Crisis Prevention and Intervention

People who have sustained a brain injury can often be combative as they reorient to the world around them and become aware of their deficits.

If a behavioral crisis situation does occur, staff should be equipped with techniques to calm the client, decreasing the likelihood of injury to himself and others.

The Assault Cycle

Each client has specific responses to stress that can be recognized as predictable patterns. These patterns can be divided into five separate phases: triggering event, escalation, crisis, recovery, and post-crisis depression. This is known as the assault cycle. The triggering event is any stimulus that exceeds the client's tolerance for stress. For example, demands for compliance. Any prevention techniques have to occur before the triggering event. The escalation stage is characterized by increasing levels of agitation. De-escalation techniques are used during this phase to try to help the client return to normal levels of behavior. The crisis stage is characterized by the client becoming combative. At this point, physical intervention may be necessary. During the recovery phase, the client's level of activity is decreasing. Post-crisis depression is characterized by activity that falls below normal levels. The client may require a rest, or less active tasks, until he recovers.

There are many techniques for preventing a crisis situation or intervening once it has started.

Monitor body posture, tone of voice, content of speech, and use of gestures. To prevent a crisis situation, increase rest time, keep the environment simple, keep instructions simple, give feedback and set goals, stay calm and redirect, provide choices, decrease the person's chance of failure, vary type of activities, over-plan, and use task-analysis.

Once the escalation phase has begun, staff responses change from prevention to intervention. Some of the most effective de-escalation techniques include active listening, orientation to time and place, setting limits, redirection, and withdrawal of attention. Active listening incorporates a variety of listening skills, such as paraphrasing, clarifying, and perception checking.

Orienting a client to the time, location, and to whom he is with, can sometimes help to calm the individual.

Setting limits can be useful for clients who are trying to intimidate by threatening behavior. Staying calm and redirecting a client to another task or activity can also interrupt the escalation phase.

Withdrawal of attention is usually more effective with manipulative types of behavior.

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