Dealing with Violent and Challenging Behaviour
RELEVANT CHAPTERS
Contents
1. Policy
The Council recognises that it has an obligation to strive to eliminate both the dangers posed by threats of violence at work and risks posed to lone working employees; that suitable and sufficient assessments of risks in all work activities are carried out; and that adequate and sufficient training is given to employees to enable them properly to conduct this task.
2. Key Issues in Dealing with Violent and Challenging Behaviour
| 2.1 | East Riding of Yorkshire Council has a "Code Of Practice On Violence And Challenging Behaviour Towards Employees and Guidelines On Working Alone In Safety", which should be referred to in conjunction with these guidelines. |
| 2.2 | The objective of all staff should be to prevent incidents of challenging behaviour arising, wherever possible; to effectively manage such incidents wherever they occur; to encourage good practice in dealing with the after effects of such behaviour; and to ensure that practice is compatible with Health and Safety procedures. |
| 2.3 | All staff should receive training in the use of Therapeutic Crisis Intervention - see Use of Restraint and Physical Intervention Procedure - and should apply its principles and methods when dealing with violent and aggressive behaviour. |
| 2.4 | The attached Good Practice Guide (Appendix 1: Violent and Challenging Behaviour Good Practice Guide in Children's Homes) should be referred to in addition to the above. |
3. Procedure for Dealing with Violent and Challenging Behaviour
- The Registered Manager should ensure that a copy of the Council's Code of Practice on Violence And Challenging Behaviour Towards Employees & Guidelines On Working Alone In Safety is readily available to staff within the Home;
- The Registered Manager should ensure that all staff employed in the Home are appropriately trained in the methods of Therapeutic Crisis Intervention;
- All staff should use the Therapeutic Crisis Intervention methodology when dealing with violent and challenging behaviour. (For additional information about this, please refer to the Use of Restraint and Physical Intervention Procedure);
- All incidents of violent and challenging behaviour should be fully recorded in the appropriate logs and forms. (For additional information about this, please refer to the Use of Restraint and Physical Intervention Procedure);
- The Registered Manager should review all incidents of violent and challenging behaviour and should ensure that all risk appropriate assessments are undertaken or updated.
Appendix 1: Violent and Challenging Behaviour Good Practice Guide in Children's Homes
Behaviour is a language, a medium through which people express their inner selves. Insofar as residential care and treatment is concerned, it is the underlying message which is often more important than actual behaviour.
Difficult behaviour is usually the symptom of a problem and not the problem itself
In order to effect change in behaviour, the staff group will need to develop individual and group strategies designed to anticipate and pre-empt certain behaviour rather than adopting a purely reactive stance to regularly exhibited behaviour patterns of young people.
Each individual staff member will have their own strengths and weaknesses, and it is important that they feel free to deal with situations as they occur without any additional problems created by inappropriate expectations or attitudes on the part of colleagues or managers.
It is essential that staff have regular time to discuss together their own roles, responsibilities and performance. This will also allow colleagues to be aware of what is on offer within the team as a whole and to exploit the strengths available in the work team.
Staff should be prepared to accept that they could get it wrong sometimes.
Admitting mistakes can be healthy and offer a positive model to young people,
Strength is about never being right all the time but rather about being able to respond intelligently and with control.
Young people do not need to be protected from knowing that adults also have irrational and aggressive feelings, provided that they know those adults can control those feelings and deal with them in an acceptable manner.
Keeping Safe
Staff members need to be aware that their work imposes upon them a duty of care for the young people living in our homes.
Many young people who are admitted to our homes may have experienced neglect or abuse.
Violent behaviour may have been reinforced for them as ways of dealing with problems.
The consequence of this experience is likely to include low self-esteem, poor self-control and lack of social and interpersonal skills.
One of the aims of behaviour management is to enable young people to interact with others more constructively.
A key task for all staff is to help young people understand and control their behaviour and to move on to more appropriate patterns of behaviour.
Contributing Factors to Aggression
Fear - of noise or of people leading to desperation and a feeling that the only way out is to fight.
Paranoia - Feelings of being persecuted may be directed towards certain groups in society that may have resulted from previous contact with then.
Anger - At being provoked by other people.
Voices - Telling them to injure themselves or others.
If the challenging behaviour leads to violence, it is because the young people feel that they have lost control of their own situation.
