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Understanding Human Behavior
Forming Therapeutic Rapport
Constructing Solutions
Crisis Behavior Assessment
De‑escalating, Escalating Behavior


Key Point

1) Factors such as low self–esteem, unresolved issues between staff and person served, feeling they are the only one taking care of the person and/or they voice negative comments concerning care of the person are signs that abuse of the individual in services is a possibility.


When Staff Distress Can Lead to Abuse



  • Staff low self esteem can lead to abuse
  • Having issues that are still not solved only places more pressure on the care giving relationship
  • Studies have shown that the risk for abuse increases as the amount of care needed increases
  • if the caregiver has experienced abuse or violence from the person they are caring for


This is a video of the stress that a mom is going through with her autistic son. She is patient but is obviously stressed out. Now imagine a group home where you may have to serve several individuals with severe autism or other challenging behavioral disabilities. These types of situations can lead to abuse.

How to Reduce the Risk of Abuse

  1. Ideally, family members and provider agencies should observe for the "perfect storm" of circumstances where abuse may occur so an intervention can be planned.
  2. Arrangements should be made for additional relief help from other staff/caregivers, to lighten the care giving load.
  3. Attendance at support groups or educational sessions should be encouraged for staff/caregivers to learn beneficial coping skills.

Key Point

2) You have a legal and ethical duty to report any one, including co–workers that are engaging in abusive behavior.



Reporting Abuse

  • Ethically and Legally, you are required to report abusive behavior
  • You have a responsibility to see that people with disabilities are treated with respect and without harm, and your agency will hold you accountable for that
  • If you notice that a co–worker seems to be having difficulty with others, you can set up a "buddy system" to help
  • If you see something getting out of hand, you must step in to stop it and get the co–worker out of the situation
  • talk over what happened and how to avoid it in the future. In many cases, your supervisor needs to know what happened

Key Point

3) If you recognize a co–worker having difficulties short of physical or verbal abuse you can suggest a "buddy system" to help, suggest they have a break, talk to them about it and notify your supervisor of the difficulties your co–worker may be having.

Key Point

4) Signals and cues that a person's aggressive behavior is escalating include both physical cues such as sweating clenched fists, shaking, rapid breathing, pacing, fidgeting. Behavioral changes include loud speech. finger jabbing, swearing, aggressive posture, tone of voice or kicking or banging things.

Behavioral Cues That May Indicate Distress

Aggressive Individuals


Some of these responses are classed as open or direct responses and are more likely to be the reactions of aggressive individuals

  • Clenched fists
  • Swearing
  • Verbal abuse
  • An aggressive posture


Anyone working in situations where aggression leading to violence is a threat should make sure they have adequate protection

Key Point

5) "Fight or Flight" is a programmed response in times of crisis and fear. Families might teach that fighting is good; that only cowards talk or run away. If fighting has worked out in the past, a person will tend to fight again. If running away has worked out, the person will tend to run away

Fight or Flight People show distress through behavior escalation and aggression for a lot of reasons. One reason is the "fight or flight" response. Animals and humans are programmed to do one of these in times of crisis and fear. Families might teach that fighting is good; that only cowards talk or run away. If fighting has worked out in the past, a person will tend to fight again. If running away has worked out, the person will tend to run away.

Understanding Challenging Behavior

'Challenging behavior' refers to any non–verbal, verbal or physical behavior by a person being served which makes it difficult to perform clinical tasks and/or poses a safety risk. It can describe actions, but can also include non–compliance, particularly if staff needs to intervene to deliver treatment or care.

There are different types of challenging behavior:

  • Non–verbal challenging behavior may include wandering, pacing, cornering, intimidating facial expressions
  • Verbal challenging behavior may include shouting, swearing, racist, sexist or offensive speech
  • Physical challenging behavior may include scratching, biting, slapping, inappropriate touching, self harm, spitting, punching, hitting furniture

Why does it happen?

  • Individuals who display challenging behavior often have some degree of cognitive impairment
  • There is always a cause of clinically related challenging behavior, even if it is not evident to staff at the time
  • Challenging behavior is often an expression of distress or an attempt by the person to communicate an unmet need
  • It is vital that staff take care in determining whether an Individual's behavior is a result of an illness or injury which requires urgent attention

Identifying Patterns

Searching for patterns to challenging behavior can help staff predict when challenging behavior is more likely, to plan and prepare, and to prevent it. For example, challenging behavior in many people has a tendency to occur during certain interventions, such as:

  • during care tasks,
  • administration of medication, or at
  • particular times of day, such as at mealtimes

Key Point

6) Triggers are environmental, situational or physical factors that set off an individual's challenging behavior. These factors vary depending on the individual, but they may include the care environment, interventions, activities, objects, thoughts, feelings, pain or discomfort.


