CHAPTER EIGHT Separating
Student Workbook © 1975 – 2017 The Mandt System, Inc.
Overview This chapter is focused on de-escalating potentially aggressive situations so that restraint is not needed. The skills taught are intended to be for “low arousal,” which means the interaction between the caregiver and the individual receiving services involves minimal contact and minimal force and is of minimal duration. In this way, an individual’s autonomic nervous system will be less likely to signal body systems that the actions of caregivers pose a threat of harm.
When instructing caregivers who have been taught in another program, be prepared to take more time! It is more difficult to unlearn a skill and then learn a new skill than it is to just learn a new skill. If the organization has recently switched to The Mandt System®, it will take approximately 1½ times as long to teach each of the technical (physical) chapters. Caregivers have been told that the previous program would maintain their safety and the safety of others, and now they are being told something else. People will need time to vent and express their fear, frustration, anxiety, and tension. Honor their concerns! Instructors may have experienced similar concerns at the time of their initial certification. Allow opportunities to vent and share information on how to resolve those concerns.
Turn-Step: This skill provides a method to move a person away from someone they may be aggressive toward, or it can help the caregiver move away from the person if the person is perceived as aggressive toward them. It also provides the bridge between the principles presented in Chapter Seven and the technique of restraint if restraint is needed. This is the most important skill taught in this chapter! If people can develop a high skill level in turn-step, releases from other holds may not be needed. See Chapter Nine for information on assessing whether or not a restraint may be needed.
Physical Releases: As you teach this section, remind people of the Five A’s. If someone grabs for attention or affection, the program plan and/or R.A.D.A.R. will inform as to whether or not there is a need to gain release. If someone grabs for assistance, never gain release! You may cause them to fall. If a person grabs for aggressive purposes, pay close attention to the assessment stage of R.A.D.A.R.. If someone grabs because they are afraid, use R.A.D.A.R. to assess the situation, attempt to de-escalate and reassure the individual, and try to determine what the cause of the fear might be. If someone is becoming aggressive, it is not wise to use both hands to try to gain the release as there is no way to protect from aggression. Instead, use stance and balance, body mechanics and movement, and body positioning to either be outside the reach of the person’s other hand, or be close and, if possible, behind them.
Learning Objectives Upon completion of this chapter, participants will have:
1. Explained the Five A’s of why people may grab you or others.
2. Defined immediate risk of harm.
3. Identified the seven concepts of physical interaction.
4. Distinguished between situations requiring physical release and those that could be resolved through non- physical release.
5. Explained how Maslow, R.A.D.A.R., and the crisis cycle apply in releases.
6. Demonstrated the use of each of the physical skills presented in this chapter.
SODAS model of conflict resolution (physical)
In Chapter Three, Healthy Conflict Management Skills, the SODAS model was introduced as a problem solving method. Apply the same approach to the use of restrictive physical interaction skills.
The SODAS physical model is suggested when the conflict with the person has escalated to a level where physical interaction is necessary. All of the underlying philosophy and theory taught in the non-physical model still applies. The SODAS physical model is a set of strategies used for people who have very low thresholds for frustration and stress. Aggression and violence from the person has created a situation that threatens the safety of the person(s) involved in the interaction.
Assessing danger or threat
The following information will help with the assessment process:
1. Is there a believable threat of harm to self and/ or others? Many organizations using The Mandt System® serve individuals who make threats that are not believable. In many cases, they are “posturing behaviors” where people make statements that are designed to maintain their safety by appearing threatening to others.
Some individuals make threats that mimic or replicate verbal behavior they see and or hear used by others on television or in movies. Questions to ask may be:
• Has the person made threats in the past that were not carried out?
• What is the tone of voice of the person?
• What does their body language say about the believability of the threat?
2. Is the person capable of carrying out the threat of harm? Some of the individuals make threats that are believable, but the person does not have the physical capacity to cause harm.
Questions to ask may be:
• How old is the person? Generally speaking, children under seven years old do not have the physical capacity to hurt an adult. They may have the capacity to cause injury to other individuals.
• What is the physical capacity of the individual?
• Are they affected by a physical disability that may limit their range of motion, use of limbs, etc.?
3. Is the threat of harm immediate? Is there something else that can be done besides moving closer to the person and touching them? If there are other options, it may be reasonable to try those before physical interaction.
When people see a dog standing with its teeth showing, saliva dripping down its jaws and growling, how do they typically respond? If a cat has its back arched, hair standing on end, hissing, what is being conveyed by its communication?
In both cases, the animals are communicating that they want distance (Lindsay 2005, Bradshaw 2013). The neurological structures of all mammals are very similar, especially in the lower parts of the brain where threat perception and response are housed. When humans use communication to attempt to gain distance between themselves and a perceived threat, caregivers should respond by backing up slightly in a nonthreatening stance, ensuring their hands are open and nonthreatening. When people communicate they want distance, their R.A.D.A.R. will be on you. It’s a dance, the person leads and caregivers follow. Backing up is not backing down. It gives people the space they need to feel safer.
