Author(s):     B. Gersons, I., Carlier and M. Olff                  Country :   Netherlands                   Level of Intervention: Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

Protocol Brief Eclectic Psychotherapy (BEP) for Post Traumatic Stress Disorder (PTSD) is a work-related violence victim rehabilitation model which is currently in use at the University Hospital of Amsterdam. Protocol Brief Eclectic Psychotherapy is based on psychodynamic, cognitive-behavioural and directive psychotherapies. This evidence-based programme seeks to address the rehabilitation needs of traumatised police officers and thereby promote successful return to work and overall employee health and well being.

Implementation:

The intervention contains five key elements (maximum 16 sessions):

1) Psychoeducation: teaching about the phenomenon and reasons for unexplained feelings.

2) Imaginal exposure: re-experiencing the damaging experience/traumatic event (4-6 sessions, 15-20 minutes each). A key success factor for imaginal exposure is for patients to feel a sense of reclaiming control of one’s own life.

3) Writing tasks and mementos: Written assignments are completed by clients outside the therapy sessions. These written tasks serve an explicit purpose; to help patients uncover difficult feelings connected to the traumatic experience and learn to address these feelings. The use of mementos, objects linked to the traumatic event, may be used to instigate this process.

4) Meaning and integration: issues explored are psychoeducative, including security issues, decision making, meaning of self worth, life history issues, understanding of feelings, reintegration to work.

5) Farewell ritual: the therapy finishes and the traumatic experience is left behind, however, is not forgotten. The patient is encouraged to look into the future

Recovery needs approximately 16 sessions with a trained therapist. However, duration may vary according to the needs of the individual.

Practical applications:

The method has been successfully used with victims of work-related violence. The successful implementation of this intervention requires a trained therapist.

Innovative aspects:

The patient’s partner is invited to attend/participate in the first meeting of the rehabilitation therapy; in order to increase their understanding and promote support for his/her partner throughout the therapeutic process. In so doing, this takes the overall situation of the patient into consideration.

Evaluation (including process issues, outcomes and sustainability):

An evaluation of the client’s therapeutic development is conducted six months following their treatment.  

Benefits (including cost effectiveness):

Ten years of experience of implementing this programme has demonstrated its overall effectiveness.

References:

Gersons B., Carlier I., & Olff M. (2004). Protocol, Brief Eclectic Psychotherapy (BEP), for Posttraumatic Stress Disorder. University of Amsterdam, Center for Psychological Trauma.

Comments:

It is heavily recommended that the intervention is adapted and tailored to the individual.

Author(s):   Nina Isotalus and Kaija Leena Saarela                                   Country:   Finland                             Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The KAURIS method (Risks in the retail trade) is a systematic model for the assessment and management of the risks of third party violence in the workplace. It is a basic but comprehensive method where the physical environment, training of the employees, and after care are taken into account. The method includes a set of tools (such as check-lists and information sheets) to assess the risks of violence, and how the workplace is prepared for violent or threatening situations. The primary aim of KAURIS is to develop a more safe and secure workplace by training staff with the help of different kinds of technical and functional solutions.

Implementation:

The method includes the following steps:

• collection of information on the working group and on the process and situation;

• distribution of an employee survey about violent and threatening situations;

• assessing the state of preparation for violent situations in the workplace;

• development and planning of the interventions needed;

• training for the entire staff; and

• regular evaluation and development of the management of the risks of violence as part of normal daily life in the workplace.

Implementation of the KAURIS process utilises a participative approach in which a team, consisting of the supervisor and employees, is formed for planning and carrying out the necessary operations like organising training, developing the work environment, supplying the necessary safety equipment etc. In addition, the entire staff is involved in the process.

A core component of the method is staff training; where the knowledge and skills of staff and managers grow and develop. It is recommended that employees and managers work collectively to address the issues.  

Practical applications:

Although the method has been developed in trade, it can be used in a variety of other occupational sectors by tailoring it to the needs of each organisation. Modifications of the method have been made, for instance for taxi drivers and real estate branches.

Innovative aspects:

Kauris is an innovative method that has raised awareness of the causes and consequence of work-related violence (for both organisations and individuals); and provides a systematic procedure for enterprises to begin to address this issue. Many violence interventions have some of their roots in this method.

Evaluation (including process issues, outcomes and sustainability):

The KAURIS method has been tested and evaluated during its development. A pilot study was conducted in several different target organisations. Researchers visited half of the participating organisations whilst the other half received only the handbook¹ of the method. The pilot study demonstrated that the handbook gave sufficient information for interventions. A subjective assessment of the effectiveness of the KAURIS method, as observed by staff members, was recorded; however, during the evaluation process the reduction of violent incidents was not measured. The authors note that there was no reporting system that would have fulfilled scientific criteria.

