Presentation on theme: "Prevalence and Effects of Client Violence on Social Workers: Implications for Keeping Social Workers Safe National Association of Social Workers Florida."— Presentation transcript:
1Prevalence and Effects of Client Violence on Social Workers: Implications for Keeping Social Workers SafeNational Association of Social WorkersFlorida ConferenceJune 11, 2010Pam Criss, PhD, LCSWSoutheastern University
2Purposes of TrainingTo understand what personal and organizational factors may be related to client violence toward social workersTo discover how social workers are affected when they have encountered client violenceTo 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
3U.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.
4Reasons for increased risk to mental health professionals Increased use of hospitals for the care of acutely disturbed individualsIncreasing numbers of chronically mentally ill people being released from hospitals without follow up careLong waits for agency servicesLow staffing ratesLow staffing rates may lead to working in isolation in agencies (OSHA, 2004)
5Reasons for increased violence towards mental health professionals Solo work at remote locationsPrevalence of handgunsIncreased membership in gangsIncreased presence of drugs and alcohol(OSHA, 2004)
6Reasons for increased violence towards social workers (Weinger, 2001) Cuts in services/provisionsIncreasing violence in societySocial 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
7Reasons 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?)
8NASW 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 safetyThe report concludes that “ a profession cannot successfully retain its workforce when issues of personal safety go unaddressed” (p. 35).
9Prevalence 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).
10Practice 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.
11Client 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).
12Client Violence towards Social Work Students (Criss, 2009) ParticipantsRandom sample of 1500 social work students from NASW national membership, with equal numbers of BSW and MSW studentsOversampled students of ethnic/racial minority groups – 1/3 of BSW and MSW students45.25% response rate (N = 667)595 students met inclusion criteria (completed or currently in field placement)
13Prevalence 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 violenceRate of Client Violence by Type of Violence(N= 589)%nVerbal abuse37.5223Threat of physical harm14.184Threat of lawsuit9.456Property damage7.243Physical assault3.221
14Total Number of Incidents of Client Violence Towards Social Work Students Sum ofincidents% of total incidentsVerbal abuse75968.75%Threat of physical harm16114.58%Threat of lawsuit797.15%Property damage776.97%Physical Assault282.53%Total incidents110499.98%
15Vicarious 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.
16Prevalence of Indirect Exposure to Client Violence towards Social Work Students 60.2% (n = 361) Witnessed and/or heard about some type of client violenceType of Client Violence%nVerbal abuse54.1322Threat of physical harm36.8219Physical assault23.4139Threat of lawsuitProperty damage20.5122
17Total Number of Indirect Incidents of Client Violence Experienced by Social Work Students (n = 361) Sum of indirect incidents% of total incidentsVerbal abuse185251.40Threat of physical harm75120.70Physical assault38810.46Property damage3248.91Threat of lawsuit3098.52Total indirect incidents360399.9
18Failure 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).
19Reasons for failing to report violence Concern about how the worker will be perceived by co-workers and supervisorsFear of criticism, rather than supportFear 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)
20Reasons for failure to report violence Perception that violent incidents are part of the jobTendency 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)
21Reasons for failure to report violence 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).
22Reasons for failure to report violence 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).
23Which gender of social workers experiences more client violence?
24Prevalence 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)
25Male 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 ViolenceGenderMeant-valuepPhysical assaultFemale.04-1.36.179Male.12Threat of physical harm.21-3.24.002***.69Verbal abuse1.05-2.20.031*3.09Threat of lawsuit.13-1.01.314.19Property damage-22.214.171.124Total client violence1.59-2.45.017*4.32
26Do older social workers or younger social workers experience more client violence?
27Prevalence 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 threatsYounger student social workers more likely to view social work as a dangerous profession and expressed some discomfort working in inner city (Knight, 1996)
28In 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 CategoriesPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolenceMSDUnder age 25(n = 145).126.96.36.199.841.84.08.31.06.291.272.60Age 25-30(n = 162).03.26.391.051.5188.8.131.52.13.522.355.55Over age 30(n = 285).05.25.751.3184.108.40.206.16.671.894.90F = .710F = 2.26F = 1.48F = 4.01F = 1.61F = 2.03p = .491p = .106p = .229p = .019*p = .201p = .132
29Do more experienced workers or less experienced workers have more exposure to client violence?
