Violent incidents in a forensic adolescent unit: A functional analysis

Abstract

This paper reports on a survey which identified categorised and measured the relative frequency of specific antecedents before, and the consequences following, violent incidents in an adolescent forensic unit during a two-year period. Retrospective analysis of 219 violent incidents involved the examination of incident forms, nursing-process records and accident reports. Antecedents and precipitating factors were also recorded. The results demonstrated that the vast majority of incidents were precipitated by several observable antecedents or precipitating factors (186, 85%). Only a small proportion of the violent incidents were preceded by a single risk indicator (21, 9.5%) and a minority were reported to have occurred in the absence of observable antecedents (12, 5.5%). The severity of violent incidents was rated on a four-point scale but no significant correlation was found between category or frequency of antecedent and the violent act itself. The consequences for the young person following acts of violence were also documented, and the results show that the large majority of incidents were followed by increased staff observation (197, 90.5%). Coercive interventions such as physical restraint (177, 80.8%) or idiosyncratic sanctions (88,40.2%) were commonly recorded. A significant proportion of violent incidents did not appear to be followed by staff intervention, sanction or punishment (80, 36.5%). Finally, results are considered against research and best practice evidence, and suggestions for further studies are presented. Organisational interventions, strategies for the management of aggression and violence, and a staff training needs analysis are also indicated.

Understanding inpatient violence in a New Zealand child and adolescent psychiatric setting

“…2004). However, in his UK‐based study of violence in forensic psychiatric care, McDougall (2000) found adolescents with a diagnosis of schizophrenia were overrepresented in the group of service users who were aggressive. Another study found that over a 12‐month period, 66.7% of hospitalized adolescents with psychosis exhibited violent behaviour (Inamdar et al .…”

“…2001; Fritsch et al . 1992; Gabel & Shindledecker 1991; McDougall 2000). This is not surprising, given that a history of aggression is a diagnostic criterion for the disorder (American Psychiatric Association 2000; Barton et al .…”

“…2005). However, McDougall (2000) finds fewer incidents of the lowest severity (damage to property or aggression that does not cause injury) than more severe forms where victims are directly hit.…”

“…There are few studies investigating antecedents to violent incidents. In an adolescent forensic psychiatric setting, boredom, invasion of personal space, threats of violence, anger, touching by others, or limit setting by staff emerge as the most common antecedents (McDougall 2000). Ryan et al .…”

“…Furthermore, published literature on the consequences of inpatient aggressive behaviour is sparse, and focuses primarily on verbal and management strategies used by staff. McDougall (2000) reports the most common consequences for aggression as increased observation, separation, individual sanction, and physical restraint. Other studies report high levels of control and restraint in response to aggression in child psychiatric settings (Garrison 1984; Garrison et al .…”