Care planning for aggression management in a specialist secure mental health service: user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.

Animated virtual agents to cue user attention: comparison of static and dynamic deictic cues on gaze and touch responses

This paper describes an experiment developed to study the performance of virtual agent animated cues within digital interfaces. Increasingly, agents are used in virtual environments as part of the branding process and to guide user interaction. However, the level of agent detail required to establish and enhance efficient allocation of attention remains unclear. Although complex agent motion is now possible, it is costly to implement and so should only be routinely implemented if a clear benefit can be shown. Pevious methods of assessing the effect of gaze-cueing as a solution to scene complexity have relied principally on two-dimensional static scenes and manual peripheral inputs. Two experiments were run to address the question of agent cues on human-computer interfaces. Both experiments measured the efficiency of agent cues analyzing participant responses either by gaze or by touch respectively. In the first experiment, an eye-movement recorder was used to directly assess the immediate overt allocation of attention by capturing the participant’s eyefixations following presentation of a cueing stimulus. We found that a fully animated agent could speed up user interaction with the interface. When user attention was directed using a fully animated agent cue, users responded 35% faster when compared with stepped 2-image agent cues, and 42% faster when compared with a static 1-image cue. The second experiment recorded participant responses on a touch screen using same agent cues. Analysis of touch inputs confirmed the results of gaze-experiment, where fully animated agent made shortest time response with a slight decrease on the time difference comparisons. Responses to fully animated agent were 17% and 20% faster when compared with 2-image and 1-image cue severally. These results inform techniques aimed at engaging users’ attention in complex scenes such as computer games and digital transactions within public or social interaction contexts by demonstrating the benefits of dynamic gaze and head cueing directly on the users’ eye movements and touch responses.