From June 2001 NASW NEWS
Safety Need Not Conflict With Client Care
Security Training Helps Deflect Assaults
The best way to manage client violence is to prevent it.
By Corinna Vallianatos, NEWS Staff
Rebecca Binkowski, a part-time graduate student in social work at Western Michigan University (WMU), was giving a client from a Kalamazoo halfway house and community mental health clinic a ride. She was alone with him. He was dangerous, but she didn't know it, or didn't want to believe that she could be at risk. Sometime during the ride, he pulled out a knife, and stabbed her to death.
Kenneth Reid, who taught Binkowski in 1992, said news of the popular student's death came as "a terrific shock. Many of us had been in social work for a long time, and while we might have been cuffed around a little, we'd never known anyone who had been killed."
Reid said after the shock and grief, which enveloped the social work program, the faculty knew they had to act. "We became committed to bringing the issue of violence against social workers to the forefront."
A group of faculty came together, said Reid, and devised a safety-awareness program, three and a half hours in length, which is now required for all WMU social work students before they embark upon field placement. He said faculty brought in a field instructor from Kalamazoo's Residential Program Center to conduct the safety training, so that "faculty, who had become counselors for grieving students, could take care of our own needs too."
Reid said there was very little recognition of violence against social workers when Binkowski was killed in 1992, so the idea that a school, and subsequently area agencies, might offer training on the subject was fairly new. "And we figured if we can protect a life or two in the process, we're doing a good job."
Linda Reeser, who was also a professor of Binkowski's at WMU, said that at the time of Binkowski's death, safety measures that may appear to be no more than common sense were often disregarded or were not thought of to begin with. For instance, she said, Binkowski should not have been transporting a client alone, especially a client like hers, who had a history of violence and had attempted to burn down the residence where he was living. Also, she should have had the client sit next to her in the car, rather than in the back seat, to maintain visual and verbal control more effectively.
The training that WMU began to offer after Binkowski's death presented a potentially violent situation and taught students how to handle it how to "de-escalate" someone who is becoming violent, how to defuse a situation that is spiraling out of control. But Reeser believes that in Binkowski's case, some very basic tactical mistakes were made.
In the aftermath of the tragedy at WMU, Reeser and a fellow faculty member, Robert Wertkin, surveyed directors of field education of all BSW, MSW and combined programs in the U.S. that were accredited by the Council on Social Work Education.
The 1999 survey, "Safety Training in Social Work Education: A National Survey," slated for publication in Teaching in Social Work, elicited several telling findings. Forty-two percent of all schools had at least one student threatened in the two-year period preceding the survey, and 13 percent had at least one student who had been physically assaulted, but only 12 percent had formal written policies on student safety, and only 38 percent, slightly more than one-third, provided students with safety training.
Reeser said that while one-fourth of male respondents thought the need for more attention to student safety was unnecessary, a fraction of female respondents, only 10 percent, felt the same. She said the survey found that 73 percent of field directors placed students in "high-crime areas," such as juvenile corrections and prisons, but there was no correlation between type and potential hazard of field placement and training provided. She said 71 percent of respondents believed that risks to student safety were increasing.
Field directors, Reeser said, think both schools and agencies are responsible for safety training, yet the communication between the two entities is very poor, with most directors simply hoping that agencies are providing training.
It was only after Binkowski's family sued the agency where she had been working with chronically mentally ill clients that the agency initiated safety training and put in place a lengthy violence assessment for clients, according to Reeser.
Despite the progress that has been made since Binkowski's murder, the issue of violence against social workers still begs attention. According to Susan Weinger, professor of social work at WMU and author of Security Risk: Preventing Client Violence Against Social Workers, published this year by NASW Press, research on the subject is sporadic at best. "Violence against social workers is written about very infrequently," she said.
There are reasons for that. Perhaps the paramount reason is that social workers are trained to help clients, not size them up as potential perpetrators. Social workers empathize; they don't suspect.
