Confrontational Avoidance Techniques (C.A.T)
Confrontational avoidance techniques help maintain relationships, reduce stress, preserve productivity, promote communication, and facilitate conflict de-escalation.
Confrontation Avoidance Techniques (C.A.T.)
Confrontation Avoidance Techniques are some common sense techniques used to calm down an agitated person. Avoiding confrontation is your responsibility as a Direct Support Professional. If the people you are providing services to could avoid such confrontations, they would not be living in a specialized residential setting. As the “trained” DSP, you are responsible for knowing how to calm a person down when they become upset or agitated about something. The better relationship you have with the person the better chance these techniques will work for you. Think of a time in the past where you were upset or agitated. If you needed someone to calm you down which would you choose? A complete stranger or someone you know well and feel comfortable with?
ALWAYS:
Reward “good” behavior a much as possible. When you see it...reward it!!!
Show care and concern daily; not just when a person becomes upset.
Actively listen. Stop what you are doing and pay close attention to the person.
Be fair, sometimes firm, and be consistent. It is important for all DSP’s to work together as a team to provide consistent treatment. This is the “key” to successfully teaching people appropriate social skills.
Get to know each person you provide services to. Learn their earliest signs of agitation so you can intervene at the beginning of the problem.
Look out for and avoid events or situations that may upset the person. Remember it is your responsibility to avoid confrontations. People who display challenging behavior on a regular basis may be living in this home to learn some appropriate ways to deal with their emotions. This will be an important part of your job.
Stay in control of yourself. Be aware of your voice tone and body language. If you show signs of anxiety, this may increase the person’s agitation.
WHAT TO DO WHEN AGITATION IS JUST BEGINNING:
(These techniques do not have to be done in the order they are listed....you will use whatever works “best”for that individual based on their challenging behavior and communication style)
Approach immediately and talk to the person. Find out what is going on. Let them know you are there for them to listen, help, and support them with their problem.
Remain calm and friendly. Keep that “positive attitude”. Stay in control of your actions.
Invite the person to sit with you, or stand with the person if they refuse to sit. Stay at eye level. If the person decides to sit down this tells you they are beginning to calm down.
Speak in a low, calm voice, slowly and clearly. Be aware of your voice tone. When people become upset, they do not think, listen, or focus clearly. If you remain calm and speak clearly, this will help the person respond and begin to calm down.
Ask what the problem is. If the person has good communication skills let them tell you what is upsetting them. Be supportive and try to help them with the problem if you can.
Do NOT: demand, command, argue, disagree, or make any threats.
Remember these are “beginning” signs of agitation. Getting “emotional” or “bossy” could make the situation worse.
Don’t bribe or promise what you can’t deliver. If you think you need to promise someone something to get them to calm down you will need to follow through with that promise.
Be patient. Time is on your side. Be available to take the time required to help the person calm down. It will take MORE of your time if you don’t!!!
WHAT TO DO WHEN AGITATION IS INCREASING:
(Just like the previous set of techniques, these do not have to be done in any certain order. Do what works best based on your relationship with the person you are trying to calm down.)
Speak in a calm, relaxed voice at low volume. Be a “role model” for remaining calm under pressure.
Show no emotion. Be polite and respectful. Don’t be overly “friendly” or show signs of becoming upset with the person. Try to stay “neutral”.
Continue to talk to the person, listen to them, and wait (be patient) for them to respond and start calming down.
Acknowledge how the person feels. Try to understand where they are coming from. Put the person first.
Never turn your back or walk away. If you must leave the area be very watchful and careful. Walk backwards away from the person if you need to. Try to not leave the person when they are agitated. Call for help from another DSP.
Do not disagree, argue, command, demand, or make threats. Again...this will only make the situation worse, especially if agitation is increasing. Stay in control of your own emotions and behavior.
Continue to “be patient” and do not give up working with these techniques, unless you are scared, and know the person will continue to escalate to the point of attacking someone, time is on your side.
Keep your body posture relaxed. Try not to show it if you are feeling tension. Remember your body language represents 55% of your communication.
Stand slightly to the side of the person, at an angle, face to face, maintaining eye contact. This is especially important if you feel or know the person has the potential to attack you physically. You are in a better position to move away from the person quickly by standing to the side of the person.
