Tackling violence effectively

The role that alcohol plays in assaults at work is seen to be high, but this, reports the BCS: “can only provide an indication of the role of alcohol or drugs in offences, as a relatively high proportion of respondents are not able to make this judgment, particularly for drugs”.
    
Nevertheless, victims of actual or threatened violence at work said that the offender was under the influence of alcohol in 36 per cent of incidents, and that the offender was under the influence of drugs in 18 per cent of incidents. Alcohol was more often named as a factor by victims of assaults at work than by victims of threats at work. Perhaps an indication, amongst many, of society’s wider ills but also a hint that a multi-agency approach to the problem of violence at work is necessary.

Effective multi-agency working
Ascertaining the root causes of conduct disorder is key to working on long-term solutions. Smith (1995) highlights the importance of beginning to apply sufficiently prompt support. She cites: “the indications of later problems are usually present at an early age” and that “the case for early intervention is irrefutable”. Leaman (2005) focuses on three main areas that cause challenging behaviour, namely low self-esteem, egocentricity and internalised anger.
    
Glanz, Rimer & Lewis (2002) posit that an individual’s behaviour is influenced by their own beliefs and values, and there is ample evidence that both can be changed through effortful intervention strategies. Behind every problematic childhood behaviour is often a complex range of issues and parents are at the heart of these. Frequently parents are beside themselves with frustration and often anger as they find themselves in difficulty with their children’s behaviour.
    
Greenberg et al (1993) in Sutton (2000) refers to a review of studies on aggressive behaviour disorders in children [which] grouped the developmental factors contributing to these disorders into four clusters – which may be seen as drawn from the same pool of variables as those shown by Herbert (1981) in the frontispiece:

1. Family stressors
2. The nature of discipline given to the children
3. The child characteristics, including temperament or neurobiological factors
4. Attachment relationships

Working with children and their families or carers, assessing their needs, formulating a holistic approach and working through to help people make the changes will offer the chance to bring sustainable improvements. Now, more than ever agencies are attempting to work together, but the results are not always effective due to cultural differences as well as entrenched procedures and perspectives.
    
Back in 1998 Dyson, Lin and Millward in DCSF RB60, were flagging up a common problem: “Interviewees reported a series of problems in securing and maintaining effective cooperation. There were sometimes delays and difficulties in the exchange of information between agencies and joint information handling systems were rare. Schools did not always find it easy to identify appropriate contacts in Social Services Documents or to secure the sorts of interventions from Social Services Documents which they thought were appropriate. There were ‘border disputes’ over responsibility for providing particular services – notably speech and language therapy. Sometimes interventions in the same case were made by two or more agencies with little or no coordination between themselves.”
    
Current good practice fosters a culture of cross agency communication and liaison, however, due to the differences in training between agencies; some of the difficulties listed above have still not been ironed out.
    
For agencies to be able to communicate effectively with each other, five aspects need to be consistent: shared training, shared criteria, shared goals, equitably accessible cross-agency finance, and moderation between different areas with similar demography.
    
Until these are addressed few sustainable improvements will be made and successes will be hap-hazard and difficult to quantify. It must be a priority for an incoming government to re-evaluate inter-agency strategy and to put the necessary structures into place to take things forward and make tangible improvements. This multi-agency approach coupled with effective training and post-incident management could then provide a realistic solution to preventing and managing the problem of violence at work.

Safe & effective training
The Institute of Conflict Management (ICM) has been established since 1997 working with all sectors that face the problem of work related violence. During this time the ICM has been aware of the plight of workers within the NHS and agrees that it is totally unacceptable for doctors and nurses to be subjected to verbal abuse and violence whilst treating patients. But with high quality training, effective management systems and post-incident support, incidents of violence to staff can be reduced effectively. The new ICM certificated education & training Awards provide greater resources to enable the NHS to address this issue.
    
Although incidents of aggression and violence are comparatively rare, from time to time, employees may be confronted by service users presenting particular management problems and challenging behaviours; a problem especially acute in hospital settings. But these can be managed effectively by putting in place the correct management systems and risk assessing job roles and deciding how this risk can then be minimised. The National Occupational Standards on Preventing and Managing Work-related Violence provide a useful framework from which to set up procedures and where necessary, adequate training to ensure the safety of their workers; from initial risk assessment to post-incident procedures. The reporting of incidents, effective deterrents (such as tougher sentencing) and victim support all form a valuable part of an organisation’s overall strategy for preventing and managing work related violence. An effective strategy that also promotes an anti-work related violence culture and combines this with a logical and systematic procedure for risk assessments, reporting of incidents, post incident counselling and relevant training, and, where possible, the use of technology, can all help to reduce incidents of work related violence. These are all issues that are highlighted time and again as effective measures with which to deal with violence and abuse to staff in the NHS, but all too often become lost in the wider priorities of an organisation, especially where budgetary constraints are an issue.
    
In acknowledging our responsibilities towards the health and safety of NHS workers and our duty of care to service users, one of the key objectives must be to receive high quality training. The training should enable all staff to recognise and manage the factors, which lead up to a person becoming aggressive and deal effectively with any untoward incidents of conflict. In certain circumstances (where a risk assessment identifies this) it may also require the teaching of physical intervention skills, but only with careful consideration to the following values:

• Physical interventions should only be used in the best interests of the service user.
• Service users should be treated fairly and with courtesy and respect.

It is also a basic principle in the management of aggressive people that physical management techniques are only used as a last resort and that interactional skills should always form the employees core skills. All training should be provided by suitably qualified instructors with a capacity to teach theoretical and practical skills to work colleagues enabling them to manage challenging behaviour in a skilled, confident, non-confrontational, non-judgmental manner which is of paramount importance. All members of the ICM charged with the task of facilitating management of violence and aggression training are expected to maintain standards of professionalism to teach techniques correctly and help implement procedures in a professionally disciplined manner, ensuring that the imperative philosophy of duty of care to service users is maintained at all times.
    
These new ICM Awards are intended to provide a recognised standard for this type of training, which is backed up by a system of accreditation and monitoring for trainers engaged in training delivery, ensuring their continuous professional development, adherence the ICM’s Code of Practice, and subject to desk top audits and panel reviews. Already, the ICM has had interest from a number of NHS Trusts who are looking to use the ICM as the lead body for all matters relating to violence and aggression at work.

The ICM is a not-for-profit organisation dedicated to setting standards in the prevention and management of work related violence and aggression.

References:
Glanz, Rimer & Lewis (2002) in Hall and Fong, Health Psychology Review Vol1: No1, Routledge, Abingdon, 2007, page 40
Leaman L, Managing Very Challenging Behaviour Continuum, London, 2005, page 5
Smith H, Unhappy Children Reasons and RemediesFAB, London, 1995, page 50
Sutton C, Child and Adolescent Behaviour Problems, British Psychological Society, 2000, page 11
A multidisciplinary approach to assessment and intervention, Leicester

For more information
Tel: 0116 2691049
E-mail: conflictmanagement@associationh.org.uk
Web: www.conflictmanagement.org
The Latest Findings from the British Crime Survey 2008/9 can be found at www.hse.gov.uk/statistics/causdis/violence/bcs2008-09.pdf