Workplace Violence

Workplace Violence is defined as any incident where an employee or employer is abused, threatened or assaulted in situations related to their work. Client-related violence is described as violence or aggression displayed by a client of a service, towards the workers, when trying to provide support services to the client.   All forms of potential violence should be addressed through a Prevention of Workpalce Violence Policy.

Workplace violence includes acts such as physical assault, including spitting, verbal abuse or threats, threats with a weapon, sexual assault, robbery and vandalism.

Disability services work with a varied range of workplace locations and with people with a diverse range of disabilities and needs. Service users often have complex care needs requiring innovative and well-planned responses. These responses have to be both appropriate to the support needs presented and safe for both service users and staff.

Violent or aggressive behaviour on the part of a client can be a component of any disability service. As a result, the day to day work of staff may unavoidably entail the need, from time to time, to cope safely with client-related violence. See the SAFER approach.

Client related violence can be one of many challenging behaviours and can be a particular risk for the disability workplace. An approach was developed during the 1990s which endeavours to deal with the behaviour in positive ways. This approach is still considered a best practice approach as it considers the needs and dignity of the clients involved in addition to improving safety and reducing risks for the workers involved.  The main objective of this approach is the prevention of the behaviours in positive ways. 

Organisations, in consultation with workers, need to develop approaches to violence and aggression which recognise the risk control hierarchy and the specific needs of their industry and the needs of their individual client.

Violent or aggressive behaviour on the part of a client in the workplace may result from both client and staff related issues:

• Communication difficulties e.g. inability to express needs verbally to carers
• Health problems e.g. physical illness, pain
• Fear e.g. not being informed of changes
• Environment e.g. amount of people, noise levels, room temperatures
• Emotional, psychological, psychiatric e.g. feelings of frustration or depression
• Poor self-esteem
• Experience of abuse
• Limited knowledge or lack of information provided to staff about triggers for individual client
• Unsuitable workplace practices e.g. often organised for group management rather than individualised  activities e.g. set times for meals, activities with little flexibility, no opportunity for client choice
• Poor match between staff skills and  client needs
• Behaviour support plan not updated or followed

  Remember

Ask yourself what is the purpose of the client’s behaviour?

It is important to remember that violent or aggressive behaviour often has multiple and complex causes. 

Client related violence in the workplace may be minimised by:

• Thorough assessment procedures with new clients
• Behaviour Support Plans (BSP) where appropriate dependent on the risk assessment
• Staff trained, supported and following Behaviour Support Plans
• Client Management/Individual Plans updated and reviewed regularly. Staff informed of changes
• Reassessment procedures if client circumstances change and review of  client management /individual plan on a regular basis
• Provision to clients and their carers of information about rights and responsibilities including their responsibilities to behave in an appropriate manner
• Provision to  clients and carers of  information about the possible consequences of violent and aggressive behaviour e.g. restricted support, increased costs due to need for two workers
• Matching of  skills and abilities of staff to  client needs
• Provision of information and training to staff on as part of induction and ongoing training programs. This should include identification of precursors to violence and aggression, the role of behaviour support plans and complaint and grievance handling
• Adequate staffing levels
• Appropriate client placement

Remember good communication and the use of an effective behaviour support plan for clients whose behaviour is a concern is an important part of reducing risk. (Risk assessment alone does not prevent incidents but may be a part of a BSP.)

Know Your Client

When working with a client with behavioural support needs it is important to be very familiar with and consistently implement their behaviour support plan. The goal of the plan is to prevent or minimise the risk of a violent or aggressive behaviour on the part of the client, i.e. one client may verbally threaten staff but will never escalate into physical violence, and other clients may threaten and act on the threats.   This knowledge assists a worker to make judgements about the seriousness of some client situations. 

General Behaviour Identification, Recognising the Basic Signs

It is important as workers that we identify behaviours that may indicate the potential for client related violence or aggression; early identification increases the possibility of de-escalating the situation.

A client may appear to be frowning, agitated or irritable. At other times a client may appear to be clenching their fists and making verbal threats, or a client may be pushing other clients and staff, throwing items or furniture and trying to do physical harm to others.

The behaviours described may not necessarily appear in any order and it is important to be aware of these signs in context with the client and the environment.

