Mod4 Facilitator

A safer place to work –
preventing and managing violent

behaviour in the Health workplace
Module 4
AMT004
Aggression minimisation refresher training
Facilitator manual
NSW Health is a zero tolerance zone

NSW DEPARTMENT OF HEALTH
73 Miller Street
NORTH SYDNEY NSW 2060
Tel. (02) 9391 9000
Fax. (02) 9391 9101
TTY. (02) 9391 9900
www.health.nsw.gov.au
This work is copyright. It may be reproduced in whole or in part for study training purposes subject to
the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or
sale. Reproduction for purposes other than those indicated above, requires written permission from the
NSW Department of Health.
© NSW Department of Health 2003
SHPN (CMH) 030136

ISBN 0 7347 3557 X
July 2003
updated August 2004
MODULE 4
Contents
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Overview of the manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 3
Modular structure of the aggression minimisation program . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 3
How the manual is set out. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 4
Facilitator preparation before training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 6
Recognition of prior learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 7
Other resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . . . . . . . 8
Introduction to Module 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
How Module 4 fits into the whole program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Recommendation on the delivery of this module. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Training room requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Assessment for Module 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 11
Assessment method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 11
Assessment conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 11
Assessment resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 11
Assessment questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 11
Self assessment checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 12
Peer assessment checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . 13
Session plan for Module 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... . 15
Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... . 15
Equipment required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... . 15
Participant requirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... . 15
Beginning the training session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1. Welcome participants to the module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2. House keeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3. Principles of adult learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4. How Module 4 fits into the whole program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
5. Structure of Module 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Background information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Learning outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Part 1 The zero tolerance response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Always remember your attitudes and behaviours are important in promoting a zero tolerance response to violence . . 25
Part 2 New developments in preventing and managing aggression and violence . . . . . . . . . . . . . . . . . . . . . 27
Part 3 The Prevention of aggression and violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Part 4 Managing aggression and violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Know your options for action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Short-term response options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Long-term response options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
De-escalation strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Related NSW Health policies and guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
NSW Health A safer place to work – preventing and managing violent behaviour in the Health workplace Module 4 AMT004
i
Aggression minimisation refresher training (Version 1) © July 2003 updated August 2004
MODULE 4
Acknowledgments
This NSW Health violence prevention training program was developed by Brin FS Grenyer,
Olga Ilkiw-Lavalle and Philip Biro from the Illawarra Institute for Mental Health. Mark Coleman
provided assistance with the facilitator manuals and pilot workshops. The project was coordinated
from the Violence Taskforce, Centre for Mental Health by Frances Waters. The members of the project
contract steering committee who provided extensive guidance during the development of this project were
Frances Waters (Violence Taskforce, Centre for Mental Health), Kathy Baker (Community & Extended Care
Services and Nursing Services, Northern Sydney), Trish Butrej (Occupational Health and Safety, NSW
Nurses’ Association), Maggie Christensen (Learning and Development, Central Coast), Nicole Ducat
(Occupational Health and Safety, South Eastern Sydney), Louise Newman (Royal Australian and New
Zealand College of Psychiatrists), Gemma Summers (Learning and Development, Northern Sydney)
and Choong-Siew Yong (Australian Medical Association, NSW Branch).
A project content reference group also provided input during the development of the project, and the
members were Greg Hugh, Peter Bazzana, Greg Cole, Stephen Allnut, Distan Bach, Liz Cloughessy,
Jim Delaney, Regina McDonald, David Gray, Rajni Chandran, Jennifer Bryant, Terry Tracey and Linda
Sheahan. Consumer input was gratefully provided by Laraine Toms and Robyn Toohey. The NSW Health
Learning and Development Managers forum and others affiliated with the reference group also provided
helpful comment and guidance during the developmental phases of this project, including Jenny Wright,
Earle Durheim, Judy Saba, Brenda Bradbury, John Lain, Bill Wood, Aileen Ferguson, Simon Richards,
Vaughan Bowie, Louise Fullerton, Mira Savich, lain Morriset, Lorraine Hyde, Glenda Hadley, Julie Reid,
Natasha Mooney and Bill Tibben.
The developers would like to thank those staff of the South Western Sydney Area Health Service who
provided useful feedback during the four days of piloting of each of the modules in October 2001. We
also thank the fifteen educators from across the state who provided feedback during the two day trainer
orientation at Western Sydney Area Health Service in November 2002.
The developers would like to give special thanks to Professor Beverley Raphael and Professor Duncan
Chappel from the Violence Taskforce for support, Dr Claire Mayhew for timely insights, Linda Graham for
sharing her wisdom over the years through the development and implementation of the INTACT training
program, Professor Kevin Gournay and Steve Wright from the Institute of Psychiatry, London, for helpful
advice and resources, Dr Nadia Solowij and Jane Middleby-Clements for editorial assistance and to
Professor Frank Deane from the Illawarra Institute for Mental Health for practical support. We also thank
Shane Pifferi, Marie Johnson, Vicky Biro, Tim Coombs, Ralph Stevenson, Dr Alexandra Cockram,
Eugene McGarrell, Samantha Reis and Andrew Phipps for assistance with the project.
This program has incorporated and referred to relevant NSW Health policies and guidelines where
appropriate and a list of these is given at the end of the relevant modules. Modules 1 and 2 of this
program were adapted from a modular aggression minimisation program developed originally by
Austraining (NSW) Pty Ltd for the Central Coast Area Health Service, which was revised by Jenelle
Langham in 2000. Module 3 of this program is a revised version of that developed by Jenelle Langham
for the Central Coast Area Health Service.
1
FA C I L I TAT O R M A N U A L
Introduction
NSW Health: Preventing and managing aggression in the

Health workplace
What is it?
A number of key projects have flowed from the work of the Violence Taskforce. One of
these is the development of a statewide, appropriately accredited aggression minimisation
training program.
The focus of this training is to provide staff with the most up-to-date strategies, skills and
techniques to prevent and minimise workplace aggression and violence. It is also based on
relevant task force findings and incorporates key task force initiatives.
The program includes a basic module for all staff identified as being at risk of workplace violence,
a module for staff working in high risk environments, a module designed specifically for managers
and a refresher module.
What materials are provided?

