SOCW 6520 Assignment: Week 3 Blog

Refer to the topics covered in this week’s resources and incorporate them into your blog.

Post a blog post that includes 300 to 500 words my field experience is going to be at Sound options in Tacoma Washington I will be doing some in office work, some home visits but mostly telecommunication. For the telecommunication part I need to talk about how to set up my computer so that clients can not see any personal things like pictures or things that can identify my location ect. I will not be driving clients during my internship. This is a social work internship 

Questions in bold then answers

A description of your personal safety plan for your field education experience

An explanation of how your personal safety plan might differ from your agency safety plan during your field education experience

I have uploaded this chapter please use something out of every bullet point

Birkenmaier, J., & Berg-Weger, M. (2018). The practicum companion for social work: Integrating class and fieldwork (4th ed.). New York, NY: Pearson.

Chapter 3, “Safety in Social Work Settings” (pp. 63-77)

Incite citations and full references APA format 7th addition

O R I G I N A L P A P E R

When Social Workers Are Stalked: Risks, Strategies,
and Legal Protections

Cheryl Regehr • Graham D. Glancy

Published online: 1 October 2010

� Springer Science+Business Media, LLC 2010

Abstract By virtue of their work, social workers are at

risk of becoming victims of stalking. This is because social

workers assist individuals who suffer from major mental

health problems that may cause them to develop delusional

beliefs about their therapists, and because social workers

may need to exercise authority against individuals with

personality disturbances that present a risk to others. Sur-

veys suggest that 16% of social workers have been stalked

at one point in their career by a client. Stalking of social

workers by clients has far-reaching personal and profes-

sional implications, potentially affecting all aspects of an

individual’s life. This paper reviews the nature and inci-

dence of stalking of social workers, the legal remedies

available to social workers who are victims of stalking, and

strategies for protection.

Keywords Social workers � Stalking � Violence �
Threats � Client

From 1996–2002, Shauna Bailey, a social worker in Lon-

don England, was stalked by her client Richard Jan.

Ms. Bailey was a member of a mental health team that

assessed Mr. Jan under the Mental Health Act after they

were contacted by his mother regarding her concerns about

his mental health and his threats to harm her. He was

arrested in the community under mental health legislation

but was then later released from hospital as he did not meet

the criteria for involuntary admission. This marked the

onset of Jan’s harassment of Ms. Bailey and others. Ms.

Bailey sustained injuries requiring hospitalization on two

occasions after being attacked on the front doorstep of her

home late at night by Jan. He bombarded her with phone

calls. He followed her car, smashed it up, and set it on fire.

The ordeal ended when Ms. Bailey moved from her home,

quit her job and changed her name. In his 7 years of

inflicting terror on Ms. Bailey, Jan also had numerous other

victims including a west London City Councillor whose

home he firebombed. Jan, who was dubbed by Detective

Chief Inspector David Poole as ‘‘Britain’s worst stalker’’,

was convicted in 2004 on two counts of arson and causing

a public nuisance (BBC 2004; Mintowt-czyz and Edwards

2004).

While dramatic incidents such as that of Shauna Bailey

may be rare, they are not isolated. A Canadian random

survey of 171 social workers found that 16.3% reported

being stalked at some point in their careers (MacDonald

and Sirotich 2005). Other surveys while not specifically

addressing stalking behavior, report high rates of threats

and actual harm to social workers by clients (MacDonald

and Sirotich 2001; Newhill 1996; Rey 1996; Regehr et al.

2004). For instance, MacDonald and Sirotich (2001, 2005)

indicate that 87.8% of social workers in their study

reported verbal harassment, 63.5% reported threats of

physical harm, and 28.6% report being assaulted by a

client. A random sample of 1,129 social workers in two

states revealed that 83% had been threatened with harm,

and 40% had experienced an attempted or actual assault.

C. Regehr (&)
Faculty of Social Work and Faculty of Law,

University of Toronto, 27 King’s College Circle,

Toronto M5S 1A1, ON, Canada

e-mail: Cheryl.regehr@utoronto.ca

G. D. Glancy

Faculty of Medicine, University of Toronto,

Toronto, ON, Canada

G. D. Glancy

Faculty of Medicine, McMaster University,

Hamilton, ON, Canada

123

Clin Soc Work J (2011) 39:232–242

DOI 10.1007/s10615-010-0303-4

Rey (1996), in a study of 175 social workers, found

reported rates of threats and assaults at 59.6 and 23%,

respectively. In this sample 24.2% had objects thrown at

them and 17.5% reported threats with a weapon. Practice

settings where social workers are most likely to report

violence include child protective services, mental health

services, substance abuse services, and correctional ser-

vices (Jayaratne et al. 2004; Newhill 1996; Schultz 1987).

While threats and violence cannot be directly equated with

stalking, they often become part of the overall picture of

stalking and point to general concerns about safety for

social workers.

Stalking of social workers and other mental health

professionals by clients is a serious issue that has far-

reaching personal and professional implications. This paper

reviews the nature and incidence of stalking of social

workers and other mental health professionals, the legal

remedies available to professionals who are victims of

stalking, and strategies for protection.

The Incidence of Stalking

A large number of studies have attempted to determine the

nature and incidence of stalking in the general population.

The National Crime Victimization Survey in the United

States (U. S. Department and of Justice 1997) found a life-

time prevalence of stalking for women to be 8.1 and 2.2%

for men. By extrapolation, this translates to 2.04 million

women and 820,000 men in the United States who, at some

time in the lives, have been victims of stalking behavior

(Douglas and Dutton 2001). Extrapolating from the data

gathered by a Statistics Canada study surveying police

forces in Canada on the incidence of reported stalking

during 1994 and 1995 (Kong 1996), Douglas and Dutton

(2001) estimate stalking to have been reported in about 1%

of the adult population of Canadians during that 2 year

period. In a review of studies on stalking by Spitzberg and

Cupach (2007), between 60 and 80% of the victims were

female. A U.S. national survey on violence against women,

found that physical violence was reported in 32% of

stalking cases and sexual violence was reported in 12% of

stalking cases (Tjaden and Thoennes 1998).

Stalking emanating from domestic violence is the most

common form of stalking; encompassing an estimated

75–80% of all cases in some studies (Roberts and Dzieg-

ielweski 2006). Burgess and colleagues (1997) studied 120

people charged with domestic violence, who were attend-

ing a treatment program, of whom 30% admitted to

stalking their partners. Those that did stalk a former partner

had more serious histories of domestic violence. Thus,

social workers are most likely to be involved in stalking

situations where a client is being stalked by a former

intimate partner and the social worker acts in a helping

role. A body of literature addresses appropriate advice and

supports that social workers can provide to clients in this

situation. While it is critical for social workers to have

knowledge to help others, this paper focuses on social

workers as victims.

Aside from victims of intimate partner violence, mental

health professionals are one of the highest risk groups for

being stalked. Several randomized surveys have revealed

that between 20 and 30% of psychiatrists and psychologists

report being stalked (Hudson-Allez 2002; McIvor and Petch

2006; McIvor et al. 2008; Purcell et al. 2005). In a random

sample survey of Australian psychologists, 19.5% of the 830

respondents had been stalked, defined as 10 or more intru-

sions persisting for two or more weeks (

Purcell et al. 2005).

Of those who reported stalking, 38% received explicit

threats of harm or death and 9% per cent reported being

physically assaulted. An Italian survey found that 11% of

361 mental health workers (including psychiatrists, psy-

chologists, mental health nurses and social workers) repor-

ted being stalked using the criteria of 10 or more unwanted

contacts for a period of more than 4 weeks (Galeazzi et al.

2005). Fifty percent of a convenience sample of 112 mental

health nurses reported at least one stalking experience in

their careers. However, the design of this study does not

allow for generalization of this rate to all mental health

nurses (Ashmore et al. 2006). As noted earlier, a survey of

171 social workers found that 16.3% reported being stalked

at some point in their careers (MacDonald and Sirotich

2005). While methodological issues, including self-selec-

tion bias of some of the survey studies, may account for

variable rates of stalking reported, clearly this is an issue of

significant concern for all mental health practitioners.

Typologies of Stalking

Several authors have attempted to develop typologies of

stalking based on a number of dimensions including the

psychological characteristics of the stalker, and the rela-

tionship between the stalker and the victim (Dziegielewski

and Roberts 1995; Glancy 2008; Zona et al. 1993). These

typologies cover the wide range of stalking situations

spanning from stalking by strangers, to stalking arising

from intimate partner violence, to stalking of famous

people. In one the most well known typologies, Mullen and

colleagues (1999) identified five types of stalkers: (1) the

rejected stalker, who is motivated by a mixture of revenge

and desire for reconciliation after a relationship ends; (2)

the intimacy seeking stalker who often has erotomaniac

delusions; (3) the incompetent stalker who may be intel-

lectually or socially limited; (4) the resentful-retaliatory

stalker who seeks to frighten and distress the victim; and

Clin Soc Work J (2011) 39:232–242 233

123

(5) the predatory stalker who is preparing for a sexual

attack. Motivation for stalking of mental health profes-

sionals most commonly falls under the categories of either

erotomania or resentful-retaliatory stalkers (Hudson-Allez

2002; McIvor et al. 2008; Newman and Appelbaum 2007;

Purcell et al. 2005).

