Safety: In The Office and In The Field
UNC- CH School of Social Work
Matthew J. Sullivan; JD, MSW
Emergency Management Coordinator; Town of Chapel Hill, N.C.
919-968-2814
msullivan@townofchapelhill.org
Initial Questions and Concerns
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What are your thoughts about safety in field?
Have you thought about it previously?
 What are your concerns in this area?
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What have you heard about this issue?
What do you know or experience do you have in
this area?
What specific areas or questions would you like
to address prior to the end of this program?
Objectives
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Participants will articulate multiple risk factors that
might lead to violent or hostile behavior.
Participants will identify the components and the
significance of a Personal Safety Plan (PSP).
Participants will be familiarized with the pattern of
escalation that is associated with violent behavior.
Participants will learn multiple safety strategies that
may be utilized when practicing within the multiple
dimensions of human service practice inside and
outside the office.
Participants will articulate the importance of utilizing
proficient clinical skills as it relates to practitioner
safety.
NC Mental Health “Reform”
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In 2001 the NC Legislature approved a comprehensive
plan aimed at improving public mental health services.
This plan resulted in significant changes in delivery of
mental health services.
Two Main Outcomes
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Orange County Example
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Creation of Local Management Entities (LME)
Divestiture and Privatization
OPC Mental Health became the OPC Area LME
2010 to present: “Consolidation”
Managed Behavioral Healthcare Organizations
Effects of the “Reform”
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The LME becomes a HMO type entity that
authorizes and pays for services delivered to
individuals in its catchment area.
Multiple for profit and not for profit entities are
created to provide services in the LME
catchment areas.
The state, and therefore the LME, will only pay
for specific services provided to certain
“targeted populations”.
The Bottom Line
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Services in communities are more difficult to access
and are being provided by less qualified mental
health professionals.
The most limited and highest risk individuals are
not receiving needed services.
These two factors coupled with downsizing at state
mental hospitals results in more unserved mentally
ill individuals in our communities.
Locally
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Closing of mental health regional offices.
Services restricted
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Two Case Studies
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AA/M “IE”
 W/F “NC”
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What is Workplace Violence?
“Workplace violence is violence or the threat of
violence against workers. It can occur at or outside
the workplace and can range from threats and
verbal abuse to physical assaults and homicide, one
of the leading causes of job-related deaths.”
US Occupational Safety and Health Administration
Workplace Violence in the U.S.
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Almost 1.5 Million “violent victimizations” occur in
the workplace each year, most of these incidents are
simple or aggravated assaults.
This number has been declining over the past
several years, however shootings are increasing.
Over ½ of all incidents are not reported to the
police even though most have been reported to
management.
Of the physically violent acts:
16.8% Aggravated Assaults
2.3% sexual assaults
Workplace Violence Continued
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State and Local agencies far outweigh private
industry in the percentages of agencies experiencing
incidents.
Violence Rates: Mental Health
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Professional 20.5 workplace, 17.2 non-workplace
Custodial Care 17 workplace, 12.8 non-workplace
30% Coworker/Supervisor
Males perpetrate more often
Estimates are that workplace violence was the cause
1,751,000 (3.5 per incident 500,000 people) lost
work-days at cost of 55 Million.
Injury Cost 6.5 to13.5 Billion Dollars
Why Worry ?
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Incidents of violence perpetrated against human
service professionals are increasing.
These incidents are greatly underreported.
3 of 4 human service professionals may be assaulted
at least once in their career.
In service training has been shown to decrease risk
and the severity of injury.
INDIVIDUALS TEND TO IGNORE OR
DISCOUNT THE WARNING SIGNS.
It Should Also Be Noted That…..
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Most mentally ill clients are no more dangerous
than the general population.
Those who are “More Dangerous” (10%) target
family members predominately.
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Mother living with schizophrenic adult child
The “More Dangerous”
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History of Violent Behavior
Substance Abusers
Report Command Hallucinations
Non-compliant With Prescribed Medication
RISK
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“The chance of injury
damage or loss.”
