Have your say

This week’s Have your say focuses on rough sleeping and the government’s claim that two thirds of rough sleepers have been helped into temporary accommodation.

Do you believe there are two thirds less people sleeping rough than 1997 when the government came to power? And is there sufficient temporary accommodation to help vulnerable people in your area?

To Have your say and e-mail us your point click here

The last Have your say debate centred on violence against social care employees.

Ray Braithwaite, who is a freelance trainer specialising in the management of violent and aggressive behaviour,  has answered questions regarding violence in the workplace:

Question: “I am a field Social Worker on a multi disciplinary team, and work with vulnerable adults over the age of 18 of any client group, though predominantly older people.

In accordance with legislative guidelines ( NHS and Community Care Act 1990), I had to visit a client to undertake a review of their needs and care package, the outcome being a reduction in their care.

The daughter of my client became very verbally abusive, and I was concerned for my physical safety due to her threatening body language. My attempts to diffuse the situation did not work, and I had to leave the home under fear of physical violence against me.

A complaint was then made by another family member to my manager. This alleged I was not performing my job correctly, as I did not stay in the home when her sister had become abusive. The outcome is I have to undertake training to deal with difficult situations.

I feel this does not address the fact that I enter potentially violent situations on a weekly basis, and feel that I have been penalised for considering my own personal well-being before the feelings of a disgruntled daughter. Given the same situation, when all attempts at rationalising with the person fails, I would remove myself from that situation whether I have undertaken training in this area or not.“

Anonymous

Answer: I agree with you completely. In a situation where a worker is facing the potential for violence a good way of dealing with the situation is to leave. What is then required is not being told that you are ineffective in your role, by being offered training in ways of dealing with such situations, but a reappraisal by the manager of the situation and an identification of ways of reducing the potential of the situation recurring to you or any other worker.

The minimum any worker can expect following such a situation is that a risk assessment under health and safety legislation is completed, and ways of reducing the possibility of recurrence are identified. Personally I would have written to the people concerned warning them that such behaviour towards a public official is not acceptable and any repetition would not be taken lightly.

The fact that you say you enter potentially violent situations on a weekly basis causes me concern as on-going risk assessments are an effective way of ensuring workers are not placed in such situations of risk. If risk assessments are not being completed your agency could be deemed to be failing you because in law employers (employing 5 or more staff) must provide:

Safe work environments, safe work practices and safe work systems.

That includes safety from situations which the agency knows are risky or those where they ‘ought to know’ (Health and Safety Act and regulations). Furthermore the agency must then take measures to reduce high and medium grade risk – including those where the worker is facing repeated situations of verbal abuse, let alone ‘potentially violent situations’. Incidentally if your agency fails to comply with health and safety legislation penalties such as fine and/or imprisonment could be imposed upon individuals as well as the agency (your manager could be fined up to £5000 or imprisoned for up to 2 years!)

I am pleased you are being offered training in managing aggression because I think everyone who deals with the public should have the same opportunity. It provides a way to influence the formation of policies and procedures within your agency; receive support from colleagues as well as identifying ways to help manage difficult behaviours/situations. However, good trainers in the subject will always identify the leaving option as a productive method of ensuring personal safety, and sometimes the only way of managing a situation.

Q: “Although I have not experienced physical violence at work, last year the service which I belonged to was restructured and several jobs were lost resulting in enforced redeployment. During the period of restructuring which has not quite finished yet, but basically from September last year until about July this year, I, and my colleagues, were subjected to horrendous management practices. These went over the whole range from:

telling us not to whinge or, moan

telling us to get on and find other jobs

giving us information and then retracting it

not telling us anything and then being surprised when we found out things from other people and were annoyed

arranging meetings to suit themselves and expecting us to rearrange our diaries constantly

making the stress we experienced our fault rather than theirs

complete lack of sympathy when we went off sick one after another

expecting us to arrange everything for the following year for the new service to take over

threatening us with discipline if we did not do so

trying to play one off against another giving us misinformation

Need I go on?! Looking back now from a redeployed post and grateful to still have a job, I think that what I and my colleagues above experienced was bullying and was violence of a verbal kind.

