CPI Crisis Development Levels
What are the 4 stages of the CPI crisis development model?
Anxiety, Defensive, Risk Behavior, Tension Reduction.
Give 3 examples of behaviors or communication styles that might indicate a patient is in the anxiety crisis development stage
Pacing, Fidgeting, Sighing, shutting down, brusque responses, loud volume, talking fast, not speaking
Give 3 examples of behaviors or communication styles that might indicate a patient is in the Defense crisis development stage.
Shouting, refusal, asking challenging questions, acting in a threatening manner,
Give 3 examples of behaviors or communication styles that might indicate a patient is in the risk behavior crisis development stage
Striking, throwing objects, pulling or pushing others, harming oneself.
Give 3 examples of behaviors or communication styles that might indicate a patient is in the tension reduction crisis development stage
Relaxing posture, returning complexion, reduced muscle tension
What are the 3 ways of communicating?
Verbal, Paraverbal, Non-verbal
What is the response style for the anxiety stage
supportive
What is the response style for the defensive stage?
Directive
What is the goal behind staff responses during the risk behavior stage?
Maintain safety
What is the goal behind staff responses during the tension reduction stage?
build and re-establish therapeutic rapport
What does the integrated experience component of the CPI Crisis Development model mean?
Reflects that staff reactions influence patient outcomes. Behaviors influence behaviors. Staff attitudes and behaviors influence the attitudes and behaviors of the patient in distress and vice versa.
What are 3 ways to verbally communicate support?
Acknowledge feelings. Offer help. Normalize symptoms.
What are 3 verbal ways to communicate directively?
Interrupt and redirect. Limit setting - explain which behavior is inappropriate, why it's inappropriate, give choices. Provide two acceptable alternatives.
What is the purpose of learning the CPI Crisis Development Model?
Learn how to recognize escalating behaviors and ways to intervene at different stages of a crisis
What are 3 non-verbal or para-verbal ways to communicate support?
Unse caring and supportive tones. Keep the volume appropriate. Use appropriate eye contact. Be mindful of facial expressions and gestures. Use an open posture. Give your undivided attention.
What are 3 non-verbal or para-verbal ways to communicate directively?
Short and simple statements. Give time and space to allow the patient to process. Use supportive stance to appear non-threatening while maintaining authority. Do not point/shake your finger.
What is the goal to keep in mind when using the CPI Crisis Development Model?
The goal is to reduce risk and de-escalate to help the patient reach tension reduction.
A patient begins pacing in the middle of the night. This behavior is abnormal for this patient who usually sleeps through the night. Using a supportive approach, act out how you might respond to this patient to, hopefully, prevent their development into crisis.
A patient is refusing to give back his bendy pen and continues to attempt to take it out of LOS of staff. When asked to return the pen he states, "you can't make me". Using directive strategies, act out how you might respond to this patient to prevent development into crisis.
Limit setting - provide safe and respectful choices and explain the possible outcomes. Give the patient time to process. Downplay the challenge and stick to the original topic. Let them vent and acknowledge their feelings. You can use your pen in the dayroom or you can turn your pen in so you can go relax in your room. I understand that this is frustrating, my goal is to keep you safe.
In the dayroom, a patient begins to throw chairs at staff. Using safety interventions act out how you might respond to this patient.
Analyze level of risk. Redirect other patients away from escalated patient. Remove other items from the environment that could present harm. Allow the person to use up their energy. Continue supportive strategies.
A patient who, moments ago, had been throwing chairs in the dayroom sets the chair down and sits on it. They put their head in their hands and begin crying saying that they are embarrassed of how they acted. How might you respond to re-establish rapport?
Be supportive, empathetic, and non-judgmental. Uncover what happened and let the patient express their feelings and thoughts. You could say, it can be difficult to manage really strong emotions. I know I was here and saw the event but can you tell me what happened so we can process the event together? Why did you engage in this behavior? Who else was affected? Has this ever happened before? What can we do differently next time?