Advanced De-Escalation of Teens & Young Adults

1. Advanced De-Escalation of Teens & Young Adults CITI 2012 Emily L. Ribnik, M. Ed, PCC-S

2. Emily L. Ribnik, PCC-S • Degrees in Psychology and Counseling • Professional Clinical Counselor Licensed since 2008 • 5 years experience in emergency mental health and risk assessments – ages 6 to 90 years old • CIT certified since 2007 • 5 years experience teaching in CIT classes and presenting at CITI conferences • 7 years experience working with first responders, veterans (Vietnam, Desert Storm, Iraq, Afghanistan) • Currently the mental health clinician for Kent State University at Stark – 1 of me and 4500 of them • A.L.i.C.E. certified Instructor

3. Training Objectives • Teens Today • Teens in Crisis and Types of Crises • Negotiation and De-escalation • Situation Specific Issues • Review of Priority Recommendations • Q/A

4. Where does de-escalation start? Advanced de-escalation skills begin with advanced, more refined ability to identify the situation, and subject, that you are going to de-escalate

5. Teens Today • 15 – 24 years old • Age of onset for multiple severe mental health issues – Bipolar, Schizophrenia, Psychotic features • Referred to as Generation Me, the Tech Generation, and Millennials • Self-prioritize, zero tolerance for delay/wait, high emphasis on relationships, tech savvy, saturated by media, multi-taskers • More likely to question, challenge and confront commands or directives that do not have an explanation – or what they feel is an explanation • Currently make up all the students from pre-K to traditional Undergraduate and Master’s level college courses

6. Teens in Crisis A real, or perceived, dramatic emotional or circumstantial upheaval in one’s life…cause, or will appear to cause, multiple negative changes and, although may build, will occur suddenly and abruptly. Same definition…. Different presentation

7. Developmentally lack coping skills • Associate external stimuli with emotional response • Already less rational and more emotional before the crisis • Easily escalates due to self prioritizing and zero tolerance for delay/wait • Specifically, this impacts the ability to have any future orientation…. At all • Act out quickly, emotionally and irrationally • Although highly emotional, may tire out much faster than an adult

8. With adults, you start with an advantage as a police officer or authority figure. You will not have this advantage with a teen. Impact on De-Escalation

9. Faster, less predictable pace • Faster reactive processing and response • Very clear, straight forward agenda by teen • More genuine reactions – typically have less skill in “masking” when in crisis • Teen will struggle to grasp or respond to future orientation, and will very stubbornly emphasize the present All of this impacts your physical set-up and approach

10. Types of Crises Suicidal vs. Aggression Either could escalate to a barricade or hostage situation

11. Similar cause: a need not being met The Four “Teen Needs” • Love and belonging • Power and importance • Fun and pleasure • Freedom and choice

12. Suicidal Behavior Risk factors for suicidal ideation • Mostly similar as adult risk factors • Fewer, less developed coping skills • Emphasis on relationships • Emotional reactions more closely linked to perceptions • Media saturation • Privately suicidal can become publicly suicidal very quickly, and NOT initiated by the teen

13. Suicidal Behavior 3 main factors in attempting/completing suicide: • Thwarted belonging • Real or perceived burdensomeness • Fearlessness These factors are what you look for to find your hook

14. Aggressive Behavior Why do teens become, or “turn to” being, aggressive? • Anger is empowering • It may be the only (perceived) option left to use in order to meet a need

15. Types of Aggressive Behavior Emotional vs. Deliberate Aggression

16. Emotional Aggression • More common in teens • Loud and attention grabbing • Comes in waves • Typically does not have a plan or long-term agenda • Typically short-lived, but repetitious

17. Deliberate (or Planned) Aggression • Less common, but more destructive • Has thought and agenda • “Simmering to a boil” • Specific outcome desired • Emotional Aggression can escalate to this, but typically remains impulsive

18. De-escalation & Negotiating with any Teen • You will not have the advantage of automatic trust and compliance from a teen just because you are a police officer or authority figure – in fact, you may feel more challenged and questioned which will be unusual for you • Remove the audience – specifically limit media exposure • This will include telling families and peers to not make contact with the teen unless you are with them to supervise

