Work-related violence, aggression and harassment

• Walk through and inspect the workplace (including for low visibility in service areas, entries and exits for workers after hours, long patient queues and wait times).
• Identify situations and areas of the workplace where patients, residents and others may experience heightened negative emotions such as stress, distress, frustration, communication difficulties, anger, a sense of unfairness or have unreasonable expectations of the services that can or should be provided.
• Observe interaction between workers and others in the workplace (e.g. rudeness and incivility, poor relationships, racism, or workers avoiding being around certain people).
• Conduct confidential worker surveys about incidents or behaviours that have caused discomfort and situations that had the potential to become more violent.
• Identify factors external to the workplace which may lead to violence or aggressive behaviour (e.g. patients affected by drugs or alcohol).
• Talk to patients or clients about their support needs, including any unmet needs.
• Consider the mix of patients or clients and what ‘triggers’ they may have.
• Consider varying communication abilities (e.g. clients with an intellectual disability).
• Consider the different impacts on workers depending on their role (e.g. are workers in a role that is more likely to expose them to aggressive people?)
• Consider the types of services offered at the facility and the different types and levels of risk involved (e.g. emergency departments, mental health, drug and alcohol, brain injury, aged care, neurology, midwifery and early childhood are often higher risk environments for aggression).

• providing care or services to people who are distressed, confused, afraid, ill, impacted by mental health, an intellectual disability or dementia, or affected by drugs and alcohol
• handling valuable or restricted items (e.g. cash or medicines)
• working offsite or alone (e.g. a patient's home, without supervision)
• working in unpredictable environments (e.g. where family members may pose a risk to workers’ safety)
• inappropriate placement (e.g. younger clients placed in residential aged care)
• service and care methods, policies or communication that causes or escalates frustration (e.g. low staffing levels, unclear policies, insecure employment, high staff turnover, setting unachievable expectations of the services an organisation or workers can provide, not sharing information about patient progress)
• poor quality behavioural support plans
• untrained staff being directed to perform complex care work
• low worker diversity and a workplace culture that accepts or tolerates gendered violence.

• acceptance of inappropriate behaviour (e.g. racially or sexually crude conversations, innuendo or offensive jokes are part of work culture or not challenged when they occur)
• power imbalances along gendered lines (e.g. workplaces where one gender holds most of the management and decision-making positions)
• treatment of workers as disposable or replaceable, or promotion of the idea that care and support work is unskilled work that “anyone can do”
• working in isolation in restrictive spaces with limited supervision or access to support (e.g. vehicles such as ambulances, remote locations, wards late at night, patient’s homes)
• poor understanding among workplace leaders of the nature, causes and impacts of sexual harassment. While anyone can experience harassment, there are certain groups who are more likely to experience it. Some workers may be at greater risk because of their age, gender, sexuality, migration status, disability and literacy skills.

Prevent harmful behaviours and escalation

• Arrange rooms to minimise agitation. For example, avoid cluttered rooms and allow enough space to move and use equipment.
• Promote comfort including by reducing noise and other stimuli, controlling temperature, allowing access to food, drink, entertainment and other items that may reduce stress or boredom (e.g. provide mobile phone charging points and other distractions).
• Provide security cameras to monitor risks and deter harmful behaviours.
• Roster on additional workers and have supervisors perform more regular check-ins to monitor potential causes of escalation.
• Ensure workplace design and lighting provides good visibility, including in car parks.

Reduce harm

• Separate workers from the public with fixed or removable barriers (e.g. high counters, furniture, screens on counters or screens between a driver and passenger).
• Provide two exits in all interview and treatment rooms.
• Provide both fixed and portable duress alarms.
• Arrange the workplace (e.g. furniture and partitions, observation mirrors) to ensure good visibility of areas accessible to patients/families where appropriate. Improve natural surveillance and avoid restrictive movement.
• Ensure there are no areas where workers could become trapped, such as rooms with keyed locks.
• Provide secure areas where workers can retreat.
• If patients need to be restrained, provide access to quiet, private and secure areas to minimise distress to others.
• Home visits should not be undertaken by workers without police or security when there is a high risk of violence.

