CRISIS INTERVENTION EAR MODEL/LOSS MODEL/LAST MODELadamhscc.org/pdf_adamhscc/en-US/CIT inservice 2016... · 2016-07-07 · LOSS MODEL In response to any call, officers should be aware

CRISIS INTERVENTION

EAR MODEL/LOSS

MODEL/LAST MODELSgt. Melissa Dawson #9115

EAU

PURPOSE

The following general guidelines will assist you

during an encounter with a person in crisis,

including special populations encounters.

LOSS MODEL

In response to any call, officers should be aware

that the situation may not be as straightforward

as dispatch has relayed

In a special populations encounter, the

individual may be experiencing pronounced

emotions or feelings (e.g., anxiety, paranoia,

despair, anger)

As an officer, you will not perform a clinical

diagnosis, but by applying the Loss model to the

situation, you should be able to determine a way

to engage, assess, and resolve the situation

LOSS MODEL

It describes four crisis profiles that reflect

identifiable characteristics that you can observe

and react to

The Loss model will allow officers to focus the

de-escalation efforts of the officer to address the

specific type of incident they are facing

The Loss model emphasizes observable

characteristics, not diagnostic or clinical

symptoms

FOUR CATEGORIES OF THE LOSS MODEL

SPO #1

1. Loss of Reality

2. Loss of Hope

3. Loss of Control

4. Loss of Perspective

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Effective Date: 2013/01/01 BAS 3-4 Crisis

Intervention

LOSS MODEL – LOSS OF REALITY (CONT.)

• Profile description

o Person may be frightened, confused, and have

difficulty concentrating or communicating

o The person may appear to be experiencing

delusions or hallucinations and the officer should

neither validate nor deny the existence of what the

person is experiencing

o Instead, officers should defer the issue of a person’s

delusions by acknowledging how the person’s view

of the situation must make them feel6


Intervention


• De-escalation goal

o Try to ground the person in the “here and now”

o Ask his/her name and use it

o Try to make eye contact

o Ask simple questions (e.g., “How are you

doing?”, “Do you take any medications?”, “How

are you feeling?”)

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Intervention


o Cut through the fear and confusion and get the

person to voluntarily comply with your request

o If the person is experiencing “command voices,” it

is especially important, for officer safety, for the

officer to be aware that the “voices” may be telling

the person to do something. Try to understand by

asking, “Are you hearing voices?” and if their

response is “Yes”, then ask, “What are they telling

you?”

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Intervention

LOSS MODEL – LOSS OF HOPE (CONT.)


o The person may be emotional, very withdrawn,

fatigued, feeling of being overwhelmed, suicidal

talk or gestures, crying, despair

o They may have strong feelings of being helpless,

hopeless, and worthless; they may have

experienced a recent loss

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Intervention

LOSS MODEL – LOSS OF HOPE (CONT.)


o Instill some hope within the encounter so that the

person can be persuaded to talk to someone or seek

help

o You should be prepared to address thoughts of

suicide as outlined later in this lesson plan and by

agency policy and procedures

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Intervention

LOSS MODEL – LOSS OF CONTROL (CONT.)


o This person may often be angry, irritable, or

hostile

o Can present themselves as victims (e.g., life is

unfair) and they do not feel listened to

o May be manipulative, impulsive, destructive, or

argumentative

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Intervention

LOSS MODEL – LOSS OF CONTROL (CONT.)


o Remain professional; do not take what they say

personally

o Be aware of signs, such as clenched fists, pacing, or

flushed cheeks, which may indicate potential

violence

o Attempt to calm the person by letting them vent

and using active listening skills

o When establishing trust within these encounters,

try to identify the source of the person’s anger12


Intervention

LOSS MODEL – LOSS OF PERSPECTIVE (CONT.)


o This person is anxious, worried, or nervous which

could escalate to feeling panicked

o Physical symptoms include trembling, shaking,

chest pain, and/or discomfort

o The person could also seem overly energetic or be

displaying extreme highs and lows (i.e., mood

swings) during the encounter

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Intervention

LOSS MODEL – LOSS OF PERSPECTIVE (CONT.)


o Bring the person’s energy down

o Calm the person’s anxiety through empathy and

patience

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Intervention

LARGE GROUP DISCUSSION

Worksheet #3 and Worksheet #4.

Large Group Discussion – Discuss as a whole.

