An entire staff must be equipped to manage patient conflict

One of the many byproducts of high comorbidity in the treatment population involves the potential for hostile, aggressive patient behavior. A professional trainer whose coursework includes aggression control training says program staff members—and not just clinicians—need to remain mindful of how to assess situations accurately and assist patients before a conflict escalates.

In many states, regulations require every staff member in a state-certified substance use treatment facility to receive de-escalation training. “The maintenance man might be in the hallway when two clients are about to erupt,” says Darlene Silvernail, PhD, LMHC, owner of Silvernail Consulting Services.

In Florida, for example, state-licensed outpatient and residential facilities must ensure that all employees annually take a two-hour course in aggression control techniques. The Department of Children and Families oversees enforcement of the requirement, for which programs must be able to demonstrate compliance during audits.

Environmental factors

Silvernail says that in order to take a proactive stance on making program settings safe for patients and staff, organizations need to pay particular attention to environment-of-care factors that could have an impact.

“Some young people have lived half their life in treatment,” she says. “They may lack coping skills, and the environments they're in are not always the best match.”

Most visitors to a treatment operation will know an environment conducive to high-quality treatment when they see it, Silvernail says—it is the kind of place that conveys a calming feeling from the start, rather than one that feels dominated by noise and other distraction.

Other environmental factors that can make outpatient or residential treatment operations safer might involve the size and composition of groups, or the availability of activities within the program that can reduce stressors.

Silvernail says aggression control training includes education on accurate assessment, including how to interpret patient behaviors, communication patterns and body language.

“Clients exhibit [therapeutic] resistance as a form of protection from awareness,” Silvernail's training course description states. “Anger is a natural human emotion; however, when anger gets out of control, it can lead to problems.”