Martin Gardner – Case Management Basics – 7/13/2017

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.