Threat Reduction Strategies

The following list includes threat reduction strategies that can be used during the provision of oral care for persons who are behaviourally complex. Threat reduction strategies are behavioural techniques that are designed to minimize a person’s fight or flight response to fear and/or distress (8). The following list is not exhaustive; rather, it provides suggestions of strategies identified in the literature.

Threat Reduction Strategies:

• Engage in social conversation with the person before asking them to engage in mouth care.
• Approach the person at or below eye level to establish rapport. Have a calm and pleasant demeanor.
• Approach the person in a non-rushed manner and smile throughout the interaction.
• Provide mouth care in a quiet environment with few ambient or distracting noises.
• Start mouth care, and then have the person complete the task.
• Use gestures to cue the steps in mouth care.
• Use short, one-step requests. These can be done in conjunction with gestures.
• Encourage the person to engage in self-care by having them complete mouth care in their own manner.
• Use gentle touch to reassure the person.
• Use a hand-over-hand method, such that person places their hand on the provider’s hand (or the provider places their hand on the person’s hand) to guide mouth care.
• If the person begins to engage in care-resistant behaviours, use distraction techniques (e.g., singing, talking or asking them to hold an object)
• If the care-resistant behaviour escalates and threat reduction strategies do not appear to be working, another provider should intervene to replace the first provider (8, 42, 183).