Community-Based Care

COMMUNITY-BASED CARE

For many clients with aggressive behavior, effective man-agement of the comorbid psychiatric disorder is the key to controlling aggression. Regular follow-up appointments, compliance with prescribed medication, and participation in community support programs help the client to achieve stability. Anger management groups are available to help clients express their feelings and to learn problem-solving and conflict-resolution techniques.

Studies of client assaults on staff in the community become increasingly important as more clients experience rapid discharge from inpatient or acute care settings. Assaults by clients in the community were caused partly by stressful living situations, increased access to alcohol and drugs, availability of lethal weapons, and noncompliance with medications. Episodes of assault were often precipi-tated by denial of services, acute psychosis, and excessive stimulation (Flannery, Laudani, Levitre, & Walker, 2006).

Flannery, Juliano, Cronin, and Walker (2006) studied assaults by clients in community residences, including physical or sexual assaults, nonverbal intimidation, and verbal threats. Clients who were assaultive were most likely to be older male clients with schizophrenia and younger clients with personality disorders. These authors described the assaulted staff action program (ASAP) established in Massachusetts to help staff victims cope with the psycho-logical sequelae of assaults by clients in community-based residential programs. In addition, ASAP works with staff to determine better methods of handling situations with aggressive clients and ways to improve safety in commu-nity settings. It is their belief that similar programs would be beneficial to staff in residential settings in other states.