Resentful-retaliatory stalking may arise as a result of

duties performed by the social worker that had an adverse

effect on the stalker, including a negative court report,

apprehending a child in a protection case, or participation

in arranging involuntary admission to a mental health

facility. A study of 175 child welfare workers revealed that

52% of front line protection staff had been threatened with

assault and 19.1% had been physically assaulted when

investigating or intervening in cases of child abuse (Regehr

et al. 2005). Schultz (1987) in a study of 150 social workers

in one U.S. state, indicated that threats towards mental

health social workers frequently occurred when commit-

ment to a mental health facility was discussed, planned or

attempted with a client. In the above-noted case of Ms.

Bailey, her involvement in attempts to admit Richard Jan to

hospital, following threats made toward his mother, pro-

voked retaliatory stalking. In studies of perceived motiva-

tion for stalking of professionals in other mental health

disciplines, 42% of psychologists Purcell et al. (2005), 21%

of therapists (Hudson-Allez 2002), and 34.1% of psychia-

trists (McIvor et al. 2008) who reported being stalked,

believed that the client was angry either because of nega-

tive outcomes of an assessment, or the termination of

treatment. Stalking behavior of mental health professionals

motivated by resentment or retaliation is most commonly

perpetrated by males who have never been married, misuse

substances, have a diagnosis of personality disorder

or major mental illness, have a history of assault and

self-harm, and have repeated hospitalizations (Galeazzi

et al. 2005; Gentile et al. 2002; McIvor et al. 2008;

Rosenfeld and Harmon 2002; Sandberg et al. 1998, 2002).

Erotomania is best described as delusional loving, that

is, a love relationship that exists only in the mind of one

party and which is not based on reality. This syndrome was

first described in 1942 by De Clerambault in his book Les

Psychoses Passionelles and thus has become known as ‘De

Clerambault’s syndrome’. The client suffering from this

syndrome (most frequently a woman) believes that a per-

son of higher social stature is passionately in love with her,

but that this person is restricted from expressing this love

because of external constraints (Purcell et al. 2001). These

constraints can be imagined to be a spouse or family, or

rules that restrict behavior. For instance, the stalker may

believe that the victim would marry her if rules did not

forbid relationships between social workers and clients,

or between students and professors. The stalker may begin

to harass and threaten family members of the victim.

Subsequently, when the love and hope are not realized, the

love can disintegrate to resentment and anger (De Cler-

ambault 1942).

A study of 200 stalkers revealed that 42% of all inti-

macy seeking or erotomanic stalkers targeted professional

contacts (McEwan et al. 2009). Further, 39% of therapists

(Hudson-Allez 2002), 19% of psychologists Purcell et al.

(2005) and 29.3% of psychiatrists (McIvor et al. 2008)

believed that the motivation for stalking perpetrated against

them fell into the category of erotomania. Erotomanic

stalking is most likely to be perpetrated by clients with

mental health problems, commonly those with delusional

disorders or personality disorders (Harmon et al. 1998), and

clients with insecure attachment and preoccupied styles

(Tonin 2004). While an erotomaniac stalker can be very

difficult to dissuade, when compared to other types

of stalkers, generally he or she is least likely to resort

to threats of violence or actual violent activity (Rosenfeld

2000).

Effects of Stalking on Victims

Victims of stalking feel that they are under siege, whether

they are victims of intimate partner violence, famous

people or professionals. Repeated unwanted phone calls are

received where the stalker hangs up immediately, remains

silent, declares love, shouts obscenities or threatens. Calls

are usually received at inconvenient times such as in the

early morning or at work and answering machines are often

filled with the stalker’s messages. Letters are sent

or written messages dropped off. Gifts arrive with some

frequency. The stalker may come to the victim’s home or

office and refuse to leave. In the current days of electronic

communication, stalking can include harassing or threat-

ening e-mail messages, inappropriate e-greeting cards, and

digitally altered pornographic photos that lead to distress of

the victim (Amar 2006; Galeazzi et al. 2005; Glancy et al.

2007; Tjaden and Thoennes 1998). In a study of people

experiencing various forms of stalking conducted by Pathé

and Mullen (1997), 36% of a sample of 100 victims

reported property damage. Cars were covered with graffiti,

paintwork was scratched, and tires were slashed. Homes

were attacked via broken windows and smashed fences. In

addition, in more than half the cases, the stalker made

threats directly to harm the victim or their family and

friends, or threatened to discredit the victim by spreading

malicious gossip. In one-third of the cases the victim was

assaulted.

In light of these repeated attacks on the privacy, prop-

erty and life of the victim, it is not surprising that stalking

victims experience a wide range of social and psycholog-

ical sequelae. In a study of 145 people in the general

234 Clin Soc Work J (2011) 39:232–242

123

population who were victims of stalking, 83% reported

personality changes as a result of being stalked, 41% said

that they felt paranoid, 52% reported being easily fright-

ened, and 27% indicated that they had become more

aggressive (Hall 1998). Symptoms of depression, anger and

helplessness are also reported, occasionally leading to

suicidal ideation (McEwan et al. 2009). In a study of 100

victims of stalking, Pathé and Mullen (1997) indicated that

85% reported increased anxiety, 75% reported over-

whelming powerlessness, 74% reported chronic sleep dis-

turbances and 24% reported suicidal ideation. Similarly, in

a study of mental health professionals who were stalked,

53% reported fear, 43% reported anger, and 28% reported

helplessness (Galeazzi et al. 2005). The arousal, intrusion

and avoidance symptoms associated with post-traumatic

stress disorder are also common among stalking victims.

For instance, 55% of 100 victims reported physiological

startle responses to a knock on the door or telephone ring

(Pathé and Mullen 1997) and 33.9% of 236 stalking victims

met the criteria for PTSD Purcell et al. (2005).

Hall (1998), in a study of stalking victims in the general

population, reported that 88% of respondents were more

cautious as a result of fears caused by stalking. Victims check

their rear-view mirror and drive home by different routes.

Victims begin to avoid any possibility of contact, they restrict

activities, often becoming housebound and refusing to answer

the telephone, and thereby become more isolated from social

supports. These symptoms are likely to be more pronounced

when the stalking involves a former history of violence, when

the number of stalking behaviors increases, or when the

duration of the stalking is prolonged (Kamphuis and Emm-

elkamp 2001; Kamphuis et al. 2003; Pathé and Mullen 1997).

On a social level, the victim’s occupational and educa-

tional status is affected if they reduce their attendance or

have frequent interruptions at work. Pathé and Mullen

(1997) reported that over half of the victims in their study of

stalking victims in the general population decreased or

ceased work or school attendance. Tjaden and Thoennes

(1998) found that stalking ended for 19% of victims in their

study because the victim relocated. Among psychologists

who were stalked, 71% modified aspects of their person and

professional lives, including increasing security, changing

phone numbers, and relocating their offices and or homes

(Purcell et al. 2005). In the clinical experience of the authors

of this paper in forensic mental health and threat assessment,

friends and family are called upon to accompany the victim

to various places or stay at the victim’s home. Family

become distraught that there seems to be no end in sight and

as a result may alternately express anger towards the justice

system for failing to protect the victim, and anger towards

the victim for bringing this into their lives. Social supports

can diminish with prolonged stalking as friends and family

seek to have their own lives return to normal.

Social workers who are stalked by clients may experi-

ence additional reactions related to their roles as therapists

and mental health professionals. Social workers may be

concerned that they have in some way caused the stalking

behavior due to a perceived or actual failure to maintain

clear boundaries or manage counter-transference in the

therapeutic relationship (Lorberg 2002). Mullen and col-

leagues (2009) describe how the termination of a treatment

relationship may be perceived by clients to be a breaking of

an implicit promise. The resulting humiliation may lead to

stalking (Meloy 2002), for which the social worker may

assume a sense of responsibility. Further, the duty of care

which a social worker holds, is challenged when a coun-

selling relationship must be terminated due to harassment

or stalking perpetrated by a client (Seeman 2008).

According to the National Violence Against Women

Survey, 30% of female stalking victims and 20% of male

victims seek psychological counselling as a result of their

victimization (Tjaden and Thoennes 1998). However, ser-

vices for victims of stalking are primarily directed at those

who are victims of stalking by intimate partners or victims

of sexual assault by predatory stalkers (Spence-Diehl and

Potocky-Tripodi 2001). As a result, social workers who

experience stalking may have few places to turn for

assistance.

