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Crisis intervention strategies chapter 14

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



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