30Prevalence 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)
31Prevalence 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)
33Student 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 CategoriesPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolenceMSDNo experience(n = 292).03.22.19.71.881.87.09.30.10.471.292.661-2 years’experience(n = 89).04.21.33.941.2220.127.116.11.18.702.003.973-5 years’(n = 82).46.372.076.21.15.61.582.857.246-10 years’Experience(n = 66)1.061.212.26.20.59.521.863.58F = 1.38F = 1.65F = 3.01F = 1.53F = .75F = 3.45p = .247p = .177p = .030*p = .205p = .520p = .016*Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
34Do social workers of minority ethnic groups or races experience more client violence than white social workers ?
35Prevalence 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)
36Prevalence 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)
37Native 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 SettingPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolenceMSDLatino/Hispanic(n = 25).00.20.65.801.32.58.041.242.06NativeAmerican(n = 13).18.104.22.1686.6114.80.08.28.381.127.9218.01White(n = 425).27.822.214.171.124.13.541.804.42Asian(n = 5).601.3126.96.36.199.453.003.74Black(n = 98).24.25.861.252.80.09.35.311.703.43MixedHeritage(n = 19).188.8.131.521.572.46.471.262.52F = 1.14F = .38F = 5.43F = 3.54F = 2.59F = 4.26p = .339p = .858p = .000***p = .004***p = .025*p = .001***Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
38Do BSWs or MSWs experience more client violence?
39Prevalence 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)
40MSW 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 ViolenceGenderMeant-valuepPhysical assaultMSW.031.42.156BSW.07Threat of physical harm.35-2.77.004***.17Verbal abuse1.52-1.94.053*.96Threat of lawsuit.16-1.77.077.09Property damage.13.22.826.14Total client violence2.24-1.96.031*1.50Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
41Does client violence occur more often in an office, at a home visit or in some other place?
42Prevalence 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 homeProperty damage- OfficeActual attacks- Wide array of places(Newhill & Wexler, 1997)
43Prevalence 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)
44Client 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)
45Every 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 ViolencePhysical AssaultThreatened Physical HarmVerbal AbuseThreatened LawsuitProperty DamageTotal Client Violence%nHome visit11.8224.72026.95715.788.1323.4148Office41.2754.34451.410958.83070.32654.464Other47.121.01721.74625.51321.622.662
46Of 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 MadePhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolenceMSD1-5 home visits(n = 84).02.15.53.851.73.06.24.13.651.212.276-10 home visits(n = 55).07.33.16.60.7184.108.40.2061.102.3111 or more home visits(n = 177).08.38.401.091.3220.127.116.11.662.244.17F = .86F = 2.71F = 2.00F = 4.57F = .46F = 3.71p = .422p = .068p = .137p = .011**p = .632p = .027*Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
47What time of day is client violence more likely to occur to a social worker?
48Time 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)
49Social work students experienced client violence much more often during daytime hours. Practicum Exposure Rate to Client Violence per Time of DayTime of ViolencePhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client Violence%nDaytime76.51371.85671.615182.04271.42569.69184Evening23.5524.41926.513.7725.7926.1369Early morning3.831.943.922.914.1611
50Those 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 EveningHours WorkedPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolenceMSDNo evening hours(n = 197).04.23.24.801.318.104.22.168.591.896.241-25% evening hours(n = 253).05.28.741.082.38.16.54.141.683.2926-50% evening hours(n = 65).02.32.831.072.03.09.34.381.602.7751-75% evening hours(n = 43).57.531.322.214.171.124.203.025.8676-100% evening hours(n = 30).00.681.473.08.552.103.84F = 2.34F = 1.35F = 81F = .54F = .30F = .83p = .054*p = .250p = .520p = .704p = .881p = .501Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
51In what practice settings is client violence most likely to occur to a social worker?
52Practice 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 abused60% said it was a daily occurrence
53Seattle Times, by Jonathan Martin Social worker, Edith Vance, 52 yrs Seattle Times, by Jonathan Martin Social worker, Edith Vance, 52 yrs. old, WashingtonFather slain after machete attack on social workerA 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.
54Ms. Vance’s advocacy to the Washington state legislature by Rachel LeCort, Associated Press, Vancouver, WA 3/25/05OLYMPIA 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.