Stalking Laws

In 1990, in part as a response to a high profile celebrity

stalking case and in part due to repeated cases of ex-partner

stalking and violence, California passed the first stalking

law in the Western world (California Penal Code 1990).

Over the next decade, all U.S. states, Australia, Canada, the

United Kingdom and several Western European countries

followed suit (Dennison and Thomson 2005). These laws

primarily came about as a result of public concern that

members of the community were virtually powerless to

protect themselves against harassing or intimidating

behavior. Prior laws addressing stalking came from a

variety of standpoints, each limited in their ability to

address the pervasive nature of stalking. For instance, in

most jurisdictions, victims could (and still can) obtain a

protection order, a peace bond or a restraining order aimed

at limiting contact between the perpetrator and the victim

(Regehr and Kanani 2006). These forms of restraint gen-

erally arise from civil law and may or may not result in

criminal charges if the named individual breaches the

conditions of the order. However, these orders are highly

criticized in that the onus is on the victim to notify police

about a breach. In addition, concerns have been raised

about the motivation and ability of police to enforce the

orders (Purcell et al. 2004). Indeed, the National Violence

Clin Soc Work J (2011) 39:232–242 235

123

Against Women Survey revealed that 69% of female vic-

tims and 81% of male stalking victims who had obtained

restraining orders indicated that their stalkers had violated

the order (Tjaden and Thoennes 1998).

Other laws cover harassment, trespass or vandalism,

which not only address very specific aspects of stalking

behavior, but also are frequently misdemeanours and

therefore are not given serious attention (Dennison and

Thomson 2005; Purcell et al. 2004). Further, most of the

previous law pertaining to stalking behavior could not be

enacted until the stalker had inflicted physical assault or

property damage. This was exemplified by the testimony of

Sandra Pollard, the mother of a stalking victim, who tes-

tified before the 1992 U.S. Senate Judiciary Committee

Hearings on Antistalking Legislation. ‘‘Despite threats he

has made against our lives, despite repeated violations of

restraining orders, despite the professional assessment of

him as dangerous, both the District Attorney and our own

attorney have said that nothing can be done until he has

‘‘done something’’. What is the ‘‘something’’ they must

wait for him to do? Kidnap [my daughter]? Rape her? Kill

her?’’ (Purcell et al. 2004, p. 159) Public pressure and

concern led to legislative reform aimed at better addressing

the needs of stalking victims.

In the United States, stalking legislation generally cov-

ers repeatedly following or harassing an individual, where

the behavior of the pursuer contains a credible threat of

harm. The Model Anti-Stalking Code for the States

(National Institute of Justice 1996) defines stalking as

repeatedly maintaining a visual or physical proximity to a

person, or repeatedly conveying verbal or written threats or

threats implied by conduct. Available sanctions vary

widely, however. Some states classify stalking as a mis-

demeanour, while others define it as a felony. Even where

there is a felony offense, sentences vary from a maximum

of 12 months in West Virginia to 7 years for an equivalent

offense in Illinois. Further, some states require prior inci-

dents of stalking or the violation of existing protection

orders, while others do not (Dennison and Thomson 2005).

Stalking (defined as criminal harassment) was intro-

duced into the Criminal Code of Canada in April 1993. The

Code stipulates, ‘‘No person shall, without lawful authority

and knowing that another person is harassed or recklessly

as to whether the other person is harassed, engage in

conduct referred to in subsection (2) that causes that other

person reasonably, in all the circumstances, to fear for their

safety or the safety of anyone known to them’’. Prohibited

conduct outlined in the Code includes: repeatedly follow-

ing from place to place the other person or anyone known

to them; repeatedly communicating with, either directly or

indirectly, the other person or anyone known to them;

besetting or watching the dwelling-house, or place where

the other person, or anyone known to them, resides, works,

carries on business or happens to be; or engaging in

threatening conduct directed at the other person or any

member of their family. Criminal conviction of stalking

behavior carries a penalty of up to 5 years imprisonment.

In summary, legislation that has been enacted since

1990 throughout North America has lead to considerable

improvement in legal options available to manage stalking

behavior. Nevertheless, these laws do not provide perfect

protection and victims of stalking, to a large extent, are still

left to their own devices to ensure their safety.

Management of Stalking Behavior

Stalking behavior by clients causes significant distress in

mental health professionals and can at times lead to risk of

violence. The section below discusses strategies for man-

aging stalking behavior. It should be noted, however, that

research evidence is largely absent regarding the efficacy of

specific approaches and thus most suggestions noted below

are based primarily on the consensus of experts in the field.

Prevention

Perhaps the most important aspect of risk management

related to stalking or threatening behavior is prevention.

Prevention can occur at three levels, preventative education

for social workers, individual prevention strategies, and

organizational policies that enhance safety. Violence

prevention training is a part of many agency practices

(Newhill 1996) and generally covers basic physical safety

measures in the office or institution and during home visits,

and means for de-escalating violent encounters (Rey 1996;

Spencer and Munch 2003). In addition, however, it is

important that training addresses issues of boundaries in

professional practice and draws attention to the types of

interactions between clients and mental health profession-

als that may subsequently develop into a stalking situation.

For instance, situations where the worker must be con-

frontational may inadvertently provoke a retaliatory

stalker, while loosening of agency rules for a particular

client may reinforce misperceptions of an emerging ero-

tomaniac stalker. Part of this training should underline the

fact that despite precautions taken by social workers, they

are still vulnerable to stalking and threatening behavior

because of the nature of their occupation.

On an ongoing basis, social workers should be vigilant

about the ongoing possibility of threats to safety. Personal

information shared with clients, or made publically avail-

able, should be kept to a minimum. If social workers are

using social networking sites (such as Facebook), they

should have security settings that limit access only to

known parties. Those working with forensic or other high

236 Clin Soc Work J (2011) 39:232–242

123

risk populations generally refrain from displaying family

photographs or other items that give cues to aspects of their

personal life. Precautionary measures employed by foren-

sic evaluators in a study by Leavitt and colleagues (2006)

included the use of unlisted home phone numbers, post

office boxes, and home and office security systems. Basic

home and private office security should be evaluated and

consideration should be given to the installation of inex-

pensive security measures. Doors and windows should be

locked and outside lights can be installed to illuminate

alleys and backyards. Cars should be parked in well lit

areas and highly identifying licence plates avoided. Any

unusual occurrences or uncomfortable feelings about situ-

ations should give rise to concern (Dietz 1989).

Organizational policies must acknowledge threats to

safety and provide means for social workers to report their

concerns. A survey conducted by MacDonald and Sirotich

(2001) explored reasons that social workers did not report

threats of client violence to agency management. Sixty-five

percent of respondents indicated that they did not report

because they viewed client threats and violence to be part

of the job, and 45% did not report because they were

concerned about negative consequences for the client.

Other reasons for non-reporting included: concern that it

would appear that the social worker could not cope (31%);

concern that the agency would not be supportive (24%);

and concern that the social worker would be blamed for the

incident (14%). These findings are similar to those in other

studies of social workers as victims, which suggest that

underreporting of threats and violence is endemic (Little-

child 1995; Spencer and Munch 2003). In situations where

workers did report incidents of violence, the reasons given

included: to obtain support (90%); to protect themselves

from further danger (76%); and because the agency dictates

reporting (69%) (MacDonald and Sirotich 2001). Agency

policies can therefore send a clear message that violence

against workers will not be tolerated and that action will be

taken (Regehr et al. 2002). Such action should include

methods of risk assessment, means for deciding when

police will be involved, when a worker will be removed

from a case, and when services to the client will be

discontinued.

Assessing Risk

Despite efforts at prevention, social workers may find

themselves in situations where they are being stalked and are

concerned they may be at risk of harm. In these cases, a

formal risk management assessment may need to be con-

ducted by those with expertise in threat assessment to

ascertain the risk of violence towards the victim (Kropp et al.

2008). Most stalkers who assault their victims give warnings

of their intentions through threats of violence (Resnick

2007). Risk factors for violence among stalkers include

substance abuse, a history of previous violent criminal

offenses, the specificity of expressed threats, suicidality, the

presence of personality disorder or delusions, and social

isolation (Resnick 2007). Risk management involves not

only the consideration of a number of characteristics of the

stalker that are known to increase risk, but also should take

into account contextual factors that include the proximity of

the parties and the vulnerability of the victim.

Prediction of dangerousness based solely on clinical

assessments of offenders of any kind has proven to be

remarkably inaccurate and results in very low rates of

interrater reliability among professional assessors (Hilton

and Simmons 2001). Consequently, there has been con-

siderable effort in the past decade focused on the devel-

opment of actuarial tools with the aim of improving

accuracy in predicting dangerousness. Although developers

of the tools have reported favorable results in terms of

predictive validity, nevertheless, considerable controversy

exists about the role of actuarial testing in the assessment

of offenders (Sreenivasan et al. 2000; Zonana 2000). A

further issue is that most of these tools predict the recidi-

vism of physical or sexual violence and are not useful for

understanding the risk in someone who has not offended.

