Before getting too deep into this second part on crisis intervention with youth, I want to remind the reader that this is far from an exhaustive treatment of things to know. I’m sure one point I make here could easily be dedicated to a full chapter in a book on the subject. This is really basic, and I would encourage anyone reading this to study for themselves and, more importantly, align themselves with the nearest veteran staff member working in your program/unit/facility/school. The perspective of a veteran staff with a rep for doing good work is invaluable and more often than not the ideal example to follow.
Read this scenario. This is a textbook example of how a crisis might start in your setting.
“Danny, can you take a seat?”
“Don’t fuckin talk to me.”
“Ok, but you can’t stand in the middle of the classroom while I teach math.”
“FUCK this CLASS.” (Pushes books off of your desk)
I want you to re-read that and really imagine it. I want you to note how the situation made you feel and what you thought. This is what will inform your decisions, and your decisions can make this easier or way more difficult. I want you to think about whether you imagined “Danny” as white, black, latino, Asian, or any other background. I want you to note whether or not you imagined this young person as big or small, athletic, skinny, or fat. I need you to consider all of this because your expectations will alter your choices.
I also want you to note whether you took it personal. If you take it personal, you will not be effective.
To be truly effective you have to have a lot of background knowledge. I said in part one that you should already know the objectives and guidelines of the organization you work for, what the rules and expectations of the classroom/unit are, what the enforceable consequences are and what qualifies in your organization as aggressive behavior. You should know the case history of the young person if that is possible. You should have some familiarity with family and community issues. The more you know, the better chance you have at making decisions that don’t blow up in your face. Even knowing how the weather might be affecting your clients is valuable. Our clients got restless around winter and the holiday season. The times that are stressful for the rest of us can impact youth with emotional problems much more significantly.
In a public school, a teenager sweeping the books off of a teacher’s desk in a threatening manner would be a huge deal. It was a huge deal in the schools I worked in, but for us, detention, suspension, and expulsion were not options. We had to deal with these situations and attempt long-term strategies to change the behaviors so that this young person might become a functional adult. In the program I worked in, we were also authorized to use physical restraint-a “last resort” decision that sometimes was the only option when things went south badly.
Time and Space
If you are too angry to be rational, do you want to have conversation with a manager at work that is always enforcing rules and checking up on you to make sure you are doing your job? The answer is obvious. These clients often have a difficult time trusting adults because the adults have failed them. In some cases, adults have severely abused them physically, sexually, or through neglect. They have been made promises that have ended up broken. They have learned that authority figures like teachers, case managers, police officers, magistrates and judges are only present to crack down on them.
Giving a young person time to calm down (note: do not EVER use the phrase “calm down.” It comes off as condescending and only makes people more aggravated) and space away from you or others can start to de-escalate the situation. There must be boundaries to this, however. For example the young person can stay in THIS room with me and one other staff member. When he calms down enough, we’ll ask if he wants some water just to feel out how he is responding. We issue directions only with the goal in mind of helping the young person to get calm and collected. If there is no need to touch him, DO NOT touch him. If talking to him about your expectations will agitate him, don’t. Just have the plan in mind. But be ready to change the plan if necessary. Holding on to a plan concretely can cause some problems.
In the above situation, I might start with asking “Danny” if he would please just leave the room so that the rest of the clients could have math class. Obviously, this doesn’t always work, especially if you haven’t caught on to the problem in time (there are a lot of distractions in a classroom). Next I might have other staff escort the remaining clients out of the space to take away the audience. If the client doesn’t want a major situation, then he will stay in the classroom alone. If he makes a move for the door (which you and at least one other staff member should be standing at, ready, anyway), then obviously you have to physically intervene (remember to ask yourself if this is allowable in your organization. Don’t put yourself in a bad legal situation or in the unemployment line because you didn’t think things through.) He may amp up as soon as I start making directions, and depending on what he is doing we may have to move in and limit his space. We need to send a message that this isn’t ok and we won’t stand for it, but we’re not just moving right into using force. And if he starts getting physical, then your restraint training will be necessary. Be keenly aware of the rules for this and the physical safety of the client and others around you.
I hope you are noticing how many different twists and turns this all takes. That’s why I say not to be bound to the plan. Being aware of multiple strategies, multiple possibilities, not taking it personally and keeping safety as the number one objective is all crucial. Otherwise, you are making your job impossible and creating dangerous circumstances for yourself and everyone working with you, as well as the clients you are serving.
There is a range of physical interventions that are appropriate for dealing with these kinds of situations. As I said before, if touching the client isn’t absolutely necessary, don’t. If you do touch him, then be ready to get really physical really fast. You are probably dealing with a trauma survivor. It’s possible that touch can trigger a traumatic reenactment and push the client even further into aggressiveness and irrationality.
But you have boundaries and a right to protect them, for sure. It should ideally start with a verbal command and an assertion of what you feel your boundary is. The client should be made clear what he is allowed to do.