55Practice settings noted to have higher prevalence of client violence 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
56Practice settings noted to have higher prevalence of client 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)
57Practice settings noted to have higher prevalence of client violence 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
58National study of violence towards school social workers (Astor, Behre, Fravil, Wallace, 1997; Astor, Behre, Wallace, Fravil, 1998)576 school social workersMore than 70% reported that potentially life threatening events occurred in their schools in the past yearYet, only 20.5% said that violence was a big or very big problem in their school(s)
59Study 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 violence35% physically assaulted or physically threatened within the past yearOf those:77% identified assailant as student49% identified assailant as a parent
60Practice settings noted to have higher prevalence of client violence Any residential setting (Brockman, 2002; Leadbetter, 2003; Ringstad, 2005)Children’s residential group care may be dangerous
61Students 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 SettingPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client Violence%nMedical/Health2.829.9739.42811.381.4143.731Alcohol/Substance abuse7.1314.3650.02116.752.522Developmental disabilities13.320.046.76.753.3Corrections/Criminal Justice2.613.2536.81410.547.942.116Community Organization5.318.420.5Child & Family/ChildProtection2.99.61030.83214.4155.838.540Family services2.015.739.2209.85.937.319Schools4.319.6937.0176.58.740.4Services to theAging7.314.634.12.4Mental health/Psychiatric3.023.02347.0479.014.054.5X2 = 9.67X2 = 13.60X2 = 15.45X2 = 12.47X2 = 15.62X2 = 19.17p = .470p = .192p = .117p = .254p = .111p = .038*Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
62Social 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
63Predicting Occurrence of Client Violence Model Summary for Predictors of Occurrence of Overall Client Violence Coefficient for Final Model of Occurrence of Overall Client ViolenceStepFactorsRR2R2adj∆ R2Fchgpdf1df21Male.173.030.02815.66.0005072Mental health setting.208.043.039.0136.98.008506311 or more home visits.231.053.048.0105.48.0205054Alcohol/substance abuse setting.251.063.0565.14.024504FactorBβtpBivariate rPartial rMale.201.1252.84.005.151.126Mental health setting.135.1082.43.015.10911 or more home visits.1152.48.014.098.110Alcohol/substance abuse setting.206.1063.37.018.085.105
64Predictors of Physical Assault towards Social Work Students: having more field agency training, particularly in self defense topicsworking in a developmental disability settingOther factors associated with physical assault:being aged 25-30working increased (51-75%) evening hours
65Predictors of Threat of Physical Harm towards Social Work Students being maleworking in a mental health practice settingOther factors associated with increased threats of physical harm:being of mixed ethnic/racial heritagebeing an MSW studenthaving more field agency training
66Predictors of Verbal Abuse towards Social Work Students being maleinterning in a mental health settingmaking 11 or more home visits,interning in an alcohol/substance abuse setting.Other factors associated with verbal abuse of students:Native AmericanMSW studenthaving 3-5 years’ experiencereceiving more training in field seminar, the field agency and sources other than the social work program
67Predictors of Threat of Lawsuit towards Social Work Students being years oldbeing of mixed ethnic heritagemaking more home visitsinterning in an alcohol/substance abuse settingAdditional factors associated with threat of lawsuit:having more field agency training
68Predictors of Property Damage towards Social Work Students being maleworking in a mental health/psychiatric settingOther factors associated with property damage:Being of mixed racial heritagehaving more field agency training
70Effects 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) .
71From Brady, C. Surviving the incident Possible reactions following assaultImmediately following assaultIn the days following assault (24-72 hours)In the long termPhysical painShakingCryingFearShockDisbeliefConfusionEmbarrassmentAngerFeeling “energized”Feeling “ready to work”Anger, resentmentDenial of effectsFeeling of lossGuilt, shame,humiliationPoor concentrationLack of confidenceAnxiety in similarsituationsSleep difficultiesDepressionAttempts to make senseof what happenedSituation specificanxietyFeeling “burned out”Post-traumatic stressdisorder
72Initial Reactions(I was )“shocked, physically shaken, emotionally assaulted. Jumpy and emotionally labile…” (Littlechild, 2005, p. 73)Sense of control is lostAdrenaline surge has depleted the bodyMay 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)
73Longer 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)
74Longer term effects of client violence More caution in practiceLess 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)
75Long term effects of client violence Tendency to “retreat” to administrativepositionsReluctance to visit a client aloneRefusal to work certain shifts alone(Norris, 1990)
76Long term effects of client violence Self blameFeelings ofIncompetenceFailureGuiltShameSense of vulnerabilityAnger toward clients (Mostly unspoken)(Weinger, 2001)
77Long term effects of client violence 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)
78Long term effects of client violence towards students Uncomfortable engaging in all practice activitiesTendency to plan to be in private practice(Knight, 1999)
79Measuring Fear of Future Violence Fear of future violence- Fear that a client violence incident will occur in the futureUsed 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.
