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1 Understanding People with Developmental Disabilities, Mental Illness, and/or Special Health Care Needs Tri City Partnership for Special Children & Families First Responder Smart Card Program TM Slide 2 2 Performance Objectives At the end of this course of instruction, through verbal response and use of notes and handouts provided, the student will: Develop and describe practical skills that can be used when interacting and communicating with people who have mental illness, mental retardation or special needs. Develop and describe practical skills that can be used when interacting and communicating with people who have mental illness, mental retardation or special needs. Identify appropriate referral agencies for various situations involving individuals with MI/DD. Identify appropriate referral agencies for various situations involving individuals with MI/DD. Demonstrate how to effectively handle situations involving people with MI/DD or special needs. Demonstrate how to effectively handle situations involving people with MI/DD or special needs. Slide 3 3 Performance Objectives List several types of Disabilities that fall into the special needs category List several types of Disabilities that fall into the special needs category Identify safety techniques to be considered when responding to calls for service involving individuals with MI/DD. Identify safety techniques to be considered when responding to calls for service involving individuals with MI/DD. Identify verbal and non-verbal behaviors that are indicative of persons who are emotionally unstable and/or potentially hostile. Identify verbal and non-verbal behaviors that are indicative of persons who are emotionally unstable and/or potentially hostile. ID the following w/ respect to detaining persons w/ MI: Legal Basis; Notification Procedures; Procedures for Serving Court Order; Procedures for Restraining and transporting; Where to Transport. ID the following w/ respect to detaining persons w/ MI: Legal Basis; Notification Procedures; Procedures for Serving Court Order; Procedures for Restraining and transporting; Where to Transport. Slide 4 4 What Can Cause A Disability? Genetic (or inherited) conditions Genetic (or inherited) conditions Problems at birth Problems at birth Problems after birth Problems after birth Poverty and cultural deprivation Poverty and cultural deprivation Problems during pregnancy Problems during pregnancy Accident or injury Accident or injury Slide 5 5 Examples of Disabilities Mental Retardation (MR) Mental Retardation (MR) Autism Autism Cerebral Palsy (CP) Cerebral Palsy (CP) Epilepsy Epilepsy Traumatic Brain Injury (TBI) Traumatic Brain Injury (TBI) Developmental Disability (DD) Developmental Disability (DD) Seizure Disorder Seizure Disorder Slide 6 6 Understanding Functional Limitations Communication Communication Self-care Self-care Home living Home living Social skills Social skills Leisure Leisure Community use Community use Health and safety Self-direction Functional academics Work Slide 7 7 AUTISM - A condition which may be characterized by severe disorders in communication and behavior, resulting in limited ability to communicate, understand, learn, and participate in social relationships. AUTISM - A condition which may be characterized by severe disorders in communication and behavior, resulting in limited ability to communicate, understand, learn, and participate in social relationships. Disability Definitions Slide 8 8 Autism Inability to relate to other people Inability to relate to other people Delayed communication skills Delayed communication skills Language comprehension is impaired Language comprehension is impaired Highly sensitive to sensory input, noise levels and touch Highly sensitive to sensory input, noise levels and touch May react indifferently or with emotional outbursts May react indifferently or with emotional outbursts Difficulty in dealing with changes Difficulty in dealing with changes Obsessive or compulsive behavior Obsessive or compulsive behavior Slide 9 9 BRAIN DAMAGE- Generally described as any defect of the brain specifically occurring from injury before, during or anytime after birth. It may affect any brain function, but is especially related to movement, thinking and learning. BRAIN DAMAGE- Generally described as any defect of the brain specifically occurring from injury before, during or anytime after birth. It may affect any brain function, but is especially related to movement, thinking and learning. CEREBRAL PALSY- A permanently disabling condition resulting from damage to the developing brain which may occur before, during, or after birth and results in loss or impairment of control over voluntary muscles. CEREBRAL PALSY- A permanently disabling condition resulting from damage to the developing brain which may occur before, during, or after birth and results in loss or impairment of control over voluntary muscles. Slide 10 10 Cerebral Palsy Slide 11 11 EPILEPSY- A neurological condition characterized by abnormal electrical- chemical discharge in the brain. This discharge is manifested in various forms of physical activity called seizures.EPILEPSY- A neurological condition characterized by abnormal electrical- chemical discharge in the brain. This discharge is manifested in various forms of physical activity