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Home Visitor Safety - Wyoming Department of Health

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Home Visitor Safety
What YouNeed to KnowWDH Technical AssistanceJennifer Davis, DPTSarah Nicholas, MOTR/L
Introduction: Home Visitor Safety
Have you ever had a situation where you felt unsafe during a home visit?How did you handle the situation?Would have done anything differently now that you can reflect on it?
Initial Assessment
Family history (including social issues)Stressors/Concerns for the family (including relationships)Note any potential for violenceCurrent/past issues with substance abuseCurrent/past issues with mental illnessCurrent/past history of criminal behaviorCurrent/past history with child welfare
Initial Assessment
If a family has any of these issues, staff immediately for appropriate services and precautionsCurrent/past criminal historyCurrent/past mental illnessCurrent/past issues with substance abuseCurrent/past issues with violenceRemember these may not be reported initially but may become more evident laterIf there is a questionable safety, don’t do the visit in the home or take another provider with youReview your agencies home visitor safety policy
Always Be Prepared
Preparing for the VisitReview the file for any known issues of violence or concerns in the homeKnow your agency’s safety policy for home visitingKnow your resources in case of an emergencyLet someone know where you are going and when to expect you to be done (sign in and out of office)Ensure that your vehicle is in good working order (have plenty of gas)Carry your drivers license and a small amount of money on youTake your work ID with you, BUT do not wear a lanyard around your neckDo not wear excessivejewelryWearsensibleshoes with low or no heelCarry a cell phone with you
Know YourSurroundings
Approaching the homePark your vehicle in a spot that allows for a quick get away if neededBe aware of your surroundings (look and listen)Be aware of any smells coming from the home that might indicate substance abuseLock valuables in your trunkpriorto arriving at the visitBe aware of anything that appears unusualIf you are approached outside of the home by a bystander, be briefIf the person persists or if you feel unsafe yell for help
Know YourSurroundings
DO NOT ENTER THE HOME IFQuestionableperson is presentCaregivers are intoxicatedViolence is in progressVicious animals are presentYou feel uncertain or unsafe for ANY reason
Entering the Home
Stand to the side of the door when knockingDo not enter if you do not see your clientIf denied entry, do not attempt topersuadeentrance (notify supervisor and/or police ifsuspicious)When door opens do a quick scan for safety prior to enteringOnly enter if adult is presentObserve anysuspiciousbehaviorLeave immediately if you feel unsafe
Inside the Home-During the Visit
Remain near an exitDo not have your back to the doorBe aware of any information related to substance abuse, violence or inappropriate behaviors (drugparaphilia,pornography, weapons,etc)Remain alert to others in the home (inquire about others who are present)Do not accept food or beverageLimit personal information that you shareLEAVE IMMEDIATELY IF YOU FEEL UNSAFE
Child Abuse and Neglect
Mandated Reporter of SUSPECTED child abuse and neglectIf you notify the caregiver that you will be reporting, ensure your safety firstYour safety and the child’s safety are first priority
Domestic Violence
CharacteristicsEmotional abuseIntimidationCoercionand ThreatsIsolationUsing childrenEconomicabuseMaleprivilegeMinimizing, Denying and BlamingPhysical and/or sexual abuse
Domestic Violence
No mandated reporting laws BUT best practice to report if there are children in the homeDetermine any imminent danger to you or othersDo not perform domestic violenceinterventionin the homeStaff should not transport families to shelters (call law enforcement or family)Consult with supervisor on all DV mattersContinue to provide support (if safe) whether the victim stays, leaves or returnsAny threats should be well documented and reported
Domestic Violence
If imminent danger, leave the home and follow agency’s safety policy guidelinesIf no imminent danger, but domestic violence is an issueRefer to DV servicesProvide hotline numbersUtilize your resources from Healthy Moms, Happy Babies home visiting curriculumConnect family to local resourcesRefer to child welfare services for family supports
Mental Illness/Psychiatric Emergencies
Characteristicsrequiring additional assessment/referralHallucinations or delusionsBizarre behavior or speechExtreme lethargy (catatonic)Extreme change in hygiene or functioningSignificant change eating/sleeping patternsLoss of interest in daily activitiesFeelings of hopelessness or helplessnessRapid mood changes or extremes in moodsDangerous, aggressive or risky behaviorsSelf injurious behaviorsStops medications or combines meds without the physician’s knowledge (combining with illegal drugs or alcohol)
Mental Illness/Psychiatric Emergencies