This is particularly challenging in the area of stalking

where although there may be an implicit threat, there may

not be overt indications of aggression or violence.

In response to concerns about actuarial tools, risk

assessment in this area is often conducted as a structured

clinical interview that may be supplemented by biological,

psychological, and actuarial tests to aid in the prediction

(Glancy and Regehr 2002). One such approach has been

developed by Kropp and associates (2007), known as the

Stalking Assessment and Management (SAM). Another

such approach is the stalking-HARM (Handy Assessment

of Risk Management), based on the work of the Group for

the Advancement of Psychiatry (GAP) (Pinals 2007;

Glancy et al. 2008).

Responding to a Threat

The first step in managing stalking behavior involves not

discounting fear created by harassing behavior, and not

dismissing discomfort as simply paranoid thinking or over-

reacting. By the very nature of stalking, it can be difficult to

define when annoying interactions actually become stalking

or when threats are no longer idle. Denial and minimization

by clinicians is the norm but this may serve to inadvertently

potentiate the victimization in that early precautionary

measures are not undertaken and that assistance from others

is not sought (Galeazzi et al. 2005; Knoll 2007).

Once a threat is experienced, social workers faced with

stalking attempt to manage the threat in various ways.

Clin Soc Work J (2011) 39:232–242 237

123

Strategies employed by inpatient mental health staff in the

study by Sandberg et al. (2002) most commonly involved

notifying coworkers or managerial staff members and

avoiding contact with the patient. Over � of those that
experienced harassing or stalking behavior notified police

or security and a small minority obtained a restraining

order or had the stalker arrested. In general, seeking police

or legal assistance was viewed by these participants as

helpful. A common strategy employed by 2/3 of respon-

dents was to confront the patient about the behavior. Of

those choosing this strategy, only half felt that this

approach was useful and 17% felt it worsened the situation.

Seeking consultation from others is a highly recom-

mended strategy. A social worker who works within an

organizational context should inform his/her supervisor of

their concerns and may convene a multi-disciplinary team

meeting to discuss strategies and suggestions. A social

worker in independent practice should consult trusted

colleagues. Such consultation with others provides support

and validation for the professional who is feeling victim-

ized, allows for the garnering of helpful input from others,

and increases safety by making others aware of the situa-

tion. However, while support from others is helpful, vic-

tims should be aware that they are primarily responsible for

their own safety (Meloy 1997). That is, despite even the

best efforts of interdisciplinary team members, police, and

others in justice system, they will be unable to ensure that

no harm comes to the victim.

If harassing or stalking behavior is occurring, victims

should create and maintain documentary evidence of the

stalking in order to assist with apprehension and successful

prosecution of the offender. Phone machine messages,

although upsetting and often abhorrent, should be recorded

and stored. All letters, emails, notes and gifts should be

retained. Photos should be taken of damage and of mes-

sages left on property, such as writing on windows. Con-

temporaneous recording of incidents are excellent ways of

demonstrating a pattern of repetition. For instance, in a

situation where the phone rang on twenty separate occa-

sions in one evening and no one was there when the phone

was answered. While any single occurrence seems innoc-

uous, pages of notes recording repeated small events leads

to a more compelling argument of threat (Dietz 1989).

To this point, all suggested approaches could be clas-

sified as indirect, that is, not directly involving the perpe-

trator of the threatening or stalking behavior. Taking direct

action requires some caution due to what Knoll (2007)

refers to as the intervention dilemma. That is, actions taken

with the intent of decreasing stalking behavior may actu-

ally result in an increased risk of violence. For instance,

consideration may be given to the procurement of a

restraining order, but in rare cases restraining orders

actually increased stalking and violence (Meloy 1997).

Thus, the decision to take this action should also take into

account whether the perpetrator is highly invested in the

victim, for instance, due to a psychotic transference or a

delusional system; and whether the stalker is suicidal, in

which case the threat of jail does not serve as a deterrent.

The fact that there is no clear evidence of outcomes related

to specific direct actions is understandably problematic and

thus underlines the need for ongoing consultation and

assistance if a social worker finds his or herself to be the

victim of stalking.

Consideration should be given to having a supervisor or

security guard meet with the client (with or without the

social worker depending on circumstances) to discuss

appropriate behaviors and expectations. Sometimes it is

helpful for law enforcement to issue a verbal warning in a

professional but firm manner, explaining the potential

consequences of threatening or violent behavior (Dunn

2008). If the stalking continues and there is a continued

threat, then the victim should avoid all contact with the

stalker and never initiate further contact. While at first

glance this suggestion may seem obvious, it is not

uncommon for victims to attempt to confront the stalker,

plead for him or her to stop, or try to negotiate limited

contact. These actual contacts can be reinforcing for the

stalker, demonstrating that repeated attempts do result in

intermittent reward (Meloy 1997). Alternatively, these

contacts can serve to incite anger and violence if the stalker

feels slighted or rebuked.

If the decision is made to terminate care, it is incumbent

upon the agency or independent practitioner to arrange

ongoing care for the client, preferably in a different loca-

tion. This should be communicated to the patient by way of

a letter from the administrator rather than the clinician.

Support for Social Workers as Victims

Where a social worker is stalked within the context of work

for an agency, organizational support is paramount. Orga-

nizational cultures need to be established that encourage

the reporting of violence and assist those who report

(Littlechild 2005; Regehr et al. 2005). Jokes and stories

that glorify surviving violent situations unscathed must be

removed from the organizational folklore (Regehr and

Cadell 1999). Supervisors need to acknowledge workers’

fears and avoid any insinuations that violent and threat-

ening client behavior is part of the job. Supervisors can

assist by mobilizing medical treatment or psychological

support services, cancelling client appointments, covering

shifts, reconfiguring caseloads, arranging for legal advice,

and organizing a leave of absence if necessary (Spencer

and Munch 2003).

Social workers who do not have organizational supports

should seek assistance from either supportive others or

238 Clin Soc Work J (2011) 39:232–242

123

should consider professional assistance. While social

workers acknowledge the importance of, and encourage

such support and assistance for their clients, they are less

likely to seek such support themselves. However, the

insidious nature of stalking often results in colleagues and

friends not fully appreciating the resulting fears and

impacts. Thus expert assistance may be necessary.

Case Example

Sarah is a social worker in a community mental health

agency that serves a wide range of clients. One client,

Linda, was seeing Sarah for over a year while working on

issues related to childhood sexual abuse and ongoing

interpersonal coping problems. Linda has substance abuse

problems, has made multiple suicide attempts and at times

of acute distress cuts her arms. Linda lives in a common-

law relationship with a woman who is physically and

emotionally abusive of her. Her partner has two children in

their early 20 s who also live in the household and are

supported by Linda’s income from her part-time job as an

office cleaner. Sarah was working with Linda to increase

control over her life and in doing so had supported her

positive efforts. One of Linda’s passions is guitar playing

but her guitar was in disrepair and she could not afford a

new one. Sarah had an unused one in her basement that she

gave to Linda, as a gesture of her continued support of

Linda’s independence and self-care.

A few months ago, Sarah told Linda that she was

pregnant and would be leaving the Center for a period of

time to care for her child. As a result, Sarah was trans-

ferring Linda’s care to someone else. Linda became upset

and indicated that she was ‘‘not just a client’’ and could not

‘‘be pushed off to another worker’’. She left the session

tearful. Sarah, feeling concerned and guilty, contacted

Linda the next day in an attempt to ease the termination of

treatment. She agreed to meet for a talk in the coffee shop

beside the Center. This meeting did not go well with Linda

becoming increasingly upset and abruptly running out.

Sarah decided to consult her supervisor.

In the subsequent weeks, Linda called the agency mul-

tiple times each day demanding to speak to Sarah. When,

on the advice of her supervisor, Sarah declined to speak to

her outside of their regularly scheduled session, Linda

began to drop off letters at the receptionist indicating her

love for Sarah and her dismay that their ‘‘relationship had

ended’’. The name plate from Sarah’s office door was

stolen and flowers were left outside her door. Sarah then

contacted Linda to indicate that she could not continue as

her therapist and her care would be transferred immediately

to another social worker. Linda refused contact with the

new social worker. As the weeks progressed, Linda left

messages on Sarah’s car and was seen hanging around the

parking lot. An angry call was received from Linda’s

partner accusing Sarah of stealing her girlfriend. Most

frightening and distressing for Sarah was a letter left in her

home mailbox addressed to her husband which claimed

that a romantic relationship existed between Sarah and her

client and accusing him of standing in their way.

At this stage the Center director arranged a meeting with

Sarah, which included her supervisor and a representative

of the community police department. Linda was contacted

and informed that she was not to attend, or call the agency,

or to communicate with Sarah either directly or indirectly.

