape. He grabs her hair and attempts to force her to the floor. She strikes him in his ribs and kicks his shins while shouting for him to stop. Are her actions acceptable?

44 P.L.A.N. P = Proportionate – am I using the right level of force? (don’t use a sledgehammer to crack a nut) L = Legal – Am I covered by law? A = Accountable – Am I accountable for my actions? Yes you are! N = Necessary – Was the action taken necessary?

45 Key messages: how would you rather manage violence and aggression?
With this? Think people… Or this? Think problems… Empathy Listening Restrain Prosecute Patience Understanding Compassion Helping Section Medicate Seclude Caring Talking Empowering Hearing Sharing Inject Contain Paterson and Miller 2005 45

46 Challenge the language…
Change the culture… Challenge the language… She went crazy Frightened It is just behavioural She is acting up Distressed Agitated It is just attention- seeking He is playing up Unwell She is a typical P.D. Tormented Angry Upset He is bad not mad He kicked off 46

47 Thank you for participating…
Any Questions?


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