19. Technology: Don’t fight it.. USE it! • Will find names or even cited events • Look up information in recent posts, blog entries and photographs • May help you find a supportive person in their life • However, remember anything you say can and will be looked up by the teen • Limit media exposure • Be in contact with your secondary via texts and images – you want to avoid looking like you are multi-tasking • Technology confiscation – ie. Cell phone

20. Visuals and Visibility • Any hint at posturing can damage the rapport you are building • Be aware of jaw clenching, hiding your hands, and rigid walking • Slow down hand movements • Try to limit how many people are visible to the teen – it is another stimuli that you can reduce

21. Voice • Aim for an even, real tone – a very low tone may be perceived as anger or frustration • Explain, Explain, Explain and Explain some more – it will feel excessive to you • Be careful of association statements and arguing • corrections (“I didn’t say…), because regardless – that is what they heard • “I know how you feel” because you don’t – instead try to put out stories and information that aligns with teen’s experience

22. Voice • Say names and avoid pronouns • Stay in the present – you could get stuck in the past, and teens struggle with future orientation • Ask their opinion and work towards them making decisions and finding solutions • Remember – de-escalation is about joining with the person

23. Specific Situations Some situations call for some additional advanced skills, suggestions and recommendations. • Suicidal • Aggression • Psychosis

24. Suicidal Behavior • Rapport – needs to be doctor/patient, not friend • Can give the impression that you are doing things for the teen you don’t usually do • Remember – this generation expects and wants to be treated like they are “special” • Can build rapport without becoming a friend • The idea is to partner with the teen and allow them to feel they are leading and that they are regaining some level of power/control that they feel they have lost

25. Suicidal Behavior • Identifying rank if it has benefits • This is completely your call • Remember, they can look it up anyway • Can support the idea that you are in a position to help them

26. Suicidal Behavior • Set up multiple observers that can communicate with each other • Watch agitation level – reactive and escalating aggression can happen if the teen feels forced, minimized, or has lost face/control (or perceives any of this) • Talk vs. behavior “dissonance” – if the teen talks calmly on the phone, BUT is behaviorally aggressive/agitated when not in contact, this could indicate • the possibility of a vindictive suicide or suicide-by-cop • The stronger possibility of an agenda

27. Suicidal Behavior • Avoid trading/bargaining – offer choices instead or ask for suggestions • Instill hope • Empathize and try to find a personal connection – even if tenuous • Do NOT state “I know how you feel”, this WILL sever everything you have built because you have taken the feeling away from them

28. Aggressive Behavior • First, determine which aggression you are dealing with • If you don’t know, or don’t have enough information, start with the skills for emotional aggression – they will quickly show you if it is deliberate aggression

29. Emotional Aggression • Remember – a staple of this aggression is that it will come in “waves”, so be prepared to adjust and “go with the flow” • May take hostages – however, this will typically be a reactive impulse • The danger is that once they have a hostage, they will panic because they didn’t want or plan to

30. Emotional Aggression • Do not force a contact/conversation – it can escalate the aggression • Instead, consistently provide reassurance that you are there and available when (not if) they want to talk • Announce out loud (megaphone or building speaker) when you are going to call – it allows them to decide whether they want to talk to you at that time • Allow silences

31. Emotional Aggression • Literal Reflective Listening • Allows venting, checking accuracy, being a “sound board” • Gives teen ability to hear what they said and think about it • Repeating exactly what was said sounds strange, which can interrupt an behavior cycle

32. Emotional Aggression • Literal Reflective Listening • Long pauses or the teen asking why you are repeating what they are saying is a signal of openness for conversation • Always use an explanation • “I was repeating it to make sure I was hearing what you were saying” • “I wanted to repeat it to make sure I was understanding you”

33. Emotional Aggression • Offer suggestions • Only for the immediate situation – remember, they will struggle to connect with future orientation • Only after prompting the teen to provide acceptable options • If the teen’s answer is “I don’t know”, that is typically a sign that they are open to other suggestions and is your signal to provide some • “I don’t know” is often genuine – look at how they are acting

