NHS CRT Syllabus

Content

Detail of Course Content

a)  describe the common causes of conflict and identify the different stages of conflict

Conflict Triggers

The Six 6Cs of Conflict

How to recognise the conflict triggers in ourselves and others, including the cues signal that a person has been triggered.

The 6 Cs of conflict is a simplified version of the Kaplan-Wheeler analysis which offers a framework for understanding the process of arousal, mapping the stages of conflict.

b) learn from their own experience of conflict situations to develop strategies to reduce the opportunity for conflict in the future

Conflict Primer

Core Principle

Empathy

Trauma Responsiveness

Social Contracts

Leverage the learners own experiences of conflict to discuss the results of poorly managed conflict, the causes of conflict and personal thoughts and feelings about how to best resolve conflict.

The core principle in Conflict Resolution must be to Treat every person with Dignity by Showing them Respect, even when there is disagreement or discord.

Empathy eases tension, and is the most versatile tool we can use to defuse conflict. We must: acknowledge their perspective, seek to understand what is driving them and anticipate their needs.

Trauma Responsiveness means that we need to acknowledge the possible effects of past psychological, emotional and/or physical trauma that a person has experienced.

A social contract is an agreement by all to treat each person with dignity by showing respect, consistently, with the goal of building respectful and safe environments.

c)  describe two forms of communication

Verbal / NonVerbal

Talking/ Listening

Nonverbal Communication consists of the messages people send by how they present to the other person through their body posture, hand gestures, facial expression, tone, volume and pace of language.

Verbal Communication consists of the word choice and structure of messaging used to convey meaning through the use of voice in an interaction.

Listening is paying attention - “listening with all our senses” - to what the person is saying and trying to decipher the core meaning of their communication, not simply waiting for our turn to speak and telling the person what we want them to hear.

d)  indicate the level of emphasis that can be placed on verbal and non-verbal communication during a conflict situation

Be Alert and Decisive

Threat Indicators

Learning to be situationally aware and ready to take action - a ‘preplanned and practiced response’ - if a threat is identified or a safety risk is presented.

Threat indicators consist of proximity breaches, nonverbal cues such as pointing fingers or shaking fists, and verbal veiled or overt threat statements.

e)  understand the impact that cultural differences may have in relation to communication

Core Principle - 5 Approaches All People

Proxemics

All people want to be treated with dignity and be shown respect in interactions with public-facing staff. Therefore the 5 approaches become important:

• We See the world through their eyes
  
• We Listen with all our senses
  
• We ask and explain why
  
• We offer options, letting the other choose
  
• We give an opportunity to think again
  

Some communication cultures are different - examples to be shown and discussed in class.

f)  identify the causes of communication break down and the importance of creating conditions for communication to succeed

Conflict Triggers

Empathy - 5 Approaches

Respond, Don’t React

Showtime Mindset

The SCARF model describes an excellent short-hand for the key social influencer domains for human beings - Status, Certainty, Autonomy, Relatedness and Fairness.

The 5 Approaches match to the SCARF model extremely well (see above).

Rather than acting or speaking on first impulse, we must respond to events rather than reacting with our emotions to what is happening. First impulses are often driven by ego and can be disastrous in conflict. Learn to control own conflict triggers to maintain emotional equilibrium.

The Showtime Mindset is a way of achieving emotional self-control and resetting to a place of emotional equilibirum so that we can respond to the interaction rather than being reactive. Leverage self-confidence and self-belief to project an appropriate level of professionalism into the encounter.

g)  utilise three communication models that would assist in dealing with different levels of conflict

Universal Greeting

Persuasion Sequence

Redirections

Crisis Management

When we first encounter someone - often interrupting them in their day or task - it can be useful to have a habitual way of opening the interaction politely, professionally and giving it the best chance of proceeding without escalation. The Universal Greeting is about getting the interaction off on the right footing.

The persuasion sequence is used to gain the other person’s voluntary cooperation when there is a rule or procedure laid down for them to follow in order to maintain an orderly, safe and secure transaction between the organisation and them.  It offers staff a verbal process to follow when meeting resistance from the other person which offers dignity and respect.

Redirections are tools used by staff to redirect negative behaviour such as abuse, intimidation or insults in such a way as to keep the interaction on-track for a positive outcome. A variety of redirection verbalisations exist to help staff to achieve their task while not getting ‘involved’ in verbal abuse. They also create opportunities for staff to decide if it is time to disengage if feeling unsafe.