A CD-ROM is available and includes:
● Facilitator manual: Modules 1 through to 4 (in Acrobat PDF format).
● Participant manual: Modules 1 through to 4 (in Acrobat PDF format).
● Powerpoint slides for Modules 1 through to 4.
● Recognition of prior learning forms and assessment of competency forms (as a separate
Acrobat PDF format).
● Assessment scenarios and Question sheets for Module 1 (as a separate Acrobat PDF format).
All of the above are included on the CD.
Who will attend?

Module 1 should be attended by all staff identified as being at risk of workplace violence,
and generally speaking is a prerequisite for all other modules. More detailed advice on the
application of this training is provided in the covering circular. Attendance at additional modules
is recommended for staff determined by the Health Service to be at higher risk of workplace
violence and includes, but is not limited to, security, mental health, Emergency Department,
admissions, drug and alcohol, disability services, brain injury and aged care staff.
All managers of staff identified as being at risk of workplace violence should attend the manager’s
module and all relevant staff should attend the refresher module at least every two years. Health
Services may determine that some groups need to attend the refresher more regularly.
A safer place to work – preventing and managing violent behaviour in the Health workplace Module 4 AMT004 NSW Health
2 Aggression minimisation refresher training (Version 1) © July 2003 updated August 2004
MODULE 4
Overview of the manual
This manual has been developed to provide educational resources for a facilitator to
deliver a comprehensive education program in aggression minimisation.
The manual is divided into four training manuals. Facilitators must have each of the following:
1. Certificate IV in Assessment and Workplace Training.
2. Experience in working in areas of significant violent risk.
3. Experience in effectively managing violent incidents.
4. An ability to related to staff at all levels of the organisation.
Modular structure of the aggression minimisation program

Module 1
HLTCSD6A – Respond effectively to difficult or challenging behaviour
This eight-hour program is designed for all staff identified as being at risk of workplace violence. It is
designed to meet the Health Training Package competency HLTCSD6A – Respond Effectively to Difficult
or Challenging Behaviour.
The day is divided into five parts:

1. Understanding difficult or challenging behaviour.
2. Preventing aggression occurring.
3. Preventing aggression escalating.
4. Bullying, harassment and discrimination at work.
5. Reporting and reviewing aggressive incidents.
Module 2
AMT002 – Aggression minimisation in high-risk environments
This eight-hour program is designed for mental health and other staff working in high risk areas, eg
emergency, security, community, aged care, disability, dental, midwifery and early childhood, methadone,
brain injury, neurology, admissions and drug and alcohol services. Other staff members identified, via the risk
assessment process, as being at significant risk of aggressive behaviour should also attend this module.
The day is divided into four parts:
1. Working in high-risk environments.
2. Prevention in high-risk environments.
3. Understanding aggression in high-risk environments.
4. Managing aggression in high-risk environments.
3
Module 3
90405NSW – Course in aggression minimisation for managers

This four-hour module is designed for managers of health units and facilities. It provides the participant with
detailed information, obligations and practical strategies for promoting a safe workplace environment free of
aggression, assessing and managing risks and types of support to provide to staff, who have been victims of
aggression. Completion of Module 1 is recommended prior to undertaking this module.
The day is divided into three parts:
1. The legal and policy framework for managing aggression.
2. Promoting an aggression-free workplace.
3. Assisting staff when aggression and violence occurs.
Module 4
AMT004 – Aggression minimisation refresher training
This two-hour module is designed for all staff identified as being at risk of workplace violence, and should
be repeated at a minimum of every two years after completion of Module 1. Depending on the level of risk,
some staff may need to attend more frequently. It is designed to keep staff up-to-date with policies and
practices, provide refresher training of skills, and workshop problems.
The day is divided into four parts:

1. The zero tolerance response.
2. New developments in preventing and managing aggression and violence.
3. The prevention of aggression and violence.
4. Managing aggression and violence.
How the manual is set out

The Facilitator manual is divided into the four modules.
All facilitator notes throughout each module look like this.
Basic course content in the Facilitator manual duplicates that found in the Participant manual.
This course content forms the basic syllabus of the training and the trainer needs to know this
material prior to conducting training.
For each module, at the beginning of each section the relevant page number in the
Participant manual is noted.
Relevant slides that should be shown at each point are reproduced throughout this manual.
Layout icons
The following symbols have been used throughout the Facilitator manual to assist in the
presentation of material. In all cases, trainers should use their discretion in the presentation and
timing of material depending on the mix of staff in the training group. Where possible, flexible
delivery is encouraged and specific recommendations are made at the beginning of each module.
4 A safer place to work – preventing and managing violent behaviour in the Health workplace Module 4 AMT004 NSW Health
MODULE 4
Key points
Key points help you to summarise the major themes and information from the section.
Explain and discuss

This icon suggests that you will need some verbal explanation and discussion of this
concept or topic.
Background reading
This icon appears when further background information and reading is supplied
on a topic to assist the facilitator in understanding and delivering the training course.
It should be read before the facilitator conducts any training. The background information
may be verbally summarised by the trainer as the need arises.
Ask the group

Whenever this icon appears in the manual a large group activity is suggested.
Facilitators should ask the suggested question to the group as a whole and elicit
answers or suggestions as appropriate. Participants may choose to write answers
in the space in their manuals.
Small group exercise

This icon represents small group activity. Whenever this icon appears in the manual
a small group activity is suggested. Facilitators may get the group to break into smaller
groups of two to five participants to discuss the question, before reporting back to the
group as a whole. Participants may choose to write answers in the space in their
manuals.
Individual reflection exercise

This icon represents personal reflective activity. Whenever this icon appears in
the manual personal reflection is suggested. Individual participants may complete
this exercise alone. The facilitator may then choose to address the question to the
group as a whole and collect responses from individuals. Participants may choose
to write answers in the space in their manuals.
Answers
Suggested answers to the individual, small and large group activities are provided.
These amplify and reinforce the subject material covered in the Participant manual.
Important training point

Important training points are highlighted with this symbol.
You are on Participant manual page X

These icons assist you to keep the training program in sequence with the
Participant manual. It is suggested that you regularly refer participants to the relevant
page in their Participant manual for further information or to complete an activity.
NSW Health A safer place to work – preventing and managing violent behaviour in the Health workplace Module 4 5
AMT004 Aggression minimisation refresher training (Version 1) © July 2003 updated August 2004
Show overhead slide

