#  Safety Checklist - Home and Community Visits

It is unlikely that you will be the victim of a violent crime, but it is
always possible that you may encounter a potentially dangerous situation
or unpredictable client. Two major themes to always keep in mind are 1)
practice good safety habits and 2) "listen to your inner voice" or
"trust your gut". If in doubt, leave the situation and seek supervision
or management support.

## General Safety

-   Be aware of your surroundings and familiar with the area

-   Have daily schedule available, (e.g. Outlook calendar) so that your
    location and your estimated time of return is known

-   Have a mobile phone available to call for directions or help

-   If risk is a concern, make a plan with supervisor and department
    team

-   [Prepare for the unexpected]{.underline} and have back up safety
    plans

### Around Clinic, Parking Lot and in Community

-   After dark, walk out with a partner or group to car

-   Carry your phone and keys for quick, easy access

-   If you are staying late, consider moving your car to the parking
    garage before dark

-   Observe on-comers. If approached use direct, confident language of
    your intentions, "sorry, I cannot help you"

-   If threatened, fight, scream, run, but NEVER get into a vehicle or
    AVOID being pulled into an unknown vehicle

### En Route to Client Visit/Home Visit

-   Drive with plenty of gas; keep doors locked

-   Don't stop your car if "bumped"; drive to the nearest, well-staffed
    business and call the police for a report

-   Park where there are multiple exits to the lot, if possible. Never
    park in a driveway, where you can be blocked in

-   Call client to let him/her know you have arrived. If possible have
    client meet you at the door or lobby

### During the Home Visit

-   Wear your nametag. If confidentiality is a concern, carry it in your
    pocket for easy identification

-   Listen outside the door for yelling or fighting. If there is
    disturbance, leave and call to reschedule. Do not enter the home
    during or directly after a disturbance

-   Note the location of exits. Leave the door unlocked if possible -
    state that this is part of your home visit protocol

-   Scan for weapons, signs of previous, current or potential violence.
    If weapons are present, leave and reschedule location

-   Assess your client's/family's demeanor, possible substance use,
    threat of violence to self or others

-   Be cautious of animals; you are a stranger. You always have the
    right to ask for animals to be held in another room or yard

-   Keep your phone out and available. If needed, state that your office
    is expecting you back at (time) /expecting your call

-   Do not hesitate to leave and reschedule to time or location for any
    reason (gut feeling, threat, other concerns). Document concern and
    report to supervisor

## **Predicting and Dealing with Violence**

### Assessing Prior Violence

-   History is the best predictor of violence. At initial assessment,
    document past violence, current violent thoughts, and client's
    treatment or interventions

-   Assess triggers, feelings or factors that have been associated with
    aggressive encounters

-   Assess physical factors that increase risk (i.e. if violence is
    associated with substance use, always asses clients substance use on
    that day)

-   Take the responsibility to conference with multidisciplinary team to
    assess history of violence in community or history of
    threats/violence in the Clinic

### Assessing Current Situations

-   Assess client access to weapons, historical abuse, aggression at
    home, intentions with family, community, authority, etc.

-   If there are no signs in the client's history observe common warning
    signs: Pacing or fidgeting, clenching fists or jaws, standing
    abruptly or with close proximity, verbal abuse

-   Identify triggers, cues and give the client the opportunity to get
    out of the agitating situation (this seems to upset you; should we
    take a break? Is the conversation bothering you; should we stop here
    for now?)

### Violence in the Moment

-   Never reach out for the threatening weapon. Back up and tell the
    client your moves before you make them so that nothing is unexpected
    or threatens a client who may be violent.

-   Use de-escalation techniques and non-violent self defense when
    possible. Learn basic non-violent self defense techniques

-   Protect your head; block with cushion, pillow, arms, clipboard

-   Call 911 immediately

### After an incident

-   Call 911. Get medical attention immediately

-   If you are sexually assaulted, call police. Do not change or alter
    your condition in any manner and seek medical examination

-   Consult your supervisor and any available director (as soon as
    appropriate after the violent incident)

-   Complete a Clinic incident report with supervisor

**Staff Safety Review:**

**Outside of Clinic, Home Visit and Field/Community Work**

**For your safety you are expected to be familiar with the following:**

-   Assessing client's history of violence and current level of
    dangerousness

-   Recognizing and be prepared to react at first signs of agitation
    (de-escalation techniques or diffusing situations)

-   How to call for help, security, or police

-   What to do if you become a victim, how to report an incident of
    violence or threat

**If you do not feel prepared in these areas, consult your supervisor
for support or further training or guidance.**

Staff should review and understand general guidelines for personal
safety and security, including the *Safety Checklist* and *Verbal
De-escalation Skills*. Staff should consult their supervisor at any time
that they do not understand personal safety procedures, guidelines or
need further support in their own personal safety.

