Prevalence and Effects of Client Violence on Social Workers: Implications for Keeping Social Workers Safe National Association of Social Workers Florida.

Prevalence and Effects of Client Violence on Social Workers: Implications for Keeping Social Workers Safe National Association of Social Workers Florida Conference June 11, 2010 Pam Criss, PhD, LCSW Southeastern University

Purposes of Training To understand what personal and organizational factors may be related to client violence toward social workers To discover how social workers are affected when they have encountered client violence To discover how much safety training is occurring with social workers, where training occurs and whether the training has a beneficial effect. To discuss implications for social workers and their agencies, with particular emphasis on safety training

U.S. Statistics for Social Services and Health Care
Bureau of Labor(BLS) statistics % of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services (OSHA, 2004). BLS also reports that the violent assault injury rate for health care and social services is seven and a half times the rate for the overall private sector.

Reasons for increased risk to mental health professionals
Increased use of hospitals for the care of acutely disturbed individuals Increasing numbers of chronically mentally ill people being released from hospitals without follow up care Long waits for agency services Low staffing rates Low staffing rates may lead to working in isolation in agencies (OSHA, 2004)

Reasons for increased violence towards mental health professionals
Solo work at remote locations Prevalence of handguns Increased membership in gangs Increased presence of drugs and alcohol (OSHA, 2004)

Reasons for increased violence towards social workers (Weinger, 2001)
Cuts in services/provisions Increasing violence in society Social control role for social workers – social workers are often in a position where they must set limits for clients and/or to report when clients have failed to meet court ordered requirements

Reasons for increasing violence towards social workers
Negative image of social workers – representatives of unwanted authority (Aren’t you the ones who take children out of their homes?)

NASW Center for Workforce Studies
Almost licensed social workers in the U.S. responded to the survey (135 from Florida; 4 BSW social workers replied) 47% had some concern about their personal safety The report concludes that “ a profession cannot successfully retain its workforce when issues of personal safety go unaddressed” (p. 35).

Prevalence of Client Violence against Social Workers
More than 20 studies on client violence toward social workers in the U.S. within the past 30 years. National prevalence rates for social workers’ exposure to violence indicate that between 65% and 86% of social workers have encountered client violence at some time during their career (Beaver, 1999; Ringstad, 1995).

Practice exercise: Recording the numbers of client violence incidents that have occurred to you
Please complete the form regarding numbers of client violence incidents that you have experienced directly or indirectly in the past year.

Client Violence Rates for Social Work Students
Prevalence rates for social work students’ exposure to violence in their practicum have ranged from 21% to 54% (Knight, 1999; Mama, 2001).

Client Violence towards Social Work Students (Criss, 2009)
Participants Random sample of 1500 social work students from NASW national membership, with equal numbers of BSW and MSW students Oversampled students of ethnic/racial minority groups – 1/3 of BSW and MSW students 45.25% response rate (N = 667) 595 students met inclusion criteria (completed or currently in field placement)

Prevalence of Direct Client Violence towards Social Work Students 41
Prevalence of Direct Client Violence towards Social Work Students 41.7% (n = 248) - Experienced some type of client violence Rate of Client Violence by Type of Violence (N= 589) % n Verbal abuse 37.5 223 Threat of physical harm 14.1 84 Threat of lawsuit 9.4 56 Property damage 7.2 43 Physical assault 3.2 21

Total Number of Incidents of Client Violence Towards Social Work Students
Sum of incidents % of total incidents Verbal abuse 759 68.75% Threat of physical harm 161 14.58% Threat of lawsuit 79 7.15% Property damage 77 6.97% Physical Assault 28 2.53% Total incidents 1104 99.98%

Vicarious exposure to client violence
In study of 273 child protection social workers, Horwitz(2006) found that vicarious exposures to traumatic workplace events were more highly associated with trauma effects than were direct events.

Prevalence of Indirect Exposure to Client Violence towards Social Work Students 60.2% (n = 361) Witnessed and/or heard about some type of client violence Type of Client Violence % n Verbal abuse 54.1 322 Threat of physical harm 36.8 219 Physical assault 23.4 139 Threat of lawsuit Property damage 20.5 122

Total Number of Indirect Incidents of Client Violence Experienced by Social Work Students (n = 361)
Sum of indirect incidents % of total incidents Verbal abuse 1852 51.40 Threat of physical harm 751 20.70 Physical assault 388 10.46 Property damage 324 8.91 Threat of lawsuit 309 8.52 Total indirect incidents 3603 99.9

Failure to report client violence
When social workers are harmed by clients, they may often fail to report the incidents. One study indicated that 8% of violent incidents were reported only verbally and only 29% were recorded appropriately (Norris, 1990).

Reasons for failing to report violence
Concern about how the worker will be perceived by co-workers and supervisors Fear of criticism, rather than support Fear that management might see them as unable to cope, being inadequate, or as unprofessional (Brown, Bute, and Ford, 1986; Norris, 1990; Spencer & Munch, 2003). “ I needed to be told that I hadn’t failed.” (Littlechild, 1997, p. 236)

Reasons for failure to report violence
Perception that violent incidents are part of the job Tendency to feel that social workers should be able to take care of themselves, so they may report only the most severe incidents. Social workers do not enter the profession thinking that they will become victims of the very people they hope to help. (Star, 1984)

Afraid that if they report the violence, their relationship with their client will deteriorate or that their client will face prosecution (Rowett, 1986; Star, 1984). Both assaulted and non assaulted social workers may picture assaulted social workers as poorly functioning social workers. The non assaulted workers may see the assaulted workers as being more provocative, incompetent, authoritarian, and inexperienced (Macdonald & Sirotech, 2001; Rowett,1986).

Norris points out that, like child abuse, victim disclosure must occur in order for the problem to be understood and reasonably addressed. He states that “the key to knowing how to protect social workers from the most unpredictable of attacks, without imposing protective measures that destroy the helpful aspects of social work, lies in overcoming the problem of under-reporting” (p.131).

Which gender of social workers experiences more client violence?

Prevalence of Client Violence- Gender
Several studies indicate that males are at higher risk of encountering client violence than females (McLean, 2000; Newhill, 2006; Jayarante, Croxton, & Mattison, 2004; Ringstad, 2005; Beaver, 1999). Two contradictory findings: Males had more physical assault, threats of physical harm, and threat of property damage, but females experienced more verbal abuse (Song,2005) Male social workers in Israel didn’t experience more physical threats and assaults, though American males did. (Guterman, Jayarante,& Bargel, 1996)

Male social work students experienced significantly more client violence than female social work students (Criss, 2009). Males (n = 68, 11.4%), Females (n = 525, 88.5%) Types of Client Violence Gender Mean t-value p Physical assault Female .04 -1.36 .179 Male .12 Threat of physical harm .21 -3.24 .002*** .69 Verbal abuse 1.05 -2.20 .031* 3.09 Threat of lawsuit .13 -1.01 .314 .19 Property damage -1.21 .230 .22 Total client violence 1.59 -2.45 .017* 4.32

Do older social workers or younger social workers experience more client violence?

