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School-Age Children As children mature and enter school, they may continue to display many of the same aggressive behaviors e. Adults From adolescence to adulthood, aggressive behavior may escalate into more serious and violent acts, such as domestic violence, sexual abuse, child abuse, and homicide. Older Adults As adults grow older, new situations come into play. Aggressive behavior peaks before age 2. Genetic factors and Biological factors e. Imitation of others aggression Social Learning Theory.

After repeated exposure to specific social stimuli. Social Information Processing Theory. Classroom-based programs that emphasize skill-building, such as self-monitoring and self-regulating emotions and behaviors; increasing relationships among peers; and using communication skills to express anger, frustration, etc. Teacher-led classroom discussions about aggressive behavior to facilitate open communication about aggression as a problem and make students more aware of its existence, possible triggers, and consequences.

Introduction

Target specific risk factors associated with adolescent aggressive behavior, such as underage alcohol use. Classroom discussions, including role playing and skill rehearsal, to help adolescents learn coping strategies and problem solving. Creating a positive academic environment, including extracurricular activities, sports, and arts programs.

Additionally, a positive school environment should include the presence of teachers and other professionals who convey a caring and supportive attitude toward students. Use of the prevention strategies for children and adolescents mentioned above, particularly school programs, where children and teens spend much of their time , may prevent aggressive behavior later in adulthood.

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Understanding Aggressive Behavior Across the Life Span

Occupational programs that focus on awareness of workplace violence, bullying, and anger management. Target specific risk factors associated with adult aggressive behavior, such as substance abuse. Many preventive interventions have been proposed and tested to reduce aggressive behavior among persons with dementia. These include managing pain, including administering analgesics prior to personal care; knowing and honoring the resident as a person; communicating clearly, calmly and in a warm manner; explaining actions before performing them to reduce surprise or startle; involving the resident in performing self-care; staff consistency in assignments; avoiding use of restraints; and environmental stimulus control e.

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INTRODUCTION - Violence and Aggression - NCBI Bookshelf

Aggressive Behaviors Emerging During Childhood Many theories about the emergence of aggressive behavior during childhood have also been posited to explain the occurrence of aggressive behavior in adolescents and adults. Aggressive Behavior Emerging in Adolescents, Adults, and Older Adults Aggressive behavior may also appear for the first time in adolescents, adults, or older adults. Consequences of Aggressive Behavior After it appears, aggressive behavior can have profound health and psychosocial effects on the perpetrator, victim, as well as bystanders.

A Three-Pronged Approach Due to these significant consequences of aggressive behavior, steps for prevention and treatment must be taken to mitigate these harmful effects. Conclusion The concept of aggressive behavior across the life span is very complex. Footnotes No conflicts of interest have been declared by the authors.

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  • Table of Contents: Prevention and control of aggression and the impact on its victims /?

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Given the risks posed by violent behaviour in mental health, health and community settings, all trusts have policies for its prevention and management. These policies can be wide ranging and are often directed at other primary goals, but also have secondary beneficial impacts on reduction of violent incident rates, reductions in their severity when they do occur and amelioration of their outcomes. For example, prompt and effective psychiatric treatment resolves acute symptoms and, because symptoms can be linked to violent behaviour, this constitutes one way that incidents are reduced.

Within forensic settings, specific psychotherapies may be available to help people reduce their own capacity to act in a violent way. Buildings and wards are sometimes designed with the possibility of violent behaviour in mind, so in many areas, and especially in forensic or psychiatric intensive care settings, buildings are made out of stronger materials. Doors and furniture may be more robustly constructed, windows are fitted with stronger or safety glass, and living areas are designed in a way to maximise observation and supervision so that violent incidents can be quickly identified and responded to.

Service users are searched for weapons on admission to hospital, and a number of items that could be used as weapons are banned from being brought onto the wards. As an aid to observation, closed-circuit television CCTV may be fitted in public areas and a variety of alarm systems may be fitted, from wall-mounted buttons to personal alarms for staff that quickly identify where an incident is taking place.

These measures are accompanied by policies dictating their use and procedures as to who responds and takes control. In most psychiatric hospitals, if weapons are involved or the situation is beyond the capacity of staff to manage, the police may be called to manage the situation. Within psychiatric hospitals, the main professional group that manages violent incidents and who are most likely to be victims are mental health nurses and healthcare assistants.

The basic training of mental health nurses includes instruction on the causes of aggression, good communication skills and non-confrontational practice. During their training, nurses learn how to quickly establish and strengthen good relationships with service users, and these act as a safeguard against violence to staff, or aid in the de-escalation and management of agitated and violent behaviour.

