INTERN SAFETY IN THE COMMUNITY

1. INTERN SAFETY IN THE COMMUNITY Deborah Sarsgard LCSW-C Faculty Field Instructor Family Connections/Title IV-E September 6, 2007—New Intern Orientation

2. Family Connections-Specific Factors • In 10 years, with over 100 interns, FC has never had an intern assaulted or injured. • Why? FC services are voluntary. By and large, FC clients are not psychotics or involved in the drug trade. We are not in the community after 7-8 p.m. when most of the violence occurs. We know, too, that most crime in Baltimore City is drug-related and involves victims known to the perpetrator. • This string of factors is intended to reduce intern anxiety without eliminating it. A manageable degree of anxiety is not only normal but ESSENTIAL to safety. • EVERY SURVEY OF WORKPLACE INCIDENTS INVOLVING HELPING PROFESSIONALS HAS CONFIRMED THE #1 RISK FACTOR IS WORKERS FEELING SO COMPLACENT ABOUT THEIR SAFETY THAT THEY LET DOWN THEIR GUARD AND ARE NOT VIGILANT ABOUT RISK REDUCTION.

3. SAFETY AND AGENCY CULTURE • A central aspect of the Family Connections culture is the permission to feel whatever you feel and the provision of a safe setting to talk about these feelings without fear of being judged. You are expected to have strong personal reactions to this work and we would be concerned if you didn’t. • Fortunately, most agencies have become attuned in recent years to the pernicious effect of vicarious trauma on staff and routinely conduct critical incident debriefings after an incident (e.g. child death, attack on worker). It is a requirement of agencies to have safety protocols for staff and considered a sign of strength/professionalism rather than weakness to ask for back-up when indicated.

4. Two Components of Safety • Cognitive—Your social work assessment of the dynamics and risk factors. This is an intellectually informed construct. • Subjective—Your gut reactions and instincts which, as we will see, must be valued inasmuch as they are emanating from some reality-based source and alerting you to something that has not yet reached conscious awareness.

5. Steps to Follow Before Leaving the Agency for a Home Visit • Be sure your cell phone is charged. • Be sure you have enough gas in your car and tires are fully inflated. • Make sure your car is empty (e.g., no bags, CDs in view on seats). • Tell someone at FC where you are going—ideally field instructor—and when you expect to return. (Call if you will be late returning.) • Check what you are wearing to ensure it is not going to put you at risk of being a target (e.g. sexually provocative, high heels, expensive jewelry). Wear your Agency (SSW) ID badge. • Make sure you have directions to and from client’s home. • If a first visit, call client to let them know you are on your way and ask where it’s best for you to park. • Assess the need to have someone accompany you. (NOTE: A staff member will always go with you on at least the first visit to a new client.)

6. Steps to Follow Once You Arrive at the Client’s Home • Park on a well-travelled street, not an alley. Be sure it’s a space where you will not be blocked in. • Before leaving your car, scan the environment and visualize the path you’ll take to the house. (NOTE: If something feels “off,” you can: 1) return to FC, 2) call the client and ask her to meet you, or 3) call your field instructor for guidance.) • Lock your car and proceed directly to the door with a firm, brisk step. Project an image of knowing where you are going and what you are doing. • If there is a hostile dog, avoid eye contact while backing away toward your car. • Acknowledge anyone you pass—briefly—with a nod or hello. Much of the rage of oppressed peoples comes from feeling unseen and invisible to the broader society. By acknowledging another’s humanity, they are more likely to see yours.

7. Steps to Follow Once You Are At the Door • Have your car keys in your pocket or another immediately accessible place.Listen for fighting/loud noises before you knock. • Stand to the side rather than right in front of the door. • Before you enter, see who else is in the home. If there’s a group of non-family members, it’s okay to ask, “Would you prefer I come back later when you don’t have company?” • If you see drug paraphernalia or weapons lying out, leave immediately. • It’s not sufficient to consider only your own safety. There are, by definition, vulnerable children in the household and you must make an assessment (preferably in a phone conversation with an FC staff member) about child safety and if the police need to be called. • Another reason to leave is if the client is under the influence of drugs or alcohol since no meaningful work will be accomplished. • Know that your clients are your greatest asset in ensuring your safety. They are highly protective of their FC workers, will watch for your arrival, let neighbors know you are trustworthy, and walk you to your car.

8. De-Escalation Skills • The ability to de-escalate is the most important skill set in ensuring your safety. Your goal is to reduce the client’s level of arousal. • Both the client and the worker contribute to determining whether the crisis will escalate or resolve. Your responses and demeanor are often critical to the outcome. • Remain calm and self-assured. Your anxiety will only increase the client’s anxiety, which in turn can lead to aggression. • Assess what level of crisis the client is in—beginning, middle or end—as this will determine your response. • Watch your body posture. Never point your finger or touch the client if they are agitated. Maintain an assertive yet supportive body stance. Try to keep at the same eye level with the client (e.g., don’t stand over them if they are seated). Maintain a respectful personal space. If you are going to do something (e.g., take a pen out of your purse), tell the client what you are about to do. Use a low, monotonous tone of voice, disciplining yourself not to match their vocal intensity. • Remember that aggression escalates when people feel powerless, so always be thinking of ways to help the client reclaim their power.

9. De-Escalation Skills (cont’d) • Never tell an agitated client to “calm down.” • Ignore inflammatory comments, even if directed against you (don’t personalize). • If given the opportunity to ventilate anger/frustration, most people will naturally calm down. Just listen to their story without offering advice or playing forensic investigator. If you truly need more clarity, say “Help me understand what happened…” • Generally stay neutral without adding additional content. Respond selectively. • Use reflection (“It really made you angry to be treated that way”) only if it will not add fuel to the fire. • This is not the time to offer feedback on solutions or ways the client may have contributed to the situation or handled things differently. • After the client has vented, assess whether your presence is resulting in de-escalation or only further agitating. One option is to ask, “What can I do to help right now?” Another is to give the client a way out and end the session (ASSUMING THERE ARE NO SAFETY CONCERNS) by saying something such as, “How about if we stop for today and I come back tomorrow when you’ve had more time.” • Keep in mind it takes 30-40 minutes for the human body to come down physiologically from a rage state. • Call Agency staff member if anger is escalating rather than reducing over time to assess child safety concerns or any homicidal/suicide concerns. • At the next visit, you will process what occurred and make plans for how to deal with similarly stressful incidents in the future.

10. SUMMARY • Your safety is the first priority. • Trust your gut instincts. • Never enter a home where you feel unsafe. • Do not hesitate to leave a home if you sense danger. • Keep in mind, however, that you must simultaneously be assessing (not necessarily taking any personal action in this regard) the safety of vulnerable people (children, seniors) in the home and must reach a decision about whether the police, B-CARS, etc. need to be called. • Check everything out with your field instructor or another staff member. Never be afraid to call in for back-up.