Techniques for Effective Communication and De-Escalation with Mentally Ill Clients Instructional Design Final Project

EDUC 580/ Spring 2013 Alissa Kugler-Snarr

INSTRUCTIONAL PROBLEM IDENTIFICATION

There is insufficient experience and training for staff at Senior and Disabled Services to

adequately and confidently communicate with our population of mentally ill clients. When an

employee feels unprepared or anxious about communicating with these clients, the client may

not get their needs met, or the employee may escalate symptoms of behavior which can be

scary and upsetting for the both parties involved

Aim of Instruction

Staff will be instructed on effective communication techniques with clients in various stages of

mental crisis; panic attacks, an episode of psychosis, and incidents of aggressive behavior.

Goal of Instruction

Identifies symptoms of panic attack

1. Rules out a heart attack; contacts emergency medical professionals if they cannot

2. Applies de-escalation techniques for a panic attack to reduce client's symptoms

3. Meets the client’s with needs that brought them to the office

Applies correct communication techniques

1. Recognizes the symptoms of psychosis

2. Applies de-escalation techniques appropriate for psychosis

3. Provides the client with the need that brought them to then office

Assess aggressive behavior

1. Evaluate the scene for safety of client, staff, and others nearby

2. Applies correct de-escalation techniques to communication

3. Recognizes when the situation is beyond the ability of the learner and requests outside

assistance from more experienced mental health professionals or law enforcement.

AUDIENCE DEFINITION

General Characteristics Prerequisite skills vary from person to person. Staff displays many

levels of experience and background work in mental health and social work fields. All staff

members are committed to providing the best communication possible to assist clients. There

is low turnover, so implementing a new policy will have a lasting effect on the population of

staff.

Specific Characteristics In the most novice category, some employees have no experience

communicating with mentally ill clients. The behavior and aggression from these clients can at

times be completely unnerving for the staff falling under the novice category, leading them to

make errors with clients. In the next category, we find employees who have had some

experience with this population, and are aware of certain challenges this population presents.

They have had encounters with people who have been diagnosed with mental illness, and are

aware of the unexpected changes in conversation and the aggressive and confusing behavior

presented by certain illnesses. These employees will make fewer mistakes, but still not be

aware of the proper techniques to most effectively communicate. They may respond in an

inappropriate way that inadvertently escalates a situation that could have been deescalated

instead.

CONTEXTUAL ANALYSIS

Orienting Context The learner goals for receiving instruction are to recognize symptoms of

three common mental illness and utilize appropriate techniques for effective communication,

incorporate methods of de-escalation so as not to further agitate clients, and to help staff feel

confident in their dealings with mentally ill clients, so they proceed with certainty and sureness

as they enter into a conversation with the client. Workers will see this as valuable instruction

because it will allow them to do their jobs better and more effectively.

Instructional Context Environmental factors to consider are lighting, temperature, seating, and

equipment. This training will take place in the basement of the Eugene office of Senior and

Disabled Services. It is a large area, with good lighting for speaking and for showing PP slides

and other instructional material; there is also a video projector in the basement so materials

may be shown on a large view so that all employees attending the training can have a clear

view of the instructional material. The temperature is slightly cool, which can be distracting for

some, but better than hot for most. There are ample seating arrangements, and the chairs and

tables can be arranged to encourage small group discussion with their neighbors.

Transfer Context Employees who attend the training will be given time to practice and discuss

the newly acquired skills during the training. They will also be given feedback from the

discussion to help with transfer context. The training will be repeated in an annual basis to

refresh skills and allow for more discussion, feedback, and practice.

TASK ANALYSIS

1. Correctly identify the symptoms of a panic attack

A. Staff will correctly recognize the signs and symptoms of a panic attack and

proceed in a manner that alleviates the symptoms being experienced by the

client.

