Last Updated on February 14, 2022
The human services field can present some serious challenges that can test your mental and emotional fortitude. There are also times when you are challenged physically and have to respond accordingly to ensure the safety of all parties involved. As a human services professional, you will occasionally encounter a client or family member who is verbally and/or physically aggressive. In most cases, a client is displaying aggression in the clinical setting. Staff working in residential and day support settings tend to encounter aggression more often than any other human service professions. Psychiatric hospital settings also pose a significant risk to mental health technicians, nurses, and doctors. I will list a few tips that are common sense but it doesn’t hurt to remind yourself how to respond to difficult personalities and behaviors.
Professionalism
Remember to be professional. Again, it sounds simple but
there are times when you are tested with irate clients or family members. The
key is to take a step back and remember that they are contacting you to help
them solve a problem. Sometimes you have to get past the tone and volume and
focus on what is being said. Respond in a calm, professional tone. It’s easy to
forget and respond with something inappropriate and unprofessional. In some
cases, ending the phone call until the person is in a calmer state of mind is
the most appropriate action.
Remain Calm
It is important not to take the behavior personally. Of
course, this is easier said than done in the heat of the moment. In most
situations, the support staff is not the intended target of frustration. It
could be a number of problems that may cause a person to act out or become
verbally aggressive. Remember that you as the professional must maintain a calm
demeanor and voice tone. Escalating along with the client will only make
matters worse.
Use Only Approved
Techniques
There will be some occasions when physical intervention is
needed. This is usually the case with residential, day support, and other
settings where more direct care is provided. Case managers and social workers
may also be exposed to these behaviors so it is important to know how to
respond.
Therapeutic Options , Mandt , and CPI are the most popular techniques (that I know
of) that are used to train staff in managing aggressive behaviors. Training is
typically required on an annual basis. These trainings are beneficial to all
human services professionals regardless of the amount of direct contact. In
some cases, just being aware of proper techniques can help with preventing injury
to all parties. Of course, these techniques should be used as a last resort and
when there is significant risk to the client, staff, and others.
Prevention
Prevention is the best form of managing aggressive
behaviors. As you gain more experience working with people, you can discover
what mannerisms and behaviors are signs of frustration and be able to prevent a
situation from getting out of control. In direct care settings it is critical to
recognize signs of frustration and anxiety in your clients. Clients who are
non-verbal can still communicate frustration through their behaviors. Here are
just a few signs to look for in order to prevent aggressive behaviors:
Pacing or other
gestures- Pacing is often a sign of increased anxiety and agitation. Some
also show signs of agitation by covering their ears or rocking back and forth. Addressing
these behaviors early by communicating with the client can prevent further
escalation. Offering an alternative
activity and/or providing supportive counseling might reduce the anxiety.
Changes in speech
and/or voice tone- Pay close attention to speech patterns and changes. Pressured Speech
and an increase in volume are often signs of agitation and anxiety.
Changes in routine- Changes
in the daily schedule can also trigger behaviors. This is especially true for
clients on the autism spectrum
and/or have intellectual disabilities. These individuals tend to be very
routine oriented and any change will cause a problem. The key to avoiding
aggression in these situations is to provide advance notice of any changes if
possible. In addition, having a backup plan if something is cancelled
unexpectedly can also reduce behavior problems.
Changes in family/living
situation- Significant changes in the family or at home can also effect
behaviors. The illness or loss of a parent or other loved one can bring on
feelings anger and depression. In group home settings, frequent changes in
staff can also cause changes in client behavior.
Changes in
medications- Changes in medications can impact behaviors. Increases or
decreases in psychotropic medications can result in an increase in aggressive
behaviors among many other side effects.
Changes in medications often take a while to get to a therapeutic level
so behaviors may be unstable until reach that level.
Changes in health-significant
health changes can impact behavior. In my experience, tooth pain is one of the primary
reasons for aggressive behaviors. This is especially true for individuals who
are non-verbal and have no other way to express pain. The inability to express
the discomfort verbally often results in physical aggression.
Documentation-It’s important to document critical incidents according to
agency policy and local/state regulations. Some incidents also need reported to
the local Human Rights agency depending on the severity of the incidents. This
is often the case when there is a serious injury to the client or there is
suspicion of abuse. Thorough
documentation in the client record as well as to regulatory agencies insure
that both the client and staff are protected.