Suggested place to present slide.
Facilitator instruction
Specific training hints are given here.
Write responses on board

Suggested place where the trainer may wish to reinforce points or collect
responses from the group on a whiteboard/blackboard/butcher’s paper.
Session time
Suggested times to conduct sessions are given and a session plan is provided
for each module. These are to be used flexibly to meet the needs of trainers
and participants.
Session overview
An overview of the session is given here.
Suggested break time

Suggested breaks are provided. These are flexible.
Readings and resources

Additional readings and resources are highlighted here and should be read prior to
commencing training.
Facilitator preparation before training

Before running this training it is important to be familiar with:
● All NSW Health documents and policies relating to aggression minimisation, prevention and
management (see reference lists at the end of each module).
● All local policies relevant to aggression minimisation. These will include documentation
and emergency responses relating to aggression minimisation, prevention and management,
eg duress response, reporting protocols.
● It is helpful if you have an awareness of recent incidents in your area, where these have
been a particular problem and the outcome. This enables the training to be more relevant
for participants.
● Facilitators need to familiarise themselves with the reference list at the end of the modules.
● Facilitators should ensure that participants are informed that prior to attending this module they
need to review the contents of the Participant manual for Module 1 – Respond effectively to
difficult or challenging behaviour, or the equivalent training attended.
MODULE 4
Sequence and timing of the modules

The individual modules do not need to be taught together as a block. The space between
teaching individual modules may be separated by weeks or months. It is important to consider the
retention of information from previous training and be ready to reinforce previous training material,
particularly from Module 1. Each module contains some common material from other modules to
help reinforce basic concepts, eg zero tolerance. Module 1 forms the prerequisite
for the other modules so needs to be made available to participants prior to offering the
other modules.
Assessment of competency
Assessment activities accompany Modules 1-4 to facilitate demonstration of competency.
Facilitators should ensure that training outcomes for each participant are appropriately
documented. Recording forms accompany the Facilitator manual.
Flexible delivery
The materials in this training program provide a core recommended syllabus for preventing and
managing aggression in all NSW Health facilities. Each module has a set of learning outcomes
and corresponding assessments. The training is designed in a modular format to allow ease of
delivery, however it is possible that the training may be delivered using flexible delivery methods.
Examples of how the training could be altered include (but are not limited to) the following:
1. Dividing a full day module into two parts, spread over two half days.
2. Emphasising some components of training over others for specific groups. For example,
if the participant training group is non-clinical then the trainer may decide to focus more on
communication strategies and bullying, harassment and discrimination than on some of
the components that are more relevant for clinical staff.
3. Flexibly incorporating materials from other local training programs that overlap with the
learning outcomes and provide additional training.
4. Shortening a module by providing advance reading materials and exercises to be reviewed
in the participants’ own time and reinforced and assessed in the workshop. However, the
trainer will need to determine that this approach is appropriate for the participant group.
In considering flexible delivery options, it is important to ensure that the learning outcomes are
met as set down in this program.
Recognition of prior learning

Recognition of prior learning can be considered for this training. The relevant forms for recognition
of prior learning accompany the Facilitator manual.
Recognition of prior learning is based on the following:

● Competence – a focus on the competencies an individual has acquired as a result of any
formal or informal training and experience.
● Commitment – to recognise prior learning of individuals, therefore individuals will not have to
duplicate their training unnecessarily.
● Access – every individual may have his or her prior learning recognised.
● Fairness – that the recognition of prior learning process is fair.
● Support – is provided for individuals in applying for recognition of prior learning. Certificate IV
workplace trainers and assessors must provide support so that an efficient and effective service
is maintained.
Portfolio documentation
Appropriate documentation is to be filled in and evidence collected to be submitted with the
application form. All documentation should be submitted as a portfolio. See below for types of
evidence to be collected and included in a portfolio.
Evidence guide
The following is a guide for the evidence to be provided for recognition of prior learning.
For each item of evidence you will need to indicate which part of the item is relevant to which
learning outcomes.
The following types of evidence may be collected:

● Formal accredited certificates of previous training programs attended, or transcripts of
courses of study.
● Authenticated reports on activities participated in, relevant to aggression minimisation.
● Certified evidence of discussions of case studies that shows evidence of having attained
learning outcomes.
● Authenticated reports of work, skills and experience in responding to aggressive behaviour.
Other Resources
Participant manual
A Participant manual is also available and should be used during the training. Participants are
to use the manual during the training session, but also should take it away as a resource. There
is additional information in the Participant manual, and it is not expected that every point can be
covered during the training sessions. The training provides an orientation to the major issues in
aggression minimisation and points the participant to further readings and resources in the area.
Lecture slides
The CD-ROM contains the full set of Powerpoint slides. The Powerpoint slides can also be
printed and transferred to overhead transparencies as needed.
Forms
The CD-ROM contains the recognition of prior learning forms and the assessment of
competency forms.
MODULE 4
Introduction to Module 4
How Module 4 fits into the whole program

Module 4 is the last module dealing with aggression prevention, minimisation and
management. This two-hour module is a refresher training program designed for staff
identified as being at risk of workplace violence, and should be completed every two
years after finishing Module 1 of the training (or its equivalent). It is designed to keep
staff up-to-date with policies and practices, provide refresher training of skills and
enable problems to be discussed and worked through.
Session times
Part 1 Allow 15 minutes for Part 1
Assessment of competency Allow 15 minutes
NB. A session plan is provided at the beginning of Module 4.
Recommendations on the delivery of this module

Recommendation 1
This module is designed to be flexible. Although there are tasks and exercises to
complete, these are only suggestions and the individual trainer is encouraged to
adapt the workshop to meet the needs of the training group.
Recommendation 2
Staff from the same or similar work areas should be encouraged to train together.
This will help the trainer focus the refresher onto issues that are relevant for the
participants’ particular work area.
Recommendation 3
Trainers need to keep up-to-date with new developments in aggression minimisation.
Teaching this module presupposes recent knowledge of:
a. state legislation
b. NSW Health policies and guidelines
c. local policies, procedures and protocols
d. national research and initiatives and
e. international research and initiatives. As a trainer you will be specifically required to
address each of these in the training.
9
Recommendation 4
Staff should be encouraged to review their Module 1 workbooks and any other relevant
readings prior to attending the workshop.
Training room requirements