If the answer to any of the questions is “no,” further assessment with the person is needed, recognizing that the perception of the person’s ability to carry out a threat or to make a believable threat may not be accurate. Perception checking skills (Chapter Three) are important tools, as is teamwork (Chapter One).
If the answer is “yes” to the three questions, then it may be reasonable to use physical skills to prevent harm to people involved in the interaction. This is called a clear and present danger. Keep in mind the goal is to de-escalate the person(s) as safely and quickly as possible.
This will not be possible if caregivers fail to manage themselves first. Remember, the caregiver is part of the interaction. Once it has been decided that the threat (behavior) presents a clear and present danger to people, it is important to act and act quickly. Use both physical and non-physical skills to help the person move from crisis to de-escalation as quickly and safely as possible, using the least amount of interaction necessary for safety.
After attempting non-physical methods for de-escalation of the crisis, the SODAS physical model is used as a guide through the conflict. This model will examine:
The situation is that the behavior of an individual poses a threat of harm to themselves and/or others.
Non-physical interaction has been attempted, but has not been effective in assuring the safety of everyone present.
Options are then reviewed by the caregiver, in line with the graded and gradual system of alternatives (Chapter One). Remember that there are three responses discussed as part of the R.A.D.A.R. model: non-physical, general physical responses, and specific physical responses. Can the caregiver move out of the way, and/or verbally direct others out of the way? Can the caregiver use redirection or deflection skills, or can they use one of the releases taught in Chapter Eight? There are a number of physical interventions that are less invasive and intrusive than restraint.
Evaluate the advantages and disadvantages of each option relative to the risk for injury (evaluate risk).
Help the caregivers and the other person select solutions (stop the physical interaction).
The purpose of the SODAS model is to enhance the safety of all people within the environment. Do so by empowering the person to exercise reasonable control over their environment. When people feel they have control, their perception of safety is increased. This also helps to regain self-respect, establish trust with caregivers, and can help develop effective ways of coping with troubling situations in the future.
To frame the difference between immediate and imminent threat of harm, the following information from John S. Harper with the Florida Department of Children and Families (Harper, 2010) has been adopted by The Mandt System®:
Time Frame Immediate Imminent Open-ended
Definitions A safety threat- not separated in time, acting or happening at once, next in order
The likelihood of severe harm that may occur in the near future; impending
Consequences High Risk Moderate Risk Low Risk
Conditions Severe out of control
Why we teach releases
When caregivers are in a situation where someone has grabbed their wrists or clothing, many of them feel an immediate sense of fear and as a result enter the fight or flight continuum. This process of escalation could result in a coercive reaction, “Let me go!” or a quick physical action to get away that may actually cause more harm to the person and/or the caregiver.
By teaching simple, easy-to- remember techniques to gain release, caregivers can apply what was taught in Chapter One, Affirm your feelings and choose your behaviors™. When people feel safe, they act safe, and this includes caregivers. By having a sense of competence and confidence in physical skills, caregivers can give non-physical methods of gaining release more time to work, remain centered on their own values and beliefs, and interact with individuals receiving services with dignity, respect, patience, trust, and forgiveness.
The five A’s
The five A’s explain the reasons why people may grab and hold on to someone.
Based on anecdotal evidence and class discussion, The Mandt System® believes there are five basic reasons for human-to- human contact. They are, in order of perceived frequency:
Affection — While communicating, many people use touch as a means of showing they care about the individual. There are cultural differences around touch as communication, as some cultures have almost no physical contact while communicating, while others have almost constant physical contact while communicating.
Assistance — Requests for assistance are the second reason people may initiate physical contact. The need for assistance may be non-physical, or it may be physical if someone is losing their balance.
Attention — Sometimes people, especially children, will want to show something to others, or may want to have the person focus on them.
Afraid — People often grab others when they are afraid. Examples include grabbing the person who is about to draw your blood or the person sitting next to you on an airplane.
Aggression — Based on a review of incident reports, aggression towards others was the least frequent reason for physical contact.
If caregivers respond to all physical contact as if it were aggressive, they will end up cueing aggressive behavior! Pay attention to the individual before they make physical contact to assess the reason behind their
behavior, and consider if you really want to gain a release.
One of the most important concepts to understand is this: The hand that is holding is not the hand with the potential to hurt, except in the case of hair pulling and bending fingers back.
Student Workbook © 1975 – 2017 The Mandt System, Inc.
Physical Interaction Concepts In The Mandt System® approach, the purpose of the skills taught in Chapter Eight is to facilitate the process of de-escalation. In previous chapters there was an emphasis on inviting people to de-escalate, and at the point at which the skills of this chapter are needed, the person may not have heard the invitation or rejected the invitation for some reason. It will be important then, for the caregivers to manage themselves by affirming their feelings and choosing their behaviors.
