© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Workplace Violence Prevention Teleconference November 30, 2005

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 2 Four Types of Workplace Violence (Cal/OSHA 1995)  Type I (Criminal Intent): perpetrator has no relationship to the workplace  Type II (Client/Customer): perpetrator is a client who becomes violent towards a worker or another client “ Majority of threats and assaults against caregivers come from patients/families/visitors ” ( Arnetz & Arnetz, 2000 )  Type III (Worker-to-Worker): perpetrators are employees or past employees  Type IV (Personal Relationship): perpetrator usually has a relationship with an employee (e.g. domestic violence in the workplace)

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 3 A Guide to the Development of a Workplace Violence Prevention Program Booklet one: Implementing the Program in Your Organization Booklet two: Developing Crisis Prevention & Communication Strategies Booklet three: Developing Human Resources Strategies for Managing Workplace Violence Booklet four: Preventing Client Aggression Through Gentle Persuasive Approaches

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 4 5 Steps in Violence Prevention Program Development  Secure management commitment  Assess your program needs  Develop program components  Implement program  Evaluate program

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 5 Step 1: Secure management commitment  Management commitment is:  the foundation of an effective program  necessary to ensure that other resources (budget, human resources, materials, equipment, training, etc.) are available to develop, implement and maintain the program  Assigning responsibility to program leader  Using a multidisciplinary committee

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 6 Step 2: Assess program needs  Community workplace violence issues  Internal documents  Security, emergency response, unusual occurrence, client abuse, EAP  Employee incidents/accidents  Physical environment  Work setting and clients  Point-of-care work practices  Employee perceptions

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 7 Step 2: Assess program needs cont’d Workplace Violence Documentation Analysis tool Appendix D Unit Workplace Violence Incident/Accident Analysis Collection tool Appendix E Organizational Workplace Violence Incident/Accident Summary tool Appendix F Environmental Assessment toolAppendix G-1 Community Workplace Assessment toolAppendix G-2

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 8 Step 2: Assess program needs cont’d Work Setting and Client Risk Factors Checklist Appendix H Checklist of Risk Factors for Aggressive Behaviour Appendix I Point-of-care Staff Work Practice Assessment Appendix J Workplace violence employee survey Appendix K Appendices taken from HCHSA’s “Guide to the Development of a Workplace Violence Prevention Program” and are included in the Participants’ Manual

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 9 Step 3: Develop the program  A comprehensive Workplace Violence Prevention program includes:  Workplace violence prevention policy  Associated procedures  Reporting  Emergency response  Investigation  Environmental and security controls  Administrative controls  Work practices

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 10 Step 4: Implement the program  Critical steps  Ensure development of Workplace Violence Prevention policy and procedures  Develop a communication and marketing plan  Develop and present staff training  Launch the program

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 11 Step 5: Evaluate the program Goals of program evaluation:  Create and maintain a safe working environment without the threat of violence  Review, revise, enhance and improve program components based on:  program self-audit  results of qualitative and quantitative evaluation procedures  Maintain the program  Continuously improve Workplace Violence Prevention program

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 12 A Guide to the Development of a Workplace Violence Prevention Program  Book 2: Developing Crisis Prevention and Communication Strategies  Staff training in crisis intervention  Recognizing and responding to stages of violence  Crisis response team  Effective communication skills  Environmental conditions during crisis interventions  Cultural sensitivity  Emergency response  Employees’ needs during and after crises

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 13 A Guide to the Development of a Workplace Violence Prevention Program  Book 3: Developing Human Resources Strategies for Managing Workplace Violence  Prevention of violence among employees  Harassment  Domestic violence  Threats  Weapons  Hiring and termination practices

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 14 A Guide to the Development of a Workplace Violence Prevention Program  Book 4: Preventing Client Aggression Through Gentle Persuasive Approaches  Partnership between HCHSA & Continuing Gerontological Education Cooperative (CGEC )  Two-part education initiative  Program infrastructure  GPA training  Master trainers:  Regional Psychogeriatric Resource Consultants (PRC)  Public Education Coordinators of Alzheimer's Association  Case Managers of Psychiatry and Medicine for Aging in the Community (PMAC)

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 15 Traditional Approaches to Aggression Prevention  Focus on methods to manage, contain, or reduce the impact of the aggressive act  Rely on physical methods to deal with the situation  Focus on body containment techniques – based on a philosophy of care that focuses on pathologies that reinforce negative perceptions of persons with dementia as being assaultive, violent, dangerous and passive recipients of care!  Do not seek to understand the underlying reason for the responsive behaviours (Jones, 1999)  Focus on containment and control of aggressive individuals (dictated care regimes, use of physical or chemical restraints)

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 16 GPA Curriculum  Curriculum developed as an adjunct to the PIECES, U-First, and Enabler Programs – educational initiatives that were part of the Ontario Ministry of Health and Long-Term Care’s Alzheimer Strategy (Initiative #1).  Philosophy: an individual’s life experience, unique personality, and network of relationships should be valued and taken into account by staff as having a direct application to the interpretation and response to behavioural episodes.  Assists point-of-care staff and managers to respond effectively and with respect to the catastrophic verbal and physical expressions of needs, demonstrated by persons with dementia in long-term care settings.

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 17 Part One: Developing Program Infrastructure Assist the organization to understand:  The five steps in planning a program  The multidisciplinary steering committee approach to program development  How to conduct a program needs assessment  How to develop a Preventing Client Aggression policy and associated procedures  How to implement the program through marketing, communication and education strategies

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 18 Part One: (continued) Developing Program Infrastructure  How to evaluate the program  How to integrate program infrastructure into existing resident care systems  MoHLTC resident care standards clearly identified under the ‘Standards and Rationale’ sections  Program uses existing PIECES assessment tools – organizations are very familiar with these tools  Endorses use of the regional psychogeriatric resource consultants for problem solving with difficult cases

Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. 19 Part Two: Preventing Client Aggression Through Gentle Persuasive Approaches Assist the caregiver to :  Understand that the client with dementia is a unique human being who has an emotional response to stimuli  From a holistic perspective, explain the relationship between the disease process and the individual’s behavioural response  Describe emotional, environmental, and interpersonal aspects of communicating with persons with dementia  Choose strategies that serve to diffuse challenging behaviours, rather than escalating them  Demonstrate the suitable and respectful protective techniques to use in response to more catastrophic expressions of need