Module 12: working with intoxicated young people: learner's workbook

4.3 Managing aggressive and disruptive behaviours

Page last updated: 2004

Understanding aggressive behaviour
Self-protection strategies
General defusion strategies
Managing an intoxicated young person
Distance learners
Summary

Understanding aggressive behaviour

Managing an episode of aggressive or disruptive behaviour can be stressful for all concerned, particularly when a young person is intoxicated. The challenge for the worker is to minimise danger to themselves and the young person (and, on occasions, others who are present) and at the same time, maximise the opportunity for a positive outcome. Remember that aggression does not necessarily result in a crisis. While the worker might identify it as a 'critical incident' it may be defused without a crisis occurring.

No matter how extreme the intoxicated behaviour, it may quickly subside if the young person feels that you pose no threat and that you have their concerns as your priority. Be sensitive to what the person is trying to say to you, even if it is largely incoherent.

Warning signs of aggression

When talking to the young person try to recognise early signs of aggression such as:
  • agitation and intense frustration
  • fearfulness
  • clenched fists
  • invasion of your personal space
  • 'eyeballing'
  • banging/pushing furniture
  • facial muscle tension, furrowed brow, tight and quivering lips.
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Preventing aggression

By being aware of the potential for aggression, you may be able to take steps to prevent it.
  • Do not invade 'personal space' unless you are applying first aid. It is very easy to feel threatened and to misinterpret situations when intoxicated.

  • Keep other clients from becoming involved.

  • Be calm and speak slowly and clearly while keeping communications short, simple and to the point. Avoid long-winded explanations. Concentration spans are short when people are intoxicated, and memory is impaired.

  • Be patient, and repeat information where necessary.

  • Personalise your communications. Be on a first name basis with the young person. Acknowledge their feelings and needs, and try to satisfy any reasonable desires the young person may have.

  • Don't confront an intoxicated person. Nobody likes to be confronted at the best of times. Confrontation and intoxication is a volatile mix.

Self-protection strategies

If a young person does become aggressive:
  • Ensure that you have an exit strategy in case you need to protect yourself.
  • Call for help from other staff members.
  • Call the police if the situation is beyond your control.
While these actions may seem self-evident, it is not uncommon for health and welfare workers to do and say things that exacerbate tension and aggression when under stress - particularly when we take insults personally, or attempt to be authoritarian with young people.

General defusion strategies

Although it is not an everyday occurrence, there may be times when a situation involving an intoxicated young person escalates into violence. Some knowledge of general defusion strategies may therefore be helpful.

Defusion strategies can include:
  • When violence is threatened, stop what you have been doing and actively listen. Now is not a time for problem solving, reframing, or pointing out irrational thinking.
  • Avoid excessive questioning.
  • Be aware of your body language – use non-threatening gestures make eye contact.
  • Take any other young people away from the situation if you think it is safe to leave the individual alone.
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Managing an intoxicated young person

Role play

The following role-play activity will provide you with an opportunity to practice your skills in managing intoxicated young people. Remember, the success of this exercise as a constructive learning opportunity will depend on the way you provide and take on feedback.

Working in groups of three, each person will take a turn at playing the worker, young person and observer. (If you are undertaking this exercise via distance learning, try to conduct the role play with some of your co-workers).

Read the following: Allow approximately 15-20 minutes for each role play including the debriefing. Allow time for role changeover. The observer will manage time and the debriefing process.

Role play scenario

James is a 15-year-old boy, who is truanting from school with some of his friends. He is a fairly fit boy, of medium build and is about 6-feet tall. James and his friends left school early and have been drinking cans of beer at the local park after one of the boys used his 'fake' license to buy alcohol. James has drunk around five cans of beer. An argument with one of his friends ensues and James decides to head home to the accommodation service where he lives.

As it is the middle of the day and the other four residents are at school, you are the sole youth worker on duty. When James arrives, you notice that he is slurring his words and seems a little unsteady on his feet.

When you ask James about his slurring and being a little unsteady he raises his voice and tells you to stop interfering – he can do what he likes and what are you going to do to stop him. He pushes over a chair in his effort to go to his room.

Respond to James' current state and determine how best to manage this episode of intoxication. Take steps to ensure that the situation does not escalate as James has pushed a staff member once before.

Role play debriefing sheet

Those taking the Observer role are responsible for facilitating the debriefing.
  1. Ask the person who played 'the worker' to state their response to the role play - what they think they did well and what could be done differently next time.

  2. Ask the 'young person' to give constructive feedback (from the client viewpoint) to the 'worker' and to state in detail how they responded to their approach. (What was helpful and not so helpful, including verbal and non-verbal aspects of worker's approach.)

  3. Give the worker an opportunity to comment or seek any further feedback (e.g. 'How was it for you when I ... ?')

  4. Ask the young person and worker role players to stand, physically move away from their seating position and shake off the role, state their real name and two qualities about them which are different from the role they played.

  5. Observers then give constructive feedback to the worker. Finish by restating what strengths the worker demonstrated.

  6. All group members then identify the key learning points of the role play.
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Observer worksheet (management of intoxicated young person)

Your role as observer is to:
  1. Complete observations and questions below.
  2. Call time - after 15 minutes (maximum).
  3. Lead your group through the debriefing procedures. Debriefing includes giving your feedback at the end (see the separate debriefing sheet for the specific steps)
Provide yes/no feedback and comment on the following aspects:

Communication techniques:
  • Stayed calm, approached the young person in an appropriate nonthreatening manner
  • Asked open ended questions
  • Checked to see if it was an appropriate time to conduct a brief intervention (e.g. listened to what the young person had to say, assessed their level of intoxication and body language)
  • Gave client ample opportunity to express their feelings – didn't interrupt
  • Spoke respectfully and avoided lecturing
  • Predicted reactions and observed the young person's reactions
  • Used appropriate body language?
  • Used appropriate tone and language (e.g. 'I' statements, paraphrasing, young person's name)
Gathering information:
  • Raised the issues of concern regarding intoxication (based on factual information)
  • Ascertained the need for any immediate medical assistance
  • Clarified aspects about the drug/s being used such as
  • Type of drug/s
  • Amount used
  • How was it administered, when, where, how often
  • Poly-drug use
  • Clarified individual factors such as the young persons age, gender, weight, mood, physical and psychological status
  • Clarified environmental factors such as where, when and with whom the young person/s use with
  • Ascertained whether the young person uses alone or with others
Help develop a strategy:
  • Explained client's rights?
  • Discussed confidentiality?
  • Looked for what's important for the client?
  • Identified non-negotiable aspects?
  • Provided choices, provided options
  • Reached agreement with young person about what would happen next
  • Considered young person's immediate needs
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Reflection sheet

Task

Reflect on what you have just learnt and write down your responses to the following questions:

Question - Consider what went well in the role-play and what didn't go so well.

Question - What would be some constraints that you may come across in this type of situation at work?

Question - What steps could you take in your workplace to apply what you have learnt in this topic?

Distance learners

(A good point for student to contact facilitator.)

Distance learners should take time now to reflect on their learning, check in with your facilitator and determine your progress.

Summary

  • Always consider the immediate physical and psychological wellbeing of the young person to ensure that minimal harm comes to them.
  • Young people can sober up in a variety of settings, depending on the supports available and the potential for problems to arise.
  • Other factors may also be relevant to better understanding the context and events leading up to the episode of intoxication.
  • A worker must be able to manage an episode of aggressive behaviour through means of defusion strategies.