PROTECTING THE RIGHTS OF THERAPISTS WITH DIFFICULT AND THREATENING CLIENTS: ETHICAL AND LEGAL CONSIDERATIONS Florida Psychological Association (3 HOURS) Abridged Powerpoint from seminar originally presented by: Presented by Ernest J. Bordini, Ph.D. - PowerPoint PPT Presentation

Loading...

PPT – PROTECTING THE RIGHTS OF THERAPISTS WITH DIFFICULT AND THREATENING CLIENTS: ETHICAL AND LEGAL CONSIDERATIONS Florida Psychological Association (3 HOURS) Abridged Powerpoint from seminar originally presented by: Presented by Ernest J. Bordini, Ph.D. PowerPoint presentation | free to download - id: 5fc106-Yjg0M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

PROTECTING THE RIGHTS OF THERAPISTS WITH DIFFICULT AND THREATENING CLIENTS: ETHICAL AND LEGAL CONSIDERATIONS Florida Psychological Association (3 HOURS) Abridged Powerpoint from seminar originally presented by: Presented by Ernest J. Bordini, Ph.D.

Description:

PROTECTING THE RIGHTS OF THERAPISTS WITH DIFFICULT AND THREATENING CLIENTS: ETHICAL AND LEGAL CONSIDERATIONS Florida Psychological Association (3 HOURS) – PowerPoint PPT presentation

Number of Views:118
Avg rating:3.0/5.0
Slides: 41
Provided by: Erne57
Learn more at: http://cpancf.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: PROTECTING THE RIGHTS OF THERAPISTS WITH DIFFICULT AND THREATENING CLIENTS: ETHICAL AND LEGAL CONSIDERATIONS Florida Psychological Association (3 HOURS) Abridged Powerpoint from seminar originally presented by: Presented by Ernest J. Bordini, Ph.D.


1
PROTECTING THE RIGHTS OF THERAPISTS WITH
DIFFICULT AND THREATENING CLIENTS ETHICAL AND
LEGAL CONSIDERATIONS Florida Psychological
Association (3 HOURS)Abridged Powerpoint from
seminar originally presented byPresented by
Ernest J. Bordini, Ph.D. Robert Henley Woody,
Ph. D., Sc. D., J. D., ABPP July 14, 2006 --
Sarasota, Florida
2
PROTECTING THE RIGHTS OF THERAPISTSWITH
DIFFICULT AND THREATENING CLIENTSETHICAL AND
LEGAL CONSIDERATIONS (3 HOURS)Presented by July
14, 2006 -- Sarasota, Florida
  • Presenters 
  • Robert Henley Woody, Ph. D., Sc. D., J. D., ABPP
  • Ernest J. Bordini, Ph. D. (Clinical Psychology
    Associates of North Central Florida, P.A.,
    Gainesville, FL)
  • Tony Galietti

3
(No Transcript)
4
(No Transcript)
5
WORKPLACE VIOLENCE
6
Workplace Homicide Trends
  • Workplace homicides 1993 through 2002 declined
    from 1,074 workplace homicides in 1993 to 609 in
    2002 - a 43 decline.
  • This decline did not, however, occur uniformly
    across all demographic and occupational
    categories.
  • Within that time period, health service industry
    homicides did not decline 14 in 1993 vs. 13 in
    2002.
  • Source Census of Fatal Occupational Injuries
    (CFOI)
  • The Bureau of Labor Statistics Census of Fatal
    Occupational Injuries (CFOI) reported an average
    of just under 800 homicides per year between 1992
    and 2006. The largest number of homicides in one
    year (n1080) occurred in 1994, while the lowest
    number (n540) occurred in 2006.