She was also informed that there could be legal conse-

quences if she did so, including possible criminal charges.

She was told that arrangements had been made for her to

see a male therapist at another agency, and that this was

strongly recommended.

Sarah was advised to remove her home address and

telephone number from any publicly accessible place. She

also met with a community police officer with a view to

increasing the security of her home without undue expense.

As a result of these interventions, Linda ceased attempting

to contact with Sarah. However, Sarah remained fearful

and she and her husband decided to accelerate their plans to

move to a new home to accommodate their growing

family.

In this case example, Linda is a client at particular risk

of falling in love with her therapist and developing beliefs

that these feelings are reciprocated (Galeazzi et al. 2005;

Harmon et al. 1998; Tonin 2004). She has been disap-

pointed with past and current relationships and is vulner-

able to seeing her therapist as an idealized alternative.

Sarah is an experienced social worker who is well aware of

the nature of professional boundaries and would not engage

in dual relationships, such as a sexual relationship with her

client, or depending on her client to meet her own emo-

tional needs (Kagle and Giebelhausen 1994). Yet, in her

efforts to support Linda, she has engaged in boundary

crossing, defined by Gabbard and Gutheil (1993) as tran-

sient, non-exploitative deviations from classical therapeutic

practice. According to Gutheil (2005), often these crossings

do not hurt therapy and may even promote it, however,

given the nature of the client’s needs, they may lead to

reinforcement of emerging erotomanic beliefs. The situa-

tion was enflamed when Sarah needed to terminate treat-

ment which may precipitate stalking behavior in some

clients (Meloy 2002; Mullen et al. 2009). Linda’s behavior

and Sarah’s reactions are typical of stalking situations

perpetrated by a client against a mental health professional.

Sarah appropriately sought assistance when she became

concerned, but earlier consultation with colleagues or a

supervisor may have helped to avoid the situation or stop

the stalking behavior at an earlier stage.

Clin Soc Work J (2011) 39:232–242 239

123

Summary and Conclusions

By virtue of their work, social workers are at risk of

becoming victims of stalking. This is because clients of

social workers suffer from major mental health problems

that cause them to develop delusional beliefs about their

therapists, and because social workers may need to exercise

authority against individuals with personality disturbances

that present a risk to others. Further, the nature of the

therapeutic relationship and the duty of care to those in

need, often require ongoing contact even as problematic

behaviors arise. Threatening or harassing behavior is

notoriously difficult to manage and in most cases few legal

remedies exist to end the behavior. As such, social workers

must take personal responsibility to monitor potential risk

situations, seek early assistance from others, and ensure

their own safety and security.

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Author Biographies

Cheryl Regehr MSW PhD is Vice- Provost, Academic Programs at
the University of Toronto. Former Dean of Social Work, she is a

Professor in the Faculties of Social Work and Law. Her clinical

Clin Soc Work J (2011) 39:232–242 241

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background is in forensic social work specializing in civil and

criminal assessments of trauma victims and violent offenders.

Graham Glancy MB, ChB, FRCPsych, FRCP(C) is an Assistant
Professor of Psychiatry and an Adjunct Professor of Law at the

University of Toronto. He is a past President of the Canadian

Academy of Psychiatry and the Law, and Vice-President of the

American Academy of Psychiatry and the Law. His psychiatric

specialty is threat assessment.

242 Clin Soc Work J (2011) 39:232–242

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• c.10615_2010_Article_303

When Social Workers Are Stalked: Risks, Strategies, and Legal Protections
Abstract
The Incidence of Stalking
Typologies of Stalking
Effects of Stalking on Victims
Stalking Laws
Management of Stalking Behavior
Prevention
Assessing Risk
Responding to a Threat
Support for Social Workers as Victims
Case Example
Summary and Conclusions
References

Safety in Social Work Settings THE SCOPE OF PERSONAL SAFETY RISKS IN SOCIAL WORK

Have you wondered about your physical safety at your practicum site? Does the thought of home visits create feelings of anxiety? Have family members worried about your choice of profession because of safety issues? Have you heard other students and faculty discuss agency safety issues? Has the absence of any discussion of safety worried you? Many students, especially beginning students, have concerns about safety and security and struggle with the decision to voice their concerns to their professors, other students, and their field instructors. Students may be reluctant to discuss safety fears and concerns with others for fear of being viewed as uncommitted to the profession or to clients. Other students may assume that the role of the social worker is viewed strictly as one of helper and enabler and cannot fathom it being viewed as a threat. However, the practice of social work typically does involve some degree of risk. If not addressed, concerns about personal safety can significantly affect learning opportunities in the field placement. This chapter will address safety concerns associated with social work and provide guidelines that can assist you in minimizing the risk of harm.

Corina Wonders about Her Safety On her first day of practicum,

Corina was given a tour of the detention facility, introduced to all of the staff, oriented to the various systems, and provided with agency manuals and policy guidelines. She began shadowing other social workers and sat in on their group therapy sessions. On the third day, she remembered to ask about the unusual name of the unit in which she would be completing her practicum. She was told it was named after a staff member who had been shot to death by a client in the office a year ago. She was shocked. She had no idea that this practicum could pose a threat to her well-being. Are her fears real? What would you do on learning this information?

Faced with this kind of information, most students would be concerned about working at the agency. Some might even contemplate requesting a transfer to another agency. Other students might consider the likelihood of this kind of incident occurring twice to be very small and so disregard safety as a serious matter. Should safety be a concern for students in practicum? While most social work employers adequately address safety issues (Whitaker, Weismiller, & Clark, 2006), research findings suggest that concern over personal safety issues in social work is warranted. Estimates of the proportion of social workers who report experience with work-related violence range from 42% to over 80% (Criss, 2010; Ringstad, 2009; Winstanley & Hales, 2014). The National Institute for Occupational Safety and Health (2002) defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” Almost half of all nonfatal injuries in the United States from work-related assaults and violent acts occurred in health care and social services (U.S. Bureau of Labor Statistics, 2006). Of the injuries and illnesses occur-ring in health care and social services, 13% were the result of violence, a proportion that has been increasing over the past few years (U.S. Bureau of Labor Statistics, 2014). Studies have found that 15%–75% of survey respondents reported verbal aggression and 2%–29% reported physical aggression in medical practice settings (Hills & Joyce, 2013). Approximately half of all mental health professionals, including social workers, will be physically or psychologically assaulted at least once in their professional careers (Arthur, Brende, & Quiroz, 2003; Bride, Choi, Olin, & Roman, 2015), with social workers being nearly six times more likely than other workers to experience workplace violence (Respass & Payne, 2008). Social workers are the target of violence for a wide variety of reasons, including the following (Anderson & West, 2011; Newhill, 2013; Weinger, 2001): • Social problems (e.g., unemployment, poverty, and racism) that create an environment conducive to violence • Budget cuts that cause rising caseloads, resulting in less time with clients to assess for violence • The paradox of the professional role as both a helper and an agent of social control • Inadequate mental health services for the potentially violent client

Safety in the Practicum Setting

Social work practitioners and students are increasingly subject to threats in the workplace, the most common place where violence occurs, with approximately 50% reporting the experience of client physical or verbal violence (Sousa, Silva, Veloso, Tzafrir, & Enosh, 2014). Students are well advised to consider safety and liability issues when considering practicum sites and learning activities. The anxiety felt by many students regarding safety is justified by the experience of previous students. Although most students never experience any personal risk in practicum, approximately 42% of MSW and BSW practicum students experience some form of violence in the field placement (Criss, 2009). Violence mostly occurs in the form of verbal abuse, followed by threat of physical harm (Criss, 2009), with physical assaults rarely happening (Robson, Cossar, & Quayle, 2014). In one study, the majority of students experienced or were exposed to at least one incident in practicum that was emotionally or physically distressing (Didham, Dromgole, Csiernik, Karley, & Hurley, 2011). The most common form of threat to a practicum student is a verbal threat from a client, paraprofessional, or other professional (Robson et al., 2014). The 2015 Council on Social Work Education (CSWE) Educational Policy and Accreditation Standards do not address physical safety, assessment of potentially dangerous clients, or strategies for ensuring safety in the workplace. Thus, social work pro-grams vary widely in their knowledge of and approach to safety concerns (Criss, 2009). Although the National Association of Social Workers (NASW) offers safety standards for social work practice and guidelines about student safety (National Association of Social Workers [NASW], 2013), school policy that addresses safety issues is sparse: Only 12% of social work schools have a formal written policy on student safety (Reeser & Wertkin, 2001), and approximately 50% of practicum sites do not have agency safety policies regarding client violence (Barlow & Hall, 2007; Criss, 2009).