B. This action is mental; recognizing and identifying behaviors in a client

2. What does a person need to know to do these steps?

A. The knowledge necessary is the ability to correctly identify the

symptoms of a panic attack:

a. Rapid heartbeat

b. Shortness of breath

c. Nausea/dizziness

d. Lightheaded

e. Fear of death

f. Sweating

g. Shaking

h. Chest pain

i. Chills or hot flashes

j. Feeling of “going crazy”

k. Numbness /tingling.

B. Worker will follow dos and don’ts for the situation

a. DO ask if they have had a panic attack

b. DO rule out a heart attack

i. Call 9-1-1 if there is uncertainty

c. DO remain calm

d. DO give the client time to work through their symptoms

e. DON’T show your own anxiety

f. DON’T panic or become agitated

B. What does the learner need to know about the location or orientation of the

components that are part of this step?

a. Staff should ensure safety for the client

i. Make sure they have a place to sit

3. What cues inform a person that there is a problem, the next step is done, or a difference

step is needed?

A. The cue that would alert the employee that there is a problem would be the

presentation of a client under duress.

B. The client would be visibly shaken and panicked.

C. The visual clue will be a reduction or the complete cessation of the panic attack

symptoms being experienced by the client.

OBJECTIVES AND PRESENTATION STRATEGIES

Objective 1

Learners will use appropriate tools and techniques to de-escalate the symptoms of a panic

attack being experienced by a client and resolve the issue that brought them to the office,

Content Category The content category of this objective is procedure.

Performance This objective meets both recall and application criteria.

Initial Presentation The initial presentation will be face-to-face; training conducted at the

monthly all staff meeting. It will be presented to each new employee during their orientation

training as well, so that all employees will have received the same training. It will be presented

in a traditional lecture format, with visual aids of slides, with text and pictures.

Generative Strategy This objective has several performance criteria to consider; procedure to

learn the symptoms of panic attack and heart attack and ask questions to determine which the

client is experiencing, recall remembering the appropriate de-escalation techniques, and

application to understand how to correctly apply the recalled information. To meet those

performance criteria, the generative strategy used for the first objective will be demonstration,

organization, and practice. Learners will watch a video demonstrating how to handle this

situation, and will be given follow up information and notes. The video addresses procedure,

the lecture and facts on panic attack covers recall, and the verbal and written material of dos

and don’ts will address application.

Objective 2

Learners will recognize the symptoms of psychosis and will apply de-escalation techniques

appropriate for the situation. The learner will provide the solution to the need that brought the

client to the office.

Content Category The content category of this objective is interpersonal skills.

Performance This objective meets application criteria.

Initial Presentation The initial presentation will be face-to-face; training conducted at the

monthly all staff meeting. It will be presented to each new employee during their orientation

training as well, so that all employees will have received the same training. It will be presented

in a traditional lecture format, with visual aids of slides, with text and pictures.

Generative Strategy The generative strategy here will follow four part social learning theory

described by Bandura. The first step, initial instruction, will be provided by the first slide

outlining the signs of psychosis and the demonstration of psychosis and effective

communication skills. The second step, developing models of correct behavior, will be provided

by the dos and don’ts of effective behavior, relating back to the demonstration slide. Mental

rehearsal, the third step, and overt practice, the fourth step, will be met by allowing small

group discussion time and role playing between learners, with feedback provided by the

instructor and the learners’ peers.

Objective 3

Learners will assess aggressive behavior by clients in the office and will evaluate the scene for

safety, apply correct de-escalation techniques to communicate effectively with clients, and will

know when to get outside assistance as the situation and aggression of the client exceeds the

knowledge and ability of the learner.

Content Category The content category of this objective is interpersonal skills.

Performance This objective meets application criteria.

Initial Presentation The initial presentation will be face-to-face; training conducted at the

monthly all staff meeting. It will be presented to each new employee during their orientation

training as well, so that all employees will have received the same training. It will be presented

in a traditional lecture format, with visual aids of slides, with text and pictures.

