# Considerations for Developing Robot-Assisted Crisis De-Escalation Practices
## 4 Integrating the De-Escalation Process into Human-Robot Interactions
### Assessment: Sensing the Environment and Knowing When to Intervene
During these phases, agitated individuals begin to regulate their emotions and regain self-control. Their abilities to think and act rationally begin to return; they may feel remorseful about their actions, with a dip in mood to below baseline before returning to normal. During the transition from \"crisis\" to \"recovery\", individuals may continue to experience elevated stress hormones. As such, though the immediate crisis may have passed, anger can be easily reignited, prompting a possible return to the crisis phase [21]. [PERSON] [20] elaborated on the continuum models of agitation and aggression by describing the progression of emotions and behaviours through the stages. Individuals move from a state of calm through to anxiety, agitation, aggression, and violence. Assessing and distinguishing between the different stages of escalation is far from an exact science with clear algorithms, though some authors have attempted to delineate markers of each of the stages, e.g., [20] (p. 33). Furthermore, there is variability in how individuals display emotions and states of agitation. Robots equipped with the hardware and software to perceive and identify these behaviours could rely on actuarial predictions of the state of agitated individuals; the more behaviours an individual displays within a certain stage along the continuum, the more likely they are to be at that stage. Experts on de-escalation in the context of emergency medicine and psychiatry recommend the use of objective scales to assess agitation [10]. Examples of such measures include the Overt Agitation Severity Scale (OASS) [22] or the Modified Overt Aggression Scale (MOAS) [23]. These scales are behavioural checklists quantifying the severity of agitation based on observable behaviours or varying degrees of specificity. For example, the OASS requires the assessor to indicate the degree of the presence of vocalizations and oral/facial movements (e.g., smacking or licking of lips, chewing, jaw clenching; licking, grimacing, spitting), upper torso and upper extremity movements (e.g., slapping, swatting, hitting at objects or others) and lower extremity movements (e.g., pacing, wandering). The MOAS takes a different approach, classifying signs of agitation and aggression into categories of verbal aggression, aggression against property, self-aggression, and physical aggression. Each category contains subcategories of behaviours ranging from the least severe to most severe form of each type of agitation/aggression. For example, the verbal aggression category asks the assessor to rank agitated individuals according to the structure given in Table 1.  
There is a gap between what assessment of agitation means for humans and the requirements to equip robots with the necessary skills. For the human assessor, these measurement scales may add an element of \"objectivity\" and provide benchmarks of behaviours to look for in quantifying the severity of agitation. In contrast, robots are not privy to the baseline knowledge possessed by humans to determine the difference between \"curses mildly\" or \"curses viciously\". Even among humans, there may not be perfect agreement about what constitutes mild vs. vicious cursing, or about any of the other behaviours. Humans, however, can conjure an image or thought of how each of these five subcategories may look, sound, and feel. The descriptions above and behavioural \begin{table}
\begin{tabular}{c l} \hline \hline
**Rating** & **Descriptor** \\ \hline
0 & No verbal aggression \\
1 & Shouts angrily, curses mildly, or makes personal insults \\
2 & Curses viciously, is severely insulting, has temper outbursts \\
3 & Impulsively threatens violence toward others or self \\
4 & Threatens violence toward others, either self-repeatedly or deliberately \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Agitation ranking from low to high. From MOAS [23].