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