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Chapter Fourteen: Violent Behavior in Institutions

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.

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Chapter Fourteen: Violent Behavior in Institutions

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  1. Chapter Fourteen: Violent Behavior in Institutions

  2. Precipitating Factors Putting workers at risk: • Substance Abuse • Deinstitutionalization (lack of facilities) • Mental Illness • Gender • Gangs • Required Reporting • Elderly (no longer passive)

  3. Institutional Culpability • Readily accessible to clientele • Easy prey for people looking for money or drugs • Minimal security system

  4. 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)

  5. 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

  6. 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

  7. 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.

  8. Violence Potential Assessment Instruments • HCR-20 • Violence Screening Checklist–Revised (VSC-R) • Broset Violence Checklist (BVC) • Dynamic Appraisal of Situational Aggression (DASA)

  9. Bases for Violence -pridictors • Age (males 15-30, elderly) • Substance Abuse • Predisposing History of Violence • Psychological Disturbance • Social Stressors (loss of job, relationship, abuse, financial stress)

  10. Bases for Violence Cont. • Family History of violence • Work History • Time (admission and tenure before help) • Presence of Interactive Participants (those brining the person to treatment) • Motoric Cues (physical cues, verbal cues, threats) • Multiple Indicators

  11. 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

  12. 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

  13. Follow-up with Staff Members

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