Violent and aggressive behaviours have a huge impact, affecting the health and safety of the young person as well as carers, staff and others using the service.
As far as possible, focus on preventing, anticipating and reducing the risk of violent and aggressive behaviour occurring.
Involve the young person in decisions about their care wherever possible, and collaborate with whoever has parental responsibility. When supporting the young person to manage and minimise any violent or aggressive behaviours, consider their physical, intellectual, emotional and psychological maturity, including any variation in their development.
Understanding the likely causes of violent and aggressive behaviours helps to prevent them happening. Together with the young person, when they are in a calm and safe space.
Think about times when they have shown violent or aggressive behaviour, and what might have triggered it.
Triggers can be:
Consider their history, including any experience of abuse or trauma and how they responded during any previous incidents of violent and aggressive behaviour.
Talk about what happens when they are becoming distressed and angry, and what helps them to feel calmer.
Identify any cognitive, language, communication or cultural factors that might increase the risk of violent and aggressive behaviour.
Record this information in the care plan and support the young person, if they wish, to make an advance statement recording their wishes in case they become agitated in future.
This could include what they would find acceptable, when and how staff should intervene and how to minimise harm or discomfort should restrictive interventions be needed.
Give copies of this information to the young person and make sure they understand it.
De-escalation means using techniques, both verbal and non-verbal, to reduce agitation and avoid violent and aggressive behaviour. It may include the use of ‘when needed’ medication in combination with other techniques.
De-escalation requires advance planning and it is more likely to be successful when staff:
If the young person becomes agitated:
Only use restrictive interventions if all attempts to defuse the situation have failed and there is a risk of harm to the young person or other people. Continue to attempt de-escalation during the restrictive intervention.
To help reduce the risk of violent and aggressive behaviours, and avoid the use of restrictive interventions wherever possible, staff should have training specific to working with young people. Training should include a focus on de-escalation and cover:
Anyone who might use restrictive interventions should be trained in how to do so safely with young people.
Staff should be aware of relevant legislation, organisational policies and procedures, and how to respond effectively and appropriately.
Share information within the organisation about the triggers and early warning signs identified by the young people using the service to help inform learning and practice.
This content has been co-produced by NICE and the social care institute for excellence (SCIE). It is based on NICE’s guideline and quality standard on violence and aggression.
As health care professionals, we are sometimes faced with patients in crisis. An estimated 4 percent of visits to primary care physicians involve psychiatric or social crises. Proper assessment and intervention are essential to ensure the safety of the patient and others.
For purposes of this article, crisis moments refer to those points in time when individuals lose physical and rational control of their behavior. Almost always, there are warning signs a person’s behavior is moving toward a crisis.
EMOTIONAL SIGNS: Crying, Yelling, No Talking at All, Arguing, Inappropriate Laughter, Fear, Confusion
BEHAVIORAL SIGNS: Rocking/Swaying, Rapid Breaths, Shaking Extremities, Pressured Speech, Tenseness in Body, Loud or Quiet, Clenched Fists, Poor Eye Contact, Pacing, Skittish Behaviors
The following tips can aid in early interventions and increase the likelihood of staff de-escalating an incident before it becomes dangerous.
These are some basic steps we hope all staff members can use to improve their interventions in potential crisis situations. The points above are not intended to replace training, but rather to provide an overview of some of the techniques and strategies that can be effective.