1. PREVENTION AND MANAGEMENT OF INTER-PERSONAL AGGRESSION

2. 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

3. 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

4. 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 **

5. 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”

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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.