HOME VISITING SAFETY

1. Sally Torres MSW LMSW JoAnne Vincent MSN RN CPNP HOME VISITING SAFETY

2. THE IMPACT • From 2004- 2006 at least five home visitors (SW) murdered across the country • Today, home visiting is less safe than even ten years ago • Lack of education regarding home visiting safety, yet home visiting has been a mainstay of service delivery for social workers, teachers, nurses, and others for many years

3. THE BENEFITS OF HOME VISITING • See client in living environment • Tailor services • Reach families not in system • Cultivate special relationship

4. SAFETY: Even the Pros Need Reminders

5. THREE BASIC RULES • DO stay alert • Keep your mind on your surroundings, who’s in front of you and who is behind you. Don’t get distracted. • DO communicate the message that you are calm, confident, and know where you are going. • Stand tall, walk purposefully, and make quick eye contact with people around you. • DO trust your instincts! • If you feel uncomfortable in a place or situation, LEAVE

6. THREE ELEMENTS OF A CRIME • DESIRE: The desire of a criminal to commit a crime. We as citizens can not affect this desire from the criminal. • ABILITY: The criminals ability to commit a crime. We as citizens can impair the criminals ability by practicing good crime prevention methods. • OPPORTUNITY: The criminal’s opportunity to commit a crime is where we have the biggest opportunity to impact the event. We can take away the opportunity for the crime – thus preventing us from becoming a victim.

7. SELF DEFENSE • Use your voice first, last, and during conflict • Decide ahead of time whether to fight or FLEE • Fighting back • Control breathing : Don’t hold your breath • Targets: Knees, groin, sternum, throat, eyes • Your weapons: Fists, elbows, feet, knees, teeth, head

8. PREPARING FOR HOME VISITS

9. CAR PREPARATION • Gas/well maintained • Hand sanitizer/first aid kit • Emergency roadside assistance numbers • Jumper cables, spare tire, shovel, blanket, extra food, water, and clothing • Maps and/or GPS system • Know public transportation options • Plan for the weather

10. PREPARATION FOR HOME VISIT • Conduct a “Risk Assessment” • Review available files and histories • Identify high risk potential • History of violence • History of mental illness • Suicide attempts • Any incidents involving firearms or weapons • History of substance abuse • Extreme political or religious views

11. PREPARATION FOR HOME VISIT (cont’d) • Conduct a reconnaissance drive-by • Neighborhood & neighbors • Parking • Front porch and door • Cars and foot traffic • Dogs • Signs, bumper stickers • Blackened-out windows

12. PREPARATION FOR HOME VISIT (cont’d) • Revise your risk assessment after drive-by • Develop your plan • High risk • Meet at neutral location • Medium Risk • Buddy system • Daylight visit • Low Risk – is it??

13. PREPARATION FOR HOME VISIT (cont’d) • Develop an Itinerary • Let a co-worker or someone else know when you are leaving and when you expect to be back, and destinations • Set code word (SOS) with co-worker or someone else • Keep addresses and phone numbers of homes to visit in a location that co-workers or someone else can get to if needed • Co-worker or someone else should know make, model, license number of your vehicle

14. PREPARATION FOR HOME VISIT (cont’d) • Clothing and Equipment • Shoes with protective soles and toes • Loose fitting clothing • Nothing around the neck that can be used to grab hold of you • Avoid jewelry and valuables • Charged cell phone • Loud whistle

15. ARRIVING AT THE HOME

16. ARRIVING AT THE HOME • “Combat Park” • Close by but not directly in front of the home or in driveway • Leave room to make quick getaway • Enough to pull straight out / not enough for someone to park in front of you • Lock vehicle and set alarm • Put valuables in trunk before arriving • Look, Listen and Smell as you approach • Any changes since your reconnaissance?