I would rather not say which authority it was as I need to keep working!“

Anonymous 

A: “This is bullying of the worse kind and cannot be tolerated. OK, it may occur because your manager(s) may be under pressure to ensure targets and deadlines BUT that does not make it acceptable.

Such management practice identifies the manager who cannot manage. It should be eradicated. BUT let’s be realistic if the person who is doing the bullying is in a management position the chances of you stopping the bullying is pretty slim, even if a group of you work together to challenge it.

Have a look at chapter 6 in my book for reasons why it becomes so difficult to challenge the bullying manager and for some ideas (your training section/officer should have one). Find out if your organisation has an anti-bullying policy, sometimes called ‘Dignity at Work’, and see what that says. Contact your union head office (one ploy of the bullying manager is to befriend the local rep, as a means of warding off any challenges to their position).

Talk openly about the situation with friends and colleagues for support if you find it happening again, BUT be careful you are not breaching confidentiality! Consider the whistleblowing legislation (a number of good articles have appeared in Community Care over the last couple of years). Finally, if the situation reoccurs think about leaving, sometimes there is nothing else to do. Sorry to sound so pessimistic but if you’ve got a group of managers doing this, then you’ve got problems. A good web site for further information www.successunlimited.co.uk

Q: “A pity that Ray in his excellent article does not reference under web sites www.doh.gov.uk/violencetaskforce

The National Institute of Social Work, whose research Ray quotes, commissioned further research papers from experts across all client groups and their papers are all available on the web and, in their frequently shared conclusions, make very interesting reading. There are also extensive reference lists for anyone interested in pursuing this topic further.“

A: Claudine, thanks. You are right its a splendid site for information. Some of my stuff is also on it!

Q: “I did for a while work for a school for children with Autistic Spectrum Disorders and associated challenging behaviour. As part of this role (child care worker) I supported a child age 12 with challenging behaviour. His chosen method of communication, and to get your attention, involved a great amount of pinching, slapping and scratching. This would be sometimes continuous, of up to 6 hours ( a shift).

I worked with this child on a 1-1 basis. It was my responsibility to support this child within a group of other children with severe and profound disabilities and to stop him harming other children (and staff).

I questioned on numerous occasions senior staff about his behaviour and how much I was expected to take regarding harm to myself. It was decided that if the behaviour left marks then this would have to be recorded. I was doubtful if this recording was acted upon!.

My main concern was that as this child’s behaviour became worse then he was more and more segregated from the rest of the children. The knock-on effect of this was that I had to contain this child in his own room and obviously due to his boredom and the constant attention from myself, his behaviour was more intense and consequently I was left exhausted and harmed on more occasions.

I was wondering how much injury are you expected to be exposed to? Is it to be expected that you will have some injuries due to the nature of the work?

My main concern is that people with this extreme challenging behaviour may be segregated more than they do at the moment, and this is not the solution that I would like to see.“

J. Skelton

A: My starting point is clear, no-one is paid to be abused let alone injured in the course of their profession and if it is happening every resource possible should be made use of with the sole purpose of attempting:

a) to reduce the incidents ( poorer option) or                  

b) stop them altogether (best option).

I am not saying there is a magical solution for every situation BUT I am saying there is a lot more we can do to make situations better for those on the receiving end. First of all we call a case conference to examine the situation from the perception of protecting the worker (case conferences are usually focussed upon the needs of the service user), and in this conference we identify how that may be achieved. Sometimes it may be with the taking of simple precautions like for example the wearing of a cap can prevent hair from being grabbed, or in this case the use of arm cuffs or specially designed protective body clothing to reduce the possibility of being pinched or scratched.

It is not just a question of considering the needs of the service user we must also consider the needs of those who are facing the behaviour. 1-1 sounds good, but it may not be enough what about 2-1 or even 3-1 to prevent injury (such action can eventually be cost effective especially if it prevents admission to a more costly care facility). Sometimes it will call for the taking of unpleasant decisions and these must be taken. Unfortunately, however, good practice is so often dictated by inadequate funding so I would always insist on the provision of an advocate to consider every option and act for the service user to demand better resource options which do not require carers to be injured.