7
Workplace Homicide Trends
  • Victimization rate for mental health
    professionals and custodial workers was 6.82 per
    100 workers compared to a rate of 1.26 per 100
    workers across all occupations combined (Durhart
    2001).
  • Non-fatal assaults on health care workers
    includes assaults bruises, lacerations, broken
    bones and concussions but those reported to the
    Bureau of Labor Statistics (BLS) only include
    injuries severe enough to result in lost time
    from work.
  • References Duhart, D.T. (2001). Violence in the
    workplace, 1993-99 (No. December 2001, NCJ
    190076). Washington, DC U.S. Department of
    Justice, Office of Justice Programs.

8
ABC7 Newsline Psychologist Gunned Down In
Vallejo Office
  • Nov. 2, 2005 Was it a patient who
  • murdered an East Bay psychologist?
  • Vallejo police are planning to look
  • through his patient files after the doctor
  • was gunned down after a long day of
  • counseling. It's a theory Vallejo police
    confirm they're pursuing, after the 64-year-old
    Polonsky was gunned down in his office Tuesday
    night.
  • A lone gunman walked up to Polonsky's second
    floor office past a waiting patient and shot the
    doctor in the chest in the hallway.
  • Dr. Polonsky provided family, couples and
    individual therapy in Vallejo for 25 years.
  • ABC7 Talks To Victim's Sons

9
  • Reform school teens charged in counselor's death
  • Tuesday, November 11, 2003 - By Barbara White
    Stack and
  • Patrick Hernan, Pittsburgh Post-Gazette
  • Two teenagers at a Mercer
  • County reform school yesterday were accused of
    strangling a school counselor, whose legs and
    hands had been tied and a sheet fastened around
    his neck and head, and taking his truck to
    Pittsburgh.

10
Assaults in the Health Care Sector
  • Average of 1.7 million episodes/yr. of
    victimization at work per year 1993-1999
    (Department of Justice National Crime
    Victimization Survey (NCVS), Durhart, 2001).
  • The health care sector continues to lead all
    other industry sectors in incidence of nonfatal
    workplace assaults. In 2000, 48 of all nonfatal
    injuries from violent acts against workers
    occurred in the health care sector (Bureau of
    Labor Statistics BLS, 2001).
  • Nurses, nurse's aides and orderlies suffer the
    highest proportion of these injuries.

11
Non-Fatal Victimizations
12
I ncidence rates for nonfatal assaults and
violent acts by industry, 2000 Incidence rate per
10,000 full-time workers Source U.S.
Department of Labor, Bureau of Labor Statistics.
(2001). Survey of Occupational Injuries and
Illnesses, 2000.
13
Violent Crime against Mental Health Workers
  • Violent crime for all occupations is 12.6 per
    1,000 workers.
  • The average annual rate for physicians is 16.2
  • for nurses,21.9
  • for mental health professionals, 68.2
  • for mental health custodial workers, 69.

14
Factors Associated with Workplace Violence in
Health Care Settings OSHA, 2004
  • The prevalence of handguns and other weapons
    among patients, their families or friends
  • The increasing use of hospitals by police and the
    criminal justice system for criminal holds and
    the care of acutely disturbed, violent
    individuals
  • The increasing number of acute and chronic
    mentally ill patients being released from
    hospitals without follow-up care
  • The availability of drugs or money at hospitals,
    clinics and pharmacies, making them likely
    robbery targets
  • Factors such as the unrestricted movement of the
    public in clinics and hospitals and long waits in
    emergency or clinic areas that lead to client
    frustration over an inability to obtain needed
    services promptly
  • The increasing presence of gang members, drug or
    alcohol abusers, trauma patients or distraught
    family members
  • Low staffing levels during times of increased
    activity such as mealtimes, visiting times and
    when staff are transporting patients
  • Isolated work with clients during examinations or
    treatment
  • Solo work, often in remote locations with no
    backup or way to get assistance, such as
    communication devices or alarm systems (this is
    particularly true in high-crime settings)
  • Lack of staff training in recognizing and
    managing escalating hostile and assaultive
    behavior and
  • Poorly lit parking areas.