Prevalence of Client Violence-Age
Younger workers in agency settings have been found to be at greater risk of physical threat, threat of lawsuit, verbal abuse and sexual harassment (Jayarante et al., 2004; Jayarante, 2005, Ringstad, 2005) Younger workers also significantly more like to report knowing co-workers who had experienced physical threats Younger student social workers more likely to view social work as a dangerous profession and expressed some discomfort working in inner city (Knight, 1996)

In national study, younger social work students did not experience more client violence, though those who were aged experienced significantly more threats of lawsuit (Criss, 2009). Age Categories Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence M SD Under age 25 (n = 145) .69 .35 .23 .65 .84 1.84 .08 .31 .06 .29 1.27 2.60 Age 25-30 (n = 162) .03 .26 .39 1.05 1.57 4.53 .22 .64 .13 .52 2.35 5.55 Over age 30 (n = 285) .05 .25 .75 1.34 4.11 .11 .45 .16 .67 1.89 4.90 F = .710 F = 2.26 F = 1.48 F = 4.01 F = 1.61 F = 2.03 p = .491 p = .106 p = .229 p = .019* p = .201 p = .132

Do more experienced workers or less experienced workers have more exposure to client violence?

Prevalence of Client Violence- Job experience
Early client violence study showed that workers with 11 or more years of experience were assaulted or threatened at a ratio of 1:4 compared with workers with less than 11 years experience (Bernstein, 1981) Less experienced workers have been found in other studies to have more exposure to client violence (Privatera, 2005; Beaver, 1999) Less experienced social worker in U.S. had more violent incidents, though not true with less experienced workers in Israel (Guterman et al., 1996)

Prevalence of Client Violence- Job experience
One conflicting finding- “Professionally seasoned MSW’s” experienced more client violence that “less experienced student clinicians” (Tully, Kropf, and Price, 1993)

NASW Workforce Study (2006)

Student with no experience or less than 2 years experience had less direct exposure to client violence than students who had 3-5 years experience. Those with 3-5 years experience had significantly more verbal abuse and total client violence (Criss, 2009) Experience Categories Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence M SD No experience (n = 292) .03 .22 .19 .71 .88 1.87 .09 .30 .10 .47 1.29 2.66 1-2 years’ experience (n = 89) .04 .21 .33 .94 1.27 3.19 .17 .63 .18 .70 2.00 3.97 3-5 years’ (n = 82) .46 .37 2.07 6.21 .15 .61 .58 2.85 7.24 6-10 years’ Experience (n = 66) 1.06 1.21 2.26 .20 .59 .52 1.86 3.58 F = 1.38 F = 1.65 F = 3.01 F = 1.53 F = .75 F = 3.45 p = .247 p = .177 p = .030* p = .205 p = .520 p = .016* Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Do social workers of minority ethnic groups or races experience more client violence than white social workers ?

Prevalence of Client Violence- Ethnicity/Race
There has been little research on how social workers of ethnic minorities in the U.S. are affected by client violence. Some evidence that social workers of ethnic minorities in the U.K. are disproportionately affected by client violence (Butt, 2000, as cited in Brockman, 2002) One study found that non-White social workers worried more about future exposure to workplace violence, though they experienced less than White participants (Budd, Arvey, & Lawless, 1996)

Prevalence of Client Violence- Ethnicity/Race
Another study showed that African American social workers were significantly less likely to have fear of all types of client violence (Jayarante, Croxton, and Mattison, 2004) Yet another study found that ethnic minorities were significantly more likely than White social workers to view the community around a school as dangerous (Astor, 1998) One epidemiological study of several U.S. national workplace violence studies showed that African American and Hispanic workers had higher frequencies/rates of workplace violence (Kraus, 1996)

Native American social work students were significantly more likely to experience verbal abuse and total client violence, whereas students of mixed racial/ethnic heritage were more likely to experience threat of lawsuit and property damage.(Criss, 2009) Practice Setting Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence M SD Latino/ Hispanic (n = 25) .00 .20 .65 .80 1.32 .58 .04 1.24 2.06 Native American (n = 13) .15 .55 .46 .77 6.61 14.80 .08 .28 .38 1.12 7.92 18.01 White (n = 425) .27 .83 1.15 3.30 .12 .13 .54 1.80 4.42 Asian (n = 5) .60 1.34 1.20 2.16 .48 .45 3.00 3.74 Black (n = 98) .24 .25 .86 1.25 2.80 .09 .35 .31 1.70 3.43 Mixed Heritage (n = 19) .16 .50 .37 .68 1.57 2.46 .47 1.26 2.52 F = 1.14 F = .38 F = 5.43 F = 3.54 F = 2.59 F = 4.26 p = .339 p = .858 p = .000*** p = .004*** p = .025* p = .001*** Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Do BSWs or MSWs experience more client violence?

Prevalence of Client Violence- Social Work Degree
Only two studies have reported on client violence rates with BSW social workers vs. MSW social workers. Both found that social workers with a BSW experienced more client violence (Beaver, 1999; Privitera, Weisman, Cerulli, Tu, & Groman, 2005)

MSW students experienced more of every type of violence, except physical assault. They were significantly more likely to experience threat of physical harm, verbal abuse, and total client violence. MSW (n = 340, 57.1%), BSW (n = 248, 42.2%) (Criss, 2009) Types of Client Violence Gender Mean t-value p Physical assault MSW .03 1.42 .156 BSW .07 Threat of physical harm .35 -2.77 .004*** .17 Verbal abuse 1.52 -1.94 .053* .96 Threat of lawsuit .16 -1.77 .077 .09 Property damage .13 .22 .826 .14 Total client violence 2.24 -1.96 .031* 1.50 Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Does client violence occur more often in an office, at a home visit or in some other place?

Prevalence of Client Violence-Place of Violence
A study of probation officers, about half of whom were social workers, found that they were more likely to be verbally threatened and physically intimidated in the office (Rapp-Paglicci, 2004) One study of child welfare workers found that different types of violence happened in different places: Threats- Client’s home Property damage- Office Actual attacks- Wide array of places (Newhill & Wexler, 1997)

Prevalence of Client Violence- Place of Violence
Two student social work studies found that incidents of violence were more likely to take place in an agency (Mama, 2001; Tully et al., 1993) A small study of child welfare workers (n=31), 61.3% of the social workers had been threatened while on a home visit, whereas 94% had heard of a coworker being involved in a client violence situation (Castellanos, 1998)

Client violence during home visits
Another study with a small sample size of 15 home visiting social workers found that 93% had experienced client violence and none of them felt completely safe (Vergara, 2006) A student study found that 48% of MSW students were concerned about their personal safety at least sometimes when making home visits. Of those, 30.1% had actually encountered verbal threats during a home visit and 45% were physically threatened during a home visit (Schwarzmueller, 1998)

Every type of client violence except physical assault was experienced by social work students more often in an office setting. Practicum Exposure Rate to Client Violence per Place of Violence (N = 274) Place of Violence Physical Assault Threatened Physical Harm Verbal Abuse Threatened Lawsuit Property Damage Total Client Violence % n Home visit 11.8 2 24.7 20 26.9 57 15.7 8 8.1 3 23.4 148 Office 41.2 7 54.3 44 51.4 109 58.8 30 70.3 26 54.4 64 Other 47.1 21.0 17 21.7 46 25.5 13 21.6 22.6 62

Of social work students who made home visits, those who made 11 or more home visits experienced more of every type of violence and significantly more threats of lawsuit. Number of Home Visits Made Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence M SD 1-5 home visits (n = 84) .02 .15 .53 .85 1.73 .06 .24 .13 .65 1.21 2.27 6-10 home visits (n = 55) .07 .33 .16 .60 .73 1.46 .36 .42 1.10 2.31 11 or more home visits (n = 177) .08 .38 .40 1.09 1.35 2.94 .25 .70 .66 2.24 4.17 F = .86 F = 2.71 F = 2.00 F = 4.57 F = .46 F = 3.71 p = .422 p = .068 p = .137 p = .011** p = .632 p = .027* Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

What time of day is client violence more likely to occur to a social worker?