Benefits (including cost effectiveness):

Main results, including cost effectiveness): The method was found to be cost-effective and user-friendly.

References:

Isotalus, N. & Saarela, K-L (2001). Kauris, menetelmä työväkivaltariskien kartoitukseen ja hallintaan (The method to assess and manage workplace violence risks).Helsinki, Finland: Työterveyslaitos (Finnish Institute of Occupational Health).

Isotalus, N.(2002). Prevention of physical violence at work. African Newsletter on Occupational Health and Safety, 12, 12-15.

Comments:

¹ The KAURIS method is outlined in a handbook that provides information and knowledge about the responsibilities, duties and tasks of the safety manager and of all employees in relation to safety at work. The handbook also outlines possibilities and practical measures useful in promoting and developing a safety work environment. Additionally, the manual provides advice on how to deal with violent customers and drug users, how to calm oneself in a threatening situation and how to protect oneself. It also includes all the necessary forms to carry out the KAURIS process: such as, the survey for the employees, and a form for the assessment of the state of preparation for violent situations. 

Author(s):     P. Peerdeman                                                                Country:   Netherlands                                 Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

In 2000, the “Safe Care Policy” project was developed in the health care system in the Netherlands. The project’s development was underpinned by the active cooperation between the police and the public prosecutor with the overall aim to: (a) decrease internal and external aggression (especially verbal aggression), and (b) to present an overview of the prevalence of external and internal aggression and violence.

Implementation:

The method is based on the policy cycle: global inventory of problems, declaration of intent, problem analysis, set goals/prioritize, develop strategy, implementation, evaluation, and adjust goals/measures. More specifically, the policy consists of different components. First, a collective agreement is made between the hospital, the police and the Public Prosecutor according to which, visitors and patients who misbehave receive a warning and after two warnings the person can be banned from entering the hospital.

Incidents of violence are reported by the head of in-house emergency and first-aid service that are responsible for dealing with the situation. Furthermore, workplace safety is increased by additional camera surveillance and an increased availability of security service for emergencies. The house regulations are presented and communicated by means of posters. Additionally, in the hospital employers work according to an ‘aggression-protocol’ whereby all employers are familiar with the necessary procedures on how to handle cases of aggression.

Practical applications:

Because the intervention is based on a collective agreement between the hospitals, the police and the Public Prosecutor, some law- or legal requirements underpin it. 

Innovative aspects:

The main innovative aspect of this approach is the development of an organisational-level policy directly addressing issues surrounding workplace violence through a process of social dialogue between several key stakeholders.

Evaluation (including process issues, outcomes and sustainability):

As the policy outlines, all incidents are reported, providing a clear overview of the prevalence of aggression and violence in the hospital. Information from reported incidences of violence is used to evaluate the effectiveness of the policy and to identify prevalent trends in perpetrator behaviour.

Benefits (including cost effectiveness):

Safe Care Policy has been implemented in over 15 hospitals. On the basis of registration information from 2006, the amount of incidents involving verbal or physical violence has decreased. Additionally, employers working at the hospitals have reported increased feelings of safety.

References:

Goede praktijken tegen geweld - casusboek. (Ministerie van Sociale Zaken en Werkgelegenheid). 2006.  (in Dutch)

Comments:

Safe Care Policy can be adapted and tailored to a variety of occupational sectors or other national contexts however, the degree to which it can be tailored is dependent on legal requirements unique to that area/or national legal framework.

Author(s):   Judith Arnetz and Bengt Arnet                                               Country:   Sweden                                 Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The violent incident form (VIF) is a practical instrument developed for the registration of all types of violent and threatening behaviour directed towards staff in the health care sector. The method is designed for implementation into the daily business routines of high-risk workplaces.

VIF includes a checklist of 20 items and summarises information pertinent to the incident such as time and place, details describing the aggressor, the circumstances, the actual incident, how the incident was handled, and the staff victim's injuries and/or reactions. Information concerning the VIF checklist is disseminated to all participating workplaces. Following a threatening violent incident the employee is required to fill in the VIF.

VIF can be viewed as a user-friendly approach, as the implementation of the method requires no training and is easy to use. The method aims to minimise the stigma associated with violence, and encourages employees to act and speak out after the incident; thereby, building social cooperation in the workplace.

Implementation:

VIF was implemented as a working tool at 47 health care workplaces in Stockholm, Sweden. The workplaces were randomly assigned to either the intervention or control group.  The work sites encompassed a total of approximately 1500 health care workers. In the intervention workplaces, a structured feedback program, where the circumstances concerning registered incidents were discussed on a regular basis with the staff. 

Practical applications:

VIF has been found to be easily practically applicable at the enterprise level, as it has been designed to include a user-friendly process.

Innovative aspects:

Easy, simple and not time consuming method.