80Direct experience of client violence significantly affected fear of future client violence. Physical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolencerpFear of Physical Assault.08.042*--Fear of Threat of Harm.22.000***Fear of Verbal Abuse.13Fear of Threat of Lawsuit.19Fear 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)
81Indirect experience of client violence significantly affected fear of future client violence (Even more so than direct experience of client violence)(Direct Experience)Physical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolencerpFear of Physical Assault.17.000***--Fear of Threat of Harm.23Fear of Verbal Abuse.21Fear of Threat of Lawsuit.29Fear of Property Damage.14.001***Fear of Any Type of Client Violence.27.15Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
82Effects 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 work791 social workers from 21 schools in EnglandVerbal and physical abuse by clients; 92% had been verbally abused, 32% had experienced physical violenceSome of those who had left cited violence as a reason for leaving.
83Effects 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)
84NASW Center for Workforce Studies (2004) 5% of the social work workforce planned to leave the profession of social workThe workers in this group were more likely :to be between the ages of 26 to 34to have a BSW as their highest degreeto be in their first four years of practiceThey were significantly more likely to report that they faced personal safety issues.
85Measuring 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)
86Types 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)
87Relationship between client violence and occupational commitment (DirectExperience)Physical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolencerpAffective Commitment.04.359.03.488.01.910.00.998.02.679.682Normative Commitment.11.011**.05.271.733.572.192.474Continuance Commitment.06.143.384.686-.07.091-.01.776.837Career Withdrawal Intentions-.06.162.839.780.35.944.516.858Note: * p ≤ .05, **p ≤ .01, *** p ≤ .004 (Significant after Bonferroni adjustment)
88There 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 ofPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageFear of Any Client ViolencerpAC-.10.014**-.08.046*-.01.820-.04.285-.07.089.102NC.14.001***.13.002***.18.000***.12.003***.17C C.004***.15Note: * p ≤ .05, **p ≤ .01,*** p ≤ .004 (Significant after Bonferroni adjustment)Note: AC =Affective Commitment; NC = Normative Commitment; CC = Continuance Commitment
90Training on Safety and Violence Time spent in safety training may be limitedNational random study of 1000 social workers:4% recalled receiving training BSW/MSW program3% recalled training at field internship site79% said that they needed more safety training(Newhill, 1996)National study of school social workers:5% recalled receiving training during their social work education62% said that they had training from the school district70% got training at conferences59% said they needed more training on school violence(Astor et al., 1998)
91Training on Safety and Violence 175 social workers:41% had training on predictors of violence2% had training on violence prevention22% had training on home visit safety(Rey, 1996)
92Training 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)
93Social work student training- student perspective Training at field agencies:32% - training on how to handle dangerous situations atthe field agency (Mama, 2001)35%- agency training about predicting violence18%- 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 violence41%- violence prevention43%- threats towards students
94Knowledge 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)
95Social 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)
96Social work student safety training- Field director’s perspectives 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 trainingorb. not all field agencies may be providing training(Reeser & Wertkin, 2001; Faria & Kendra, 2007)
97Social work student safety training- Field director’s perspectives 12% -26% of social work education programs have some type of safety policySome 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)
98Safety 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 situationsCreating safe office spacesHigh-risk practice settingsMaintaining a confident, secure demeanorVerbal de-escalation of a client’s rageHow t0 behave with an angry clientHow to dressHow to sit when interacting with a client
100Percentages of Students Who Had Safety Training Content per Training Venue Social WorkPractice Classes%Field SeminarField AgencyOtherAssessing history of violence in clients33.9 (n=202)8.6 (n=51)27.1 (n=161)14.8 (n=88)Characteristics/life experiences of people more likely to commit violent acts42.2 (n= 251)8.9 (n=53)20.2 (n=120)16.3 (n=97)Forms of mental illness associated with violent behavior55.5 (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 violence51.1 (n=301)20.8 (n=124)28.6 (n=170)18.7 (n=111)Maintaining a confident, secure demeanor52.8 (n=214)26.7 (n=159)33.3 (n=198)22.5 (n=134)Recognizing verbal acts of violence41.8 (n=249)16.1 (n=96)27.2 (n=162)23.5 (n=140)Physical signs that an attack is imminent24.9 (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)