The training room should be comfortable with desks for participants so that they can write in
their copy of the Participant manual. Equipment required: projection facilities for Powerpoint slides
(or an overhead projector if the slides have been printed on overheads), a whiteboard and
whiteboard pens (for writing up feedback from participant exercises). Participants will need pens
or pencils for writing in their copy of the Participant manual. Refreshments should be available
during the breaks.
MODULE 4
Assessment for Module 4
Assessment questions Learning outcomes
Question 1 1. Demonstrate an understanding of new developments in the

prevention and management of violence.
Question 2 2. Acquire further understanding of how to prevent and
manage violence.
Assessment method
The learning outcomes are to be assessed through peer and self assessment. Participants
are required to pair up. Each participant then directs the questions to their partner and assesses
their partner’s verbal responses, using the peer assessment checklist. The partner is also
given the opportunity to assess his or her own responses using the self assessment checklist.
When this is complete, participants are to change roles. Participants may choose to jot down
dot point answers in the column provided in the relevant checklist, though this is not mandatory.
The participants, as a whole group, are then to be debriefed. The trainer may encourage the
group members to share their responses and the discussion should focus on areas that
need clarification.
There are two critical aspects of the assessment relating to the two assessment questions.
The questions have been designed to align with the critical aspects of the assessment.
Participants are deemed competent if they demonstrate the correct responses to these
questions. The critical aspects of the assessment are identified in the marking guide (checklists).
Assessment conditions
Participants are to be informed about the assessment and what is required. Participants are to
complete the assessment following the training.
Assessment resources
● Assessment questions.
● Peer and self assessment checklists.
NB. Assessment questions and Peer and Self assessment checklists are shown below and can also be found as a separate
Acrobat PDF document on the CD-ROM, in order that the Assessment questions and checklists may be printed out
and handed to participants.
Assessment questions
1. What are two new developments that have arisen in regards to aggression management
and prevention in your local area in the last two years, or since you last attended aggression
minimisation training?
2. Identify what new knowledge and skills you have acquired from the training provided in
Module 4 (identify at least three).
11
Self assessment checklist
Yes No Unsure Briefly detail new developments,

knowledge and skills (optional)
Identified new developments
in the local area in the last two
years (or since you last attended
aggression minimisation training).
Identified acquired knowledge

and skills from the training provided
in Module 4.
MODULE 4
Peer assessment checklist
Yes No Unsure Briefly detail new developments,

knowledge and skills (optional)
Identified new developments in
the local area in the last two years
(or since you last attended aggression
minimisation training).
Identified acquired knowledge

and skills from the training
provided in Module 4.
MODULE 4
Session plan for Module 4
Training session: Module 4 Date:

Aggression minimisation Time:
refresher training
Learning
Time Topic outcomes Content/activity
15 mins ● Introduction. 2 Small and large

● The zero tolerance response. group discussions.
15 mins ● New developments 1 Small and large

in preventing and group discussions.
managing violence.
30 mins ● The prevention of violence. 2 Small and large

group discussions.
45 mins ● Managing violence. 2 ● Small and large

group discussions.
● Role play activity.
15 mins ● Assessment of competency. 1 and 2 Small and large

group discussions.
Materials
The training room should be comfortable with desks for participants so that they can write in
their copy of the Participant manual.
Equipment required
● Projection facilities for Powerpoint slides (or an overhead projector if the slides have been
printed on overheads).
● A whiteboard and whiteboard pens (for writing up feedback from participant exercises).
Participant requirement
Pens or pencils for writing in their copy of the Participant manual.
15
MODULE 4
Beginning the training session
Session time
15 mins for introduction and Part 1
The relevant slides that should be shown at each point are reproduced in small size
in the facilitator manual. The title slide should be showing when participants begin
to arrive at the workshop.
Show overhead slide
1. Welcome participants to the module
You may wish to facilitate an introductory activity (ice -breaker).
Example: Have participants pair off and:

● introduce themselves and the area they work in
● discuss what they hope to gain from the training.
After a few minutes have passed re-assemble the group and ask each participant
to introduce their partner.
2. House keeping
Inform participants of:

● program times
● breaks and meals
● toilets
● mobile phones
● message board
● occupational health and safety (fire escapes).
17
3. Principles of adult learning

Inform participants that:
● everyone’s opinion will be respected
● every participant’s work experience will be valued.
Show overhead slide
4. How Module 4 fits into the whole program

Module 4 is the final of four modules dealing with aggression prevention,
minimisation and management. It builds upon Module 1. The material in
Module 1 is assumed knowledge for this module, and completion of Module 1,
or its equivalent, is recommended for completing Module 4. This two-hour
module is designed for staff to complete every two years after finishing
Module 1. It is designed to keep staff up-to-date with policies and practices,
provide refresher training of skills and enable problems to be discussed
and worked through.
Show overhead slide
MODULE 4
5. Structure of Module 4
Explain that the program is divided into four parts:

Part 1 – looks at the zero tolerance response.
Part 2 – looks at new developments in preventing and managing violence.
Part 3 – looks at the prevention of violence.
Part 4 – looks at managing violence.
Explain that the aim of the program focuses on problem solving and that it is
expected that during each section participants will raise examples of incidents
that have occurred in the workplace that were difficult to manage. Explain that
this will enable a group problem solving approach and permit participants to
learn from the experience of others.
Assessment
At this point, introduce the assessment component of the course.
Show overhead slide
You are on Participant manual page 3
Key points
• Point out that the program aims to discuss difficult instances of violence in
the workplace.
• By completing this refresher training and continually updating your knowledge
and improving the way in which you respond to aggression, you may achieve:
– improved knowledge on new directions to prevent and manage aggression
and violence
– reduced physical injury to staff, patients and members of the public
– reduced levels of stress on the job
– reduced levels of aggression and violence in the workplace
– fulfilment of your ‘duty of care’ responsibility under the Occupational Health
and Safety Legislation.
MODULE 4
Background information
Background reading
This two-hour module is designed for staff to complete every two years after finishing
Module 1 (or its equivalent). It is designed to keep staff up-to-date with policies and
practices, provide refresher training of skills and enable problems to be discussed
and worked through.
Aggression in the health industry is a significant problem.1,2,3 Regular ongoing education4,5

