3 WPV Prevention Programs and Strategies

This chapter is tailored for use by employers, managers, and safety and health practitioners who desire to develop and implement or evaluate company WPV prevention programs. Conference participants were asked to identify and discuss WPV prevention strategies, which may range from comprehensive, overarching company policies and programs to individual intervention strategies that seek to modify environment or behavior. Prevention programs and strategies that might offer increased protection against WPV in general are discussed first, followed by program and strategy elements that are unique to specific WPV typologies.

3.1 Strategies or Approaches That May Apply to More Than One Type of WPV

3.1.1 Management and Worker Commitment

The importance of management commitment to WPV prevention policies and programs cannot be overemphasized. Top management support helps ensure that adequate resources (including staffing) will be applied to the program, that the program will be launched from the top down, and that the effort will likely be accepted throughout the organization and sustained. Worker participation in planning, development, and implementation of programs and strategies is also important. The concept of dynamic commitment (i.e., involving both management and workers) in WPV prevention was discussed as a fundamental necessity underlying the allocation of adequate prevention program resources and the development of a violence prevention culture within an organization.

3.1.2 Multidisciplinary Team Approach to WPV Prevention

Another common theme voiced often during the conference was the need for collaboration of people from different disciplines, company units or departments, and levels of the organization. The involvement of persons with diverse expertise and experience is especially critical due to the depth and complexity of WPV prevention. Such teamwork is crucial for planning, developing, and implementing programs, as well as serving discrete functions, such as threat assessment teams formed to review and respond to reported physical, verbal, or threatened violence. Some of the key levels, disciplines, and departments mentioned included management, union, human resources, safety and health, security, medical/psychology, legal, communications, and worker assistance.

The pre-arranged use of outside expertise and collaboration with local law enforcement and local service providers was also offered as a way for companies to ensure effective programs, particularly in smaller companies with fewer workers, departments, and resources. Proactive planning/collaboration with local law enforcement may be helpful should an incident requiring police response occur.

3.1.3 Written WPV Policy/Program Tailored to Organization’s Needs

A documented company policy/program must include definitions that clearly indicate what behaviors constitute WPV, including threatening or abusive physical and verbal behavior. Prohibited actions must be specified, and the specific consequences of those actions spelled out. A review and response system for all reported violent incidents must be in place, along with guidelines to assist those with the responsibility to review and respond. Specific procedures are needed for reviewing each reported incident, and mechanisms are needed to support and protect all affected persons. Ineffective followup undermines worker perception of management commitment and negates incentives to report incidents. Victims and recipients of threats or harassment expect a firm response. Review and response to reported violence might best be accomplished via a team approach (e.g., a threat assessment team).

Clear, precise definitions; mandatory comprehensive (all incidents) reporting; a structure and process in place for reporting; and timely and reliable review and response will all contribute to accurate reporting, which in turn enables precise risk assessment and dedication of appropriate resources to the program. These elements will also provide a basis for program evaluation. Programs that discourage reporting or blame the victim will not likely be successful. At a minimum, the WPV policy/program should be reviewed annually but optimally can be easily tweaked as necessary. Good communication, confidentiality, teamwork, and accountability are musts. Communication must flow vertically (management to staff and vice-versa) and horizontally (i.e., across organizational divisions or departments). Communication can take many forms, and organizations should think outside the box when communicating information about WPV policies/programs. For example, information about company policy/programs can be communicated as inserts with pay stubs or on stickers for telephones. A WPV prevention program should be well integrated with other company programs.

3.1.4 Training

Training for both managers and workers is a key element in any WPV prevention program. The presence of management at training sessions can increase the visibility of the organization’s top-level commitment to prevention. Training content may differ by type of WPV (see Sections 3.2 through 3.5), but in general, training (initially and on a recurring basis) should be provided on the hazards found in the organization’s workplaces and in the organization’s prevention policies and procedures, with emphasis on reporting requirements and the companies’ review, response, and evaluation procedures. Training can be implemented from the top down, with managers and supervisors trained first. A train-the-trainer approach can be used, with supervisors responsible for training and evaluating training for their own staffs. Specialized training on creating a positive work environment and developing effective teams could be useful, as well as training to improve awareness of cultural differences (diversity) and to enable the development of workers’ cultural competence.

3.1.5 Culture Change

Employers should examine the workplace to determine if there are cultural barriers to WPV awareness and prevention. If needed, the workplace culture should be modified to foster increased awareness of WPV and prevention, the clarification and enumeration of acceptable and unacceptable behavior, WPV reporting, availability of support for victims, and availability of help for perpetrators (if employed by the company, as in Type III and sometimes Type IV WPV).

3.1.6 Evaluation

Prevention programs and strategies should be evidence-based to the extent that evidence is available. However, often action must be taken before data can be collected and evidence of effectiveness obtained. It is crucial that companies make the effort to evaluate programs and strategies and cooperate with researchers in intervention effectiveness evaluation research. Employers may waste valuable resources on hazard control and training if evaluation procedures are not integrated into programs to measure impact. Information about successful programs and strategies must be effectively shared and communicated within companies and industry sectors and, where applicable, across sectors. While it is true that rigorous evaluation is challenging and often involves substantial cost, employers and researchers may, through collaboration, find ways to leverage their combined resources to selectively assess strategy and program effectiveness. In addition, such partnerships may provide a vehicle for sharing evaluation methods and results across many companies in an industry sector.