101Percentages of Students Who Had Safety Training Content per Training Venue Social WorkPractice Classes%Field SeminarField AgencyOtherVerbal 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 client58.0 (n=345)26.6 (n=158)19.0 (n= 113)Home visit safety35.5 (n=211)29.9 (n=178)17.3 (n= 103)Keeping supervisor informed of one’s itinerary35.6 (n=212)30.1 (n=179)49.1 (n=292)17.6 (n= 105)Physical techniques for self protection14.5 (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 violence27.6 (n=164)15.3 (n=91)37.8 (n=225)19.3 (n= 115)Knowledge of social work program’s safety policies40.5 (n=241)30.9 (n=184)25.0 (n=149)10.4 (n= 62)Knowledge of field agency’s safety policies16.5 (n=98)15.6 (n=93)67.3 (n=385)6.5 (n= 6.2)
102Is 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
103Study showed that safety training and incidents were positively correlated (i.e. Increased training correlated with increased incidents of violence)Training VenuesPhysical AssaultThreat of Physical HarmVerbal AbuseThreat of lawsuitProperty DamageTotal Client ViolencerpSocial work classes.02.717-.01.848.07.098.947.03.434.06.151Field 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)
104Why 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!)
105What might make safety training more effective? Effective training consists of:Presenting knowledge about a subjectProviding a demonstrationAssuring 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)
106What might make safety training more effective? 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)
107What might make safety training more effective? 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)
109Safety training components I. Understand where violence comes from (Weinger, 2001):Innate aggressionSocial learning- We learn from what we see and experienceFrustration leads to aggressionPeople behave violently when human needs aren’t metDisequilibrium of power- Reaction to perceived threatViolence occurs in context ( interaction between person’s internal dynamics, the interpersonal situation, and the environmental system)
110Safety 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 disorderBorderline personality disorderMood disorderManiaPanic disorder
111Safety training components- II 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
112Safety training components- II Safety training components- II. Recognition of potentially violent client (Newhill, Weinger, 2001)Substance abuseDemographicsAge15-40 (peak age15-24)Male genderMilitary or combat experienceSituational/environmental stressorsLack of social support
113Safety training components-Recognition of potentially violent clients (Newhill, 2006) Biological Risk FactorsLow I.Q.Neurological impairmentFamily risk factorsHistory of directly experiencing child abuseWitnessing child abuse or domestic violenceExcessive punishmentLoss of parentChild neglectHx of mental illness of parentFamily’s attitude about violenceRemoval of family member is imminent
114Practice 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. )
115Safety training components- III Safety training components- III. Social worker’s self awareness concerning violenceUnderstanding of how violence may affect victims (O’Keefe & Mennan, 1998)Learning how to cope actively with stressesManaging 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)
116Gaining ability to manage one’s own anger Safety training components- III. Social worker’s self awareness concerning violenceUnderstanding 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 co- worker) (Faria & Kendra, 2007)
117Safety training components- III Safety training components- III. Social worker’s self awareness concerning violenceBe 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 reliefwhen managing violent behavior in a client
118Practice 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 response10= least likely to evoke a response)Using chart, identify what your behavioral response might be to the given circumstancesAlso list the intensity of your response to each circumstance (stimulus)(Rage scale from Kaplan & Wheeler (1983))
119Sample personal rage scale StimulusBehavioral Response to StimulusIntensity of ResponsePerson attacking wife and kidsMurder100%Physically threatening gestures to me or familySevere injury upon another90%Spitting at meHit80%Attempts to strike meMake threatening gestures70%Verbal abuse towards meYell obscenity60%Fighting between 2 peersGive direct orders to stop50%Continuance of annoying behaviorLeave/have person leave40%Continued failure to respondVerbally tell person30%Misuses propertyTake something away20%Fails to respond to directionsShow that I’m upset with a frown10%
120Safety 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 powerRecognizing theories of violence and having ability to apply those theories (O’Keefe & Mennan, 1998; Rey, 1996)
121Safety training components- IV Safety training components- IV. Understanding dynamics of violence Cycle of ViolenceTriggering PhaseEscalation PhaseCrisis PhaseRecovery PhasePost Crisis Phase
122Safety training components- IV. Understanding dynamics of violence 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 phaseTakes client to assaultive behaviorsBehavioral symptoms become more noticeableAbility to respond rationally declinesStaff must take first action to curb behaviors
123Safety training components- IV. Understanding dynamics of violence Understanding the cycle of violence (Kaplan & Wheeler, 1983)Crisis phaseBecomes increasingly arousedLess capable of controlling impulsesMoves into directly assaultive behaviorTop concern must be for the safety and protection of the social workerRecovery phaseGradual return to baseline behaviorMost errors are made hereClinicians may discount the function of the adrenaline, which may remain active for up to 90 minutesClient should determine the pace of the interventionIt helps to reassure the client of their safety at this point.
