To increase workers’ awareness of health and safety risks in outreach and to promote prevention efforts and guidelines for intervention

Recommendations for Instructors The learning activities in this section are designed to engage participants with the subject material using informative and interactive approaches. Instructors will need to determine which, if not all, of these activities to carry out depending on a) participants’ learning needs and interests, b) the focus of the training, and c) time available.

Instructors are encouraged to prepare for each activity by reviewing the handouts to be given to participants and by reading the recommended resource papers and materials that are listed. These papers and materials, along with other relevant resources, will provide useful background information to assist in fulfilling the purpose of this section. The amount of time suggested for each activity should be adjusted as needed.

Purpose: To have workers anticipate and identify those health and safety risks they are likely to encounter in outreach

Time: 20-30 minutes

Materials:

Flip chart and markers

4"x6" cards and masking tape

Preparation:

The outreach worker’s work setting is a unique and ever-changing environment. Taking services to "where people are" presents intriguing and unique possibilities for where a worker’s daily sojourn might lead. Outreach also presents certain risks for the worker’s health and safety. Employers need to fully inform workers of these risks and workers need to take these matters seriously. Workers must commit themselves to abide by agency policies, maintain awareness of their environment, and to be well prepared to minimize these risks.

Familiarize yourself with the procedure as outlined below. The method described is an effective way to help groups engage in creative brainstorming and subsequently begin to define the issues in more measurable terms.

Procedure:

1. Break into small groups of 3-5.

2. Ask each group to brainstorm the various kinds of health and safety risks outreach workers encounter. Encourage them to think broadly. For example, remind them to define health not only in physical terms, but in relation to one’s psychological, emotional and spiritual health as well. Urge participants to freely brainstorm ideas that come to mind without regard to how insignificant or "off the wall" they might appear. Often by voicing such ideas, other ideas are spawned.

3. Ask each group to choose around 10-15 risks from those they brainstormed and write each one down on a 4"x6" card or larger. Express the idea briefly in five words or less and write it in legible letters. (It’s meaning can be expanded upon verbally later in the exercise.)

4. Have each group take turns bringing three of their cards at a time to the front of the room and place them on a flipchart, board or wall with masking tape or other suitable fastening method. Each group should choose three different ideas than those already presented. Groups can explain at this time what their ideas mean if they need elaboration.

5. After this first round of ideas has been presented, have the group assist in grouping the ideas. For example, groupings likely to emerge will include: exposure to diseases, accidents, physical violence, harassment or verbal/emotional abuse, emotional/psychological symptoms, burnout, etc.

6. Ask for additional rounds of ideas until all the different brainstorm ideas have been put on the board. Continue to group them.

7. Although the primary intention of this exercise is to simply identify areas of risk, you might use this opportunity to prioritize those issues that need to be addressed further and how and when that will occur.

Note: Another approach to this activity is to simply have participants call out various health and safety risks and to group these ideas as you go.

Purpose: To identify and generate discussion about safety guidelines in street outreach

Time: 20-25 minutes

Preparation: Review the guidelines noted on the handout. Note the opening statement: "These safety guidelines for street outreach are adapted from guidelines developed by outreach workers in the downtown skid row area of Los Angeles. They are designed solely to assist staff in avoiding trouble on the street. They do not address how to handle difficulties once they arise. The strength of these guidelines is that they address the needs of the street outreach worker who operates in a very different work environment than staff who are agency-based. The guidelines are intended as only one part of an agency’s overall safety policies and procedures."

Procedure:

1. Review the guidelines together as a large group. Comment on selected guidelines as you see fit. Also, provide examples from your own experience. It may be helpful to give examples of situations when workers did not adhere to guidelines or agency policies and experienced negative consequences as a result.

2. Invite participants to ask questions and give their own illustrations.

3. As facilitator, even when the truth of a guideline seems self-evident, ask why it was included on the list. Play the role of "devil’s advocate" periodically to urge the group to think more deeply about these guidelines.

4. After reviewing the guidelines on the handout, ask the group for other guidelines they would add to the list. Some workers who do outreach in specific settings or with specific populations will generate guidelines that may be unique to their situation.