De-escalation or defusion refers to talking with an angry or agitated service user in such a way that violence is averted and the person regains a sense of calm and self-control. Most potential occurrences of violence are averted in this way, especially when there is some warning that they are about to occur, such as raised voices and abusive language. All NHS psychiatric services provide additional training to their staff, especially those working in inpatient areas, in the prevention and management of violence.

Such training typically but not always consists of 5 days with subsequent annual refresher courses, contains instruction on de-escalation, breakaway techniques and manual restraint, and is provided by an in-house training team. Where such training is commissioned from external private providers, a plethora of courses exists with different content. There are no detailed national guidelines on the content of violence management courses or on the specific physical techniques that are taught, and there are no standards, quality control processes or accreditation procedures for the courses concerned, whether provided in house or by external providers.

If an actively violent service user cannot be verbally calmed and is judged likely to imminently assault another, they will be manually restrained by suitably trained nurses and healthcare assistants. Such manual restraint is aimed at securely holding the person so that they cannot strike out or hurt others, so that they are not injured themselves and so that attempts to verbally engage with them can continue.

Such holds can be slowly released when the person is emotionally calmed and can negotiate about their behaviour. If a state of calm cannot be immediately achieved, sedating medication may be offered by mouth or given by injection without the person's consent rapid tranquillisation. If these efforts fail, the service user may be secluded in a specially constructed room, although not all hospitals have these. Additionally or alternatively, as the person becomes calmer, they may be asked to stay away from other service users by remaining in their own bedroom or other area but without the door being locked , or be placed on some form of special psychiatric observation to facilitate early intervention if the violent behaviour seems likely to recur.

Further changes to the person's regular medication regime may occur following a violent incident in an effort to prevent recurrence. Debriefing of the staff team and service user involved may also occur in an effort to learn from the incident and plan, so as to prevent the chance of a repetition. All these procedures are variously guided by a trust's policies and training provision for staff. It is important to note that the nature and extent to which violence and aggression is experienced in the NHS varies greatly with the setting.

The experience and hence the management of such incidents will differ between community and hospital environments. The interface with non-NHS agencies such as the police, the courts and social services has a role to play, and these links are well developed in some settings. Within the NHS hospital setting, there are particular areas that are better developed by virtue of their philosophy of care, skills mix and clinical experience to therapeutically manage acute or sustained risk of violence and aggression in the context of mental or physical health problem.

These include emergency departments linked to general medical hospitals, psychiatric intensive care units within the acute inpatient psychiatric care pathway and forensic psychiatric inpatient facilities. The prediction of the risk of violence and aggression by service users in mental health, heath and community settings is challenging in a number of ways. The key challenges include the lack of definition of what is being predicted, over what time-frame and in which context. Intuitively, the clinical tools required to predict imminent or short-term violence and aggression would be different by some degree to those utilised in the prediction of medium to longer-term violence or aggression.

Furthermore, the heterogeneity in clinical populations where violence and aggression is exhibited seriously hinders the reliability and validity of specific clinical tools; there is no broad clinical assessment tool that can be applied in all circumstances where violence and aggression needs to be predicted. Clinicians in the healthcare system have a duty to protect service users both as potential perpetrators of violence and aggression, and as the victims of such acts , to protect healthcare and other professionals which includes the attending clinician's personal safety , and to protect the wider public.

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Such duties are explicit in most professional codes of practice and are most apparent in the codes that regulate the practice of medical doctors and nursing staff. In this guidance, the prediction of violence and aggression relates to that which is felt to be imminent or occurring in the very short-term; that is, within minutes or up to 72 hours. The fundamentals of predicting the risk of violence and aggression are driven by the best available psychiatric assessment of the person.

Comprehensive assessment, which includes a psychiatric history, a mental state examination and an assessment of physical health, leading to clinical and risk formulations, will usually be difficult to achieve in acute clinical scenarios, and much of the clinical and risk information may not be readily available at the outset. The assessment is an iterative and dynamic process that should lead to responsive changes in the clinical and risk management plan. Particular significance is attached to a past history of violence and aggression because past behaviour is a guide to future presentation.

The impact of mental health problems, physical health problems, personality disorders, substance-use disorders, social impairment and cultural factors should be considered within the health or social care framework so as to understand the aetiology of the person's violent or aggressive presentation. The approach described in the preceding paragraph is essentially that of unstructured clinical assessment. Although it suffers with low reliability, it is operator dependent and the reliability and validity are likely to be improved when it is used by more experienced and skilled clinicians.

