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In March 2006, Sally Blackwell, a social worker in Texas, was killed. Blackwell's family indicated that she had received threats in her position as program director of several offices of caseworkers. Was it job-related? No one knows just yet as the investigation continues, however, this should be yet another wake-up call for agencies and organizations to improve safety plans to protect these workers.
For many years, social service workers have faced a significant risk of job-related violence. According to OSHA, assaults represent a serious safety and health hazard within these industries. NIOSH defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty."
A study released in March 2006 by the National Association of Social Workers found that 55% of 5,000 licensed social workers surveyed said they faced safety issues on the job. Sixty-eight percent said their employers had not adequately addressed their concerns.
Violence toward social workers includes physical assault, verbal assault, harassment and the threat of assault. Violence inflicted on these employees may come from many sources-external parties such as the clients whom social workers visit in the field during investigations, robbers and muggers, and internal parties such as co-workers and patients or clients. Social workers face several types of threats due to, but not limited to:
Holly Jones, a social worker with the Texas Child Protective Services, has been cursed at, chased by dogs and run out of houses by angry parents in her 6 years on the job. A year ago, a woman fired a shotgun at two caseworkers as they approached the house to investigate a child abuse complaint. Stories of this kind can be found all over the U.S. and U.K.
In the U.K., a 1999 study of violence conducted by the National Institute of Social Work found that nearly half of the 2,000 social care staff interviewed had been verbally abused in the previous year, almost one-fifth were threatened and one in eight were physically attacked.
Low morale and fear of violent attacks have caused many to leave the sector and have contributed to a serious recruitment crisis, particularly among social workers in the U.K. In 2001, Health Minister John Hutton said, "Violence, threats and abuse to staff are unacceptable. We should not and will not tolerate it-accepting violence is not part of the job. The government is determined to improve the safety of social care workers and volunteers who often face violence and abuse while at work."
Such incidents have made social workers revisit the issue of safety on the job and begin thinking about what steps the government can take to better protect them. Typically, social workers do not carry weapons, and there is a noted lack of training in self-defense and in recognizing and managing hostile and assaultive behavior.
The five main elements of any safety program include the following:
First, employers must recognize this as a workplace hazard. Workplace violence programs do not exist on a wide enough scale to protect thousands of workers in the U.S. and the U.K. This must change. Threats that do not lead to injury or death often lead to complacency about this type of hazard. However, waiting for an injury or the death of an employee as a wake-up call to take action is too late. Steps must be taken prior to such incidents, as with any risk or hazard in any occupation.
A clear, concise policy that does not tolerate violence of any type, including verbal, nonverbal and other threats, is the foundation of a violence prevention program. This policy should be provided to all employees in the organization.
Once management recognizes this issue, the steps are well outlined for worksite analysis in OSHA's guidelines, by the Committee for the Study and Prevention of Violence against Social Workers' Safety Guidelines (revised in March 1996 by the National Association of Social Workers' Massachusetts Chapter) and in other similar sources.
A key action is to perform a step-by-step review of each work area to identify places and times that violent incidents are occurring and the risk factors present. To ensure multiple perspectives, it is best for a team to perform this analysis and to assign a leadership position or team coordinator for organizational and implementation purposes. Key members of the analysis team should be front-line field social workers safety, management, the human resources department, legal staff and security professionals in the organization.
The team can review injury and illness records and workers' compensation claims to identify patterns of assaults that could be prevented by workplace adaptation, procedural changes or employee training. The team should also analyze incidents and include as part of the analysis the characteristics of assailants and victims, the account of what happened before and during the incident and the relevant details of the situation and its outcome. Be sure to evaluate items such as:
The items identified during the review of these documents and other key information should be assigned various controls. As the team or coordinator identifies feasible and appropriate controls, these should be instituted. The organization's policy should also outline all identified areas of threat that were uncovered during the assessment phase and the controls in place for each item. An evaluation of current and newly implemented controls must be accomplished on a regular basis-annually or more often. If a control is not working, it must be changed so that it does work.
