Dangerous Situations

Effective date: September 30, 2011

Revised January 2018

Relevant Legislation:

Not applicable to this policy.

Intent:

This policy is intended as a general guideline for all staff at LOFT Community Services. Each Program and their health and safety committee should have a more detailed policy regarding the potential for violence at each work site, with procedures in place to deal with it, after an analysis of the potential risks from the individuals they are in contact with. The Program Director will also be responsible for orienting staff, volunteers or student placements regarding possible dangerous situations at each program.

Violence is acknowledged as an occupational hazard for the social services sector. Acts of violence may be directed at staff from many sources, including difficult clients or consumers, family or friends of consumers, unauthorised people in the workplace, or members of the public. A critical step in preventing violence is recognising the situations in which it may occur, and taking appropriate steps to de-escalate a potentially dangerous situation.

Definitions:

Violence can be defined as a threat or an act of aggression resulting in physical or psychological damage, pain, or injury to a worker.

Verbal Abuse is the use of vexatious comments that are known, or ought to be known to be unwelcome, embarrassing, offensive, threatening or degrading to another person.

Threats are a communicated intent to inflict physical or other harm.

Physical Attacks can include hitting, shoving, pushing, biting, pinching, kicking or inciting a dog to attack.

Policy:

While all staff can be exposed to dangerous situations, those having direct contact with the public may be more vulnerable to some form of abuse directed at them. In other situations, many medical conditions, systemic, mental and psycho-geriatric illnesses can increase the possibility of violent behaviour in clients. The toxic level of some medications and chemicals can also cause confusion, agitation and violent behaviour in the elderly. Consumers with psychotic symptoms, especially paranoia can be more physically aggressive to others. Finally, the one true predictor of violence from an individual is a history of violent behaviour from that individual. Therefore it is key for staff to review all available documentation on a client, to communicate with other staff regarding client behaviour and to document their behaviour in order to predict other possible behaviour. Staff should also be aware that they can be vulnerable to violence, when:

  • working alone, especially at night,
  • interacting with violent consumers,
  • dealing with public complaints,
  • providing care, advice or information impacting directly on a client’s life, or
  • handling money or medications.

The level of risk increases when two or more of these factors occur together. Recognising the triggers and responding to them before problems escalate is the best way to reduce this risk.

THE STAGES OF AGGRESSIVE BEHAVIOUR

 

Aggressive behaviour can progress through stages and an appropriate response to it by a staff member depends on the stage that has been reached. Recognising the first signs of behaviour change and erring on the side of caution (i.e. anticipated aggression or potential violence) will protect staff from harm. Staff must also communicate with each other regarding approaches that succeed or fail with particular clients. The three stages are:

  1. agitation or distress,
  2. aggression and mounting vulnerability,
  3. violence or chaos.

 

Stage 1

In stage 1, an individual takes the first step to aggressive behaviour. Most give non-verbal warning signals of increasing anxiety, frustration and anger before a violent incident. These signals can be:

  • clenched fists and teeth,
  • rapid breathing and flared nostrils,
  • a flushed face,
  • restless, repetitive movements,
  • pacing,
  • aggressive gestures such as pointing,
  • raised voice.

 

An intervention at this stage is to assist in identifying the cause of their agitation or distress.  The following actions may help to avert and diffuse agitated behaviour in individuals:

  • encouraging them to talk by using active listening skills,
  • empathising by using statements such as, ‘You seem to be upset”,
  • talking to the individual, not at them and speaking slowly, softly and clearly,
  • asking permission to approach the individual, making eye contact, approaching slowly in a calm, confident manner,
  • respecting their personal space,
  • meeting with them in an environment that is free from distractions.

Staff should also remember that when dealing with agitated individuals they should inform other staff of where they are and have them check on the situation. They should also NOT become cornered with the individual and always ensure there is an escape route available.

 

Stage 2

In the next stage, stage 2,  the individual continues to move towards increased aggression. The individual may become defensive, protective and on the verge of losing control. They may exhibit increased activity and exaggerated verbal communication, as well as:

  • assuming a threatening stance,
  • pacing,
  • raising their voice,
  • slamming doors or throwing objects,
  • clenching fists and pointing.

