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 -pridictors 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 brining 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