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 )
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