Evaluation (including process issues, outcomes and sustainability):

A structured feedback programme that included regular discussions with staff involved in violent incidents registered at the workplace was implemented. A follow-up was carried out after one year to compare the amount of violent incidents reported, and to assess staff perceptions surrounding the year-long project.

Benefits (including cost effectiveness):

The evaluation of VIF demonstrated the following benefits: (a) staff in the intervention work sites reported significantly more violent incidents than the control work sites during the one year; (b) the intervention group reported better awareness of risk situations, had increased knowledge on how to effectively handle risk situations, and how to deal with aggressive patients; and (c) intervention workplaces had better routines for managing violent incidents after the project than before. VIF was found to be a user-friendly method and tool.

References:

Arnetz J.(1998). The Violent Incident Form (VIF): a practical instrument for the registration of violent incidents in the health care workplace. Work and Stress , 12 (1), 17-28. (includes the VIF form)

Arnetz, J. & Arnetz B. (2000). Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers. Journal of Advanced Nursing 31(3), 668-680.

Comments:

If employees report all the violent incidents using the VIF, the method could yield rich information on the prevalence of work-related violence in a given workplace, hospital or ward. This information can then be used in planning of interventions for prevention and management of violent incidents.

Author(s):       Phil Leather, Antonio Zarola, Angeli Santos                       Country:   United Kingdom                    Level of Intervention: Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

Training Needs Analysis (TNA) is a structured approach through which an analysis of incidents, a risk assessment and an examination of legal matters are conducted. Specifically, TNA seeks to address several key aspects when examining violence and bullying in the workplace: 1) exposure to violence, what forms of violence there are; 2) what factors make exposure more likely; 3) vulnerabilities (location, day or night, working alone etc.); 4) the existence of trigger factors and antecedents for violence, learning from employee experience; 5) what is the overall impact of exposure; and 6) how can this impact be changed through coping, managing situations, support etc. Targeting training needs aims to increase both individual and organisational skills, for instance communication, de-escalation and physical intervention skills. Other important topics central to training are knowledge of the nature of violence, violence effects and policies. Following training, staff should feel more capable in front of violence; both in terms of individual capability (employee's own efforts) and collective capability (all community members working together against violence).

Implementation:

Assessment of training needs can be done in several ways: firstly, through incident report forms; secondly, investigations of the antecedents; and finally, consequences of specific incidents and legislative requirements. When designing training, four aspects are of central importance: (1) investigation and assessment of training needs; (2) actual training design; (3) delivering the training; (4) evaluation of the training.

Several trainer competencies are required to successfully conduct TNA: 1) knowledge, 2) translation from theory to practice, 3) drive to train and empower people, 4) facilitation that helps to build cooperation and change, 5) managing the learning environment for people.

Practical applications:

This approach has been successfully used in the public and private sectors in the UK. However, the TNA approach can be used in variety of occupational sectors and sizes of enterprises. The successful implementation of the training requires a highly skilled trainer.

Innovative aspects:

This approach provides very precise training guidance for managing violence with a concentrated focus on its effective management. It has also been scientifically evaluated.

Evaluation (including process issues, outcomes and sustainability):

The evaluation of the training package seeks to address whether the training made a difference and how, whether it is effective in delivering its intended outcomes, and if legal matters are taken into sufficiently into consideration. This was accomplished by conducting a comparative assessment of those individuals participating in the training, and a comparison group that received the same procedure but without the actual training. Measurements were taken prior to training, directly following and with a longer term follow up.

Benefits (including cost effectiveness):

Overall the evaluation of the training package was successful in terms of the prevention and, management of workplace violence. Positive impact has been judged in terms of the degree of change, pre to post training, in a range of outcomes namely, fear of violence, anxiety about violence and perceived capability to respond to and manage difficult situations.

References:

Leather, P., Zarola, A. & Santos, A.(2006). Building Quality Approaches to Work-Related Violence. Training: Pillars of Best practice In S. McIntyre and J. Houdmont (Eds.) Occupational Health Psychology, European Perspectives on research , education and practice(pp.205-232). Castelo da Maia, Portugal: ISMAI.

Beech B. & Leather P (2006). Workplace violence in the health care sector: A review of staff training and integration of training evaluation models. Aggression and Violent Behavior, 11 (1), 27-43.

Comments:

This approach introduces the pillars of best practice for work-related violence training.

Author(s):     J. Perkins.& D. Leadbetter                                        Country:   United Kingdom                           Level of Intervention: Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The CALM (Crisis, Aggression, Limitation and Management) training programme is an approach to aggression management that employs an ecological perspective which views aggression as an interaction between individual pathology and the environment. CALM promotes an approach to behavioural control based on the systematic analysis and assessment of the underlying mechanisms of behaviour and assumes that a whole organisation approach, involving policy development and staff support are key determinants of workplace safety.