Generative Strategy The generative strategy here will follow four part social learning theory

described by Bandura. The first step, initial instruction, will be provided by the first slide

outlining the signs of aggressive behavior and the demonstration of aggressive behavior and

effective communication skills. The second step, developing models of correct behavior, will be

provided by the dos and don’ts of effective behavior, relating back to the demonstration slide.

Mental rehearsal, the third step, and overt practice, the fourth step, will be met by allowing

small group discussion time and role playing between learners, with feedback provided by the

instructor and the learners’ peers.

PREINSTRUCTIONAL STRATEGY- OVERVIEW

Considering that this is a model designed for a group of adult learners, using this pre-

instructional strategy will meet the adult education principles of "Need to know", and

"Relevance". The overview will introduce the topics and will describe how the learner will

benefit from this additional instruction and how it will improve upon their ability to do their job

well. The overview will be less than one page long, and will touch on each category and what

the learner can expect to learn from the instruction

SEQUENCING CONTENT- TEMPORAL RELATION

The sequencing will be based on a Posner and Strike sequencing scheme, World-Related

Sequencing, specifically world-related sequencing using a temporal phenomenon. The learners

are adults working in challenging personal situations with mentally ill adults, so the content

must be presented in a way that is consistent with the real world. The instructional sequencing

strategy will follow the three major instructional areas of learning; panic attacks, psychosis, and

aggressive behavior. The temporal sequence will introduce each topic and review the signs

and symptoms for each of the three behaviors. The information will be presented in a historical

manner, so that they learn the correct sequence of assessment and communication. The

learner will be instructed on the most effective communication techniques for each situation,

then will be presented with a review of the information with do’s and don’ts for each situation.

The learner will understand how to assess clients and the appropriate communication

strategies to implement, and also to understand the important dos and don’ts of

communicating with mentally ill people.

DESIGNING AND DEVELOPING THE INSTRUCTIONAL MATERIALS

CONTENT PRESENTATION There have been seven graphics designed for this instruction; a

cover/title page, a design of the signs, symptoms, and underlying causes of each of the three

symptoms, and a recap of the dos and don'ts for effective communication with the client. The

cover/title page is purely decoration, and the others would be classified as representation, or

transformation. The introduction slides outlining the symptoms and underlying causes of each

condition are paired with an image that is intended to make a stronger connection between the

words and the images presented for the learner, which may help them transform the

information better. In consideration of Paivio's Dual Coding theory, this states that verbal

information is enhanced by a relevant visual, each intro slide shows a person in a state of panic,

confusion, or aggression.

LEARNER PRACTICE ACTIVITIES During the instruction, there will be several opportunities for

learners to practice these skills. There will be small group discussion sessions during the

instruction and role play will be encouraged among groups.

FEEDBACK AND GUIDANCE The instructor will be on site for this instruction and will be ready to

provide feedback during small group discussion and role playing. There will be ample amounts

of guidance from the instructor, particularly for those employees who are new to

communication/interaction with mentally ill people. The instructor will also be onsite for staff,

as the instructor is also an employee of S&DS, and will be available for follow up questions and

guidance after the instruction period.

IMPLENETATION PLAN (CLER MODEL IMPLEMENTATION PLAN)

CONFIGURATION The agency of Senior and Disabled Services is comprised of approximately

120 people, with a small management team consisting of a Program Manager, and 10 Program

Supervisors. The rest of the population is made up of various departments who coordinate

efforts and services.

LINKAGES S&DS has a very supportive community. For the most part, all departments work

together in support of once another to provide a service to the clients. Management is

supportive and aware of the stresses that are placed on employees and are often searching for

cost effective and available ways to support staff and reduce the workload and other stresses

placed upon them. There is very low turnover at this agency, so much of the staff have

developed friendships over the years that exist outside of work, between different groups. This

is a deeply connected population, with many linkages to help the implementation of this

instruction.