Reasonable Concerns and Caution

Social workers often work in neighborhoods and communities and with groups and clients that others may deem unsafe. In fact, many social workers will work in challenging situations and with challenging people as a routine part of their jobs or as part of being a social work professional. For example, in some states, social workers may be trained to be a “mental health first responder,” who actively assists people experiencing a mental health or substance abuse crisis by, for example, de-escalating the situation safety (Crisanti, Pasko, Pyeatt, Silverblatt, & Anastasoff, 2015; National Council for Behavioral Health, 2015). Social workers in mental health or clinical roles often work with clients who have difficulty regulating their emotions, reacting appropriately to situations, or tolerating dis-tress, which can lead to violence. Developing some level of acceptance and tolerance for challenging behavior and learning how to react professionally in a manner that is helpful to the client and that promotes safety will prove useful in practicum (Hyde, 2014). Although being careful is important, strive to separate stereotypes and myths from reality by having a realistic perception of risks so you can be an effective practitioner. If not addressed, the beginning anxiety you may feel can impede your willingness to draft ambitious and valuable learning plans. Talking with other students in practicum at your site, other current and former practicum students at the agency, and your field instructor can help you to determine the level of risk involved in conducting specific tasks and your comfort level in completing those tasks. You must ensure your safety and avoid allowing unfounded fears or inexperience to become impediments to the delivery of effective services. Situations posing physical threats to social workers can occur in any setting, and students should exercise due caution regardless of the perceived risk. The agency setting can significantly influence the level of perceived risk to the staff. Toward that goal, NASW safety standards suggest that agencies create and maintain an “organizational culture that promotes safety and security for their staff” (NASW, 2013). If your practicum agency is a residential setting (e.g., a children’s residential facility, hospital, substance abuse treatment facility, domestic violence facility, or correctional facility) that seeks to create this type of culture, you will likely encounter a highly structured setting with specific policies and procedures regarding some or all of the following (NASW, 2013): • Locks, both keyed and keyless • Metal detectors • Panic buttons • The need to receive permission from security guards for movement within the site • Confidentiality regarding location • Client restraints • Movement to and from your car in the agency parking lot • Situations in which staff must work in teams to ensure safety • Standard precautions (e.g., universal precautions) for avoiding exposure to illnesses such as HIV/AIDS, hepatitis, and tuberculosis • The completion of safety and violence response workshops in which you are trained to respond to violent aggression by clients and are expected to intervene physically with clients • The posting by staff of personal information on the Internet (possibly through social media networking sites), since these sites are highly accessible Administratively, you may also find that agency leadership has committed in writing to staff safety, actively manages workplace behaviors and collects data on incidents that involve safety risks, and has created safety committees to monitor agency safety policies (NASW, 2013). If you are working in a community-based agency, you may find fewer (if any) protocols and safety guidelines. Your field instructor may discuss safety matters with you during your interview to provide a realistic view of risk prior to your commitment to the agency. He or she will likely discuss policies and procedures regarding safety as you begin your practicum as well as the agency process for reporting safety policy and procedure violations. Completing the following practice applications can help you to gain a realistic perception of the safety risks in your setting and implement agency safety policies.

At Your Practicum Site •

Inquire about the number of recent incidents of physical or verbal abuse, harassment, and other violence that staff have experienced inside or outside the agency. • If the information was not included in the orientation, inquire about agency safety protocols (e.g., telephone number for emergency assistance, location of the first aid kit, emergency exit procedures for the building, and locations of fire extinguishers) as well as the process for reporting protocol violations. • Request a tour of the surrounding neighborhood, particularly if you will be conducting home visits. • Ask whether certain neighborhoods or areas should be avoided or approached with more caution than usual by staff members for safety reasons, and be prepared to follow suit when working independently.

Within Your Social Work Program •

Ask how many students have experienced problems related to safety in practicum in recent years. • Research the safety protocols of your social work program. • Take advantage of safety resources available from your social work program, or ask the faculty for assistance in obtaining resources such as safety training, seminars, videos, handouts, and discussions. After you have gathered all the information noted, demonstrate the knowledge you have gained through a discussion with your field instructor, a reflection paper for your integrative practice field seminar, or a journal entry

Ask to be observed by a staff member as you are making the transition to independent work with clients, and ask for feedback regarding safety risks and the implementation of safety guidelines. Journal about these early experiences related to safety issues as well as the safety precautions utilized and not utilized by you or by staff. Discuss and critique the following with a member of your practicum team: • Information gathered regarding safety issues in the practicum site • Skills you are developing related to the implementation of safety guidelines • The safety training and/or protocols of both the agency and your social work program (Were the protocols sufficient? Was the training helpful?) • Your apprehensions or fears concerning your safety while conducting practicum activities (Are your apprehensions based on reality and experience? How much of a factor could myths, stereotypes, inexperience, or bias be playing in your fears?). History is often the best predictor of risk. Increased caution should be exercised when working with clients who have these characteristics (Newhill, 2008; Ringstad, 2009; Weinger, 2001): 1. Severely violent behavior 2. History of remorseless parental brutality 3. History of fighting and school problems 4. Difficulty getting along with others and authority figures 5. History of overt parental seductiveness 6. Familiarity with and access to weapons 7. Currently under the influence of drugs or alcohol 8. Currently under severe stress and feeling over-whelmed or hopeless 9. Currently verbalizes being upset and angry or will not communicate with you 10. Currently threatens you either verbally or physically 11. Currently involved in illegal activities 12. Erupted verbally or physically in the last 30 to 40 minutes 13. Unable to sit still or is pacing 14. Currently suicidal 15. Was the victim of verbal or physical assault by a social worker

Assessment of Potentially Violent Clients

Due to the increased safety risks faced by social workers in many settings, it is critical that you be able to assess potential risk accurately. While human behavior is unpredictable and you will not be able to determine risk accurately in advance of an actual threat to your safety, be aware that certain factors may increase the risk of harm (see Box 3.1). Caution should be exercised when working with certain client groups under the following circumstances (Anderson & West, 2011; Criss, 2009; NASW, 2013; Ringstad, 2009; Scalera, 1995; Weinger, 2001): • Young male clients with criminal records or histories of substance abuse, weapons possession, or violence • Clients with a mental illness with specific risk factors and acute symptoms (i.e., paranoid delusions, command hallucinations, and syndromes such as mania, paranoid schizophrenia, and panic) • Clients with a history of weapons possession or training • Clients with a history of child or adult violence, substance abuse, or ritualistic or cult practices • Clients with lower intelligence or history of head trauma • When you are engaging in a high-risk activity during the visit (e.g., preparing for or actually removing a family member, such as a child; notifying a client about a reduction in benefits; terminating parental rights; carrying out a civil commitment procedure; or helping a partner attempting to leave a relationship) • When you are working in a geographic location that may pose danger (e.g., a rural, isolated, or high-crime area) • When you are working during evening or nighttime hours • When animals that may pose a threat are present

Specific Guidelines for Safety within the Office

Many students will meet with their clients in an office setting and encounter few problems. However, even the most structured setting cannot guarantee complete safety. The following suggestions can reduce the chances of experiencing physical harm in the office (Hyde, 2014; NASW, 2013; Newhill, 2013; Weinger, 2001): • Follow agency safety policies to the letter. Take advantage of any agency safety training opportunities, and read agency policy about staff and client safety. • Study the files of all clients before interacting with them to ascertain the risk involved in working with them. • Learn how to do a risk assessment, to include consideration of a client’s history of violence, involvement with correctional systems, appearance, demeanor, intent to harm self or others, and psychiatric or medical risk factors, including substance abuse, and the degree to which the client is compliant with requests. • Ask a staff member to accompany you when working with a client who has a his-tory of violence or who exhibits behaviors that may pose a threat. • Remove all objects from your desk (pens, staplers, and paperweights) that could be used as weapons. • Leave a client who is becoming belligerent or threatening, and seek help from a colleague. • If there is no system in place, develop one whereby you can discreetly signal another staff member that you need assistance (e.g., call another staff member, state the client name, and say that you need “the progress folder”). • Leave office doors open, and arrange the furniture so that both you and the client could make a quick exit. • When possible, develop relationships with those who are charged with ensuring your safety. Let them know when you will be working late, and ask the guards/ safety patrol officers to escort you to your car when needed. • When at the agency, keep your valuables in a confidential, locked location. • If clients have access to the office in which you are working, lock it whenever you leave • Have a working knowledge of the technology available from the agency to ensure your safety, such as panic buttons within offices and internal alert systems that can be activated from a mobile device, and the location of the security cameras. While all violence cannot be prevented, these steps represent the efforts that you can make to help ensure your safety in the office setting. If safety is an issue within the practicum office and some of the aforementioned suggestions are not being utilized, consider recommending them. It is important to take safety issues seriously within an office setting.