  • In the strictest sense of the term, trigger is used to refer to experiences that "re–trigger" trauma in the form of flashbacks or overwhelming feelings of sadness, anxiety, or panic.
  • The brain forms a connection between a trigger and the feelings with which it is associated, and some triggers are quite innocuous
  • Once identified, many triggers can be avoided. That is why observing, identifying and documenting potential triggers can be the first part of a proactive strategy for minimizing stressful or distressing situations
  • The term is used more loosely to refer to stimuli that trigger upsetting feelings or problematic behaviors, and these feelings are often associated with a psychiatric condition
  • People who have triggers may re–engage in unhealthy behaviors when exposed to triggers
  • It is impossible to predict or avoid all triggers because so many triggers are innocuous, but images of violence, substance abuse, or weapons are sometimes labeled with a trigger warning

(Complete Trigger Activity)

Recognizing Precursors Precursors are behaviors which often precede challenging episodes. They may be an obvious prelude to distressed or aggressive behavior or they may just leave staff feeling uncomfortable. They may signpost the onset of challenging behavior. Staff needs to be aware of precursors and recognize them so they can effectively de–escalate a situation. Precursors to challenging behavior are specific to individuals, so they can often be recognized from earlier episodes.

Staff Contributions to Escalating Behavior


  • The poor care, actions or inaction's from staff can lead to abuses of people that they serve as well as contribute to the escalation of aggressive behaviors that can illustrate only too clearly what can go wrong when there are poor standards of care and a culture which allows it to happen
  • What you do and say can help people stay calm or can contribute to behavioral escalation and aggression

Key Point

7) Staff attitudes and behaviors such as ignoring people, expecting absolute obedience, telling rather than asking, teasing or picking or making unreasonable or unenforceable consequences can tend to escalate behaviors in individuals we serve.

Staff Attitudes and Behavior

  • ignoring people
  • expecting absolute obedience to your authority (authoritarian)
  • telling rather than asking
  • giving unnecessary commands
  • acting superior to the people with disabilities (condescending)
  • making decisions for the person instead of with the person
  • behaving aggressively (yelling, speaking loudly, being "in–the–face", threatening, criticizing)
  • teasing or picking – this may be OK with friends and family, but people with disabilities might not understand it or be hurt by it
  • not following through – "don't make promises you can't keep"
  • making unreasonable and unenforceable consequences
  • interrupting something the person likes doing

Factors That Can Contribute to Distress

Environmental Factors

  • noise
  • bright lights
  • uncomfortable temperatures
  • overcrowding
  • overstimulation
  • inactivity and boredom

Internal Factors

  • the person's inability to process new information, explanations or instructions
  • loss of inhibitions
  • poor judgment and planning
  • difficulty with communication and inability to articulate needs
  • memory loss
  • disorientation
  • reduced spatial awareness
  • loss of insight

More Examples of Factors That Can Contribute to Distress

  • Feelings of anxiety or powerlessness
  • Anger
  • Social isolation
  • Depression
  • Delusions, especially where people feel threatened and react defensively
  • Mania
  • Hallucinations
  • Suicidal tendencies
  • Personality disorders which may cause difficulty anticipating the consequences of their actions and acute distress

Communication Strategies & Skills

  • Pre–dis–positioning the individual as to what to expect is critical
  • Let the person know what is going to occur
  • Establishing Psychological Connection
  • Clarifying Intentions
  • Problem Exploration: Defining the Crisis (core listening skills: empathy, genuineness, and acceptance or positive regard)
  • Psychological Support – Deep, empathetic responding using reflection of feelings and owning statements about the person's present condition serves as a bonding agent
  • Providing Support – communicating to the individual that the staff is a person who cares about the individual
  • Default Task: Safety – we are concerned about the physical safety not only of the person but also of those who may interact with him or her and, just as important, about keeping ourselves safe.

Examining Alternatives

Exploring a wide array of appropriate choices available to the person

  1. Situational supports are people known to the person in the present or past who might care about what happens to the person
  2. Coping mechanisms are actions, behaviors, or environmental resources the person might use to help get through the present crisis
  3. Positive and constructive thinking patterns on the part of the person are ways of re–framing that might substantially alter the person's view of the problem and lessen the person's level of stress and anxiety

Key Point

8) Many factors influence a person's chance of developing a mental and/or substance use disorder. Effective prevention focuses on reducing those risk factors, and strengthening protective factors, that are most closely related to the problem being addressed.

Risk and Protective Factors

  • Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes
  • Protective factors are characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor's impact. Protective factors may be seen as positive countering events

Individual Level Factors
Risk and Protective Factors Risk Protective

  • genetic predisposition to addiction
  • exposure to alcohol prenatally
  • parents who use drugs and alcohol
  • parents who suffer from mental illness
  • child abuse and maltreatment
  • positive self–image
  • self–control
  • social competence
  • Interpersonal Skills
  • Self–Awareness
Risk and Protective Factors Risk Factors Protective Factors Personal Characteristics Personal Characteristics
  • Premature birth
  • "Difficult" temperament
  • Fetal drug/alcohol exposure
  • Shy temperament
  • Developmental delays
  • Neurological impairment
  • Low IQ (below 70)
  • Chronic medical disorder
  • Substance abuse Mental illness
  • Mental retardation
  • Sense of responsibility
  • Problem solving abilities
  • Reading skills
  • Good self esteem
  • A feeling of control over one's life
  • Planning for future events
  • Optimism about the future
  • Being successful at something
  • Good social and interpersonal skills
  • Able to leave conflict behind
  • Able to look for support from others

How Should Staff Encourage Positive Behaviors?

  1. Reinforce Good Behavior
  2. Provide Structure and Consistency
  3. Collect Data
  4. Name the Behavior
  5. Give Words for Emotions
  6. Change the Environment
  7. Give Choices
  8. Avoid Power Struggles