Time of day of client violence
Student study found that almost 40% of students were concerned for their personal safety during evening hours (Knight, 1999) Another student study found that 33% experienced physical threats during evening hours (Schwarzmueller, 1998) Analysis of seven national (non social work) studies indicated that occurrence of homicide and nonfatal assault is more frequent in the afternoon and evening hours than late morning or early afternoon hours (Kraus, 1996)

Social work students experienced client violence much more often during daytime hours.
Practicum Exposure Rate to Client Violence per Time of Day Time of Violence Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence % n Daytime 76.5 13 71.8 56 71.6 151 82.0 42 71.4 25 69.69 184 Evening 23.5 5 24.4 19 26.5 13.7 7 25.7 9 26.13 69 Early morning 3.8 3 1.9 4 3.9 2 2.9 1 4.16 11

Those social work students who worked 51-75% of their practicum hours during the evenings were significantly more likely to experience physical assault than those who worked up to 50% of their hours during the evening or those who worked almost all of their hours during the evening (Criss, 2009) % of Evening Hours Worked Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence M SD No evening hours (n = 197) .04 .23 .24 .80 1.38 5.40 .12 .48 .59 1.89 6.24 1-25% evening hours (n = 253) .05 .28 .74 1.08 2.38 .16 .54 .14 1.68 3.29 26-50% evening hours (n = 65) .02 .32 .83 1.07 2.03 .09 .34 .38 1.60 2.77 51-75% evening hours (n = 43) .57 .53 1.32 2.14 4.45 .36 .20 3.02 5.86 76-100% evening hours (n = 30) .00 .68 1.47 3.08 .55 2.10 3.84 F = 2.34 F = 1.35 F = 81 F = .54 F = .30 F = .83 p = .054* p = .250 p = .520 p = .704 p = .881 p = .501 Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

In what practice settings is client violence most likely to occur to a social worker?

Practice settings noted to have higher prevalence of client violence
Child protection settings (Jayarante et al., 2004; Newhill, 1996; Schultz, 1987; Snow, 1994) National survey of child welfare workers in 10 states found that over 70% had been victims of violence or threats of violence (AFCME, 2007) Qualitative study in Ontario of 20 child welfare workers- All said that they had been kicked, spit upon, and hit by clients using weapons of various sorts. 95% verbally abused 60% said it was a daily occurrence

Seattle Times, by Jonathan Martin Social worker, Edith Vance, 52 yrs
Seattle Times, by Jonathan Martin Social worker, Edith Vance, 52 yrs. old, Washington Father slain after machete attack on social worker A machete-wielding father was fatally shot yesterday after he attacked a veteran Child Protective Services (CPS) worker in the worst-known case of on-the-job violence at the state child-welfare agency. The CPS worker, accompanied by a co-worker and a Ferry County sheriff's deputy, was investigating a complaint that three children were living in a home near Curlew without running water or electricity when she was attacked by the children's father, State Patrol trooper Jim Hays said. Bryan S. Russell, 35, pummeled one of the social workers with a machete and a 2-by-4 as she lay on the ground before the sheriff's deputy shot and killed him, Hays said. The worker, whose name was not released, suffered cuts, a broken arm and wrist and a possible skull fracture. She was admitted to Deaconess Medical Center in Spokane for a CAT scan.

Ms. Vance’s advocacy to the Washington state legislature by Rachel LeCort, Associated Press, Vancouver, WA 3/25/05 OLYMPIA A state social worker who was attacked by a machete- wielding father during a child welfare check made her first public appearance Thursday, testifying in support of a bill intended to prevent future assaults. Still sporting bandages that cover a splint on her broken right wrist, 52-year-old Edith Vance was not eager to talk about the details of the day that Bryan S. Russell beat her with a machete last month. Russell, 35, was fatally shot by a Ferry County sheriff's deputy who had accompanied Vance and another welfare worker on the visit. Instead, Vance said she wanted to focus on the needs of workers like her, who face potential conflict every time they knock on a door, sometimes in rural areas with sketchy cell phone service. Vance has worked in child services for 22 years, of which 14 have been in Washington with the state Department of Social & Health Services. "Wherever we need to go, there is danger present and something needs to be done to address those dangers," she told lawmakers on the Senate Human Services & Corrections Committee. The bill, sponsored by Rep. Ruth Kagi, D-Lake Forest Park, passed the House on an unanimous vote earlier this month. It would create a work group to develop policies and consistent protocols on welfare workers' safety.

Criminal justice settings (Newhill, 2006; Beaver, 1999; Ringstad, 2005) 4 of 5 social workers in criminal justice settings have concerns about their safety (NASW, 2004) Criminal justice workers may have more encounters with physical violence

Institutional mental health (Jayarante et al., 1995; Jayarante et al., 2004; Ringstad, 2005; Privitera et al. 2005) 82% of social workers working in psychiatric hospitals reported concerns about personal safety on the job (NASW, 2004) (Florida State Hospital, Chattahoochee) In a study of injuries to staff in a large state psychiatric hospital , 71% of the injuries to staff were head injuries (Carmel & Hunter, 1993)

School social work (Jayarante et al., 1995; Jayarante et al., 2004; Mattison, 2004; Ringstad, 2005) School social workers may fear for their safety, especially if they are at inner city schools (Astor et al., 1998) One study found that school social workers experienced the highest amount of assaults

National study of violence towards school social workers (Astor, Behre, Fravil, Wallace, 1997; Astor, Behre, Wallace, Fravil, 1998) 576 school social workers More than 70% reported that potentially life threatening events occurred in their schools in the past year Yet, only 20.5% said that violence was a big or very big problem in their school(s)

Study of school social workers (cont.)
44% said that they feared for their safety one or more times in the past year because of worries about school violence 35% physically assaulted or physically threatened within the past year Of those: 77% identified assailant as student 49% identified assailant as a parent

Any residential setting (Brockman, 2002; Leadbetter, 2003; Ringstad, 2005) Children’s residential group care may be dangerous

