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CRISIS INTERVENTION
EAR MODEL/LOSS
MODEL/LAST MODELSgt. Melissa Dawson #9115
EAU
PURPOSE
The following general guidelines will assist you
during an encounter with a person in crisis,
including special populations encounters.
LOSS MODEL
In response to any call, officers should be aware
that the situation may not be as straightforward
as dispatch has relayed
In a special populations encounter, the
individual may be experiencing pronounced
emotions or feelings (e.g., anxiety, paranoia,
despair, anger)
As an officer, you will not perform a clinical
diagnosis, but by applying the Loss model to the
situation, you should be able to determine a way
to engage, assess, and resolve the situation
LOSS MODEL
It describes four crisis profiles that reflect
identifiable characteristics that you can observe
and react to
The Loss model will allow officers to focus the
de-escalation efforts of the officer to address the
specific type of incident they are facing
The Loss model emphasizes observable
characteristics, not diagnostic or clinical
symptoms
FOUR CATEGORIES OF THE LOSS MODEL
SPO #1
1. Loss of Reality
2. Loss of Hope
3. Loss of Control
4. Loss of Perspective
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF REALITY (CONT.)
• Profile description
o Person may be frightened, confused, and have
difficulty concentrating or communicating
o The person may appear to be experiencing
delusions or hallucinations and the officer should
neither validate nor deny the existence of what the
person is experiencing
o Instead, officers should defer the issue of a person’s
delusions by acknowledging how the person’s view
of the situation must make them feel6
Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF REALITY (CONT.)
• De-escalation goal
o Try to ground the person in the “here and now”
o Ask his/her name and use it
o Try to make eye contact
o Ask simple questions (e.g., “How are you
doing?”, “Do you take any medications?”, “How
are you feeling?”)
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF REALITY (CONT.)
o Cut through the fear and confusion and get the
person to voluntarily comply with your request
o If the person is experiencing “command voices,” it
is especially important, for officer safety, for the
officer to be aware that the “voices” may be telling
the person to do something. Try to understand by
asking, “Are you hearing voices?” and if their
response is “Yes”, then ask, “What are they telling
you?”
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF HOPE (CONT.)
• Profile description
o The person may be emotional, very withdrawn,
fatigued, feeling of being overwhelmed, suicidal
talk or gestures, crying, despair
o They may have strong feelings of being helpless,
hopeless, and worthless; they may have
experienced a recent loss
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF HOPE (CONT.)
• De-escalation goal
o Instill some hope within the encounter so that the
person can be persuaded to talk to someone or seek
help
o You should be prepared to address thoughts of
suicide as outlined later in this lesson plan and by
agency policy and procedures
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF CONTROL (CONT.)
• Profile description
o This person may often be angry, irritable, or
hostile
o Can present themselves as victims (e.g., life is
unfair) and they do not feel listened to
o May be manipulative, impulsive, destructive, or
argumentative
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF CONTROL (CONT.)
• De-escalation goal
o Remain professional; do not take what they say
personally
o Be aware of signs, such as clenched fists, pacing, or
flushed cheeks, which may indicate potential
violence
o Attempt to calm the person by letting them vent
and using active listening skills
o When establishing trust within these encounters,
try to identify the source of the person’s anger12
Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF PERSPECTIVE (CONT.)
• Profile description
o This person is anxious, worried, or nervous which
could escalate to feeling panicked
o Physical symptoms include trembling, shaking,
chest pain, and/or discomfort
o The person could also seem overly energetic or be
displaying extreme highs and lows (i.e., mood
swings) during the encounter
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LOSS MODEL – LOSS OF PERSPECTIVE (CONT.)
• De-escalation goal
o Bring the person’s energy down
o Calm the person’s anxiety through empathy and
patience
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
LARGE GROUP DISCUSSION
Worksheet #3 and Worksheet #4.
Large Group Discussion – Discuss as a whole.
THIS IS A FLUID MODEL:
The person in crisis may be
experiencing different model
profiles within one encounter
Examples??
