Download TITLE: Crisis Intervention EAR Model/Loss Model/Last Model

COURSE INFORMATION AND INSTRUCTOR PREPARATION
TITLE:
Crisis Intervention EAR Model/Loss Model/Last Model
HOURS:
Three (3)
GOAL:
Provide the student general guide lines to assist a person who is in
crisis, including special population’s encounters
TEACHING AIDS: Dry erase board, AV Equipment, Practice Exercise, handouts,
lectern
INSTRUCTIONAL TECHNIQUES: Lecture, Group Discussion
STUDENT MATERIALS:
Handout #1 De-Escalation Decision Tree
Practice exercise
Test
REFERENCES
Peace Officer Basic Training Crisis Intervention Unit 3 – Topic 4, Ohio Peace Officer
Training Commission
STUDENT PERFORMANCE OBJECTIVES
At the end of this topic, the student will be able to:
1. Describe the four categories of the Loss Model.
2. Identify the three phases of a special populations encounter.
3. Describe the goal of an officer when talking to someone contemplating suicide.
I.
INTRODUCTION
A.
Instructor Introduction
1. Instructor
INTRO SLIDE
Slide #1
INFORMATION ON
BOARD
2. Course
B.
Purpose of Course
1. Recognize that law enforcement encounters with special
populations who are in crisis are sometimes unpredictable.
Purpose
Slide #2
2. Recognize ways to engage a person in crisis utilizing the
EAR, LOSS or LAST model.
C.
SPOs
1. Describe the four categories of the Loss Model.
LIST OF SPOs
Slide #3
2. Distinguish the EAR Model’s three phases of a crisis
encounter.
3. Describe the goal of an officer during an encounter with a
suicidal person.
II. PRESENTATION
A. Loss Model
Slides # 4 & 5
1. Officers should be aware that the situation may not be as
straight forward as dispatch has relayed.
2. In a special populations encounter, the individual may be
experiencing pronounced emotions or feelings.
3. Determine a way to engage, assess, and resolve the
situation.
4. Four crisis profiles that reflect identifiable characteristics
that you can observe and react to.
5. The Loss model will allow officers to focus the deescalation efforts of the officer to address the specific type
of incident they are facing.
6. It emphasizes observable characteristics, not diagnostic or
clinical symptoms.
B. Four categories of the Loss Model
1. Loss of Reality.
2. Loss of Hope.
SPO #1
Slide #6
3. Loss of Control.
4. Loss of Perspective.
C. Loss of Reality.
1.
Profile description
Slide # 7
a. A person may be frightened, confused, and have
difficulty concentrating or communicating.
b. 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.
c. Officers should defer the issue of a person’s delusions
by acknowledging how the person’s view of the
situation must make them feel.
d. The person may be emotional, very withdrawn,
fatigued, feeling of being overwhelmed, suicidal talk or
gestures, crying, despair.
e. They may have strong feelings of being helpless,
hopeless, and worthless; they may have experienced a
recent loss.
2.
De-escalation goal.
a. Try to ground the person in the “here and now”
b. Cut through the fear and confusion and get the person
to voluntarily comply with your request.
c. If the person is experiencing “command voices,” it is
important, for officer safety, for the officer to be aware
that the “voices” may be telling the person to do
something.
Slide #8 & 9
D.
Loss of hope.
1.
Profile description
Slide #10
a. The person may be emotional, very withdrawn,
fatigued, feeling overwhelmed, crying, in despair, or
presenting suicidal talk or gestures.
b. He/she may have strong feelings of being helpless,
hopeless, and worthless; he/she may have experienced
a recent loss.
2.
De-escalation goal.
a.
Instill some hope within the encounter so that the person
can be persuaded to talk to someone or seek help.
b.
You should be prepared to address thoughts of suicide.
Slide #11
E. Loss of Control
1.
Profile description
a.
This person may often be angry, irritable, or hostile
b.
Can present themselves as victims.
c.
May be manipulative, impulsive, destructive or
argumentative
Slide #12
.
2.
De-escalation goal
a. Remain professional; do not take what he/she says
personally.