is important to help staff retain and improve their skills in the prevention and management
of aggression and further increase staff confidence. The goals of this training are to revise
and review health care workers’ knowledge on prevention and management of aggression
within a problem solving perspective. This program aims for health care workers to
discuss difficult instances of aggression and violence in the workplace.
By completing this refresher training and continually updating your knowledge and
improving the way in which you respond to aggression, you may achieve:
● improved knowledge on new directions to prevent and manage violence
● reduced physical injury to staff, patients and members of the public
● reduced levels of stress on the job
● reduced levels of violence in the workplace
● fulfillment of your ‘duty of care’ responsibility under the occupational health and
safety legislation.
Show overhead slide
21
Explain and discuss
Learning outcomes
At the conclusion of this module, participants will:
1. be able to demonstrate an understanding of new developments
in the prevention and management of violence
2. have acquired further understanding about how to prevent and
manage violence.
MODULE 4
Part 1
The zero tolerance response
Session time
15 mins for introduction and part 1
Show overhead slide
Session overview
This section looks at the zero tolerance response to aggression.
Ask the group

What does a zero tolerance response to violence mean to you?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Write responses on the whiteboard.
23
Answers
Responses could include:

● not accepting that violence is part of the job
● reporting all violent incidents
● encouraging others to report all violent incidents
● knowing all of the various response options for dealing with violence in
both the short and long-term
● ensuring that all violent incidents are promptly, appropriately and
consistently managed
● promoting a zero tolerance culture
● being aware of violence triggers and risks
● participating in risk management.
Individual reflection exercise

List some practical ways in which you have implemented a zero tolerance response
to violence in your workplace. List some practical ways you could implement a zero
tolerance approach in the future.
Things you have done.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Things you could do.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MODULE 4
Always remember your attitudes and behaviours

are important in promoting a zero tolerance response
to violence
Show overhead slide
Key points
Point out the zero tolerance attitudes and behaviours below.
Zero tolerance attitudes and behaviours

Putting up with violence in the health workplace IS NOT an acceptable part of your job
(if you don’t get the message, neither will patients and visitors).
Know your options when confronted with violent behaviour and exercise them consistently
(the most effective way of protecting yourself AND getting the message to patients and visitors).
Management will support you in utilising these options (this is part of their responsibility).
Report all violent incidents (problems that don’t get reported don’t get fixed).
Be aware of violence as an occupational risk (it is just as real as other more recognised
OHS risks, eg manual handling, exposure to hazardous substances, etc).
Be vigilant of factors contributing to the risk of violence (prevention is better than cure).
For more detailed information on the zero tolerance response see the NSW Health Zero
Tolerance Policy and Framework Guidelines.
MODULE 4
Part 2
New developments in preventing
and managing aggression and violence
Session time
15 mins
To teach this part you will need to have familiarised yourself with any recent
developments in preventing and managing aggression.
This will involve doing some research and preparation in the following areas:
State legislation
Check whether there have been any recent, relevant legislative changes in the:
● OHS, injury management and workers compensation
● privacy and freedom of information
● anti-discrimination
● criminal law
● mental health laws
● laws covering the security industry areas.
Useful websites:
www.austlii.edu.au
www.workcover.nsw.gov.au
www.noschc.gov.au
NSW Health policies and guidelines

Check whether there have there been any recent amendments, additions or
updates to NSW Department of Health policies and guidelines in the:
● reportable incident requirements
● NSW Health, NSW Police MOU (Memorandum of Understanding)
● incident and post incident management requirements
● security and safety requirements
● OHS and risk management training requirements
● violence prevention and management requirements
● general OHS and injury management requirements
● emergency management requirements
● duress response requirements
● requirements regarding working in the community
● mental health policies and guidelines, eg relating to seclusion, restraint, clinical
guidelines for the management of the mentally ill, Emergency Department

guidelines for managing challenging behaviour etc.
Useful website:
www.internal.health.nsw.gov.au
27
Local policies, procedures and protocols

Check whether there have been any changes to local policies, procedures and
protocols in response to changed department policies and guidelines or as
part of the ongoing internal monitoring and review of existing activities, including:
● incident reporting requirements
● hazard reporting requirements
● incident and post incident management requirements
● security and safety requirements
● liaison with local police, including NSW Police MOU
● violence prevention and management requirements
● general OHS and injury management requirements
● emergency management requirements
● duress response plans
● requirements regarding working in the community
● protocols covering seclusion, restraint, management of the mentally ill,
Emergency Department guidelines for managing challenging behaviour etc.
Useful website:
See your local Area Health Service intranet site.
National research and initiatives

● Indigenous mental health.
● National responses to suicide and depression.
● Rights of children and responses to adolescent mental health.
● Aged care policies.
● Use of medicines.
● National responses to trauma and terrorism.
Useful websites:
NSW interagency guidelines for child protection 2000: www.kids.nsw.gov.au
Youth and violence: www.acys.utas.edu.au/ncys/ysa/index/bullying.htm
International research and initiatives

● Aggression and social justice – marginalised groups.
● Bullying in the workplace.
● Communication skills – developments and programs.
● Causes and prevalence of aggression.
● Controversies around restraint and seclusion.
Useful websites:
Aggression and the workplace:
www.hrmguide.co.uk/relations/violence.htm
Theories of aggression:
www.nursing-standard.co.uk/archives/vol12-27/research.htm
MODULE 4
Discretion will need to be used as to the amount and level of detail provided,
depending on the amount of information gathered, the time constraints and the
characteristics of the target group, eg clinical, security, administration staff etc.
However, as a general guide, relevant legislative changes, and any

changed departmental and local requirements should be given priority.
You may wish to provide summaries of the changes to the group for future
discussion, or elicit as many as possible from the group prior to tabling any
information. A third option is for participants to make their own notes in
the section provided in their copy of the Participant manual as you lead
or guide the discussion on the changes.
Facilitators should also have copies of any updated policies, procedures,

publications and protocols to show the group, and advise of where copies
can be obtained. Depending on the size of the group, copies of the more
relevant documents could be provided at the session.
Show overhead slide
Session overview
This section looks at new developments in aggression prevention and minimisation.
Show overhead slide
Use the whiteboard when introducing a new development.
The field of aggression minimisation is continually evolving. This module is designed

for a flexible update and review of new developments.
These developments usually fall into five areas:
1. State legislation.
2. NSW Health policies and guidelines.
3. Local policies, procedures and protocols.
4. National research and initiatives.
5. International research and initiatives.
1. State legislation
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. NSW Health policies and guidelines

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. Local policies, procedures and protocols

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MODULE 4
4. National research and initiatives

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
5. International research and initiatives

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Ask the group
Is anyone aware of any recent developments?
MODULE 4
Part 3
The prevention of aggression and violence
Session time
30 mins
Show overhead slide
Session overview
This section looks at the prevention of violence.
Explain and discuss
● Prevention should always be the first priority.