called seizures. SEIZURE DISORDER- The result of a disorder of the central nervous system causing loss of consciousness, muscle spasms, mental confusion or uncontrolled or aimless body movements.SEIZURE DISORDER- The result of a disorder of the central nervous system causing loss of consciousness, muscle spasms, mental confusion or uncontrolled or aimless body movements. Slide 12 12 Epilepsy Slide 13 13 MENTAL RETARDATION- As defined in Arizona, a condition involving significantly sub average general intellectual functioning existing concurrently with significant deficits or impairments in adaptive behavior and manifested before the age of 18. MENTAL RETARDATION- As defined in Arizona, a condition involving significantly sub average general intellectual functioning existing concurrently with significant deficits or impairments in adaptive behavior and manifested before the age of 18. Slide 14 14 What is a Mental Disability? IQ (Intelligence quotient) is below 70-75 IQ (Intelligence quotient) is below 70-75 Mild - IQ 55 - 70 Mild - IQ 55 - 70 Moderate - IQ between 40 - 55 Moderate - IQ between 40 - 55 Severe - IQ between 25 - 40 Severe - IQ between 25 - 40 Profound - IQ is below 25 Profound - IQ is below 25 Limitations in Functional Limitations Limitations in Functional Limitations Slide 15 15 Most people are mildly affected Slide 16 16 Intelligence means Paying attention Paying attention Demonstrating good memory Demonstrating good memory Using abstract thinking Using abstract thinking Using practical problem- solving skills Using practical problem- solving skills Generalizing knowledge Generalizing knowledge Slide 17 17 Problem Solving Ability 362,379 x 9,737 = ? Slide 18 18 BENEFITS OF TRAINING Effecting positive change in our communities. Effecting positive change in our communities. Slide 19 19 Common Syndromes Associated With Mental Retardation Fetal Alcohol Syndrome Fragile X Syndrome Down Syndrome Caused by drinking during pregnancy Inherited disorder; males more affected than females Chromosome disorder Severe learning disabilities and behavioral disorders Short attention span, repetitive speech, lack of eye contact. Risk of developing severe behavior disorders is low Small eyes, thin upper lip, large ears, shortened fingers Large ears, loose joints, long face, prominent forehead and chin. Slanting of eyelids, depressed nasal bridge, small mouth, hands and feet. Slide 20 20 What Would You Do? A suspect is read his Miranda rights by an officer who asks, Do you waive these rights? and the individual responds by smiling and waving his right hand. A suspect is read his Miranda rights by an officer who asks, Do you waive these rights? and the individual responds by smiling and waving his right hand. A middle-aged woman sees a sign in the window of an empty parked car that says, baby on board. She spends a long time looking inside the window of the car searching intently for a baby. A middle-aged woman sees a sign in the window of an empty parked car that says, baby on board. She spends a long time looking inside the window of the car searching intently for a baby. Slide 21 21 Waiving Rights? Slide 22 22 Traits to Consider Communication Communication Limited vocabulary Limited vocabulary Speech Impairment Speech Impairment Unable to read or write Unable to read or write Say what others want to hear Say what others want to hear Have difficulty understanding directions or answering questions. Have difficulty understanding directions or answering questions. Takes things at face value Takes things at face value Slide 23 23 Traits to Consider Behavior: Behavior: Be easily influenced and anxious to please others. Be easily influenced and anxious to please others. Easily victimized Easily victimized Easily frustrated (not able to understand others) Easily frustrated (not able to understand others) Dont want their disability to be noticed Dont want their disability to be noticed Have difficulty making changes, reading, using the telephone, telling time and giving accurate directions. Have difficulty making changes, reading, using the telephone, telling time and giving accurate directions. Unable to pick up on social cues. Unable to pick up on social cues. Unable to relate socially to others Unable to relate socially to others Slide 24 24 May Be Easily Led Slide 25 25 Traits to Consider First Responder (FR) contact: First Responder (FR) contact: Not able to understand Miranda rights or commands. Not able to understand Miranda rights or commands. Overwhelmed by FR presence Overwhelmed by FR presence May act upset and try and run away May act upset and try and run away Be over willing to please officer and admit to something they did not do. Be over willing to please officer and admit to something they did not do. Be less likely and less able to report criminal acts or victimization Be less likely and less able to report criminal acts or victimization Slide 26 26 Vulnerability of victims Segregated from others Segregated from others Heavy dependence on caregivers Heavy dependence on caregivers Praised for compliance Praised for compliance Easily persuaded or led by others Easily persuaded or led by others Impaired judgment Impaired judgment Not trained on safety or basic legal rights Not trained on safety or basic legal rights Slide 27 27 One Officers Personal Experience One Officers Personal