CREATING SAFE WORKPLACES FOR SOCIAL WORKERS: …



CREATING SAFE WORKPLACES FOR SOCIAL WORKERS: LEARNING FROM EACH OTHER

Molly Farrell, LISW-S

Cleveland Executive Fellow

August 27, 2008

TABLE OF CONTENTS

Acknowledgements 3

Executive Summary 4

Introduction 5

Background 5

Strategies from the Field: Learning From Each Other 7

Recommendations 11

A Call to Action 11

Bibliography 12

ACKNOWLEDGEMENTS

I would like to thank the individuals who participated in focus groups and responded to the online survey. This report is possible only because you took time to share your knowledge and expertise.

I thank the local social service agencies, to remain nameless in order to protect confidentiality, who generously allowed me to interview staff members. Your willingness to participate in this project demonstrates your commitment to ensuring safe workplaces for your staff.

I especially thank Rebecca Sanford, LISW-S and NASW Ohio Chapter President Elect for her guidance, technical assistance and mentorship throughout this project.

Finally, I thank the Cleveland Executive Fellowship for the opportunity to dedicate the final two months of the program to the issue of workplace safety for social workers.

EXECUTIVE SUMMARY

The Cleveland Executive Fellowship is an experiential, immersion program designed to accelerate professional development of civic leaders. Its goal is to prepare individuals for effective and ethical leadership in the public-affairs arena. The program allows Fellows to devote the final two months of the program to an independent project. Molly Farrell, LISW-S, Cleveland Executive Fellow identified a need within the social work profession, and focused her project on workplace safety for social workers.

In partnership with the NASW, Ohio Chapter, Region 3, Ms. Farrell conducted focus groups with employees of social service agencies in the Greater Cleveland area, and administered an online survey to members of the Ohio Chapter of the NASW to identify effective workplace safety strategies. The report provides a brief overview of the literature on the prevalence, consequences, and potential solutions to client violence against social workers, (2) outlines the safety strategies identified by focus group participants and survey respondents, and (3) recommends actions steps for improving workplace safety for social workers at the local level.

Based on a review of the literature and focus group and survey results, the report recommends the following action steps:

1) Establish an ongoing forum comprised of interested stakeholders, including case managers, counselors, social workers, employers, policy makers, to discuss and problem solve workplace safety concerns of employees in the social service sector.

2) Share best practices identified in this report by focus group participants and survey respondents with the leaders of local social service agencies, as well as the state of Ohio’s Social Work Reinvestment Committee.

3) In partnership with professional groups such as the NASW, advocate for the establishment of basic workplace safety measures to be implemented in any setting where social workers are employed.

4) In partnership with professional organizations and academic institutions, explore the possibility that “productivity” demands on individual employees in social service settings may decrease their ability to utilize workplace safety strategies, such as team sessions, supervision, acquiring thorough background information on clients.

INTRODUCTION

As an advocate and ally of clients of the social work profession[1], it is with some hesitation that I write this report. I fear that by acknowledging the existence of client violence toward social workers, I will perpetuate unfair stigmas. The reality is that most clients do not commit violent acts, and client violence toward social workers is a relatively rare occurrence. However, clients do sometimes perpetrate violence against social workers, and it is a valid area of concern for the profession. The National Association of Social Workers’ (NASW) Social Work Reinvestment Initiative, which aims to strengthen the social work profession, and thereby our communities, through recruitment, retention, training and research, identifies workplace safety issues as a major barrier to recruitment and retention of social workers (). We must find ways to advocate for the wellbeing of both clients and social workers.

This report was inspired by my experiences working as a direct practice social worker for four years and it was made possible by the Cleveland Executive Fellowship as well as a partnership with the National Association of Social Workers (NASW) Ohio Chapter, Region 3. The purpose of the report is to (1) share strategies that social workers use to stay safe in the workplace, and (2) identify action steps toward improving workplace safety. This report is intended as a first step in organizing local efforts to improve workplace safety for social workers.

