instructor: certified pmab trainer, scott lepine

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Instructor: Certified PMAB Trainer, Scott Lepine. What is PMAB?. Cognitive Behavioral Theory C.B.T. Cognitive Thinking Errors. POWER THRUSTING (“My way or the highway”) FALSE VIEW OF SELF (“I’m the best”) UNREALISTIC EXPECTATIONS (“Good things will come my way”) - PowerPoint PPT Presentation


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Instructor: Certified PMAB Trainer, Scott Lepine

What is PMAB?Cognitive Behavioral TheoryC.B.T.

Cognitive Thinking Errors

POWER THRUSTING (My way or the highway)

FALSE VIEW OF SELF (Im the best)

UNREALISTIC EXPECTATIONS (Good things will come my way)

LACK OF PERSPECTIVE TAKING (Im the only one who counts)




AWFULIZING (Its all over!)

Predisposing/Precipitating Factors of Aggression

SummaryCommunication During the Aggression Cycle

THE CYCLE OF AGGRESSIONPRE-CRISIS PHASERATIONALITYPhysiologicalIncreased heart rate, blood pressure, lung capacity and metabolismGastrointestinal changesBehaviouralLow level agitation / muttering to staff / more activeClenched fists, staring, tensing of bodySuddenly outgoing or quietPsychologicalListens and responds to directionReasoning capacity remainsCRISIS PHASE: IRRATIONALITYPhysiologicalMaximum heart rate, blood pressure, lung capacity. Metabolism and physical strengthGastrointestinal changesBehaviouralHigh level agitation, shouting, swearing, punching, kickingDangerous to self and othersPsychologicalWill not listen or respond to directionNo reasoning capacityangryPOST-CRISIS PHASE: RATIONALITYPhysiologicalheart rate, blood pressure, lung capacity, metabolism and physical strength return to normal state.Gastrointestinal functions return to normal.BehaviouralLevel of agitation slowly recedesBody relaxes, high levels of tiredness/cryingTalkative or reclusiveRemorseful or defiantPsychologicalReasoning capacity returnsWilling to listenRespond to directionNOTE:Aggressive acts never happen in isolation. They are always preceded and followed by observable and recognizable behavioural and psychological features.Everyone in close proximity to the aggressive act is directly affected. Just as the aggressor, behavioural, psychological and physiological changes occur in those involved. The physiological feature may nor be recognized by staff but affect the individual.The behavioural, psychological and physiological in each phase will directly influence the staffs choice of effective management strategies and techniques. There are no differences where the pre-crisis finishes and the crisis begins.

CONTINUE:Although the graphic suggest a continuity and predictability to the cycle, this is not the actual fact because the cycle can be compressed into a space of a few minutes or extended over the course of several days. The behavioural and psychological changes can be occurring hours or even days before an aggressive act occurs, but the physiological changes begin shortly before the crisis phase and can continue several hours after the post-crisis.During the crisis phase, the gradual build-up of such changes may not be a steady one. During the crisis phase, staff needs to physically intervene in order to protect the others. This risk of injury is greater during the crisis phase.KNOWLEDGE OF THE CYCLE PROVIDES INFORMATION ON WHEN/HOW/WHERE TO INTERVENE.THE PROGRESSION FROM ONE STAGE TO THE NEXT CAN BE PREVENTED!Calming and Diffusing TechniquesCalming TechniquesWhen to use:In pre-crisis when the resident is willing to listen and able to reason

Purpose:To explore the situationTo get resident to discuss the problemTo reduce residents agitationPre-crisisOpen Questions

Definition specifically phrased questions intended to elicit a detailed repsonseCharacteristics questions usually begin with what, how could youPurpose to begin interviews-to allow appropriate venting of anger-to help non-communicative residents to share or to elaborate thoughts and feelings-to help residents articulate concrete examplesCautions avoid why-use sparingly with over-talkative residents (may encourage wandering)63Listening Responses

Definition short prompts demonstrating staff interest in resident's thoughts and feelingsCharacteristics examples mmm go onPurpose to get further information without interrupting the residents train of thoughtCautions do not use when resident is rambling64Paraphrases

Definition repetitions or restatements of residents message-statement of feelings expressed by residents verbal and non-verbal messagesCharacteristics a concrete demonstration to residents that staff are listening and understandingPurpose to build relationships-to encourage the silent resident-to enable resident to safely vent hostile feelingsCautions too much direct repetition becomes parroting-parroting may antagonize residents65Stating Clear Expectations

