Creating a Climate of Safety
Given the realities of the social work practice environment the importance of emphasizing safety for social workers is clear. The NASW MA Chapter recommends that all social service agencies have policies that address the safety of workers, management, and administration, as well as clients. Safety polices reflect the profession’s ethical values, are critical to the effective provision of services, and are integral to a positive, productive, and professional work life. Attention to safety in the workplace can reduce the level of burnout and help with staff retention.
Reports of violence against social service employees during the past decade are notable.
- According to a 2000 U.S. Bureau of Labor Statistics report, 48% of all non-fatal injuries from assaults and violent acts in an occupational setting took place in health care and social services settings. This report also noted that social workers had an incidence rate of 15 per 10,000 full-time workers for injuries resulting from assaults and acts of violence.
- Ringstad (2005) reported the results of a national study of 1,029 NASW members, finding that:
- 62% had been subject to psychological aggression in the past year, with 85.5% experiencing this at some point in their careers
- 14.7% had experienced physical assault perpetrated by clients in the past year, with 30.2% having experienced this at some point in their career.
The National Association of Social Workers, Massachusetts Chapter (NASW-MA) and its Safety Task Force provide the materials on this webpage for informational and general resources purposes only. The training and educational materials are to assist you in addressing social worker safety in the workplace. NASW-MA makes no representations or warranties regarding the training and educational materials provided on this webpage.
While even the most comprehensive and detailed safety policies cannot assure safety at all times for all parties, the conscientious use of safety policies underscores the importance of safety to staff, clients, administration, and governing boards. Raising awareness about safety can create a level of preparedness that helps build an agency climate of safety.
Develop Professional Skills Related to Risk Assessment and Safety Promotion
Social workers are encouraged to participate in education and training in skills associated with risk reduction and safety promotion. These skills include: risk assessment, safety planning, de-escalation techniques, and non-violent defense. Social workers are also encouraged to participate in education and training in cultural competence that emphasizes an awareness of the roles of bias, stereotyping, and racism, as well as the historical, political, and economic contexts that may impact safety considerations, individual actions, and agency policies and procedures.
Essential is knowledge and skills on the subjects of:
- Risk assessment – What is the client’s potential for violence?
- Safety planning – What procedures and activities should be followed in client care and when transporting clients.
- Verbal de-escalation techniques – How to diffuse a potentially explosive situation with clinical interventions.
- Non-violent self-defense – Special training specifically for mental health professionals.
Resources for safety skills:
Develop Safety Policies for Agencies
All agencies, public or private, state-funded or privately-funded, are encouraged to establish and review, on an ongoing basis, comprehensive safety policies and procedures that address the safety and security of clients, direct service staff, management, and administration. Policies and procedures should be based on current recommendations of practitioners, researchers, and professional associations, and involve relevant constituencies in their development. Policies and procedures include training of direct service staff; protocols for preventing, assessing and responding to risk; how to respond to situations, incidents, and aftermath; and guidelines for administrative actions and oversight.
When developing your policies...
- Promote a climate of safety
- Develop policies for each division of agency
- Address the needs of clinical, support and administrative staff
- Include staff input and expert consultation
- Be comprehensive and include:
- Safety procedures for home and community visits
- Safety procedures for office visits
- Procedures for clients with weapons
- Procedures for clients under the influence of substances
- Train all new staff and students
- Review and update regularly.
To protect you and your clients...
- Assess history of violence routinely as part of intake procedure
- Assess an ongoing client’s potential for violence and level of agitation, anger and impulsivity
- Develop procedures to communicate violent history to staff when danger exists
- Develop a plan of action at the first signs of agitation, including enlisting assistance
- Define how to immediately end a potentially dangerous situation
- Provide training and supervision of work with potentially violent clients
- Plan for how and when to call security and/or police and when to evacuate facility.
To create a safe physical facility:
- Maintain and furnish facility with attention to the waiting areas (Create a calming environment)
- Organize traffic patterns to limit access by unescorted clients
- Evaluate need for safety equipment and implement where necessary (This may include buzzers and alarms at entrances and in offices)
- Furnish offices to allow a comfortable distance between client and worker with easy exit for both (Eliminate items that may be thrown or used a weapon in waiting areas and offices)
- Ensure adequate staffing at all times (No one should work in a building alone).