SHOW THE FOUR LOSS VIDEOS
1. “Mark” (Mall preacher)
2. “Dwayne” (Bridge)
3. “Baseball bat”
4. “Sally in the kitchen”
Worksheet #5
DE-ESCALATION BASICS (HANDOUT #3)
Maintain officer safety
De-escalation decision tree – officers must make a
continuous threat assessment during a special
populations encounter to ensure everyone at the
scene is safe
Verbal de-escalation is a tool that officers can use to
take control of a situation
If any one is an immediate threat, officers must
use the objective reasonableness standard to
determine the amount of force necessary to gain
Compliance
(Covered in detail within OPOTC BAS 2-6 Civil Liability
& Use of Force)
If safety is not jeopardized and officers realize
they are in a special populations encounter,
officers should apply a de-escalation mindset
Remain alert
View the crisis as a medical encounter
FOSTERING A DE-ESCALATION MINDSET
Taking a less physical, authoritative, and
controlling approach to a special populations
encounter may increase the probability of a safe
resolution
Empathy and patience, It is important that
the officer appears calm, interested, confident,
and resourceful
EAR MODEL
SPO #2
Three Phases of a Special Populations Encounter
1. Engage
2. Assess
3. Resolve
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ENGAGE (CONT.)
• Purpose of Engage – make a connection with the
person so you can calm him/her
• The first 10 seconds of a special populations encounter
are critical in setting the tone for de-escalation
• Remove distractions from the scene (e.g., people who
are upsetting the person, loud noises)
• Introduce yourself and ask for the person’s name
• State the reason why you are there and let them know
you are there to help
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ENGAGE (CONT.)
• If safety is not compromised, remember that special
populations encounters are medical encounters and
you should begin considering the Loss model profiles
• Ask questions (e.g., “Are you alright?” or “Is there
something bothering you?”)
• Vocalize about the subject’s observable characteristics
(e.g., “You look angry.” or “You look stressed.”)
• Ask the person “What help do you need right now?”
• Model calmness that you want the person to mirror
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ENGAGE (CONT.)
• In order to make a connection and calm the situation
during the Engage phase, you need to be empathetic
to the person’s situation or state of mind
• Individuals who feel they are understood are more
inclined to calm down
• Speak softly, simply, briefly, and move slowly
• If there is more than one officer present, have
someone take the lead in communicating and de-
escalating the situation to avoid confusion
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ASSESS (CONT.)
• Purpose of Assess – gather the information you need about the situation and the person’s condition so that you can make the needed resolution
Remember, your threat assessment is continuous
If the encounter changes and there is an imminent risk of harm, use the objective reasonableness standard to determine the amount of force necessary to gain control of the situation
Recognize that the person may be overwhelmed by frightening beliefs, sounds, or other things in the environment
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ASSESS (CONT.)
Be patient during the encounter
Check to see if a crime has been committed
If the person perpetrated a crime, your job is to gain control of the situation, which may include trying to de-escalate the person first and then investigate the crime second, provided that no one has been injured
Ask about medical history
Ask about and/or look for signs of drug or alcohol use (e.g., track marks, paraphernalia)
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ASSESS (CONT.)
When warranted, talk to other people about the person’s medical history, current medications, and ongoing medical treatment
If you are dealing with a suicidal person, gauge the seriousness of the person’s intent using the LAST model
Be non-threatening, yet remain vigilant
A trained officer can conceal his/her combat ready stance while offering an empathetic tone of voice and appearing non-threatening
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – ASSESS (CONT.)
If there is more than one law enforcement officer present, the other one should provide cover
This cover officer should avoid engaging the subject, as speaking to more than one person may be confusing and/or agitating
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – RESOLVE (CONT.)
Purpose of Resolve – bring the encounter to a safe resolution and get the person to obtain the help that the person needs
The resolution usually depends on whether a crime was committed, if the person meets commitment criteria, and the availability of mental health and diversion resources
The decision matrix, using Engage and Assess, was developed to help officers guide their exercise of discretion
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
EAR MODEL – RESOLVE (CONT.)
Once you decide on a course of action, forecast your intentions to the person by telling the person what you are about to do or what will happen next (e.g., “I am going to ask you to come with me.” or “I am going to have to pat you down and check for weapons.”)
