Aims of this module
This module has been designed to equip Youth AOD practitioners to:
- Understand the legal and organisational context for a professional approach to the issue of aggressive behaviour and potential violence
- Minimise the risk of aggression and violence occurring
- Understand the phases of incidents involving aggressive and potentially violent behaviour
- Preventing escalation of aggression and potential for violence
- Manage crisis and support the recovery of clients who were aggressors and others involved in incidents
- Provide and access follow up care and support
- Prevent recurrence of incidents involving aggressive and potentially violent behaviour
Considerations for different practice contexts
Incidents of aggression and violence are complex and do not occur in isolation. Organisations have responsibility to ensure that staff are well supported and have the capacity to prevent and respond to aggression and violence across all youth AOD settings. Even so, there are particular considerations each practice context.
Clinic based settings are controlled environments. The services and interventions delivered within clinical settings are generally consultation based and involve counselling or specific treatment. In practice this means each occasion of service involves young people and/or families attending for a short, defined period usually on the basis of a prearranged appointment.
This means that in most cases the clients visiting for appointments will have interacted with reception staff and spent time in a waiting area prior to meeting with a practitioner. Reception staff are well positioned to identify and diffuse client anger and aggression and if seems likely to be a problem alert the practitioner who can then plan to take appropriate precautionary measures. Alternatively, clients become aggressive in response to experiences with reception staff and in the waiting area. Where the potential for aggression and violence arises in a session with a practitioner reception staff and colleagues can in most cases to be drawn on to assist. Specific plans might be in place for particular clients who are known to resort to aggression but most services will have systems in place to manage incidents when they arise.
Outreach settings offer practitioners flexibility and creativity in devising suitable methods to engage young people and families. This means spending time with the young person in a variety of contexts and means that practitioners can be proactive in connecting with young people and families in environments where they feel comfortable and calm. This flexibility also has a downside in that service managers have little control over how those environments are set up and what happens. When practitioners are meeting young people outside the service setting and in unfamiliar circumstances suitable procedures need to be in place to minimise risk. This can include a buddy system, regular or predetermined check in with colleagues, back up call support and potentially duress alarms.
Day programs offer young people safe, contained spaces in which to participate and access services. Day programs generally provide a blend of structured activities, direct care and an opportunity for unstructured participation. As young people have control over when they attend, depending on their needs and connection with the service, they might access assistance to prevent becoming aggressive or after an incident. Equally, if they are concerned about losing control of their anger they might avoid the service.
Because day programs are open at prescribed times, they can be targeted by young people (individuals and/or groups) who use intimidation, threats and at times violence to control or dominate the space and the resources available. This is one reason why day programs need to set and continually reinforce a non-violent culture. Services need to make sure that all people participating in the space are clear on expected standards of behaviour. Where behaviour is not in line with these standards action needs to be taken promptly. Boundaries need to be reinforced and at the same time practitioners should work with the young person who is potential aggressive to find constructive way to participate in the service.
Residential service settings: Youth AOD sector residential services are contained environments and the even shorter-term withdrawal services do not have a lot of client throughput. This enables managers and practitioners to intentionally minimise the exposure of clients to triggers for anger and aggression and to maintain a culture of non-violence.
Clients who are undergoing withdrawal from substance use may experience physical or emotional discomfort and irritability that can reduce their capacity to cope with triggers for anger and aggression.
In all residential services the pre-admission period offers an opportunity to begin the process of engaging young people to determine whether anger and possibly aggression is an issue that needs to be managed. This can also include contact with families and other service providers that are involved in the care of the young person. Young people who have decided to take up a residential option are generally aware that the service needs to know how best provide support and care for them during their placement. The focus is on working with the young person to ensure that any issues with anger and aggression won’t restrict their ability to achieve their goals.
Young people reside in residential units 24 hours a day, providing practitioners the opportunity to monitor the ability of clients to regulate their emotions and control their behaviour. This allows for support to be offered in a timely and sensitive manner that enables young people to learn and put in place strategies managing their anger. The downside is that young people can feel closed in and pent up. Residential services that have the flexibility to take young people out can offer them a way to find relief from this dynamic.
While staying in a residential unit young people will generally have contact with family and friends via phone or online. This can potentially trigger anger and lead to an aggressive and violent incident. Young people might also ruminate on the issues that arise through contact with people outside the unit and become distressed and frustrated. Other young people become distressed when there family does not show interest or contact.