Creative Strategies to Support Clients in a Crisis Cycle

Grafton’s Richmond facility has made significant progress towards becoming an environment fully free of physical restraint.  Grafton’s company- wide philosophy of focusing on comfort versus control includes the idea of treating all individuals with dignity, respect, and unconditional positive regard.  This means supporting them in learning about their own behavior and triggers, and utilizing creative, calming strategies to resolve difficult situations.

So how does a provider go about supporting individuals during a crisis cycle?

There are a number of therapeutic interventions that not only reduce safety risks, but also accelerate the de-escalation process when individuals are experiencing behavioral distress.

• For verbal individuals:
  • Attempt to change the topic to something they might be interested in.
  • Encourage the individual to verbally express how he/she is feeling or what has angered them.
  • Encourage/assist with problem-solving to identify a solution to the situation.
• For non-verbal individuals:
  • Offer a communication device and/or encourage use of communication strategies.
  • Avoid repeating phrases that include the negative and target behavior, such as, “Don’t bite/Stop hitting/Stop that.” The less words, the better during the crisis cycle.
  • Offer choices and present the client with a “first-then” board. For example, if the client is upset due to denied access to favorite activity or item explain that “first” the client must engage in a staff-directed activity (could be a calming activity like deep breathing) and “then” the client can obtain his/her desired item/activity.
  • Lessen the original demand and reward compliance with the lesser demand with immediate access to preferred item/activity. For example, if Client J wanted to listen to music, but was denied the music because it was time to participate in group, present the “first – then” board and reward the client for sitting for three minutes (enough time to allow compliance, but also catch the client “being good”) by allowing a break away from the group to listen to music for a timed duration. Then redirect the client back to the group and repeat the process.
  • Provide the client with space. If the client is unable to use a communication book or if visuals are not effective with the client, use objects to reiterate the message.
  • Give the client a sensory item if he/she is aggressive or model how to punch or bite a safe object. Sometimes, modeling can actually turn into an opportunity to utilize humor or distract the client.
• For all clients:
  • Attempt to engage the client in an alternative activity or invite him/her to help with a household task (i.e., help in kitchen).
  • Attempt to have other staff interact with the client (unless the client is upset with other staff person; in that case, remove that staff person) or utilize staff with whom the client has better rapport.
  • Practice reflective/active listening (e.g., “it sounds/seems like you’re feeling angry”, “I can see that you’re very upset. I’m here to help you”).
  • Attempt to remove the trigger.
  • Have the client move to another/quiet area to calm down.
  • Consider whether the situation has become a “power struggle” and adjust actions
  • Offer a break, walk, snack, shower, or other calming activity.
  • Decrease the demands on the client.
  • Speak to the client in a soothing/calming voice.
  • Encourage client to take deep breaths.

Effective interventions obviously vary among different individuals.  The overall goal, however, is to allow the individuals we serve to increase their self-sufficiency in working through challenging moments.  Our role as professionals is to utilize creative strategies that lead to independence, functional autonomy and community integration.