I would like to acknowledge the traditional Aboriginal and Torres-Strait Islander custodians of the lands and seas on which we work, the first people of this country. I pay my respect to them, their culture, and their Elders past, present and future.
Paul Dessauer Outreach Coordinator This presentation remains the intellectual property of Peer Based Harm Reduction WA, trading as WASUA. Content should not be used without permission.
Dealing with difficult or challenging behaviour; Prevention and Management of Aggression.
OBJECTIVE: To develop participants’ attitudes, knowledge and practical skills in anticipating, preventing, and managing aggression and other challenging behaviour.
Theories of aggression. Risk; (awareness, assessment and management of risk).
Preventative measures; (behavioural and environmental).
De-escalation skills; (verbal and non-verbal).
Worst case scenario; (protective strategies and response to violent incidents).
Any employer has a responsibility to;
Provide a safe workplace for employees, clients and visitors.
Develop policies and procedures designed to minimise the risk of aggression and violence in the workplace, and to provide suitable training for all relevant staff members in implementing these.
Ensure systems are in place to anticipate, identify, report and manage any risks.
Provide adequate guidance and support to staff at all levels of the agency. Any employee has a responsibility to;
Follow legal direction from employers. Be familiar with, and follow all policies and procedures.
Report all risks detected and any critical incidents, as per policy.
Take reasonable care to protect themselves and others, be aware of potential risks, and implement appropriate strategies to manage them.
What is “Reasonable Force” in self defense? Under WA law a person who has reason to believe they are threatened with physical assault may use “reasonable” force to protect themselves or others. Reasonable force is; Minimal (no more than necessary).
In proportion to the level of harm that is threatened. Open and accountable. To be defensible in a Court of Law, any use of force must be considered by a Magistrate to be; Legal, Proportionate, Accountable, and
Necessary to protect life and limb.
Violence and Aggression are different things; What is the difference?
“You will not be punished for your anger, you will be punished by your anger.” -Buddha
“The most excellent General in the World is not the man who fights a thousand battles and wins a thousand battles… …the most excellent General in the World is the one who never fights any battles at all.” -Sun Tzu
The Stress Vulnerability Model as a tool for understanding mental illness and aggressive behaviour.
The Stress Vulnerability Model as a tool for understanding mental illness and aggressive behaviour.
There are an escalating series of psychological and physiological responses to environmental stressors.
Stress changes brain function. The neurochemical substrate of fear and aggression are both closely related.
Any behaviour is a response to perceived stimuli. However, how any one person perceives and interprets any particular stimuli is a “black box” STIMULI something happens…
↓ PERCEPTION someone notices it…
↓ COGNITION they think something about it…
↓ RESPONSE they react to what they think is happening…
↓ NEW STIMULI how they behave changes what is happening…
This is the most important thing you can ever learn about any kind of confrontation… You can never control another person’s behaviour. The only thing you can ever truly control is how you anticipate or respond to that behaviour.
But when you learn to respond effectively, you begin to redirect the other person’s behaviour. The more skilled you can become at anticipating another person’s behaviour the easier it is to avoid trouble before it starts. But most importantly, the more skilled you are at controlling your own responses to an aggressive person’s behaviour, the more confident and effective you will be at avoiding, redirecting and diffusing that aggression. This type of awareness (of others and of yourself) is the essence of de-escalation skills.
Warning Signs; violence rarely erupts without warning. Awareness, and early recognition of behaviours that “telegraph” increasing risk, are key to anticipating and preventing a serious incident before it even arises. Changes in speech- becoming more rapid, loud, disrespectful, and repetitive. Increased muscle tension- clenching fists, arm muscles tensing, gritting teeth. Widened eyes, nostrils flaring, red face. Motor agitation- pacing, rocking, tremors. Self report of angry or violent feelings. Violence to property, “acting out”. Verbal threats or physical gestures. Invading personal space, eyeballing.
What is the “Assault
Cycle” ?
The “Assault Cycle” describes the pattern of escalation and resolution typical of most violent episodes.
The “Assault Cycle” describes the pattern of escalation and resolution typical of most violent episodes.
De-escalation strategies are designed to interrupt the “Assault Cycle” before the crisis phase is reached.
Preventative Measures involve designing and controlling both the physical environment and the behaviour of your staff to minimise the risk of a serious incident arising.
Protective Strategies involve verbal and non-verbal techniques that are used to de-escalate a threatening situation, and to protect your body should a violent assault occur.
De-escalation in it’s purest form involves strategies employed during a potentially dangerous situation which attempt to delay, divert or diffuse aggression in order to prevent a person harming you, themselves, or others.
Preventative Measures; Environmental. Policies and procedures must be in place, known to staff, and followed at all times. The physical layout of the venue must be designed to limit the potential for incidents to arise, and to allow staff to assist each other or to evacuate the area easily should the need arise.
Assistance and Duress alarms greatly increase safety for all staff, other clients and visitors.
Specific policies and procedures are required for “outreach” or homevisit staff.
Preventative Measures; Environmental. When an incident does arise, you must already;
Have a plan, (but recognize quickly if it isn’t working, and be prepared to change tactic or run),
Be aware of entry and exit points, Be aware of objects that may be used as weapons, Be aware of safe distance and protective stances, Be prepared to run, to evacuate bystanders and/or to call for appropriate assistance.
Preventative Measures; Behavioural. Ensure staff are adequately trained, and all know policies and procedures for responding to aggression and other incidents. If appropriate consider issuing duress pendant-alarms. All staff must know who to call or how to summon emergency assistance. Any potentially dangerous incident must be reported. Critical incidents should be analysed to allow risk assessment and (if necessary) modification of policies, practices, or physical layout of the building to reduce unnecessary risks. Best Practice involves treating all clients equitably. If staff are patient and polite, pay equal attention to all clients, are calm, reasonable and display empathy even to “annoying” clients, the risk of any incident is greatly reduced.