There are 2 other types of violence-related risk assessment: Actuarial risk assessments use quantifiable predictor variables based on empirical research often derived of an actual patient dataset, which ultimately limits their generalisability ; they aim to provide a quantifiable value to the outcome in question.

For the purposes of this discussion, the outcome in question would be the probability of violence or aggression occurring in the short-term. Structured clinical judgements are an amalgam of the clinical assessment approach and the actuarial approach. Risk factors derived from a broad literature review are rated by the assessor using multiple sources of clinical information. A number of violence-related risk assessment tools are currently available and some are in general use in specified clinical settings.

Current clinical wisdom is that many of the available risk assessment instruments that predict future violence are broadly similar in their somewhat moderate predictive efficacies Yang et al. The risk assessment tools listed above cover a wide variety of clinical settings, and most progress has probably been made in the area of forensic psychiatry. The majority of the risk assessment tools focus on medium- to long-term risk. A few have some emerging evidence base for their applicability to the prediction of violence and aggression in the short term and in non-forensic settings.

Any method that is to predict violence and aggression in the healthcare setting needs to look further than just patient-related factors. Patient-related factors are often well covered in clinical assessments and in violence-related risk assessment tools. Other areas requiring consideration include: These non-patient-related factors are just a few examples, but they serve to illustrate the multitude of factors that can potentially shape the expression of violence and aggression.

The knowledge and understanding of such factors by staff in more secure settings, such as PICU or forensic psychiatric services, is well described by the model of relational security Department of Health, In terms of prediction, with its aim to better manage and reduce violence and aggression, these areas are probably of equal relevance to the direct patient-related factors. The problem of aggression and violence seems to be endemic in the healthcare sector. The background literature is equivocal and the prediction of violence and aggression is an area of ongoing debate and research.

Good clinical teams will make ongoing clinical and risk assessments with or without the benefit of a violence-related risk assessment tool , and have quite a low threshold when considering a service user to be at high risk of violence or aggression. The low threshold usually leads to the use of clinical measures to prevent or manage the behaviour in the least restrictive and most therapeutic manner possible.

Therefore, one argument is that good clinical management should lead to false positive predictions of violence and aggression, where it is predicted that violent and aggressive behaviour will occur but it does not Steinert, With this in mind, the very purpose of risk assessment can be brought into question: The 2 outcomes would seem to require different instruments; the latter would be based in more of a formulation approach to identify relevant factors that may incite violence in a particular service user, rather than estimate how likely that person is to be violent in the future.

Clinicians may be well advised to consider a formulation-based approach that facilitates the prevention and management of aggression and violence, as opposed to an over-reliance on purely predictive methods. Due to the complex determinants and broad manifestations of violence and aggression, its full economic impact is difficult to measure and, to date, no formal attempt has been made to quantify this for the UK.

Violence and aggression in the context of mental health issues is associated with a range of negative consequences, which may be broadly grouped into costs to individuals and costs to the UK health service. Incidents of violence and aggression may result in physical pain, stress, loss of confidence and other psychological problems. These personal costs accrue to the individuals at the centre of the episode, to other staff and fellow service users.

The wider health and social care system incurs the costs associated with secure care for service users, staff absence, legal services, extra training costs, NHS trust liabilities, compensation, ill-health retirements, staff replacement costs, counselling, and a myriad of retention and recruitment issues. There was a wide variation between the numbers of reported incidents in the different sectors with an average of 36 assaults per staff reported in the ambulance sector, 19 per staff reported in the acute sector and 16 per in the community care sector.

Furthermore, the same report suggested that incidents of assaults across all sectors may be increasing with This trend has the opposite direction in mental health and learning disabilities trusts with incidents falling from Apparent trends in this data should be interpreted with caution because changes in populations, service provision health body amalgamations and reporting culture may all affect published figures. Another report from the Wales Audit Office Colman et al.

Incidents of violence and aggression also varied according to service area within mental health services. Violent and aggressive incidents are the third biggest cause of workplace injuries in the health and social care sector, as reported to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations.

To estimate the healthcare costs associated with incidents of violence, Flood and colleagues collected 6 months' of incident data from a sample of acute psychiatric wards in England and combined these with end-of-shift reports from nurses in 15 wards to estimate the resource use per violent event.

The cost calculation only accounted for the payment of identified staff and medication costs and as such does not observe fixed costs such as specialised facilities. The outputs of this analysis are estimates for the mean cost of violent incidents for individual psychiatric wards and for England as a whole.