“Danny, you have this whole room to use if you need, but I can’t let you in my space. You need to back up.” If the client is amped up, pacing, you are likely standing at this point anyway. If you are, you may want to position yourself in a way that makes it easier to respond to whatever happens next. You may want to take a step back with one foot, leaving one side of your body more forward than the other (my right side is dominant, but I always step back with the right as a habit of martial arts training. I feel more comfortable with my strong side “chambered,” even though I don’t intend to use any strikes at all). I don’t raise my hands to chest level unless the client is close, so if I can I keep my arms extended with my hands no higher than my belt-line. High hands can signal a desire to fight, or make an excuse for the client to become more aggressive. Stepping back as opposed to stepping forward implies that I don’t want a conflict, but I’m wary of what is happening and readying myself.
If the client has gotten too close, I may use my left forearm and open palm against his chest with a firm command “You need to get out of my space right now.” I don’t mention the restraint. That’s a challenge that leads to more physical aggression. I don’t have to make eye contact with him to see him. I may keep my eyes trained on his chest or at the wall or floor keeping him tracked in my peripheral vision. Meeting eyes is a challenge as well. Being mindful of all the non-verbal communication is really important, because you can set yourself up for an unnecessary altercation by looking through to the back of a client’s head because he just called you a bitch.
Often when we become frustrated we take in a deep breath and let out a heavy sigh. It’s just this kind of breathing we should practice in times of calm and use as soon as situations begin to get stressful. We’ll be more likely to maintain level-headedness despite the dump of adrenaline, which often leads to a dry mouth, spaghetti noodle knees, a shaky voice and even shakier hands. At least that’s what happens to me. These symptoms can be frustrating for someone used to that adrenaline dumb since they appear to be signs of fear. Looking fearful can be a button that an aggressive person uses to push and manipulate you. Breathing can still help to keep you rational enough not to make major errors in your tactical thinking. You will likely be getting called every name imaginable, threatened, and eventually even assaulted, and you can’t afford to let upset be the major motivating factor in how your intervention plays out.
In the program I worked for, we were trained in TCI-Therapeutic Crisis Intervention, which has it’s own approved restraint techniques. Make sure you know well what is trained in your program and do your best not to deviate from that training. I am often asked if I used my martial arts training in this kind of work. Aside from being physically more fit and acclimated to physical aggression, I always answer, emphatically, “no.” Obviously striking is 100% unacceptable. Joint locks could lead to major injuries, and throws on a concrete floor could kill a client. I think I reacted quickly because of the training I received, and could change what I was doing relatively easily in response to whatever the need was, but knowing how to hurt people was only useful in helping me know what NOT to do at work. Sensitivity training was useful though, because you could tell what someone was intending to do based on how they moved against you. It’s important to know the difference between an attempt to scratch an itch and an attempt to grab a handful of skin from your abdominal region.
I won’t advise anymore on physical intervention because your organization will have it’s own rules regulating the use of physical intervention. Know them, follow them, and do what you can (within reason) to prevent needing to use them. But when you have to use them, don’t be hesitant. That can lead to injury for you or the client and make the situation more explosive.
In the aftermath of a physical intervention it’s important to debrief with a client, peers, and supervisors to review what worked, what didn’t work, and what everyone can do differently in the future to prevent the need for a physical intervention. The debrief with the client is separate from the one with coworkers, even if all of your co workers were present during the crisis and the debrief with the client.
Debriefing with the client might look like this:
“Ok Danny, can you tell me what happened?”
“I was mad about what Steven said to me in the bathroom so when I came to math I wanted to fight someone.”
“Ok. What did Steven say to you that made you want to fight?” (This statement reflects that I heard what he has already said)
“He said I looked gay in the shirt I’m wearing.”
“Oh…that really bothered you, huh?”
“Nah, not really, but when I tried to leave the bathroom he touched my arm and I told him don’t do no shit like that.”
“Do you think you handled this the best way you could have?”
“What could you have done differently?”
“Asked you to let me sit in the hall until I calmed down.”
“Do you feel comfortable telling me what’s going on before we have a problem?”
“Can we try that next time?”
“Ok. Now you know this situation was serious. You will have to deal with the consequences of what happened. I don’t want to hold this against you for long though, but we have to be fair.”
“Ok. So in the future what can you do?”
“Tell you what’s going on and ask to leave the classroom til I calm down.”
That is really oversimplified, but essentially what a debrief with the client looks like. It is to ensure that all parties are on the same page, understanding what is expected going forward and united towards the same goals. It certainly doesn’t always go smoothly and depends a lot on rapport between client and staff.
Debriefing with colleagues looks similar. What happened? What can we do differently? How can we prevent this? Who else can help? What is our plan for tomorrow when Danny and Steven see each other? What other staff members need to be informed so they can be prepared as well? Are you okay? How can we help you next time? This is also a good time to own up to mistakes. This builds trust with colleagues and lets them know you are invested in what they are trying to accomplish with their clients.
Again, this is too brief to really do justice to the topic, but I think it provides the reader with a good place to start. Again, genuine care for the job and the clients, being aware of your organization’s expectations, rules and policies, knowing when to talk, when to shut up, when to give space or limit it, and the appropriate physical interventions is all key to success working with young people who are severely emotionally disturbed.