15
Workplace Violence in Health Care Settings OSHA,
2004
  • Elements of an effective violence prevention
    program
  • Management commitment and employee involvement
  • Worksite analysis
  • Hazard prevention and control
  • Safety and health training and
  • Recordkeeping and program evaluation.

16
De-institutionalization means higher risk
patients are being seen outpatient

17
De-institutionalization means higher risk
patients are being seen outpatient
  • Even patients estimated to be at high risk of
    violence to others may be discharged in a few
    weeks, or increasingly, in a few days, assuming
    that they are ever hospitalized in the first
    place
  • Monahan, J., Bonnie, R., Appelbaum, P. S.,
    Hyde, P. S., Steadman, H. J., Swartz, M. S.
    (2001). Mandated community treatment Beyond
    outpatient commitment. Psychiatric Services, 52,
    11981205.

18
What do most therapists consider in assessing
violence risk?
  • history of violence (66)
  • Medication noncompliance (33)
  • substance abuse (28)
  • poor anger control (21)
  • Eric B. Elbogen, Matthew T. Huss, Alan J.
    Tomkins, Mario J. Scalora Clinical Decision
    Making About Psychopathy and Violence Risk
    Assessment in Public Sector Mental Health
    Settings Psychological Services 2005, 2(2)
    133141

19
Kevin S. Douglas, Jennifer L. Skeem VIOLENCE
RISK ASSESSMENT Getting Specific About Being
Dynamic Psychology Public Policy, and Law 2005,
Vol. 11, No. 3 347383
  • A causal dynamic risk factor is a variable that
    has been shown to
  • precede and increase the likelihood of violence
    (i.e., be a risk factor)
  • change spontaneously or through intervention
    (i.e., be a dynamic factor)
  • 3. predict changes in the likelihood of
    violence when altered (i.e., be a causal dynamic
    risk factor).

20
Evolution of Study of Static Factors to Dynamic
Risk Factors for Violence
  • Proposed Dynamic Risk Factors
  • Impulsiveness
  • Negative affectivity
  • Anger
  • Negative mood
  • Psychosis
  • Antisocial attitudes
  • Substance use and related problems
  • Interpersonal relationships
  • Treatment alliance and adherence
  • Treatment and medication compliance
  • Treatmentprovider alliance
  • Kevin S. Douglas, Jennifer L. Skeem VIOLENCE
    RISK ASSESSMENT - Getting Specific About Being
    Dynamic Psychology, Public Policy, and Law 2005,
    Vol. 11, No. 3, 347383

21
Screening for Domestic Violence Recommendations
Basedon a Practice SurveySarah L. Samuelson and
Clark D. CampbellProfessional Psychology
Research and Practice 2005, Vol. 36, No. 3,
276282
  • Steps That Psychologists Can Take to Assist
    Victims of Domestic Violence
  • Decide to implement a screening protocol.
  • Obtain more training as needed. Previous training
    may be insufficient
  • or outdated.
  • Establish links with community resources prior to
    screening
  • implementation.
  • Obtain information regarding hotline numbers,
    local shelters, domestic
  • violence therapy groups, law enforcement, legal
    aid, advocacy
  • groups, educational and financial services, and
    food and housing
  • assistance.

22
(No Transcript)
23
Screening for Domestic Violence Recommendations
Basedon a Practice SurveySarah L. Samuelson and
Clark D. CampbellProfessional Psychology
Research and Practice 2005, Vol. 36, No. 3,
276282
  • Maintain a supply of domestic violence literature
    to offer to clients.
  • Screen all adolescent and adult clients for
    domestic violence at the time
  • of intake.
  • Also include questions regarding personal safety
    on client completed
  • intake forms.
  • Screen in privacy and maintain confidentiality.
  • Screen couples individually. Emphasize that this
    is a standard
  • component of the intake process.
  • Validate identified victims experiences.