Limit the number of instructions you give at one time
If you have to use force, you can expect many special
populations people to have a high threshold for pain
and greater than normal strength
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Effective Date: 2013/01/01 BAS 3-4 Crisis
Intervention
The EAR model is flexible in that the phases
may need to be reordered or may overlap as each
situation differs
LAST MODEL
Lethality of chosen method
Availability of chosen method – does the person actually possess the means to harm himself/herself?
Specificity of the plan – specific details about time, method
Timing – proximity of help
This model generally addresses individuals
contemplating suicide who are depressed
The large majority of suicide attempters do not
try again
Most people who commit suicide are ambivalent
about killing themselves
WHEN TALKING TO A PERSON CONTEMPLATING
SUICIDE, THE GOAL OF THE OFFICER SHOULD
BE…
SPO #3
… to get the individual to focus on the elements of his/her story causing the ambivalence (e.g., children,
spouse)
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Intervention
RESPONDING TO ARMED SUBJECT
THREATENING SUICIDE
Dangerous
Officer safety is paramount
Gaining control of the situation is critical
Threat assessment and availability of backup
De-escalation skills
RESPONDING TO ARMED SUBJECT
THREATENING SUICIDE(CONT.)
“Suicide by Cop”
Deadly force may be a first resort to stop a threat
Your threat assessment in the particular
circumstance is the basis for your actions
SUICIDE MYTHS
Myth – asking about suicide will plant the idea
in a person’s head
Fact – asking about suicide does not create suicidal
thoughts
Fact – the act of asking the question simply gives
them permission to talk about their thoughts or
feelings
Myth – people don’t talk about committing
suicide
Fact – most people who die by suicide have
communicated some intent
Fact – someone who talks about suicide gives
someone the opportunity to intervene before suicidal
behaviors occur
Myth – if someone really wants to die by suicide,
there is nothing you can do about it
Fact – most suicidal ideas are associated with
treatable disorders
Fact – if you can help the person survive the
immediate crisis, you have gone a long way toward
promoting a positive outcome
Myth – he/she really wouldn’t commit suicide
(e.g., made plans for a vacation, have young
children, made a verbal or written promise)
Fact – the intent to die can override any rational
thinking
Fact – someone experiencing suicidal intent must be
taken seriously
INDIVIDUALS UNDER THE INFLUENCE
Unpredictable
An individual can fall under any of the four Loss
categories as the alcohol or drugs may cause anger,
sadness, fear, or confusion
This group must always be viewed as a potential
threat
Withdrawal from alcohol is serious and can be
fatal
Symptoms usually occur within 72 hours of the last
drink
They include tremors, changes in mental function,
seizures
ENCOUNTERS WITH AN INDIVIDUAL THAT
APPEARS DRUNK OR DRUGGED :
First assess whether this is a medical emergency before attributing the behavior to the substance alone
Low blood sugar can mimic someone under the influence in that there may be a fruity or sweet odor on a person’s breath that is similar to alcohol
This person may also exhibit lightheadedness or slurred speech
EAR MODEL
Engage
Obvious signs of Alcohol/drug use
Repeat instructions as many times as you feel necessary.
Avoid arguing with a person under the influence of alcohol or drugs
ENGAGE
Recognize that you may not be able to reason
with a person under the influence of alcohol or
drugs (Skip to resolve stage)
ASSESS
Consider the person’s physical condition to determine whether the behavior is actually caused by other medical conditions (e.g., delirium, diabetic)
Ask questions to assist with this (e.g., “Have you eaten today?” or “Have you hit your head today?”)
Attempt to gain information from friends or family members
ASSESS
If you suspect drug use, you should look for track marks on a person’s arms or legs and the presence of drugs or drug paraphernalia
Note physical symptoms related to drug use like dilated (i.e., big) pupils or vomiting
Any person you contact who appears to be exhibiting the symptoms of withdrawal or delirium tremens (i.e., the shakes) is experiencing a medical emergency
RESOLVE
If you are unable to convince the individual to
respond to your directions, it is acceptable to use
force as you would with any non-compliant
subject
Get the individual to appropriate resources (e.g.,
jail, community programs)