17. ARRIVING AT THE HOME (cont’d) • Call from car to announce your arrival • Leave if you feel in danger • Trust your instincts!!! • Use door as a shield • Stand on door handle side at 45 degree angle • Avoid standing in front of windows

18. ARRIVING AT THE HOME (cont’d) • Knock loudly and identify yourself • If in doubt about activities inside, ask the person to come onto the porch • If no answer – go back to car and call on phone if necessary • DOGS: • Block outer/screen door with your foot • Ask owner to put ANY pets away before entering • Don’t look dog straight in the eyes

19. IN THE HOME

20. IN THE HOME • Establish rapport • Include other family members if appropriate • Review visit purpose and anticipated length of visit • Minimize distractions

21. IN THE HOME • When entering building or home, follow- do not lead • Determine who else is in the home • Take note of your surroundings (left to right/top to bottom) • Hold visit in central location (kitchen, living room or dining room) • Sit near door with back to wall • Identify escape routes • Sit on furniture edge, do not lean back

22. IN THE HOME • Be respectful of a person’s personal space • Use discretion if accepting food, drinks, gifts • Don’t turn your back – most vulnerable position • Be confident

23. IN THE HOME • When can you leave? • If you feel threatened • If you are asked to leave • When you recognize potentially dangerous situations • TRUST YOUR INSTINCTS!!!

24. MEETING AT A NEUTRAL SITE • How to have a private meeting in a public place • You choose the site • Neither you or other party should be regulars • Meet in between normal meal hours 10a-2p • Place should have two exits • You choose the seating • Nobody within earshot • View of whole room – especially exits • “We are having a private business lunch, may we sit over there” • You get there first • Do drive-by • Check safety inside and out • Talk quietly and change the discussion if you have to

25. FOLLOWING THE HOME VISIT • Report in after leaving • If feeling threatened, proceed to nearest police or fire station • Debrief urgent concerns • Document visit

26. OUT OF CONTROL BEHAVIOR • Don’t argue or try to reason • Let it be known that you are not a threat • Break eye contact – but don’t turn your back • Hold your hands-up (surrender/non aggressive sign) • Nod your head in agreement • Yield all possible space • GET OUT OF THERE!!! • Back away at an angle

27. ADMINISTRATIVE RECOMMENDATIONS • Orientation and safety training • Develop policies regarding home visiting • Refusing visits • Cancelling visits (weather, current events) • Abandoning visits (weather, pets, staff abuse) • Supplies and equipment • Code word or phrase for staff SOS call • Plan if home visitor doesn’t call/return • Post trauma support • Termination of visits • Yearly safety education • Document visit

28. BE SAFE!!!

29. We would like to acknowledge Charlie Dickson and all of the officers at Children’s Hospital of Michigan and the Detroit Medical Center for keeping us safe...

30. REFERENCES • Allen, S.F. & Tracy, E.M. (2008). Developing student knowledge and skills for home-based social work practice. Journal of Social Work Education. 44:1. 125-143. • Denard Goldman, K. & Jahn Schmalz, K. (2008). The “Home Ranger” rides again! Making home visits safer and more effective. Health Promotion Practice. 9:4. 323-327. • Every, M. (2002). Safe community working. Royal College of Midwives Journal. 5:6. 194. • Homecare Education Management. (1996). American Health Consultants: Atlanta ,GA. 5-7.

31. REFERENCES • Jodway, V. (2004). Knock before you enter. Home Healthcare Nurse. 22:6. 427-428. • Kendra, M. A., Weiker, A., Simon, S., Grant, A., & Shullick, D. (1996). Safety concerns affecting delivery of home health care. Public Health Nursing. 13:2. 83-89. • McPhaul, K. (2004). Home Care Security. American Journal of Nursing. 104:9. 96. • O’Boyle, M.E. (1995). Preparing for a safer home health care visit. Home Health Care Management Practice. 8:1. 34-43. • OSHA. (2008). Home Visitor Safety: Taking Charge of Your Personal Safety.