PREVENTION AND MANAGEMENT OF INTER-PERSONAL AGGRESSION

Typical Assault Cycle (Based on Kaplan and Wheeler 1983) Aggressive / Challenging / Violent Behaviour Escalation Phase (B) (Potential Additional Assaults) Trigger Phase (A) Post-Crisis Depression Phase (E) Crisis Phase (C) Recovery Phase (D) Approximately 90 mins to fully recover. Baseline Behaviour

What may constitute challenging behaviour? Interpreting physical care as an assault Side effects of medication. Meeting people they find threatening. Frustration with their disabilities. Frustration with help that is not required. Feeling that care workers are unhelpful. Feeling angry at restraints e.g. locks on doors

Things to avoid Signalling your anger or potential aggression (through verbal and non verbal behaviour) Being negative or un-interested in the other persons problem. Stereotyping Being contrary Heavy criticism. Shouting or touching **

Defusing: principles for action Be aware of the situation Respond early in a realistic and suitable manner Provide a choice (win/win situation) Think ahead be proactive Address the issues (long and short term) Work towards “together we can sort this out”

Strategies to Defuse Trigger Positive Negative Open questions Stop listening Identify alternatives Patronizing Summarize Interrupting them Open NVC Agitation Being aware of own agg Being laid back Closed questions Use of WHY BE PERCIVED AS POSITIVE AND HELPFUL

Strategies to Defuse Escalation Positive Negative Continue with above Telling them to calm down Consider own safety Using humour Consider barriers Trivializing their problem Consider escape route Consider raising alarm Remove audience Ask them to stop Distraction Consider their inhibitors

Strategies to Defuse Crisis Positive Give clear instructions Be precise and unambiguous Consider your safety and that of others Don’t physically intervene to early Use alarms if assault takes place Get away keep clear Negative Fighting back Screaming

Strategies to Defuse Recovery Positive Give them space to come down Contain the situation Get help for self and others Can someone else deal with them? Give them opportunity to discuss (once calm) Keep records Negative Intervening to early Not recognising own needs Continuing as if nothing has happened Being perceived as rushing, punishing and crowding them REMEMBER TO POSSIBILITY OF ADDITIONAL ASSUALTS

Strategies to Defuse Post Crisis Depression Positive Meet their needs Talk things over Offer support (will help understand the situation/prevent re-occurrence) Negative Avoiding them Minimalising the event Expecting normal behaviour all round with no support

CORE SKILLS Active listening: really attending to what the other person is saying. Paraphrase and summarize: repeating statements in your own words, demonstrates you are listening. Reflect feelings: comment on and identify their feelings for them. Use open questions: e.g. “tell me about…” invites exploration of problems and may help them run out of steam.

Summary We all do our best but we can learn from incidents. We cannot prevent escalation every time: getting it right in this case is keeping safe. Sound procedures help. Our behaviour can trigger events: (we can control our own behaviour not that of others). Effective use of skills can help de-escalate incidents, we can develop our skills. The chance of experiencing really aggressive behaviour is quite small.