Verbal de-escalation of responsive behaviours

The first time learners use Bodyswaps, an onboarding sequence familiarises them with the features of the app, takes them through an avatar selection and embodiment activity, and prepares them for the experience to come. 

In the onboarding, learners will: 

• Find out how this training is different from the rest
• Select their avatar
• Discover their virtual journal
• Learn how to navigate and use the tools and settings

The learner begins in the tutor room, where they meet their virtual coach, de-escalation specialist Olivia. She shares her own experience with a resident whose behaviours she initially found difficult, until she learned to see these behaviours not as ‘acting out’, but as responses to unmet needs.

Olivia emphasises the importance of meeting those needs and getting to know the subject of care rather than focusing on how their behaviour inconveniences others. These, she reveals, are the skills that she’s going to help the learner practise in the two scenarios featured in this module.

Before moving on, she invites the learner to complete a short, Likert-type self-reflection survey, to indicate how confident they feel about the following key learning points:

• Detecting signs of escalating responsive behaviours
• Using verbal techniques to de-escalate the situation
• Supporting the individual while keeping themselves and other residents safe

These self-reflection questions are repeated in the debrief at the end, to assess how the learner’s confidence levels have changed.

Once the learner has given their answers, Olivia offers them a choice of scenarios. They can either work with Nancy, an older woman living with dementia in a long-term care facility, or with Johnny, a young autistic man in a supported living group home. These are not mutually exclusive; after completing one, the learner is able to go on to the other.

Once the learner has confirmed that they want to work with Nancy, Olivia provides a quick overview of her as a resident with middle-stage Alzheimer’s at Riverside Lodge. She gives a little information about Nancy’s routine, likes and preferences, and impresses on the learner the importance of getting to know Nancy by reviewing her support plan. This plan is available here or via a link in the app, and should be provided to all learners before they attempt the simulation.

Afterwards, the scene moves to a corridor at the Lodge itself, where Nancy is standing near the exit in a state of distress. Nearby is the door to her neighbour’s room, where Betty is trying to listen to the radio. If at any point Nancy raises her voice, Betty will come out of her room to complain about the noise and complicate the situation.

Here, the learner will speak in their own voice over four to five freeform exchanges (depending on their choices), with the aim of calming Nancy down and supporting her to return to her usual routine. AI technology processes their statements and determines Nancy’s response and the subsequent direction of the conversation, based on how supportive the learner was of her needs.

Learners can also see a helpful ‘traffic light’ chart on a nearby TV screen, which shows whether Nancy’s behaviour is currently at baseline (green), escalation (amber), crisis (red), or recovery (blue). A full list of Nancy’s behaviours, and the categories to which they belong, can be found below:

• Chatting amiably (green)
• Looking around, confused (amber)
• Shaking her head vigorously (amber)
• Loud sobbing (amber)
• Trembling, confused and withdrawn (amber)
• Pulling her own hair (red)
• Jabbing her finger at the learner (red)
• Attempting to strike Betty (red)
• Crying softly (blue)

The learner will not see Nancy return to green during this scenario, but bringing her to recovery will unlock a bonus ‘good ending’ where they see her at baseline after the debrief. As well as the immediate visual feedback from Nancy and the traffic light, learners receive texts from Olivia that provide guidance on how well they did and how to improve on it, if needed.

Successfully navigating the first four exchanges will end the scenario on a high note, with Nancy in recovery. The third and fourth exchanges, if failed, will always lead immediately to the fifth, in which Betty comes out of her room and must be redirected away from the situation. Failure here results in Nancy attempting to strike Betty, at which point Olivia calls an end to the activity.

The overall number of successful answers is tracked and results in personalised feedback from Olivia during the debrief. Should the learner struggle and repeatedly indicate confusion, they will be offered a chance to exit the activity.

Whether they succeed, fail or quit early, the learner is called back to the tutor room with Olivia for a debrief.

Back in the tutor room, Olivia opens with some personalised feedback, which varies based on the overall number of helpful responses the learner gave to Nancy. In all cases, she points out the likely causes of Nancy’s behaviour and re-emphasises the importance of reading a resident’s support plan in providing care for them.

Afterwards, she asks the learner what they think could have been done to help prevent the situation they just played through from arising in the first place. Keyword analytics determine whether the learner has picked up on strategies from Nancy’s support plan or come up with viable strategies of their own. If they have, Olivia praises them for taking the time to understand Nancy’s needs; if they have not, she assures them that it’s all right to be unsure, and reminds them that they can find these strategies in a resident’s support plan. In either case, she lists a few suggestions of her own to act as starting points for the learner’s thoughts.

If the learner didn’t manage to de-escalate the situation in the scenario, they jump right to the end. If they did, Olivia suggests they check in with Nancy now, and they return to the Lodge to see Nancy and Betty chatting about how helpful the learner was earlier. The traffic light is still here and shows Nancy’s behaviour at the green level.