**Verbal De-Escalation Techniques for\
Defusing or Talking Down an Explosive Situation**

*prepared by NASW\'s Committee for the Study and Prevention of Violence
Against Social Workers*\
\
When a potentially violent situation threatens to erupt on the spot and
no weapon is present, verbal de-escalation techniques are appropriate.

> **There are two important concepts to keep in mind:**
>
> 1\. Reasoning with an enraged person is not possible. The first and
> only objective in de-escalation is to reduce the level of arousal so
> that discussion becomes possible.
>
> 2\. De-escalation techniques are abnormal. We are adrenally driven to
> fight or flight when scared. However, in de-escalation, we can do
> neither. We must appear centered and calm even when we are terrified.
> Therefore these techniques must be practiced before they are needed so
> that they can become \"second nature.\"

**A. The Worker in Control of Him/Her Self**

1.  Appear calm, centered and self-assured even though you don't feel
    it. Anxiety can make the client feel anxious and unsafe which can
    escalate aggression.

2.  Use a modulated, low monotonous tone of voice (our normal tendency
    is to have a high pitched, tight voice when scared).

3.  If you have time, remove necktie, scarf, hanging jewelry, religious
    or political symbols before you see the client (not in front of
    him/her)

4.  Do not be defensive-even if the comments or insults are directed at
    you, they are not about you. Do not defend yourself or anyone else
    from insults, curses or misconceptions about their roles.

5.  Be aware of any resources available for back up. Know that you can
    always leave, tell the client to leave or call the police should
    de-escalation not be effective

6.  Be very respectful even when firmly setting limits or calling for
    help. The agitated individual is very sensitive to feeling shamed
    and disrespected. We want him/her to know that it is not necessary
    to show us that they should be respected. We automatically treat
    them with dignity and respect.

**B: The Physical Stance**

1.  Never turn your back for any reason

2.  Always be at the same eye level. Encourage the client to be seated,
    but if he/she needs to stand, you stand up also.

3.  Allow extra physical space between you -- about four times your
    usual distance. Anger and agitation fill the extra space between you
    and your client.

4.  Do not maintain constant eye contact. Allow the client to break
    his/her gaze and look away.

5.  Do not point or shake your finger.

6.  Do not touch -- even if some touching is generally culturally
    appropriate and usual in your setting. Cognitive disorders in
    agitated people allow for easy misinterpretation of physical contact
    as hostile or threatening.

7.  Keep hands out of your pockets, up and available to protect
    yourself. It also demonstrates non-verbal ally, that you do not have
    a concealed weapon

> **C: The De-escalation Discussion**

1.  Remember that there is no content except trying to calmly bring the
    level of arousal down to a safer place.

2.  Do not get loud or try to yell over a screaming person. Wait until
    he/she takes a breath; then talk. Speak calmly at an average volume.

3.  Respond selectively; answer only informational questions no matter
    how rudely asked, e.g. \"Why do I have to fill out these (g-d
    forms?\" This is a real information-seeking question). DO NOT answer
    abusive questions (e.g. \"Why are all social workers ass holes?)
    This question should get no response what so ever.

4.  Explain limits and rules in an authoritative, firm, but always
    respectful tone. Give choices where possible in which both
    alternatives are safe ones (e.g. Would you like to continue our
    meeting calmly or would you prefer to stop now and come back
    tomorrow when things can be more relaxed?)

5.  Empathize with feelings but not with the behavior (e.g. \"I
    understand that you have every right to feel angry, but it is not
    okay for you to threaten me or my staff.)

6.  Do not solicit how a person is feeling or interpret feelings in an
    analytic way.

7.  Do not argue or try to convince.

8.  Wherever possible, tap into the client's cognitive mode: DO NOT ask
    *Tell me how you feel.* But: *Help me to understand what your are
    saying to me*. People are not attacking you while they are
    explaining to you what they want you to know.

9.  Suggest alternative behaviors where appropriate e.g. \"Would you
    like to take a break and have a cup of coffee (tepid and in a paper
    cup) or some water?

10. Give the consequences of inappropriate behavior without threats or
    anger.

11. Represent external controls as institutional rather than personal.

Trust your instincts. If you assess or feel that de-escalation is not
working, STOP! Tell the person to leave, escort him/her to the door,
call for help or leave yourself and call the police.\
\
There is nothing magic about talking someone down. You are transferring
your sense of calm, respectful, clear limit setting to the agitated
person in the hope that he/she actually wishes to respond positively to
your respectful attention. Do not be a hero and do not try de-escalation
when a person has a gun. In that case, simply cooperate.

**Reprinted from:**

> ***National Association of Social Workers - Massachusetts Chapter\
> Copyright 2001, NASW/MA. All rights reserved.***