Administrations must proactively provide all-encompassing safety measures across every agency level by...
- Establishing protocols for debriefing and record-keeping following reports of threats and violent situations
- Addressing the aftermath of client violence which includes the needs of the assaulted worker, worker’s family, co-workers, and affected clients
- Communicating with all agency-related constituencies including boards of directors and advisory bodies
- Providing portable phones and other safety equipment
- Providing option of escorts by staff or police during home visits and in isolated parking areas
- Reassessing a community-based assignment and cancelling or rescheduling when the risk of imminent violence is high, or perceived as high
- Establishing ongoing relationships with security and police
- Developing policies for responding to the press (as needed) and addressing public concerns
- Developing a format to determine if, when and how legal action will be taken
- Logging and communicating to staff, all work-related occurrences of violence including threats
- Re-evaluating policies, procedures and training needs following an occurrence of violence.
- Safety Training and Crisis Response
This training has been in existence for several years, and has been re-written and updated at least annually. The material comes from several sources. First, the training uses, with permission, elements of the Therapeutic Crisis Intervention program created by the Family Life Development Center at Cornell University of Ithaca, NY. Each of the slides used is clearly identified with their logo. Second, it also uses material from the Worker Safety Training program of the Connecticut DCF Training Academy, again used with permission. Finally, many of the elements were developed by Family Continuity Staff and especially its Safety Committee. Specific citations and other information related to the material can be obtained by contacting Family Continuity at firstname.lastname@example.org.
- Safety incident tracking
- Safety checklist
- Safety assessment scale
- Weapons policy
National and professional guidelines:
Safety standards and guidelines have been developed by professional membership organizations, accrediting organizations, federal, state and local licensing bodies. NASW MA recommends the following resources:
Develop Safety Policies in Schools of Social Work
Social work schools are encouraged to establish and review, on an ongoing basis, safety policies and procedures for students in the field. Such policies and procedures should be reviewed with students prior to their engagement in field placements. School policies and procedures should include the expectation that agencies in which students do their field placements have comprehensive safety policies and procedures that are reviewed with the student as part of orientation to the agency. Safety content in the school’s curriculum is also encouraged, especially in practice courses.
Schools of social work should:
- Develop effective school safety policies
- Develop policies on student agency recruitment and student placement
- Develop training opportunities for students.
An effective school of social work safety policy includes:
- A statement of the importance of student safety in field placements and a commitment to promoting a climate of safety
- The responsibilities of the social work school, the student and the agency in addressing safety issues
- A protocol for handling and responding to incidents
- Safety tips and information.
Agency recruitment and student placement policies:
- Ask each agency to provide information about risk associated with the community and population served and about the agency’s safety policies, protocol and trainings
- Work with agencies to develop an agency safety policy if none exists (Schools might consider not using an agency that does not meet this expectation)
- Expect each participating agency to provide an orientation and ongoing supervision to students on agency safety, procedures and practices
- Provide Safety orientation/training as part of the student / agency learning contract
- Inform students, during the placement process, of any known risks associated with a placement
- Provide the option for students to request a different assignment if they express significant safety concerns about a placement.
Schools of social work can support both students and field agencies by:
Example of a School of Social Work Safety Policy (Boston University)
- Providing safety information as part of an orientation prior to the beginning of field placement
- Developing and offering integrative field seminars to support and train on safety issues
- Training field advisors (liaisons) on safety issues, policies, practice and protocol to strengthen their work with field instructors and students
- Requiring that field advisors discuss safety issues at site visits
- Building safety and risk reduction training into orientations and training seminars for field instructors
- Developing and providing safety workshops for students and agencies, wherever possible Incorporating risk assessment and risk reduction skills into the curriculum
- Keeping accurate data on threats and incidents and using this data to annually review and revise policies.
