by Anastasia Johnson, JD
former Staff Attorney
The Therapist
May/June 2016

Workplace violence is something most of us never think about. No one wants to imagine a violent act carried out by a fellow employee, or an individual who comes into your workplace for support services. However, these days it is not enough to have a fire extinguisher or 911 on speed dial. Today, it is as important as ever, to have a safe workplace free from violence.

Introduction: The Problem
Workplace violence is something most of us never think about. No one wants to imagine a violent act carried out by a fellow employee, or an individual who comes into your workplace for support services. However, these days it is not enough to have a fire extinguisher or 911 on speed dial. Today, it is as important as ever, to have a safe workplace free from violence.

Workplace safety and health hazards affecting California employees have traditionally been viewed as being caused by unsafe practices such as hazardous industrial conditions, or exposure to harmful chemicals—not from violent acts committed by other people.¹ Recently though, owners, employees and supervisors, have become frequent victims of assaults, harassment, stalking or other violent acts in the workplace.² These incidents pose a substantial risk of physical or emotional harm. Many of these assaults result in fatal injuries, but an even greater number result in nonfatal injury, which can lead to medical treatment, missed work, lost wages and decreased productivity.³

While there is plenty of information about this subject, no specific diagnosis or type of patient can predict future violence. However, there is research⁴ that has identified factors that may increase the risk of violence for some employees at certain workplaces. Such factors include emotionally charged situations, family conflict, unfamiliar surroundings, mind and mood altering medications, drugs and alcohol, and the decrease in social services to the poor and mentally ill.⁵ These risk factors can cause agitation and ultimately violent behavior, which no therapist should have to endure.

Many CAMFT members are employers or employees and have expressed concerns about workplace violence and how to ensure the safety of therapists in the work setting. This article will briefly look at workplace violence and provide guidance about the California Division of Occupational Safety and Health (Cal/Osha) requirements for employers, specifically the creation of an Injury and Illness Prevention Program.

A Look at Workplace Violence
The United States Department of Labor defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at or off the work site.⁶ These behaviors can affect and involve employees, patients, clients, and visitors. While some workplaces may offer ways for their employees to report workplace violence most do not, only adding to the commonly held notion that actual rates of workplace violence in the health care industry are vastly underreported.

There may be many reasons to account for this perceived deficiency in reporting. One of the most cited reasons is that healthcare has some unique cultural factors that may contribute to under reporting or the acceptance of violence.⁷ For example, health care professionals might be reluctant to report assaults or threatening behavior when part of the “professional culture,” of health care workers is that violence comes with the territory. Some professionals will also put their own safety and health at risk to help the patient because they recognize that many injuries caused by patients are unintentional, and are therefore likely to accept the behavior as routine or unavoidable.⁸ Healthcare professionals may also attribute the incident as a failure to deal effectively or therapeutically with the patient and thus attribute the incident to professional incompetence.⁹ Other reasons may be, a lack of reporting procedures and lack of support from employers and supervisors in coming forward to report threatening or harassing behavior.

That being said, healthcare professionals who have experienced violence report that it contributes to stress, role conflict, depression, fear, loss of sleep, disturbed relationships with family and friends, and decreased ability to function effectively at the workplace¹⁰—which might amount to feelings of burnout.¹¹

Therefore, it is important for employers to understand workplace violence and take corrective steps.

California Occupational Safety and Health Administration Guidelines
In California, the agency that sets the standards for workplace safety and health hazards is the California Occupational Safety and Health Administration (Cal/Osha), a division of the Department of Industrial Relations. Cal/Osha, along with other regulatory bodies has developed the categories of workplace violence to assist researchers and policy makers to target preventative measures appropriately. Currently, there are three types of workplace violence.

Types of Workplace Violence
Type I-Criminal Intent: Violent acts by people who enter the workplace to commit a crime, such as robbery. Acts of terrorism may also fall into this category.

Type II-Customer/Patient/Client: Violence directed at employees by customers, clients, patients, students, inmates or any others to whom the employer provides a service.