BACKGROUND

CLIENT VIOLENCE AGAINST SOCIAL WORKERS: SCOPE OF THE PROBLEM

A significant body of literature shows that social workers encounter risk in the workplace. In her book, Client Violence in Social Work Practice: Prevention, Intervention and Research[2], Christina E. Newhill provides a thorough overview of twenty years worth of research on the topic. She summarizes the prevalence and impact of client violence toward social workers, and concludes by recommending strategies to effectively decrease risk, as well as respond to social workers who have experienced client violence. Newhill’s comprehensive work serves as the basis for this report’s brief overview of the topic.

Prevalence

Newhill notes that social workers are increasingly called to work with potentially violent clients. She argues that individual, organizational and societal level factors are responsible for this shift.[3] At present, national statistics tracking client violence toward social workers do not exist. Therefore, as a means of gaining some idea of the scope of the problem, Newhill summarizes the findings of existing studies on client violence toward social workers.

Between 1976, when the first study on the topic was done, and 2003 when Newhill’s book was published, twenty-five studies on client violence toward social workers had been completed. The United Kingdom initiated research on the topic, and the United States soon followed. The studies vary methodologically in terms of time frame, sample source, definition of violence, types of violence examined, and types of respondents.[4]Regardless of methodological variations, however, the studies clearly show that violence is a valid concern for the social work profession. The following section outlines the findings of studies that surveyed NASW members on incidence of client violence.[5]

1) Mace (1989) surveyed a national sample of registered NASW clinical social workers on their experiences of assault by clients at anytime in their career. Twenty-eight percent of respondents reported being assaulted at some point in their careers.

2) Skolnick-Acker et al. (1993) administered a survey to a random sample of NASW members in the state of Massachusetts. Respondents were surveyed on their experiences of verbal assaults or threats, physical assaults, and property damage at anytime during their career. Twenty-eight percent of respondents reported assaults, 63% reported verbal assaults or threats, and 19% of the sample reported property damage.

3) Newhill (1996) surveyed a random sample of NASW members in the states of California and Pennsylvania on their experiences of actual and attempted assaults, threats and property damage at anytime during their career. Fifty-seven percent of respondents reported at least one experience of client violence, 25% of the sample reported property damage, 51% of the sample reported being threatened, and 25% of respondents reported being assaulted.

4) Jayaratne et al. (1996) surveyed a national random sample of NASW members on their experience of physical threats, assaults, threat of lawsuit, lawsuits filed, verbal abuse, and sexual harassment in the year prior to the survey. Seventeen percent of respondents reported physical threats, 3% reported assaults, 15% of respondents reported threat of lawsuits, and 1% reported lawsuits filed, 43% reported verbal abuse, 6% reported being sexually harassed.

5) Finally, Beaver (1999) conducted a national survey of NASW direct practice social workers on incidence of assault, threat, verbal abuse, sexual harassment, personal or agency property damage, assault or threat toward family member. Sixty-five percent of respondents reported experiencing violence at least once during their career, and 23% of the sample reported client violence during the past year. [6]

An overview of the literature shows that client violence toward social workers does occur and warrants concern. The following sections discuss consequences of client violence toward social workers, as well as recommendations from the literature for reducing risk.

Consequences

People who survive a trauma experience a range of responses, and social workers who have been victimized by a client are no exception. Reactions to trauma typically include feelings of numbness, shock, anxiety, fear, anger, and eventually acceptance.[7]Some individuals, however, develop symptoms of Post Traumatic Stress Disorder (PTSD), defined by the DSM IV as

an anxiety disorder consisting of certain characteristic symptoms that develop following exposure to an extreme traumatic stressor. These characteristic symptoms include persistent re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the traumatic stressor, numbing of general responsiveness, and persistent symptoms of increased arousal, with the full symptom picture present for at least one month and causing clinically significant distress or impairment in functioning.

Social workers who experience client violence face complications related specifically to their jobs, and in some cases leave the profession. The high rate of turnover within the social work profession is influenced by several factors, but concern about safety is certainly among them.