124Safety training components- IV. Understanding dynamics of violence Post crisis depression phaseClient regresses to less than baseline behaviorMentally and physically exhaustedRemorseful, tearful, distraught, feelings of shameClient can begin to return to the environment as a functional member.
125Safety training components- V Safety training components- V. Using verbal communication to diffuse violent situationsCommunicate acceptance, respect, empathyRespond succinctlyEncourage problem solvingRedirectEliminate aggressive responses ( being non-confrontive)(Weinger, 2001)
126Safety training components- V. De-escalation using verbal communication Set appropriate limitsClients may fear losing controlClarify limits (“It’s okay to be angry, but it is not okay to strike out at someone”)Set firm limitsSometimes ask or tell the client directly and repeatedly (“Put the chair down”)
127Safety training components- V. De-escalation using verbal communication Stay calmSpeak:EvenlySlowlyNeutral voiceAlter the environmentSuggest that the client leave the immediate areaLeave the room with the clientHave a snack(Weinger, 2001)
128Physical approach (Weinger, 2001) Safety training components- De-escalation using nonverbal communicationPhysical approach (Weinger, 2001)Approach from an angleDon’t isolate yourselfDon’t turn your backMaintain appropriate distance(Give the client 5x the physical space that youmight normally give)
129Practice 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.
130Safety training components- De-escalation using nonverbal communication Physical approachFeet apart (hips’ width)One foot extended more in front than the otherDon’t touch!Mirror body languageDo not cross arms; rather, allow arms to hang relaxed at your side
131Safety training components- V Safety training components- V. De-escalation using nonverbal communication (Newhill, 2006)Pay attention to how you are dressedNot too tightNot too revealing or provocativeAvoid loose or dangling earringsRemove necktiesAvoid high heeled shoes
132Safety training components- V Safety training components- V. De-escalation using nonverbal communicationEye contactAvoid staringMake enough eye contact to convey interest(Weinger, 2001)Try to look at a point between his/her eyes(Newhill, 2006)
133Practice 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
134Practice 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?
135Creating safe office space Interview room should be in a safe location and designated with safety in mindRoom should be quietPainted neutral colorsNot too dim or too bright(Kaplan & Wheeler, 1987; Newhill, 1996)
136Creating safe office space Interview options, from least restrictive to most restrictive:Interviewing client alone in office with door closedInterviewing client alone in office with door openInterviewing client alone in the office with door open and staff members present outside the officeInterviewing the client with staff members present inside the officeInterviewing 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
137Creating safe office space Consider installing alarm systems and other security devicesPanic buttonsHand-held or mounted buzzersCell phoneIntercomPredetermined signals(Weinger, 2001)
138Creating safe office space Evaluate all of the furnishings in the roomAvoid having heavy objects that can be thrown and used as weaponMethods 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)
139Practice 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)
140Safety during home visits Know your clientReview 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)
141Safety during home visits Know the environmentFind out what you can about potentially dangerous neighborhoodsFind out potential dangers in a home , including finding out who will be thereConsider the time of day- Refrain from going after office hours or after dark, particularly if there are other danger signal
142Safety during home visits Know the environmentFind out if there are dangerous animals (Scalera, 1995)Find out about entrances and exits, if possible (Davies, 1989)
143Safety during home visits Do advanced preparationIf 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???