Experience Ive got an uncle. He has down syndrome. He is just slow. Like he has all the same feelings and emotions as anyone else but hes just like a ten year oldoften people with mental retardation wont stand up for themselves, and when someone says to them, you are wrong, well, they say, OK theyd just rather agree with you. Ive got an uncle. He has down syndrome. He is just slow. Like he has all the same feelings and emotions as anyone else but hes just like a ten year oldoften people with mental retardation wont stand up for themselves, and when someone says to them, you are wrong, well, they say, OK theyd just rather agree with you. Slide 28 28 Developmental Disability A First Responder Approach Speak directly to the person Speak directly to the person Keep sentences short Keep sentences short Use simple language Use simple language Speak slowly and clearly Speak slowly and clearly Ask for concrete descriptions Ask for concrete descriptions Break complicated instructions down into smaller parts Break complicated instructions down into smaller parts Use pictures, symbols and actions to convey meaning Use pictures, symbols and actions to convey meaning Slide 29 29 Individuals w/ DD as Witnesses Slide 30 30 Developmental Disability A First Responder Approach Take time giving or asking for information Take time giving or asking for information Repeat questions more than once Repeat questions more than once Avoid confusing questions about reasons for behavior Avoid confusing questions about reasons for behavior Dont speak louder in an effort to increase the persons understanding. Dont speak louder in an effort to increase the persons understanding. Use firm and calm persistence if the person is non-compliant. Use firm and calm persistence if the person is non-compliant. Avoid yes or no answers Avoid yes or no answers Slide 31 31 Keep an Open Mind Dont assume he or she cant understand or communicate Dont assume he or she cant understand or communicate Be genuine in your desire to understand him or her Be genuine in your desire to understand him or her Demonstrate the same respect given to others without a disability Demonstrate the same respect given to others without a disability Slide 32 32 Victim case scenario While on patrol you get a call from across town about a sexual assault that has just occurred. You arrive on the scene to find two middle-aged women talking. One woman, Mary, has a mental disability and is alleging sexual assault by the driver of the bus she just exited. She says it happened many times, but she has been too afraid to tell anyone until now. The other woman is Marys caseworker who sees Mary on a weekly basis. She works at the local mental health center. Marys case worker called the police immediately after the allegation was made. While on patrol you get a call from across town about a sexual assault that has just occurred. You arrive on the scene to find two middle-aged women talking. One woman, Mary, has a mental disability and is alleging sexual assault by the driver of the bus she just exited. She says it happened many times, but she has been too afraid to tell anyone until now. The other woman is Marys caseworker who sees Mary on a weekly basis. She works at the local mental health center. Marys case worker called the police immediately after the allegation was made. Slide 33 33 BENEFITS OF TRAINING Effecting positive change in our communities. Effecting positive change in our communities. Increased safety for first responders, consumers and the public. Increased safety for first responders, consumers and the public. Slide 34 34 Mental Illness Slide 35 35 Mental Illness A disorder causing severe disturbances in thinking, feeling and relating. The result is a diminished ability to function or cope with ordinary demands of life. A disorder causing severe disturbances in thinking, feeling and relating. The result is a diminished ability to function or cope with ordinary demands of life. Characteristics are abnormalities in perception, thought and mood. Characteristics are abnormalities in perception, thought and mood. Usually triggered when an individual experiences distress. Usually triggered when an individual experiences distress. Observe duration and frequency of cognitive, emotional and behavioral impairment. Observe duration and frequency of cognitive, emotional and behavioral impairment. Slide 36 36 Mental Retardation & Mental Illness are NOT the same thing Mental Retardation Mental Retardation Decreased ability to learn Decreased ability to learn Low IQ Low IQ Before the age of 18 Before the age of 18 Disability usually noticeable Disability usually noticeable Mental Illness Mental Illness Impacts moods and emotions Impacts moods and emotions Low or high IQ Low or high IQ Occurs at any time Occurs at any time Disability may be noticeable Disability may be noticeable Slide 37 37 Dually Diagnosed Term used to describe a condition where a single person has more than one major clinical psychological/ psychiatric diagnosis. (mental retardation/mental illness, mental illness/poly-substance abuse) Term used to describe a condition where a single person has more than one major clinical psychological/ psychiatric diagnosis. (mental retardation/mental illness, mental illness/poly-substance abuse) Slide 38 38 Mental Illnesses Are: Biological brain disorders that interfere