Everyone deserves to feel and be safe at their job each day. Workers and their employers share the responsibility for making this happen. By law, employers must do whatever is reasonably practical to make sure workers are safe. They must inform staff of risks and how to handle them in order to stay safe. Workers must take reasonable care to protect their own health and safety and that of other workers.
While occupational health and safety laws were designed for people who routinely wear steel-capped boots and hard hats, the same laws apply to disability workers who support individuals in their homes, workplaces and elsewhere in the community. A 2013 survey of frontline staff by the Alberta Council of Disability Services (ACDS) found that the biggest safety concerns among disability workers were related to working alone with aggressive individuals. So we will concentrate on that concern in this E-Bulletin.
Supporting People with Complex Needs
Not everyone works with individuals who have “complex needs,” and not everyone who has complex needs is aggressive. But working with individuals who may become violent puts the worker at greater risk of injury. As a result, employers and the workers who support such individuals have greater responsibility than usual to do what it takes to make sure staff are safe on the job. Here are some best practices for employers and staff in this situation.
- Make a good plan and follow it.
Individuals with a history of aggression should have a detailed support plan based on observing and interacting with them over time and across situations. The main purpose of this plan is to identify events, situations, actions and stimuli that trigger aggression or other problematic behaviours, and the actions staff can take to prevent or deal effectively with these behaviours. The goal is to help the individual have the best life possible in the community while keeping everyone safe.
A good plan will identify
- things that have been triggers for the person in the past
- signs to watch for that tell you the person is becoming upset or preparing to take aggressive action
- behaviours that you should take (or not take) to calm the person or keep the person calm
- what to do if the situation continues to get worse
Employers are responsible to see that you have read the plan, understand it and are able to follow it BEFORE you start working with the individual. Shadowing other staff who work with the individual before you start working with them gives you a chance to connect what you have read with the actual person. Workers are responsible for reading and understanding the plan. Ask questions if you are not sure you understand the plan. Then follow the plan. As you learn more about this individual’s behaviour, what triggers it, and what works well with that individual, you should share that information to make the plan better (and keep your co-workers safe).
- Get the right training and practise what to do.
One of the main tools that employers in the disability field use to keep staff safe is to make sure they have the right training to deal with situations that can arise. Agencies typically require staff to take some form of crisis prevention and intervention training (e.g., CPI, Pro-ACT, PACE, SIVA, DAV, MANDT) and maintain certification with refresher courses. Some of these courses have advanced training for those working with people who have complex needs. It is important to take this training BEFORE you start working with the individual with complex needs in order for you to be safe and support the individual’s emotional well-being effectively. The next step is to be mentored by someone familiar with the plan and the individual.
It is also important to practise regularly the skills you learned, as well as the responses that are in the plan for that individual. In a crisis, people tend to do automatically what they practised the most.
- Pay attention to the signs of trouble and take appropriate action.
It is important to pay attention to the clues an individual gives that something is not right. This is a key part of providing excellent support to anyone, but it is essential to your own safety when supporting someone with complex needs. A good plan identifies what to watch for and how to respond for your safety and the individual’s well-being. Get an update from other staff at shift change as to the individual’s state of mind, any incidents and what has been going on, or read the most recent contact notes.
- You are not the exception to the rule.
As you get to know the individuals you support, it is easy to feel that a bond is developing based on mutual respect and liking. But it is dangerous to believe that the individual would never become aggressive toward you because he or she likes you. Developing a relationship with someone doesn’t get rid of the behaviour. Being supportive and watchful is safer than just being supportive.
- Make sure you have a way to safely remove yourself from physical danger.
Be aware of your surroundings when you are with the individual. Even if you carefully follow the plan and do what you were trained and what you practised, there is no guarantee that the situation will not escalate. No one benefits if you are backed into a corner and have to fight your way out to avoid being injured; do not let the individual get between you and your escape route (i.e., the door). Get to a safe place BEFORE you call police or a supervisor.
The Working Alone legislation says that employers must assess the risks and take steps to minimize them for employees working alone. They must also make sure that employees on their own have a way to communicate with someone who can respond immediately in an emergency. Make sure you have a way to contact someone for help if you think you may need it. If you said you would call and you don’t connect on time, it is cause to investigate. Where risks of violence are extremely high, video surveillance is an option and a case can be made for having more than one staff present at all times for everyone’s safety.
Your safety on the job is important. Make sure that you have the training and resources you need. Then stay aware and make use of what you have learned to be effective and safe.