It is very important for workers to recognise risk factors in clients by knowing the client’s history. This can be done by:
- examining case notes
- reading observational charts
- receiving handover reports from co-workers
- researching any relevant information available on the client.
Factors that may dispose clients to be in conflict with the service deliverer or carer and/or to act aggressively include:
- A history of aggression/violence/acting out
- The presence of hallucinations (which are revealed as sensations of hearing, seeing, smelling, tasting and feeling)
- Drug and alcohol abuse
- Incorrect use of medication
- Feelings of paranoia
- Feelings of entrapment and powerlessness
- High levels of frustration
- Lack of impulse control
- Anxiety arising from conscious/unconscious conflicts
- Delusions of persecution
- Use of inappropriate defence mechanisms (e.g. lying, projected hatred).
(Keane & Dixon 1999)
The behaviour can develop slowly, with the client remaining unaware of their conduct and the potential impact it may have on others. It is important that workers are aware of the changing behaviour in clients that may lead to conflict.
Workers sometimes need to take action to respond to client behaviour as a result of either:
- Evidence of a client’s negative behaviour over time
- Crisis situation (act of violence or aggression).
Evidence-based assessment of client behaviour
Negative behaviour can relate to a person’s coping skills or problem behaviour.
Sometimes monitoring client behaviour can be for the purpose of assessing a client’s changing coping skills. As we indicated earlier, this can relate to diminishing skills (e.g. through withdrawal, confusion, lack of motivation, passive aggression, ageing, health condition), to regaining skills as a person recovers from an injury or surgery, or to developing skills through training and information sharing.
Sometimes client behaviour may not be a risk to safety, but may still be a major problem for the client in reaching their goals. An assessment of client behaviour over time, together with accurate knowledge about the client’s current situation and issues, can go a long way towards taking the right action to prevent future problematic behaviour.
Responding to crisis situations or inappropriate behaviour
Agencies usually have specific procedures in place to deal with crisis situations, including acts of violence and aggression.
Regardless of the procedures in place to support workers in a crisis situation, it is also important that aggressive incidents are managed at an agency level. There are three phases to managing an aggressive incident – before, during, and after an event.
- Before an incident, the workers (and agencies) need to be implementing preventative measures.
- During the incident, the worker(s) involved must use strategies that will not only assist the client to regain control, but will also prevent injury – to the worker(s), to the client, to others, and to property.
- After the incident, a debriefing needs to be conducted with all of those involved (usually on an individual basis), and especially with the client to help the client deal with the underlying issues and prevent further episodes.