with normal brain chemistry Biological brain disorders that interfere with normal brain chemistry Very common Very common Equal opportunity diseases Equal opportunity diseases Devastating to ill persons and their families Devastating to ill persons and their families Treatable Treatable Slide 39 39 Mental Illnesses Are Not: Anybodys Fault Anybodys Fault Preventable or curable at this time Preventable or curable at this time Hopeless Hopeless Slide 40 40 Contributing factors Biological factors - inherited genetic factors influence persons present functioning. Biological factors - inherited genetic factors influence persons present functioning. Social influences - environmental norms of persons support system. Social influences - environmental norms of persons support system. Emotional influences - general temperament of the person. Emotional influences - general temperament of the person. Developmental influences - current developmental stage and tasks. Developmental influences - current developmental stage and tasks. Slide 41 41 Seriously Mentally Ill SMI is a legal term not a diagnosis SMI is a legal term not a diagnosis SMI is a term for people who are eligible to receive publicly funded services in Arizona. SMI is a term for people who are eligible to receive publicly funded services in Arizona. Slide 42 42 3 Basic Types of Illness Psychosis/ Thought Disorder Psychosis/ Thought Disorder Mood Disorder Mood Disorder Anxiety Disorder Anxiety Disorder Slide 43 43 Psychosis / Biochemical A symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality. A symptom or feature of mental illness typically characterized by radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality. Slide 44 44 Schizophrenia Schizophrenia will impact: Schizophrenia will impact: Way a person sees the world Way a person sees the world Their thought patterns Their thought patterns Speech Speech Movement Movement Almost all aspects of daily living Almost all aspects of daily living Slide 45 45 Schizophrenia - WDC Shooting Slide 46 46 Delusion A delusion is a persistent belief that something is true when there is no evidence suggesting that this is the case. The delusional person cannot be dissuaded from the delusion by force of logical argument. A delusion is a persistent belief that something is true when there is no evidence suggesting that this is the case. The delusional person cannot be dissuaded from the delusion by force of logical argument. Slide 47 47 Hallucination Seeing, hearing, smelling, tasting, or feeling things that arent there. Seeing, hearing, smelling, tasting, or feeling things that arent there. Disorganized speech-symptom can be observed if the person discusses issues illogically, jumps from topic to topic or uses unintelligible words. Disorganized speech-symptom can be observed if the person discusses issues illogically, jumps from topic to topic or uses unintelligible words. Slide 48 48 Schizophrenia Common Medications Common Medications Haldol Haldol Zyprexa Zyprexa Risperdal Risperdal Side Effects: blurred vision, tremors, stiffness, drowsiness, muscle spasms, uncontrolled muscle movements, jerking, and twisting movements. Side Effects: blurred vision, tremors, stiffness, drowsiness, muscle spasms, uncontrolled muscle movements, jerking, and twisting movements. Slide 49 49 Hallucinations Norman / Part 1 Slide 50 50 Schizophrenia A First Responder Approach Recognize and acknowledge that their delusions or hallucinations are real to them. Recognize and acknowledge that their delusions or hallucinations are real to them. Dont tell them there is no one there Dont tell them there is no one there Dont tell them you see or hear something that you dont Dont tell them you see or hear something that you dont Consider asking what the voices are saying to get an idea of what the person is going through Consider asking what the voices are saying to get an idea of what the person is going through Slide 51 51 Schizophrenia A First Responder Approach Recognize they may be overwhelmed and frightened by sensations, thoughts, sounds, voices, or their current environment. Recognize they may be overwhelmed and frightened by sensations, thoughts, sounds, voices, or their current environment. Use brief, clear and simple language Use brief, clear and simple language Never argue Never argue Announce your actions Announce your actions Slide 52 52 Hallucinations Norman / Part 2 Slide 53 53 Mood Disorders Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood. Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood. Sad or elated moods. Sad or elated moods. Prolonged mood states that disrupt their daily functioning. Prolonged mood states that disrupt their daily functioning. May appear as severe agitation May appear as severe agitation Slide 54 54 Depression Major depression, known as clinical depression, is an abnormal low of mood characterized by disturbances in eating, sleeping and concentrating. Major depression, known as clinical depression, is an abnormal low of mood characterized by disturbances in eating, sleeping and concentrating. Estimated in 9.9 million adults Estimated in 9.9 million adults Slide 55 55 Depression Common Medications Common Medications Prozac Prozac Paxil Paxil Effexor Effexor Side effects can be dry mouth, constipation, blurred vision, insomnia, dizziness, agitation and/or confusion. Side