Slide #13
b. Be aware of signs, such as clenched fists, pacing, or
flushed cheeks, which may indicate potential
violence.
c. Attempt to calm the person by letting him/her vent;
use active listening skills
d. When establishing trust within these encounters, try
to identify the source of the person’s anger;
acknowledge the emotions and give directive.
F.
Loss of Perspective.
1.
Profile description
Slide # 14
a. This person is anxious, worried, or nervous which could
escalate to feeling panicked.
b. Physical symptoms include trembling, shaking, chest
pain, and/or discomfort.
c. The person could also seem overly energetic or be
displaying extreme highs and lows.
2.
De-escalation goal
a. Bring the person’s energy level down
b. Calm the person’s anxiety through empathy and
patience.
Slide #15
Slide 18 - 20
G. This is a fluid Model
Slide # 16 large group
discussion
Slide # 18 Videos
H. EAR model
Slide #17
1. Three phases of a special populations encounter
a.
Engage
SPO #2
Slide #23
b. Assess
c. Resolve
I.
Ear Model – engage
1. Purpose of Engage – make a connection with the person so
you can calm him/her
2. The first 10 seconds of a special populations encounter are
critical in setting the tone for de-escalation
3. Remove distractions from the scene (e.g., people who are
upsetting the person, loud noises)
4. Introduce yourself and ask for the person’s name
5. State the reason why you are there and let them know you
are there to help
6. If safety is not compromised, remember that special
populations encounters are medical encounters and you
should begin considering the Loss model profiles
Slide 24 - 30
7. Ask questions (e.g., “Are you alright?” or “Is there
something bothering you?”)
8. Vocalize about the subject’s observable characteristics
(e.g., “You look angry.” or “You look stressed.”)
9. Ask the person “What help do you need right now?”
10. Model calmness that you want the person to mirror
11. 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
12. Individuals who feel they are understood are more inclined
to calm down
13. Speak softly, simply, briefly, and move slowly
14. If there is more than one officer present, have someone
take the lead in communicating and de-escalating the
situation to avoid confusion
15. EAR model – Assess
16. Purpose of Assess – gather the information you need about
the situation and the person’s condition so that you can
make the needed resolution
17. Remember, your threat assessment is continuous
18. 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
19. Recognize that the person may be overwhelmed by
frightening beliefs, sounds, or other things in the
environment
20. Be patient during the encounter
21. Check to see if a crime has been committed
22. 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
23. Ask about medical history
24. Ask about and/or look for signs of drug or alcohol use (e.g.,
track marks, paraphernalia)
25. When warranted, talk to other people about the person’s
medical history, current medications, and ongoing medical
treatment
26. If you are dealing with a suicidal person, gauge the
seriousness of the person’s intent using the LAST model
27. Be non-threatening, yet remain vigilant
28. A trained officer can conceal his/her combat ready stance
while offering an empathetic tone of voice and appearing
non-threatening
29. If there is more than one law enforcement officer present,
the other one should provide cover
30. This cover officer should avoid engaging the subject, as
speaking to more than one person may be confusing and/or
agitating
31. When warranted, talk to other people about the person’s
medical history, current medications, and ongoing medical
treatment
32. If you are dealing with a suicidal person, gauge the
seriousness of the person’s intent using the LAST model
33. Be non-threatening, yet remain vigilant
34. A trained officer can conceal his/her combat ready stance
while offering an empathetic tone of voice and appearing
non-threatening
35. If there is more than one law enforcement officer present,
the other one should provide cover
36. This cover officer should avoid engaging the subject, as
speaking to more than one person may be confusing and/or
agitating
J.
EAR model – Resolve
1. Purpose of Resolve – bring the encounter to a safe
resolution and get the person to obtain the help that the person
needs
Slide 31 & 32
2. 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
3.
The decision matrix, using Engage and Assess, was
developed to help officers guide their exercise of discretion
4. 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.”)