Advocate for Legislation and State Guidelines
Recent murders of social workers in Massachusetts, Kentucky and West Virginia prompted state legislation to promote workplace safety for social workers. State NASW chapters and local social work activists partnered to fight for the enactment of this legislation. At the federal level, The Teri Zenner Social Work Safety Act was introduced in 2007 and still awaits passage. Three states have guidelines that address workplace safety and social work. Below are links to state legislation (enacted), federal legislation, and to state guidelines.
State and federal legislation:
- An Act to Promote the Public Health Through Workplace Safety for Social Workers, H3864
On February 15, 2013, Governor Deval Patrick signed legislation that creates social work safety in the workplace. Filed by State Senator Sal DiDomenico and Representative Sean Garballey, this legislation was in response to recommendations of the National Association of Social Workers (NASW) Safety Task Force which convened after the 2008 death of a social worker on a home visit.
"This law requires all programs providing direct services to clients who are operated by, licensed, certified, or funded by a department or division of the Executive Office of Health and Human Services have a workplace violence prevention and crisis response plan, which is key to keeping social workers and other workers safe in direct care settings,” said Rebekah Gewirtz, Director of Government Relations and Political Action at the National Association of Social Workers, MA Chapter.
Plans must be updated at least annually for social workers, human services workers, volunteers, and all other employees. In addition, programs that do not have safety training in place shall require their employees to enroll in safety training which will be developed and offered by the Executive Office of Health and Human Services.
"Many industries invest tremendous resources into workplace and worker safety. This legislation offers safety protections to employees who are on the front lines of public health, caring for and working with individuals and families who are struggling through troubling and often precarious circumstances. Social workers, human service workers and others who are dedicated to helping those in need should be afforded the same expectations of a safe and secure work environment,” said Senator Sal DiDomenico (D-Everett).
"I am proud to have been able to partner with the National Association of Social Workers on passing legislation that aims to protect our social workers so that they can continue to provide essential services to so many throughout the Commonwealth of Massachusetts”, said Rep. Sean Garballey (D-Arlington.)
"Social worker safety has been a priority for Massachusetts and this law will further enhance our efforts to protect those who are caring for our most vulnerable populations,” said Health and Human Services Secretary John Polanowicz. "I thank the legislators and advocates who advanced this legislation to ensure that providers contracting with state agencies have strong workplace safety plans in place.”
In 2008, Diruhi Mattian, a 53-year-old social worker was performing a home visit and was stabbed to death by her client. As a result of this tragedy, NASW MA Chapter convened the Safety Task Force to determine the best strategies for making the social work profession as safe as possible. Stakeholders in the task force included NASW MA, schools of social work, employers across the Commonwealth, union representatives and state departments. Over the course of two years the group met and ultimately determined it was necessary to file this legislation.
- The Boni Frederick bill, Kentucky SB59
This bill was enacted in 2007 after the tragic death of social worker Boni Frederick. The aim of the bill is to increase safety measures and improve working conditions for social workers. The legislation also creates a state commission to study and recommend ways to better meet safety funding needs of state social workers.
- Social Worker Safety Bill, West Virginia SB2566
This legislation was enacted in memory of Brenda Lee Yaeger, a social worker who was brutally raped and murdered in 2008 while doing a home visit for an early intervention program. This bill increases criminal penalties for those who assault or murder a social worker. www.naswwv.org/whats_new.cfm
- The Teri Zenner Social Work Safety Act, H1490
As of this writing NASW continues to advocate for national legislation to promote safety and end violence to social workers. The Teri Zenner Social Work Safety Act was introduced in 2007 and authorizes federal grants to states to provide safety measures to social workers and other professionals working with violent, drug using or other at risk populations. The bill is named in honor of Teri Zenner a social worker from Kansas who was stabbed to death by a teenage client while on a home visit in 2004. For updates on the progress of the bill and to join advocacy efforts please visit the website.
- The Occupational Safety and Health Act of 1970 (amended in 1990)
This act mandates that all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious injury.
What you can do: Contact your state chapter of NASW, your state representatives, and your congressional delegation to let them know that legislation is needed to prevent and address violence against social workers.
