De-escalation: Why Prevention is Better Than Cure When Supporting Behaviour

De-escalation. A word we frequently use across education and health and social care when thinking about behaviour support. We know that to reduce risk, mitigate or avoid crisis, and offer the best support to individuals, de-escalation is often the most effective option.

The question is: are we clear about what is meant by de-escalation, why it matters, and how to de-escalate situations successfully in our settings, before crisis is reached?

De-escalation as pivotal to effective behaviour support

Sometimes, when we encounter distressed behaviour, or witness individuals in crisis, there may have been opportunities to intervene – or de-escalate – earlier; opportunities that could have prevented situations from escalating.

Often, those early warning signs are very subtle and can be easily missed. However, when we do spot them, taking prompt and decisive action can mean that risk is reduced for everyone, and individuals can avoid continuing into crisis. Using timely de-escalation strategies also means that we can often decrease, or even eliminate, the need for restraint and other restrictive practices.

In a nutshell, de-escalation is pivotal to effective behaviour support.

A toolkit approach to de-escalation strategies

It can be helpful to think of de-escalation as a toolkit of positive, proactive measures that are designed to defuse escalating situations, and help individuals re-regulate and calm themselves down.

To de-escalate effectively, we can focus on reassurance, communication, and diversion to support individuals when they show early signs of dysregulation. We can pause and try to understand the function of the behaviour and what is driving it. This allows us to respond in a considered, measured manner, rather than reacting automatically to what is going on.

As well as focusing on the individual involved, we can also look at what we are bringing to the situation, and consider how we can adapt our body language, voice, posture and facial expression to further support de-escalation.

De-escalation and the Stages of Distress and Support model

Understanding the stage of distress an individual is experiencing can help us decide on the best response to meet their unique needs and de-escalate the situation. To do this, we can use the Team Teach Stages of Distress and Support model as a helpful reference point.

While not always linear or clear-cut, there are stages that an individual can experience before, during and after crisis. These phases fall into 6 categories:

• Stage 1: Anxiety / trigger
• Stage 2: Defensive / escalation
• Stage 3: Crisis
• Stage 4: Recovery
• Stage 5: Depression
• Stage 6: Restoration

It is during the first two stages – anxiety /trigger, and defensive /escalation – that we have the best opportunity to intervene and deploy de-escalation strategies.

Indeed, to help prevent individuals from even reaching the first stage, we can be thinking about primary strategies to use in our settings, to create calm, positive and supportive environments. These include building predictable routines, developing clear communication channels, fostering strong relationships, considering the physical environment and providing additional support to meet an individual’s needs.

After all, prevention is better than cure with behaviour support, and by taking a person-centred, relational approach, we can strive to create conditions where an individual always receives exactly the right support, at exactly the right time.

Secondary strategies to support de-escalation

Sometimes individuals can become distressed despite the measures we have in place, and we need to be prepared to employ strategies to promptly defuse and de-escalate situations. The following suggestions can be used in isolation or in combination, depending on the needs of the individual.

Of course, everyone is different, and anxious or distressed behaviours for one person may be crisis behaviours for another. This underlines the importance of a person-centred approach where we use our knowledge of an individual to decide on the best interventions and support.

Strategies for Stage 1: Anxiety / trigger

When someone is beginning to feel anxious, upset or agitated, they need our reassurance and support. Typical behaviours we may see during this stage can be quite subtle and may include individuals hiding their face; rocking, pacing or stimming; withdrawing or shutting down; and refusing to speak.

If we notice these early signals, and they differ from an individual’s baseline behaviours, there are a number of strategies we can try, in order to de-escalate quickly:

• Remove sources of frustration, if practical and possible
• Offer reassurance, including positive physical prompts, such as guiding away
• Talk to the individual using a well-rehearsed help script: “Asha, I can see that something has happened. Talk and I’ll listen…”
• Explain clearly what is happening and what will happen next
• Use CALM body language
• Talk slowly and quietly, using a low tone of voice
• Divert and distract by introducing another activity or topic
• Use strategies that have worked well for this individual in the past

Often, these strategies will be enough to support the individual and prevent escalation. We can continue to monitor the situation, to decide whether further intervention is necessary.

Strategies for Stage 2: Defensive / escalation

During this stage, an individual is beginning to show higher levels of tension, stress and anxiety. They might be shouting, crying, or using abusive language; changing their facial expression, for example looking angry; moving in an agitated way; picking up objects that could be used weapons; challenging instructions; and breaking minor rules.

To de-escalate a situation where someone is engaging in these behaviours, we can employ a range of strategies, either in isolation or in combination:

• Continue to use Stage 1 de-escalation responses
• State desired behaviours clearly
• Offer alternatives and options
• Give clear, limited choices
• Move furniture and remove objects that could become weapons
• Offer them a way out that maintains their dignity
• Encourage others in the vicinity to move to a different environment

We can then continue to monitor and assess the situation, reflecting on ways to make the environment safer. We may also need to decide whether assistance from another colleague is required, to further support de-escalation.

Taking an individualised approach to de-escalation

Creating a culture of de-escalation and early intervention helps us to foster calm, supportive and positive environments where individuals feel safe and can fulfil their potential.

While there are a number of de-escalation strategies we can employ, the most successful ones are those that are personalised to the needs of the child, young person or adult we are supporting. We therefore need to apply our professional discretion when deciding on the strategies that work best for the individuals we support. That way, we stand the best chance of reducing risk, preventing crisis and creating conditions where all can thrive.

If you’d like to talk to us about your needs when it comes to supporting behaviour in your setting, please get in touch any time.