1. Presented by the Hospitals and Health Centers Security Services Creating a Culture of Safety

2. A Unified Division Committed to Protecting the University of Michigan UM Hospital & Health Centers Security Services, UM Police Department, UM Housing Security, UM Security Services and UM Emergency Management

3. The Nature of Health Care A Hospital of Last Resorts One in four adults−approximately 61.5 million Americans−experiences mental illness in a given year. One in 17−about 13.6 million−live with a serious mental illness such as schizophrenia, major depression or bipolar disorder.

4.  Police and Fire Emergencies -911  Security (DPSS) – (734) 936-7890  Social Work -  Human Resources -  Employee Assistance Program -  Office of Clinical Safety -  Psychiatry -  Legal –  Managing Aggressive Behavior Website Resources (Do not go it alone!)

6. UMHS Internal Home Page

7. Clinical Home Page

8. Disruptive Behavior is NOT tolerated at UMHHC

9. Feeling Unsafe at Work Cell phones dial 734-936-7890 for Hospital Security and 734-763 -1131 for UMPD (911 on cell phones go to WCSD)

10. Lessons Learned

11. Early Intervention Is Critical

12. Supervisors Responsibilities  Your Departments Critical Incident Plan  If you don’t have one, make one (we can help)  If you have one up date it (We can help)  Know It  Prepare your staff  Teach your staff the critical incident plan  Consider Non-Violent Crisis Intervention Training for your staff  Create an environment where staff are encouraged to deal with improper behavior early. Where they are encouraged to use resources.

13.  Direct or veiled threats of harm.  Physical or verbal intimidation.  Previous history of threats or violence.  Paranoid and/or anti-social behavior.  Moral self-righteousness: Blaming the institution or others for their problems.  Unable to take criticism of job performance.  Holds a grudge.  Desperation over recent family, financial, or personal problems.  Disregard for the safety of self and/or others.  Obsessive behavior  Work related  Unrequited love interest  Fascination with incidents of extreme violence  Fascination with weapons Recognizing early warning signs of violent behavior

14. Communication Skills – Personal Space – Mehrabian Communication Study Non-Violent Crisis Intervention Training available.

15. Threats Security Must Be Involved! – Background Investigation (Our PVP Program) Risk Code Assessment Completed – Behavior Plan Clinical and/or Mental Health Intervention Review Department’s Security Status Civil Legal Actions – Personal Protection Orders – Law Suits Law Enforcement intervention – Criminal Prosecution

16. Risk Codes  (S0) - No Security Response, Investigation only.  (S1) - First Level Response, Observe & Verbal Interactions (if needed).  (S2) - Second Level Response, Observe, verbal & active physical management (as needed).  (S3) - Third Level Response, Observe & preventative force (including law enforcement as needed).  (S4) - Fourth Level Response, Observe & preventative force; Security presence during visit.  (S5) - This is indicating that the PVP maybe a family member that is not a patient or in our system.

17. Where you find risk codes: MiChart

18. Where to find Risk Codes: MiChart Continued

19. Act Immediately Call 911 Implement your department’s Critical Incident plan – Have regular discussions within your department about proper responses to specific threats.

20. Case #1 A 9 year old patient is Survival Flighted in from Midland Michigan. Yesterday she began suffering from a severe head ache and was taken to Midland General’s Emergency room… The patients condition is critical and deteriorating. The parents have just arrived and are highly emotional. They are upset and loud. What are your concerns and what do you do?

21. Case #2 One of your employee’s is a 40 year old male. He has a flash temper and a history of conflict with other employee’s. You have become aware of rumors that the staff members wife has left him and has taken their children with her. The employee has started calling off a lot and when he is at work he is extremely contentious and hostile. His work is becoming sub standard. You pull him in to talk to him. As you begin the conversation he stands up and says “You really don’t want to mess with me!”. He storms out of the office slamming the door behind him. What are your concerns and what do you do?

22. Case #3 You’re a clinic manager. A female neurologist in your clinic examines a 45-year old closed head injury victim. After the exam, the patient tells the physician that she’d better qualify him for SSI income, or he’ll kill her. The physician reports the threat to Security. An investigation reveals that the patient has been convicted of five felonies during his lifetime. Four of the convictions were for assaultive offenses, and the fifth for a property crime. The victims in three of the assaults were female. What are your concerns and what do you do?

23. Case #4 A clerical staff member in Mott has left her husband, taking their 5-year old child with her. They’re living temporarily with a relative. Her husband calls her at work and says, “I know where you park,” and hangs up. The staff member is afraid to tell her supervisor fearing repercussions. Other staff on the unit know something’s wrong, and rumors are circulating. She confides in a colleague, who urges her to report the threat which she does. The staff member says that she and her child had been physically abused by the husband. The husband’s criminal history indicates that he has a 2-year old conviction for child abuse, for beating their child with an electric cord, and is on probation.

24. How To Contact Us Police and Fire Emergencies: Dial 911 Medical and patient related emergencies: Dial 999 (Main medical campus, 300 NIB, Kellogg and EAAHC) 24/7 requests for assistance, information, or for an on-duty supervisor : (734) 936-7890 Security Administration : (734) 763-5511 Lost and Found: (734) 647-8448 Website: www.med.umich.edu/security www.med.umich.edu/security Email: security-support-team@med.umich.edu security-support-team@med.umich.edu Questions for UMPD: (734) 763-1131 DPSS Website: http://dpss.umich.edu/

25. Resources: Guidelines for handling violence in the workplace http://www.med.umich.edu/i/policies/umh/Violence.html Disruptive employee policy http://www.med.umich.edu/i/policies/umh/04-06-047.htm Disruptive visitor and patient policy http://www.med.umich.edu/i/policies/umh/62-10-004.html UMHS Critical Incident Video https://mlearning.med.umich.edu/quiz/cbtlib/modules/criticalcombined/index.htm The Crisis Prevention Institutes, Non-Violent Crisis Intervention Training is available for staff. If interested please call (734) 936-6832.