Webster
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Three Dimensions
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Desire
Opportunity
Ability
Field Tactics
Skills utilized by the Human
Services Professional to minimize
risk within his or her discipline.
Global Concepts
 The
Personal Safety/Defense Plan
(PSP/PDP)
 Self Awareness & Personal Appraisal
 Personal Evaluation
 Chart Evaluation/Case Load Analysis
 Documentation
Internal Crisis Response
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BONUS
Improved Sensory
Ability
Increased Strength
Improved Reaction Time
Increases Alertness and
Focus (narrow)
Increased Energy
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ALTER IMPACTS
Increases Error Potential
Decreases Judgement
Decreases Attention Span
Decreases Ability To
Discriminate Between
Trivial and Dangerous
Tactic 1: Recognize the Pattern of
Escalation
Triggering
 Escalation
 Crisis
 Recovery
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(Kaplan and Wheeler, 1983)
Triggering
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Anxiety
Miscommunication
Non-communication
Nonverbal Cues
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pacing
clenched fists/jaw
posturing
too much or no eye contact
angry affect
Escalation
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Client exhibits a loss of rationality and/or
increased anxiety.
Begins to test limits or issue challenges, makes
unrealistic demands upon the worker.
Increased hostility, verbal abusiveness, insulting
communication and use of profanity.
Defusing Escalation
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Re-Direct Conversation
SLOW DOWN- Initiate Helping Support
Help The Client To Nonviolent Alternatives
Take Away Audience
Make Mental Notes Of This Incident’s Impact
On Bystanders, Other Clients & Staff.
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DO NOT PARTICIPATE IN A POWER
STRUGGLE
Crisis
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Loss of Control
Physical Action/Violence
Release of energy that has
been building.
Usually not premeditated
PROTECTION OF SELF
AND OTHERS IS YOUR
FOCUS
Recovery
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Reduction of anxiety.
Perpetrator becomes remorseful and apologetic.
Worried about consequences
Proactive Stress Management
Do Not Rush the situation by attempting to
process with perpetrator or moving past the
situation. CALL FOR HELP
Should An Incident Occur
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CALL APPRORIATE PUBLIC SAFETY
SERVICES
Initiate immediate treatment for staff victim
and other effected personnel.
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Caring social supports and a sense of mastery.
Evaluate any needs for debriefing.
Levy consequences on the perpetrator.
Use the incident as a planning/ training tool.
Documentation
Hostile Behavior: Risk Factors
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Physiological
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Sleeplessness
Hunger
Chronic Pain or Illness
Drugs or Alcohol
Medication Interactions
Heat
Organic Pathology
Low IQ, Head Injury
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Research Proven
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Deprivation of Low Level
Basic Needs
Poverty and Poor Housing
Negative Behaviors
Documented at 8-10 Yrs..
Harsh Discipline
Embarrassment
No Family Stability
Parental Factors
 Supervision/Discipline
HOMICIDAL TRIANGLE
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BED WETTER
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FIRE STARTER
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ANIMAL CRUELTY
Warning Signs of Potential Violence
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Past History of Violent Behavior
Weapons or Threats of Weapons
Substance Abuse
Bizarre or Violent Thoughts/Obsessions
Extreme Paranoia
Major Behavior or Belief Changes
Psychosis, Hallucinations, Delusions
Other Important Considerations
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The probability of violence escalates with each act.
The most important risk factors are:
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Alcohol Abuse & History of Violent Behavior
Cognitive Interpretation By Perpetrator
It is important to always assess current stress.
The most likely victims are:
Objects of Fantasy
 Family Members
 Members of Target Groups (Hate Crime)
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Tactic 2: Develop Personal Safety
Plans
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Pre-plan situations or occurrences in an attempt
to become familiar with response prior to the
crisis.