34. Emotional Aggression • Agenda? • Typically, one will not exist due to impulsivity of the aggression – which you can work to your advantage • Can be used to help with releasing hostages because “that wasn’t planned – we don’t have to keep going in that direction” • “Unknown agenda” • This is the idea that although they do not have a conscious agenda, they need to express or release the emotions • Once this expression or release has completed – remember the waves – the aggressive behavior is also completed

35. Deliberate Aggression • Remember – there is a reason and agenda behind the aggression • Seen more in shooters and hostage takers • Meeting their real or perceived “unmet need” is the agenda/goal • Genuine agenda – work WITH it, not against it if possible • The agenda = your hook • Clearest indicator that it is Deliberate Aggression

36. Deliberate Aggression • Techniques are progressively more direct • Remind – subtle, verbal hint that the behavior is not acceptable • Warn – State consequences if there is not compliance • Confront – Clearly, firmly state the situation/behavior and an instruction

37. Active Shooter What’s their agenda? • Power and importance • Mass media attention, historical significant, get in to Wikipedia • Hurt or kill a specific person • High body count • “Beat Columbine”

38. Active Shooter Response • Minimize loss of life and availability of targets • A.L.i.C.E. • Most law enforcement follow “first response” or “solo engagement” • An individual officer/responder will enter and attempt to engage/eliminate the threat (shooter). They will not wait for backup, SWAT, approval, or medical response preparedness • Law enforcement response will focus on the shooter, not aiding others present • Do not expect negotiations or de-escalation

39. Psychosis • Reduce stimuli as much as possible – including your own movements and gesticulations • Emphasize participation, choice and decision-making • Expect non-linear communication • Hallucinations • Possible visual signs – shaking head a lot, hitting head, eye darting, sudden looking around, excessive jumpiness, talking to self (could also be stress)

40. Psychosis • Delusions • May initially appear to be assumptions or generalizations • Find “work-around” • Monitor for incorporation

41. Priority Recommendations • Social Media • Have a non-personal log in for common sites (Facebook, Twitter, MySpace) • Ask family and peers if there is another site that teen uses (ie. My Yearbook) • Specifically tell family and peers to NOT message teen during the negotiation • Consider options for cutting off access if possible – turning off power, turning off wi-fi

42. Priority Recommendations • Significant reduction of ALL stimuli • This could include social media to cut out “audience” factor • Look at privacy options • Stimuli includes lights, sirens, number of people, etc. • If possible, keep media the farthest back • Rope off as large an area as possible

43. Priority Recommendations • Use technology - Utilize text and image messages on your phones so it does not overtly appear you are multi-tasking • Use names – try to avoid pronouns • Use explanations – it will feel excessive, but this is a primary thing in de-escalating teens • Remain in the here and now – teens will struggle to connect with future orientation

44. Priority Recommendations • Remember – Anger is empowering and aggression may be the last (perceived) option • Identify the type of aggression • One of their needs is not being met • Identifying which need will give you your hook for negotiation and de-escalation

45. Readings & Information Why People Die by Suicide – Dr. Thomas Joiner, specifically Ch 2 about acquiring fearlessness De-Escalating Juvenile Aggression – Jeffrey S. Golden, J.D. (www.policechiefmagazine.com – May 2004 Archives) Classroom De-Escalation – An Unnatural Act! – www.keepschoolssafe.org A.L.i.C.E. Trainings – www.responseoptions.com Active Shooter: How to Respond – U.S. Department of Homeland Security 2008, www.dhs.gov Guide for Preventing and Responding to School Violence – Bureau of Justice Assistance and International Association of Chiefs of Police, www.theiacp.org Why Teens Kill: Warning Signs, Causes, Triggers and Prevention – Phil Chalmers, www.philchalmers.com

46. Emily L. Ribnik, M. Ed, PCC-S eribnik@kent.edu Office: 330-244-5048 Cell: 330-990-6963 6000 Frank Avenue NW North Canton, OH 44720