instructor: certified pmab trainer, scott lepine

Instructor: Certified PMAB Trainer, Scott Lepine

What is PMAB?

Cognitive Behavioral TheoryC.B.T.

Cognitive Thinking Errors

1. POWER THRUSTING (“My way or the highway”)

2. FALSE VIEW OF SELF (“I’m the best”)

3. UNREALISTIC EXPECTATIONS (“Good things will come my way”)

4. LACK OF PERSPECTIVE TAKING (“I’m the only one who counts”)

5. VICTIM STANCE (“Blaming”)

6. JUMPING TO CONCLUSIONS (“I wasn’t thinking”)

7. FAILURE TO BE STRAIGHT (“Liar liar!”)

8. AWFULIZING (“It’s all over!”)

Predisposing/Precipitating Factors of

Aggression

Summary

Communication During the Aggression Cycle

THE CYCLE OF AGGRESSION

PRE-CRISIS PHASERATIONALITYPhysiological

Increased heart rate, blood pressure, lung capacity and metabolism

Gastrointestinal changes

Behavioural

Low level agitation / muttering to staff / more active

Clenched fists, staring, tensing of body

Suddenly outgoing or quiet

Psychological

Listens and responds to direction

Reasoning capacity remains

CRISIS PHASE: IRRATIONALITYPhysiological

Maximum heart rate, blood pressure, lung capacity.

Metabolism and physical strength

Gastrointestinal changes

Behavioural

High level agitation, shouting, swearing, punching, kicking

Dangerous to self and others

Psychological

Will not listen or respond to direction

No reasoning capacity

angry

POST-CRISIS PHASE: RATIONALITYPhysiological

heart rate, blood pressure, lung capacity, metabolism and physical strength return to normal state.

Gastrointestinal functions return to normal.

Behavioural

Level of agitation slowly recedes

Body relaxes, high levels of tiredness/crying

Talkative or reclusive

Remorseful or defiant

Psychological

Reasoning capacity returns

Willing to listen

Respond to direction

NOTE: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 staff’s 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 Techniques

Calming 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 resident’s agitation

Pre-cr

isis

Open Questions

Listening Responses

Paraphrases

Stating Clear Expectations

Disarm Power Struggles

Timing Out

Humour

Distraction

Planned Ignoring

Reviewing Option, Choices and Outcomes

ChoicesOptionsInformation  

Positive Reinforcement

Negotiate (Win/Win)

Defusing TechniquesWhen to use:

In crisis phase before verbal behaviour becomes violent

Purpose:To de-escalate potentially violent situations without violence occurring

Crisis Phase

Defusing

Defusing

Preparation

Approach

What to Say

Light to Heavy

Physical Presence

Observation

Summary

The Art of Paraphrasing

The Art of Paraphrasing

Involves using fresh words to state back what the youth has just said.

The focus is on the situation or ideas rather than on feelings.

The Art of Paraphrasing

Paraphrasing has two important purposes:

First, it allows youths to know and feel that you are hearing them and that you want to try and understand.

Second, it usually prompts youth to continue expressing more thoughts and feelings about their

situation.

Be careful not to overuse paraphrasing, because it will seem gimmicky, ingenuine, and may become annoying

to the youth.

The Art of ParaphrasingThe Most Powerful

Communication ToolDefinition:

Paraphrasing is a necessary backup system to communication. It means to put the other person’s MEANING into your WORDS and give it back. As a power tool it does 14 things to improve your communication power.

1. You can INTERRUPT someone and not generate resistance.

2. You can take CONTROL of the encounter.3. You ‘get it right’ on the spot. We don’t’ always hear

well.4. The other can CORRECT you if you have mad en

error. Makes the other feel good, and is good for you.5. It MAKES the other a better LISTENER. No one will

listen harder than to his OWN point of view.6. It CREATES EMPATHY. The other will believe you are

trying to understand.

The Art of Paraphrasing

7. It often MAKES the other MODIFY his or her initial statements (become more reasonable) because her or she gets to hear his or her MEANING in different WORDS and tones.

8. It overcomes SONIC INTENION. People often think they have said something to you because they have ‘heard’ themselves say it in their mind. When you paraphrase, they hear what you have heard, not what they THINK they have said.

9. It can CLARIFY for those who may be standing nearby.10. It prevents METAPHRASE: the use of the ‘skewed

phrase’. The good paraphraser will never ‘put words into the other’s mouth’

The Art of Paraphrasing

11.Whenever you GIVE directions to others, insist THEY paraphrase back to you your meaning, 8 out of 10 people misunderstand the POINT of a verbal exchange. Protects you as manager/supervisor.

12.Whenever YOU take direction, it ensures you heard and interpreted correctly the other’s MEANING, PARAPHRASE BACK. The other may not have even said what he or she intended. Covers you from making errors. Makes you EFFICIENT and EFFECTIVE.

13.It reinforces your own memory. The mind remembers what the mind DOES. Your reports, written or oral, will be more concise and accurate.

14.It generates ‘THE FAIR PLAY’ response. You have listened and made an effort to understand the other. The other is almost forced

The Art of Paraphrasing

Physical Restraints&

Legislative Expectations and

Residential Child Care Experience

Excited Delirium and Risk of Positional

Asphyxia

Excited Delirium and Positional Asphyxia

Excited Delirium and Positional Asphyxia

http://blutube.policeone.com/police-training-videos/935602325001-excited-delirium/

Written Theory TestGOOD LUCK!

Scott.lepine@parnipcas.org