Students in alcohol/substance abuse, mental health/psychiatric, and developmental disabilities settings experienced significantly more client violence. Those in community organization settings experienced the least client violence. Practice Setting Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence % n Medical/ Health 2.8 2 9.9 7 39.4 28 11.3 8 1.4 1 43.7 31 Alcohol/ Substance abuse 7.1 3 14.3 6 50.0 21 16.7 52.5 22 Developmental disabilities 13.3 20.0 46.7 6.7 53.3 Corrections/ Criminal Justice 2.6 13.2 5 36.8 14 10.5 4 7.9 42.1 16 Community Organization 5.3 18.4 20.5 Child & Family/Child Protection 2.9 9.6 10 30.8 32 14.4 15 5.8 38.5 40 Family services 2.0 15.7 39.2 20 9.8 5.9 37.3 19 Schools 4.3 19.6 9 37.0 17 6.5 8.7 40.4 Services to the Aging 7.3 14.6 34.1 2.4 Mental health/ Psychiatric 3.0 23.0 23 47.0 47 9.0 14.0 54.5 X2 = 9.67 X2 = 13.60 X2 = 15.45 X2 = 12.47 X2 = 15.62 X2 = 19.17 p = .470 p = .192 p = .117 p = .254 p = .111 p = .038* Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Social work student- client violence study
Threats of lawsuit were significantly higher in alcohol/substance abuse settings than every other practice setting. F (10/574) = 1.88, p = .046, η2 = .03

Predicting Occurrence of Client Violence
Model Summary for Predictors of Occurrence of Overall Client Violence Coefficient for Final Model of Occurrence of Overall Client Violence Step Factors R R2 R2adj ∆ R2 Fchg p df1 df2 1 Male .173 .030 .028 15.66 .000 507 2 Mental health setting .208 .043 .039 .013 6.98 .008 506 3 11 or more home visits .231 .053 .048 .010 5.48 .020 505 4 Alcohol/substance abuse setting .251 .063 .056 5.14 .024 504 Factor B β t p Bivariate r Partial r Male .201 .125 2.84 .005 .151 .126 Mental health setting .135 .108 2.43 .015 .109 11 or more home visits .115 2.48 .014 .098 .110 Alcohol/substance abuse setting .206 .106 3.37 .018 .085 .105

Predictors of Physical Assault towards Social Work Students:
having more field agency training, particularly in self defense topics working in a developmental disability setting Other factors associated with physical assault: being aged 25-30 working increased (51-75%) evening hours

Predictors of Threat of Physical Harm towards Social Work Students
being male working in a mental health practice setting Other factors associated with increased threats of physical harm: being of mixed ethnic/racial heritage being an MSW student having more field agency training

Predictors of Verbal Abuse towards Social Work Students
being male interning in a mental health setting making 11 or more home visits, interning in an alcohol/substance abuse setting. Other factors associated with verbal abuse of students: Native American MSW student having 3-5 years’ experience receiving more training in field seminar, the field agency and sources other than the social work program

Predictors of Threat of Lawsuit towards Social Work Students
being years old being of mixed ethnic heritage making more home visits interning in an alcohol/substance abuse setting Additional factors associated with threat of lawsuit: having more field agency training

Predictors of Property Damage towards Social Work Students
being male working in a mental health/psychiatric setting Other factors associated with property damage: Being of mixed racial heritage having more field agency training

Effects of Client Violence

Effects of Client Violence
When social workers are the victims of client violence, they can experience the acute effects of trauma that include becoming timid, withdrawn, frightened, nervous, and angry (Guy & Brady, 1998; Horwitz, 2006; Norris, 1990; Snow, 1994) .

From Brady, C. Surviving the incident
Possible reactions following assault Immediately following assault In the days following assault (24-72 hours) In the long term Physical pain Shaking Crying Fear Shock Disbelief Confusion Embarrassment Anger Feeling “energized” Feeling “ready to work” Anger, resentment Denial of effects Feeling of loss Guilt, shame, humiliation Poor concentration Lack of confidence Anxiety in similar situations Sleep difficulties Depression Attempts to make sense of what happened Situation specific anxiety Feeling “burned out” Post-traumatic stress disorder

Initial Reactions (I was )“shocked, physically shaken, emotionally assaulted. Jumpy and emotionally labile…” (Littlechild, 2005, p. 73) Sense of control is lost Adrenaline surge has depleted the body May be exhausted and need to rest (Weinger, 2001) Often takes about 12 hours before employees process what has happened and are ready to talk (Ceniceros, 1999)

Longer term effects of client violence
PTSD- re-experiencing the trauma, avoidance, numbing of responsiveness, increased arousal (75% of victimized child welfare workers in one study met criteria) (Snow, 1994) Negative effects on health (longitudinal study indicated that even 2 years after an incident, social workers had significantly higher scores on General Health Questionnaire) (Balloch, Pahl, & McLean, 1998) Worry about litigation/malpractice, if they had self protective responses (Guy & Brady, 1998)

Longer term effects of client violence
More caution in practice Less ability to confront clients (Norris, 1990) “ I watch every word I say or write, body language, everything. This probably results in a stilted lack of communication.” “General reluctance to visit. Difficulty being positive with my client. My anxiety and anger prevent me from being positive with the family.” (Littlechild, 2005, p. 73)

Long term effects of client violence
Tendency to “retreat” to administrative positions Reluctance to visit a client alone Refusal to work certain shifts alone (Norris, 1990)

Self blame Feelings of Incompetence Failure Guilt Shame Sense of vulnerability Anger toward clients (Mostly unspoken) (Weinger, 2001)

May affect the worker’s private life “My family was concerned about the nature of my work and risks involved.” “Reduced visits to town with husband and teenager children- not wanting to put them at risk… Watching back mirror when driving home, stopping en route to ensure not being followed.” “My husband gets angry that I have to put up with such behavior and suffer the effects in my private life.” (Littlechild, 2005, p. 73)

Long term effects of client violence towards students
Uncomfortable engaging in all practice activities Tendency to plan to be in private practice (Knight, 1999)

Measuring Fear of Future Violence
Fear of future violence- Fear that a client violence incident will occur in the future Used a modified version of Fear of Future Violent Events at Work Scale (Rogers & Kelloway, 1997). Measured by noting level of agreement that the student had fear that each of 5 client violence events would occur in the next year.

Direct experience of client violence significantly affected fear of future client violence.
Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence r p Fear of Physical Assault .08 .042* -- Fear of Threat of Harm .22 .000*** Fear of Verbal Abuse .13 Fear of Threat of Lawsuit .19 Fear of Property Damage .09 .040* Fear of Any Type of Client Violence .02 .564 .18 .002*** .15 .043*. Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Indirect experience of client violence significantly affected fear of future client violence (Even more so than direct experience of client violence) (Direct Experience) Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence r p Fear of Physical Assault .17 .000*** -- Fear of Threat of Harm .23 Fear of Verbal Abuse .21 Fear of Threat of Lawsuit .29 Fear of Property Damage .14 .001*** Fear of Any Type of Client Violence .27 .15 Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Effects of violence- Career turnover
Experiences of client violence may be related to social workers’ decisions to leave the profession (Lyons, Lavalle, & Grimwood, 1995). Only study to date to look at possible reasons for turnover in the profession of social work 791 social workers from 21 schools in England Verbal and physical abuse by clients; 92% had been verbally abused, 32% had experienced physical violence Some of those who had left cited violence as a reason for leaving.

Effects of violence- Career turnover
In one study, 19% of those attacked reported not wanting to return to work, being reluctant to practice with certain types of clients or wanting to change jobs “It has reinforced my belief that the profession does not take the threat of violence seriously….. It adds to other reasons to leave social work.” (Newhill & Wexler, 1997)

NASW Center for Workforce Studies (2004)
5% of the social work workforce planned to leave the profession of social work The workers in this group were more likely : to be between the ages of 26 to 34 to have a BSW as their highest degree to be in their first four years of practice They were significantly more likely to report that they faced personal safety issues.

