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 2. Course B. Purpose of Course 1. Recognize that law enforcement encounters with special populations who are in crisis are sometimes unpredictable. INTRO SLIDE Slide #1 INFORMATION ON BOARD 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 1. Officers should be aware that the situation may not be as straight forward as dispatch has relayed. Slides # 4 & 5 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 Slide #8 & 9 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.
D. Loss of hope. 1. Profile description a. The person may be emotional, very withdrawn, fatigued, feeling overwhelmed, crying, in despair, or presenting suicidal talk or gestures. Slide #10 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. Slide #11 b. You should be prepared to address thoughts of suicide. E. Loss of Control 1. Profile description a. This person may often be angry, irritable, or hostile Slide #12 b. Can present themselves as victims.. c. May be manipulative, impulsive, destructive or argumentative 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. G. This is a fluid Model H. EAR model Slide #15 Slide 18-20 Slide # 16 large group discussion Slide # 18 Videos Slide #17 1. Three phases of a special populations encounter a. Engage b. Assess SPO #2 Slide #23 c. Resolve I. Ear Model engage 1. Purpose of Engage make a connection with the person so you can calm him/her Slide 24-30 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
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: 1. To get the individual to focus on the elements of his/her story causing the ambivalence SPO #3 Slide #35 M. Responding to armed subject threatening suicide 1. To get the individual to focus on the elements of his/her story causing the ambivalence Slide #36 2. Officer safety is paramount
3. Gaining control of the situation is critical 4. Threat assessment and availability of backup 5. De-escalation skills 6. Suicide by Cop 7. Deadly force may be a first resort to stop a threat Slide #37 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) Slide #41 11. Fact the intent to die can override any rational thinking
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 1. Engage Slide #45 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 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 Slide #48 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 Slide #49 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)
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 IV. 2. Have students complete exercise 3. Review exercise with students 4. Be available for questions if necessary TEST 1. Administer TEST
HANDOUT #1 TITLE 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.
TEST 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.