THIS IS A FLUID MODEL:

The person in crisis may be

experiencing different model

profiles within one encounter

Examples??

SHOW THE FOUR LOSS VIDEOS

1. “Mark” (Mall preacher)

2. “Dwayne” (Bridge)

3. “Baseball bat”

4. “Sally in the kitchen”

Worksheet #5

DE-ESCALATION BASICS (HANDOUT #3)

Maintain officer safety

De-escalation decision tree – officers must make a

continuous threat assessment during a special

populations encounter to ensure everyone at the

scene is safe

Verbal de-escalation is a tool that officers can use to

take control of a situation

If any one is an immediate threat, officers must

use the objective reasonableness standard to

determine the amount of force necessary to gain

Compliance

(Covered in detail within OPOTC BAS 2-6 Civil Liability

& Use of Force)

If safety is not jeopardized and officers realize

they are in a special populations encounter,

officers should apply a de-escalation mindset

Remain alert

View the crisis as a medical encounter

FOSTERING A DE-ESCALATION MINDSET

Taking a less physical, authoritative, and

controlling approach to a special populations

encounter may increase the probability of a safe

resolution

Empathy and patience, It is important that

the officer appears calm, interested, confident,

and resourceful

EAR MODEL

SPO #2

Three Phases of a Special Populations Encounter

1. Engage

2. Assess

3. Resolve

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Intervention

EAR MODEL – ENGAGE (CONT.)

• Purpose of Engage – make a connection with the

person so you can calm him/her

• The first 10 seconds of a special populations encounter

are critical in setting the tone for de-escalation

• Remove distractions from the scene (e.g., people who

are upsetting the person, loud noises)

• Introduce yourself and ask for the person’s name

• State the reason why you are there and let them know

you are there to help

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Intervention


• If safety is not compromised, remember that special

populations encounters are medical encounters and

you should begin considering the Loss model profiles

• Ask questions (e.g., “Are you alright?” or “Is there

something bothering you?”)

• Vocalize about the subject’s observable characteristics

(e.g., “You look angry.” or “You look stressed.”)

• Ask the person “What help do you need right now?”

• Model calmness that you want the person to mirror

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Intervention


• In order to make a connection and calm the situation

during the Engage phase, you need to be empathetic

to the person’s situation or state of mind

• Individuals who feel they are understood are more

inclined to calm down

• Speak softly, simply, briefly, and move slowly

• If there is more than one officer present, have

someone take the lead in communicating and de-

escalating the situation to avoid confusion

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Intervention

EAR MODEL – ASSESS (CONT.)

• Purpose of Assess – gather the information you need about the situation and the person’s condition so that you can make the needed resolution

Remember, your threat assessment is continuous

If the encounter changes and there is an imminent risk of harm, use the objective reasonableness standard to determine the amount of force necessary to gain control of the situation

Recognize that the person may be overwhelmed by frightening beliefs, sounds, or other things in the environment

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Intervention


Be patient during the encounter

Check to see if a crime has been committed

If the person perpetrated a crime, your job is to gain control of the situation, which may include trying to de-escalate the person first and then investigate the crime second, provided that no one has been injured

Ask about medical history

Ask about and/or look for signs of drug or alcohol use (e.g., track marks, paraphernalia)

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Intervention


When warranted, talk to other people about the person’s medical history, current medications, and ongoing medical treatment

If you are dealing with a suicidal person, gauge the seriousness of the person’s intent using the LAST model

Be non-threatening, yet remain vigilant

A trained officer can conceal his/her combat ready stance while offering an empathetic tone of voice and appearing non-threatening

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Intervention


If there is more than one law enforcement officer present, the other one should provide cover

This cover officer should avoid engaging the subject, as speaking to more than one person may be confusing and/or agitating

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Intervention

EAR MODEL – RESOLVE (CONT.)

Purpose of Resolve – bring the encounter to a safe resolution and get the person to obtain the help that the person needs

The resolution usually depends on whether a crime was committed, if the person meets commitment criteria, and the availability of mental health and diversion resources

The decision matrix, using Engage and Assess, was developed to help officers guide their exercise of discretion

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Intervention

EAR MODEL – RESOLVE (CONT.)

Once you decide on a course of action, forecast your intentions to the person by telling the person what you are about to do or what will happen next (e.g., “I am going to ask you to come with me.” or “I am going to have to pat you down and check for weapons.”)