Measuring Occupational Commitment
Occupational commitment is “a person’s belief in and acceptance of values of his or her chosen occupation or line of work and willingness to maintain membership in that occupation” (Vandenberg and Scarpello, 1994) Three types of occupational commitment: a. Affective- The participant’s attitudes and feelings toward the occupation and his/her identification with the profession (Staying because they want to do so) (Meyer, Allen & Smith, 1993)

Types of Occupational Commitment
b. Normative- Remaining with the occupation because the participant feels that they ought to do so. c. Continuance- Staying in the occupation because the participant needs to do so. It involves tangible items such as salary, time investment and job security. (Meyer, Allen & Smith, 1993)

Relationship between client violence and occupational commitment
(Direct Experience) Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence r p Affective Commitment .04 .359 .03 .488 .01 .910 .00 .998 .02 .679 .682 Normative Commitment .11 .011** .05 .271 .733 .572 .192 .474 Continuance Commitment .06 .143 .384 .686 -.07 .091 -.01 .776 .837 Career Withdrawal Intentions -.06 .162 .839 .780 .35 .944 .516 .858 Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

There were significant positive correlations between normative and continuance commitment and all types of client violence. There were significant negative correlations between affective commitment and experiences of physical assault and threats of physical assault. Fear of Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Fear of Any Client Violence r p AC -.10 .014** -.08 .046* -.01 .820 -.04 .285 -.07 .089 .102 NC .14 .001*** .13 .002*** .18 .000*** .12 .003*** .17 C C .004*** .15 Note: * p ≤ .05, **p ≤ .01,*** p ≤ .004 (Significant after Bonferroni adjustment) Note: AC =Affective Commitment; NC = Normative Commitment; CC = Continuance Commitment

Safety Training

Training on Safety and Violence
Time spent in safety training may be limited National random study of 1000 social workers: 4% recalled receiving training BSW/MSW program 3% recalled training at field internship site 79% said that they needed more safety training (Newhill, 1996) National study of school social workers: 5% recalled receiving training during their social work education 62% said that they had training from the school district 70% got training at conferences 59% said they needed more training on school violence (Astor et al., 1998)

Training on Safety and Violence
175 social workers: 41% had training on predictors of violence 2% had training on violence prevention 22% had training on home visit safety (Rey, 1996)

Training on safety for field educators who have students in the field
59%- 94% of field educators/instructors report a need for more training on client violence (Mama, 2001; Tully et al., 1993) Only 30% of social work education programs give safety training to their field educators/instructors (Ellison, 1996) Median time that field educators spent in safety training- 45 minutes (Ellison, 1996)

Social work student training- student perspective
Training at field agencies: 32% - training on how to handle dangerous situations at the field agency (Mama, 2001) 35%- agency training about predicting violence 18%- training on home visit safety (Elwood & Rey, 1996) Training in social work curriculum: Slightly over half had safety training in the social work curriculum (Tully et al., 1993) 18%- training on predictors of violence 41%- violence prevention 43%- threats towards students

Knowledge of agency safety policies
2 social work student studies asked about students’ knowledge of field agencies’ policies- about ½ of the students were aware of agency safety policies (Mama, 2001; Elwood & Rey, 1998)

Social work student safety training- Field director’s perspectives
61%-69% say that they offer safety training (Faria & Kendra, 2007; Ellison, 1996; Reecer & Wertkin, 2001) Median length of safety training- 2 hours (Ellison, 1996)

Many social work field directors feel that it the primary responsibility of the field instructor ( in the agency) to provide field training to students, but: they don’t know how many of the field agencies are actually providing training or b. not all field agencies may be providing training (Reeser & Wertkin, 2001; Faria & Kendra, 2007)

12% -26% of social work education programs have some type of safety policy Some say they have informal policies, though a large amount of those stated that the informal policy consisted on relying on safety training in field seminar, student orientations, and social work practice classes. MSW programs were significantly more likely to have safety training policies. Those programs in which a student had been physically assaulted were more likely to have safety policies. (Ellison, 1996; Faria & Kendra, 2007; Reeser & Wertkin, 2001)

Safety training content in social work schools
Only one study has asked field directors specifically about safety training content (Faria & Kendra, 2007) 90% (n=12) of those programs that offered safety training said that they included content on: Characteristics of high risk situations Creating safe office spaces High-risk practice settings Maintaining a confident, secure demeanor Verbal de-escalation of a client’s rage How t0 behave with an angry client How to dress How to sit when interacting with a client

Percentages of Students Who Had Safety Training Content per Training Venue
Social Work Practice Classes % Field Seminar Field Agency Other Assessing history of violence in clients 33.9 (n=202) 8.6 (n=51) 27.1 (n=161) 14.8 (n=88) Characteristics/life experiences of people more likely to commit violent acts 42.2 (n= 251) 8.9 (n=53) 20.2 (n=120) 16.3 (n=97) Forms of mental illness associated with violent behavior 55.5 (n= 330) 11.4 (n=68) 24.5 (n=146) 23.0 (n=137) Characteristics of high risk situations (i.e. non-public, isolated places) 48.1 (n=286) 24.4 (n=145) 31.1 (n=185) 23.9 (n=142) Identifying and managing feelings that can arise when working with victims and perpetrators of violence 51.1 (n=301) 20.8 (n=124) 28.6 (n=170) 18.7 (n=111) Maintaining a confident, secure demeanor 52.8 (n=214) 26.7 (n=159) 33.3 (n=198) 22.5 (n=134) Recognizing verbal acts of violence 41.8 (n=249) 16.1 (n=96) 27.2 (n=162) 23.5 (n=140) Physical signs that an attack is imminent 24.9 (n=148) 12.1 (n=72) 21.8 (n=130) Understanding of student’s rights (For example, the right to refuse to make a home visit) 38.0 (n=226) 33.6 (n=200) 22.9 (n=136) 8.2 (n=49)

Percentages of Students Who Had Safety Training Content per Training Venue
Social Work Practice Classes % Field Seminar Field Agency Other Verbal de-escalation techniques( How to behave with an angry client) 44.0 (n=262) 19.5 (n=116) 31.3 (n=186) 25.2 (n=150) Knowledge of office safety (arranging work space to maximize safety) 38.8 (n=231) 20.3 (n=121) 32.6 (n=194) 19.0 (n=113) Where to sit when interacting with a client 58.0 (n=345) 26.6 (n=158) 19.0 (n= 113) Home visit safety 35.5 (n=211) 29.9 (n=178) 17.3 (n= 103) Keeping supervisor informed of one’s itinerary 35.6 (n=212) 30.1 (n=179) 49.1 (n=292) 17.6 (n= 105) Physical techniques for self protection 14.5 (n=86) 8.7 (n=52) 17.5 (n=104) 25.9 (n= 154) Debriefing and support after an incident (Reporting the incident) 19.8 (n=118) 38.7 (n=230) Recording incidents of violence 27.6 (n=164) 15.3 (n=91) 37.8 (n=225) 19.3 (n= 115) Knowledge of social work program’s safety policies 40.5 (n=241) 30.9 (n=184) 25.0 (n=149) 10.4 (n= 62) Knowledge of field agency’s safety policies 16.5 (n=98) 15.6 (n=93) 67.3 (n=385) 6.5 (n= 6.2)