The physical skills taught in The Mandt System® are designed to use movements that are small and smooth, as the person has their R.A.D.A.R. on the caregiver. The person is assessing how threatening the caregiver’s actions are. Chapter Two presented the idea that “Their R.A.D.A.R. is on you,” meaning that when people have escalated, they are using their R.A.D.A.R. to determine if it is safe to de-escalate. The instruction has organized these physical interaction concepts in a way that increases the likelihood that people will accept the invitation to de-escalate that is offered to them. Ensuring that movements are small and smooth will help caregivers appear less dangerous to others.
Speed and motion
In order to accomplish the movements described in this chapter, elbows must be in close to the body (with the exception of the bite release). With hands open, use slow, small, and
smooth movements, keeping everyone on balance.
It is important to do the skills slowly and as smoothly as possible to gain a release. If the skills are performed fast and/or with large movements, this may startle the other person and they may become afraid or confused and try to strike back. Also, time to escalate may make them hold on more tightly or grab in a different, perhaps worse, place.
Note: If the person being held is experiencing pain, movements will need to be quicker, but remaining smooth and small.
It is important to always be concerned about how others are interpreting the caregiver’s physical movements. If in gaining a release, the caregiver’s physical presence and body language look aggressive (e.g., hand balled up in a fist or hand high up in the air above their shoulder), the other person, or someone else watching, may misinterpret their actions and think the caregiver is trying to physically attack or abuse the person whom they are trying to assist. Keep hands open so the person being served can see light coming through the fingers. This kind of hand appears to be much less threatening than a hand that is open but with fingers close together.
When the caregiver is relaxed it provides a better chance to think through options. It will also convey to the other person that the caregiver is not going to overreact or hurt them. If the caregiver is relaxed, this may
cause the other person to relax and feel safer, which provides a better chance of gaining a release from the hold.
If, while a release is being sought, the person holding thinks there is an intent to hurt them, in most cases individuals will react in a different manner than if they do not think they will be hurt. Ask yourself how you would react if you were in the same position.
It is important to note that at no time should a caregiver use thumb or finger “come-along,” “crank,” or grab (i.e., hyper- extension of joints, pressure points, or pain techniques). Those types of techniques are prohibited by The Mandt System® and are a violation of the individual’s rights and abuse policies. At no time should any techniques like those be used.
Always keep everyone balanced. If the other person is off balance, they, as well as the caregiver, have a chance of falling down. This means that either or both parties could get hurt.
Real time versus psychological time
Also consider real time versus psychological time. The principle of “real time or psychological time” in an incident where help is needed is the difference between the actual time it took to get help by the clock (e.g., 30 seconds), and the time perceived to get help (e.g., 10 minutes).
When people are under stress, time has a way of speeding up or slowing down. An actual time frame of 10 minutes, for example, may seem like a few seconds or may seem like half an hour.
In Chapter Four, Trauma Informed Services, a model by Dr. Bruce Perry was presented that showed how psychological time narrowed and sped up as stress increased. Remember when people receiving services
escalate, are experiencing similar effects in the conflict between psychological time and real time.
To make slow, smooth, and small movements, the caregiver will need to de-escalate first and operate on real time, not psychological time. If most people are given 10, 20 or 30 minutes of real time to de- escalate, it also gives caregivers time to de-escalate. In some cases, the caregiver may need the time to de-escalate more as they may unintentionally be contributing to the problem.
Action — An individual served, whose past aggressive behavior has resulted in injury to others, begins to pace, glower at the caregiver, and make threats. One of the caregivers nonchalantly makes a call for a third caregiver to join them.
Reaction — Because it feels like it is taking forever for the other caregivers to arrive, the caregivers who are present decide that they had better get into a position so if the person attacks, they can defend themselves. In the process of moving, the caregivers look at each other anxiously and the individual served picks up on their anxiety and attacks
Action — Two individuals are arguing with each other. One of them wants to disengage, but the other person keeps moving closer. The caregiver is busy completing necessary forms for end-of-shift report and says “I’ll be with you in a minute.”
Reaction — The individual who wants to escape escalates 10 seconds later because help did not arrive immediately.
Voice/vocal tones/ paralanguage
While interacting with people physically, remember to also interact with them verbally. People will be assessing the caregiver’s tone of voice, volume, and the sounds they are making.
Use shorter sentences, speak more slowly, and keep hand gestures to a minimum. In the section on the vocal elements in communication, these aspects were stressed, as well as when speaking with someone whose primary form of communication is nonverbal. These concepts are applicable in this section as well.
This section deals with situations in which people have moved
into the caregiver’s intimate space. After gaining release, the caregiver is encouraged to step back slightly, making sure to keep hands up. Being too close to someone may increase their own sense of being threatened.
Chapter Two, Healthy Communication Skills, taught that physical contact can be used to communicate in either a positive or a negative way. Touch is a very subjective thing. People who have experienced significant trauma may respond differently to touch than others. The caregiver may be using physical touch in order to provide safety, but they are also communicating. Remember this while going through the chapters in the technical section.
Principles of touching:
1. Ask permission to touch…