Using a behavioral influence model developed by Dr. Gregory M. Vecchi, formerly a Special Agent in the Federal Bureau of Investigation who served as the Chief of the Behavioral Sciences Unit and as a negotiator in the Crisis Negotiation Unit, the Behavior Change Stairway Model (BCSM)3 establishes the foundation of the crisis communication skills that are utilized throughout the CIT training program. The skills are adapted from crisis and hostage negotiation training and are grounded in extensive research on how to effect a behavioral change. The training emphasizes the use of communication techniques in a calm and courteous manner with the ulti-mate goal of changing the subject’s behavior and gaining their voluntary compli-ance. Voluntary compliance is achieved through the utilization of a variety of de-escalation and communication techniques that are outlined below. This module entails both a lecture presentation and numerous interactive elements where the trainees practice the skills being reviewed.
The core topics discussed include the following:
Active Listening – An important set of crisis communication skills that greatly contributes to each of the below elements. Active listening is the most critical set of skills a person needs to effectively communicate during a crisis situation.
3 Vecchi, G. M., Van Hasselt, V. B., & Romano, S. J. (2005). Crisis (hostage) negotiation: Current strategies and issues in high-risk conflict resolution. Aggression and Violent Behavior, 10(5), 533–551.
Deceleration and utilization of time – Officers are instructed on how to slow the pace of an incident and not rush towards a quick resolution, whenever possible.
Rapidly made decisions, when not required due to an immediate safety concern, lessen an officer’s reaction time, prompts an uninformed decision making process, and may provoke an individual who is already in a crisis state. Decelerating the process contributes to achieving a successful outcome by allowing time for more informed decisions to be made that include the person in crisis as the primary stake-holder in the overall process.
De-escalation – Slowing the process down through active listening and crisis communication naturally de-escalates a critical incident and reduces the effect of the emotions the subject is experiencing. These emotions directly influence the subject’s actions and must be addressed.
Additionally, the emotional contagion experienced by responding officers is also addressed as they are active participants in the incident and are subject to making poor decisions due to their own emotional fluctuations and perceived challenges to their ego. The final component of de-escalation discussed in this module includes the importance of proper tactical management of the incident scene and the effective utilization and deployment of necessary resources (NYPD and others) which help minimize any potential uses of force, if required.
Participants are also taught about empathy and rapport. Basic psychology and negotiation research demonstrates that in order to change a person’s current behavior you need to understand their perspective. This is what true empathy entails. Engaging the subject in a respectful and positive manner builds rapport and increases our legitimacy with the subject and any other persons involved or observing the incident. In order to change a person’s behavior and gain voluntary compliance, the officer must be able to positively influence, not manipulate, the individual to change their current behavior and actions. The purpose of demon-strating empathy and building rapport is to eventually influence the person to the point of behavioral change, getting them to voluntarily do what the officer needs him or her to do at that time. Through this process, the officer’s actions clearly demonstrate a willingness to help the individual through the process by listening and offering assistance. For responding officers, a critical incident frequently entails a feeling of lack of control over the situation and its participants. The offi-cer, by effectively utilizing the above skillset and techniques, can often regulate the incident and reestablish a sense of order without diminishing their own tacti-cal control over the scene or using force on the subject. Throughout this module, repeated connections are made to the policy, procedure and tactics module in order to underscore the importance of employing a coordinated tactical plan containing de-escalation and deceleration techniques while simultaneously maintaining full situational awareness.
An introduction to both the mental health and criminal justice system is given on the second day of training. This provides trainees with a brief examination and over-view of the mental and behavioral health industry, the laws governing the taking of persons into protective custody, and how these issues intersect with the criminal
justice system. Instructors address the issues of limited access to and the use of mental health services, mental illness stigma and attitudes towards individuals with mental health issues, recidivism rates, and the frequency of calls for service.
Modules
The following are the mental and behavioral modules covered over the rest of the course. Each module has various scenarios that will be employed in the mock scenarios.
Psychotic Disorders – In this module the clinicians define psychosis and provide statistics on its prevalence in society. They also explain how psychosis affects an individual cognitively and behaviorally. The central mental illness discussed during this module is schizophrenia. The trainees are provided with a list of indicators of the illness and guidance is provided on how to effectively communicate with some-one who is symptomatic. The trainees participate in an auditory hallucination exer-cise which aids in building empathy and rapport between law enforcement and this population. The exercise entails the participants using MP3 players which simulate typical schizophrenia symptoms (e.g. voices) playing constantly in their ear; they are then asked to perform simple tasks. It has proven to be a very effective exercise, as the trainees are not capable of performing the tasks.
Mood Disorders –This module provides the trainees with the knowledge, skills, and abilities to recognize the signs and symptoms of commonly occurring mood disorders and how to safely and effectively render assistance to those persons in crisis. The major disorders that are presented in this module are depression and bipolar disorder. The impact of these and similar disorders among the homeless population is discussed. The trainees are advised that persons with bipolar disorder can have intermittent periods of psychosis and are reminded to employ proper crisis communication strategies and tactics, when applicable.
Suicide Indicators and Prevention – The purpose of this module is to provide the trainees with an overview of suicide that includes the features of ideation, common risk factors, assessment tools, intervention techniques, and prevention strategies. Each year more than 34,000 individuals take their own life, leaving behind thousands of friends and family members to navigate the tragedy of their loss. Suicide is the 10th leading cause of death among adults in the U.S. and the 3rd leading cause of death among adolescents. Suicidal thoughts or behaviors are both damaging and dangerous and are therefore considered a psychiatric emergency (NAMI 2015).