Preventative Measures; Behavioural.
Self awareness is key. Be aware of your tone of voice and manner at all times, and pay attention to how the person is responding to them. You are not expected to like every client you interact with. However, you ARE expected to be capable of hiding any distaste, disapproval or prejudice the person provokes in you. A professional should treat all clients consistently with the same respect and regard, not just the “likeable” or “deserving” ones.
Preventative Measures; Behavioural.
It does not necessarily require a saint’s empathy to behave in this way. You can just as easily take pride in the fact that your manner remains professional even when you disapprove of, or feel superior to, the person you are talking to, as long as you are capable of behaving empathetically in a convincing and caring way. You can learn to manipulate any situation, maneuvering to be seen as a part of the solution to the person’s problem. Do not do it to be nice to the person- do it because it is safer for everyone involved. If you succeed they will never direct their anger at you.
Protective Strategies; Verbal. Be aware of your voice and talk calmly, at a normal volume, pitch and tempo. Be succinct but be polite.
Use open-ended questions, and draw out information. Use active listening to encourage client to elaborate useful responses. Use the person’s name if you know it. Agree with the person about anything you reasonably can.
Do not get caught up in anything the person says that is provocative, offensive or upsetting. Don’t mirror their aggression. Your job is not to win an argument. Your job is to make sure no-one gets hurt.
Protective Strategies; Verbal. Explain why you can’t do what they want. (If necessary, you can empathise and expediently re-direct the blame).
Offer choices or alternatives. Remain assertive and establish limits. Don’t ask “why”. Ask “what”.
Keep returning the focus to the present and resolving the immediate situation. If possible, encourage simple compliance, (such as inviting them to sit down, come Outside for a cigarette, or move to a quieter room). If the person is psychotic or delusional, do not confront delusions “head on”. Sidestep, distract or redirect. Don’t be afraid to allow the aggressor to save face.
Protective Strategies; Non-verbal. Maintain appropriate eye contact. Adopt a non-threatening posture.
“The Fence” (aka “Bouncer’s stance”, aka “steady on tiger”)
Indicate genuine interest. Be aware of your facial expression; a fixed smile is as bad as a sneer.
Be confident. If you can’t, then look confident. Use silence and give the person time to talk and time to process. If possible offer drinking water. Maintain a casual defensive stance and be aware of safe distance. Try not to look frightened or angry. Be alert to subtle non-verbal clues that the situation is deteriorating.
Worst Case Scenarios; Protective Strategies. When push comes to shove… Activate duress alarm. Call co-workers, police or security as appropriate. Avoid the danger zone, maintain safe distance. Escape the situation. Use any available barrier to place an object and/or distance between you and the aggressor.
Protect your body, especially head, neck, and midline.
Worst Case Scenarios; Protective Stances. “Dart” stance
“The Fence” (aka ‘Please don’t hurt me.’)
Ranbou shinaide kudasai
Always maintain safe distance. Safe distance required depends on reach (of the aggressor) and stance (both your stance and the aggressor’s).
Less safe distance is needed if there is an effective barrier between you and the person.
Be aware and don’t get cornered. Workplaces accessible by clients should always have a clear exit for staff. Be aware of where you are in relation to the aggressor, your safe exit, and other staff, clients or visitors. As long as you can move you can minimise injury until you can maneuver to escape. Getting backed into a wall or pushed to the ground will make you helpless.
It is a normal consequence of being in a flight-or-flight situation to “crash” afterwards.
It is very common for people to perform calmly during a crisis, and then collapse, cry, shake uncontrollably, or get embarrassed, angry, anxious or depressed once the danger is passed. This is the aftermath of adrenaline and may occur anytime from several minutes to an hour or more after an incident. It will typically pass within 30 minutes or so as hormone and neurotransmitter levels normalise. Do not allow someone to drive home immediately after any incident; talk to them and wait at least 30 minutes.
Response to extreme stress varies greatly from person to person, but also at different times for the same person. Previous experience does not always protect against this sort of response. This frequently surprises and embarrasses the person.
It is important that people experiencing such responses are reassured that this is a normal part of the body’s response to a dangerous situation, and that it will pass shortly.
Debriefing should always be offered immediately follow an incident.
Critical Incident reports should be written immediately by all staff involved or witnessing the incident, while memories are fresh.
Critical Incident reports should always be analysed to identify possible changes to the layout of the room, to policies and procedures, or to individual worker’s practices, that could reduce the risk of a reoccurrence. The object is not to find someone to “blame”, but rather to improve safety for everyone.
Most employers have independent counseling services available for staff. Seriously stressful situations can induce long term psychological problems in perfectly healthy people. If you have been in a situation that disturbed you, and it bothers you for more than a few days, be open to the idea that talking to an experienced, confidential counselor may be beneficial and may also be better for your friends or family as well.
Relevant and Related WASUA Documents;
WASUA Critical Incidents Policy (aka Responding to Disruptive Incidents)
WASUA Critical Incident Report form
WASUA Outreach Safety Policy and Procedures
WASUA Managing Clients with Psychosis Policy and Procedures
WASUA Occupational Health and Safety policy
WANADA Crisis Referral Tool (aka Principles of Crisis)
Western Australian Substance Users Association. “WASUA- Because sometimes, what you don’t know CAN hurt you…”
(08) 9325 8387 Paul Dessauer, Outreach Coordinator. 0418946706
[email protected] 