effects can be dry mouth, constipation, blurred vision, insomnia, dizziness, agitation and/or confusion. Slide 56 56 Mood Disorders Slide 57 57 Depression A First Responder Approach Ask if they are having thoughts of suicide Ask if they are having thoughts of suicide Use a calm and supportive approach Use a calm and supportive approach Empathize with their dilemma Empathize with their dilemma Give strong reassurance that they are safe and you will assist them in getting help Give strong reassurance that they are safe and you will assist them in getting help Slide 58 58 Bipolar Also known as manic depression Also known as manic depression Experience alternating episodes of mania (severe highs) and depression (severe lows). Experience alternating episodes of mania (severe highs) and depression (severe lows). Manic Phase May include hyperactivity, anger, impaired judgment, aggressive behavior, delusions, exaggerated feelings, extreme irritability and disorganization. Manic Phase May include hyperactivity, anger, impaired judgment, aggressive behavior, delusions, exaggerated feelings, extreme irritability and disorganization. Often described as the best feeling ever. Often described as the best feeling ever. Slide 59 59 Bipolar Common Medications: Common Medications: Lithium can cause seizures, blackouts and the appearance that the individual is drunk Lithium can cause seizures, blackouts and the appearance that the individual is drunk Depakote Depakote Lamictal Lamictal Side effects can be tremors, dizziness, dry-mouth and memory problems Side effects can be tremors, dizziness, dry-mouth and memory problems Slide 60 60 Bipolar Manic Phase A First Responder Approach Use a firm and direct approach Use a firm and direct approach Set clear limits on behavior Set clear limits on behavior Reduce environmental stimuli Reduce environmental stimuli Re-direct behavior and thoughts if they begin to escalate Re-direct behavior and thoughts if they begin to escalate Help them to slow down by using controlled, rhythmic breathing Help them to slow down by using controlled, rhythmic breathing Slide 61 61 Bipolar Disorder Slide 62 62 BENEFITS OF TRAINING Effecting positive change in our communities. Effecting positive change in our communities. Increased safety for first responders, consumers and the public. Increased safety for first responders, consumers and the public. Increased professionalism through education thereby lowering issues of liability. Increased professionalism through education thereby lowering issues of liability. Slide 63 63 Anxiety Disorders A group of illnesses that have in common persistent feelings of apprehension, tension, or uneasiness, and are accompanied by physical symptoms such as sweating, palpitations, and feelings of generalized stress. A group of illnesses that have in common persistent feelings of apprehension, tension, or uneasiness, and are accompanied by physical symptoms such as sweating, palpitations, and feelings of generalized stress. Phobias Phobias Panic attacks Panic attacks Generalized anxiety disorder Generalized anxiety disorder Obsessive Compulsive Disorder Obsessive Compulsive Disorder Posttraumatic stress disorder Posttraumatic stress disorder Slide 64 64 Anxiety Disorders Common Medications Common Medications Ativan can cause memory loss Ativan can cause memory loss Valium Valium Klonopin Klonopin Side effects include sleepiness, dizziness, nausea, irritable bowel, loss of memory Side effects include sleepiness, dizziness, nausea, irritable bowel, loss of memory Slide 65 65 Anxiety Disorders A First Responder Approach Be calm, supportive and empathetic Be calm, supportive and empathetic Reassure them they are safe and you will assist them in getting help Reassure them they are safe and you will assist them in getting help If they are exhibiting OCD compulsions do not ridicule them or try to make them stop If they are exhibiting OCD compulsions do not ridicule them or try to make them stop If their actions make you nervous, let them know and try to agree on a possible alternative If their actions make you nervous, let them know and try to agree on a possible alternative Slide 66 66 Post Traumatic Stress Disorder A specific type of anxiety disorder. A specific type of anxiety disorder. Fear of re-experiencing a traumatic event. Fear of re-experiencing a traumatic event. May try to avoid these experiences by self numbing or medicating with substances. May try to avoid these experiences by self numbing or medicating with substances. Possible extreme reaction to normal actions Possible extreme reaction to normal actions Slide 67 67 Emotions and Behaviors Emotions are a way of communicating and often substitute for language. Emotions are a way of communicating and often substitute for language. All behavior is purposeful All behavior is purposeful This behavior is an attempt to get a need met. This behavior is an attempt to get a need met. Slide 68 68 Behaviors you always counted on may not exist with the person who has a mental illness. Slide 69 69 Responding to Mental Illness Slide 70 70 Insight about what is happening Insight about what is happening Ability to focus and concentrate Ability to focus and concentrate Pride in appearance and personal hygiene Pride in appearance and personal hygiene Ability to exercise self-control Ability to exercise self-control