Safety Policy & Procedures Guidelines for Social Workers

Work-related violence against social workers is a fact of life.  Violence includes physical assault, verbal assault, intimidation, harassment and the threat (verbalized or implied) of future assault. The impact of assault can be lessened, some incidents may be prevented entirely, and the possibility of anticipating a high risk situation and therefore having good contingency planning is increased through good preparation.

To maximize social worker and staff safety and to minimize agency liability, the following guidelines are offered.

NASW Massachusetts Chapter's Committee for the Study and Prevention of Violence Against Social Workers recommends that every agency and private practitioner develop safety policies and procedures which address prevention, intervention and aftermath strategies.  This outline is general. Each agency or private practice can develop specific, comprehensive guidelines to address their unique characteristics and needs. Agencies will need a separate plan of action for each unit and specialized function.

I: Safety Plan of Action

A written safety plan specific to the function and layout of each agency, branch or division of an organization can be developed.  Both staff input and expert consultation are important in the planning.  Each safety plan must be detailed and comprehensive so that all staff members, clinical and non-clinical, know exactly what to do in case of emergency.  The plan should be reviewed and practiced on a regular basis if it is to be useful.  A comprehensive safety plan should include:

How to recognize signs of agitation.
• A specific plan for what to do at the first signs of agitation. This includes recognizing subtle signs of agitation like high blink rate and lower body movement.
• Code words and phrases to signal for help without increasing the client's awareness to be developed.
• Format for ongoing assessment of a client's level of agitation, anger and impulsivity.
• Format for assessing the dangerousness of a particular situation.
• Format for intervention including: 
--When and how to attempt verbal de-escalation.
--When and how to use non-violent self-defense, physical evasion, force deflection and disengagement skills.
--When and how to call security or police.
--When and how to evacuate building.
• Everyone in the facility: administrative, clinical and service staff, can be trained in these areas for maximum safety.

II. Exterior and Physical Layout 

• Maintain and furnish the facility so that it presents an organized, calm and respectful appearance to clients.  Pay particular attention to the waiting area.
• Ensure adequate lighting inside and out.
• Be aware of traffic patterns with special attention to where    clients can go unescorted.  If the location of bathrooms and coffee area allows unescorted clients to walk through the building, be aware of the risks. NOTICE ALL ACTIVITY!
• Establish a risk room where potentially violent or agitated clients can be seen.  This room should be furnished in a sparse, neutral manner, and located in a central area with ready access to help. Have staff assigned to check on risk room activities.
• Evaluate the need for safety equipment including buzzers and alarms in offices.
• Furnish offices to allow a comfortable distance between client and worker and to permit easy exit for both.  Eliminate items that may be thrown or used as weapons.
• Routinely inspect exterior and interior layout and all safety equipment to ensure all is in working order.

III. Rules, Regulations and Procedures

• Establish a format for taking a required history of violence as a part of regular intake procedure.
• Establish a format for communicating violent history to staff when current danger exists.
• Ensure adequate staffing at all times; no one should work in a building alone.
• Communicate safety policies to clients, when indicated.
• Orient new staff to safety policy and plan.
• Formulate and post a policy re: providing services to clients who carry or have guns and weapons.
• Formulate and post a policy re: providing services to clients who are under the influence of alcohol or drugs at the time of service.
• Provide ongoing supervision, consultation and training in: 
--Details of safety policy and plan with regular updates.
--Assessment of client's potential to become violent.
--Treatment and clinical interventions with potentially violent clients.
--Competent limit setting
--De-escalation techniques.
--Non-violent self-defense, physical evasion, force deflection and disengagement skills.
--Tarasoff decision - the duty to warn and protect.
--Aftermath of client violence.
--Trusting the physical feedback worker is getting from his/her body as the first warning sign of trouble.
--Give permission to end a potentially dangerous situation immediately.
• Address institutional practices that unintentionally contribute to client violence.
• Develop a policy on home visits which include:
--leaving itinerary with office staff so worker location is known at all times.
--phoning office frequently when in the field; preferably after each appointment ends.
--providing portable phones and other safety equipment.
--providing options for escorts: staff or police.
--giving permission not to go when risk of imminent violence is high.
• Establish relationships with security and police.  Let them know what you do and what you need from them.
• Design a program to address the aftermath of client violence.  Address the physical and emotional needs, short and long term, of the assaulted worker, worker's family, co-workers and affected clients as well as a format for debriefing and communicating with all staff following an occurrence of violence.
• Develop a format to address the consequences of violent or threatening behavior with the client.  Include the effect of the violence on services.  Develop a format to determine when and how legal action against the violent client will be taken.
• Log and communicate to staff all work-related occurrences of violence including threats.
• Re-evaluate policies, procedures and training needs following an occurrence of violence.
• Develop a "Risk Assessment" tool, and train all staff to use it.

Prepared by NASW's Committee for the Study and Prevention of Violence Against Social Workers
Revised August 2008