Solutions

Newhill argues that individual social workers, employers and the profession as a whole bear responsibility for effectively addressing workplace safety issues. Individual social workers must use proper assessment, engagement and intervention techniques with clients. They must seek supervision when necessary, and advocate for their own safety needs as they arise. Employers must make workplace safety a priority, through activities such as establishing a safety committee comprised of staff members at all levels, making safety concerns an agenda item at every staff meeting, and implementing and reviewing a formal safety policy and communicating it to all staff.[8]Finally, the social work profession must acknowledge that workplace safety is a valid concern for the profession, and advocate on behalf of its membership.

STRATEGIES FROM THE FIELD: LEARNING FROM EACH OTHER

Social workers working directly with clients use effective safety strategies on a daily basis in their offices, cars and communities. Incorporating their knowledge and experience into workplace safety policies has the potential to make the profession safer.

In an effort to document effective safety strategies, I conducted focus groups with direct practice social workers, counselors and case managers in the Greater Cleveland area. A total of 15 people participated in 3 focus groups. In collaboration with the NASW, Ohio Chapter, Region 3, I administered an online survey to members of the NASW Ohio Chapter. The survey was posted on the NASW Ohio Chapter’s website for one week. A request for survey participants was also sent via e-mail to NASW Ohio Chapter members who registered their e-mail addresses with the organization. One hundred forty-two people responded to the survey. Focus group participants and survey respondents represented a variety of backgrounds and practices areas, but they all had experience working directly with clients. The following themes emerged from their feedback.

Focus group participants and survey respondents identified the following safety strategies social workers use in an office setting:

Office Set-Up

➢ Arrange office furniture so that the clinician sits near the door

➢ Keep the door open when meeting with a potentially violent client

➢ Remove objects that could be used as weapons from the office

Communication with Co-workers

➢ Alert colleagues when meeting with a potentially violent client

➢ Make schedule known to other staff

➢ Use a panic button to alert staff of a dangerous situation

➢ Ask supervisors for help

➢ Use a cell phone to communicate with colleagues or police in emergency situations

Support of Colleagues

➢ Have a colleague or supervisor present while meeting with a potentially violent client

➢ Ensure that more than one staff person is present in the office building while meeting with clients

➢ Enlist support from security or police officers when necessary

Clinical Skills

➢ Acquire, maintain and utilize the following clinical skills: crisis intervention techniques, assessment (of individuals and environments), and boundary setting

Focus group participants and survey respondents identified the following safety strategies social workers use on home visits:

Logistical Strategies

➢ Identify exits and stay near the door

➢ Be aware of risk factors in neighborhoods, and make home visits when fewest risk factors are present; this is usually earlier in the day

➢ Keep keys and cell phone accessible

➢ Park the car so that it can be moved easily. Do not park in the driveway in order to avoid being blocked in

➢ Meet in a public place if possible

➢ Avoid meeting in the kitchen where potential weapons (such as knives) are often kept

Communication with Co-workers

➢ Use a cell phone to communicate with colleagues or police in emergency situations

➢ Make schedule known to other staff

Support of Colleagues

➢ Have a colleague or supervisor present while meeting with a potentially violent client

➢ Request police to be present when meeting with a potentially violent client

Clinical Skills

➢ Conduct thorough assessments of clients as well as their home and community environments. Make sure assessment of home environment includes questions about access to a gun, information about other people living in the home, and information about pets

➢ Keep home visits short and non-confrontational

➢ Assess client and his or her environment before every home visit

➢ “Trust your gut”—don’t enter a home if you feel fearful

➢ Do not make home visits if risk factors are too high

➢ Treat clients with dignity and respect

Focus group participants and survey respondents identified the following safety strategies that employers implemented to support safety in the office setting:

Technology

➢ Install panic buttons

➢ Install metal detectors

Logistical Strategies

➢ Provide security personnel on site, and offer escorts to staff if necessary

➢ Keep outer office doors locked

➢ Incorporate safety strategies into office design

➢ Require staff to escort clients in and out of office

Communication with Co-workers

➢ Establish protocol regarding the use of code words to indicate different types of emergencies

➢ Provide resources for staff to post their schedules publicly within the office

➢ Support staff/receptionist staff share information about clients’ behavior and potentially volatile situations

Support of Colleagues

➢ Administrators and supervisors encourage staff to “team up” for office visits with potentially violent clients