Willingness to follow a treatment plan Willingness to follow a treatment plan Emotional resiliency Emotional resiliency Behaviors that MAY NOT be present Slide 71 71 Behaviors that MAY be present Irritability, criticalness, nervousness Irritability, criticalness, nervousness Irrational statements and responses Irrational statements and responses Uncontrollable sadness or crying Uncontrollable sadness or crying Rudeness and hostility Rudeness and hostility Inappropriate and bizarre behaviors Inappropriate and bizarre behaviors Constant tension and nervousness Constant tension and nervousness Slide 72 72 Defensive Coping Strategies & Behaviors Controlling Controlling Anger and attack Anger and attack Blaming others Blaming others Substance abuse Substance abuse Violent behavior Violent behavior Refusing services Refusing services Denial Denial Making excuses Making excuses Running Away Running Away Refusing medication Refusing medication Abusive criticism Abusive criticism I dont want to talk about it. I dont want to talk about it. Stubbornness Stubbornness Self-blame Self-blame Suspicion Suspicion Slide 73 73 Psychotropic Medications A medication which is prescribed for the purpose of reducing or eliminating certain behaviors. (behavior modifying) A medication which is prescribed for the purpose of reducing or eliminating certain behaviors. (behavior modifying) Slide 74 74 Keep an Open Mind Dont assume he or she cant understand or communicate Dont assume he or she cant understand or communicate Be genuine in your desire to understand him or her Be genuine in your desire to understand him or her Demonstrate the same respect given to others without a disability Demonstrate the same respect given to others without a disability Slide 75 75 SLOW DOWN Slide 76 76 In-Custody Deaths Excited Delirium Delirium A mental disturbance marked by illusions, hallucinations, short unsystematized delusions, cerebral excitement, physical restlessness and incoherence. Delirium A mental disturbance marked by illusions, hallucinations, short unsystematized delusions, cerebral excitement, physical restlessness and incoherence. Excited Delirium A state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength and endurance without apparent fatigue. (also called in custody death syndrome) Excited Delirium A state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength and endurance without apparent fatigue. (also called in custody death syndrome) Slide 77 77 Physical Characteristics Dilated pupils Dilated pupils High body temperature hyperthermia High body temperature hyperthermia Profuse sweating Profuse sweating Skin discoloration Skin discoloration Slide 78 78 High Risk Individuals for Sudden Death Obese specifically having a large belly Obese specifically having a large belly Enlarged Heart or Heart Problems Enlarged Heart or Heart Problems Coronary Atherosclerosis Coronary Atherosclerosis Myocardial Infarction Myocardial Infarction Myocarditis inflamed heart muscle Myocarditis inflamed heart muscle Fibrotic heart scar tissue formation Fibrotic heart scar tissue formation Under influence of alcohol and/or drugs Under influence of alcohol and/or drugs Weather is hot and/or humid Weather is hot and/or humid Head injury Head injury Slide 79 79 Behavioral Cues: High Risk Individuals for Sudden Death Demonstrates intense paranoia, violent, bizarre behavior Demonstrates intense paranoia, violent, bizarre behavior Is extremely agitated Is extremely agitated May be running wildly and/or screaming May be running wildly and/or screaming Stripping off clothing Stripping off clothing Psychotic in appearance Psychotic in appearance Rapid fluctuations in emotions Rapid fluctuations in emotions Disoriented about place, time, purpose and even himself Disoriented about place, time, purpose and even himself Slide 80 80 Behavioral Cues: High Risk Individuals for Sudden Death Possess great or even super-human strength Possess great or even super-human strength Seemingly unlimited endurance Seemingly unlimited endurance Diminished sense of, or is insensitive to, pain Diminished sense of, or is insensitive to, pain Impervious to Pain Control; Pepper Spray; Taser; Baton Strikes Impervious to Pain Control; Pepper Spray; Taser; Baton Strikes Violently resists during control and restraint as well as after being restrained Violently resists during control and restraint as well as after being restrained Slide 81 81 Excited Delirium A First Responder Approach Assess the scene Assess the scene Wait for back-up Wait for back-up Call for EMS or Fire Personnel Call for EMS or Fire Personnel Attempt to verbally diffuse the situation Attempt to verbally diffuse the situation Slide 82 82 Excited Delirium A First Responder Approach Quickly and safely CAPTURE the subject Quickly and safely CAPTURE the subject Quickly and safely CONTROL the subject Quickly and safely CONTROL the subject RESTRAIN the individual RESTRAIN the individual Do not hog tie Do not hog tie Do not allow to lie prone for too long Do not allow to lie prone for too long Roll subject on his side to aid breathing Roll subject on his side to aid breathing Can have them sit up if safe Can have them sit up if safe Provide information to EMS/Fire personnel Provide information to EMS/Fire personnel Transport immediately Transport immediately Slide 83 83 Excited Delirium DOCUMENTATION