De-Escalation in Care Settings

Overall Feedback

Kai felt frustrated and like he wasn’t being heard.

The provider did not focus on his safety and function, and instead created additional conflict. Kai didn’t feel like Andrea was listening or on his side, which left him unable to consider what she was saying. He wasn’t ready to move on to the Facilitate step, where she would discuss next steps for him.

Let’s take a closer look at how Andrea used MI techniques in partnership with the CAF steps.

Techniques Feedback

Empathy

The provider was not effective in affirming, validating, and normalizing Kai’s feelings to show understanding.

She said, “Someone should’ve brough this up with you by now, for your safety,” which left Kai feeling defensive.

This was an attempt at the Calm step, but instead it increased the emotional intensity of the situation.

A more effective approach could have been “I want to understand more about those bad days you mentioned. I’m hear to listen and help, not to judge,” which would show Kai the provider is there to help him solve problems, not add to them.

Open-Ended Questions

The provider wasn’t successful in encouraging Kai to share more about his experiences.

She said, “I can’t help you until I understand why you’re concerned.” Kai felt like she wasn’t trying to understand his concerns, so all he heard was “I can’t help you.”

This was an attempt at the Assess step, but it steered the discussion away from the root cause of Kai’s problems.

A more effective approach could have been, “I know this system isn’t ideal, but can you tell me more about your concerns with working?” which is an open-ended question that could show Kai the provider wants to understand his concerns.

Recommendations

In future conversations with clients, remember you can use both the CAF (Calm, Assess, Facilitate) model and MI (Motivational Interviewing) to discuss sensitive topics and address emotions in a way that helps de-escalate the situation.

CAF Model:
Calm: Decrease the emotional, behavioral, and mental intensity of the situation.

Assess: Determine an appropriate response based on the facts and on the individual’s willingness to discuss.

Facilitate: Promote the most appropriate resolution based on information gathered by discussing next steps.

MI:

Express Empathy: Affirm, validate, or normalize the individual’s feelings and show them you understand.

Open-Ended Questions: Help the individual share more about their experiences and help you better understand where they’re coming from.