Modifying Staff Attitudes and Behavior

Chronic/Persistent Staff Attitudes towards Individuals (particularly in crisis situations):

  • Anxious: catastrophizing “Things will get out of control”, may be reprimanded by supervisor or lose job unless individual is brought under control.
  • Hopeless:“Nothing I do seems to work with these individuals. They are not able to improve”.
  • Apathetic:“It is justa job. Check in in the morning and check out at night. It doesn’t matter what happens to these individuals. Might as well work with those who are easy.”

Staff Behaviors:

  • A persistent staff attitude may reflect their parents rearing style which is:
    • “Safety First”: (rules) to keep the youngster off the streets, off of drugs and attending to personal hygiene.
    • Overly Aggressive: When an individual is acting out( ex. undressing in public, smearing feces, attacking, engaging in self-harm, suicide ideation or attempts), staff using physical methods to bring the individual under control.
    • Isolation from “Difficult” Individuals: Only work with individuals who are approachable and malleable.
    • Strict application of Rules: Reward and punishment (for example, if an individual does not shower, he would not be allowed to go on an outing).

Our Systematic Approach to Crisis:

  • Try to handle the crisis by determining the pathway (chain reaction) leading up to the event. The individual is always upset when engaged in bizarre behavior, so it is important to pick up or anticipate the upset at the earliest point.
  • Example: Individual transferred to a forensic unit had not been informed of transfer and became upset about the new unit and undressed and walked around naked.
  • The usual precipitating factor is that the individual is upset, feels out of control, or controlled by others, resulting in bizarre behavior as a kind of mood regulation strategy. It is similar to taking a substance when upset.
  • Systematic approach to crisis when it occurs: attempt to engage the individual in an activity that worked previously –listening to music, watching television, going for a walk, meditation.
  • Following engagement/refocusing: determine what is upsetting the individual. Recognize that although the crisis behavior of the individual may be bizarre, the upsetting incident is entirely plausible. Often when the individual starts to talk about what is upsetting him, he shows a “cognitive switch” to a partially adaptive mode.
  • Show empathy for upset and then proceed to refocus, problem solve, etc.