144Safety during home visits Do advanced preparationProgram 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)
145Safety during home visits Do advanced preparationDon’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)
146Safety during home visits Do advanced preparationDress appropriately – Professionally attired, yet not intimidating (Avoid wearing expensive clothing)Avoid wearing lots of jewelry or expensive jewelryDon’t carry your credit cards or check book
147Safety during home visits Do advanced preparationCarry only your I.D., keys, and items necessary to complete your assessment/intervention into the visitDo not take your purse into the homeIf people are loitering outside of the home and seem threatening, leave and return at another time(Newhill, 2006; Weinger, 2001)
148Safety during home visits Advanced preparation Park where you can get out easily
149Safety during home visits Plan for connection with your agencyCharge your cell phoneBefore you leave the office, sign out- make sure that others know where you are
150Safety during home visits Conduct during visitClearly identify yourselfNote exits; Sit in the front room, next to the doorWalk confidently-look alert and aware
151Safety during home visits Conduct during the visitDon’t interview people in the kitchen or bedroomsDon’t interview people in rooms where you can be boxed inDon’t interview people in a room where you do not have ready access to an outside exit
152Safety during home visits Conduct during home visitKnow when to back off or take a time outStay aware of people in the vicinityTerminate visit if things seem to be getting out of hand
153Practice 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?
154What to do when violence has occurred (Weinger, 2001) Admit that the violence occurred.Crisis intervention- within hoursVerbalizeNormalizeAlert worker to possible crisis reactionsTalk about coping strategiesOpportunity to work through feelings and reactions
155What to do when violence has occurred (Weinger, 2001) Remove the stigma of seeking supportCounseling for others:FamilyClientsCo-workersOrganizational review of the incident
156Practice 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)
157What to do when violence has occurred (Weinger, 2001) Support for the victim from other staff membersIncident report writing
158Practice 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 knowHow could the form(s) be changed to more fully document the incidents?(Forms are from OSHA and Newhill’s(2006) book)
160Implications for Social Work – Micro level planning and intervention Safety training for individual social workersIndividual debriefing and support to social workers in the event that violence has occurred3) Provide support to individuals when there is vicarious exposure to violence or fear of client violence
161Need 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)
162Mezzo 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
163Macro 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)
164Implications for Social Work- Macro level planning and intervention Agency safety policies and proceduresPlan for prevention/reduction of workplace violenceZero 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.
165Practice exercise: Awareness of Workplace Safety Plans See OSHA and Newhill’s (2006) suggested workplace safety guidelines
166Macro 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)
167Macro level interventions for social work education programs Written safety policies in social work education programsInclude 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).
168Implications for Social Work - Macro level planning and intervention Support federal/state policies on social work safetyRisk management concerns- Get legal experts to review social work program safety policies and procedures
169Teri Zenner Social Work Safety Act Support for federal/state legislation that advocates for social work safetyFederal policy- None exists to date2007- U.S. Congressman Dennis Moore proposed a bill that would award grants to states to provide safety measures such as:GPS tracking devicesFacilities safety improvementsSafety training for social workers and other helping professionalsPlease support:Teri Zenner Social Work Safety Act
170Support 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)
171Kansas-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.
172Comment 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.”
173Comment 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.”
174Comment of Teri’s dadTeri 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.”
175Risk 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
176Precedent for agencies/schools who may not adequately attempt to protect their social workers or students1995 Florida case – Nova Southeastern vs. Jill Gross, S.C. Case No. 94, 07923 yr old female doctoral student placed at a field agency that she knew to be in a dangerous neighborhoodGiven a manual which included safety precautions/ suggestions that she use a buddy system when leaving the buildingShe was robbed and raped in the parking lot of the agency
177Precedent for agencies/schools who may not adequately attempt to protect their social workers or studentsFiled suit against the agency and the schoolAgency settled out of court for $900,000
178Maintaining 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)
179In Memory- Social workers who have given their lives in the course of duty Teri Zenner, KansasKilled 8/17/0426 yrs. old, graduate student at University of Kansas, died making a home visit to a mentally ill 17 yr. oldBoni Frederick, Henderson, KyKilled 10/17/0667 years oldKilled by a mother and her boyfriend, when she took a 9 month old child to visit his mother
180In Memory- Social workers who have given their lives in the course of duty Greg Gaul, Des Moines, Iowa yrs old Killed by a 16 yr. old clientBrenda Lee Yeager, Huntington, West Virginia51 years old,Died 7/30/06Killed while on a home visit
181In Memory- Social workers who have given their lives in the course of duty Nancy Fitzgivens, Columbus, Ohio53 years old (social worker for 2 years)Killed during home visit
182In 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)