Home
 Work
 Community
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When Crisis Occurs, It Is Too Late
Personal Safety Plan
Considerations
In The Field:
 Communication Means
 Pairs Visit Designated Clients/Neighborhoods
 Personal Protective Gear
 Pepper Spray w/Training & Bullet Proof Vests
 Neighborhood Assessments
 Vehicle Maintenance
 The Home Visit……..
The Home Setting
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Leave itinerary at work with times, clients and return
Drive by, do not park directly in front
Upon approach listen, do not stand in front
Make mental note of door knob and swing
At first contact assess individuals and activity
Keep everyone in your line of vision
Position yourself for easy and quick departure
Remember: Guns in Bedroom, Knives in Kitchen
If all else fails, “A good retreat is better than a bad
stand.”
In An Office Environment
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Work Alone?
Secured Access Areas
Verbal Distress Code
Consider Physical Plant Arrangement
What’s on your desk?
What is the case load?
Friendly/Welcoming Office Environment?
HOT ROOMS
Office II
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Warning/Help Lights or Buzzers
Multiple Access Points?
Survey Office Space and Arrangement
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(aka. security survey)
Documentation
Flag Records
Eliminate Weapons of Opportunity
FORMAL SAFETY CRISIS PLAN
Car Safety Skills
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Keep car locked
Keep car well maintained
Keep car door key in hand
Look around and under upon approach
Keep fuel level at least ¼ tank
Carry a cellular telephone, don’t stop
Park in busy and well lit areas
Street Safety Skills
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Walk in well lit areas
Walk in groups
Know your surroundings
Walk facing traffic
Be alert watch those watching you
Walk away from buildings and shrubbery
Keep valuables on your person not in bag
Practitioner Considerations
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Promises Promises
The Relationship
TAXI????
Work Schedule
Take Responsibility For Your
Mistakes.
Do Not Use Humor Clinically
Allow Silence
Change Pace and Rhythm
For The Difficult Individual
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Friendly Greeting
Identify Yourself Clearly
Ask For Compliance
(If refused ask a second time with reason)
Present Options
Confirm Refusal
Take Action
Tactic 3: Non-Clinical Hazards
“Environmental Occupational Hazards”
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Personal Protective Equipment?
Bio-Hazards
 Bloodborne and Vectorborne Disease
 Resurgence of TB in the homeless population
 Personal Defense Weapons?
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Drug House Considerations
Campsites
Methlabs
Tactic 4: Agency Safety Policy
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Agency develops a formal policy that addresses
employee safety and workplace violence.
No tolerance for violence with strong
consequences for violation.
Development of a Safety Committee
Practice Plan
Defensive Tactics?????
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“Walk Like a Champion”
Seated
Arm or Hand Aggression
Use Head to Put Off Balance
Infra-Orbital Pressure Point
Ground Defense and “Snow Angel”
Bear Hugs
Choke Holds
Legal Issues In Self Defense Cases
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North Carolina’s Castle Doctrine
Self Defense Requirements:
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Necessity
Proportionality
Fault
“Norris Test”
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Honest Belief
Reasonable Belief
Not the Aggressor
Must Not Have Used Excessive Force
What About Personal Defense Weapons?
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Biohazard Protective Gear
Bullet Proof Vest
Pepper Spray or Mace
Noise Making Device
Blunt Objects
Non-Traditional
Firearms ?
Cautions With Personal Weapons
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Training is a necessity
Cost and Upkeep Associated
Access
Will you be able to deploy when needed?
They can be used against you.
Finally……
Social Worker Know Thy Self
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It is important to trust your instincts.
What are your strengths …???? AND
What are your limitations….?????
“Am I in over my head”
Pre-Plan Every Encounter
Collaboration is key
Professional Supervision
And…. Take Care of Yourself
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Effective social workers must develop and
maintain a keen sense and maintain clear strong
boundaries.
Maintain Balance
Utilize formal and informal social supports
Nutrition, sleep, rest ect.
Seek and ask for assistance if indicated
Keep each other “in check”
Some Final Questions
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Where do you go from here?
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What will you apply from this afternoon’s
presentation to your field practice?
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What will you implement in the next 48 hours?