Limit the number of instructions you give at one time

If you have to use force, you can expect many special

populations people to have a high threshold for pain

and greater than normal strength

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Intervention

The EAR model is flexible in that the phases

may need to be reordered or may overlap as each

situation differs

LAST MODEL

Lethality of chosen method

Availability of chosen method – does the person actually possess the means to harm himself/herself?

Specificity of the plan – specific details about time, method

Timing – proximity of help

This model generally addresses individuals

contemplating suicide who are depressed

The large majority of suicide attempters do not

try again

Most people who commit suicide are ambivalent

about killing themselves

WHEN TALKING TO A PERSON CONTEMPLATING

SUICIDE, THE GOAL OF THE OFFICER SHOULD

BE…

SPO #3

… to get the individual to focus on the elements of his/her story causing the ambivalence (e.g., children,

spouse)

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Intervention

RESPONDING TO ARMED SUBJECT

THREATENING SUICIDE

Dangerous

Officer safety is paramount

Gaining control of the situation is critical

Threat assessment and availability of backup

De-escalation skills

RESPONDING TO ARMED SUBJECT

THREATENING SUICIDE(CONT.)

“Suicide by Cop”

Deadly force may be a first resort to stop a threat

Your threat assessment in the particular

circumstance is the basis for your actions

SUICIDE MYTHS

Myth – asking about suicide will plant the idea

in a person’s head

Fact – asking about suicide does not create suicidal

thoughts

Fact – the act of asking the question simply gives

them permission to talk about their thoughts or

feelings

Myth – people don’t talk about committing

suicide

Fact – most people who die by suicide have

communicated some intent

Fact – someone who talks about suicide gives

someone the opportunity to intervene before suicidal

behaviors occur

Myth – if someone really wants to die by suicide,

there is nothing you can do about it

Fact – most suicidal ideas are associated with

treatable disorders

Fact – if you can help the person survive the

immediate crisis, you have gone a long way toward

promoting a positive outcome

Myth – he/she really wouldn’t commit suicide

(e.g., made plans for a vacation, have young

children, made a verbal or written promise)

Fact – the intent to die can override any rational

thinking

Fact – someone experiencing suicidal intent must be

taken seriously

INDIVIDUALS UNDER THE INFLUENCE

Unpredictable

An individual can fall under any of the four Loss

categories as the alcohol or drugs may cause anger,

sadness, fear, or confusion

This group must always be viewed as a potential

threat

Withdrawal from alcohol is serious and can be

fatal

Symptoms usually occur within 72 hours of the last

drink

They include tremors, changes in mental function,

seizures

ENCOUNTERS WITH AN INDIVIDUAL THAT

APPEARS DRUNK OR DRUGGED :

First assess whether this is a medical emergency before attributing the behavior to the substance alone

Low blood sugar can mimic someone under the influence in that there may be a fruity or sweet odor on a person’s breath that is similar to alcohol

This person may also exhibit lightheadedness or slurred speech

EAR MODEL

Engage

Obvious signs of Alcohol/drug use

Repeat instructions as many times as you feel necessary.

Avoid arguing with a person under the influence of alcohol or drugs

ENGAGE

Recognize that you may not be able to reason

with a person under the influence of alcohol or

drugs (Skip to resolve stage)

ASSESS

Consider the person’s physical condition to determine whether the behavior is actually caused by other medical conditions (e.g., delirium, diabetic)

Ask questions to assist with this (e.g., “Have you eaten today?” or “Have you hit your head today?”)

Attempt to gain information from friends or family members

ASSESS

If you suspect drug use, you should look for track marks on a person’s arms or legs and the presence of drugs or drug paraphernalia

Note physical symptoms related to drug use like dilated (i.e., big) pupils or vomiting

Any person you contact who appears to be exhibiting the symptoms of withdrawal or delirium tremens (i.e., the shakes) is experiencing a medical emergency

RESOLVE

If you are unable to convince the individual to

respond to your directions, it is acceptable to use

force as you would with any non-compliant

subject

Get the individual to appropriate resources (e.g.,

jail, community programs)

Documents

CRISIS INTERVENTION EAR MODEL/LOSS MODEL/LAST MODELadamhscc.org/pdf_adamhscc/en-US/CIT inservice 2016... · 2016-07-07 · LOSS MODEL In response to any call, officers should be aware