Interacting with Clients within the Home and the Community

Ben Has a Frightening Client Encounter Ben was unsure about the contents of the long case in the client’s hand. The client walked quickly, put the case in the backseat, and joined Ben in the front seat. As Ben greeted him and reiterated the need for the trip to the office, the client began to ramble incoherently. However, Ben was able to understand that the client wished to go first to a different location to pick up a check. When Ben objected, the client referred to the shotgun he had placed in the backseat. The client made disparaging remarks about Ben’s Asian heritage. Frightened and unclear about what he should do, Ben drove to the location the client requested and then drove him home. As Ben debriefed later with his field instructor, he found himself shaking and short of breath. Did he do the right thing in this situation? How did diversity issues impact the interaction?

As Ben discovered, stepping into the community to serve clients entails leaving the structured environment of the office setting. Working with clients outside an office setting can also, as in Ben’s case, leave a practitioner wondering which course of action is best as an interaction with a client unfolds in the real world. Making home visits and encountering clients in the community can offer the opportunity to gather a rich array of infor-mation about them that is not available from a meeting in the office. The home visit enhances the delivery of services to clients in their natural setting. While interacting with clients outside of the agency can be intimidating for a new professional, the delivery of professional services on the “home turf” of the client can be essential to the success of the intervention. Although not every home visit poses a safety risk, consider the follow-ing suggestions to decrease the potential for harm (NASW, 2013). Preparation Preparing for work with clients outside of the agency can minimize your risk of physical harm and liability. Transportation If you will be transporting clients in a vehicle, • Determine the ages of any children you may be transporting. Make arrange-ments for carseats and child safety locks for young children. • Check the number and condition of seatbelts. • Review the travel location resources available in your car. Have access to a current street map (either hard copy or electronic) or a GPS device, and practice using the map/device prior to independent home/community visits • Ensure that your car is equipped for emergencies, including a spare tire (and the necessary changing equipment), ample fuel, and battery cables. If your work will involve extensive travel, consider obtaining emergency roadside assistance coverage. • Verify that there is insurance coverage for clients transported in your personal vehicle. Before using an agency vehicle, confirm that students and volunteers are covered by the agency policy. • Keep only necessary keys on your key ring. Consider obtaining a two-part key ring that allows you to detach a portion that contains your car keys. Home Visits As a practicum student, you may conduct a home visit on your own or shadow another worker or your field instructor. The following precautions may mini-mize your risk in the community. If you shadow another worker, consider discussing this list and taking responsibility for some of these preparations (Burry, 2003; Hyde, 2014; NASW, 2013; Respass & Payne, 2008; Spencer & Munch, 2003; Weinger, 2001): • Before leaving for a home visit, gather information from colleagues, administra-tors, and the case file at the agency so you can assess any known risks, including acute symptomatology, noticeable behavior changes, alteration or discontinuance of medication, known or suspected use of drugs or alcohol, mandated treatment, previous threats, and known history of violence. • Determine whether the visit can occur in a public location and/or with another worker, supervisor, or law enforcement personnel. • Inform agency staff of the addresses you plan to visit and your expected route and return time. If you suspect a potential for danger, arrange for someone to call you during your visit, or take another staff member. Take only materials necessary for the home visit, and leave valuables (e.g., extra cash, unneeded credit cards, and jewelry) at the agency or at home. • Schedule home visits in the morning when possible. Neighborhoods and homes tend to be calmer during the morning hours than at any other time of day. • When calling to establish the visit, attempt to determine the client’s level of cooperation. Be clear about the expectations for your visit. • If cell phones or beepers are standard for other staff in the field, consider asking for a loan of this equipment during your practicum or taking your own phone, and have a charger in the car. Leave your number with agency staff, and have emergency contacts on speed dial. A cell phone can be tempting for thieves, so plan to keep it concealed, but keep it turned on during your visits (possibly with the vibration function activated) so that you can use it at a moment’s notice. If a phone is needed during an encounter with a client, use the phone discreetly to avoid becoming a target for robbery and escalating a volatile situation. It may be helpful to use a smartphone app that allows someone to locate you through the smartphone’s GPS and/or the audio/video recording capabilities of a smart-phone when meeting with a client deemed potentially dangerous. • Prominently display forms of identification to the client (e.g., agency name badge, business card, or logo on the agency vehicle). • Pattern your dress after that of the other field staff. Some agencies prefer a profes-sional look in the field, while others promote a casual dress style. Limit jewelry. Have clear written directions to the home location. Allow extra time if you are unfamiliar with the area. If you get lost, retrace your route. If you must ask for directions, do so at a public place. Do not ask directions from persons on the street, and never allow anyone to get into your car to show you the way to your destination. • Listen to and trust your instincts. If the situation seems uncomfortable and you sense the possibility for trouble, reschedule the appointment or make alternative arrangements. During the Visit Adhering to the following suggestions can ensure safety during home visits. If you are shadowing another social worker, consider asking a few questions prior to the visit. First, you could ask whether the social worker has a safety plan and if so, whether she or he will share it with you. Second, you could ask whether the social worker has ever had a conversation about personal safety with the client or created any sort of safety contract with the client. Last, consider discussing the specific recommendations below prior to your visit to ensure the safety of both of you (Burry, 2003; NASW, 2013; Weinger, 2001): • Use confident (but not arrogant) nonverbal behavior, and avoid acting timid. • Park your car as close to the client’s home as possible and in a location that allows for a quick departure, and store unnecessary belongings (e.g., large bags, back-packs, coats, purses) in the trunk. • Lock all car doors, and keep your keys in a place in which you have quick, easy access to them (e.g., in a pocket, on your clipboard). • Note the presence of any animals on the property, and ask the client for assis-tance with any unleashed animals. • Avoid walking through a group of unknown individuals when attempting to enter the house. (You may wish to leave and call to reschedule.) • Avoid entering any elevators or stairwells with anyone who appears threatening. • Take note of individuals present in the home, and ask the client about strangers. If you are uncomfortable in the presence of others in the home, ask if you can meet with the client alone or somewhere quiet. Encourage the client to keep confiden-tial the information you will be discussing by asking others to leave the home. • If possible, sit on a hard chair near a door with your back to a wall so that you can leave quickly if necessary. • Take note of all exits as you enter the house. • Avoid talking with a client in the bedroom or the kitchen, as weapons are fre-quently stored in these rooms. • Leave the home immediately if weapons or drugs are visible or if anyone appears to be under the influence or actively engaging in risky illegal activity. • After the visit, move your car to another location to complete the paperwork. Avoid sitting in a car in front of a client’s home after a home visit. Document any risks associated with your visit.

Working with Angry, Resistant, or Aggressive Clients

Despite the best planning, preparation, and adherence to protocol, you may find yourself in a situation with an angry, resistant, or aggressive client. Ideally, you should be able to leave a situation or attempt to get help. If this is not an option, consider the following strategies (Burry, 2003; Hyde, 2014; Respass & Payne, 2008; Weinger, 2001): • Maintain a quiet, calm, and firm demeanor. Avoid exhibiting any alarm, hostility, distress, or defensiveness. • Talk to the client in simple, direct sentences. Facilitate the expression of feelings and thoughts through empathy, summarizing, and paraphrasing, and encourage problem solving. Validate the client’s point of view to the extent possible, and avoid arguing. • Offer positive choices to the client (e.g., “Would you like to move over to my desk so that we can sit and discuss this?”). • Use assertive language to calm the client when appropriate (e.g., “I feel threat-ened when you shout at me like that. Can you tell me what you want in a lower voice? Otherwise, I am scared of you.”). • Use language to give the client control over the situation (e.g., “If you don’t want to talk right now, that’s fine. We can talk later.” or “Is it OK if I ask you about this?”). • Attempt to redirect the conversation away from the topic presented by the client. • Attempt to slow down the pace of the interaction so that the client has time to ventilate, calm down, and think (e.g., “OK, why don’t you take a deep breath?” or “Let’s get a cup of coffee.” or “Why don’t we just take a break and pick this up later?”). • Avoid any physical contact with the client. Attempt to engage verbally with a client at the first outward signs of agitation to allow for ventilation at the earliest possible point. • Allow ample room between the two of you (more than one arm’s length) to give the client plenty of personal space. Approach the client at an angle rather than from the back or directly from the front. • Make every effort to seat the client. If it is not feasible to sit, allow ample room between the two of you, and stand off center to the client to give yourself plenty of room to maneuver. • Invite another staff member into the interaction. Invite the client to share her or his point of view with the staff member. • If the situation appears immediately unsafe, leave the room. Working with agitated clients requires a calm, professional demeanor, preparation, and personnel resources. If you are presented with a risky situation in the office or in the field, these suggestions can serve to defuse a potentially dangerous interaction. Follow-Up to Crises Even with the best preparation, planning, and use of defusing techniques, crises still occur. For example, if available, using a panic alarm to call other staff or security may be the best option. If no panic alarm is present, you may be able to use a cell phone to call security or the police. If attacked, use the minimum force needed to restrain the person or to free yourself and move to another location for assistance. If you need medical assis-tance, seek it right away (Hyde, 2014). After moving to a safe place and attending to your physical needs (if necessary), if you are involved in an incident, report the incident to your field instructor in a manner that is in accordance with the agency policy. Your field instructor should communicate with agency administration and provide you with the support and guidance you need. With the sup-port of your field instructor, you will likely complete an incident report that documents what occurred in the situation, including the type of incident (e.g., verbal threat/abuse, intimidation, attempted or successful physical assault, property damage) and its severity (in terms of physical or mental health or financial cost). The incident report may also ask about any witnesses or breaches in protocol or policy that led to the incident (NASW, 2013). This incident report is an important document, and you should review it carefully with your field instructor, as it may be used for a variety of purposes, including inform-ing management. It is important that the facts be carefully recalled and documented so the response to the client is appropriate to the situation. Agencies should thoroughly review every incident and support those who are involved in and affected by serious incidents. Such efforts might include filing a police report, pressing charges against the client, obtaining a restraining order, arranging mediation with the staff and the client, referring the client to another staff member or a different agency, holding debriefing sessions, making changes to staff schedules and suggested routes, and identifying resources and protocols to ensure staff safety in the future (Hyde, 2014; Spencer & Munch, 2003; Weinger, 2001). Regardless of the response of your field instructor and agency, take advantage of the peer-support networks available at your agency and within your social work program as well as your personal support system. If the incident involved a high degree of risk or you are finding that you have been deeply affected by the situation, you may wish to consider taking time off from the practicum and/or developing an individualized safety plan for completing the practicum. Contacting a mental health practitioner to process and work through the incident, learning to monitor self-talk, and learning stress reduction tech-niques may also be helpful (Hyde, 2014).

