1

Communication and

interaction training (CAIT):

De-escalation skills

Ian A. James, Roberta Caiazza

& Associates

Warning - DVD involves use of the ‘F’ word

Stepped Care Model

Step 4: Formulation-led interventionsIndividualised assessment, formulation and intervention (Specialist teams)

Step 3: Protocol-led interventionsInterventions tailored to specific presentations and needs

(Experienced practitioners/CPNs)

Step 2: Assessment and treatment of causesThorough assessment & good practice in care environment (Carers/GP)

Step 1: Recognition

Identification of difficulties, physical health & initial monitoring

(Carers/GP)

Treatment strategies

BtC

* Tranquilisation

& sedation to

reduce activity

Drug treatment for

a physical/mental

health cause

Environmental

modification

Care

practices

Psychological –

Reactive vs

Preventative

Carer-centred

Person-

focused

strategies

Magic bullet

4

AimsCarper 1978 – ‘Problem with nursing as a

practice discipline’

• Nurses know more than they can

communicate

• What nurses know has not been

communicated well

Help you become aware of what you do, and

enable you to articulate this! (Strength-

based relationship training)6

7

Vocalisation

AppearanceBehaviour

Mental health

Physical health

Social

Environment

Cognitive

abilities

Life story

Need

Medication

Functional

assessment

features

Personality

Background

status

Formulation Template (James, 1999)

Trigger

Therapies

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Communication skills

Long List of do’s and don’t’s

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Mac Model plus…….

13

Law enforcement

Emotions

• Sad

• Disgust

• Fear

• Surprise

• Anger

• Happy

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R

MA

RAM Steps – scenarioR

• Reduce the feelings; Recognise &

empathise with the person’s situation

A

• Assess situation and need - ask questions;

Summarise situation.

M

• Give person what wants; if can’t do that

reach an acceptable alternative16

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Customer service skills Three important rules

1. You cannot reason with an angry person. The first and only initial step is to reduce

his/her level of arousal so you can talk.

2. You may need to repeat these steps several times before the person calms down

3. You will need to practice the approach because it is a difficult skill to do well

4. R – reduce emotion; A – assess need; M –meet need.

Reducing emotion: Identify and reduce the emotional energy

Empathise with the person’s situation

Assess the need: Summarise his situation to show you understand him

Identify whether you can meet his need

Meeting the need: If possible, meet the need? If not, reach an acceptable alternative

Carer centred, Person focused

• Tolerate (changing carers’ perspectives)

• BANGS (rather be happy than right)

• Needs Hierarchy

– Meet need

– Simulate/Validate need

– Distract

– Therapeutic lie