5. Limit the number of instructions you give at one time
6. 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
Slide 33 &34
K. LAST model
1. Lethality of chosen method
2. A – Availability of chosen method – does the person
actually possess the means to harm himself/herself
3. S – Specificity of the plan – specific details about time,
method
4. Timing – proximity of help
5. This model generally addresses individuals contemplating
suicide who are depressed
6. The large majority of suicide attempters do not try again
7. Most people who commit suicide are ambivalent about
killing themselves
L. When talking to a person contemplating suicide, the goal
of the officer should be to:
SPO #3
Slide #35
1. To get the individual to focus on the elements of his/her
story causing the ambivalence
M. Responding to armed subject threatening suicide
1. To get the individual to focus on the elements of his/her
story causing the ambivalence
2. Officer safety is paramount
Slide #36
3. Gaining control of the situation is critical
4. Threat assessment and availability of backup
5. De-escalation skills
6. “Suicide by Cop”
Slide #37
7. Deadly force may be a first resort to stop a threat
8. Your threat assessment in the particular circumstance is
the basis for your actions
N. Common suicide myths and facts
1. Myth – asking about suicide will plant the idea in a person’s
head
Slide #38
2. Fact – asking about suicide does not create suicidal
thoughts’
3. Fact – the act of asking the question simply gives them
permission to talk about their thoughts or feelings
4. Myth – people don’t talk about committing suicide
5. Fact – most people who die by suicide have communicate
some intent
Slide #39
6. Fact - Someone who talks about suicide gives someone the
opportunity to intervene before suicidal behavior occur
7. Myth – if someone really wants to die by suicide, there is
nothing you can do about it
Slide #40
8. Fact – most suicidal ideas are associated with treatable
disorders
9. Fact – if you can help the person survive the immediate
crisis, you have gone a long way toward promoting a
positive outcome
10. Myth – he/she really wouldn’t commit suicide (e.g., made
plans for a vacation, have young children, made a verbal or
written promise)
11. Fact – the intent to die can override any rational thinking
Slide #41
12. Fact – Fact – the intent to die can override any rational
thinking
O. Individuals under the influence
Slide #42
1. Unpredictable
2. An individual can fall under any of the four Loss categories
as the alcohol or drugs may cause anger, sadness, fear, or
confusion
3. This group must always be viewed as a potential threat
4. Withdrawal from alcohol is serious and can be fatal
Slide #43
a. Withdrawal from alcohol is serious and can be fatal
b. Withdrawal from alcohol is serious and can be fatal
P. Encounters with an individual that appears drunk or drugged
Slide #44
1. First assess whether this is a medical emergency before
attributing the behavior to the substance alone
2. 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
3. This person may also exhibit lightheadedness or slurred
speech
a. EAR model
Slide #45
1. Engage
2. Repeat instructions as many times as you feel
necessary.
3. Repeat instructions as many times as you feel
necessary.
4. Recognize that you may not be able to reason with
a person under the influence of alcohol or drugs (Skip
to resolve stage)
Slide #46
5. Obvious signs of Alcohol/drug use
b. Assess
Slide #47
1. Consider the person’s physical condition to
determine whether the behavior is actually caused
by other medical conditions (e.g., delirium, diabetic)
2. Ask questions to assist with this (e.g., “Have you
eaten today?” or “Have you hit your head today?”)
3. Attempt to gain information from friends or family
members
Slide #48
4. 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
5. Note physical symptoms related to drug use like
dilated (i.e., big) pupils or vomiting
6. 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
c. Resolve
1. 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
2. Get the individual to appropriate resources (e.g.,
jail, community programs)
Slide #49
Q. Summarize material
a. Why Have Training
b. Recognize that law enforcement encounters with special
populations who are in crisis are sometimes unpredictable.
c. Recognize ways to engage a person in crisis utilizing the
EAR, LOSS or LAST model.
III.
PRACTICE
1. Distribute practice exercise to students
PRACTICE EXAM
2. Have students complete exercise
3. Review exercise with students
4. Be available for questions if necessary
TEST
IV.
TEST
1. Administer
HANDOUT #1 – TITLE
1. Describe the four categories of the Loss Model.
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2. Identify the three phases of a special populations encounter.
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3.
Describe the goal of an officer when talking to someone contemplating suicide.
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TEST
1.
Describe the four categories of the Loss Model.
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2.
Identify the three phases of a special populations encounter.
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3.
Describe the goal of an officer when talking to someone contemplating suicide.
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