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14 violent behavior in institutions

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  • 1. Violent Behavior in Institutions CHAPTER FOURTEEN
  • 2. Precipitating Factors Substance Abuse Deinstitutionalization Mental Illness Gender Gangs Required Reporting Elderly
  • 3. Institutional Culpability Readily accessible to clientele Easy prey for people looking for money or drugs Minimal security system
  • 4. 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)
  • 5. 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
  • 6. 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
  • 7. 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.
  • 8. Violence Potential Assessment Instruments HCR-20 Violence Screening Checklist–Revised (VSC-R) Broset Violence Checklist (BVC) Dynamic Appraisal of Situational Aggression (DASA)
  • 9. Bases for Violence Age Substance Abuse Predisposing History of Violence Psychological Disturbance Social Stressors
  • 10. Bases for Violence Cont. Family History Time Presence of Interactive Participants Motoric Cues Multiple Indicators
  • 11. 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
  • 12. 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
  • 13. The Violent Geriatric Client Mild Disorientation  Assessment  Eliciting Trust  Reality Orientation  Pacing  Reminiscence Therapy  Anchoring
  • 14. 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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