Implementation:

The CALM model includes a hierarchical five-level system of physical intervention training based on non-aversive principles with a last resort emphasis. It promotes an approach to behavioural control, based on the systematic analysis and assessment of the underpinning functions of behaviour. Training involves of a 2-day physical intervention programme.

Practical applications:

According to the authors, the CALM model is used by many Scottish councils as well as a range of other organisations across the UK.

Innovative aspects:

The CALM philosophy rejects the popular notion that individual staff competence is the sole determinant of safe practice, and alternatively promotes the notion that safe practice requires a coherent agency approach. Consequently, the CALM training programme is based on a “systems” or “whole organisation” approach aimed to ensure effective action at all levels of the organisation.

Evaluation (including process issues, outcomes and sustainability):

Evaluation of CALM training was conducted in education settings in Scotland with school children that had severe and complex learning difficulties. The study was set to examine the appropriateness of the CALM system for use in educational settings. A questionnaire was developed to explore staff stress, coping styles and attitudes towards the use of physical intervention. There were pre-training, post-training and 6 month follow-up stages. Semi-structured interviews were conducted. A random sample was gathered including all ages and one employee per school class. In addition to interviews and the questionnaire administration, researchers also used school logbook data regarding violence incidents.

Benefits (including cost effectiveness):

The evaluation of the CALM method demonstrated that staff acquired a deeper knowledge of the physical intervention techniques immediately following the initial training session. At six month follow-up this knowledge had diminished slightly. The majority of staff reported increased confidence as a result of the training. The use of verbal de-escalation techniques demonstrated a significant increase. The theory module developed increased awareness of legal aspects relating to the use of physical restraint interventions. There was increased willingness to intervene into potentially violent situations.

References:

Perkins, J. & Leadbetter D (2002). An evaluation of aggression management training in a special educational setting. Emotional and Behavioural Difficulties, 7(1,) 19-34

Comments:

From staff self-report measures, stress levels and psychological coping strategies had not altered in any way. The lack of supporting action by school and departmental managers was identified as a key inhibiting factor. Trained staff got the reputation of being more of an expert than other employees in violent situations (which is not always a good thing). Every employee should have confidence and authority to intervene into possibly dangerous situations.

Author(s):        Claire Dickinson and Jeremy Bevan                              Country:   United Kingdom                      Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

The inspections-intervention was part of Health and Safety Executive's 3-year programme on work-related violence. A series of targeted inspections were made on the UK railways. Inspectors considered arrangements and measures for managing and preventing work-related violence in train operating companies. Inspections considered risk assessments, reporting measures and investigation reports; and evaluated the preventive, protective and response measures in place. The deficiencies identified were resolved.

In the railways, experience of violence is an everyday experience for some employees, especially verbal abuse. Inspections-interventions were targeted to include individuals in jobs where risk for violence was the greatest. Incident statistics of the companies were used to identify the key worker groups at risk.

Implementation:

Three case situations were in focus: 1) the company’s response to violence being repeatedly directed towards a particular group or individual, all of whom were contractors, 2) recurring violence at one location, and 3) violence directed towards train operating company employees. A checklist for preventing and addressing work-related violence was used. Discussions about violence problems in focus group sessions were conducted.

Practical applications:

The method has been used in the UK railways.

Innovative aspects:

Use of mixed methods to ensure the development of good quality guidance.

Evaluation (including process issues, outcomes and sustainability):

Semi-structured interviews with operational staff, their supervisors and managers were conducted. Additionally, a review and evaluation of the train operating company policy, arrangements, procedures, measures and processes for measurement and auditing performance was conducted. Different measures to protect employees from violence were planned. Each train operating company’s complete safety case was considered including policy.  

Benefits (including cost effectiveness):

Improvements were sought in:

·         the arrangements for contractors,

·         more actions to ensure verbal abuse reporting,

·         more training to avoid confrontation

·         the need to arrange refresher training,

·         more initiatives with safety representatives,

·         understanding what measures have impact,

·         site-specific risk-assessments: that are usable, updated and reflect the reality,

·         the update of the quality of control measures.

A number of deficiencies were identified as a result, the most serious of which concerned the arrangements and measures in place for contract staff employed in checking tickets or in security activities.

It was also seen vital to ensure that train operating companies are: (a) fully aware of the size of violence problems, (b) using reporting systems that are flexible to ensure that maximum data are captured with minimum effort, and (c) using risk assessments that are suitable and sufficient, and incorporate local factors such as lone working.   

References:

Dickinson, C. & Bevan, J. (2005). Managing violence on the railways. Applied Ergonomics, 36 (6), 729-738.

Comments:

In the article there is a check list for good practice