State workplace safety guidelines:
Only three states, California, New Jersey and Washington, have guidelines addressing workplace security and safety for social workers and other workers. These guidelines require employers to put in place specific safeguards to reduce risk to social workers.
NASW-MA Safety Training Program
Give your employees the training and work environment they need to safely provide the best care to clients.
Upon the passage of An Act to Promote the Public Health Through Workplace Safety for Social Workers on February 15, 2013, all social service agencies are required to establish policies that address the safety of staff and clients. NASW-MA can help with the process by:
- Providing an initial assessment of the safety needs of your agency.
- Choosing a program tailored to the specific needs of your agency and its employees.
- Providing training for up to 60 employees per session by social worker safety trainers with extensive clinical experience who understand the complexity of potentially dangerous situations in a variety of human service settings.
To get started with training for your agency today, please contact the chapter office at email@example.com or call 617-227-9635.
Download the Safety Training Flyer
Safety training includes the following critical elements:
Full Staff Training
Safety Essentials: Developing a safety mindset when working with clients, family members and others. (1 hour essential foundation)
- Being a helper, not a rescuer
- Being alert to risk without being hyper vigilant
- Preparing for potentially dangerous situations with tools and knowledge of agency policies and procedures
- Distinguishing anger from rage
- Identifying the "aura” of violence (the gift of early warning)
- Examining a violence theory that guides workers in understanding why people resort to aggression
- Examining one’s personal relationship to anger
Violence Assessment: Determining who might be violent toward the worker. Includes examining common triggers of aggression and identifying indicators of imminent violence. (1 hour)
Verbal De-escalation: Theory, concepts and practice. (2 hours)
Administrative and Clinical Safety Plan of Action: Elements for in-office, home visits, in host agencies, and while transporting. (2 hours)
Treating Violent Clients: Clinical principles and practice. (2 to 3 hours after full staff training is completed)
Clinical Consultation: With supervisors and/or staff on specific cases. (Approximately 1 to 2 hours per case)
Technical assistance on reviewing safety plans and administrative policies for best practices:
- Conducting a safety audit of the facility including a review on current safety policies
- Reviewing safety plans for staff and volunteers
- Understanding issues of confidentiality in relation to client threats and aggression
- Communicating with all staff after safety incidents
- Dealing with the aftermath of assault on a staff member
- Understanding the Tarasoff decision (the duty to warn and protect)
- Measuring over and under reaction to danger using a worker questionnaire
PUBLICATIONS & RESOURCES
Social Work Education
- Burry, C. (2002) Working with potentially violent clients in their homes: What child welfare professionals need to know. Clinical Supervisor, 2(10):145-153.
- Allen, S.; Tracey, E. (2008) Developing student knowledge and skills for home visiting. Journal of Social Work Education, 44(1): 125-143.
- Pope, N. (2011). Tips for Making Home Visits. The New Social Worker. Vol.8 (3),12.
- Abbot, A. Lyter, S. (2007) Home Visits in a Violent World. The Clinical Supervisor, Vol. 26 (1/2).
Creating Guidelines & Policies
- Otto, R. (2000) Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology, (56): 1230-1262.
- Elbogen, E.; Johnson, S. (2009) The Intricate link between violence and mental disorder. Archives of General Psychiatry, 66(2): 152-161. (The above hyperlink will take you to an external website. Click on the "Begin Downloading” link in the top right-hand corner of the page.)
These books address a range of topics on social work and violence:
These policy recommendations and compilation of resources were prepared by the NASW Massachusetts Safety Task Force.
NASW thanks and acknowledges the work of Earl "Skip” Stuck, Family Continuity; Eva Skolnik-Acker, Private Practice and NASW-MA; Suzanne Sankar, Simmons College School of Social Work; Bill Keaney, Boston College School of Social Work; and Bill Fisher, Springfield College School of Social Work, and assisted by co-chairs of the NASW-MA Chapter Safety Task Force, Judith Perlstein, Boston University School of Social Work, and Carol Trust, Executive Director, NASW-MA Chapter.