Definition concise, clear outline of what is expectedCharacteristics minimizing confusion-simplicity-open, caring, supportivePurpose clearer outcome plans-trust building-relationship building-setting boundariesCautions tone of voice, not demanding66Disarm Power Struggles

Definition refocusing issues and questions to client and issues at base of-removal of power and control as an issueCharacteristics stay calm, in control-refuse to verbally and physically partake-low tone of voice (calm)-body language non-threateningPurpose to move from win-lose to win-winCautions pay attn to cues from child/youth to ensure effectiveness vs increased aggressiveness67Timing Out

Definition removal of youth from a negative sitn, conflictCharacteristics brief, time limited-isolate from group-may be used to save face before situation escalatesPurpose allows time to calm, reflect, refocus, and evaluate the sitn, then plan for re-entry-consider choices and outcomes-time should be used constructivelyCautions do not use when youths level of self-control is questionable68Humour

Definition a verbal or non-verbal intervention to help the youth see a lighter side of the sitnCharacteristics a joke, facial expression/posture, over-exaggerationPurpose to lighten up a tense sitnCautions dont over use-dont use in mocking, belittling or disrespectful manner69Distraction

Definition to create an alternative stimulus so as to re-focus the clientCharacteristics external stimulus playing with coins, humour, ask non-related questions, share/give non-related information, use other kids, change methodology, environment, change activityPurpose safety physical and emotional-de-escalate crisis or annoyance-provide face-saving out-keep peer group stable-prevent medical risk-provide break for client/staff-allow for more support staff to be present, brought inCautions make sure you return to the original issue-dont minimize the clients feelings-make sure distraction is appropriate for individual involved-avoid over-sue of distractions-make sure distraction doesnt continue to stimulate client

70Planned Ignoring

Definition purposefully ignoring negative behaviours, responsesCharacteristics provide no response-focus on another behaviour/response-supporting positive responses, conditioningPurpose reduce attention/re-enforcement given to negative behaviour thus reducing the motivation to continue the behaviourCaution dont overuse some behavious require attention/interventions71Reviewing Option, Choices and OutcomesChoicesOptionsInformation

Definition listing options that youth may choose from and predicting outcomes for each choiceCharacteristics establishing strategies that are reality based and paths that lead to certain goals-empowers client -sets limits for what is acceptable-clarifies consequences or choicesPurpose provide client with clear outlines so client can make own decision-increases autonomy-makes youth accountableCautions too many options may be confusing-limit options to those that are practical72Positive Reinforcement

Definition provision of a reinforcing stimulus following a desirable behaviourCharacteristics reinforcers may be tangible or social-reinforcer must be seen as positive by the youth-immediately follows the desired behaviourPurpose to reinforce positive behaviour to increase its likelihood in the future-build self-esteem, motivation, confidenceCautions move from tangible to social reinforcers-be genuine

73Negotiate (Win/Win)

Definition to come to mutually satisfying agreement/compromiseCharacteristics mutual interchange-gives power to all involved-recognized individuality or uniqueness of situationPurpose to avoid power struggles and eliminate losersCautions differentiate bt what limits must be firm and which may be negotiated74Defusing TechniquesWhen to use:In crisis phase before verbal behaviour becomes violent

Purpose:To de-escalate potentially violent situations without violence occurringCrisis PhaseDefusing

Definition de-escalation of potentially violent situations using verbal interventionCharacteristics physical tension and agitation of resident manifested by loudness, door banging and kicking, etcPurpose to de-escalate a potentially violent sitnCautions 1st staff communication is critical miscommunications may escalate potential for violence76DefusingPreparationApproachWhat to SayLight to HeavyPhysical PresenceObservationStep 1 prep pre-crisis coordination of staff who will defuse sitncharacteristics identify who will defuse, who will act as backup, interventions if defusing attempts failpurpose to undertake in sitns involving one or more highly agitated residentscautions staff must be comfortable with technique, know the resident, have the residents trustStep 2 approach 1st action step in defusing technique, implementation is critical to success of defusing techniquecharacteristics use calm approach, back up staff become involved when show of strength is necessarypurpose to defuse potentially violent sitn in a timely mannercautions timing of approach is critical too fast may trigger violence, too slow may miss opportunity to intervene effectivelyStep 3 What to


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