Dr. Strong to the psych unit…Dr. Strong to the psych unit!!
We need the BIT (Behavior Intervention Team) to Mr. Johnson’s class!!
All available personnel needed at Cottage 333 right now!

These are just some of the many ways people are called to a crisis situation. Often times no indication is given to the level of threat and the size of the team needed to deal with the individual(s) who have gone into or are approaching a level of crisis. Staff for the organization drops what they are doing and head off into the great unknown of what awaits them once they arrive. Often, several members arrive without any indication as to who is responsible to do what. They have simply taken up the call. Arriving with the intent to help out and lesson the threat of harm to others and self by the patient, client, or student. However, these good intentions can often times lead to the very thing we are hoping to avoid…more escalation and a greater level of crisis. When too many people arrive to assist with a crisis by a person receiving supports they create too much speed and motion, volume, shrink the distance needed for an individual to be/feel safe, and often leads to touching way to quickly.

Organizations should consider smaller crisis response teams when dealing with the individual or small group crisis that occur in schools, hospitals, detention centers, and group homes. A safe starting number is two. The first two people on the scene deal with the initial attempts at de-escalation and assessment of further needs. By starting small it allows the staff to minimize the movement, soften the noise, keep a safe distance, avoid the threat of touch to the person who is struggling to maintain their own safety. More people may be called into assist as needed but numbers are managed in a way that does not add to the perceived threat of the person struggling. Smaller crisis teams allow greater manageability of communicating safety factors to the individual who is struggling to self manage.

By avoiding larger crisis teams organizations can minimize the threats created by too many people. Trying to focus on a primary care person’s response cannot occur while others keep running into the room. The brain will occupy itself with threat assessment and miss the message of safety being presented by the person trying to help the individual regain the ability to self manage. By bringing in too many people to the crisis situation, organization increase the threat to the individual served simply by increasing the noise associated with the event. Often times initially because the team does not have a plan too many people are talking at once to gain leadership of the situation.

Many times teams are dealing with an individual’s crisis in a confined space. Too many people make that space even smaller. The more people that are called upon to help, decrease the amount of space that the individual can utilize to feel safe. It also puts people in a greater place of harm because they as staff have nowhere to go if the individual becomes physically aggressive. We block each other’s and the individual’s avenues of escape. When an individual receiving services feels they have no way out for their own safety they attack. The confided space could lead to accidental touching.
Touching someone will result often times in that person reflexing and swinging at whomever touched him or her. It is a human response. One of the best ways to not get to the point of restraining someone is to not be the one to initiate first contact. This is much easier to do when the numbers are smaller in the response team. You are less likely to have the well intended person touch out of concern or that power and control person touch out of…well, power and control!

The historic show of force has been unsuccessful in lowering the number of negative outcomes when responding to crisis. They do not lower restraint and seclusion numbers but often times, because of the number of people involved, they are the direct cause for them. If an organization really wants to work at lowering the number of negative outcomes in crisis situations they must start with smaller crisis response teams. By managing smaller numbers to the response teams organizations are able to manage the increased threat to the individual who is struggling to maintain their own safety and the safety of others. Stay safe!!

Tim Geels
Director of Organizational Sustainability