Assumptions Alternatives Take Action In Memoriam

Information on this page provided courtesy of NASMHPD

Develop a Crisis Prevention Plan

What is a Crisis Prevention Plan?
  • An individualized plan developed proactively by consumer and staff before a crisis occurs
  • A therapeutic process
  • A task that is trauma sensitive
  • A partnership of safety planning
  • A consumer-owned plan written in easy to understand language
Why are They Used?
  • To help consumers during the earliest stages of escalation before a crisis erupts
  • To help consumers identify coping strategies before they are needed
  • To help staff plan ahead and know what to do with each person if a probelm arises
Essential Crisis Plan Components
  • Triggers - Something that sets off an action, process, or series of events:
    - Being Touched
    - Yelling
    - A Certain Time of Day
    - Loud Noise
    - Being Isolated

  • Early Warning Signs - A signal of distress that is a physical precursor and/or manifestation of upset. Some signals are not obersvable, but some are, such as:
    - Restlessness
    - Agitation
    - Pacing
    - Shortness of breath
    - Sensation of a tightness in the chest
    - Sweating

  • Strategies - Individually specific calming mechanisms to manage and minimize stress, such as:
    - Time away from a stressful situation
    - Going for a walk
    - Talking to someone who will listen
    - Working out
    - Lying down
    - Listening to peaceful music

Calming Strategies (Sensory Approaches)

Understand Sensory Experience, Modulation, and Integration
  • Incorporate knowledge of sensory input and expertise of Occupational Therapy
  • Assesss the sensory diet of each person served
  • Identify sensory-seeking and sensory-avoiding behaviors
  • Sensory Input (5 well-known senses and 2 "hidden" senses):
    - Sight
    - Sound
    - Smell
    - Touch
    - Taste
    - Proprioception
    - Vestibular input
Sensory-based Approaches
  • Physical Activities :
    - holding
    - weighted blankets
    - arm & hand massage
    - push-ups
    - "tunnels" / body socks
    - walk with joint compression
    - wrist / ankel weights
    - aerobic exercise
    - sour / fireball candies
    - rocking in a rocking chair

  • Calming self-soothing activities:
    - hot shower/bath
    - wrapping in a heavy quilt
    - decaf tea
    - wrapping in a heavy quilt
    - beanbag tapping
    - yoga
    - drumming
    - meditation
    - reading a bood
    - molding clay
    - talking to a family member or friend
    - jokes
Calming and Grounding Alternatives
  • Convert a seclusion room by offering:
    - A Cuddle Swing
    - Rock Climbing Wall
    - Velcro Wall
    - Mini-trampoline

  • Simple Sensory Enhancements - Add calming, attractive features:
    - Art work; murals
    - Plants
    - Curtains
    - Music
    - Comfortable seating
    - Bedrooms with new bedspreads
    - Place to exercise
    - Low lighting (dimmer switches)
    - Pleasant aroma

  • Other Enhancements to a calming room:
    - lava lamps
    - fish tanks
    - bouncy balls
    - stuffed animals

De-escalation (Therapeutic Intervention)

Techniques that help counter aggression/violence that can lead to SR
  • Assess the situation promptly. If you see signs and symptoms of a person entering into crisis, intervene early
  • Maintain a calm demeanor and voice
  • Use problem solving with the individual -- ask "What will help now?"
  • Be empathetic. Offer to help
  • Reassure individual that no harm will come to him or to others
  • Avoid an argumentative stance. Give the individual time to think
  • Use stress management or relaxation techniques such as breathing exercises.
  • Don't crowd the individual; give him or her space.
  • Offer choices.
  • Ignore challenges; redirect challenging questions.
  • Tell them what you can do to help them.
  • Allow venting and pacing.
  • Avoid power struggles. Don't say "you must."
  • Be clear; use simple language.
  • Agree to disagree.
  • Be willing to break the rules.
Story of Successful Crisis Planning - Susan
  • A 21 year old woman with a diagnosis of Bipolar Disorder and history of sexual abuse finds bedtime frightening. This is the time where she becomes the most vulnerable and agitated.
  • Warning Signs: Susan starts to sing loudly, stops listening, and interacts aggressively with other clients.
  • Effective Strategies: Susan is not made to go to bed. She built a protective structure out of cardboard. She was given a flashlight and can watch tv in the day hall til she is tired.
  • Institutional Obstacles: Rules have been more important than individual support.
Story of Successful Crisis Planning - Henry
  • A 60 year old developmentally disabled man who wanders, becomes combative and is a fall risk
  • Effective Strategies: Henry is given a baby doll to hold. He refused to get out of his chair until he handed the doll to another person because he wanted to keep her "safe" thereby alerting staff and decreasing risk of falling.
  • Other Effective Strategies: When agitated, given a soft Teddy Bear that had been warmed in the microwave.
  • Benefits: Integrated response to restraint and fall risk.
Story of Successful Crisis Planning - Michael
  • A very large 40 year old man with psychotic and anti-social disorder in a forensic hospital for assaultive behavior. He is not able to verbally process but does admit to "bad thoughts." Due to a history of and reliance upon extensive restraint use, Michael would precipitate situations in which he was restrained and seemed to rely on such containment.
  • Effective Strategies : Staff made a deal with him to use a "vibrating pillow" in exchange for restraints. Michael liked the softness, buzzing sound and motion of the pillow. He couldn't idenify warning signs but would ask staff to use the pillow if needed.
  • Historical Experience : One of the highest "users" of restraint and considered "untreatable."
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