Type III-Personal Relationship: Violence carried out by an individual who has some employment related involvement with the workplace. For example they may be current or former employees, current or former friends of employees, relatives of employees, or current or former customers.¹²

Type II violence is most likely to take place where therapists are employed. Type II violence most frequently occurs in acute care hospitals, outpatient clinics, home health agencies, alcohol and drug treatment centers and to mental health and psychiatric care providers, and with other types of service providers.¹³ Unlike Type I events which often represent irregular occurrences in the life of any particular establishment, Type II events occur on a daily basis in many workplaces, and therefore represent a more pervasive risk for many services providers.¹⁴ Cal/Osha has recognized its obligation to develop standards and guidelines and therefore the next step in the process is implementing and maintaining an effective Injury and Illness Prevention Program.¹⁵

The Injury and Illness Prevention Program
Cal/Osha states that every employer is required by law to provide a safe and healthful workplace for their employees. As a result, Title 8 of the California Code of Regulations (8 CCR), requires every California employer to have an Injury and Illness Prevention Program (IIPP) in writing that must be in accord with 8 CCR Section 3203 of the General Industry Safety Orders.¹⁶

The IIPP is a basic written program. The program must describe how your workplace will implement the eight elements detailed in the IIPP, as discussed below. However, section 3202 outlines an exception for employers with fewer than 10 employees. Employers with less than 10 employees are “permitted to communicate to and instruct employees orally [instead of in writing] about general safe work practices.” The oral instruction must be in a form readily understandable by all affected employees and include provisions designed to encourage employees to inform the employer of hazards at the workplace without fear of reprisal.

Whichever way you decide to proceed; either choosing to have a written program or just communicating with your employees orally, your IIPP should include the following eight elements that are required by the Cal/Osha standards. They are:

1. Management’s commitment/assignment of responsibilities. This element designates the person responsible for coordinating the IIPP.
2. Safety Communication system with employees. This element describes the frequency and type of communication that will take place with employees.
3. System of assuring employees compliance with safe work practices. This element explains the disciplinary guidelines that will be in place for employees if they fail to follow the IIPP.
4. Scheduled Inspections/ Evaluation System. This element describes the process that will be used to identify unsafe workplace practices.
5. Accident Investigation. This element describes the process that will be used to investigate accidents/incidents.
6. Procedures for correcting unsafe/ unhealthy conditions. This element describes what corrective actions will be used to prevent reoccurrences.
7. Safety and health training and instruction. This element describes how new or transferred employees will be trained to the safety and health aspects of the job.
8. Recordkeeping and documentation. This element details how employer records will be kept. (There is again an exception for employers with fewer than 10 employees. Those employers may elect to maintain the record only until the hazard is corrected.)¹⁷

Cal/Osha has simplified the process of creating the Injury and Illness Prevention Program by making available blank templates that just need to be filled in. Cal/Osha has also created informational booklets with detailed descriptions about each of the eight required elements. That information is available at the State of California Department of Industrial Relations website at http://www.dir.ca.gov/chswc/woshtep/ iipp/. In addition to the information on the website, Cal/Osha also offers on-site consultation for small businesses. The service is free and according to the Department of Industrial Relations website, the benefits include, identifying and analyzing hazards, recommending best practice solutions and helping you with your safety program, among other things.¹⁸

The basic IIPP is a required program that must be created for your business. Even though the program will not stop harassing phone calls or stalking, the creation of the IIPP will let employees and patients know that threatening behavior will not be tolerated and outlines the specific manner in which it will be addressed. The IIPP will hopefully give employees the confidence to inform managers and supervisors about an alarming incident, without the fear of reprisal or dismissal. The IIPP will also serve the employer to be in compliance with California law.

Special Concerns
As discussed above, the IIPP is a basic program aimed at addressing workplace safety and health hazards to protect your business and employees. Employers who face Type II violence should also consider integrating a specific workplace security component into their IIPP. This can be done by utilizing the Injury and Illness Prevention Model Program for Workplace Security which is also available on the Cal/ Osha website. This is a blank template that gives detailed instructions about Type II violence such as specific assessment tools and corrective measures.

The additional development of a workplace security program will also be beneficial because California may become the only state with an enforceable occupational standard aimed exclusively at preventing workplace violence in the healthcare industry, which may be applicable to therapy and outpatient offices. Currently there is proposed legislation which would add Title 8 section 3342 Workplace Violence Prevention in Healthcare. Title 8 section 3342 would require an additional written program with procedures to ensure workplace safety, above and beyond what the basic IIPP currently requires. Essentially, the proposed legislation would make the development of a workplace security program mandatory. The rulemaking process has begun and the open comment period closed on December 17, 2015.¹⁹ The proposed legislation may come into effect as soon as July 2016²⁰, and CAMFT will keep its members informed about any developments.

