# Conflict resolution and de escalation

*How to bring the temperature down, and how to keep yourself safe when it does not come down.*

## Production summary

- Modules to record: 2
- Total script: 1388 words, about 9 minutes of finished audio
- Voices: Amara (host) and Nadia (practice educator)
- Level: All health and social care staff

## Accreditation wording that must appear in the description

- **Skills for Health Core Skills Training Framework** (aligned): Mapped by us to the CSTF conflict resolution outcomes. Our own mapping, with no assurance, verification or endorsement by Skills for Health implied.
- **The CPD Certification Service** (planned): Application scheduled.

> Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved.


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## The assault cycle, de escalation and staying safe

**Runtime** about 6 minutes. **Words** 884. **Starts at** 00:00 in the full course recording.

### Learning outcomes to state on camera

- Describe the five phases of the assault cycle
- Apply verbal and non verbal de escalation
- Use positioning, exit awareness and withdrawal
- Report, debrief and support colleagues afterwards

### Script


`[CUE 1]` *Causes of aggression wheel with pain, infection and toileting needs at the top.*

**AMARA**  [00:00]
I want to start somewhere uncomfortable. A lot of care staff are told that aggression is just part of the job.

**NADIA**  [00:08]
And it is not. Let me separate two things, because they get confused and the confusion causes harm. Understanding why aggression happens is useful. Being expected to absorb assault is not the same thing at all.

**AMARA**  [00:22]
So why does it happen?

**NADIA**  [00:24]
Very rarely malice. Fear. Pain. Delirium. Dementia. Intoxication or withdrawal. Frustration at waiting or at not being heard. And the humiliation of having lost control over ordinary things, like when you eat and who sees you undressed.

**AMARA**  [00:39]
And you say that is practical, not just compassionate.

**NADIA**  [00:43]
Deeply practical. If the cause is unmet pain, then paracetamol changes the behaviour and no amount of de escalation technique will. If the cause is being told what to do by a stranger, a genuine choice changes it in about five seconds. So before you manage behaviour, exclude pain, infection, constipation, needing the toilet, hunger, thirst and overstimulation.


`[CUE 2]` *Assault cycle graph with the escalation phase highlighted as the intervention window.*

**AMARA**  [01:06]
Tell me about the assault cycle, because I have heard the term and never had it explained.

**NADIA**  [01:13]
Five phases. Baseline. Trigger. Escalation. Crisis. Recovery. And then a post crisis phase where the person is often exhausted and full of remorse.

**AMARA**  [01:22]
Which one matters most?

**NADIA**  [01:23]
Escalation. That is where de escalation works. In crisis it barely works at all, and this is the single most useful thing in this module.

**AMARA**  [01:33]
So if somebody is already in crisis and I am talking them down?

**NADIA**  [01:39]
You are probably prolonging it. Once a person is in crisis your objective changes. It is no longer talking them down, it is keeping everyone safe until the arousal falls. Reasoning with somebody in crisis is like reasoning with somebody who is drowning.


`[CUE 3]` *Recovery phase warning showing a second trigger relapsing to crisis.*

**AMARA**  [01:56]
What about recovery? That sounds like the safe bit.

**NADIA**  [01:59]
It is the bit that catches people out. Arousal comes down slowly, so a second trigger during recovery sends the person straight back to crisis from a much lower starting point. Give time and space before any conversation. Do not go straight in with we need to talk about what just happened.

**AMARA**  [02:20]
Right. De escalation. What actually works?

**NADIA**  [02:23]
Reduce the audience. Reduce the noise. And reduce the number of people talking to exactly one. Three staff all speaking at once is escalation, not help.

**AMARA**  [02:33]
And physically?

**NADIA**  [02:34]
Give more space than feels natural. Lower your voice instead of raising it, which is counterintuitive and it works, because people match your volume. Slow your speech. Keep your hands visible and open.


`[CUE 4]` *De escalation posture diagram: angled stance, space, hands visible, exit behind you.*

**AMARA**  [02:47]
What do I say?

**NADIA**  [02:49]
Short sentences. Their preferred name. Acknowledge the feeling out loud: I can see you are angry, and I want to sort this out. Do not argue about facts, because you will win the argument and lose the person.

**AMARA**  [03:04]
And what should I never say?

**NADIA**  [03:06]
Calm down. It has never calmed anybody in the history of the world. Also you need to relax, and there is no need for that. All three tell the person their feeling is illegitimate, which is a fresh trigger.

**AMARA**  [03:22]
You mentioned offering a choice.

**NADIA**  [03:24]
Two real options. Not an instruction dressed up as a question. Would you rather sit here or come through to the quiet room. Choice restores control, and lost control is usually what caused this in the first place.


`[CUE 5]` *Phrase bank: what to say in gold, what never to say crossed out.*

**AMARA**  [03:39]
Let us talk about my safety. Where do I stand?

**NADIA**  [03:43]
At an angle rather than square on. Square on is confrontational and it also means you cannot move. Stay beyond arm's reach and out of kicking range. Never let the person get between you and the door, and know where the second exit is before you need it.

**AMARA**  [04:02]
Anything to move?

**NADIA**  [04:03]
Ligature and weapon risks within reach, where you can do it safely. And that includes things people forget. Your own lanyard. Scissors. A hot drink.

**AMARA**  [04:13]
When do I leave?

**NADIA**  [04:15]
When the risk exceeds what you can manage. And I want to say clearly that leaving is a professional decision, not a failure. Summon help, follow the escalation route, and if you are a lone worker, use the check in system and the agreed distress phrase.