Finally, the learner is prompted to choose between replaying the simulation, trying the Johnny simulation, or continuing to the main module debrief.

Once the learner has confirmed they want to work with Johnny, Olivia provides a quick overview of him as an autistic, non-verbal resident of Aster House with high support needs. She gives a little information about what he likes and a warning that he’s recently started exhibiting sexualised behaviours towards female support staff. Here, she pauses to impress on the learner the importance of reviewing Johnny’s support plan before beginning. This plan is available here or via a link in the app, and should be provided to all learners before they attempt the simulation.

Afterwards, the scene moves to the living room of Aster House, where Johnny is already getting uncomfortably close to Diya, who is doing a puzzle with Jake. If the learner causes Johnny’s behaviour to escalate too far, Jake will get upset and need to be talked down, too.

Here, the learner will speak in their own voice over four to five freeform exchanges (depending on their choices), with the aim of calming Johnny down and supporting him to return to his usual routine. AI technology processes their statements and determines both whether they were supportive of Johnny’s needs and how Johnny, Diya and Jake should respond to them.

Learners can also see a helpful ‘traffic light’ chart on a nearby TV screen, which shows whether Johnny’s behaviour is currently at baseline (green), escalation (amber), crisis (red), or recovery (blue). A full list of Johnny’s behaviours, and the categories to which they belong, can be found below:

• Engages in activities with his friends (green)
• Places his hand on his genitals, over his clothing (amber)
• Stimming in an agitated way with repeated humming and hand flapping (amber)
• Stimming in a slightly less agitated way with repeated humming and hand flapping (amber)
• Stimming in a less agitated way by humming repeatedly and clenching and opening his hands (amber)
• Covers his ears and vocalises loudly in distress (red)
• Rocks back and forth, vocalising loudly (red)
• Rubs his genitals over his clothing (red)
• Nodding repeatedly (blue)
• Signs ‘Sorry’ in ASL (blue)
• Signs ‘Sleepy’ in ASL (blue)

The learner will not see Johnny return to green during this scenario, but bringing him to recovery will unlock a bonus ‘good ending’ where they see him at baseline after the debrief. As well as the immediate visual feedback from Nancy and the traffic light, learners receive texts from Olivia that provide guidance on how well they did and how to improve on it, if needed.

Successfully navigating the first four exchanges will end the scenario on a high note, with Johnny in recovery. The third and fourth exchanges, if failed, will always lead immediately to the fifth, in which Jake becomes upset and must be talked down using ‘first, then’ language. Failure here results in Johnny’s behaviour escalating to the point where he won’t listen to any verbal de-escalation, at which point Olivia calls an end to the activity.

The overall number of successful answers is tracked and results in personalised feedback from Olivia during the debrief. Should the learner struggle and repeatedly indicate confusion, they will be offered a chance to exit the activity.

Whether they succeed, fail or quit early, the learner is called back to the tutor room with Olivia for a debrief.

Back in the tutor room, Olivia opens with some personalised feedback, which varies based on the overall number of helpful responses the learner gave to Johnny. In all cases, she re-emphasises the importance of reading a resident’s support plan in providing care for them.

Afterwards, she asks the learner what they think could have been done to help prevent the situation they just played through from arising in the first place. Keyword analytics determine whether the learner has picked up on strategies from Johnny’s support plan or come up with viable strategies of their own. If they have, Olivia praises them for taking the time to get to know Johnny’s needs; if they have not, she assures them that it’s all right to be unsure, and points them to the plan to find these strategies in future. In either case, she lists a few suggestions of her own to act as starting points for the learner’s thoughts.

If the learner didn’t manage to de-escalate the situation in the scenario, they jump right to the end. If they did, Olivia suggests they check in with Johnny now, and they return to Aster House to see Johnny calm again, now seated at the table and helping Diya and Jake with the puzzle.

Finally, the learner is prompted to choose between replaying the simulation, trying the Nancy simulation, or continuing to the main module debrief.

Olivia tells the learner not to get too hung up on any mistakes they might have made, encouraging them to view the skills they’ve practised in this module as starting points that they will build on during the course of their work. She then prompts them to answer the three self-reflection questions from the start of the module again, to help them reflect on how their confidence levels have changed.

Before the learner leaves the module, they are asked to complete a short survey about their experience. 

This data helps us to assess the effectiveness of our product and identify any areas that need improvement. Clients also find it beneficial when assessing ROI. 

They are asked to mark whether they agree or disagree with the following statements, on a 10 point scale: 

• I would recommend this experience to others. 
• The experience helped me identify elements of my de-escalation skills I could improve upon.
• I now have a better understanding of responding effectively to responsive behaviours.