If imminent danger, leave the home and follow agency’s safety policy guidelinesIf children are in danger, you must report to child welfare and/or law enforcementIf no imminent danger, but concerns existEncourage contact with the treating physicianProvide community resources (warm referrals)
Suicide Plans
Characteristics/RedFlagsVague statements “sometimes I don’t want to be here anymore”Sudden change in feelings and/or behaviors; such as lack of concern about things that were previously important or starting to give possessions awayDon’t ignore vague signsIt is important to ask “Are you thinking about suicide”
Suicide Plans
If imminent danger, leave the home and follow agency’s safety policy guidelinesFor active suicide ideation or attemptCall 9-1-1Ensure safety of others in the homeDon’t leave the person aloneEnsure that the individual does not have immediate access to a weaponConsult a supervisor immediately
Homicidal Threats
ResponsibilitiesNotify law enforcementNotify potential victim if disclosedIdentify if there is a means to follow through with the actTalk to the person about making a verbal or written agreement not to harm the other individualRefer to a mental health provider (warm referral)If there is a means and you feel that you are in danger, leave immediately and call 9-1-1Notify a supervisor immediately
Firearms
Assume there are firearms in the homeAssume every client could access a firearmAsk where firearms are kept; ask about safe storage and educate about firearms and children in the homeWatch for signs of escalationEnsure you are aware of your surroundings; observe for weapons in the homeNever reach for a weaponIf you feel unsafe; leave immediatelyIf you call 9-1-1 for any reason be sure to notify them that there are weapons in the home that are accessible
Substance Abuse
CharacteristicsKnow if there is a history of or active use of substances (prescription drugs, illegal drugs, alcohol)Observe behaviors; watch for anything out of the ordinaryLack of motor coordination, slow reflexes, slurred speech, disorientation, dilated or constricted pupils, clammy skin, euphoria, hyperactive, loss of consciousness, altered perception, irritability, needle marks, glassy eyes, altered eye movements, odors, decayed teethObserve surroundings; be aware of drugparaphernalialying aroundMirrors, pipes, razor blades, water pipes, needles, syringes, burnt spoons, rolling papers, prescription bottles, empty liquor bottles/cans
DrugParaphernalia
Examples include:MirrorsPipes, water pipesRazor bladesNeedles/syringesBurnt spoonsRolling papersEmpty prescription bottlesEmptyliquor bottles/cans
Meth Labs
Do not enter a home with evidence of meth lab materials on the propertyIf you see evidence of a meth lab; leave immediately and contact law enforcementStrong odor resembling urine or ammoniaLittle to no traffic around the home during the day but significant traffic in the eveningExtra effort to cover windows or reinforce doorsTrash not put out for collectionPresence of unusual amount of cleaning chemicalsVehicles having chemical and lab materialsExcessive amount of household cooking items; cooking dishes, coffee filters, bottlesIf you feel that you have been exposedLeave immediatelyCover your seats with plastic trash bagsDisinfect your hands with wipes prior to touching anythingChange your clothes immediately and place them in a plastic trash bagClean all exposed skin with soap and waterClean all materials that were carried into the home with soap and water
Animal Considerations
When scheduling visits, ask if there are dogs on the property and ask for them to be secured prior to your arrivalIf there is a dog present; use your cell phone to call the individual and remove the dogCarry dog biscuits as a distraction for the dogIf you feel unsafe, do not enter the property
Leaving the home
Do not lingerHave keys in handObserve your surroundings
General Safety
Items to have availableCell phoneEmergency numbers programmed into phoneDisinfectant wipes/hand sanitizerLatex glovesFirst aid kitAppropriate hand washing techniques
General Safety Guidelines
ImminentDangerLeave immediately or do not enterCall 9-1-1 and ask for a child welfare checkCall supervisor
What do you already have in place at your center?
Do you have a safety policy?Do you have an updated schedule with a supervisor?Do you check in before/after visits?Do you carry your cell phone into visits?
Safety Policy
ExamplePreparation
Case Study
Follow up questions
Self Care-After a Traumatic Incident
Be sure to debrief with your supervisorReflective supervisionAsk for professional help if necessaryPerform daily self careExerciseMeditationQuiet time
Conclusion
Your safety is the first priorityWhen in doubt-DON’T ENTERAlways follow your instinctsNotify your supervisor immediately of anything out of the ordinaryAlways ensure that someone knows your scheduleFollow your agency’s policy for home visiting safety

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Home Visitor Safety - Wyoming Department of Health