24
Screening for Domestic Violence Recommendations
Basedon a Practice SurveySarah L. Samuelson and
Clark D. CampbellProfessional Psychology
Research and Practice 2005, Vol. 36, No. 3,
276282
  • Acknowledge that many women experience domestic
    violence, that
  • domestic violence is illegal and inappropriate,
    that it results in
  • physical and psychological damage, and that a
    variety of resources
  • are available for victims.
  • Assess identified victims level of safety.
  • What threats have been made to the client?
  • How accessible is the client to the abuser at
    this time?
  • Is the client requesting immediate protection by
    law enforcement or
  • the safety of a shelter?
  • If the client is not in imminent danger, has she
    devised a plan to
  • protect herself and any children if the danger
    escalates?
  • Does the client know how to access community
    resources if she feels
  • unsafe?

25
How can employees protect themselves?
  • Nothing can guarantee that an employee will not
    become a victim of workplace violence. These
    steps, however, can help reduce the odds
  • Learn how to recognize, avoid, or diffuse
    potentially violent situations by attending
    personal safety training programs.
  • Alert supervisors to any concerns about safety or
    security and report all incidents immediately in
    writing.
  • Avoid traveling alone into unfamiliar locations
    or situations whenever possible.
  • Carry only minimal money and required
    identification into community settings.

26
WHAT IS DISRUPTIVE, THREATENING, ASSAULTIVE, OR
VIOLENT BEHAVIOR?
  • Violent behavior includes any physical assault,
    with or without weapons behavior that a
    reasonable person would interpret as being
    potentially violent such throwing things at
    someone or in their general direction, pounding
    on a desk or door in a threatening manner, or
    threats to inflict physical harm such as direct
    or implied threats to hit, shoot, stab, or
    physically harm someone.

27
WHAT IS DISRUPTIVE, THREATENING, ASSAULTIVE, OR
VIOLENT BEHAVIOR?
  • Disruptive behavior disturbs, interferes with or
    prevents normal work functions or activities.
    Examples include yelling, using profanity, waving
    arms or fists, or verbally abusing others.
  • Threatening behavior includes oral or written
    threats to people or property, and can include
    indirect or even vague threats that imply violent
    action or retaliation. This involves statements
    that a reasonable person could believe was a
    threat.
  • A specific threat to someones safety or
    well-being with the apparent ability to carry it
    out is legally considered an assault and may be
    subject to criminal investigation and
    prosecution.

28
When faced with an escalating individual
  • Avoid yelling, name calling, sarcasm, or other
    behaviors -These are disrespectful can go a long
    was in reducing the intensity of a conflict or
    problem.
  • Being firm is not the same as being loud.
  • Speaking softer and slower is better.
  • Keeping hands relaxed and avoiding
    threatening stances, gestures or postures.
  • When dealing with an angry individual, dont
    crowd, leave space.

29
When faced with an escalating individual (no
threat or weapons)
  • Respond quietly and calmly. Try to de-escalate
    the situation.
  • Do not take the behavior personally.
  • Ask questions, display respectful concern.
    Indicate you are taking the person seriously.
  • Communicate understanding by calmly and clearly
    summarizing what the person is telling you.

30
Dealing with escalation or disruption (no
weapons, threat, ctd.)
  • Consider offering an apology, even if you've done
    nothing wrong. This may calm the person now.
    Try to establish mutual cooperation in solving
    the problem. Try to establish some areas of
    agreement.
  • If this does not stop the disruption, and in your
    judgment the person is upset, but not a threat or
    dangerous, set some boundaries or limits and seek
    any necessary assistance
  • Calmly and firmly set limits by directing the
    person to lower their voice, or stop engaging in
    whatever disruptive behavior they may be doing,
    with the message that this will make it easier
    for you to try to help them or help to resolve
    the problem.
  • If the behavior persists warn the individual that
    appropriate action may follow, such as calling
    for some for of assistance from other staff that
    may be available, superiors, or if necessary law
    enforcement. Ask them to leave or follow up with
    getting assistance if they do not.