Verbal cues include:

• Raised voice
• Threats
• Repetitive statements by the client
• Racist, sexist and other types of verbal abuse
• Withdrawal

Non-verbal cues include:

• Agitated movements
• Threatening gestures
• Eye to eye staring
• Standing very close
• Banging on the furniture
• Clenching the fists
• Towering posture

Remember

the earlier potential aggressive behaviour is identified the greater likelihood of successfully de-escalating violence and keeping everyone safer.

What Action to Take?

The action you take in the event of client related violence will depend on a number of factors such as: *Your knowledge of the client. *The existence of a management plan and critical incident response plan. *Your level of experience and training. * The level of violence and your perception of the immediate threat. * Other staff available for assistance.

A useful strategy for assessing a situation is by using the THREAT model

Always be aware of your surroundings

Know your escape routes, and available back-up.

Critical Incident Response Plan

When violence or aggression occurs, immediate action is necessary to protect those nearby, including other clients and staff, against the risk of injury, and to protect the person against self-injury. Having a plan that identifies the formal steps to take during & after an incident is referred to as a Critical Incident Response. Post Incident Procedure and Incident Response Chart, Preventing Violence DOCS and Work Cover NSW 1996 

Cooling Down the Situation

Workplace procedures and practices should be geared to preventing violence and aggression.  It is always preferable to have a pro active approach to preventing violence and aggression, irrespective of the client you are working with. Only a small percentage of the clients have violence and aggression as some component of their behaviour. Like everybody else in the community there is potential, given the right circumstances and stresses, for any client to become aggressive or violent. In many instances client-related violence does not escalate past verbal aggression and threats.  

The background to violent or service users’ aggressive behaviour may be many faceted and complex. The reason for a particular behaviour may be difficult to identify and occasionally the cause of behaviours cannot be identified. There is a difference between the “cause” of behaviour in a particular situation (for example, disappointment at an unexpected cancellation of a visit) and the “cause” of quite a range of events that arises from communication issues.

If the client is irritable, agitated, verbally threatening, you need to assess the situation to identify the purpose behind the behaviour. The client may be unwell, they may be having difficulty with another client, or they may have had a visit by a family member cancelled. A client behaviour plan should outline the preliminary steps. Use non-aggressive language when talking to the client and take a non-aggressive stance. Continually assess the situation in case it escalates to physical violence.

  Remember

It is important to remain as calm as possible and know your options.

You should leave the situation when:

You feel you do not have the skill to deal with the situation

Your deescalating attempts are not working

You endanger others by staying

When you are alone with an actively aggressive or violent client

If the situation is moving towards physical violence, without putting your own safety at risk, try to reason with the client using non confrontational language, and utilise the client’s behaviour support plan or management plan for the behaviour. Do not try to physically stop them damaging property and do not try to restrain the individual.  Be ready to leave if you cannot de-escalate the client’s behaviour and there is risk of physical harm or lives are at risk. You may have to call the police.

Remember the busier you are the more at risk you are because:

• You do not notice the early warning signs of violence
• You may take less time to clarify a clients problem before acting
• You may be more vulnerable to taking unnecessary risks

Workpalce violence may also include incidents of bullying and harrassment whether initiated by a client or family members or by another staff member.  Such incidents are as unacceptable as actual violence and managment but have systems in place to prevent where-ever possible and to assist staff who report such incidents.  See sample policy.

Risk Management and Violence

Under the Occupational Health and Safety Act 2000 NSW (OHS Act) and Occupational Health and Safety Regulation 2001 (the Regulation) employers must ensure the health, safety and welfare of employees in relation to violence in the workplace. The Regulation supports the OHS Act and it requires employers to identify workplace hazards, assess the risks arising from those hazards, implement risk control measures, provide training and consult with employees.

Occupational violence is a significant OHS risk and is specifically referred to in the OHS legislation. Workplace violence should be recognised as a significant workplace hazard. Some of the risks associated with violence in the workplace include physical and emotional trauma, low morale, high staff turnover, financial costs, and lost productivity. OHS legislation requires employers to take all practical steps to eliminate, as far as possible workplace violence risks.