● The aim is to prevent or reduce levels of violence as far as possible.
Prevention of violence in the workplace is your first priority. While not all incidents of
aggression can be prevented, the aim is always to prevent or reduce levels of aggression
and violence as far as possible, and to have in place appropriate control measures if a
violent incident does occur.
Prevention of violence in the workplace should always be the first priority.
33
Ask the group

How have you actively participated in preventing violence in your work area?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Answers

● reporting workplace violence hazards eg locks on windows and doors that are
not working, burnt out external lighting, facilities not working such as phones and
food and drink dispensers in patient waiting areas etc
● testing emergency equipment, eg fixed or personal duress alarms
● instigating changes to the workplace including the physical environment and
work practices and systems
● attending aggression minimisation and management training
● using de-escalation techniques in a potentially violent situation
● reviewing the duress response
● having been part of a working party to propose control strategies for a specific
violence hazard, eg violence from patients in Emergency Departments.
Have participants give specific examples.
Explain and discuss
Point out the importance of effectively preventing and managing bullying in

the workplace, in terms of OHS legislative requirements, and also in terms of
the zero tolerance response. It is hard for staff to take zero tolerance seriously
if bullying is a feature of the workplace.
Ask the group

Where might there be a high risk of encountering bullying?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MODULE 4
Answers

● highly stressful situations, eg tight or unreasonable deadlines, limited resources
● culture that condones bullying
● where there is a high degree of change
● where there are closed systems that are not open and accountable, eg where
there is limited interaction with other areas.
Ask the group

How would you reduce bullying to as low a level as possible?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Answers
● Have a clear, anti-bullying statement signed off and supported by the CEO.
● Ensure that it is communicated to all staff.
● Have a clear reporting mechanism for bullying.
● Train managers and other relevant persons in how to investigate and
manage bullying.
● Ensure that managers respond promptly and appropriately to all reported
incidents of bullying.
● Ensure that hazards/risks associated with bullying are considered as part of
the overall OHS risk assessment and risk management process.
Show overhead slide
Ask the group
What are the key steps in the risk management process?
Answers
● Identify the problem.

● Assess the risk.
● Eliminate or control the risk.
● Monitor, review and improve the system.
The risk management process

Step 1. Identifying the problem (hazard identification).
Step 2. Assessing the risk (determining how serious the problem is).
Step 3. Eliminating or controlling the risk (deciding what needs to be done to solve the
problem and in what order. Risk controls need to be ranked from the most effective
to the least effective).
Step 4. Monitoring, reviewing and improving the system.
Give the following example as a simple illustration of the risk management

process in action.
Example:
Hazard – violence from intruders.
Risk – a faulty exit door that fails to open to allow exit.
Risk assessment – high, as staff may possibly become trapped inside by a

violent patient or an intruder.
Risk control – repair the door, consult with staff on the existing circumstances
(to determine why the door was unable to be opened, or why the system failed),
ensure there is a future procedure in place for regularly checking all relevant locks,
for reporting faults and for ensuring urgent repairs take place.
Monitor the system and improve if necessary – if random checks of locks still
show that all locks are not working effectively all of the time, this suggests that the
system for checking and repair is not working satisfactorily. Consult with staff to
determine why the system isn’t working, discuss how it might be improved and
implement the recommended changes to the system.
MODULE 4
Ask participants to work in small groups and complete the following exercise.
Allow fifteen minutes. Ask participants to elect someone in their group who will
share their responses with the larger group at the end of the discussion.
Consider an aggressive incident that has occurred at your workplace. Use the results of
the incident investigation, and risk management principles to do the following in order to
prevent a recurrence of the incident. For example, if the incident investigation identified
that lack of knowledge of how to operate the duress alarm was a factor in the incident,
the level of risk associated with not being able to summon urgent assistance would be
high. A risk control measure would be to train all relevant staff in how to operate the
duress alarm, and a monitoring activity would be regular drills in its operation.
Identify the main hazards and/or risk factors that led to, caused and/or contributed to
the incident.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Assess the level of risk resulting from the various factors, and prioritise for elimination
or control.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Identify measures that would eliminate or control the hazards and risks associated with
this incident, to prevent a recurrence.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Monitor, review and improve the system.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Ask the group
At the end of the small group discussion, ask each elected participant to share
their groups’ responses with the larger group.
Reinforce the key points.
Key points
● Prevention of violence in the workplace should always be your first priority.

● The risk management process:
– Identify the hazard.
– Assess the risk.
– Eliminate or control the risk.
– Monitor, review and improve the system.
MODULE 4
Part 4
Managing aggression and violence
Session time
45 mins
Show overhead slide
Session overview
This section looks at the management of violence.
Show overhead slide
39
Explain and discuss
● There are always options available to you when you are confronted with an
aggressive person, therefore, it is most important that you are aware of these
response options, and when to use them.
● The responses used will depend on a number of factors; the nature and
severity of the event; whether it is a patient, visitor or intruder; the experience,
skills and confidence of the staff member/s involved. This may include going
straight to calling for back-up, security or local police.
● When choosing your response options, your aim is to maintain safety to
yourself and others, and prevent an aggressive incident from escalating.
● Emphasise the importance of safety eg in all violent situations you should
immediately seek help, regardless of whether you decide to stay or leave.
Explain and discuss
When considering your options you always need to keep in mind the following:
● Whether the person has an underlying physical or mental condition that is
contributing to the person’s aggressive or violent behaviour.
● Always remain calm and assess the level of threat and the different levels of
aggression displayed as this will help you to make a decision on the appropriate
response to take.
● Regardless of the response option you choose, de-escalating and containing
the situation should be considered where possible.
● If at any time you feel unsafe you need to call for support and/or leave.
● At all times your priority is for the safety of yourself and others.
● Be aware of the potential for violence, look for contributing factors or
warning signs.
You can use more than one option, depending on the circumstances.
Familiarise yourself with local policies and procedures for short and long-term
response options.
Briefly go through each short and long-term response option.
MODULE 4
Explain and discuss
Short-term response options (in no particular order):