Purpose: To review, discuss, and role-play effective ways to address clients’ aggressive behaviors

Time: 45-50 minutes

Materials:

Preparation: Review the resource paper and handout to prepare for a presentation on "Guidelines for Addressing Aggressive Behaviors." The main points for your presentation are outlined in the Safety Manual that has been developed by the Wasatch Homeless Health Care Program in Salt Lake City, Utah. Note that these materials are taken from Sample Safety Guidelines in Homeless Health Services Programs compiled by the Health Care for the Homeless Clinicians’ Network (1996).

Procedure:

1. Provide about a 20-25 minute presentation using examples and including time for questions and discussion. Focus your presentation on:

• Purpose and importance of having safety guidelines

• Acknowledgement of client stress and special extenuating circumstances that influence their behaviors

• Three levels of intervention: prevention, de-escalation of tension, and action aimed toward safety for all individuals involved

• Four basic steps: observing, skilled listening, talking, and taking action.

2. Break into groups of three and set up a role-play situation between two individuals: an aggressive client and an outreach worker. The third person is a witness-observer to the interaction who acts as a "coach" for the worker during and after the role-play. Instruct the client to pick an issue and act in an angry, aggressive manner, short of physical violence, towards the worker. The outreach worker is to practice the skills just discussed to try to de-escalate the client. Provide ample time so that everyone gets to play each of the three roles.

3. Take time to debrief the role-play experience with the group. What was it like to be in the various roles? What de-escalation skills worked well? Which ones didn’t? What did participants learn?

Purpose: To identify specific suggestions for outreach workers and programs to ensure worker safety is promoted and addressed in the work environment

Time: 30-45 minutes

Materials: None

Preparation: Be familiar with the activity instructions below.

Procedure:

1. Form small groups of approximately four to six participants.

2. Each group is given the assignment to create a proposal for an outreach worker safety plan for their program or agency. This proposal is to identify some of the key elements to be included in the plan and some specific ways to address them. The proposal is to focus on prevention efforts vs. emergency responses. These ideas will be presented for consideration at an all-staff planning retreat.

3. Ask each group to take various perspectives into consideration as they form their plan. These might include:

• Outreach workers representing various clinical backgrounds

• Those doing site-based outreach and those doing outreach on the streets

• Workers involved in outreach to various subpopulations, e.g. families, youth, persons with issues related to chemical dependency, mental health, HIV, domestic violence, etc.

• Program supervisors, administrators, members of the Board of Directors

• Homeless clients

4. Instruct each group to take about ten minutes, or more if needed, to generate as many ideas as they can that are aimed at promoting and sustaining awareness of safety for outreach workers. Urge them to think broadly and to include ideas related to program policies and procedures as well as to individual worker awareness and responsibilities. (See the handouts from Activities II and III to prompt some ideas.)

5. After this period of brainstorming, each group is given another ten minutes or so to create a presentation for the all staff retreat that highlights the top plans/activities from their worker safety plan. The following expectations apply to the presentation:

• All members of the group are urged to participate in the presentation itself (unless they have a note from their mother!)

• It is to be interesting and imaginative, not boring! (The use of skits, songs, limericks, haiku, games, role-plays, etc. is highly encouraged.)

• The presentation should include approximately 3-5 specific activities for implementation.

• The presentation should take no more than five minutes.

6. Have the small groups make their presentations to the retreat attendees. After each presentation, or after all have been completed, allow time for questions and comments from the audience.

7. Conclude the activity by discussing the most viable ideas that were raised and challenge participants to consider ways to promote and implement them in their own work settings.

Purpose: "Nonviolent Crisis Intervention" is a non-harmful behavior management system to aid staff in maintaining the best possible care and welfare of agitated or out of control individuals – even during their most violent moments. This video is designed to help staff develop preventative techniques necessary to defuse potentially violent situations. It also presents a philosophy of care and welfare, as well as safety and security for all who are involved in interventions.

Time: Running time 27 minutes

Materials:

TV/VCR

Copy of video: Nonviolent Crisis Intervention. Volume I: The Preventative

Techniques. Produced by Crisis Prevention Institute, Brookfield, WI.

Preparation:

Borrow a copy of the video at no cost from the Health Care for the Homeless Information Resource Center at (888) 439-3300. Reservations must be made at least two weeks in advance.

Procedure:

1. Introduce the video and show it to the group.

2. Allow ample time for discussion afterwards including possible role-playing and practicing techniques.

(Alternatively, consider showing the video in segments with time between spent in discussion, role-playing and practicing techniques.)