CHAPTER FOURTEEN

Violent Behaviorin Institutions

Precipitating Factors

Substance Abuse

Deinstitutionalization

Mental Illness

Gender

Gangs

Required Reporting

Elderly

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 Seung-hui Cho (Virginia Tech) Rehabilitation Act of 1973 and the Americans With

Disabilities Act of 1990

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

Age

Substance Abuse

Predisposing History of Violence

Psychological Disturbance

Social Stressors

Bases for Violence Cont.

Family History

Time

Presence of Interactive Participants

Motoric Cues

Multiple Indicators

Intervention Strategies

Security PlanningCommitment and InvolvementWorksite AnalysisHazard Prevention and Control

Threat Assessment Teams Precautions in Dealing with the Physical Setting

Training Anti-Violence Intervention Assumptions Precautions Outreach Precautions

Intervention Strategies Cont.

Record Keeping and Program EvaluationStages of Intervention

Education Avoidance of Conflict Appeasement Deflection Time-out Show of Force Seclusion Restraints Sedation

The Violent Geriatric Client

Mild Disorientation Assessment

Eliciting Trust

Reality Orientation

Pacing

Reminiscence Therapy

Anchoring

The Violent Geriatric Client Cont.

Distinguishing between Illusions and Hallucinations

Sundown Syndrome

Security Blankets

Remotivation

Severe Disorientation

Follow-up with Staff Members