And there is a down side to being too vigilant, according to Weinger: "It could be if you got too preoccupied [with your own safety], you'd prevent a connection with your client and maybe even exacerbate the problem." Social workers want to remove, not erect, barriers between themselves and their clients, and who can do that with a can of pepper spray in one hand?
So how does one bridge the gap between looking out for one's own safety and providing the kind of compassionate attention to clients that social workers want to provide? According to Weinger, the social worker should "stay with the empathic mode until there's reason not to. When something untoward happens, click back to a safety-minded knowledge base. You can't go around suspecting people, but you need an awareness in the back of your mind."
After all, Weinger said, social work requires extraordinary "people skills," which call for "a lot of complexity, and this [awareness of safety issues] just adds to them."
Although the research has been scattered, there is consensus that violence against social workers is increasing. Tabulating how much, however, is proving difficult. "There's a lot of underreporting due to shame," said Weinger. "If your client acts out against you, you may be accused of being unprofessional. Also, maybe there's no institutional encouragement to report acts of violence. Our stance as social workers should be that we will back each other."
Anecdotal evidence is that less-experienced social workers are more likely to be targets of violence. "Perhaps they don't set limits until the aggression escalates too much," said Weinger. "Perhaps they just don't handle it as expertly." But violence against social workers is not limited to novices. One-half to one-fourth of all social workers graduating from school today can expect to be victims of such behavior.
"It's important to keep in mind that violence can be defined broadly," said Weinger. "It could be verbal aggression, smashing windows, physical attacks. That's why the numbers vary so widely."
Weinger became involved with the issue as a new faculty member at the WMU School of Social Work. "The incident with Binkowski occurred before I came here," she said. "The faculty needed someone to tackle the problem who didn't have all the emotional baggage. Before Rebecca [Binkowski], violence against social workers just wasn't discussed. Schools of social work and social service agencies hadn't been sensitized to the need for safety training."
Weinger's book opens with an explanation of the profession's slow response to the problem: "Social workers work with clients in close relationships in which they try to understand how clients feel about their experiences. Because of our feelings for clients, it is difficult to consider that one of them might hurt us. Perhaps it is not surprising that as a profession we have been reluctant to address and implement safety procedures."
"The best way to manage violent behavior is to prevent it," she writes.
In that vein, Weinger's book offers practical tips on violence prevention. Using verbal communication that "helps the client restore a sense of status and control" is crucial to prevention, she writes. Weinger recommends helping the client talk out angry feelings rather than act on them, speaking simply, helping the client overcome an insurmountable problem by breaking it down, redirecting the client away from an issue that is overwhelming his or her inner controls, and avoiding aggressive responses.
Weinger also recommends nonverbal tactics to de-escalate a potentially violent situation: positioning yourself so you are neither threatening nor an easy target; maintaining eye contact that communicates involvement, not aggression; and matching your body language so that the client will follow your decrease in intensity.
According to Weinger, relationship factors can also encourage a decrease in tension, such as: providing a firm, supportive structure of limit setting; equalizing the relationship through assertive communications; personalizing or depersonalizing yourself to lessen the danger; making appropriate disclosures to help the client connect with the reality of the situation; and relating with sensitivity to diversity.
Finally, Weinger suggests allowing the client the option of flight rather than fight.
Still, training alone can't protect social workers without the proper institutional support system, according to former NASW Michigan Chapter President Jeanne McFadden. Approximately three years ago, the chapter reacted with horror after Lisa Putman, a child protective service worker on a house call, was ambushed by a client and beaten to death. The chapter has since established an award in her memory and is working for legislation that would create extra protection for child protective service workers.
"The issue of safety is a fine line to walk," said McFadden. "There are some conservative voices calling for taking these kinds of duties away from social workers and giving them to police. This is not the solution. Others call for arming social workers. [But] social workers just don't come in shooting."
McFadden said the proper direction is a combination of safety training, having back-up help available, working in teams and equipping social workers with technology like cell phones with panic buttons, or buttons they can press in their offices to call the police, much like bank tellers use.
"Lisa thought she was going on a completely routine call," said McFadden. "She didn't think she had any cause for alarm."
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