DE, or De-Escalation, is a process that involves the use of the Help, Prompt, and Wait strategies to help someone go from crisis to calm. While both the Prompt and Wait strategies can be used at any point on the staircase, the Help strategy should only be used at the bottom of the staircase. However, since there is no set sequence, it can be hard to know which strategy to start with and when to switch from one strategy to the next. The rest of this blog will break down each of the three Safety-Care De-Escalation strategies and when you should start with, or move on from, that strategy.
In Safety-Care, the first de-escalation strategy you learn about is the Help strategy. Help is a de-escalation strategy that focuses on having the person communicate what they need or want, instead of engaging in challenging behavior. This strategy can be done by having someone make a specific request like, “I want water.” Or, you could give the person 2-3 acceptable choices and have them make a selection from the options you provided. Another way to use the Help strategy involves asking the person an open-ended question like, “How can I help you?”. All three of these options have the person use some type of communication to express a need or want.
Therefore, you would use the Help strategy when you think the person is trying to get access to or avoid, a person, place, or thing. The exception to this would be if the person wants something that is unavailable. If you know the person wants something that is not available, then you would switch to the Prompt or Wait strategies instead. Once the person has escalated to the upper part of the staircase, the Help strategy would no longer be as effective. The reasons for this are that people are unable to communicate effectively when at the top of the staircase, providing access to something requested would result in reinforcement and you would not want to reinforce crisis behavior, and at the top of the staircase, the person is unlikely to ask for things that are available. You would also switch to the Prompt or Wait strategies if the individual becomes more agitated when you attempt to use the Help strategy.
While the Help strategy is all about communication, the Prompt strategy is about giving the person clear instructions to engage in safer behavior. The two types of behavior that you can prompt the person to engage in are incompatible and high-probability behavior. Behaviors are incompatible if they can’t happen at the same time, while high-probability behaviors are things the person is likely to do. Sitting is a behavior that is incompatible with pacing. Taking a deep breath, counting, or answering simple questions are all examples of high-probability behaviors. Prompts can be given verbally or nonverbally, with gestures, signs, or in writing. The Prompt strategy is the ideal place to start if the person is likely to follow directions, or if the Help strategy has not been successful, or caused the person to become more agitated.
However, if the individual is unlikely to follow prompts that are given then you would switch to the Help or Wait strategies. Conversely, if the person has become more compliant after several prompts, you may switch from the Prompt to the Help strategy to continue to guide the person down the staircase. Also, if the Prompt strategy has made the person more agitated then you should stop prompting and switch to the Wait strategy.
WAIT is an acronym that reminds us what to do during the Wait strategy, and it stands for “Why Am I Talking?”. During the Wait strategy, staff and others should not talk with, touch, or stare at the agitated individual. This strategy is often more successful if you clear the audience, move the person to a less stimulating location, or keep other staff and peers from accidentally engaging with the agitated person. While using the Wait strategy, staff should be clearing dangerous objects and substances, removing vulnerable peers, and always monitoring for the individual’s safety. Wait is a wonderful strategy to start with when you want to remove all external reinforcement, the person would benefit from being given time and space to de-escalate, nothing else is working, or the Prompt and Help strategies have made the person more agitated.
Although this strategy is a great place to start when Help and Prompt have been unsuccessful, you can’t stay in Wait forever. At some point, when the individual has shown some sign of de-escalation or taken even a small step down the staircase, then staff should attempt to switch back to using either the Help or Prompt strategies, depending on which strategy they feel would be more effective in the moment.
Knowing your individuals will make the use of all three De-Escalation strategies more effective and help give staff a better idea of when to use one strategy versus another. Help, Prompt, and Wait can all be effective and should be used in a fluent manner where staff switch from one strategy to the next, in response to the agitated individual’s behavior. Remember that there is no sequence and you should start with whichever strategy will be most effective in that moment, with that person.
References: Safety-Care Manual v. 6