Stand at an arm’s length, plus a few inches away from the person. This goes along with the previous technique. As you stand to the side try to put yourself at a safe distance from the person. If they try to reach out, hit, or grab you will have time to move away.
Never corner the person and do not allow yourself to be cornered. Most people need space to move around if they are extremely upset or agitated (This is true for all of us). When someone is this agitated you need to make sure you always have an avenue of escape and don’t get yourself blocked into a corner or up against a surface. Making the person do or say something they don’t want to do may still make them feel cornered (psychologically). Cornering any person who is agitated, angry, or scared is highly dangerous.
AGITATION IS STARTING TO DECREASE:
Continue to observe the person or remain with the person until they are completely calmed down.
Involve the person in an activity (their choice!) before you have to leave the scene. Giving the person something to do that they enjoy will help take their mind off what was upsetting them. It may be okay to allow the person to sit quietly if that helps them calm down and you are sure the agitation is ending. You could also offer the person to do something “with” you if that is an option.
Do not blame, punish, or scold the person for the challenging behavior they just did. You did a great job using the C.A.T.’s to calm the person down. That was the goal. It is okay and normal for ALL of us to become agitated at certain times. Forgive the person and try to encourage appropriate behavior so you can reward them again. Stay positive in your actions!
It may be appropriate to talk to the person about their challenging behavior. This will depend on your relationship with the person and how well they understand what you are telling them. If they do understand what occurred, it may be a learning opportunity for the person. You can explain to them how their agitation affected you and others. Make sure you are calm and feeling supportive before talking to the person.
Document what happened. Remember if it isn’t written down....it didn’t happen!! DSP’s need to document in “detail” specifically what they did to help the person calm down. The more you share this information with others the more your co-workers will be able to be consistent in their interactions with the individual. This is especially important for people who cause challenging behavior. Don’t forget to include the “good news” too! There should be guidelines in place where you work for documenting these types of incidents.
Confrontation Avoidance Techniques are considered standard procedure unless the person’s individual plan of service has a Behavior Treatment Plan!
Crisis
What is a crisis or emergency situation?
A crisis or emergency situation is defined as: A situation in which an individual has a serious mental illness or a developmental disability and one of the following apply:
• The individual can reasonably be expected within the near future to physically injure himself, herself, or another individual, either intentionally or unintentionally.
• The individual is unable to provide himself or herself food, clothing, or shelter, or attend to basic physical activities such as eating, using the toilet, bathing, grooming, dressing, or walking, and this inability may lead in the near future to harm to the individual or to another individual. Remember this is not a typical behavior for the individual!
What to do in an emergency/crisis situation:
In a crisis/emergency the DSP has multiple responsibilities and must act quickly to de-escalate the situation, assist the individual to calm down, and ensure the safety of the individual and others who may be present. The DSP who has the best relationship with the individual will have a better chance of finding out what is wrong and helping the person calm down. Emphasis should be placed on using verbal and non-verbal communication including body language as the DSP approaches the individual. Attempt to find out what is wrong, listen carefully and non-judgmentally. This is the perfect time to use the Confrontation Avoidance Techniques (C.A.T.) and the Proactive Options which were covered earlier in this unit. Your approach and ability to listen respectfully will send a message of support, care, and concern. Individuals may become upset, anxious, or agitated for a variety of reasons. It could be a symptom of a mental illness; it could be as a result of a traumatic event that the individual experienced or a reaction to a medication. Investigating the cause or trigger for the agitation will occur after the DSP has successfully helped the person to calm down.
The Do's and Don'ts
The following guidelines will help you understand the “DO’S and DON’TS” for working with an individual who has become upset and could become violent or aggressive.
The Do's.pdfThe don't's.pdfMost of the time you will be successful in helping someone calm down by using the techniques that have been covered in this unit. Occasionally, despite your best efforts the individual may continue to display severe challenging behavior. DSP staff must work together as a team to protect others who are in the area and may be in danger of being injured. For example, one DSP will continue to try to talk with the individual to determine what is wrong while the second DSP works with the others in the residential setting to get to a safe area in the home. DSP staff should call emergency numbers and follow the emergency procedure that has been established for the home. DSP staff should receive training on the procedure which should include who to call, when to call, and the emergency phone numbers. Many agencies and mental health authorities have after hour’s emergency access to services and supports. For example at CEICMH 24-Hour Crisis Line Number: 517-346-8460 OR 911 go to any hospital or other setting that offers emergency care. The DSP will have to make a decision on who to call based on their observation of the situation and the risk of injury to the individual and others.
