2016-55: Proactive action in the event of imminent aggression from clients in care facilities (Call 2016-55)

Target group

(Forensic) clients in social care facilities

Content

In social care institutions, there is a need for a working method to deal with the threat of aggression and for tools to prevent aggression, based on a restorative vision. An inventory in the field of social care facilities (KFZ Pre-call 2015-40) has shown that there is room for improvement in tightening up proactive actions in the event of (imminent) escalations.

As a result of the KFZ Call 2016–55, the Salvation Army's Welfare and Health Care department (W&G) has submitted a project proposal that focuses on an approach for proactive aggression management that can be implemented on a broad scale at the social care facilities. This proposal has been approved. In this project, the Salvation Army (W&G), in cooperation with VanMontfoort, an expertise office in the social domain, has adapted and tested a previously developed proactive aggression management method for adolescents (Individual Proactive Aggression Management Method – IPAM) at three Salvation Army pilot locations. The project has five phases: 1) exploration, 2) development, 3) pilot, 4) evaluation and reporting, and 5) adjusting products and delivery.

The result is the product ‘Proactive Aggression Management for Social Care Facilities’ (PAvO). With the PAvO, aggressive behaviour can be counteracted by systematically monitoring aggression incidents. The PAvO consists of the following elements:

1. registration of aggression incidents with the Staff Observation Aggression Scale – Revised (SOAS-R; Nijman et al., 1999);
2. feedback on the registered incidents is discussed in a team meeting;
3. individual approach to counteract (escalation of) aggression with the aid of a signalling plan;
4. general approach to counteract (escalation of) aggression, for example by adapting the living environment.

Proactive aggression management assumes that the registration of aggression incidents provides insight into the situations, events and triggers that give rise to aggressive behaviour. This insight can help in anticipating incidents of aggression and in organising an approach to prevent (imminent) aggression. An important principle of the PAvO is that the client and, where possible, their network should be actively involved in the prevention of aggression and the prevention of escalation. Together with them, we look at the triggers of aggression, how they can be removed or reduced, and what the client needs to prevent the tension from escalating. This also supports and strengthens the autonomy and self-control of the client.

After an exploratory study, the tools and methods were developed and described in a manual. The teams of the pilot locations were given a brief training, after which they started to register incidents. In total, 173 incidents were registered at the pilot locations, the majority of them in Lunteren. In Groningen, the manager's absence was one of the reasons why the registration of incidents did not get off to a good start. The results led to a better insight into the number and nature of incidents of aggression, the clients who are often involved in incidents of aggression, common reasons and the distribution of incidents over days of the week and times of the day, etc.  The team discussions about the outcomes of the registered incidents led to meaningful discussions and yielded concrete ideas to reduce triggers that cause the aggression. Within the pilot, it proved impossible to gain sufficient experience with the individual approach and the use of the signalling system.

The conclusion is that the PAvO has added value for social care facilities that want to reduce incidents of aggression. The instruments, in particular the SOAS-R, and the working method, are appreciated. This pilot offered insufficient experience in the use of the signalling system. Registration using the SOAS-R takes little time; the results lead to new insights. The registration ensures that counsellors are more aware of incidents of aggression and the factors that increase the risk of aggression and take a more proactive stance in this regard. Also, the registration and analysis of incidents provide concrete tools for reducing aggression, both at the team/location level and at the client level.

This is subject to the condition that counsellors register each incident of aggression. Meaningful analysis requires a substantial number of registered incidents. It is, therefore, important that counsellors actively register incidents, and that underreporting is prevented as much as possible. Creating support within the team and the organisation and ensuring good management are important points of attention in the implementation of the PAvO.

Executive party

The Salvation Army, in cooperation with Van Montfoort