SOP 803 Safety for Staff Working in the Community Staff.pdf

SAFETY FOR STAFF WORKING IN THE COMMUNITY

SOP 803

San Francisco VA Health Care System San Francisco, CA 94121

Signatory Authority:

Chief of Social Work

Responsible Owner:

Chief of Social Work

Service Line(s):

Social Work

Effective Date:

July 1, 2024

Recertification Date:

July 1, 2029

1. PURPOSE AND AUTHORITY

a. The purpose of this policy is to outline safe practices for Social Work Service staff to follow when working off-station, in community settings.

b. The mission of the Social Work Service programs includes reaching out to

Veterans in the community and in placement settings and providing services that will enable them to attain and/or maintain permanent housing. While in the community, Social Work Service staff will follow guidelines that will maintain their personal safety.

2. PROCEDURES

a. Cell Phones:

1) Social Work Service staff will carry a cell phone when making a home or community visit. Staff will have an individually assigned cell phone. Social Workers who are Medical Center-based without a cell phone and make occasional home/community visits, will borrow a cell phone from a supervisor prior to going into the community.

2) Do not use a cell phone when driving. If you need to make or answer a call or text, carefully pull off the roadway out of traffic to use the cell phone.

b. Infection Control:

1) Community-based staff will follow Medical Center policy and procedures regarding universal precautions and infection control procedures.

2) Wash your hands with soap and water after visiting a Veteran in the community.

3) If soap and water are not readily available, waterless handwashing products are available from EMS and should be carried at all times when working in the community. These products should not be used in lieu of soap and water when hands are visibly soiled.

4) As the COVID-19 pandemic continues, staff are required to wear masks and safety goggles/face shields when meeting with Veterans. Staff are

July 1, 2024 SOP 803 encouraged to take masks with them when meeting with Veterans to provide them to the Veterans who may not have one with them. Staff will follow Medical Center guidelines as they are updated throughout the year.

c. Exposure Control for Opiates:

1) Staff members will be aware of possible signs of opiate overdose when approaching someone including “pinpoint” pupils, respiratory distress, nodding off, or unconsciousness.

2) Should a staff member discover a Veteran who is displaying symptoms of opiate exposure or overdose – the staff member will utilize appropriate personal protective equipment and (if scope of duty allows) obtain a naloxone kit and administer, and/or call 911.

3) Any area where an unknown powder substance is discovered should be restricted from access.

4) Staff that are calling for an emergency response (rapid response/code blue) should inform the emergency response team of possible exposure to opiates.

5) Staff completing wellness checks or making contact with Veterans should always change gloves between each room to avoid cross-contamination.

d. Community Environment:

1) Have accurate directions, carry a map of the area, or use navigation on your cell phone.

2) Call ahead to ensure that someone is at the home to meet you and you are expected.

3) When visiting community placement settings, follow the facility guidelines for signing in, hand washing, and facility visitation rules.

4) Limit personal belongings to those that are essential for a community visit;

VA IDENTIFICATION BADGE, a driver’s license (or CA ID), and cash for an emergency.

5) Be alert to your surroundings at all times. Look confident. Trust your instincts and act on them. If you feel unsafe, leave the area.

6) Scan the area and know where you are at all times, i.e., cross streets, and landmarks. This is important if you need to summon assistance on the cell phone.

7) Upon arriving at your destination, check out the surrounding area before unlocking and leaving the vehicle.

8) If you feel unsafe, do not exit the vehicle. Immediately drive away and call your supervisor and/or Emergency Services from a safe location.

9) If you encounter a situation where the Veteran or any individual in the community reports possessing a bomb/any item that can explode, including but not limited to a pipe bomb, nail bomb, pressure cooker bomb, smoke bomb, Molotov cocktail, any type of homemade bomb, you must (1) -immediately remove yourself from the situation, (2) - call Emergency Services (911) and (3) - call your supervisor to report the incident and debrief to receive guidance on further steps to be taken. After these steps are taken, you must (4) call SFVAHCS Police (415-221-4810, dial 2-2222) to inform them of the incident and receive further instructions, if any, from SFVAHCS

PD.

10) If you encounter a situation where the Veteran or any individual in the community reports possessing any type of weapon that can cause physical harm and is exhibiting threatening behaviors that you deem unsafe, you must follow the same protocol: 1) - immediately remove yourself from the situation, (2) - call Emergency Services (911) and (3) - call your supervisor to report the incident and debrief to receive guidance on further steps to be taken. After these steps are taken, you must (4) call SFVAHCS Police (415- 221-4810, dial 2-2222) to inform them of the incident and receive further instructions, if any, from SFVAHCS PD.

