Crisis intervention strategies chapter 14

Chapter Fourteen: Violent Behavior in Institutions... Institutional Culpability Cont.• Universities and their Counseling Centers • Counseling offices are isolated • Denial • Do not want

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