Sally Torres MSW LMSWJoAnne Vincent MSN RN CPNP

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

THE BENEFITS OF HOME VISITING

See client in living environment

Tailor services

Reach families not in system

Cultivate special relationship

SAFETY: Even the Pros Need Reminders

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

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.

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

PREPARING FOR HOME VISITS

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

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

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

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??

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

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

ARRIVING AT THE HOME

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?

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

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

IN THE HOME

IN THE HOME Establish rapport

Include other family members if appropriate

Review visit purpose and anticipated length of visit

Minimize distractions

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

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

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!!!

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

FOLLOWING THE HOME VISIT

Report in after leaving

If feeling threatened, proceed to nearest police or fire station

Debrief urgent concerns

Document visit

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

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

BE SAFE!!!

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...

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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.

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.