Is safety training effective?
Prior to this study, only one social work study had done a simple measure of the relationship between exposure to client violence and safety training(Elwood & Rey). No other social work studies have assessed the effectiveness of safety training. Current study hypothesized that increased safety training would correlate with decreased incidents of client violence

Study showed that safety training and incidents were positively correlated (i.e. Increased training correlated with increased incidents of violence) Training Venues Physical Assault Threat of Physical Harm Verbal Abuse Threat of lawsuit Property Damage Total Client Violence r p Social work classes .02 .717 -.01 .848 .07 .098 .947 .03 .434 .06 .151 Field Seminar .611 .04 .402 .10 .013* .08 .058 .122 .11 .009** Field Agency .14 .001*** .09 .029* .044* .010** .13 .002*** Other places .888 .363 .046* .154 .022* .027* Total Training .179 .049* .039* .12 .004*** .15 .000*** Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)

Why could it be that client violence was higher when social work students had more safety training?
(No, really!.. I need some helping in solving this!)

What might make safety training more effective?
Effective training consists of: Presenting knowledge about a subject Providing a demonstration Assuring opportunities to practice the skills in the training setting (Fixen, Naoom, Blase, Friedman, & Wallace, 2005) Other professions, such as nursing, have done a better job of conducting training and evaluating its effectiveness (i.e. Beech & Leather, 2003)

Use of: Simulations and role play (Guy & Brady, 1998; Horejsic & Garthwait, 1994; O’Keefe & Mennan, 1998) Dramatic re-enactment ( Guy & Brady, 1998) Detailed discussion about cases (Guy & Brady, 1998; O’Keefe & Mennan, 1998) Small group exercises (O’Keefe & Mennan, 1998)

Discussion about field experiences (O’Keefe & Mennan, 1998) Use of excerpts from popular dramas to illustrate causes of violence and emotions surrounding violence (Rey, 1996) Use of actors, both live and on video, to perform client violence situations in social work situation (Leadbetter & Phillips, 1990)

From www.safetyfundamentals.com

Safety training components
I. Understand where violence comes from (Weinger, 2001): Innate aggression Social learning- We learn from what we see and experience Frustration leads to aggression People behave violently when human needs aren’t met Disequilibrium of power- Reaction to perceived threat Violence occurs in context ( interaction between person’s internal dynamics, the interpersonal situation, and the environmental system)

Safety training components- II
Safety training components- II. Recognition of potentially violent clients (Newhill, 2006; Weinger, 2001) History of violence (most powerful predictor) Mental illness (overall not a good predictor) Schizophrenia (especially those with persecutory delusions; command hallucinations of violent types) Antisocial personality disorder Borderline personality disorder Mood disorder Mania Panic disorder

Safety training components- II. Recognition of potentially violent clients (Newhill, 2006; Weinger, 2001) Mental illness- Those with violent fantasies, especially if they have engaged in activities that reinforce the fantasies. High levels of hostility/suspicion/ agitation/ thought disorders= likely violence, regardless of disorder

Safety training components- II. Recognition of potentially violent client (Newhill, Weinger, 2001) Substance abuse Demographics Age15-40 (peak age15-24) Male gender Military or combat experience Situational/environmental stressors Lack of social support

Safety training components-Recognition of potentially violent clients (Newhill, 2006)
Biological Risk Factors Low I.Q. Neurological impairment Family risk factors History of directly experiencing child abuse Witnessing child abuse or domestic violence Excessive punishment Loss of parent Child neglect Hx of mental illness of parent Family’s attitude about violence Removal of family member is imminent

Practice Exercise: Recognizing risks of violence
For each case vignette that you have been given, discuss the following two questions: What risk factors are present? What precautionary measures would you take? (Vignettes and questions are from Weinger (2001). Security risk: Preventing client violence against social workers. )

Safety training components- III
Safety training components- III. Social worker’s self awareness concerning violence Understanding of how violence may affect victims (O’Keefe & Mennan, 1998) Learning how to cope actively with stresses Managing feelings that can arise when working with victims and perpetrators (O’Keefe & Mennan, 1998; Rey, 1996) Examining one’s own value system around violence (O’Keefe & Mennan, 1998)

Gaining ability to manage one’s own anger
Safety training components- III. Social worker’s self awareness concerning violence Understanding how one’s own culture impacts victim’s exposure to violence (O’Keefe & Mennan, 1998; Adamson, 2006; Ringstad, 2005) Gaining ability to manage one’s own anger (Reeser & Wertkin, 2001) Understanding personal rights in the workplace ( for example, right to refuse to make a home visit or to request to be accompanied by a coworker) (Faria & Kendra, 2007)

Safety training components- III
Safety training components- III. Social worker’s self awareness concerning violence Be aware of bodily symptoms (Kaplan & Wheeler, 1983) Inform other staff members of behaviors that may upset you (Kaplan & Wheeler, 1983). Develop comfort in asking for help or relief when managing violent behavior in a client

Practice exercise: Self awareness concerning violent incidents
Rank the stimuli that would be likely to evoke an emotional response in you (1= most likely to evoke a response 10= least likely to evoke a response) Using chart, identify what your behavioral response might be to the given circumstances Also list the intensity of your response to each circumstance (stimulus) (Rage scale from Kaplan & Wheeler (1983))

Sample personal rage scale
Stimulus Behavioral Response to Stimulus Intensity of Response Person attacking wife and kids Murder 100% Physically threatening gestures to me or family Severe injury upon another 90% Spitting at me Hit 80% Attempts to strike me Make threatening gestures 70% Verbal abuse towards me Yell obscenity 60% Fighting between 2 peers Give direct orders to stop 50% Continuance of annoying behavior Leave/have person leave 40% Continued failure to respond Verbally tell person 30% Misuses property Take something away 20% Fails to respond to directions Show that I’m upset with a frown 10%

Safety training components- IV. Understanding dynamics of violence
Understanding the prevalence of different forms and types of violence (Digiulio, 2001; O’Keefe & Mennan, 1998; Rey, 1996; Reeser & Wertkin, 2001) Understanding the use and misuse of power Recognizing theories of violence and having ability to apply those theories (O’Keefe & Mennan, 1998; Rey, 1996)

Safety training components- IV
Safety training components- IV. Understanding dynamics of violence Cycle of Violence Triggering Phase Escalation Phase Crisis Phase Recovery Phase Post Crisis Phase

Understanding the cycle of violence (Kaplan & Wheeler, 1983) Triggering phase- The client’s first move away from baseline behavior is the beginning of this phase. Indicative a client’s discomfort. Key is to know the client, so that this phase can be recognized. Escalation phase Takes client to assaultive behaviors Behavioral symptoms become more noticeable Ability to respond rationally declines Staff must take first action to curb behaviors

Understanding the cycle of violence (Kaplan & Wheeler, 1983) Crisis phase Becomes increasingly aroused Less capable of controlling impulses Moves into directly assaultive behavior Top concern must be for the safety and protection of the social worker Recovery phase Gradual return to baseline behavior Most errors are made here Clinicians may discount the function of the adrenaline, which may remain active for up to 90 minutes Client should determine the pace of the intervention It helps to reassure the client of their safety at this point.