Practical Tips to Avoid Violent Behaviour:If you think that someone is becoming unstable and distressed do not:
- Stare at them or react with sudden movements;
- Shout at them;
- Whisper to other people;
- Comer or surround them;
- Look aggressive;
- Feel aggressive;
- Keep the person wondering what you might be about to do to them.
Warning Signs for Violent Behaviour:
- Sweating;
- Clenched fists;
- Eyes darting about;
- Frowning;
- Increased reaction to sounds;
- Voice becoming louder;
- Eyes widening;
- Threats.
Act Immediately to Stop Challenging Behaviour turning to Violence
More Practical Steps to Avoid Violent Behaviour:
- Take a pace backwards to let the person know you are giving them space;
- Talk calmly and evenly;
- Be aware of your body language;
- Keep your hands in view;
- Ensure that they know you don't mean them any harm;
- Ask them why they are upset;
- Take them out of a noisy environment;
- Identify if there is a simple solution;
- Only one person should talk and keep movements to a minimum;
- Continue to reassure them.
Preventing and Managing Violence
Definition of Violence
Violence is behaviour that is intended to injure harm or intimidate people either through physical actions or verbal threats. (This definition includes racial and sexual harassment or abuse).
Responsibility for Violence
The perpetrator is responsible for acts of violence. (Nothing in these guidelines, e.g. about possible preventative action, should be construed as implying victims of violence are to blame).
Responsibility to Respond to and Seek to Prevent Violence
Health & Safety at Work Act 1974 states:
All employers have a legal responsibility to provide a safe working environment for their staff.
Also all employees are required to take reasonable care for the health and safety of themselves and of other persons who may be affected by their acts of omissions at work.
Understanding Violence and how it Happens
Many factors contribute to violence in the course of work; its origins can be personal, cultural or situational.
Personal and Cultural factors:- Analysing what triggers anger and violence in oneself and how one responds can assist understanding;
- Immaturity, belligerence or mental disturbance in the individual may be factors;
- Cultural norms on the use of violence may be factors;
- Racism and sexism may lead to harassment and physical assault.
Situational Factors:
- Particular frustrating situations may trigger violence, e.g. unexplained delay for an appointment or visit, waiting to use phone, needing to see a busy staff member etc.
- Drink, drugs and the use of solvents may low inhibitions against violence;
- Social and economic factors may put intolerable pressures on individuals.
Signs and Symptoms
Although some incidents occur without warning, in others there are warning signs in terms of behavioural or mood changes in individuals. Where individuals or situation are seen as having potential for violence, a helpful model for understanding how violence occurs and proceeds is provided in the "Assault Cycle".
Trigger Phase
Everyone has a normal or baseline behaviour that varies according to setting, role expectations etc. Trigger behaviour indicates the first behaviour that moves away from this baseline.
If the young person is unknown, this behaviour could go unnoticed and therefore unheeded. Therefore it is important to monitor new residents very carefully.
Escalation Phase
Behaviour continues to move away from baseline behaviour and become more erratic.
Behavioural symptoms become more discernible to those around the person.
It is now apparent that behaviour is not 'normal'. The longer this phase continues the less chance of diversionary tactics working.
Crisis Phase
Young Person becomes increasingly aroused physiologically, emotionally and psychologically and less capable of controlling aggressive impulses. The result can be assault / violence.
Recovery Phase
Aggression / violence subsides and a gradual return to baseline behaviour. However adrenalin still running high and the failure to recognise this can lead to return to Crisis Phase if young person not supported in their recovery.
De-briefing Stage
Young Person can regresses below normal behaviour. Often they are physically and mentally exhausted. They are often remorseful, tearful and distraught and the tendency to return to violence has abated. Good time to intervene and offer comfort support etc. This returns the young person to their baseline behaviour.
Phases of a Violent Incident - Possible Staff Responses
Triggering
This is the most important area for staff to concentrate on. The more that can be determined in this phase the more diversionary tactics can be applied. Picking up 'warning signals' such as a lot of pacing about, clenched fists, angry muttering, withdrawn in a tense way in a corner, is aggravating others etc.
Escalation
Try talking / spending individual time with the person. Offer help, cup of tea or try to divert person into some other activity. Attempt to get the person away from the 'triggering' environment.
Relaxation methods may work for some people. Encourage young person to take control of own behaviour. Support colleagues. Use training, skills, and intuition. Keep talking. Keep befriending. Keep calm. Keep in control. Use the three D's (Diversion, Diversion, Diversion).