ENVIRONMENT There are no environmental barriers to consider with this plan. The

implementation of this design does not change the environment; it only empowers the staff to

provide a better service to the clients. While there are several different departments at S&DS,

they are a supportive group, and will work together to make the implementation of this design

smooth.

RESOURCES The most important resource is the support that the different configurations will

provide to one another. There are linkages between each configuration in that there is

camaraderie and respect between each configuration. There is no need to take an extra step to

leverage this resources is it readily exists in the current environment.

EVALUATION PLAN

FORMATIVE EVALUATION This evaluation is being conducted to ensure that the instruction is

being understood by the learners. If the instruction is not good, or is not clear enough for

learners to follow, then it needs to be adjusted in the early stages so the time and energy of the

employees is not wasted. Adjustments could be made to make the instruction more effective,

if need be. The data-gathering techniques will be observations of employees and their reaction

to the material, surveys given on the effectiveness and clarity of each subject, and interviews of

staff between segments, to get feedback of their perceptions of the material thus far. The data

will be analyzed on an informal basis at this level, as the data sample will be small and needed

adjustments should be obvious. The primary audience is staff and management of Senior and

Disabled Services. The instruction is for them so that they are better prepared to effectively

communicate with clients of S&DS. That last one will also be for the program in its entirety.

SUMMATIVE EVALUATION The approach of this summative evaluation will be to gather

evidence supporting the effectiveness of this instruction, or feedback regarding the parts that

were not effective. The evaluation will look closely at whether or not this instruction will allow

staff of S&DS the ability to more effectively do their jobs and assist mentally ill people in crisis.

This evidence will be gathered through surveys, interviews, reactions and attitudes of the

learners. Management will also be questioned for a reaction from their side to determine if

this should be implemented permanently and will be effective in the long run. The primary

audience for this evaluation will be the learners and management, also the instructor as they

will have first hand observation of the instruction. The timing will be at the end of the

instruction period, just before staff return to work with this new information available to them.

CONFIRMATIVE EVALUATION This will be a learner oriented approach, and will be primarily

concerned with the long term implications of adding this instruction to staff training models.

This evaluation will occur one year after implementation. The evaluation will consider the level

of behavior change as employees communicate with mentally ill clients, and their proficiency in

overall competency. The methods of obtaining this information will be questionnaires,

interviews with staff and management, and observations of employee/client interaction. The

analysis will be a review of gathered data by the instructor with additional review by

management for further analysis on a secondary level. The primary purpose of this evaluation

will be to determine if the instruction has been effective on the long run, and if changes should

be made to the current instruction given to new employees, to increase the effectiveness. The

timing will be one year after the initial implementation, to give time for staff to acclimate to the

new procedure and learn the new skills and how to best apply them to communication with

clients.

PLANNING AND PROJECT MANAGEMENT

KEY PERSONNEL

The design requires:

instructional designer

instructor

staff

management in an advisory capacity, to provide feedback and ensure the instruction is

suited and appropriate for the staff of S&DS and will satisfy the goals of the project

purpose

MILESTONES AND DELIVERABLES

The project milestones for this project are:

identifying the scope of work

scheduling

starting the project

designing material

project reporting

completing the project

Deliverables:

graphic designs of introduction slides for the three content categories; panic attacks,

psychosis, and aggressive behavior, and also the

recap/dos and don'ts slides for each content category

with the completion of each unit, they will be given the instructional for formative

evaluation

SCHEDULING

This design will take approximately eight weeks to complete.

Week 1-2: defining the project purpose and learner analysis.

Weeks 3-4: designing the program outline and graphic materials associated with the

instruction.

Weeks 5-6: defining the instruction, and creating the overall plan for the instruction

implementation, and filming the video demonstrations.

Weeks 7-8: formative and summative evaluation input from management, and making

any changes, and completing the final project and materials.