Post crisis depression phase Client regresses to less than baseline behavior Mentally and physically exhausted Remorseful, tearful, distraught, feelings of shame Client can begin to return to the environment as a functional member.

Safety training components- V
Safety training components- V. Using verbal communication to diffuse violent situations Communicate acceptance, respect, empathy Respond succinctly Encourage problem solving Redirect Eliminate aggressive responses ( being non- confrontive) (Weinger, 2001)

Safety training components- V. De-escalation using verbal communication
Set appropriate limits Clients may fear losing control Clarify limits (“It’s okay to be angry, but it is not okay to strike out at someone”) Set firm limits Sometimes ask or tell the client directly and repeatedly (“Put the chair down”)

Safety training components- V. De-escalation using verbal communication
Stay calm Speak: Evenly Slowly Neutral voice Alter the environment Suggest that the client leave the immediate area Leave the room with the client Have a snack (Weinger, 2001)

Physical approach (Weinger, 2001)
Safety training components- De-escalation using nonverbal communication Physical approach (Weinger, 2001) Approach from an angle Don’t isolate yourself Don’t turn your back Maintain appropriate distance (Give the client 5x the physical space that you might normally give)

Practice exercise: How much physical space does a potentially violent client need?
With a partner, demonstrate how much physical space that you personally need. Then, demonstrate what 5 times that space would look like.

Safety training components- De-escalation using nonverbal communication
Physical approach Feet apart (hips’ width) One foot extended more in front than the other Don’t touch! Mirror body language Do not cross arms; rather, allow arms to hang relaxed at your side

Safety training components- V. De-escalation using nonverbal communication (Newhill, 2006) Pay attention to how you are dressed Not too tight Not too revealing or provocative Avoid loose or dangling earrings Remove neckties Avoid high heeled shoes

Safety training components- V. De-escalation using nonverbal communication Eye contact Avoid staring Make enough eye contact to convey interest (Weinger, 2001) Try to look at a point between his/her eyes (Newhill, 2006)

Practice exercise: Role play vignettes of interactions of potentially violent clients
With a partner and one observer, role play a vignette of a violent/potentially violent interchange. First role play how not to respond to the client Then role play how to respond to the client

Practice exercise: Role play vignettes of interactions of potentially violent clients
What were the cues that the “client” might become physically aggressive? At what phase did the worker first intervene to interfere with the assault cycle? What did the worker do (verbally and/or non verbally) to attempt to diffuse the situation? What was the effectiveness of these interventions?

Creating safe office space
Interview room should be in a safe location and designated with safety in mind Room should be quiet Painted neutral colors Not too dim or too bright (Kaplan & Wheeler, 1987; Newhill, 1996)

Interview options, from least restrictive to most restrictive: Interviewing client alone in office with door closed Interviewing client alone in office with door open Interviewing client alone in the office with door open and staff members present outside the office Interviewing the client with staff members present inside the office Interviewing the client while the client is in physical restraints (Tardiff, 1996) Generally, interview clients in the least restrictive office environment that will also ensure your safety and theirs

Consider installing alarm systems and other security devices Panic buttons Hand-held or mounted buzzers Cell phone Intercom Predetermined signals (Weinger, 2001)

Evaluate all of the furnishings in the room Avoid having heavy objects that can be thrown and used as weapon Methods of calling for help should be established and routinely reviewed/ Planning for “what if” situations need to be an ongoing part of staff meetings/training (Newhill, 2006; Weinger, 2001)

Practice exercise: Evaluating your own office setting
How risky is your own practice setting? Evaluate the physical environment of your office. What modifications are needed? (From Newhill, C. (2006). Client violence in social work practice: Prevention, intervention, and research)

Safety during home visits
Know your client Review case file –pay particular attention to history of violence and risk factors for violence (Newhill, 2006) Is there anything today that might increase the possibility of the client acting violently? (Davies, 1989)

Know the environment Find out what you can about potentially dangerous neighborhoods Find out potential dangers in a home , including finding out who will be there Consider the time of day- Refrain from going after office hours or after dark, particularly if there are other danger signal

Know the environment Find out if there are dangerous animals (Scalera, 1995) Find out about entrances and exits, if possible (Davies, 1989)

Do advanced preparation If there is question about safety, consider meeting the client in the office or a public place (Rey, 1996) Consider going with another team member or supervisor, if there is a question about safety. If necessary, request escort from police officer (Newhill & Wexler, 1997; Rey, 1996; Weinger, 2001) Make sure your car is in working order; Do you have gas in your vehicle???

Do advanced preparation Program emergency contact numbers into your cell phone (Scalera, 1995) Keep car locked (Newhill, 2006) Lock all valuables in the trunk- do not wait until you are in front of the house!! (Newhill, 2006)

Do advanced preparation Don’t leave anything within view inside the car that might tempt someone to break in (Newhill, 2006) Plan your route-minimize chances of getting lost (Newhill, 2006)

Do advanced preparation Dress appropriately – Professionally attired, yet not intimidating (Avoid wearing expensive clothing) Avoid wearing lots of jewelry or expensive jewelry Don’t carry your credit cards or check book

Do advanced preparation Carry only your I.D., keys, and items necessary to complete your assessment/intervention into the visit Do not take your purse into the home If people are loitering outside of the home and seem threatening, leave and return at another time (Newhill, 2006; Weinger, 2001)

Advanced preparation Park where you can get out easily

Plan for connection with your agency Charge your cell phone Before you leave the office, sign out- make sure that others know where you are

Conduct during visit Clearly identify yourself Note exits; Sit in the front room, next to the door Walk confidently-look alert and aware

Conduct during the visit Don’t interview people in the kitchen or bedrooms Don’t interview people in rooms where you can be boxed in Don’t interview people in a room where you do not have ready access to an outside exit

Conduct during home visit Know when to back off or take a time out Stay aware of people in the vicinity Terminate visit if things seem to be getting out of hand

Practice exercise: Safety during home visits
Referring to the information on home visit safety, discuss with your small group how each guideline affects the way that you conduct your practice (i.e. which safety considerations do you currently have/ not have). What other suggestions do you have for safety during home visits? What changes could be made at your agency to improve worker safety during home visits?