11) Any incident that involves Veteran and staff safety must be reported online in the Disruptive Behavior Reporting System (DBRS).

e. Veteran Home Environment:

1) Prior to a home visit, the staff member should review the Veteran’s medical record and consult with other staff as necessary regarding the Veteran’s psychiatric, substance abuse, or behavioral history. Staff may decide to conduct the visit with a colleague.

2) Prior to entering a home, request that any dog or other animals that may pose a threat in the home be confined.

3) Be aware of your surroundings in the home, including exits and other occupants in the home.

4) Be aware of your own health regarding smoke, mold, cockroaches, or other environmental concerns. Exit the environment if warranted and meet elsewhere.

5) Assess the Veteran’s living environment for signs of danger such as weapons, drugs, alcohol, etc. Should you feel the environment is unsafe, terminate the home visit and contact your supervisor and/or appropriate authorities, as needed.

6) Ask the Veteran to put away any weapons, alcohol/drugs, and paraphernalia.

Leave if the Veteran refuses or starts to use any controlled substance while you are there. Contact the supervisor or communicate later any such items in the living environment.

7) Do not attempt to break up a domestic fight. Immediately leave the home.

Contact your supervisor, the local police, or both.

8) If you feel unsafe at any time during the home visit, leave the premises immediately and call for assistance as appropriate. Resources for assistance include, but are not limited to your direct supervisor, other VA staff, and/or 911.

9) If you encounter a situation where the Veteran or any individual in the Veteran’s home reports possessing a bomb/any item that can explode, including but not limited to a pipe bomb, nail bomb, pressure cooker bomb, smoke bomb, Molotov cocktail, any type of homemade bomb, you must (1) -immediately remove yourself from the home, (2) - call Emergency Services

(911) and (3) - call your supervisor to report the incident and debrief to receive guidance on further steps to be taken. After these steps are taken, you must (4) call SFVAHCS Police (415-221-4810, dial 2-2222) to inform them of the incident and receive further instructions, if any, from SFVAHCS

PD.

10) If you encounter a situation where the Veteran or any individual in the Veteran’s home does not safeguard any type of weapon that can cause physical harm, as per your request prior to the home visit, you must: 1) -immediately remove yourself from the situation, (2) - call your supervisor to report the incident and debrief to receive guidance on further steps to be taken, which may include (3) - calling Emergency Services (911) and (4) – calling SFVAHCS Police (415-221-4810, dial 2-2222) to inform them of the incident and receive further instructions, if any, from SFVAHCS PD.

11) Any incident that involves Veteran and staff safety must be reported online in the Disruptive Behavior Reporting System (DBRS).

12) If a Veteran is in need of urgent medical care, call 911 or an ambulance.

Never transport a Veteran with emergency needs (medical or mental health) yourself.

13) Do not transport a Veteran who is intoxicated or experiencing extreme psychiatric symptoms.

f. Collaboration with Community Partners (Community Partners are defined as

Grant and Per Diem, HCHV Contracts, Board and Care Homes, HUD/VASH landlords and/or property management, community Skilled Nursing Facilities, Community Adult Day Health Care centers, Assisted Living Facilities, etc.):

1) Prior to Community placement, referring staff will advise the placement facility of the Veteran’s current and historically problematic behaviors. Veteran behaviors that are no longer evident but are associated with previous episodes of psychiatric decompensation are important indicators by which the facility staff and social worker can assess the veteran.

2) Community partners will advise the Social Work Service staff of any changes in a Veteran’s behavior. Any instances in which the facility fails to keep the Social Work Service staff informed will be brought to the attention of the supervisor or Chief of Social Work Service.

3) Social Work Service staff will work collaboratively with the community partner to ensure the Veteran's adjustment to community living and ensure coordination and collaboration of care.

4) When a Veteran's problematic behaviors remain resistant to therapeutic intervention and jeopardize the safety of the Veteran or other facility residents, re-location or re-hospitalization, as necessary, will be initiated by the social worker/staff member.

5) If community partners feel they cannot safely manage an individual Veteran, the Social Work Service staff will take necessary action to ensure the safe removal of the Veteran from the home and the safety of other residents.