Document physical assessments of the subject Document physical assessments of the subject Skin color Skin color Body temperature Body temperature Sweating Sweating Clothing (or not) Clothing (or not) Obtain vital signs from EMS personnel on scene Obtain vital signs from EMS personnel on scene Slide 84 84 Excited Delirium DOCUMENTATION Quote what the subject said during the incident Quote what the subject said during the incident Obtain detailed witness statements Obtain detailed witness statements Take as much time as needed to complete a comprehensive, detailed report Take as much time as needed to complete a comprehensive, detailed report YOUR CAREER MAY DEPEND ON HOW WELL YOU ARE ABLE TO DOCUMENT THE INCIDENT Slide 85 85 In-Custody Deaths - Excited Delirium Slide 86 86 BENEFITS OF TRAINING Effecting positive change in our communities. Effecting positive change in our communities. Increased safety for first responders, consumers and the public. Increased safety for first responders, consumers and the public. Increased professionalism through education thereby lowering issues of liability. Increased professionalism through education thereby lowering issues of liability. A better understanding on the part of first responders of individuals with MI/DD. A better understanding on the part of first responders of individuals with MI/DD. Slide 87 87 MI/DD Your Initial Response Arrive safely Arrive safely Use cover Use cover Use sound officer safety practices Use sound officer safety practices Call for a supervisor if necessary (per you agency policy) Call for a supervisor if necessary (per you agency policy) Begin getting as much information as possible from others at the scene. Begin getting as much information as possible from others at the scene. Slide 88 88 MI/DD Scene Assessment Gather as much information as possible about the history of the individual Gather as much information as possible about the history of the individual Family members Family members Case managers if receiving mental health services Case managers if receiving mental health services Reporting party, neighbors or bystanders Reporting party, neighbors or bystanders Dispatch Dispatch Criminal history files Criminal history files In-house files In-house files Slide 89 89 Contacting Someone in Crisis Establish communication Establish communication Calm the situation Calm the situation Establish rapport show empathy Establish rapport show empathy Gather information Gather information Slow the situation Slow the situation REMEMBER: Time is on your side REMEMBER: Time is on your side Slide 90 90 Contacting Someone in Crisis A First Responder Approach Safety Safety Use cover, distance, and barriers Use cover, distance, and barriers Move if you find yourself in a vulnerable position Move if you find yourself in a vulnerable position Reduce your own anxiety Reduce your own anxiety Avoid face-to-face if a weapon is involved Avoid face-to-face if a weapon is involved Base all decisions on safety and control Base all decisions on safety and control Slide 91 91 Contacting Someone in Crisis A First Responder Approach Self Control Self Control A person in crisis can put you in crisis A person in crisis can put you in crisis You can only control your own emotions You can only control your own emotions Project that you are calm and in control Project that you are calm and in control Be non-judgmental, sincere, genuine and empathetic Be non-judgmental, sincere, genuine and empathetic Time is on your side and will reduce the risk of unnecessary escalation of the situation Time is on your side and will reduce the risk of unnecessary escalation of the situation T.A.C.T. model T.A.C.T. model Slide 92 92 T.A.C.T. Model Tone Calm and non-confrontational Tone Calm and non-confrontational Atmosphere Scene calm and controlled Atmosphere Scene calm and controlled Communication Build rapport Communication Build rapport Time Slow the situation down Time Slow the situation down Slide 93 93 Three Ways to Obtain Treatment Voluntary Treatment Voluntary Treatment Court-Ordered Evaluation Court-Ordered Evaluation Emergency Petition Emergency Petition Slide 94 94 Voluntary Treatment Per A.R.S. 36-518 - Any person who is eighteen years of age or older and who manifests the capacity to give informed consent may be hospitalized for evaluation, care and treatment by voluntarily making a written application. Per A.R.S. 36-518 - Any person who is eighteen years of age or older and who manifests the capacity to give informed consent may be hospitalized for evaluation, care and treatment by voluntarily making a written application. Slide 95 95 Mental Health Pickup Orders An officer has the legal ability to detain a mentally-ill person under A.R.S. 36-525 and 36-526. An officer has the legal ability to detain a mentally-ill person under A.R.S. 36-525 and 36-526. Per A.R.S. 36-520, any responsible individual may apply for a court-ordered evaluation of a person who is alleged to be, as a result of a mental disorder, a danger to self or to others or is disabled. Per A.R.S. 36-520, any responsible individual may apply for a court-ordered evaluation of a person who is alleged to be, as a result of a mental disorder, a danger to self or to others or is disabled. Slide 96 96 Emergency Detention Orders Per A.R.S. 36-525 - A peace officer may take into custody any individual in