Recovery From Workplace Violence in the IDD-Care Setting

Going through an incident of workplace violence is not an easy task. Workplace violence can include some of most extreme and terrifying situations you can imagine. In some cases, workplace violence may result in the worsening of symptoms of intellectual or developmental disabilities (IDDs) or the onset of symptoms of post-traumatic stress disorder (PTSD).

These effects may begin immediately or progress over long time periods, explains the National Institute of Mental Health (NIMH). With time, the long-term side effects of going through the trauma of workplace violence can be managed successfully, but you still need to know what immediate actions to take to help people with IDDs.


Step 1: Provide Emergency Care, and Identify What Type of Workplace Violence Incident Occurred

The first step in recovery from an incident involving workplace violence is identification of the type of violence and provide emergency care, explains the Occupational Safety and Health Administration (OSHA). Some types are immediately identifiable.

For example, an irate family member becomes violent, pushing staff members, when caregivers are unable to see a child suffering from an autism spectrum disorder or learning disability. The safety of all persons involved is your top priority, so you may need to contact authorities or use aggression-management techniques to calm the person down. Furthermore, any injured staff members or people in your care should be removed from the situation and given emergency medical attention, if necessary.

The aforementioned situation is more than just meets the eye. It represents the ongoing culmination of struggle, hardship and ineffectiveness in caring for individuals with IDDs. Unfortunately, the inability of these individuals to fully communicate their needs can contribute to the development of the incident.

You must also determine how to classify the event. But, you may be incapable of classifying the event’s type until it is over, as seen in active shooter events around the country. However, for the purpose of ensuring safety for all persons involved, any event should be treated as the worst possible scenario until you know otherwise.

In other words, assume a person is dangerous until you have secured the threat, which may be through aggression management techniques or involvement by authorities.


Step 2: Report the Incident as Required

Depending on the type of incident, you may be required to report the incident to different parts of your organization and oversight agencies.

For example, an aggressive act committed by a person with an intellectual disability may require the notification of his or her treating psychiatrist, psychologist or physician. If an employee is injured in the event, you may be required to notify OSHA or the Department of Labor. The most important reporting requirements include the following:

·         For reference, you must report any fatalities related to work within eight hours.

·         Work-related hospitalizations, admissions to health facilities or loss of vision, even if it is restricted to one eye, must be reported within 24 hours.

·         Additional reporting may be necessary as part of OSHA’s recordkeeping submission requirements. In fact, OSHA will begin requiring employers to submit electronic copies of incident records in 2017.

Consequently, reporting and recordkeeping should be among your top recovery priorities.


Step 3: Include Affected Individuals in the Investigation and Response Appropriations.

Anyone who works in or was located in the vicinity of an incident may have valuable information as to what immediately preceded the incident. Gathering information is essential in identifying the root cause of the event. It can help you identify what types of training may be warranted to prevent similar events from occurring in the future.

Including affected individuals also refers to the allocation of resources to help those impacted by the incident return to health and an appropriate mental state. This may include making psychological evaluations available to employees and persons served, and depending on the severity of the event, you may need to establish additional plans or routes for employees and other victims or witnesses to obtain counseling and continuing care.

In the aftermath, it is easy to assume the person committing the act was solely responsible for his or her actions. In reality, some people with IDDs, such as those suffering from fetal alcohol syndrome (FAS), may be prone to aggression. Yet, additional outbursts could be the result of a medication change.

For example, antidepressants may be used to treat behavioral symptoms of FAS, including aggression, reports the Centers for Disease Control and Prevention (CDC). But, a change in antidepressants could have side effects, which may exacerbate aggressive behaviors.


Step 4: Determine What Other Steps or Actions May Have Prevented the Event.

This step seems repetitive, but it is actually an expansion of the beginning portion of “Step 3.” It is also important to follow this step in so-called “near misses.”

A near miss is an event that almost became an incident of workplace violence that did not escalate. In other words, the appropriate intervention methods were used to manage the threat. Most often, near misses may apply to people, specifically children, suffering from severe IDDs, reports the U.S. National Library of Medicine.

Unfortunately, some employees and caregivers may feel incompetent or otherwise unable to return to work or fulfill their duties following a workplace violence incident. As a result, you may need to provide additional training on how to respond to an incident and additional counseling within the training. Ultimately, you must determine if the employee acted appropriately to handle the situation. If so, you must reiterate his or her compliance with organizational standards and encourage return to duty at an appropriate time.

If incorrect procedures were followed, your immediate action must not be to terminate the employee, unless it demonstrates a recurrence of incorrect procedures involving workplace violence in the employee’s specific work history with your organization.


Step 5: Monitoring the Work Environment in the Aftermath of the Event.

The work environment may change in the aftermath of workplace violence. Your staff members need to learn how to recognize the warning signs of workplace violence, which are discussed in detail here, or you may need to explore additional hiring and training policies.

Individuals with IDDs may also suffer from short-term or long-term PTSD or PTSD-like symptoms. Furthermore, they may exhibit additional aggressive behaviors following an incident, even if they were not the persons committing the act of violence. Counseling or medications may be necessary to control these behaviors. Specifically, people with severe IDDs, including FAS and autism, are at a much higher risk of exhibiting aggressive behaviors following “increased stress levels.”


Understanding the Big Picture of Workplace Violence.

Workplace violence can occur anywhere, at any time and without any warning, and you can restore order and calm if an event does occur. However, the overwhelming majority of statistics on workplace violence indicate its prevalence in health care is unsurpassed, and some warning signs can be identified and managed through communication and de-escalation measures. This includes learning more about which IDDs are commonly associated with aggressive behaviors.  

If you can combine the information from this series into a cohesive set of guidelines and awareness-driven measures for your organization, you can reduce the incidence of workplace violence and maintain your responsibilities to people living with the struggles and behavioral challenges of intellectual disabilities.  

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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