`[CUE 6]` *Reporting loop showing under reporting leading to unchanged conditions.*

**AMARA**  [04:33]
What about restraint?

**NADIA**  [04:35]
Not from this course, and not from any online course. Restraint carries a real risk of death, particularly prone restraint or anything restricting the chest or airway. It requires in person training under a recognised framework, it is a last resort, for the shortest possible time, and it is always recorded and reviewed.

**AMARA**  [04:56]
Afterwards. What should happen and what usually happens?

**NADIA**  [04:59]
What usually happens is nothing. People do not report, especially verbal abuse, because they have decided it is normal.

**AMARA**  [05:07]
And the cost of that?

**NADIA**  [05:09]
The staffing level never changes. The waiting time never changes. The layout never changes. The individual's unmet need never gets found. Under reporting is precisely why nothing improves. So report everything, debrief the team, and where it is appropriate debrief the person too, because many are ashamed afterwards and will tell you exactly what set them off if you ask at the right moment.

**AMARA**  [05:34]
And the colleague who was on the receiving end?

**NADIA**  [05:38]
Check on them properly, not in the corridor. And take the cumulative effect seriously. One incident is an incident. Being shouted at every shift for two years is an injury, and it is the one nobody writes down.

### Sources for the on screen credit

- Violence and aggression: short term management, NG10, NICE
- Core Skills Training Framework, conflict resolution, Skills for Health
- Violence and aggression at work, Health and Safety Executive

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## Lone working, and what happens afterwards

**Runtime** about 3 minutes. **Words** 504. **Starts at** 05:53 in the full course recording.

### Learning outcomes to state on camera

- Plan and carry out a lone visit with a working safety system
- Recognise the environmental and situational cues that precede violence
- Withdraw safely, and understand that leaving is the correct decision
- Support yourself and colleagues after an incident

### Script


`[CUE 1]` *Four part lone working system, with the flag feeding back into the rota.*

**AMARA**  [05:53]
Most of my work is alone, in people's houses, often in the dark.

**NADIA**  [05:58]
Which is the highest risk part of care, and it is the part with the least training attached to it. Employers have duties under the 1974 Act to assess and control that risk, and a lot of them discharge it with a policy nobody has read.

**AMARA**  [06:17]
What would a real system look like?

**NADIA**  [06:19]
Four things. Somebody knows where you are and when you are due out. You can raise an alarm without being seen doing it. There is a defined response if you do not check in. And you can flag a property as higher risk.


`[CUE 2]` *A flag raised and a rota returning unchanged, marked as a document not a system.*

**AMARA**  [06:37]
We can flag things.

**NADIA**  [06:38]
Then here is the test. You flag a property, and the following week the rota comes back unchanged. What have you got?

**AMARA**  [06:47]
A document.

**NADIA**  [06:48]
A document. A flag that does not change how a visit is staffed is a filing exercise, and workers stop using it within a month because they can see it does nothing.


`[CUE 3]` *Environmental cues in a room: extra person, locked door, seating rearranged.*

**AMARA**  [07:01]
Are there warning signs? Or does it just happen?

**NADIA**  [07:04]
It very rarely just happens. And this is the difficult part: people who are hurt usually say afterwards that they noticed something and talked themselves out of it.

**AMARA**  [07:15]
What should I be noticing?

**NADIA**  [07:17]
Environment first. Somebody in the house you were not expecting. A door locked behind you. A dog loose that is usually shut away. And the room rearranged so you are the one furthest from the door.


`[CUE 4]` *Situational trigger: a benefits letter on the mat before the visit.*

**AMARA**  [07:32]
That last one is subtle.

**NADIA**  [07:34]
It is subtle and it is deliberate when it happens. Then behaviour: pacing, clenched hands, rapid speech or a sudden silence, standing too close, blocking the doorway, not letting the conversation end.

**AMARA**  [07:47]
And situational?

**NADIA**  [07:47]
The most reliable predictor of all. Bad news that arrived before you did. A care package cut this week. A benefits letter that morning. An eviction notice. You have walked into somebody's worst day and you are the nearest representative of the system that caused it.


`[CUE 5]` *Leaving the house and escalating from the pavement.*

**AMARA**  [08:06]
What do I do?

**NADIA**  [08:07]
Leave. Not after the call, not after explaining. Leave, and escalate from the pavement.

**AMARA**  [08:13]
It feels rude, and I would feel stupid if I was wrong.

**NADIA**  [08:18]
Then say something neutral. You need something from the car. That is all. And hear this clearly: nobody has ever been disciplined for leaving a house that felt wrong. Several people have been seriously hurt for staying to be polite.


`[CUE 6]` *Delayed reaction curve: fine on the night, shaky at three days.*

**AMARA**  [08:34]
And afterwards?

**NADIA**  [08:35]
Report it, including verbal abuse, because under reporting is exactly why the visit arrangements never change. And get a real debrief, not a corridor conversation on the way past.

**AMARA**  [08:46]
I would probably say I was fine.

**NADIA**  [08:49]
Most people do, on the night. And then they are shaky three days later, which is a completely normal delayed reaction and not weakness.

**AMARA**  [08:59]
What should a manager do?

**NADIA**  [09:01]
Ask more than once. A single how are you on the day gets a fine from almost everybody. The honest answer usually arrives about a week later, and only if somebody bothers to ask again.

### Sources for the on screen credit

- Violence and aggression at work, and lone working, Health and Safety Executive
- Health and Safety at Work etc Act 1974, sections 2 and 3, legislation.gov.uk
- Supporting staff after a violent incident, Social Care Institute for Excellence

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