When to call 911:
DSP staffs should call the police or 911 for assistance when an individual has become so violent and/or aggressive that there is a serious risk of physical injury to self or others and the DSP staffs are unable to get other individuals to a safe place in the home. DSP staff should call law enforcement/police when there is a weapon and the individual is threatening to harm themselves or others. DSP staffs are not trained to remove a weapon from someone. There is a great risk of harm when trying to remove a weapon from someone who is agitated and upset. The police have received special training and should be able to respond in a way that prevents injury to all people involved/present. DSP staff should continue to talk to the individual until 911 arrives. Remember it is important to work Together as a team. Others in the residential setting may be alarmed, fearful, or upset by what is happening. DSP staff should provide support and reassurance to keep everyone as calm as possible.
What to do after the crisis:
Take time as soon as possible after the crisis to “unwind" or decompress. When you have been in an intense situation, adrenaline flows. Decompression means relieving pressure or to get things back to normal. You need to take some time to relieve the pressures created by the confrontation. If this is not done, the pressures or negative feelings may get worse until they interfere with your ability to work effectively with that person and / or others who live and work in the licensed residential setting. Before taking time to decompress make sure the confrontation is over. Has the person regained self-control? Has the environment returned to normal? The safety and well-being of the people living in the home is your first priority.
Debriefing
Debriefing occurs when the DSP staffs discuss what happened during an incident. Because everyone sees things from a different angle and we want to avoid another incident, this is an important follow-up to the crisis. Debriefing can also help staff decompress by sorting out thoughts and feelings about the incident. Other DSP staff can help you get a more complete and clear picture of what really happened. Discuss what happened before, during, and after the confrontation occurred.
Answer these questions during the debriefing:
• How did I feel before, during, and after the confrontation?
• What was the person doing before, during, and after the confrontation?
• What signs of agitation did I or others observe before the confrontation?
• What confrontation avoidance techniques & proactive options were used?
• What happened as a result?
• Did other staff assist? If "no" why?
• If "yes" was communication clear between staff? Were actions coordinated?
• Were other people present? Were they removed from the area/made safe?
• If the incident happened again, what would I do?
• How will this affect interactions with this individual in the future?
Debrief with the person involved in the confrontation, if appropriate, after he or she has calmed down and re-established self-control. All physical injuries, unusual behavior, and all actions by DSP staff to calm the individual must be documented on an Incident Report.
Documentation of agitated and aggressive behavior provides important information. Remember the DSP must be descriptive not evaluative when documenting. Write down what you see, not what you think those actions mean. Remember we all become angry sometimes and we almost always have a reason for our anger. Sometimes there is a real and legitimate reason and other times it is a matter of perception: what we thought the person was doing or saying to us. Our perceptions impact how we interpret others behavior and actions. Most of us have learned how to control our anger.
Many of the individuals we work with did not have the same opportunity to learn how to control their anger. The individual may be reacting to trauma they may have experienced or something in the environment or “fill in the blank”, whatever the trigger and there are many it makes sense to respond in a calm and compassionate manner.
Remember the individual is NOT attacking you although sometimes it may feel that way. The DSP has got to be careful to be professional and separate personal feelings and reactions, becoming angry, yelling or having threatening body language will not help. These types of reactions from a DSP could escalate a situation into a “Me against You” confrontation which won’t teach the individual anything and will damage the relationship between the DSP and the individual involved.
Are you familiar with the old saying “You catch more flies with honey than with vinegar?” Meaning be nice and you're more likely to get what you want, if the DSP treats people with respect and is a good role model then you will have very few problems and many great opportunities to assist people in positive ways.
Now that you have completed the Confrontation Avoidance Technique (C.A.T.) module, please proceed to take the test. To successfully complete the course, you must achieve a passing score of 80% or higher.