 

At this stage a directive approach is required to get control of the situation and direct the individual to do something that will stop the slide to further aggression. This will be the last opportunity to intervene verbally and back-up must be available to assist with the situation. The following may be used to avert and diffuse their aggressive behaviour:

  • arranging for back-up or assistance and keeping a safe distance away,
  • using the directive approach by giving a clear, simple directive such as, “please sit in the chair” and possibly repeating it several times if necessary,
  • acknowledging their feelings of anger and offering positive reinforcement,
  • clarifying your understanding of the situation,
  • NOT becoming cornered with the individual, always ensuring there is an escape route available,
  • documenting the incident and informing the Program Director.

 

Stage 3

At stage 3, the individual cannot control their behaviour and nothing that is said to them will register. Fortunately this stage does not last very long. Verbal intervention is useless and staff should withdraw if possible and summon assistance. The police should be called if the individual displays a weapon. Isolate them by closing and locking doors. If withdrawal is not possible:

  • maintain a safe distance, and possibly a sideways stance which is less intimidating,
  • position yourself on the same physical level, avoid standing over them,
  • stay calm and use calm body language such as open hands, attentive facial expression and relaxed posture,
  • avoid staring eye contact, touching or rushing the individual,
  • avoid pointing, gesturing or making sudden movements,
  • buy time until help arrives,
  • document the incident and inform the Director immediately.

 

Interacting with an Angry Client

Should staff feel threatened by an angry client, or if the interaction with them is increasing their anger, the interaction should be terminated immediately. This can be done by:

  • calmly but politely interrupting the conversation,
  • telling them that the conversation is over,
  • leaving, or asking them to leave,
  • advising the Director or notifying other staff in the area,
  • calling police,
  • completing an incident report.

 

Should staff be required to meet with potentially violent consumers, proper preparation can greatly decrease the risk of an incident. Some of the strategies that can be used include:

  • gathering as much information on the individual as possible,
  • meeting in a safe area or room which should have opportunities for others to observe the meeting. The area should have an absence of furniture or objects which can be thrown, access to escape routes and possibly access to a panic button or other alarm mechanism,
  • advising others of where you will be meeting, bringing a co-worker or having others check on the meeting at pre-determined times,
  • giving copies of documents to the client in order to maintain distance,
  • being on time. (Tardiness can increase the level of anger.)

 

RESPONDING TO THREATS OR ABUSIVE BEHAVIOUR

 

Staff can be threatened and/or abused in person, by telephone or by letter/e-mail. Such threats may not require the intervention by others but they should not be taken lightly and should be reported at once. Threats may also need to be reported to the police because the individuals who make them often have a history of threatening and violent behaviour.

If threatened and/or abused in person, staff should:

  • remain calm,
  • keep a safe distance and leave the area if necessary,
  • be courteous, introduce yourself and ask for their name,
  • speak slowly and confidently in a non-threatening tone,
  • use simple language, not jargon or technical language,
  • employ active listening skills, do not interrupt,
  • acknowledge their feelings and concerns, repeat what has been stated to help understand the problem,
  • use silence as a calming tool,
  • avoid giving commands and look for ways to help the individual save face,
  • apologise as necessary,
  • politely and calmly terminate the interaction,
  • notify the Director and complete an incident report.

 

If staff are threatened or abused by telephone, they should:

  • listen carefully for anything that will help to determine the identity of the caller and their location,
  • stay calm, do not put them on hold,
  • interrupt the conversation firmly but politely,
  • hang up if the individual continues,
  • transfer the call to the Director if possible, (and/or notifying the Director immediately after the conversation is over),
  • complete an incident report.

 

If staff receive threatening letters or e-mails, they should be forwarded to the Program Director immediately.

 

Weapons

If staff see a weapon of any sort in a client’s unit or in their possession that causes alarm, staff are to use de-escalating techniques as outline above, get away from the client and area as soon as possible, notify Police of the weapon concerns immediately, and inform staff to devise a plan of action to ensure the safety of staff and other clients.  An incident form should be completed.

Staff and client support

Finally, after an incident of violence, threats or abuse, staff may need counselling assistance in dealing with how they feel. This assistance or support can be provided by the Program Director, co-workers, or the Employee Assistance Program (EAP) offered as part of the group benefits plan.  A plan to assist clients with their needs of support should take place by staff immediately following a dangerous situation.

 

Procedures:

See program manual.