Background: Staff-directed aggression and violence may have harmful implications for all parts of a mental health service organisation. In an effort to advance the development of competent practice in community mental health and substance abuse services in Oslo, the municipality has offered various courses in the prevention and management of staff-directed aggression and provided supportive tools for practice development. Aim: To explore managers’ perceptions of how participating in education and applying supportive tools have contributed to the development of competence and practice in their own services. Method: Qualitative interviews with 11 managers working in homebased community mental health services were analysed, using qualitative content analysis. Findings: The findings show education and application of tools contributed to: 1) increased awareness and understanding of the complexities of staff-directed aggression; 2) empowered and collaborative practice through negotiations of power relations; and 3) adjustment of perceived management responsibilities and assignments. Conclusion: The findings indicate that managers not only felt their staff had become more knowledgeable and competent following education, but that participation in education also impacted on collaboration within and outside their own services, as well as directly influencing how they dealt with threatening situations in the workplace. Implications for practice: Staff-directed aggression is a complex phenomenon and efficient practitioners are able to keep in mind a number of relevant aspects of practice simultaneously Collaboration in prevention and management of staff-directed aggression requires staff to acknowledge and accommodate service users’ perspectives regarding practice A levelling of power differentials between community mental health services and specialist mental health services takes place when partaking in the same education and sharing vocabulary and conceptual frameworks regarding risk assessment and management

Background Staff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice. Method The study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway. Results The analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) Observation, reporting and expectation of organizational intervention , (2) Application of personalized de - escalating skills and behaviour , (3) Delivery of team - based and standardized services , (4) Provision of perceptive and responsive services , and (5) Facilitation of sensitive, involving and reflexive care . The categories vary according to the participants’ attentional focus on either the responsibility of the organization, staff members’ personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants. Conclusion The results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.

Background: Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community mental health supported housing services conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method: Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of 26 semi-structured interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Participants were interviewed on two occasions, once prior to participation and once subsequent to the finalization of the education and training sessions. Results: The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: (1) Observation, alertness and awareness, (2) Established understanding and knowledge of service users, (3) Team-based risk management and deliberation, (4) Adaption of own dispositions and behaviors, (5) Reflexivity, sensitivity and care and (6) Involvement and dialogue. These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff's expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion: This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in mental health supported housing services and that the various conceptions have different implications for the way staff-directed aggression is mitigated individually and collectively. Our findings also

Background: Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community supported housing conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method: Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of two interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Results: The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: 1) Observation, alertness and awareness , 2) Established understanding and knowledge of service users , 3) Team-based risk management and deliberation , 4) Adaption of own dispositions and behaviors , 5) Reflexivity, sensitivity and care and 6) Involvement and dialogue . These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff’s expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion: This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in community mental health services and that the various conceptions will have different consequences for the way staff-directed aggression is mitigated individually and collectively. Our findings also suggest that it is beneficial to take conceptual variation regarding practice into consideration when devising education and training to enhance staff knowledge, skills and practices.