Options include immediate consultation with the interdisciplinary team regarding psychiatric re-evaluation or re-hospitalization, calling 911, or involving the community crisis team.

g. General Safety Considerations:

1) When possible, the first meeting with a Veteran should occur in a supervised setting such as an in-patient unit, clinic setting, supervised community residence, or public place. When this is not possible, you should team up with another staff member to make the visit.

2) Staff safety must be a prime consideration in determining whether a Veteran will be visited at home. The best predictor of future behaviors is past behaviors. Staff may assess that a Veteran is not appropriate for home visiting because of potentially dangerous or threatening behaviors directed towards staff. If uncertain, meet with the Veteran outside or take a walk in a public area, but away from others for confidentiality.

h. Transporting Veterans in Government Vehicles:

1) All Transports:

a) Whenever possible the Veteran should be encouraged to provide his/her own transportation to the community site via public transportation, shuttle, or privately owned vehicle.

b) Only employees with a valid California State driver’s license as verified by the VA Medical Center, with a copy in their competency file, may operate government vehicles.

c) Only Veterans enrolled in the VA Health Care System can be transported in a GSA vehicle. Family, friends, representatives of community agencies, etc. cannot be transported in a GSA vehicle. Preapproved support persons, and/or service animals may be needed for the achievement of identified treatment plan goals, such as medical or housing appointments, to ride on the shuttle with the Veteran. Check with the supervisor for approval prior to transporting.

d) Government vehicles will be used to transport Veterans. Use of a privately owned vehicle to transport a Veteran is prohibited.

e) The specific government vehicle used should be indicated on the vehicle sign-out log.

f) Accidents or mechanical failure involving government vehicles will be handled in accordance with Medical Center Policy.

g) Keys should be returned to the proper storage area upon return.

2) Transport of Veterans who pose a potential safety risk - While transport services can be essential to the Veteran’s course of service and few Veterans pose any safety risk to employees; there are occasions when caution is necessary. Transporting Veterans who may pose a safety risk will be handled as follows:

a) Safety risk prone individuals can include Veterans who have unstable medical conditions, a history of violent behavior, are intoxicated or under the influence of drugs, and have the potential of lodging false allegations of abuse against staff members.

b) Employees who suspect that a Veteran may pose a risk to their safety are not required to transport them.

c) In situations where a Veteran who is deemed a potential safety risk requires transport, appropriate resources such as VA travel or police, will be consulted about alternative transportation methods or the employee may request another employee to accompany them during the transport.

d) Transports of long duration or distance require a supervisor’s approval.

e) Veterans needing transportation due to a mental health or medical emergency should not be transported by Social Work Service staff.

3) If transporting a Veteran to a known high crime area, staff may request another employee to accompany them during the transport or arrange to meet the Veteran in a safe public area or at the clinic.

4) If conducting a home visit for a Veteran deemed a potential safety risk, staff may request another employee to accompany them or request that the meeting be held in a safe public area or at the clinic. Staff should never conduct a home visit to any area where unsafe or illegal activities are known to occur or are likely to occur.

5) The decision as to whether to transport any Veteran as part of official duties is generally left to the clinical judgment of the employee, program supervisor, and/or the Veteran's treatment team.

6) VA Shuttle - The VA Shuttle van provides service, on a first come first served basis between the various CBOC clinics and the VAMC for Veterans and staff several times daily. If the shuttle driver is concerned about the safety of transporting a particular Veteran, they will contact clinical staff.

i. Medical/Psychiatric Emergencies Occurring in a GSA Vehicle:

1) Pull the vehicle out of traffic and shut off the engine.

2) If appropriate, call 911 for assistance.

3) Instruct any passengers who are capable of assisting you with the emergency to do so. Instruct all other passengers to evacuate the vehicle and await assistance and further instructions in a place safely away from the vehicle and other traffic.

4) Perform CPR as appropriate.

5) Initiate First Aid as necessary

6) If psychiatric emergency, attempt verbal intervention to de-escalate the situation. If verbal intervention is unsuccessful, call 911.

j. Driver Safety:

1) Allow ample time for your trip.

2) Always inspect the interior of the vehicle, front and back seats, before getting in.

3) Make sure no one is hiding on the seats or floors, front and back.

4) Inspect the vehicle for visible damage, complete the damage report, and give it to the site manager.