which there is probable cause to believe, based on observations, that a person is, as a result of mental disorder, a danger to self or others, and continues to be during the time necessary to complete the petition screening procedures. Per A.R.S. 36-525 - A peace officer may take into custody any individual in which there is probable cause to believe, based on observations, that a person is, as a result of mental disorder, a danger to self or others, and continues to be during the time necessary to complete the petition screening procedures. Slide 97 97 Procedure for Civil Commitment Court Ordered If officers have probable cause to believe the person is inside their residence, and the person refuses entry by the officers, this pick-up order will be treated like an arrest warrant. A.R.S. 36-520 and 36-521 - Court ordered detention is possible if the person is likely, without immediate hospitalization, to suffer serious physical harm, or serious illness, or to inflict serious harm on another person. Slide 98 98 Civil Commitments Emergency If apprehension takes place on or about the premises of the apprehended person, the officer shall take reasonable precautions to safeguard the premises and the property thereon, unless such property and premises are in the possession of a responsible relative or guardian. A peace officer who makes a good faith effort to follow the requirements of this section is not subject to civil liability. (ARS 36-525) If apprehension takes place on or about the premises of the apprehended person, the officer shall take reasonable precautions to safeguard the premises and the property thereon, unless such property and premises are in the possession of a responsible relative or guardian. A peace officer who makes a good faith effort to follow the requirements of this section is not subject to civil liability. (ARS 36-525) Slide 99 99 Procedure for Civil Commitment If entry into the third party residence is not granted, a search warrant is required and may be written based on the order itself, as well as the information specified in the order. If entry into the third party residence is not granted, a search warrant is required and may be written based on the order itself, as well as the information specified in the order. Slide 100 100 Who Can Help? Yavapai County: Adult Protective Services- 877-767-2385 Adult Protective Services- 877-767-2385 Child Protection Services- 888-767-2445 Child Protection Services- 888-767-2445 Division of Developmental Disabilities Division of Developmental Disabilities Prescott-(928) 778-5290 Prescott-(928) 778-5290 Cottonwood-(928) 649-6883 Cottonwood-(928) 649-6883 Trauma Intervention Program (TIP)- 708-2009 Trauma Intervention Program (TIP)- 708-2009 Tri-City Partnership (928) 772-5048 Tri-City Partnership (928) 772-5048 Verde Valley Guidance Center-(928) 634-2236 Verde Valley Guidance Center-(928) 634-2236 Verde Valley Medical Center-(928) 634-2251 Verde Valley Medical Center-(928) 634-2251 West Yavapai Guidance Clinic-(928) 445-5211 West Yavapai Guidance Clinic-(928) 445-5211 Yavapai Regional Medical Center (928) 445-2700 Yavapai Regional Medical Center (928) 445-2700 Slide 101 101 Who Can Help? Family counseling and child guidance Family counseling and child guidance Victim / witness services Victim / witness services Social services / behavioral health Social services / behavioral health Substance abuse programs Substance abuse programs Adult Protective Services (APS) Adult Protective Services (APS) Child Protective Services (CPS) Child Protective Services (CPS) Division of developmental Disabilities (DDD) Division of developmental Disabilities (DDD) Local Guidance Clinic Local Guidance Clinic Local hospital Local hospital Slide 102 102 FIRST RESPONDER SMART CARD PROGRAM Tri City Partnership, in cooperation with local First Responders (Police, Fire and EMS,) have developed the First Responder Smart Card Program (FRSCP) This program offers a registration process, alerting First Responders that there is a Smart Card on site and an individual with special needs may be at the registered address. Slide 103 103 FIRST RESPONDER SMART CARD PROGRAM FRSCP includes training for First Responders on special needs, and how to better recognize and respond to an individual with special needs. This program also provides training for parents and providers on when to call first responders and what happens once the call is made. Slide 104 104 SMART CARD Please Print in English NAME DOB: ____________________ LAST, FIRST MIDDLE SPECIAL NEEDS DIAGNOSIS: TOPICS/ACTIONS TO AVOID: OFFICER SAFETY ISSUES: GUARDIAN/ RESPONSIBLE PARTY: NAME PHONE NUMBER(s) RELATION YAVAPAI REGIONAL MEDICAL CENTER 445-2700 WEST YAVAPAI GUIDANCE CLINIC 445-5211 JUVENILE DETENTION 771-3174 LOCAL POLICE AGENCY: _______________________ For more cards or information contact Tri-City Partnership for Special Children and Families (928)772-5048. Slide 105 105 SMART CARD Please Print in English NAME: DOB: ________________ LAST, FIRST, MIDDLE MEDICATIONS: DOSAGE: (PLEASE WRITE OUT THE SPECIFIC SPELLING) LIST PHYSICIANS/ COUNSELORS AND PHONE NUMBERS: ALLERGIES: BRIEF MEDICAL HISTORY: (LIST MAJOR MEDICAL EVENTS) DATE LAST UPDATED: For more cards or information contact Tri-City Partnership for Special Children and Families (928)772-5048. Slide 106 106 First Responder Smart Card Program Thank-you