Q: “As a member of the care community and a person with quite extensive actual involvement in the field of violence management I have been quite concerned with the theoretical nature of the ‘expertise’ of some of those advising the social care sector on this hugely complex subject.

May I respectfully ask what your background is and what your violence management training and qualifications are based upon?

Please do not misunderstand the directness of my question, but I have met several ‘experts’ who are dangerous in their lack of actual experience of this specialist subject.

This is clearly a subject that not only requires violence management expertise (a lifelong study in its own right), but it also requires actual knowledge of the care profession as well – if the knowledge is to be realistically and therefore successfully applied.

Hope you do not mind the question.“

A carer

A: Dear carer, I don’t mind in the least and I agree with you 100 per cent. The following is a brief summary of my knowledge base and experience which is used to describe me.

‘Ray is a qualified social worker (CQSW). He was also an Approved Social Worker. During 16 years in social work he undertook additional training in counselling, family therapy and management. He was a manager within social services for 10 years. Since 1986 Ray has been training staff in ways of managing aggression. His first book “Understanding Violence, Intervention and Prevention” was published in 1992 and a video training pack outlining his methods was produced by CENTEC the following year. He addresses national conferences on the subject of violence towards social care staff and in 1999 was a lead trainer and speaker in the ‘No Fear’ campaign aimed at reducing violence against social care staff.

Ray provided a fortnightly column for Community Care on violence at work from July 99 until December, 99. He has published numerous articles on managing aggression in a range of professional journals. As an external consultant he also helps organisations to write specific guidelines on ‘Violence at work’. In 2000 Ray was a member of the government’s working group on ‘Violence to social care staff ~ training’. Besides working for local and central government bodies and the private and voluntary sector, Ray has also trained staff in Malta – the ‘Social Development Programme’ which is the social services equivalent, and Germany, in his methods. His second book entitled, ‘Managing Aggression’ was published by Routledge in October 2001.’

Q: I was a social worker working for a housing association when I was attacked. I believe that violence towards social care staff should not be tolerated, but unfortunately police and some employers appear to pay lip service to condemning attacks and feel that a level of violence is acceptable. In the past I have known of heath care professionals, such as mental health workers, who have also been attacked and again the attitude from the police seemed to be, well its part of the job isn’t it!

Also some employers appear at a loss about how to deal with members of staff who have been attacked. My experience left me feeling like a leper and out cast at a time when I needed support. I was ignored by two members of staff with some others finding it difficult to talk to me when I returned to work. Employers need more training in this area of how to deal with the situation and how to handle staff who have been attacked.

Unfortunately I cannot see things improving as we live in what appear to be more violent times or if not violence is thrust upon us from every angle eg marketing and television etc. I believe that in society there also seems to be a level of acceptance that some violent behaviour is acceptable.

To underline this point a recent article on Radio 4 highlighting the problem:- Attacks on rail staff over the last year have risen by a fifth, and the clergy have taken up karate as the attacks on them have increased greatly. Statistically they are higher than doctors, nurses and even social workers for being attacked, Radio 4, World Today, 17 December 2001.

A depressing state of affairs. A decline in moral standards as society appears to be fragmenting in this modern world? May be as a species we need to deal with our violent and aggressive behaviour before we can move on.

Then and only then can we eradicate violence. Then the question about violence against social workers etc will not be relevant?“

Graham Hardy (DipSW)

A: I am pleased to enclose a part of the draft code of practice for employers which the General Social Care Council announced: (Employers must) ………’ make it clear to service users and carers that violence, threats or abuse to staff are not acceptable, and have clear policies and procedures for preventing violence and managing violent incidents.’

Hopefully the situation you outline will become a thing of the past BUT only with a change in the culture which indicates violence is a part of the job.

Maybe that is being changed gradually. Besides the many examples of poor practice, I have examples of courts taking assaults against carer workers seriously, the police identifying it as an issue (in some areas) and (some) employers making clear statements that violence against staff is unacceptable.