Crisis
- Focus on safety of self and others;
- Contain situation if possible in terms of yours and others reactions;
- Allow young person to leave, don't block their exit;
- Allow yourself an exit and consider withdrawing;
- Try talking if the person is listening;
- BE AWARE OF YOUR BODY LANGUAGE;
- Support your colleagues do not leave a crisis situation unresolved;
- Staff members who present a confident exterior (regardless of what they may be thinking inside) will generate confidence and tranquillity.
Recovery
- Be supportive / reassuring of person's safety if they are fearful;
- Allow the person to determine the pace of your intervention;
- Encourage them to re-establish control of their emotions;
- Don't force your attentions on the person;
- Sit quietly or get person a cup of tea.
Post Crisis Be-brief
- Be available to talk / listen;
- Help the young person to return to their usual behaviour in their usual situation;
- Don't get into blaming but make the young person aware of the consequences of their actions;
- If appropriate, talk about how the young person can make reparation to any victims / damage done etc.
Prevention
Management Responsibility
- To see that within the available resources the physical environment of the workplace is conducive to calm and the reduction of unnecessary frustration;
- To see that working practices and procedure are followed which reduce likelihood of violence;
- To see that cooperation between colleagues is reliably available in situations of particular risk;
- To see that all team members are appropriately trained;
- To ensure safe staff / client ratios for group activities;
- To review all security measures on a regular basis and ensure all team members are aware of these.
Cooperation Between Colleagues
- Share information about any potential risk with all who may fact it, including cleaning gardening and administration staff;
- To recognise that there is no shame in admitting fear of violence to management / colleagues and seeking help;
- Rehearse with colleagues a clear code of signals to show that help is needed. One signal should indicate that Police should be called;
- It may be wise to consider which member of staff team should give unpopular message to client e.g. not Linkworker;
- Don't lose your sense of humour.
Individual Precautions and Actions to Cope with Violence when it occurs
Each person needs to work out, with the help of supervision, training and discussion with colleagues, their own style for taking precautions in the light of the nature of their work and working environment. Residential childcare is very difficult job and personnel honesty is critical to positive outcomes for young people and a successful residential career.
Guidelines on possible actions when a violent incident occurs are more easily listed than acted upon in threatening situations.
The Assault Cycle gives clues on the timing of particular interventions.
Appropriately planned training to support the list below should be developed and provided.
- In violent situations it is essential to keep talking to the young person;
- Try to keep cool and in control;
- Do not shout or respond with aggression;
- Careful listening and a calm controlling voice are the main tools for talking down violence and helping young people to regain control;
- Always help young people to focus and regain composure, dignity and status;
- Try and be aware of own body language;
- When every possible, try not to be too public in dealing with incidents;
- Never ask a young person to restrain another young person unless this is absolutely necessary and you can fully justify the situation as critical;
- If faced with a weapon do not attempt to take it nor ask for it. See if the young person can be persuaded to put it down as far from you both as possible. Try to keep some furniture between you and the young person;
- Try and remain aware of all exit points in the room and stay as close as possible to one of them.
Care and Counselling of staff
Following a serious incident and once the danger is over, priority must go to the physical and psychological welfare of the staff member.
Be aware that the after effects of violence may include:- Fear, anxiety, tension, stress and loss of confidence;
- Blame, guilt and anger;
- Post-crisis depression; physical and mental exhaustion.
The physical or psychological effects may necessitate time off work and / or a phased return to full duties
Learning and Training
The best training on preventing and coping with violence is likely to come from reflecting on incidents soon afterwards (a "debriefing").
De-briefing
- For the victim and colleagues to consider if there were / are alternative ways to deal with similar situations in future;
- As part of the victim's coming to terms with the incident;
- It is not part of the debriefing to attribute blame.
Practical Steps to Help deal with Violence in a Crisis:
- Approach from in front never from behind without warning;
- Give the person room to breathe;
- Don't touch them unless you are sure they don't feel threatened by you;
- Don't stare;
- Don't leave young people guessing as to your intentions;
- Reassure the young person about what is happening;
- Don't patronise;
- Don't attempt to contradict or reason logically against a delusion;
- Protect the individual from the consequences of such delusions;
- Assess the situation by asking (not interrogating) the young person;
- What are the potential dangers of the situation and where they are;
- Always leave yourself an exit.
