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SAFETY TRAINING CURRICULUM

CD 3 –Part 3

Working with Children

Presented by: The University of Washington.

The Department of Social and Health Services.

The Washington Institute of Mental Health Research and Training.

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About this trainingThis training is about how to help younger children learn to manage their anger and how to work safely with families.

The information contained in this training was submitted by Ellis Amdur, M.A., N.C.C., C.M.H.S. ©

Jennifer Boucher, M.A., Child Therapist, Greater Lakes Mental Health Center, Lakewood, WA.

Victoria Tierney, M.A., Child Therapist, Kitsap Mental Health Services, Bremerton, WA.

We gratefully acknowledge their contributions.

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Pre-RequisitesClinical Skills (risk assessment, treatment planning)

Centering – Maintaining Self-Control

De-escalation Skills

Personal Safety Techniques

Safe Outreaches

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LEARNING OBJECTIVES

Upon completion of this training you will:

1. Possess tools to help younger children understand and manage their own emotions.

2. Have learned specific de-escalation strategies for children and families.

3. Know how to work safely and effectively with violent or volatile families.

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Opportunities to reflect.

Chances to talk with your colleagues

Aim HighTOGETHER

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INTRODUCTION

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Most aggressive behaviors,even of children,are directed toward meeting a human need.

A Core Belief

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What causes children to get angry?

A history of abuse or neglect.

Frustration and failure in school.

Poor role models.

And more.

Some challenges in working with children

Medication management is easier because their parents monitor it.

You have more information on their behavior.

Although one has to identify play activities that will match the child’s abilities and interests, once engaged children are spontaneous in expressing their internal states through play.

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Children are more concrete, linguistically less competent, and less introspective.

It is easy to overlook the importance of a client-centered approach when working with children.

Clinicians might feel a false sense of safety with children, not being mindful of the fact that children too can become very enraged and even violent, and thus be a safety risk.

Some advantages in working with children

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Need to know developmental stages.

Assessments will be very different, requiring interactions with child and caregivers.

AND …

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CONTENT

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety

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CONTENT

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety��

Emotions … what’s that?Children need to be taught what emotions are.

By the time children reach elementary school age they should be able to identify emotions in basic terms.

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Core Beliefs

We don’t tell children they cannot be angry. We teach them how to manage it better.

We are not controlling children. We are teaching them skills.

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Have children focus on their body:

“How does that feel in your body?”

Help them put words to what they are experiencing.

Educating children about emotions

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Teach them that anger does not come “out of the blue.” Help them identify what came before the anger.Teach them calming techniques:

• Take a couple of breaths• Count to 10• Blow bubbles (or another alternative behavior)• Listen to music• Talk to a teacher or parent• Go for a walk.

Educating children about emotions

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Think about what it feels like when you experience anger, fear, frustration, etc. Write down some simple physical descriptions of what your emotions feel like. You can use these as prompts when helping a child learn to recognize his or her emotions.

What do you do to calm yourself down when you are upset? Make a list of simple calming strategies that you think might also work for a child.

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CONTENT

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety�

VIOLENCE

ANGER

Trigger BASELINE

RAGE

RESOLUTION

Possible re-escalation

Post-Crisis Depression

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It’s hard to learn when you’re angry…

De-escalate first, then problem-solve.

Focus on what the child is doing,

not the cause of the upset.

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De-escalation skills for children are the same

as those for adults.

See CD on De-Escalation

About de-escalation techniques

for children

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The sooner you intervene, the better.

About de-escalation techniques

for children

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Don’t simply rush in and try to take over the situation.

Remain mindful and aware, so that moment-by-moment, you can decide the best thing to do.

About de-escalation techniques

for children

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Practice ‘lining up’rather than disputing the facts

Lining up does not mean that you agree.

It means that you are interested and concerned.

You validate the client’s experience.

You set the stage for working together to solve the problem.

Remember: you are not trying to win!

About de-escalation techniques

for children

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Use Summation Statements

You are showing that you understand what they are saying.

A summation statement simply sums up in a sentence what the child has just said in a paragraph – short or long.

You don’t have to be “smart”, and interpret anything. You simply have to listen carefully.

About de-escalation techniques

for children

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Giving two choices is different from “or else” commands:

“Either you calm down or leave now!”

“Or else” commands will usually evoke aggression, not decrease it.

“Are you able to talk to me now about what’s upsetting you, or would you like to go outside and

walk around until you feel better?”

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A rigid insistence on adherence to rules is often linked to assaults

on the rule giver.

Don’t get into a power struggle.

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VIOLENCE

ANGER

BASELINE

RAGE

RESOLUTION

Possible re-escalation

Post-Crisis Depression

Don’t discuss the incident until the child has regrouped after the crisis.

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Educative Follow-UpWait until they have calmed down to talk about the problem.

Then, encourage them to talk. You just listen.

Assure them that you are listening and you care about what they share with you.

Ask, what did they experience? Ask for more information if you don’t understand.

About de-escalationtechniques

for children

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Validate the child’s feelings and the way he or she interpreted the situation.

Apologize if you were in the wrong. Don’t worry—this doesn’t diminish your authority. It makes you more trustworthy.

Don’t blame, argue about facts, or try to problem-solve at this point. You won’t get anywhere.

And …About

de-escalationtechniques

for children

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Imagine a child who has just had an angry outburst because her older sister wouldn’t let her play with her new eye shadow. She yelled at her sister, threw the makeup across the room, and bit the hand of a parent who tried to stop her.

What do you think the child feeling right now as she comes out of her crisis cycle?

What would you say and do, in order, to de-escalate the child and begin to follow-up on the situation?