What to do when violence has occurred (Weinger, 2001)
Admit that the violence occurred. Crisis intervention- within hours Verbalize Normalize Alert worker to possible crisis reactions Talk about coping strategies Opportunity to work through feelings and reactions

Remove the stigma of seeking support Counseling for others: Family Clients Co-workers Organizational review of the incident

Practice exercise: What to do when a violent incident has occurred
Read the The Case of C (Newhill, 1995) Then respond to the questions on the handout regarding the possible feelings of the victim and possible workplace responses. (From Weinger, 2001)

Support for the victim from other staff members Incident report writing

Practice exercise: Using incident report forms
Look over the three incident report forms that are provided. Choose the form that seems most comfortable for you to use. Attempt to fill out the form, discussing a serious client violent incident that occurred to you or another worker that you know How could the form(s) be changed to more fully document the incidents? (Forms are from OSHA and Newhill’s(2006) book)

Implications for social work practice

Implications for Social Work – Micro level planning and intervention
Safety training for individual social workers Individual debriefing and support to social workers in the event that violence has occurred 3) Provide support to individuals when there is vicarious exposure to violence or fear of client violence

Need for systemic intervention
“ Rather than hunt for a few supposed “bad apples” in the barrel, we ought to examine the barrel itself, recognizing that violence is ultimately the product of social or organizational change and other factors that leave the workplace environment potentially volatile.” (Denenburg & Braverman, 1999)

Mezzo level interventions
Use of small group format to process when when incidents have occurred in an agency (i.e. Critical Incident Stress Debriefing (CISD) In social work education, use of field seminar to educate and support students when violence has occurred to one of the students or in a field agency

Macro level interventions
The agency’s response to a crisis may determine a more negative impact than the incident itself . “We individualize the impact of stress and trauma at our own peril.” (Adamson, 2006, p. 58)

Implications for Social Work- Macro level planning and intervention
Agency safety policies and procedures Plan for prevention/reduction of workplace violence Zero tolerance for violence (Reeser & Wertkin, 2001) Clear protocol for handling potentially violent and dangerous situations (Jayarante et al., 2004) Formal process for reporting violence (Jayarante et al., 2004) Consideration of temporary relief of duty or decreasing the workload and/or encouraging staff to seek medical attention, as necessary (Snow, 1994) Agencies should offer safety training update at least annually.

Practice exercise: Awareness of Workplace Safety Plans
See OSHA and Newhill’s (2006) suggested workplace safety guidelines

Macro level interventions for social work education programs
Infuse social work safety content across the curriculum (minimally in practice classes and field seminar) Field agency selection (Use only agencies that have written safety policies and procedures) Safety training for field educators (see handout)

Macro level interventions for social work education programs
Written safety policies in social work education programs Include a clear definition of client violence (Faria & Kendra, 2007) b) Obtain students’ informed consent regarding possible harmful situations in the field (Zakutansky & Sirles, 1993) Formal reporting system- Incidents (including threats) must be reported to both the field educator and the field faculty (Ellison, 1996; Faria & Kendra, 2007; Horejsic & Garthwait, 1994; Ringstad, 2005) d) Requirement to maintain record of client assaults to social work students (Mama, 2001; Ringstad, 1995).

Implications for Social Work - Macro level planning and intervention
Support federal/state policies on social work safety Risk management concerns- Get legal experts to review social work program safety policies and procedures

Teri Zenner Social Work Safety Act
Support for federal/state legislation that advocates for social work safety Federal policy- None exists to date 2007- U.S. Congressman Dennis Moore proposed a bill that would award grants to states to provide safety measures such as: GPS tracking devices Facilities safety improvements Safety training for social workers and other helping professionals Please support: Teri Zenner Social Work Safety Act

Support for federal/state legislation that advocates for social work safety
State policies on social work safety: Policies have been discussed in Michigan, Washington, Kansas, Kentucky, West Virginia (All of these are states where social workers have cruelly died and/or were severely injured)

Kansas-First in the nation to require safety training for social workers- 4/8/10
The new law requires new social workers to take at least six hours of personal safety training as part of the 40 hours of continuing education required for all first-time license renewals. Most social workers will get the training soon after graduating with a social work degree.

Comment of Kansas Gov. Parkinson, upon signing social work training legislation
“Social workers undertake one of the hardest, and sometimes, one of the most dangerous jobs for our state. They take on this challenge because, ultimately, they want to help Kansans,” said Parkinson. “Unfortunately, it took the tragedy of Teri Zenner’s death to remind us about the importance of protecting the livelihood of our social workers. However, I am pleased to sign this legislation so they can continue the important work they are doing for Kansans with a better sense of safety and security.”

Comment of Teri’s husband, Matt Zenner, upon the signing:
Teri’s husband, Matt Zenner, attended the signing of the legislation with Governor Parkinson. “I was told by investigators that, had Teri had some type of safety training, she likely would be here today practicing social work. She is not here, but her colleagues are,” said Zenner. “There are over 6,000 social workers licensed in Kansas. Every year there are about 500 to 600 social work students graduating and becoming social workers. Today, I feel hopeful and sure that they will have long careers helping others.”

Comment of Teri’s dad Teri Zenner’s father, Andy Mathis of Gardner, said more needs to be done to protect social workers. But he called today’s new law a critical step. “It means that Teri didn’t give her life in vain,” he said. “It’s been a long time coming.”

Risk Management “Risk management means prevention, early detection, and immediate intervention in injurious situations in the organization, in order to eliminate or minimize the risk of human harm or loss of resources.” (Nuehring & Houston, 1992, p. 58) Financial liabilities may exist when workers’ safety needs have not been adequately anticipated

Precedent for agencies/schools who may not adequately attempt to protect their social workers or students 1995 Florida case – Nova Southeastern vs. Jill Gross, S.C. Case No. 94, 079 23 yr old female doctoral student placed at a field agency that she knew to be in a dangerous neighborhood Given a manual which included safety precautions/ suggestions that she use a buddy system when leaving the building She was robbed and raped in the parking lot of the agency

Precedent for agencies/schools who may not adequately attempt to protect their social workers or students Filed suit against the agency and the school Agency settled out of court for $900,000

Maintaining commitment to protection of social workers
We must avoid complacency. “The moral is that preventing violence in the workplace is not about putting out fires or simply attending to the needs of the victims. Ultimately, true prevention results from the ability to undergo an enduring change of outlook…” (Denenbeurg & Braverman, 1999)

In Memory- Social workers who have given their lives in the course of duty
Teri Zenner, Kansas Killed 8/17/04 26 yrs. old, graduate student at University of Kansas, died making a home visit to a mentally ill 17 yr. old Boni Frederick, Henderson, Ky Killed 10/17/06 67 years old Killed by a mother and her boyfriend, when she took a 9 month old child to visit his mother

Greg Gaul, Des Moines, Iowa yrs old Killed by a 16 yr. old client Brenda Lee Yeager, Huntington, West Virginia 51 years old, Died 7/30/06 Killed while on a home visit

Nancy Fitzgivens, Columbus, Ohio 53 years old (social worker for 2 years) Killed during home visit

In Memory… Donna Millette-Fridge, 36, New London, Connecticut. Stabbed by a client while walking to work at a community mental health outreach program, Sept. 22, 1998. Steven Tielker, 41, Fort Wayne, Indiana. Shot by a client on probation for child molestation, April 28, Tielker, a Family and Children’s Services supervisor, counseled both victims and perpetrators of sexual abuse. The client, whom he was counseling under court order, also fatally shot a probation officer before taking his own life. Rebecca Binkowski, 25, Kalamazoo, Michigan. Stabbed in her car by a tenant at an apartment complex for persons with mental illness, where she worked as a resident manager, February 3, A graduate student at Western Michigan University, Binkowski was awarded her master’s degree in social work posthumously. Barbara Synnestvedt, 46, Whitmore Lake, Michigan. Beaten and strangled by a teenage inmate and sex offender at a juvenile detention center, April 25, Synnestvedt worked at the W.J. Maxey Training School. (From NASW News)

Contact Information: Pam Criss, PhD, LCSW Southeastern University 1000 Longfellow Blvd Lakeland, Florida

Prevalence and Effects of Client Violence on Social Workers: Implications for Keeping Social Workers Safe National Association of Social Workers Florida.

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