● Issue a verbal warning
This may be appropriate in some circumstances. Emphasise the importance
of staff using appropriate, respectful communication skills. When issuing a verbal
warning, do so in an ‘informative’ manner. It is helpful when doing this to draw
the person’s attention to any displayed zero tolerance poster and/or information
brochures outlining behavioural responsibilities. Explain the impact their
aggressive behaviour may have on yourself, others etc, eg on your ability
to deliver quality health care.
● Seek support from other staff
Sometimes the presence of others, particularly the presence of more senior
staff can have a settling effect on aggressive patients or visitors, and the targeted
staff member may feel more confident. Point out the importance of knowing
the emergency duress response procedures and procedures for calling
security or police.
● Request that a person behaving aggressively leave
This might help remove a trigger for the aggressive behaviour, eg if a relative is
causing a patient distress and the patient is showing signs of aggression, asking
the relative to leave may be appropriate, explaining that this may assist in the
better management of the patient.
● Request that the patient be reviewed by a clinician
A patient in the Emergency Department for example, may be aggressive
as a result of a medical condition, so it is important that this always be a
consideration, and that clinical assessment is sought as appropriate.
● Negotiate treatment
If appropriate, negotiate treatment, eg a patient behaving aggressively may be
offered medication to help calm their distressed state.
● Use verbal de-escalation and distraction techniques
Model calm and appropriate behaviour, acknowledge the person’s needs and
negotiate solutions. Seeking to make the aggressive individual more comfortable
may be a helpful distraction technique.
● Stay and call for help
If you stay and call for help, continually monitor your safety.
● Leave and seek help
It is most important that if you do leave a violent situation that assistance is
still sought.
● Utilise the unit emergency duress response
Always ensure you are up-to-date with the procedures.
● Initiate external emergency response, eg police
Always ensure you know the procedure.
Explain and discuss
Long-term response options
For persons with repeated aggressive behaviour, long-term response options may
be appropriate. These are generally developed and implemented in consultation
with management and other key stake holders, eg clinicians, treating staff, medical
records, security, local police as necessary etc.
Long-term response options include:

● formal patient management plans
● written warnings
● conditional treatment agreements
● exclusion from visits
● conditional visiting rights
● patient alerts in conjunction with support management plan
● formal recognition of inability to treat in certain circumstances
● taking out an AVO to protect staff
● having charges laid.
When managing aggression in the workplace, both short-term and long-term options
need to be considered. Short-term options are important to prevent an episode of
aggression from escalating and to maintain the safety of all concerned. Long-term
options are important for the prevention of repeated violent incidents and ensuring
the safety of all concerned when the risk of future aggression is significant.
Know your options for action

There are always options available when confronted with an aggressive person and
it is important that staff know the appropriate response options. These responses will
depend on a number of factors including the nature and severity of the event, whether
it is a patient, visitor or intruder, and the skills, experience and confidence of the staff
member/s involved. This may include going straight to calling for back-up, security
or local police.
MODULE 4
When considering your options you always need to keep in mind the following:
● Whether the person has an underlying physical or mental condition that is contributing
to the person’s aggressive or violent behaviour.
● Always remain calm and assess the level of threat and the different levels of aggression
displayed as this will help you to make a decision on the appropriate response to take.
● Regardless of the response option you choose, de-escalating and containing the
situation should be considered where possible.
● If at any time you feel unsafe you need to call for support and/or leave.
● At all times your priority is for the safety of yourself and others.
● Be aware of the potential for violence, look for contributing factors or warning signs.
● You can use more than one option, depending on the circumstances.
Short-term response options

Short-term response options (in no particular order):
● Issue a verbal warning.
● Seek support from other staff.
● Request that the person behaving aggressively leave.
● Request that the patient be reviewed by a clinician.
● Negotiate treatment.
● Use verbal de-escalation and distraction techniques.
● Stay and call for help.
● Leave and seek help.
● Utilise the unit emergency duress response.
● Initiate external emergency response, eg police.
Long-term response options

Long-term response options:
● Formal patient management plans.
● Written warnings.
● Conditional treatment agreements.
● Exclusion from visits.
● Conditional visiting rights.
● Patient alerts in conjunction with support management plan.
● Formal recognition of inability to treat in certain circumstances.
● Taking out an AVO to protect staff.
● Having charges laid.
For more detailed information on short-term and long-term options, see the NSW Health
Zero Tolerance Policy Framework and Guidelines.
Ask participants to work in small groups and discuss the following question
for ten minutes. Ask them to elect someone in their group who will share their
group’s responses with the larger group at the end of the discussion.
Think of an aggressive incident in your workplace that was difficult to manage.

NB. An incident that you feel comfortable talking about.
Discuss the following:
During the incident

What were some of your response options to this incident? Were the appropriate options
used? What are some other options that could have been used?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How did you ensure the safety of yourself and others?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MODULE 4
After the incident

What happened after the incident?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Who was the incident reported to and what was the outcome?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Was management supportive of you after the incident? How was this support
demonstrated?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Ask the group
At the end of the small group discussion, ask each elected participant to share
the group’s responses with the larger group.
De-escalation strategies
Show overhead slide
Briefly review the appropriate strategies for dealing with a fearful or frustrated
person and an intimidating or threatening person. Appropriate behaviours are
included below.
Point out that the strategies you choose will vary depending on whether the
person being aggressive is fearful and frustrated or intimidating and threatening.
Emphasise the importance of being aware of cultural differences, eg facial

expressions, body language, tone of voice.
The fearful/frustrated person

● Often the individual is out of control and you need to help the individual
to gain control.
● The approach to use with this person is more empathic (more
emotionally engaging).
● A useful technique is to provide the person with options and focus
on these options.
The intimidating/threatening person

● Often the individual is in control.
● This individual is more likely to be antagonistic and less likely to
be accommodating.
● The approach to use with this person is more assertive.
● Asking the person to tell you what they need may be a more useful
strategy to persuade the individual to talk about the issue, than offering
a broad range of options.
● Focus on the consequences of the individual’s behaviour.
MODULE 4
The strategies you choose will vary depending on whether the person being aggressive
is fearful and frustrated or intimidating and threatening.
Fearful and frustrated person Intimidating and threatening person

