Bx Rx of Verbal Aggression

SKILL C M O Scientific-Based
Evidence
(If) (Then) (Outcome)
Emotion “People I have
recognition, used it with have
regulation, found that
and/or skill [cognitive
development behavioral
they can learn:
This can lead to therapy] really
If individuals 1) To identify
a reduction in the helps give them
presenting with anger provoking
display of the tools for
difficulties in situations/early
aggressive trying to modify
emotional signs of anger
behavior. their thinking in
regulation have (triggers).
the future on
the necessary 2) To distinguish
their own if
cognitive skills to between
possible or even
engage in appropriate and
just with the help
interventions inappropriate
of staff
delivered by lay expression of
scaffolding
therapists (family anger.
that. It almost
or paid carers) or 3) To develop
sometimes feels
clinically trained new, positive,
like when they
staff in both skills or
first get it, it is
community and behaviors to
like a lightbulb
inpatient settings replace less
moment for some
helpful ones.
people and when
they first
understand a link
between thoughts
and emotions.”
Approaches for If staff are This can lead to This can lead to “A massive bit of
individuals trained to deliver a calmer a reduction in the it is accessing the
across all levels sensory environment, a display of physiological
of intellectual stimulation with reduction in aggressive component so
disability service users in sensory overload challenging that people are
shared for individuals behavior and able to identify
environments and an improved when they are
(including those opportunity for communication very low down in
with more de-escalation and their escalation
severe/profound when anger- relationships. cycle so that they
impairments and provoking are not waiting
those requiring situations occur. until they are
inpatient care), really, really
and/or staff are agitated before
 they do anything
so that they can
try and
deescalate before
it gets to that
stage. A lot of
people that I
have worked with
can’t actually tell
trained to provide when they are
comfort or create getting angry
relaxing spaces and then don’t
know what to do
about it at that
stage. It is almost
like it is a
runaway train
and they just
can’t stop.”
(Healthcare
professional 1)
Meaningful If staff are unmet needs for This can lead to “Because an
activities trained to sensory and improvements in environment that
organize and social interaction service user is calming, that
deliver can be met and quality of life, has
meaningful personally while preventing greenery, that
activities (music, meaningful incidences of has colors on the
hobbies, tasks, activities can aggressive walls, where
social activities) provide behavior and de- there’s not paint
with service stimulation and escalating flaking off, where
users in shared combat boredom, incidences when the echo is
environments whilst enabling they occur. reduced, it’s not
(including those service users to over stimulating
with more experience all the time. All
severe/profound enjoyment from of these things
impairments and activities they impact on how
those requiring are interested in. stressed we
inpatient care) feel. And if we
can reduce the
stress in the
environment, we
stand a better
chance of then
actually helping
someone to learn
some new skills
 as well”
(Healthcare
professional 2

Facilitating Factors of Direct Interventions

Personalizing If clinically Then This can then “Most stuff has
intervention trained therapists Interventions lead to greater been adapting
content, format, or adequately can address engagement and existing
and delivery trained lay individuals’ satisfaction, all programs, or
therapists particular of which can working on
(family or paid experiences, then help to existing
carers) wishes, complex reduce the groups, that
personalize needs and display of have been
intervention abilities, and aggressive running, and
content, session therefore can challenging thinking about
order, treatment achieve a better behavior. the participants
pace and or fit. who are coming
duration and and how to
delivery format make things
accessible to
them.”
(Healthcare
professional 2)
“Also, length of
sessions, it
 totally depends
on how long
somebody can
concentrate
for…
“(Healthcare
professional 1)
Intervention If interventions “We can keep
duration are practiced by going as long as
target Individuals gain Behavior change it is necessary. It
individuals or more is sustained, and is really hard to
their carers over opportunity to aggressive say in terms of
longer treatment practice and behavior is number of
durations embed skills. reduced. sessions.”
(Healthcare
professional 1
 Sustaining and Embedding Change for Staff & Systems Levels

SKILL C M O Evidence
Removing Then This can then Staff have said when
barriers to individuals help to ensure they’ve been going
mentorship develop a that back to their
If staff with
and support clearer interventions areas, how [support]
varying levels
for those understanding are delivered made them feel really
of skills,
delivering of the with high relieved and
abilities, and
interventions intervention fidelity with comforted. And that if
motivation
and what is treatment they were worried
receive regular
expected from outcomes about anything, then
supervision or
them as well as being they could come and
mentorship
being maintained for speak to us. As well as
from clinically
motivated to longer with a the staff team being
trained staff,
embed these reduction in really welcoming, it’s
have
skills into aggressive had the positive impact
intervention
routine behavior that’s gone back to
leads or
practice, observed. them.” (Service
champions and
allowing for manager)
have choice in
sustained and
whether they
systemic
are trained
change across
numerous
sites.
Intervention If carers and Then this can This can then “…allows staff… to air
deliverers staff facilitating promote increase a their views on
having intervention engagement sense of situations that have
protected delivery to and ensure competence happened, review how
time to learn people with they embed and confidence a situation was dealt
and practice intellectual new skills into in applying with and
skills disability have practice. new skills and managed. Come up
protected time help to ensure with ideas and
to practice and changes in formulations on how to
learn new skills behavior are manage situations in a
 better way next
time, they’re able to
sustained. throw all their ideas
out…” (Service
manager)
Facilitating If paid carers This can result “…it supports the staff
factors for and staff are in more to be consistent and
Then
collaborative taught positive shared come up with
interventions
working interventions environments, consistent approaches
will run
within teams which focus on trust and to help support them in
smoothly, and
working collective managing the
staff can share
cohesively and responsibility, individual, and also
skills and
sharing improving give the individual
support others
responsibilities staff and consistency”. (Service
to deliver the
with other staff service user manager
intervention
members outcomes (e.g.,
whilst also
sustained
building a
reductions in
shared
aggressive
understanding
challenging
of the triggers
behavior,
and
decreased staff
maintenance of
turnover,
behavior.
burnout and
stress)