1. Carol Wilkinson, MD. MSPH Medical Director, IBM Medical Director, IBM November 15, 2004 Baltimore, Md November 15, 2004 Baltimore, Md VIOLENCE PREVENTION: TRANSLATING RESEARCH TO PRACTICE TYPE III: CURRENT OR FORMER EMPLOYEE

2.  Agenda ƒ Workplace Violence: Type III ƒ IBM's Past Experience ƒ Violence Prevention Programs: IBM ƒ Threat Assessment & Management ƒ Summary WORKPLACE VIOLENCE: TYPE III CURRENT OR FORMER EMPLOYEE

3. WORKPLACE VIOLENCE: TYPE III: Current or former employee  Most media attention, least frequent  Frightening: not safe at work  Continuum ƒ Hostile evironment:verbal aggression, insult, bully ƒ Verbal: Threats ƒ Physical attack ƒ Lethal  Acts of desperation, poor judgement  Current approach is based on trial and error, experience and judgement

4. Workplace Violence: Issues Type III: Current or former employee  The meaning of words ƒ Norms ƒ Changing standards of acceptability ƒ The challenge of communication  Our culture of violence  The power of emotions such as anger  Multiple life stressors

5. VIOLENCE PREVENTION PROGRAMS OVERVIEW  Customize to workplace culture, the organizational structure and the risks  Common factors  IBM as an example ƒ Early leader in workplace violence prevention ƒ Responsibility owned by security ƒ Ongoing process of assessment, refinement, enhancement  Keys to program success ƒ Consistency ƒ Anticipation ƒ Collaboration TYPE III: Current or former employee

6. IBM's PAST EXPERIENCE  1980's Two Incidents:  Bethesda, MD  Raleigh, NC  Casualties:  Deaths: 4  Physical injury: 25+  Psychological injury: many  " Never Happen Here "  " Defining Experiences " TYPE III: Current or former employee

7.  Structural/organizational approach  Building/regional level  Members: Legal, HR. Mgt, Medical, Finance, Security, Communication, etc  Structural approach  Formal list, with back-up, phone contact information  Annual training  Rapid, effective response  Multi-purpose  Fire in building  Bomb threat  Workplace violence  Natural disaster IBM WORKPLACE VIOLENCE PREVENTION Crisis Management Teams: TYPE III: Current or former employee

8. IBM WORKPLACE VIOLENCE PREVENTION (CON’T) ƒ Physical Security - Type I, II or IV ƒ Pre-employment Background Checks: Type IV ƒ Criminal record, violent crime ƒ Does not address risk of current/former employees: ƒ Training: Type I, II, III, IV ƒ HR ƒ Managers ƒ Receptionists ƒ Mailroom TYPE III: Current or former employee

9. IBM WORKPLACE VIOLENCE PREVENTION (con't) ƒ "Zero Tolerance" Policy: Type III ƒ Identification ƒ Investigated ƒ Addressed: warning...suspension...termination ƒ Importance of ƒ Limit setting,, consequences ƒ Consistency ƒ Reasonablenesss ƒ Employees right to be safe at work ƒ EAP: Type III ƒ Troubled employees ƒ Assistance with life's stressor ƒ Risk can remain after termination TYPE III: Current or former employee

10. THREAT ASSESSMENT PROCESS  Early identification  Information collection ƒ Details of the threat  Avoid the "chicken little" syndrome  What was said, how, when ƒ Current & prior behavior  Best predictor of future is the past  At work, away from work ƒ Objective *** & subjective ***  Importance of non-verbal behavior  Professional Evaluation *** ƒ Experienced: forensic psychiatrist, FB!, ƒ Known, reputable ƒ Limits to predictive value of any assessment: only one point in time ƒ Useful part of process for employee and management TYPE III: Current or former employee

11.  Protect People  Avoid direct contact: communicate by phone  Security on hand for meeting  Panic alarms  Set Limits  Acceptable vs unacceptable behavior  Meet employee's needs as much as possible  Maintain dignity  Give employee a chance to be heard  Assistance for underlying problems THREAT MANAGEMENT PROCESS TYPE III: Current or former employee

12. Challenges to effective violence prevention  Need to get it right ƒ Infrequent ƒ Potentially high stakes  Collaborative ƒ Multiple persectives  Failure to act - ƒ Problem often won't go away ƒ May get worse ƒ Long-standing situations are the most problematic  Tolerated  Implicitly condoned  Can be effective behavior for employee

13.  Over-react ƒ Can exacerbate the situation ƒ Need to avoid panic driven behavior ƒ Need to consider options, consequences ƒ Can undermine credibility  Importance of management practices ƒ Treatment of employees  Knowledge and experience transfer TYPE III: Current or former employee Challenges to effective violence prevention (CON’T)

14. SUMMARY: Workplace violence: Type III: Current or former employees Type III: Current or former employees  Threats & hostile workplace  Experience is fragmented and inaccessible  Law enforcement shifting perspective to preventing violence  Mental health providers increasing understanding of public health implications  Challenge of translating what we know about the psychology of individuals associated with employee violence into education and processes  Danger of over-simplification(white male in 40's with weapons)  The need to building the scientific foundation of empirical knowledge