Conclusion
The development of an Injury and Illness Prevention Program is a required part of doing business in California. The basic IIPP will serve to better inform employees and patients about procedures that will be followed and standards that will be maintained to keep a safe and healthful work environment because workplace violence should no longer be considered “part of the job.” Members who are employers and are interested in developing an IIPP should consult with an employment law attorney or contact a regional OSHA office for guidance.

 

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Additional Resources
OSHA can help answer questions or concerns from employers and employees. To reach your regional or area OSHA office, got to OSHA Offices by State webpage or call 1-800-321-OSHA (6742). https://www.osha.gov/oshdir/ca.html.

Small businesses may contact OSHA’s free On-Site Consultation services funded by OSHA to help determine whether there are hazards at their worksites. To contact free consultation services, go to OSHA’s On-Site Consultation webpages or call 1-800-321- OSHA (6742).

Additional Information about the creation of an Injury and Illness Prevention Program is available under the Small Business Tab: http://www.dir.ca.gov/chswc/woshtep/iipp/.

Information about the creation of an Injury and Illness Prevention Model Program for Workplace Security is available at: https://www. dir.ca.gov/dosh/dosh_publications/iipsecurity.html.

Endnotes
¹ State of CA. Dept. of Industrial Relations, Cal/OSHA Guidelines for Workplace Security, https://www.dir.ca.gov/dosh/dosh_ publications/worksecurity.html (1995)

² Id.

³ Id.

⁴ State of CA. Dept. of Industrial Relations, Guidelines for Security and Safety of Health Care and Community Service Workers, http:// www.dir.ca.gov/dosh/dosh_publication/hcworker.html (1998) p.1

⁵ Id. p.2

⁶ U.S Dept. of Labor, Safety and Health Topics: Workplace Violence, https://www.osha.gov/SLTC/workplaceviolence/

⁷ U.S Dept. of Labor, OSHA, Workplace Violence in Healthcare, Understanding the Challenge, https://www.osha.gov/Publications/ OSHA3826.pdf (2015)

⁸ Id.

⁹ Id.

¹⁰ State of CA. Dept. of Industrial Relations, Guidelines for Security and Safety of Health Care and Community Service Workers, http:// www.dir.ca.gov/dosh/dosh_publication/hcworker.html (1998) p.4

¹¹ Definition of Burnout: Job burnout is a special type of job stress—a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. Job Burnout, how to spot it and take action. Mayo Clinic Online. http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

¹² CA. Govt. Cal/OSHA. Guidelines for Workplace Security. http:// dir.ca.gov/dosh_publications/worksecurity.html (1995)

¹³ State of CA. Dept. of Industrial Relations. Injury and Illness prevention Model Program for Workplace Security, Who should use this Model Program? http://www.dir.ca.gov/dosh/dosh_ publications/iipsecurity.html (1995)

¹⁴ Id.

¹⁵ State of CA. Dept. of Industrial Relations, Guidelines for Security and Safety of Health Care and Community Service Workers, http:// www.dir.ca.gov/dosh/dosh_publication/hcworker.html (1998) p.6

¹⁶ State of CA. Dept. of Industrial Relations, Cal/OSHA, Guide to Developing Your Workplace Injury and Illness Prevention Program with check list for self-inspection- available at: https://www.dir. ca.gov/dosh/dosh_publications/iipp.html (2005)

¹⁷ Id. Sec. (b)(1) exception

¹⁸ State of CA. Dept. of Industrial Relations, Cal/OSHA, Guide to Developing Your Workplace Injury and Illness Prevention Program with check list for self-inspection- available at: https://www.dir. ca.gov/dosh/dosh_publications/iipp.html (2005)

¹⁹ Winnet Nickole, Jackson Lewis-California Workplace Law Blog, Cal/OSHA Proposes Workplace Violence Prevention Standards in Health Care. http://www.californiaworkplacelawblog.com/2015/11/ articles/calosha-2/calosha-proposes-workplace-violence-prevention-standards-in-health-care/ (2015)

²⁰ Id.

This article is not intended to serve as legal advice and is offered for educational purposes only. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise. Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in this article.