Controls can be engineering or administrative in nature. Engineering controls remove the hazard from the workplace or create a barrier between the worker and the hazard. These may include panic buttons, handheld alarms or noise devices, cellular phones and private channel radios where risk is apparent or may be anticipated. Administrative and work practice controls affect the way staff performs jobs or tasks. Examples of administrative controls include setting up logs for reported incidents and employee training.
Encourage reporting of all incidents, whether injuries occur or not, and provide suggestions or solutions for prevention. Train employees to understand the definition of a near-hit incident as is done in the construction and manufacturing industries since these are excellent indicators of conditions that must be controlled in order to prevent injuries and fatalities.
Training is a requirement for employees to acquire the skills to prevent injuries and fatalities due to the situations outlined in the evaluation and workplace assessment process above. Employers should make certain that at-risk employees take part in a continuing education program which covers techniques to recognize escalating agitation, assaultive behavior or criminal intent, and discusses appropriate responses.
OSHA details steps for post-incident response and evaluation that are essential to an effective violence prevention program. "All workplace violence programs should provide comprehensive treatment for employees who are victimized personally or who may have been traumatized by witnessing a workplace violence incident. Injured staff should receive prompt treatment and psychological evaluation whenever an assault takes place, regardless of its severity. Provide the injured transportation to medical care if it is not available onsite."
Victims of workplace violence suffer various consequences in addition to actual physical injuries. These may include:
Consequently, a strong follow-up program for these employees will not only help them to deal with these problems but will also help prepare them to confront or to prevent future incidents of violence. Several types of assistance can be incorporated into the post-incident response. For example, trauma-crisis counseling, critical-incident stress debriefing or employee assistance programs may be provided to assist victims.
The OSH Act of 1970 mandates that in addition to compliance with hazard-specific standards, all employers have a general duty to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. OSHA will rely on Section 5(a)(1) of this act, the General Duty Clause, for enforcement authority. Failure to implement these guidelines is not in itself a violation of the clause. However, employers can be cited for violating the General Duty Clause if there is a recognized hazard of workplace violence in their establishments and they do nothing to prevent or abate it.
OSHA provides guidelines that are a template for tackling this issue in the workplace and that begin to control the risks of injuries and fatalities for social workers. The publication is OSHA 3148-01R 2004, Guidelines for Preventing Workplace Violence for Healthcare Workers and Social Service Workers. These guidelines cover management commitment and employee involvement; worksite analysis; hazard prevention and health training; recordkeeping and program evaluation.
The guidelines also contain checklists, incident report forms and suggested readings. These guidelines address only the violence inflicted by patients /clients, but OSHA suggests that workplace violence policies indicate a zero-tolerance for all forms of violence from all sources.
Currently, social workers in Texas receive a half day of safety training, and the issue frequently comes up in a 12-week course, says spokesperson Chris Van Deusen.
In 2001, Michigan lawmakers toughened the penalties for people who threaten or attack social workers after a child welfare caseworker was beaten, bound, gagged and suffocated while checking on a family. The law also requires safety training for workers who make home visits.
The death of a mental health social worker in Kansas prompted Representative Dennis Moore (D-KS) to introduce a resolution last fall that encourages state and local agencies to improve the safety of social workers. The resolution is pending.
Based on an article by David Batty, a U.K. author, dated Tuesday, Jan. 23, 2001, a "£2m campaign to reduce violence and abuse against social workers by 25% by March 2005 was launched by the government. The funding comes in response to a new action plan developed by the national taskforce on violence against social care staff, which outlines measures to protect social care staff.
"All 21,000 social care employers across England are being sent a copy of the task force report, "A Safer Place," on how to reduce the risk of staff being attacked by violent patients and clients. The £2m will be administered by National Training Organization for Social Care and used to improve training and qualifications across the social care workforce."
There is movement to protect social workers from violence, but much more must be done. Management must acknowledge these hazards and risks, then take action to protect social workers from preventable outcomes.