5) Check tire pressure, lights, turn signals, brakes, electrical systems, etc.

before using the vehicle. Immediately report any problem to the site manager, who will advise whether a replacement vehicle is necessary.

6) Make sure the vehicle has a full tank of gas. Never let the gas gauge go below half a tank.

7) Wear seat belts and ensure all passengers do likewise.

8) Observe speed limits and adjust speed to weather and road conditions.

9) If weather conditions are such that driving is hazardous (i.e., dense fog, rainy conditions, road flooding, etc.), cancel and re-schedule the home/community visit. Remember headlights are to be on when windshield wipers are on.

10) Drive defensively. Observe speed limits and all laws.

11) Keep doors locked and windows up when driving.

12) If you must stop, do so in a well-lighted, populated area.

13) Do not use a cell phone when driving.

14) Park in well-lighted and heavily traveled areas near your destination. Don’t get out of the vehicle if you see suspicious people, drive away.

15) Keep valuables out of sight, even when driving in a locked vehicle.

16) Lock the car when leaving it unattended even for brief periods of time.

17) Never leave valuables locked in the vehicle, such as VA laptops, cell phones, PIV cards, personal bags, etc.

18) Don’t stand by your locked car looking for the keys. Have the keys in hand as you approach the vehicle and enter without delay.

k. Avoid Road Rage:

1) Don’t allow someone to draw you into a test of wills on the highway. If someone is tailgating you, pull into the slow lane and let them pass.

2) Don’t tailgate others or cut them off in traffic.

3) Don’t drive in the passing lane.

4) Use your horn sparingly, as a warning, not an outburst.

5) Avoid eye contact with an aggressive driver.

6) Don’t make gestures to other drivers.

7) Check the routes you typically travel and identify the safe spots such as 24-hour gas stations, convenience stores, police, and fire stations.

l. Vehicular Accident:

1) Pull off the roadway and shut off the engine. Turn on your emergency flashers.

2) Call 911 as appropriate. This may not be necessary if no injuries have occurred, the vehicle has only minor damage and the situation is determined not to be emergent, i.e., scraping the side of a vehicle in a parking lot, etc.

3) In the event of injury to passenger(s) or even a minor complaint of discomfort, arrange for transport to the nearest Emergency Room for evaluation.

4) Take steps to prevent another accident at the scene.

5) Do not attempt to fight fires unless very minor in nature. Get away from the vehicle and call 911.

6) Instruct passengers to evacuate vehicles and assemble in a safe place away from the vehicle and other traffic. Provide reassurance to the Veteran passenger(s) and monitor to ensure the Veteran(s) remains calm.

7) If another vehicle is involved in the accident, call 911 and obtain other driver and vehicle information. Notify the appropriate clinic staff member in charge of the GSA fleet and your immediate supervisor ASAP. Follow procedures in the file found in the glove compartment or in the leather vehicle file you obtained at vehicle check-out.

8) Notify your supervisor and EMS of the accident by cell phone.

9) If you go to the VA Emergency Room or Employee Health after the accident, notify your supervisor.

10) Complete vehicle accident report forms at the earliest possible opportunity upon return to the Medical Center.

m. Training: All Social Work staff is required to attend/complete:

1) Review and sign Appendix A (see below) for this policy on initial orientation and as updated annually.

2) Medical Center annual safety training (mandatory online through TMS)

3) Service and Job-Specific Safety Training

4) Prevention and Management of Disruptive Behavior Training

5) To drive a Government vehicle, you must have a valid, current DL with no infractions and complete all required TMS training.

3. .ASSIGNMENT OF RESPONSIBILITIES

a. The primary duty of all staff is to maintain safety and security for themselves and for the Veterans they serve.

b. The Directors for the Social Work Service are responsible for ensuring the overall adherence to the policy and procedures and for educating staff and Veterans on how and when to implement these procedures.

c. All Social Work Service staff are responsible for following the safety procedures outlined in this policy and for reporting any problems to their Supervisor as they occur.

4. DEFINITIONS

a. None.

5. REFERENCES

a. Homeless Programs Handbooks

b. All required TMS safety trainings

6. REVIEW

This SOP must be reviewed at minimum at recertification.

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of July 2029 In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

Joanne Peters, LCSW Chief of Social Work Date Approved: July 1, 2024

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Standard Operating Procedures (SOPs) (sharepoint.com)

Staff Member Signature (upon hire):

https://dvagov.sharepoint.com/sites/SFC/MCP/SitePages/sops.aspx

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