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Chapter Fourteen: Violent Behavior in 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 Planning
Commitment and Involvement
Worksite Analysis
Hazard 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 Evaluation
Stages 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
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