Conflict Resolution Training

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

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.

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” (2003-2005)

http://www.nhsbsa.nhs.uk/Protect.aspx

Government body which has policy and operational responsibility for tackling violence across the NHS.

Within SHFTSecurity Management Director – Huw Stone

Non-exec SMD – Pam CharlwoodSecurity Management Specialist – Dave White (Risk Team)

Legal Protection Unit (LPU)

Memorandum of understandingSupporting staff in pursuing sanctions for those service users who

police can’t or won’t prosecute

NHS Protect (Security Management Service)

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?

What are the causes of violence and aggression?

Communication Breakdown

• Below is a simple communication model. What things could stop the correct message getting across

Transmitter Receiver

Message

Message

COMMUNICATION

NON-VERBAL VERBAL

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

How do we communicate?

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…

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.

Transactional Analysis

3 EGO STATES

PARENT ADULT CHILD

Nurturing Critical Adapted Free

Transactional Analysis

3 EGO STATES

PARENT

ADULT:You are right, I was

wrongI think it might work what

do you think?

CHILD

Nurturing:Don’t worry we can work

it outLet me help you with thatCome 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 itI’ll throw it away if you

don’t want it

Free:Yahoo! I’ve won

BRILLIANT Just what I wanted

Let’s Party

• 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”

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?”

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!”

Lines of communication

Transactional analysis

Transactional analysis.STATEMENT EGO STATE

Look, I’ve shown you this over and over again. Now you go and do it!

How do you think the first presentation went?

I love it when the boss is on holiday, work is so much more fun, I’m going shopping!

Do you realise that I called you over an hour ago? Where have you been all this time?

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!

I’m not sure I understand. Would you explain it to me again, please?

Don’t worry, never mind. It wasn’t really that bad.

Why aren’t you working? It looks bad if you’re just sitting around. Haven’t you got anything better to do?

You’re right. I have written it down incorrectly. Thanks for pointing it out

Critical parent

Adult

Free child

Critical parent

Adapted child

Adult

Nurturing parent

Critical parent

Adult

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

Communication ModelsThe 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

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.

1. SIMPLE APPEAL.

To make a reasonable request of somebody.

2. REASONED APPEAL.

The reason / understanding as to why you are making the request.

1. PERSONAL APPEAL.

Appeal to their better nature, why do YOU want them to do it?

1. FINAL APPEAL.

The last chance to get the person to stop what they are doing. Offer alternatives / options / consequences.

1. ACTION.

Make sure you do what you said you are going to do, don’t make threats!

Communication Models

Attitude and Behavioural CycleSometimes known as Betaris Box

My Behaviour

Your Behaviour

My attitude

Your attitude

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

Patterns of Behaviour

Serious or aggravated resistance

Aggressive resistance

Active resistance

Passive resistance

Verbal Resistance

Compliance

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’.

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

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.

The Recovery Phase.

• Agitation decreases, anxiety lessens, communication becomes possible.

BEWARE! IT IS AT THIS POINT THAT MOST INTERVENTION ERRORSOCCUR.

• 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.

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.

Warning and Danger SignsWarning signsDirect, prolonged eye contactFacial colour may darkenHead is backSubject stands tallSubject kicks the groundLarge movements close to peopleBreathing rate acceleratesBehaviour may stop/start abruptly

Danger SignsFists may clench and unclenchFacial colour may become palerLips tighten over teethHead drops to protect throatEyebrows droop to protect the

eyesHands raise above the waistShoulders tenseStance moves from square to

sideways Stare is now at intended targetLowering of body to launch

forward

Impact factors

People Objects Places

Sex-Age-Size-BuildAlcohol 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 WeaponsDeliberately 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

Distances

90º The “Fighting Arc” is thearea in which peoplecan fight successfully.

It covers a 90º degree anglein front of the body.

By positioningyourself in the“offside position”you will make it more difficult forhim / her toattack you

The Fighting Arc

Offside Positioning

What is Assault?

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 documentedin the service users notes and on an incident form and

physical assaults referred to the police.

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

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.

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

Using Reasonable Force

Assessing reasonablenessIn all cases, surrounding circumstances will aid the decision with regardto 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

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

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”?

» 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?

Any thoughts?

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?

Empowering

Sharing

Key messages: how would you rather manage violence and aggression?

With this?Think people…

• Or this?• Think problems…

Patience

Listening

TalkingHearing

Helping

Understanding

Empathy

Restrain

SecludeMedicate

Prosecute

Inject

Section

Contain

Paterson and Miller 2005

Compassion

Caring

Challenge the language…

• Change the culture…

He kicked off

She went crazy

She is acting up

He is playing up

She is a typical P.D.

He is badnot mad

It is justattention-seeking

It is justbehavioural Distressed

Agitated

Unwell

Angry

Frightened

Tormented

Upset

Thank you for participating…

Any Questions?