If you asked the child her side of the story and listened carefully, what do you think she would say?

Think about this “or else” statement: “Either apologize to your sister right now, or go to your room.” How could you phrase this better, so it is meaningful and logical to the child?

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CONTENT

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety��

Self-Management

Teaching information about their emotions

Developing skills to deal with stress, and coping with symptoms

Helping children establish personally meaningful goals to strive towards.

Instilling hope that change is possible.

Helping children gain more control over their lives.

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Begin problem-solving

Offer the possibility of alternative explanations or interpretations

Help children think about what they could have done differently. Brainstorm: “What could you have done instead?”

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Teach them skills to express themselves more effectivelyTeach children to:

Recognize feelings of anger welling up

State their needs clearly

Use “I” statements

Communicate assertively, not aggressively

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Help children take responsibility for their actionsIf they hurt or upset someone, help them apologize.

If they threw things around, have them pick these up.

If they damaged something, have them fix or replace it.

If they acted irresponsibly with the freedom they were given, have them give up some privileges.

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Guide children through there-entry process

Children must eventually return to the milieu where they became angry (for example, a classroom):

– Assess their readiness for re-entry.

– Give them examples of concrete behavior that they might apply when returning.

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The Crisis Plan

Teach children about the crisis cycle.

Have them join you in building a crisis plan.

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Everything in the plan needs to be talked about in advance, and agreed to by the child.

If they can’t commit to the whole plan right now, ask what they are comfortable committing to.

Calming techniques too should be talked about and agreed upon in advance, and written down in the crisis plan.

Developing a crisis plan

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Rehearse the plan many times.

Try role-playing.

Congratulate the child every time he or she practices something out of her plan.

When you notice the child getting angry, remind him or her about what you agreed upon. Keep encouraging to use the plan.

Developing a crisis plan

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Revisit the crisis plan regularly

Does it need to be revised based on what you and the child learned during

the latest incident?

Developing a crisis plan

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A word about teenagers

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With adolescents and teens:Step out of your authoritative role as clinician.

Focus on listening to what they say and how they feel.

Give them space.

Validate their experiences. Make them feel heard and understood.

Remember, there is a different between acceptance and agreement.

See also CD on Working with Youth

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Look at the positives

Peer groups, including gangs, have a strong influence on teens and adolescents.

What other interests does the youth have that you could promote?

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Setting LimitsIt is essential to be clear about ground rules

from the very beginning.

Inform the youth of the limits firmly but respectfully.

For instance, weapons are not allowed. If the youth brings a pocket knife, terminate the session.

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How would you present an alternative scenario to the child? Can you suggest ways she could have handled the situation better?

What are some communication skills you could teach the child, using this event as an example?

What can the child do to take responsibility for her actions and “re-enter” the family peacefully?

What are a few things you could suggest to the child as part of her crisis plan?

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CONTENT

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety

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Creating a Working Alliance with Parents

Parents play a central role in the influence and outcome of child treatment.

Child Treatment is intimately related to factors operating within family.

Parent schedules often determine consistency.

Parental attitudes can conflict with yours.

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Families that support violence might do so because they see it as

their only method of survival

Teach other ways of expressing their needs using Motivational Interviewing

techniques.

Demonstrate how violence leads to difficulties for them.

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Ask parents to help their child learn anger management techniques. They

will learn how to apply these techniques to themselves.

Older siblings can be especially helpful.

More about educating violent families

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A word about your safety

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Mandatory Reporting

Tell the family your policies on mandatory reporting up front during the first session.

Whenever possible, inform the family if you have to report something to CPS, unless you believe that would put the child in more danger.

See DSHS guidelineson mandatory reporting

Handout Available��

When going on an outreach

Remember,

You have less control when you are out in the field.

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Don’t go unannounced when working with families who have a history of criminal

activity or violence.

Leave immediately if you run into a drug deal.

Stop the interview and walk out at any sign of danger (i.e., someone picks up a baseball bat)

More about Home Visits

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Family Arguments

If the family is in a physical fight, or an argument where no one will back down:

Don’t side with any member of the family. Your job is to be a facilitator.

Don’t stay in the middle of it. Physically remove yourself and take a break.

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Separate family members to different rooms, or turn chairs around so their backs are facing each other.

Ask:When you are upset, how do you deal with that?

What triggered it? Focus on the small pieces, not the back story. Was is an event? A word?

What can we change in that process?

More about family

arguments

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With very volatile families, you can’t just say “Let’s talk about it.” That is an advanced skill.

You need to work backward, slowly.

Provide a lot of guidance and keep them on track.

More about family

arguments

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Your attention and intervention must be focused on

the person who is escalating,

regardless of whether this person is a client at your agency or not.

Something to keep in mind:

More about family

arguments

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Do you know your agency’s policy and state requirements on mandatory reporting? When do you report a situation? Who do you report it to? If you aren’t sure, ask to see your agency’s procedure. You can also download a publication from DSHS on mandatory reporting at the end of this CD.

Think of an argument you have gotten in with your spouse or a family member. Practice “working backward” to get to the root cause. • What were the details of the argument? • What triggered each person to get upset? • What were some recent underlying causes of the disagreement? • What do you think were the deeper root causes?

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SUMMARY

1. Education

- Emotions

- Managing anger

2. De-escalation techniques

3. Self-management

4. A word about families and your safety��

SAFETY TRAINING CURRICULUM

CD 3 –Part 3

Thank you for participating in this training!

Presented by: The University of Washington.

The Department of Social and Health Services.

The Washington Institute of Mental Health Research and Training.

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• Handout for staff

• Handout for trainer

• Creative Team questions

• DSHS mandatory reporting guidelines

PDF documents found on the main disc menu: