Aggression and violence is complex and occurs in a context involving many factors. Understanding the context in which incidents occur is a critical aspect of practice in managing aggression and potential violence effectively
There are three broad categories of factors that impact on the level of risk that an incident can generate. These are:
- Self (staff member)
- Setting (environment)
- Aggressor (client or other)
Setting related factors
Workplace design and layout
The physical layout and the nature of the environment in a service setting can have an influence on both the initiation and management of incidents involving aggression and violence.
Workplaces can be designed or set up to minimise potential risks for staff and clients while at the same time ensuring that the environment created is comfortable, welcoming and fit for purpose.
Key features of safe workplace design include:
- Functional spaces fit for purpose including space including outdoor areas
- Safe, easily accessible, confidential spaces to augment common areas
- More than one exit route for staff and clients that are easy to access
- Good visibility, especially for entrances and exits
- Secure storage for potentially dangerous items
- Safe toilet facilities
- Good ventilation and acoustics (soundproofing)
- Security devices and system where necessary e.g. duress alarms, etc
- Fixture and fittings flush mounted and unbreakable
- Strategic positioning of furniture (not blocking exits)
‘Crime Prevention Through Environmental Design’ (CPTED) offers a systematic process of creating features within a built environment that can reduce the potential for crime and other anti-social behaviour. A number of design principles and concepts are identified that can be applied to eliminate hazards.
All staff should be alert to the potential for weapons and other implements that can be used to physically harm others. Examples of other potential weapons that could be used in an aggressive or violent incident include umbrellas, bags and satchels, car keys, pens, knives and forks, coffee cups and other drink containers.
Standards of behaviour within the service setting
It is imperative that the behaviour of both staff and clients is maintained at an acceptable level. In agreeing to this, the risk that other people may be injured or offended is minimised.
Examples of “unacceptable behaviour’ may include, but are not limited to, the following:
- Physical games by persons such as ‘play fighting’ and pushing
- Throwing or swinging items to the danger of others
- Disruptive or aggressive behaviour
- Offensive, racist, insulting or threatening language
- Harassment (sexual or otherwise)
- Bullying behaviours
- Misuse or damage to property
- Persons in unauthorised areas
This is not an exhaustive list and other situations may very well fall into the category of ‘unacceptable behaviour’. Behaviours such as these should be addressed as soon as possible before they get out of control.
Practices within service setting
- Providing information to clients and keeping them informed on all aspects of the treatment process, including program rules and expectations
- Displaying a written charter and providing literature describing acceptable and non-acceptable behaviours (example needed to include as a PDF)
- Performing risk assessments on all clients ands where necessary developing management plans
- Incorporating clients into organisational and program specific decision making processes
Staff related factors
- Increasing staff skills in early recognition, intervention, problem-solving, and de-escalation skills and techniques in dealing with incidents
- Encouraging effective team functioning including implementing appropriate policies and staff training
The ability of a staff member to manage aggressive incidents is impacted by a range of factors including an individual’s knowledge, skills and abilities as well as their level of stress or anxiety. A staff member who is continuously involved in situations that are emotionally demanding will experience a reduction in their ability to cope with stressful situations and eventually may lead to burnout.
Studies indicate that staff suffering higher levels of stress and anxiety can suffer burnout and are more likely to experience difficulties and have poor coping skills when dealing with violent incidents (where research or studies are mentioned they need to be referenced). Stress and anxiety can lead to poor sleeping and eating habits that may exacerbate stress and anxiety. Regular monitoring of staff stress levels and potential for burnout is an essential management tool in dealing effectively with incidents of violence.
A primary role of all staff in any health care setting is to communicate effectively with clients and those involved in their care. Managers and practitioners are instrumental in communicating and modelling acceptable standards of behaviour. This has a significant impact on the culture set within practice settings. A non-violent culture that is reinforced and maintained will aid in the prevention of aggression and violence.
The likelihood of a clients becoming aggressive can be minimised when they are:
- Treated with respect, understanding, care and honesty
- Offered a prompt, professional and consistent service
- Engaged by polite, attentive and helpful staff
Practitioners can maintain and improve rapport with clients by:
- Keeping clients informed regarding any treatment
- Explaining the circumstances and factors affecting the type of service being provided
- Continually monitoring and evaluating the quality of communication
Aggressor related factors
Despite efforts to develop a non-violent culture and take preventative measures to improve practices and service settings, situations may arise that involve client’s becoming aggressive and potentially violent.
In most practice contexts, clients or other young people are most likely to be the aggressor but at times it can be family members or even staff from other services.
Aggression and violence can result when a person becomes angry and struggles to control it or express it in a constructive way (for more details see Anger Management). It is also possible that the young people have learned to use aggression and violence to manipulate or control a situation through intimidation and threats.
Young people who are clients of youth AOD services will have often been subject to different forms of aggression and violence. The types of aggression and violence that clients may have experienced include:
- Family violence
- Domestic violence
- Peer violence
- Sexual abuse
- Wartime and government sponsored violence and torture causing serious trauma (particularly for clients from refugee or culturally and linguistically diverse (CALD) backgrounds)
It can be useful for youth AOD practitioners to understand the influence of these experiences on how particular clients or groups of clients express and deal with anger. It is important not to assume that these experiences automatically lead to a young person being unable to control their anger nor negate their responsibility for how they behave.