Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-007948, 2010 May; :1-30
Background: Workplace violence is well recognized, albeit inconsistently addressed, in the acute mental health setting. Workplace violence is also endemic in the social service workplace, yet is often not recognized as a hazard amenable to prevention. Purpose: The ultimate goal of this project was to reduce violence toward staff working in social service settings that treat and care for individuals who are mentally ill, mentally or developmentally disabled, addicted to drugs, alcohol, and/or other substances and those who exhibit a combination of these conditions. Methods: To achieve this goal, we conducted an assessment of risk factors for violence and occurrences of violence in a sample of Social Service Agency workplaces. Upon completion of qualitative studies in a number of agencies and a comprehensive risk assessment in the Addictions Treatment setting, we developed and implemented a comprehensive violence prevention program in six of thirteen residential Addiction Treatment Centers (ATCs) in one Eastern U.S. State, with the remaining seven centers in the State serving as a comparison group. The intervention was developed in concert with federal OSHA Guidelines for violence prevention. To evaluate the impact of the project intervention, we pilot tested a violence prevention process improvement checklist to measure early indicators of the impact on workplace violence prevention efforts. Results: Results from this research project include both process and formative outcomes. In more than 40 focus groups conducted across a range of social service workplaces, we documented a number of common risk factors for violence. Across settings, staff reported 1) patient populations with higher levels of acuity and complexity, with many staff feeling ill-equipped to meet the complex social and psychological needs of their clients; 2) inadequate support and resources for early intervention and management of patients resulting in costly and ineffective crisis interventions; 3) inadequate information on the risk factors/history of new patients leading to the potential for highly dangerous encounters; and 4) inadequate staffing to meet client/patient needs resulting in mandatory overtime and staff burnout; 5) powerful regulatory requirements for patient safety which put workers' safety at risk. The quantitative and semi-quantitative data generated from our work in addiction treatment centers found a significant inverse relationship between a strong violence prevention safety culture and physical violence at baseline. Results from the implementation and evaluation of violence prevention programming across the ATCs found that post-intervention a1113 ATCs reported improvements over the previous four years; but with the six intervention ATCs making somewhat greater improvements in violence prevention programming as compared with the seven comparison ATCs. However, since this Agency has been a leader in ongoing violence prevention efforts among the state's various health care and social service agencies, it is difficult to parse the relative impact of the grant-supported efforts and those associated with ongoing process improvement measures. Conclusions and Implications: The social service workplace presents formidable challenges to staff safety as a function of the complexity of the clients/ patients they serve, many of whom suffer from a combination of addiction, mental health, and retardation issues, as well as repeated encounters with the criminal justice system. Yet the "siloing" typical of many social service and medical agencies, results in few agencies/facilities with sufficient staff, either numerically or by training, to deal with these complex and potentially dangerous patients. In addition, various regulatory and/or certifying bodies provide competing or even contradictory guidance and mandates, leading to compromised staff safety in the name of patient safety. As such, interventions must involve macro-level policy change, as well as changes at the level of the institution and unit as described in this report. Finally, the importance of a strong violence prevention safety culture at the agency, institutional, and unit-level cannot be overstated.
Jane Lipscomb RN, PhD, FAAN, University of Maryland Baltimore 655, W. Lombard St. Room 655c, Baltimore, MD 21201