Ethical Dilemmas Involving Safety Issues

• What should I do if my agency physically restrains clients and I hold a personal belief against this? • How do I decide whether to carry out activities in my practicum that my family or friends have asked me not to do? • What should I do if I observe another staff member not following agency safety procedures? • What should I do if I am required to conduct a home visit even after I discuss my uneasiness about the arrangements with my field instructor? • What should I do if I am required to work at night even though I feel uncomfort-able doing so? These questions are evidence that even under the best circumstances with clear guide-lines, students sometimes encounter situations that demand difficult decisions. At times, difficult situations emerge that involve conflict among your personal beliefs, agency protocols, and client interests. At the practicum site, you may be asked to carry out activities to which you are personally opposed or about which you feel uneasy. Although the NASW Code of Ethics (2008) is silent on the matter of safety, the primacy of client interests is clear (Section 1.01: “In general, clients’ interests are primary.”). The Code discusses the obligation social workers have to carry out the work of their employers in good faith (Section 3.09: “Social workers generally should adhere to commitments made to employers and employing organizations.”); however, it does not explicitly require social workers to follow agency policies and procedures. You may be left in a quandary when determining the best course of action in a situa-tion that involves conflict among your beliefs and comfort level, agency procedures, and client interests. Ideally, you were informed of the need for the activities in question prior to your commitment to the agency, and you either made a decision to allow the interests of the agency and the clients to supersede your feelings or negotiated different arrangements prior to your commitment. If expectations or arrangements related to safety emerge after your commitment, you may decide to do one of the following: 1. Negotiate your involvement with activities about which you feel strongly with your field instructor/agency after you begin the practicum. 2. Make a decision to engage in the activities in question regardless of your feelings. 3. Process and explore your feelings with your field instructor to determine whether your fears are founded. 4. Discuss your experiences and feelings in integrative seminar in order to deter-mine a course of action. 5. Discuss the situation with your faculty liaison. 6. Attempt to switch to another practicum site if you are unable to resolve the conflict. Although the guidelines outlined in this chapter are suggestions, situations are rarely clear-cut, and students are often left to their own best judgments to discern a course of action. Indeed, students often struggle with the same dilemmas faced by seasoned social workers. As social workers strive to deliver quality services under increasingly volatile circumstances, the struggle to integrate personal feelings with professional demands and to resolve safety dilemmas becomes more difficult and more common.

Helping to Ensure Client Safety

As a practicum student, you have a responsibility to implement agency policies designed to ensure clients’ safety. For example, as a student, you must follow agency policies and procedures to avoid falls and other injuries. The NASW Code of Ethics (2008) requires social workers (and you as a practicum student) to provide appropriate professional ser-vices during “public emergencies”—for example, during public disasters and during and after terrorist activities, when clients may need immediate medical attention (e.g., CPR). Depending on your setting, you may also need to use universal precautions to protect your-self and your clients, such as the use of materials that serve as protective barriers (e.g., gloves, masks, and protective eyewear).

HARASSMENT

Lauren Experiences Harassment

An openly homosexual female staff member has asked Lauren out several times for drinks after work. Despite Lauren’s repeated refusals, she continues to ask. She seems to create rea-sons for contact with Lauren and brings her small gifts of food. Lauren surmises that the staff member perceives that she is also lesbian. The field instructor and staff member are good friends. In discussions with her family about the situation, Lauren has been pressured to end the problem by involving administrators or outside agencies. Is she being harassed? What should she do?

Situations such as this call for careful thought, tact, and a judgment call. It may be very difficult to distinguish between friendliness and harassment. It is important to note that harassment—defined as “any unwelcomed, unsolicited, and offensive con-duct that is severe or pervasive and tends to injure, degrade, disgrace, or show hos-tility toward a person because of sex, race, color, religion, national origin, ancestry, disability, age, sexual orientation, marital status, gender expression/identity, genetic information, pregnancy, or any other characteristic protected by law” (Saint Louis University, 2013)—is a safety issue. Armed with good intentions, the NASW Code of Ethics (2008), and professional work experience, many students conclude that harass-ment will not be an issue. Given the value base and humanist orientation of the profession, you might think that the social work workplace would be free of harassment. However, social workers encounter harassment in their workplaces, with one of the most common forms being sexual harassment. In fact, sexual harassment is the third most common type of abuse encountered by social workers in practice (Macdonald & Sirotich, 2005). Social work practicum students can expect to encounter sexual harassment as frequently as do social work practitioners, and sexual harassment is experienced by female and male workers (Alink, Euser, Bakermans-Kranenbury, & Van IJzendoorn, 2014). Most sexual harass-ment crosses gender lines, but same-sex sexual harassment is also a problem (U.S. Equal Employment Opportunity Commission [EEOC], n.d.a.).

Defining Features of Harassment

Harassment occurs in many forms, ranging from jokes to sexual intercourse. Sexual harassment is currently defined as verbal (pressure for sexual activity, comments about the female or male body, sexual boasting, and sexist and homophobic comments); nonverbal (looking up dresses or down shirts, obscene gestures, and suggestive sounds); physical contact (touching, patting, pinching, and kissing); or environmental (sexually offensive literature, pictures, or music). Harassment can also include offensive remarks about a person’s sex. Agencies are compelled by law to address the issue of sexual harassment in the workplace according to Title VII of the 1964 Civil Rights Act and under guidelines issued in 1980 by the Equal Employment Opportunity Commission (EEOC) regarding policy statements and grievance procedures (U.S. Equal Employment Opportunity Com-mission [EEOC], n.d.b). The NASW Code of Ethics (2008) requires social workers to reject sexual activities with clients under all circumstances, renounce all forms of discrimina-tion, avoid relationships that pose a conflict of interest, maintain a clear interest in social justice, and preserve human dignity. Both your field instructor and your agency have a clear interest in maintaining an atmosphere that is free of harassment.

Intervention

What should you do if you encounter harassment of any type at the practicum? The cir-cumstances of the harassment will determine the response. Consider the following steps (EEOC, n.d.b): • Document the circumstances of the harassment, including dates, times, quota-tions, other details of the interaction/situation, and verification from any witnesses. • Document your work accomplishments and maintain copies of evaluations. This documentation may be critical if your work performance becomes an issue when you take action against the harassment. • Seek other victims of harassment and consider taking action as a group. • Confront the harasser in person or in written form. Include the facts, your feel-ings, and a clear directive to stop the harassment. • If appropriate, report the experience(s) to your field instructor and your faculty liaison. • Explore the complaint process available at the agency as well as within your social work program and affiliated institution, and consider filing a formal complaint. • Consult with other social work students. Take advantage of field seminars or other mechanisms to consult with and receive support from other students. • If an agency complaint process does not exist, consider advocating for one. • Consider contacting outside resources. You may wish to contact an attorney; a local, state, or federal agency charged with addressing complaints of harass-ment (e.g., the EEOC); a nonprofit organization (e.g., the NAACP); or another resource.

Reference

Birkenmaier, J., & Berg-Weger, M. (2018). The practicum companion for social work: Integrating class and fieldwork (4th ed.). New York, NY: Pearson.

Chapter 3, “Safety in Social Work Settings” (pp. 63-77)