● Be assertive – however your voice can ● Be assertive – your voice is more
range from being calm and confident to matter of fact displaying less emotion.
forceful. You may need to be repetitive. Repetitive statements are more important
especially regarding the consequences of
threatening behaviour.
● Make direct eye contact but not for long ● Eye contact can range from direct
periods of time, ie do not stare. to evasive depending on the person
behaving aggressively.
● Provide a range of options when you ● Ask the person what they need and
attempt to problem solve. provide options and consequences for
the threats made.
● Show empathy and be emotionally ● You need to be emotionally neutral when

engaging with your responses. stating the options and consequences.
In this exercise you are to de-escalate the person’s aggressive behaviour using
strategies that are correct and incorrect.
Large group exercise
Ask for a participant to volunteer to role-play a situation where the

participant takes on the role of a fearful and frustrated person who is acting
out aggressively. Have the participant think of a situation that has occurred in
their workplace that will help them with the role-play. Inform participants that
you will try to de-escalate the aggressive behaviour. Ensure you use both
correct and incorrect strategies. The aim is to illustrate for the group what
works and what does not work.
Ask the group
What were some helpful and unhelpful strategies used to de-escalate the
person’s aggressive behaviour?
Write responses on one side of the board.
Ask for another volunteer and repeat the exercise, with the volunteer taking the
role of an intimidating and threatening person being the aggressor.
Ask the group
What were some helpful and unhelpful strategies used to de-escalate the
person’s aggressive behaviour?
Write responses on the other side of the board.
As a way of concluding the training session ask the group to compare

and contrast the more successful and less successful techniques used for
de-escalating the behaviour shown in the role-plays.
Key points
• Know your short-term and long-term options when confronted with

violent behaviour.
• De-escalation strategies will differ depending on whether the person being
aggressive is fearful and frustrated or intimidating and threatening.
Show overhead slide
Assessment exercise is now facilitated.

Details of the assessment are at the front of the module.
MODULE 4
Related NSW Health

policies and guidelines
a. Mental Health for Emergency Departments, May 2002 (red book).

b. Management of Adults with Severe Behavioural Disturbance, May 2002 (green book).
c. C2003/88 Reportable Incident Briefs to the NSW Department of Health.
d. C2001/22 Workplace Health and Safety: A Better Practice Guide (currently under review).
e. C2002/19 Effective Incident Response: A Framework for Prevention and Management
in the Health Workplace.
f. C2002/50 Joint Management and Employee Association Policy Statement on Bullying,
Harassment and Discrimination.
g. NSW Health Security Manual.
h. NSW Health Zero Tolerance Policy and Framework Guidelines.
i. C2003/75 NSW Health Policy and Procedures for Injury Management and Return-to-Work.
49
MODULE 4
References
1. Mayhew C, Chappell D (2001a). Occupational violence: types, reporting patterns,

and variations between health sectors. Working Paper Series no. 139, School of Industrial
Relations and Organisational Behaviour and the Industrial Relations Research Centre, paper
written for the Taskforce on the Prevention and Management of Violence in the Health
Workplace, University of NSW, Sydney.
2. Mayhew C, Chappell D (2001b). Prevention of occupational violence in the health workplace.
Working Paper Series no. 140, School of Industrial Relations and Organisational Behaviour
and the Industrial Relations Research Centre, paper written for the Taskforce on the
Prevention and Management of Violence in the Health Workplace, University of NSW, Sydney.
3. Mayhew C, Chappell D (2001c). Internal violence (or bullying) and the health workforce.
Working Paper Series no. 141, School of Industrial Relations and Organisational Behaviour
and the Industrial Relations Research Centre, paper written for the Taskforce on the
Prevention and Management of Violence in the Health Workplace, University of NSW,
Sydney.
4. Delaney J, Cleary M, Jordan R, Horsfall J (2001) An exploratory investigation into the nursing
management of aggression in acute psychiatric settings. Journal of Psychiatric and Mental
Health Nursing, 8 (1), 77-84.
5. Ilkiw-lavalle O, Grenyer BFS, Graham L (2002). Does prior training and staff
occupation influence knowledge acquisition from an aggression management training
program? International Journal of Mental Health Nursing, 11, 233-239.
51

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A safer place to work –

preventing and managing violent

NSW Health is a zero tolerance zone

© NSW Department of Health 2003

SHPN (CMH) 030136

NSW Health: Preventing and managing aggression in the

What materials are provided?

All of the above are included on the CD.

Who will attend?

Overview of the manual

Modular structure of the aggression minimisation program

The day is divided into five parts:

90405NSW – Course in aggression minimisation for managers

The day is divided into four parts:

How the manual is set out

All facilitator notes throughout each module look like this.

Explain and discuss

Ask the group

Small group exercise

Individual reflection exercise

Important training point

You are on Participant manual page X

Show overhead slide

Write responses on board

Suggested break time

Readings and resources

Facilitator preparation before training

Sequence and timing of the modules

Recognition of prior learning

Recognition of prior learning is based on the following:

The following types of evidence may be collected:

How Module 4 fits into the whole program

Recommendations on the delivery of this module

Training room requirements

Assessment for Module 4

Assessment questions Learning outcomes

Question 1 1. Demonstrate an understanding of new developments in the

Self assessment checklist

Yes No Unsure Briefly detail new developments,

Identified acquired knowledge

Peer assessment checklist

Yes No Unsure Briefly detail new developments,

Identified acquired knowledge

Session plan for Module 4

Training session: Module 4 Date:

15 mins ● Introduction. 2 Small and large

15 mins ● New developments 1 Small and large

30 mins ● The prevention of violence. 2 Small and large

45 mins ● Managing violence. 2 ● Small and large

15 mins ● Assessment of competency. 1 and 2 Small and large

Beginning the training session

Show overhead slide

1. Welcome participants to the module

You may wish to facilitate an introductory activity (ice -breaker).

Example: Have participants pair off and:

Inform participants of:

3. Principles of adult learning

Show overhead slide

4. How Module 4 fits into the whole program

Show overhead slide

Explain that the program is divided into four parts:

At this point, introduce the assessment component of the course.

Show overhead slide