3.2 Strategies Specific to Type I (Criminal Intent) Prevention

The potential for Type I WPV exists across all industries but is prevalent in certain industries characterized by interaction with the public, the handling of cash, etc. Certain industries in the retail trade sector (convenience and liquor stores, for example) face higher than average risks. Specific environmental, behavioral, and administrative strategies have been implemented and evaluated as a result, particularly in convenience stores. A core group of interventions has been determined to be effective in convenience stores [Hendricks et al. 1999, Loomis et al. 2002],
including the following:

1. Environmental interventions
   
   
   • Cash control
     
     
   • Lighting control (indoor and outdoor)
     
     
   • Entry and exit control
     
     
   • Surveillance (e.g., mirrors and cameras, particularly closed-circuit cameras)
     
     
   • Signage
     
     
2. Behavioral interventions
   
   
   • Training on appropriate robbery response
     
     
   • Training on use of safety equipment
     
     
   • Training on dealing with aggressive, drunk, or otherwise problem persons
     
     
3. Administrative interventions
   
   
   • Hours of operation
     
     
   • Precautions during opening and closing
     
     
   • Good relationship with police
     
     
   • Implementing safety and security policies for all workers

Some interventions for convenience stores and other workplaces are controversial or not universally agreed upon by researchers. These instructions will require additional study, including the following:

• Having multiple clerks on duty
  
  
• Using taxicab partitions
  
  
• Having security guards present
  
  
• Providing bullet-resistant barriers

3.3 Strategies Specific to Type II (Customer/Client Violence) Prevention

3.3.1 Adequate Staffing, Skill Mix

One strategy that emerged from discussions of the Type II panel is that of ensuring adequate staffing and mix of skills to effectively serve client, customer, or patient needs. Low responsiveness and quality of service, which can result from inadequate staffing and skills of personnel, can produce frustration and agitation in clients or patients. For clients and patients, acute needs and accompanying real or perceived urgency combined with a history of violence, can place both staff and other clients/patients at risk. In addition, social services or health care workers who work alone may be vulnerable to assault, especially in worker-client relationships where the client has a criminal background or is mentally ill or emotionally disturbed.

3.3.2 Training

In addition to general training on WPV hazards and organizational policies and procedures, training specific to Type II violence could include recognition of behavioral cues preceding violence, violence de-escalation techniques and other related interpersonal and communication skills, new requirements (in health care) for patient seclusion and restraint, and proper restraint and take-down techniques.

3.3.3 Accreditation Criteria Tied to WPV Prevention

Another strategy would have accreditation bodies specify WPV program and training requirements as criteria for successfully meeting accreditation standards for social service and health care organizations and facilities. Specific programming and training in response to the demands of meeting such criteria should improve workplace protection from client/patient-based violence.

3.4 Strategies Specific to Type III Violence (Worker-on-Worker) Prevention

3.4.1 Evaluating Prospective Workers

Preventing worker-on-worker violence begins during the hiring process by employers who ensure that job applicants are properly and thoroughly evaluated by means of background checks and reference verification.

3.4.2 Training in Policies/Reporting

A key in worker-on-worker violence prevention is the comprehensive reporting of all prohibited behaviors among workers, including threatening, harassing, bullying, stalking, etc. Therefore, training during new worker orientation and subsequent refresher training should focus on company WPV definitions, policies, and procedures. Also, reporting should be strongly encouraged and supported.

3.4.3 Focus on Observable Behaviors

The perpetrators are present or former workers who usually have substantial knowledge of coworkers, physical surroundings, and often security and violence prevention measures. Observation and reporting of changes in behavior that become a concern are critical. Therefore, a successful prevention strategy will provide procedures for reporting and addressing observable behaviors that elevate to concerns. A strong company focus and emphasis on the observation and reporting of behaviors that generate concern, coupled with timely and consistent response (see Section 3.1.3), may help create a climate that deters violent behavior.

3.5 Strategies Specific to Type IV (Personal Relationship Violence) Prevention

3.5.1 Training in Policies and Reporting

To prevent Type IV violence, company policies and procedures must provide workers with clear-cut information about the nature of personal relationship or intimate partner violence (IPV), its observable traits and cues, and methods for discerning it in coworkers. Employers must train workers in what to do if they should suspect that a coworker is involved in interpersonal violence, either as a victim or perpetrator. Training should emphasize the relevant company policies and procedures.

3.5.2 A Culture of Support

A company should strive to create a culture of support for victims that includes assurances no penalties exist for coming forward, complete confidentiality will be observed, safety and security protocols will be implemented, and referrals to appropriate community services will be provided as options to workers. A company should also inform all workers about the consequences of being a perpetrator of IPV or any other form of WPV. The company should communicate clearly through policies and training that IPV behavior is inappropriate and will be dealt with. Furthermore, the company should attempt to create a culture that both supports victims and enables perpetrators to seek help. Providing referrals to appropriate community services and implementing long-term programs that address battering and bullying behavior are reasonable approaches.