General responsibilities.

Although it is highly unlikely that any clinician may find themselves in danger during the course of their work with clients, Au Milieu has a responsibility to set out a procedure which needs to be followed, in order to minimise any risk for our staff and trainees. This document particularly relates to situations which might elevate personal danger in client contacts, such as when working as a lone clinician where there is a likelihood of risk or seeing clients in unfamiliar venues including initial visits to their homes.

Risk should always be initially assessed by the referrer, and use of a risk check list within a request for service, where information on the presence of violence in the household is specifically asked for, is recommended. The home visiting risk assessment should be completed and be at the front of every file. Clinicians should see the Health and Safety at Work protocol for the general responsibilities which Au Milieu has for the safety of its clinicians and trainees.

Background reading. 

Au Milieu recommends that all staff are familiar with the work of the Susie Lamplugh Trust in the area of Lone Working and should absorb the warnings that their extensive material contains.

Protocol.

Au Milieu recommends caution in offering home visits by lone workers where any level of risk has been identified by the referrer; and it is recommended that the referrer or the family’s health visitor / social worker be contacted before an initial home visit in such instances in order to gather further information. Where any level of risk, actual or potential, has been identified home visits should be carried out jointly with another colleague, or with the referrer or the health visitor. 

If the worker feels at risk at any time during a home visit they should leave the premises immediately. Au Milieu does not support out of hours home visiting. If this is undertaken by a trainee while on placement then the responsibility for the trainee’s safety lies with the placement agency. 

Lone working appointments where a risk has been identified may also take place in social services bases, children’s centres, or GP premises where other people are present. If there is any chance that there will not be other staff on the premises, and if there is any reason to feel a heightened level of risk, appointments should be attended by two members of the team together. 

If an appointment is arranged where there is possible risk, the following tracking procedures should be followed:

1. All staff need to have a working and charged mobile telephone on them for all appointments. The number for this phone needs to be known by the Clinical Director and  / or the head of their placement service and other members of the team.  
2. All appointments need to be booked in with the office manager of the placement agency and put in their electronic diary, giving the time, venue and client name, as well as any available contact details for the venue or client. These details need to be entered at least 24 hours before the appointment. Colleagues should also be told verbally of any appointments, so that we are familiar with each other’s schedules. Contact should be made with the office once the destination has been reached and after the appointments have concluded.
3. Before leaving for a visit where risk has been identified, or at an unfamiliar venue, the clinician should tell colleagues in the office where they are going.
4. On arrival at the visit the clinician should text or call the office manager or a nominated colleague, and they should text again on departure.
5. If no text is received by the time of the alert, the office manager or the lead for the placement service (or other designated staff member) should try to make contact with the clinician. If such contact is unsuccessful then emergency services will be contacted.
6. In the event that the clinician has an emergency situation with a client they should follow the procedure set out in Appendix 2 .
7. If the clinician has failed to follow the procedures and no untoward event has taken place, but the clinician has failed to inform the Office/Clinical Director thus triggering emergency action (a false alarm situation) disciplinary processes may be invoked.

APPENDIX 1 : 

Safe working.

1. 1. Always keep a charged and working mobile phone on you. Know how to use it to call emergency services so that you do not panic about this in an emergency situation.
   2. Never give your personal telephone number(s) to a client or to someone working in another agency.
   3. Make sure the rest of the team know where you are going to be, what car you are driving and whether you plan to divert anywhere en route if you feel there is a potential risk.
   4. Plan your route in advance. Do not walk alone in poorly lit or isolated places or through housing estates where incidents of street violence have been reported.
   5. Make time to read the referral letter and other written information about the client(s) before arranging to meet with them. You should not be making an initial visit without a prior telephone conversation with the referrer. Pay particular attention to any history of violence, threatening or abusive behaviour towards others or issues which may increase risk such as emotional lability, alcohol/substance abuse, serious mental health conditions or current stressors. Always ensure that you know if a current or ex violent partner might be present, and if this is suspected the visit should be cancelled and re-scheduled at a safe venue.  Where there is a possibility of risk always contact the health visitor and, if involved, the social worker about their home visit experiences.
   6. If risk factors are present, always play it safe. Always conduct a risk assessment and make appointments in working hours. Where possible see the client in offices where there is CCTV and/or a staffed reception, otherwise choose a venue that is familiar and has other people around and alert them to your concerns. Where there is any history of violence or aggression do not go it alone; ask a colleague or observer to join you. Do not feel guilty if the situation precludes offering a service; there is no point in therapeutic intervention if family safety is the main concern.
   7. If you have not met a client before and there is reason to think they will be under more stress than usual or may be accompanied by someone unknown or risky, try to see them at a location where there are other people close by and/or tell other people of your concerns so that they can check on you as necessary or respond to a call for help.
   8. Seat yourself closer to the exit than the client, and ensure your way out is free from obstruction.
   9. Check on means of escape from the building in an emergency, e.g., how the front door opens.
   10. If working in a children’s centre or GP surgery, plan appointments so that other people are in the building with you.
   11. If you become concerned about the potential behaviour of a client, arrange future meetings in line with the above points.
   12. Always record your concerns, for your own safety and for the safety of others who may see the client in the future. If there has been a threat made during an appointment the health visitor and, if involved, social worker must be informed. Share concerns with the lead  of the placement service and the clinical director of Au Milieu, and make a point of telling colleagues so that they are pre-warned of potential problems.
   13. Keep valuables, handbags, cases, laptops, equipment and other high worth items out of sight.
   14. If you are made to feel uncomfortable or distressed, end or leave the session. If you feel unsafe go to where there are other people. Say whatever you need to say to leave the situation, don’t worry about making excuses that may not be true or agreeing to demands, your safety is the priority.

If you are assaulted or threatened contact the Police immediately on 999 or 112 (the latter gives your location so is preferable if you are outside or in an unfamiliar location).

1. If you are verbally abused or receive indecent telephone calls report the matter immediately to the clinical director of Au Milieu. In all instances complete an incident report form, in accordance with the Health and Safety Policy.

APPENDIX 2 : 

In the event of an emergency.

In the event that a clinician has an emergency situation with a client, the priority is to find a way to leave the situation and get to a safe place if possible. 

Say whatever you need to say to get to safety, even if it is something untrue. Agree to any demands if you are concerned about the consequences (e.g., to not tell anyone about concerns for the child, or to hand over money or equipment). Call for assistance if there is an opportunity, text “call me now” to a colleague, office manager or the service lead; or call emergency services or the office even if you cannot speak overtly. 

If you want colleagues to call emergency assistance for you, the following protocol is an example:

1. Say to the client that you are expected to call in at a particular time, and that colleagues will be concerned if you do not.
2. Telephone the office number (or another pre-arranged person) and use the emergency keyword, such as ‘Dr Rutter’, to signal you feel or are in an unsafe situation. (e.g., you may say “Has Dr Rutter called for me?”)
3. You should be asked the following questions:

      “Can you get out?”

      “Is it safe for us to continue talking?”

      “Would it help to receive an urgent telephone call?”

      “Do you need the police?”

“Are you at [expected location]?”

1. If the clinician is able to leave the situation, and can continue talking, the conversation should continue until the clinician is in a safe place (e.g., their car). It should be checked if the clinician feels well enough to drive, and what their next destination is. They should be given the first possible opportunity to debrief.
2. If the clinician cannot leave the situation, or does not reply, further to having confirmed that they are in difficulty, the following action should be taken:

Tell the clinician “I will contact the police. Leave the phone on after this call. Help is on its way.”

The police must be contacted using 999 and the Clinical/Service Director must be notified.