31
(No Transcript)
32
If the person seems Dangerous
  • Try to reduce any audience and find a quiet place
    to talk, but do not leave yourself alone with the
    individual.
  • Maintain a safe distance, do not turn your back,
    and do not place the individual between you and a
    safe exit. If seated, sit near the door and make
    sure someone is nearby if needed.
  • Do not confront the individual. Let the person
    speak and as above, try to summarize what their
    concern is in a neutral and calm manner. Never
    be sarcastic or make the person feel they have
    been demeaned. Try to help them save face if
    possible.
  • NEVER close in our touch the individual yourself
    to try to remove him/her from the area.

33
If the person seems Dangerous
  • Signal as quietly and unobtrusively as you can
    for help. In high-risk areas it may be helpful
    to have worked out pre-arranged signals or codes
    with co-workers. If you need help, the co-worker
    should alert your supervisor and/or the police if
    necessary.
  • Do not mention discipline or the police if you
    fear an angry or violent response.
  • If the situation becomes more heated or you fear
    violence will occur, find a way to excuse
    yourself and to leave the room or area for help.
  • Be aware of any weapons.

34
What if there is an assault in progress?
  • IN AN EMERGENCY OR IF THERE IS VIOLENCE IN
    PROGRESS
  • For violent incidents or specific threats of
    imminent violence, call 9-1-1. If possible use a
    phone out of sight/hearing of the individual.
    Follow instructions.
  • Do not attempt to intervene physically or deal
    with the situation yourself. It is critical that
    the police take charge of any incident that can
    or does involve physical harm.
  • Get yourself and others to safety as quickly as
    possible.
  • If possible, keep a line open to police until
    they arrive.

35
  • While most of these involve institutional
    settings, what if a stalker or violent patient
    attacks at your office? Follows you?
  • Or
  • Learns where you live?

36
Dr. Jim Trent Continues to Recover - by Ellen
Slicker, PhD and David C. Mathis, EdD
  • We were all shocked and saddened to learn of one
    of our professional colleagues being a victim of
    violence. On January 20, 2001, Jim Trent, PhD,
    Licensed Psychologist, was shot at his home by an
    individual he had recently evaluated for Fitness
    for Duty. Dr. Trent innocently opened the door
    for who he thought was one of his sons friends.
    Instead, the man raised a firearm and shot three
    times.
  • Dr. Trent was struck twice once in the right
    chest and once in his temple. The perpetrator of
    the shooting, who may have been under some
    chemical influence, sped away from the crime at
    an excessive rate of speed, ultimately crashing
    into a tree, which killed him instantly.
    Initially, Dr. Trent had severe aphasia, but
    made rapid improvement. Lately his progress has
    reached somewhat of a plateau that is at times
    frustrating to him. He receives physical therapy
    and speech therapy twice a week.

37
Dr. Jim Trent Continues to Recover - by Ellen
Slicker, PhD and David C. Mathis, EdD
  • While he had previously highly valued the ability
    to preserve normalcy in his life, he now places a
    greater emphasis upon protecting the privacy for
    himself and his family. Another area that he has
    examined is the type of clinical work he is
    accepting. Dr. Trent believes that psychologists
    should recognize and exercise their own choices
    rather than feeling compelled to help everyone.
    Especially for psychologists in private practice,
    it is important to recognize limits of resources
    when dealing with difficult clients. A full
    recovery is expected for Dr. Trent although he
    told his wife that he wont be doing any more
    Fitness for Duty evaluations in the future.
    Dr. Trent and his family greatly appreciate the
    support they have received from the community.

38
If threatened called 911 .then what?

39
Psychological Aspects of Firearm Safety
  • "Criminals are afraid of only two things Big
    dogs and guns. They stay away from cops because
    cops have both." - Ayoob
  • Grrrrrr. - Rocky

40
(No Transcript)
About PowerShow.com