➢ Administrators and supervisors encourage and facilitate staff discussions about workplace safety concerns

Clinical Skills

➢ Employers provide crisis intervention training

➢ Employers conduct background checks of new clients in order to identify history of violence and other potential risk factors

➢ Employers discontinue services, with proper referral, for clients who perpetrate violence against staff

Formal Safety Policy

➢ With input from staff at all levels, employers implement a formal safety policy, and review it on a regular basis

➢ Employers train new employees on safety policy, and review policy with all employees on a regular basis

Focus group participants and survey respondents identified the following safety strategies that employers implemented to support safety on home visits:

Technological Support

➢ Employers either provide cell phones to staff, or reimburse staff for using their personal cell phones for work purposes

➢ Provide staff with car safety kits

Communication with Co-workers

➢ Support staff call cell phone to check in with clinician on home visit with potentially violent client

➢ Make schedule known to other staff

Support of Colleagues

➢ Administrators and supervisors encourage staff to “team up” for home visits with potentially violent clients

➢ Administrators and supervisors help facilitate police escorts for home visits with potentially violent clients when warranted

➢ Employers support clinicians’ right to refuse to make home visits with clients when risk factors are too high

Clinical Skills

➢ Employers provide crisis intervention training

➢ Employers conduct background checks of new clients in order to identify history of violence

➢ Employers discontinue services for clients who perpetrate violence against staff

Focus group participants and survey respondents identified the following challenges to workplace safety:

➢ Pressure to meet “productivity” standards complicates individuals’ ability to utilize some safety strategies, such as supervision and team meetings which is not a “billable” activity, or team sessions, in which only one clinician can bill for a service.

➢ Training on workplace safety policies does not always occur

➢ Formal workplace safety policies sometimes do not exist

➢ Lack of opportunity to debrief and problem solve workplace safety concerns

RECOMMENDATIONS

Research and practical experience show that workplace safety is a valid concern of social workers. Formal safety policies vary across employment settings. The results of this informal focus group and survey suggest, however, that regardless of employment setting, social workers identify common strategies that are effective in promoting their safety on the job. I therefore propose the following action steps to promote workplace safety for all social workers in our community:

5) Establish an ongoing forum comprised of interested stakeholders, including case managers, counselors, social workers, employers, policy makers, to discuss and problem solve workplace safety concerns of employees in the social service sector.

6) Share best practices identified in this report by focus group participants and survey respondents with the leaders of local social service agencies, as well as the state of Ohio’s Social Work Reinvestment Committee.

7) In partnership with professional groups such as the NASW, advocate for the establishment of basic workplace safety measures to be implemented in any setting where social workers are employed.

8) In partnership with professional organizations and academic institutions, explore the possibility that “productivity” demands on individual employees in social service settings may decrease their ability to utilize workplace safety strategies, such as team sessions, supervision, acquiring thorough background information on clients.

A CALL TO ACTION

In the coming months, I intend to begin work on the recommendations outlined in the previous section. As one survey respondent justly pointed out, too often reports are written without any follow-up action. The goal of this project was to begin a discussion; now it is time to engage in the work!

Please contact Molly Farrell, LISW at mollyfarrell.lisw@ for more information.

BIBLIOGRAPHY

Dollard, M., Winefield, H., and Winefield, A. Occupational Strain and Efficacy in Human Service Workers. Boston: Kluwer Academic Publishers, 2001.

Jones, K., Cooper, B., and Ferguson, H. Best Practice in Social Work: Critical Perspectives. New York:

Palgrave MacMillan, 2008.

Newhill, C. Client Violence in Social Work Practice: Prevention, Intervention and Research. New York: The Guilford Press, 2003.

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[1] This report focuses on licensed social workers. However, findings and recommendations may be applicable to case managers, counselors and other social service professionals working directly with clients.

[2] Newhill, C. Client Violence in Social Work Practice: Prevention, Intervention and Research. (New York: The Guilford Press, 2003).

[3] Newhill, 17.

[4] Newhill, 35.

[5] Newhill, 214.

[6] Newhill, 53.

[7] Newhill, 224.

[8] Newhill

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