The trainees are instructed to communicate clearly and to deliberately ask the individual in crisis if they want to kill themselves, if they have a plan, and if so, why they want to carry it out on this particular day. The class reviews several positive communication strategies and how to decipher what a protective factor (a reason to live such as family, education, work, etc.) is versus a hot button issue (a topic that will drive the person further into crisis). The impact of suicidal tendencies among
the homeless population is also discussed during this presentation. Suicide risks among law enforcement officers are examined and the numerous resources avail-able to assist with handling such a crisis are presented.
Personality Disorders – This module provides officers with the knowledge, skills, and abilities to recognize the signs and symptoms of commonly occurring personality disorders. The major disorders discussed are borderline personality and narcissistic personality disorders. The training program stresses that personality disorders are deeply ingrained maladaptive patterns of thinking and behaving that are inflexible and which generally lead to impaired relationships with others.
Communication strategies are discussed and the trainees are advised on the most effective methods to interact with an individual they suspect of having a personal-ity disorder.
Anxiety Disorders – This module presents the signs and symptoms of general-ized anxiety as well as several sub-types of common anxiety disorders. The trainees are provided with direction on effective methods for rendering assistance to indi-viduals experiencing intense anxiety. Panic attacks are discussed in depth and the trainees are taught several communication strategies that are effective with this population.
Post-Traumatic Stress Disorder – This module provides the trainees with the knowledge, skills, and abilities to recognize the signs and symptoms of post- traumatic stress disorder and acute stress disorder in an individual experiencing a crisis. Statistics outlining the prevalence of post-traumatic stress disorder among US military veterans and law enforcement officers are discussed. The trainees are provided with direction on effective methods for rendering assistance to individuals with post-traumatic stress disorder.
Mindfulness – This module discusses the basic concepts of mindfulness and examines valuable connections to the work of law enforcement officers. Specifically, a model called Mindfulness Based Stress Reduction is reviewed along with informa-tion about the demonstrated efficacy of mindfulness in promoting officer wellness.
A brief guided mindfulness exercise created specifically for law enforcement is con-ducted and information about additional exercises is provided.
Developmental Issues and Childhood / Adolescent Behavior Disorders – The purpose of this module is to provide officers with the knowledge, skills, and abilities to recognize the signs and symptoms of young members of the community who are in crisis. Generally, these mental health issues originate in childhood and may involve a significant impairment of function in different areas that may continue through adult life. The specific disorders covered are conduct disorder, oppositional defiant disorder and antisocial personality disorder. The NYPD’s policies and pro-cedures regarding juvenile detention and arrest are also reviewed as many of these critical incidents occur in public schools. The trainees are provided with direction on effective methods for rendering assistance to adolescents in crisis.
Autism Spectrum Disorder – This module provides information about the signs and symptoms of someone living with Autism Spectrum Disorder. Generally, the most significant impairments are in the areas of communication and adaptability to change or unforeseen circumstances. The trainees are provided with general guidelines
for effective communication and incident scene management. Additionally, a discussion about the impact Autism Spectrum Disorder has on caregivers and fam-ily is facilitated. This module has a particular emphasis since the disappearance of Avonte Oquendo, an autistic 14 year-old boy who went missing from his Long Island City school in Queens on October 4, 2013. The NYPD, working with other governmental agencies, took extraordinary steps. Over 100 NYPD officers were assigned to search for him, the Metropolitan Transportation Agency (MTA) took the unprecedented step of halting overnight track maintenance and ordered at least 200 workers to instead scour the tunnels for him and the NYPD Harbor Unit combed the shoreline. It wasn’t until January 17, 2014 that searchers began finding clothing and body parts on a set of rocks along the shoreline in College Point. The following week the Medical Examiner confirmed that the remains where those of Avonte Oquendo. The population of people with autism grows, as the Centers for Disease Control and Prevention (CDC) estimates autism’s prevalence as 1 in 59 children in the United States, which includes 1 in 37 boys and 1 in 151 girls,4 and police interactions increase, the more skills police are taught, the better these inter-actions will be.
Alzheimer’s Disease and Other Dementias –This module reviews several differ-ent types of demdiffer-entia that may be encountered by the trainees while carrying out their duties. The emotional impact of losing one’s memory is discussed as it can manifest quite seriously during crisis situations. As with Autism Spectrum Disorder, an examination of the impact on caregivers and family is provided for the officers.
The class reviews several positive communication strategies for dealing with some-one suffering from dementia. Additionally, the NYPD is examining the ways in which technology can aid in tracking individuals with Alzheimer’s when they go missing.
Substance Use Disorder and Co-Occurring Disorders –The purpose of this module is to provide the trainees with the knowledge, skills, and abilities to recog-nize the signs and symptoms of individuals experiencing a crisis due to impairment by a legal or illegal substance. The prevalence rate of substance abuse and co-occurring disorders is discussed. The trainees are given communication strategies that will assist in determining if the individual has a mental health disorder and / or a substance abuse disorder. A discussion is facilitated about how there is a greater risk of violence and suicide when a subject abuses a substance. Synthetic cannabi-noids and opioid pain medications are discussed in detail as this is a current phe-nomenon impacting many of our local communities. The link between substance abuse and the homeless population is also discussed. Finally, the impact of sub-stance use on law enforcement professionals is discussed along with information about what treatment and recovery options are available. The trainees are provided with direction on effective methods for rendering assistance to individuals with substance use disorder.
4 Centers for Disease Control April 27, 2018 / 67(6); 1–23 (2017).