The ProDeMa®-7-Step-Model for the De-escalation of violence and aggression

The 7-Step-Model of de-escalation shows clearly the different levels, on which de-escalation or the prevention of violence and aggression can take place. All 7 steps are closely interrelated and therefore must all be accounted for during schooling and implementation in institutions. 




De-Escalation-Step 1:
Prevention of the origins of violence and aggression.
(Primary Prevention)

At this stage we concentrate mainly on the surrounding conditions that might influence the development of violent an aggressive behaviour of patients, occupants or clients, i.e. all stimuli that might lead to violent or aggressive behaiour are deliberated. This includes rules and regulations, patterns of social interaction, imposed times of delay, excessive demands etc. 


De-Escalation-Step 2:
Revision of the assessment of aggressive behavior

Individual evaluation processes when dealing with violent patients/clients are decisive for whether the reaction of personnel will lead to an escalation of the situation or not. At this stage we deliberate our personal patterns of perception and assessment. Thereby we learn to differentiate ourselves from the momentary existential orientation and possible verbal aggression of the patient/client. In addition we reflect the origin of our own aggression potential and work out possibilities and strategies to cope with and appease our feelings of anger or worse. 

De-Escalation-Step 3:
Understanding the reasons and motives of violent behaviour

Violent behavior of human beings always has a reason or trigger and a motive or underlying intention. The knowledge and deeper understanding of these reasons and motives is the precondition for de-escalative communication with patients/clients. By detecting the momentary needs, problems and feelings underlying any violent behavior, we can come into contact with, understand and soothe our patients/clients, thereby helping them and ourselves to deal with the situation and avoid any further escalation.

De-Escalation-Step 4:
Communicative methods in direct contact with highly stressed patients/clients
(secondary prevention)

De-escalation can be described as successful, when the aggressive tension and the inner need of the patient/client subside and it is possible to lead a resolving or relieving conversation in order to find solutions for his momentary problems and mental state.

Which form of communication and negotiation is beneficial in direct contact with highly stressed patients/clients? Can I verbally de-escalate an acutely threatening situation with patients/clients? How do I react, if a violent assault seems imminent? We deal with these and similar questions at this stage of de-escalation. 

De-Escalation-Step 5:
Respectful and Gentle Techniques of Self Defense and Escape

The use of physical techniques of self defense must be the last resort in controlling dangerous situations. They should only be put to use when all the other options have failed.

We teach special developed patient-friendly and injury-free techniques especially for the use with patients/clients to minimize the risk of injury on both sides. 



De-Escalation-Step 6:
Patient-Friendly Techniques for Escorting, Holding, Immobilisation and Physical Restraint

In many situations, when patients/clients present a danger to themselves or others, they have to be held or immobilized to make sure, that neither they nor others will get hurt. Also, escorting confused or intoxicated patients/clients requires great caution. Our techniques for escorting, holding and immobilization are adjustable concerning varying patients/clients, varying situations or a varying measure of violence.

Restraining a patient against his will by strapping him into his bed is one of the most disagreeable tasks for employees in health care institutions. But, depending on the legal system, there are cases in which this has to be done to avoid any serious threat a patient can pose to himself or others. If restraining actions are undertaken unplanned, without prior arrangements or by non-skilled staff, they can lead to severe physical and mental trauma for both staff and patients alike. Professional schooling in dealing with these situations is inevitable to guarantee professionalism, security and lack of injuries for everyone involved.

De-Escalation-Step 7:
Preventive Measures Following Violent Situations
(Tertiary Prevention)

Violent incidents, provocative behaviour, experiences with escalation or unavoidable measures of immobilisation or physical restraint are reviewed with the affected patients/clients, and any involved staff, so as to avoid future incidents. In this process we look at possible alternatives concerning actions and timely communication of personnel.

Cooperative first aid, follow-up conception and schooling of executive staff in contact with affected employees to avoid PTSD and related syndromes are also part of De-Escalation Step 7.