| I. PURPOSE
| | To ensure appropriate clinical management of client aggressive behavior occurring within Los Angeles County Department of Mental Health (DMH) programs that do not have Lanterman-Petris-Short (LPS) Designation.
Contracted agencies shall develop an internal policy and associated procedures that are consistent with their organizational practices and meet the requirements set forth in this policy.
| II. DEFINITIONS
| Aggressive Behavior: Forceful actions, directly expressed physically or verbally, by a client that have caused or may indicate the potential for causing bodily injury toward others, including staff and/or other clients. Such behavior may be directed toward the client themself.
Crisis Intervention: A short term response to assist someone in a crisis situation.
An unplanned, expedited service, to or on behalf of a client to address a condition that requires more timely response than a regularly scheduled visit. Crisis intervention is an emergency response service enabling a client to cope with a crisis, while assisting the client in regaining their status as a functioning community member. The goal of crisis intervention is to stabilize an immediate crisis within a community or clinical treatment setting.
De-Escalation: The reduction of the intensity of a conflict or potentially violent situation by providing active listening, non-verbal communication, para verbal communication, and debriefing with client, team and collaterals. This may be ineffective in highly reactive situations or when a client experiences psychosis, intoxication, or becomes physically aggressive.
Emergency: A situation where immediate action is necessary for the preservation of life or the prevention of serious bodily harm to the client or others. In this situation it may be impracticable to first gain consent and to impose treatment over the client’s objection.
Lanterman-Petris-Short (LPS) Designation: A facility designated by the County and approved by the California State Department of Health Care Services as a facility for 72-hour treatment and evaluation.
| | III. POLICY
| | Administrative Requirements:
All staff shall adhere to requirements set forth in the DMH Injury and Illness Prevention Plan and DMH Policy 109.01 Security/Safety/Threat Management and Violence Prevention, including: - Maintaining the safety of all staff, clients, and visitors
- Mitigating potential risk factors within the environment
- Assuring knowledge of verbal code warnings and functionality of clinic panic alarms
- Escorting clients at all times
- Following procedures for emergent situations
- Alert security/police for stand-by support
Clinical Requirements:
Clients' aggressive behavior should be addressed in a manner which: - Maximizes safety for everyone
- Shows respect and dignity for the client
- Acknowledges a trauma-informed perspective
- Acknowledges the client's current mental status
- Recognizes the therapeutic tasks involved in crisis or emergency services
Clients' aggressive behavior shall be clinically managed utilizing: - The least restrictive crisis or emergency intervention techniques
- De-escalation efforts which avoid demands of compliance
- Objective self-awareness of staff and use of silence
- Non-verbal communication including awareness of eye contact
- Active listening avoiding arguments
- A solution focus avoiding predetermined outcomes
- Open ended questions avoiding judgment
In the event there is an immediate risk to life, staff may intervene by calling 911 for emergency assistance.
For the safety of all individuals in the vicinity, a designated safe area may be utilized to manage the situation.
Staff shall remain with the client at all times (Injury, Illness Prevention Plan, pg. 94).
As needed security sheriff officer, security guards, or local police may be asked to be on stand-by.
Clients under the age of 18 shall be inclusive of the caregiver (unless the conflict is with the caregiver).
| | IV. PROCEDURES
| | | | V. AUTHORITIES
| | | | VI. ATTACHMENTS
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