• Secure any objects that could be thrown or used to injure someone.
• Use face shields where spitting or intentionally coughing is a risk. However, consider how this may impact communication and potentially increase frustration.
• Ensure communication systems (e.g. phones, intercoms, panic buttons and duress alarms) are provided, maintained and tested.
  • Ensure community workers have access to duress alarms. These should work in all locations and be able to be responded to quickly.
• Provide suitable personal protective equipment (e.g. stab-proof vests and protective clothing for security guards).
• Ensure vehicles are fit-for-purpose (e.g. have central locking devices, GPS tracking devices to allow drivers in distress to be located, lighting to allow the driver to monitor passenger behaviour, are well maintained so they do not break down at unsafe locations or times).

Prevent harmful behaviours

• Communicate regularly and transparently to reduce distress. For example, provide family and friends with information about patient progress and location.
• Provide enough workers to both care for and support clients and patients, and to keep workers safe. Staff should not work alone where there is a risk of violence.
  • In some workplaces and only where appropriate, this may include security guards or staff trained in restraint, mediation or de-escalation techniques.
• Consider the gender mix of workers (e.g. roster male workers to provide care where there is a known risk of harassment towards female workers).
• Identify rostering practices that minimise escalation and ensure continuity of supports for the patient or client.
• Alternate tasks in the workplace where possible (particularly tasks requiring high levels of interaction) and ensure workers have regular breaks if aggression or incivility is likely.
• Use barring notices that limit or prevent access to the facility for visitors who display aggressive behaviour.

Prevent escalation and reduce harm

• Ensure there are enough workers to identify escalating behaviour early to give the best chance of de-escalation.
• Establish a system for screening patients, clients and visitors for risk of violence, and ensure the right worker cares or supports them. (e.g. where possible, triage and prioritise care for patients with acute mental health conditions or under the influence of drugs or alcohol, ensure staff rostered for patients or clients have sufficient training).
• Match staffing levels and supervision to patient or client needs.
• Provide ‘buddy’ shifts for workers delivering supports to complex clients for the first time.
• Establish risk management and behavioural plans that can be clearly understood by any worker using them and ensure workers have access to them, especially for in-home care and higher risk patients. Plans should consider:
  • Who should be providing care? (e.g. gender, skill mix, violence prevention training)
  • How many staff are required to provide care safely? (e.g. pairs for personal care, 3 to shower an elderly person who is resisting)
  • Is a 1 to 1 ‘patient special’ required? Should this be a clinical or a security special?
  • Where will the patient be located?
  • Access to duress devices and response times.
  • Has the area been cleared of anything that can be used as an improvised weapon?
  • Medical management (e.g. PRN medications charted)
  • Escalation pathway where controls are ineffective, and
  • The risk of violence from family members.
• Use behavioural contracts that set expectations about behaviours that will not be tolerated and consequences (e.g. stop treatment, stop providing support or care in-home, treatment or support only provided in a particular facility).
• Establish procedures for working in isolation and uncontrolled environments (e.g. risk assessments to determine the safety of a patient’s home at the beginning of each visit).
• Establish systems for immediate medical attention where needed, reporting, debriefing and support after an incident, and consideration of paid leave for impacted staff).
• Report criminal behaviour to police.

• Establish pre-shift team briefings to share information on potential risks.
• Provide training for staff in:
  • identifying early warning signs of violent behaviours from patients and visitors
  • de-escalation techniques
  • personal safety (e.g. understanding the physical environment, breakaway techniques, using evasive measures)
  • specific care and support needs (e.g. dementia, mental health conditions, other medical and health-related supports as required)
• Establish a dedicated, trained, regularly drilled, multi-disciplinary team to respond to high  risk situations (e.g. code black team).
• Provide additional supervision and support for new, young and inexperienced workers.
• Encourage workers to keep records and screenshots if harmful behaviour occurs online or through phone communication and report the behaviour to their supervisor.