The Crisis Management Approach and the 5 Crisis Management tools offer staff a framework which can be used with any person exhibiting signs of short- or long-term cognitive difficulties. These tools help staff to work effectively with vulnerable people.

h)  recognise the behavioural pattern of individuals during conflict

The Six Cs of Conflict

Our ideal progress through Context, Contact and Closure may be derailed and complicated by Conflict, Crisis or Combat (See above for reference to Kaplan-Wheeler)

i)  recognise the warning and danger signals displayed by individuals during a conflict situation including the signs that may indicate the possibility of physical attack

Be Alert and Decisive

Threat Indicators

Take Appropriate Action

Learning to be situationally aware and ready to take action - a ‘preplanned and practiced response’ - if a threat is identified or a safety risk is presented.

Where attempts at resolution or de-escalation may fail or be inappropriate OR where an immediate and clearly articulable safety violation or concern may occur, staff must take appropriate action.  This may include calling for appropriate assistance, disengaging from the contact, or using self-protection methods to physically protect and escape from a situation if it has become a physical confrontation.

j)  identify the procedural and environmental factors affecting conflict situations and recognise their importance in decision making

Social Contract

Gateway Behaviours

Take Appropriate Action

A Social Contract exists when there is a clear understanding of what behaviours are inappropriate and there is consistent - albeit firm/gentle - intolerance by every contact person for such behaviours. So-called “Gateway behaviours” must be addressed to maintain the social contract and build respectful and safer environments.

k)  understand the importance of keeping a safe distance in conflict situations

Proxemics 10-5-2

Distance affects the comfort level of people interacting with each other and their personal safety.  At key distances (10feet - 5feet- 2feet), dynamis risk assessments can be  made about safety and mood, presentation, behaviour and other intangibles, very quickly. Positioning, and hand gestures also influence safety and may enhance or detract from the quality of interaction. Poorly managed proxemics are the first step towards a person making the choice to assault a member of staff, and therefore warrant our attention and focus.

l)  summarise the methods and actions appropriate for particular conflict situations bearing in mind that no two situations are same

Treat with Dignity by Showing Respect 

Listen with all senses

See the world through their eyes

Ask and Explain Why

Give Options

Offer a Chance to Reconsider

Staff apply the core Dignity through Respect maxim at all times. Respect is shown through the 5 Approaches (described above in detail) and then use empathy to discover which of the available tools are best deployed within the interaction to reach the desired peaceful outcome.

See the “Non-Escalation / De-Escalation Card”

m)  explain the use of ‘reasonable force’ as described in law and its limitations and requirements

Take Appropriate Action 

Dynamis ‘Principles of Reasonable Force’

Reasonable Force is a concept in English Law which is governed by core principles.  These principles can guide staff in the right responses to physical threats to their safety and include the concepts of Lawful Excuse, Necessity, Last Resort, Proportionality and Honestly Held Belief. Each concept has its own well-refined meaning in legal precedent.  Although ‘it would be for a court to decide’ in any dispute, these principles when well-learned by staff can serve as excellent guides for decision-making and incident reporting frameworks.

n)  identify the range of support, both short and long-term, available to those affected by a violent incident

Trauma Responsiveness

Empathy

Trauma may be acute, complex, historical or even secondary. Many people we meet will have experienced trauma and due to its essential nature and deep pathways in the brain, certain situations, contexts or behaviours may traumatise (or re-traumatise) people or trigger in them behaviours which they find completely unexpected. 

Peer support for our colleagues in the aftermath of an incident can be an extremely important healing opportunity for many.  However, some of our colleagues may need more considered help and support, and it is important that in the aftermath of an incident that we carefully assess their need for this kind of in-depth care and support.

“Are you okay?” is a hugely important question which we need to give appropriate care and attention to.

Empathy:

Acknowledge their perspective

Seek to Understand

Anticipate their needs

o)  understand the need to provide support to those directly affected by a violent incident and the wider organisational benefits of this.

Closure 

Peer Support Debriefing 

Supervisor Debrief as per NWAS policies

Post-Incident Support as per NWAS policies

Incident Reporting as per NWAS policies

Closure has the aim of ending an interaction with someone safely and on a positive note, which establishes a positive foundation for any future interactions and leaves them in a better state of mind than when we first encountered them.  Closure as a concept also includes properly checking that the person we interacted with is emotionally, mentally and physically safe before we end our interaction with them, underlining the importance of handing over (for example, patients) after any high-stress encounter.

A significant part of this module of the course will be built around the processes and procedures in place at NWAS for post-incident debriefing, post-incident in-depth- review, staff support, incident recording, reporting and additional support services available to staff which are built-in to NWAS operational doctrine.