Crisis intervention strategies chapter 14

Chapter Fourteen: Violent Behavior in Institutions Precipitating Factors Putting workers at risk: • Substance Abuse • Deinstitutionalization (lack of facilities) • Mental Illness • Gender • Gangs • Required Reporting • Elderly (no longer passive) Institutional Culpability • Readily accessible to clientele • Easy prey for people looking for money or drugs • Minimal security system Institutional Culpability Cont • Universities and their Counseling Centers • Counseling offices are isolated • Denial • • Do not want bad publicity Crime Awareness and Campus Security Act of 1990 (Clery Act) Staff Culpability • Believe they are immune from the threat because they are supportive and caring • Client may act aggressively if they feel they have little control over their treatment • Staff also need to set limits in a positive, firm, fair, and empathic manner Staff Culpability Cont • Staff members who are burned out are more likely to be assaulted than those who are not • 46% of all assaults involved students or trainees and the incidence of assaults decreased as the workers gained experience Legal Liability • Health-care providers may be the victims of assaults but they may also become legally liable for their actions • Liability extends to the institutions and directors of those institutions • Failure to properly diagnose, treat, and control violent clients or protect third parties from assaultive behavior • One of the better predictors of who will be at risk to become violent is the collective judgment of clinical workers Violence Potential Assessment Instruments • HCR-20 • Violence Screening Checklist–Revised (VSC-R) • Broset Violence Checklist (BVC) • Dynamic Appraisal of Situational Aggression (DASA) Bases for Violence -predictors • Age (males 15-30, elderly) • Substance Abuse • Predisposing History of Violence • Psychological Disturbance • Social Stressors (loss of job, relationship, abuse, financial stress) Bases for Violence Cont • Family History of violence • Work History • Time (admission and tenure before help) • Presence of Interactive Participants (those bringing the person to treatment) • Motoric Cues (physical cues, verbal cues, threats) • Multiple Indicators Intervention Strategies • Security Planning • Commitment and Involvement • Worksite Analysis • Hazard Prevention and Control Threat Assessment Teams • Precautions in Dealing with the Physical Setting • Training (pages 552-555) • Anti-Violence Intervention • Assumptions • Precautions • Outreach Precautions • Intervention Strategies Cont • Record Keeping and Program Evaluation (recording of incidents) • Stages of Intervention • • • • • • • • • Education (through reasoning and reassurance) Avoidance of Conflict Appeasement (but not be a doormat) Deflection (shifting to less threatening topics) Time-out Show of Force (open to others that can help) Seclusion (severe limit setting) Restraints, for safety not punishment Sedation Follow-up with Staff Members [...].. .Intervention Strategies • Security Planning • Commitment and Involvement • Worksite Analysis • Hazard Prevention and Control Threat Assessment Teams • Precautions in Dealing with the Physical Setting • Training (pages 552-555) • Anti-Violence Intervention • Assumptions • Precautions • Outreach Precautions • Intervention Strategies Cont • Record Keeping and Program... (pages 552-555) • Anti-Violence Intervention • Assumptions • Precautions • Outreach Precautions • Intervention Strategies Cont • Record Keeping and Program Evaluation (recording of incidents) • Stages of Intervention • • • • • • • • • Education (through reasoning and reassurance) Avoidance of Conflict Appeasement (but not be a doormat) Deflection (shifting to less threatening topics) Time-out Show of Force ... Anti-Violence Intervention • Assumptions • Precautions • Outreach Precautions • Intervention Strategies Cont • Record Keeping and Program Evaluation (recording of incidents) • Stages of Intervention. .. to treatment) • Motoric Cues (physical cues, verbal cues, threats) • Multiple Indicators Intervention Strategies • Security Planning • Commitment and Involvement • Worksite Analysis • Hazard