Hazard Identification and Risk Assessment are pivotal components of a comprehensive behaviour assessment and risk control strategies associated with an identified behaviour should be included in behaviour support plans.

If a violent incident does occur, there should also be response procedures (such as, giving first aid, supporting persons affected, counselling in place for those involved to minimise the impact of the event). Reporting and documenting the incident is also a requirement after an incident. See Aggression Incident Report form attached.  Documentation and reporting allows for management to review incidents and reassess the controls to eliminate or reduce the likelihood of a reoccurrence of a similar incident.  A Critical Incident policy and procedure is vital.  Access to an EAP program or trauma debriefing should be available if required.

A clear and simple incident response procedure is a key component for organisations in the management of processes after an incident Preventing Violence in the Accommodation Services of  the Social and Community Services Industry 1996 NSW Department of Community Services.

Organisations have a responsibility to manage client related violence or aggression in a systematic way by identifying hazards, assessing or quantifying the risks and applying risk control strategies.  See the case examples developed during the DSOP project which are aligned with the I'm OK Approach.

Risk Control options

This section outlines practical ways to eliminate or minimise violence and aggression in your workplace.  You should select the most suitable risk controls for your service. Having more than one control measure for a particular risk may be a more effective way of preventing workplace violence.

• Undertake adequate assessments so that a suitable support plan is developed
• Develop an Incident Prevention and Response Plan where required
• Ensure staff receive training in managing challenging behaviours as well as de-escalting agression and breakaway techniques
• Provide a secure work environment (see violence audit for review of premises safety when potential for violence exists):
  • externally, buildings should be well lit, have ready means of access and egress and be maintained free of possible hiding places for aggressors;
  •  remove or restrict access to equipment that could be used as a weapon;
  • restrict business hours to safe times and locations when possible.
• Install and use physical barriers and security systems:
  • provide a workplace that has service counters that act as a barrier to physica contact between clients and staff;
  • lock doors to “staff only” areas and ensure that only staff have (and use) keys;
  • install security and access key/card/code systems;
  • provide a “safe area” for workers to retreat to in the event of an emergency.
• Ensure effective management including selecting the right people for the job, fair employment conditions, training, employee consultation and regular supervision:
  • promote the fact that harassment and bullying will not be tolerated and will result in disciplinary action;
  • provide effective management and supervision - know where your workers are and what is happening in the workplace, both immediately and in the longer term;
  • develop and implement grievance procedures to allow reporting and action.
• Change the method of contact between clients and employees to a “remote” service - use telephone or correspondence instead of face-to-face interaction if the risk warrants this.
• Limit client interaction to times when there is “safety in numbers” for your staff.
• Ensure that work systems and service do not provoke aggression from clients:
  • provide reasonable waiting times and facilities;
  • ensure staff are trained in violence detection and management including complaint and grievance handling
  • provide clients with information about rights and responsibilities including their responsibilities to behave in an appropriate manner.
• Provide detection measures - security video cameras, mirrors, “beepers” to announce customers’ entry to certain areas, and duress alarms.
• Where staff must work alone or in isolated locations, keep in contact with them:
  • provide an effective means of communication in case of emergency (mobile telephone, duress alarm);
  • know where staff should be (movement notification, itinerary) and keep in contact regularly.
• Ensure that workers can get to and from work in safety:
  • provide security or other staff to escort them to their car at night or provide a taxi;provide personal alarms, or mobile telephone.
• Ensure that workers are not alone when dealing with potentially violent clients or when they have to raise and handle issues that may cause violence, such as changing the level or type of service.
• Where it provides an additional, back-up safety measure, which is necessary and acceptable to employees, provide employees with training in self-defence. It is always preferable to withdraw from a violence situation. Self-defence or restraint should be used only when a person under attack believes it is life threatening. The self defence response should only be of sufficient force to enable the victim to escape further harm.

Risk management need not be costly for you, your business or organisation. Many simple and inexpensive measures can greatly reduce risk. You need to consider the potential exposure of your organisation if you do not manage your risks in relation to client related violence.

 A proactive and consultative approach can create a safer workplace for staff and clients.  Document your evidence of how, what, when and by whom this is required to achieve a positive outcome.