4 Things You Could Be Doing Right Now to Mitigate the Threat of Workplace Violence- Form a Threat Assessment Team (Part 4 of 4)

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This is a part four of a four-piece article written by guest contributor, David Corbin. He is the former Director of Facilities, Engineering and Public Safety & Parking at Newton-Wellesley Hospital. Corbin managed all aspects of Public Safety, Facilities, Engineering and Construction operations for a 3.6 million square foot, 313-bed institution. He created and held the co-chair positions for the hospital’s first multidisciplinary Infant Security Committee and Workplace Violence Subcommittee. Corbin has an extensive background in the security industry and consults on a national level. He is a Certified Protection Professional (CPP) and a Certified Healthcare Protection Administrator (CHPA). Corbin obtained both a Bachelor’s Degree and Master’s Degree in Criminal Justice from Roger Williams University and Northeastern University respectively. Visit David’s website here.

A disgruntled pharmacy technician confronts another employee outside the front door of the hospital on a weekday evening. The two exchange words and the situation quickly escalates to a shouting match. The valet staff outside call security, but before they can arrive, the tech stabs the other employee in the stomach and flees the scene. The victim survives the incident, but a review of the situation prompts many questions the next day from administration. How did this happen? Did anyone know about the argument between the two employees? Did we miss some red flags along the way?

While this is an extreme example of how a simple argument between employees can go awry, it illustrates an important point- there is a need for a resource within your hospital to identify, evaluate, and address employees and others who may pose a threat to your organization. Enter the Threat Assessment Team (TAT)– a specialized internal team focused on these activities.

The Threat Assessment Team- Taking Lessons From Educational Institutions

The TAT, also known as a Threat Management Team (TMT) pulls the right people from within your organization who each bring some level of expertise or unique perspective to the table to examine a situation involving an employee, patient, visitor, or another person who may pose a threat to the hospital community. While TATs are not necessarily common within hospitals, it’s time for the healthcare community to take a page from the K-12 schools and higher education playbook and establish this resource within their organizations.

In K-12 schools & higher education institutions, TATs were born from necessity after mass shootings on their campuses claimed the lives of their students and faculty. The Secret Service, who are experts in the realm of threat assessment, teamed up with the Department of Education on the Safe Schools Initiative study after the Columbine shootings in 1999. The study, which examined 37 incidents involving 41 student shooters, sought to identify the pre-incident behaviors of the students that could have been discovered/identified before the attack to prevent the casualties these shooters inflicted within their schools. The study resulted in two final products: The Final Report and Findings of the Safe School Initiative: Implications for the Prevention of School Attacks in the United States and Threat Assessment in Schools: A Guide to Managing Threatening Situations and to Creating Safe School Climates. These products ultimately helped schools across the country to form their own Threat Assessment Teams and to educate these teams about how to identify, assess, and manage potentially violent students within their schools.

Ok, by now you’re probably wondering how a study about school shooters is going to apply to the healthcare environment. Well, for starters, some hospitals are affiliated with or are intertwined with higher education institutions while others have their own medical and dental schools. Of course, other hospitals have no such arrangements or affiliations. Regardless of your hospital’s nexus to education, there are lessons to be gleaned from this study and other publications that have come from the tragedies within our nation’s schools. The formation of an active Threat Assessment Team (TAT) is one of these major takeaways. I could go really deep on this topic, but in today’s post, I hope to give you a starting point for forming your own internal TAT and to direct you to the right resources to develop this team into a key part of your overall workplace violence prevention plan.

Getting Started

Before you get started on forming this team, you’ll need to get buy-in and support from your executive management team. Sound familiar? Of course it does! Per my previous posts, none of the workplace violence prevention mitigation strategies can be successfully executed in a vacuum. These are all collaborative efforts that need support from the top. You’ll need to educate yourself on TATs if you’re not already familiar with them before pitching the idea to your execs.

Once you’ve garnered support from the top, it’s time to start forming the team. Who should be on this team? Well, if you’ve already formed a workplace violence committee, you’re halfway there! The leaders from this group can likely serve as members of your newly-formed TAT. However, not everyone from this committee is appropriate for your TAT. Here are some of the folks you’ll want to consider adding to your team:

•     Executive Sponsor (Vice-President level)
•     Security Director
•     Human Resources Director
•     Risk Management Director
•     Domestic Violence Program Manager (where applicable)
•     Employee Assistance Program Manager
•     Chair of Psychiatry or other Psychiatry/Psychology Leadership Resource
•     Occupational Health Manager
•     Internal Legal Counsel
•     Law Enforcement Resource (as needed)

Goals of the Team

OKAY – so you’ve assembled your team, now what? Your team should have three primary goals:

Goal #1: Identify individuals of concern. Most likely, these individuals of concern will be employees from your institution. However, at times they may include patients, visitors, or others who are threatening staff or who pose a risk to the organization. Does this mean that the team should go on a witch hunt for potentially violent employees? Of course not! Your team needs information to flow to them through a variety of means within the hospital: security reports, safety reports, concerned supervisors/managers, frightened employees, your confidential compliance tip line, and more. The key here is to establish the team as a trusted resource within the organization for analyzing information from a variety of sources.

Goal #2: Assess individuals of concern. This is a challenging goal of the TAT. However, this is why you have a multidisciplinary team on board. No one individual on your team can thoroughly and confidently assess a situation on his/her own. It takes the combined expertise of everyone on the team to analyze the behavior and communications of the individual along with this person’s history and background. In my opinion, threat assessment is part science and part intuition. The threat assessment process may take a few hours or may be lengthy and ongoing. However, your team is going to need training to learn how to conduct a proper threat assessment. The type and level of training will ultimately depend on the availability of resources within your institution (what else is new?). We’ll talk about training more in a minute.

Goal #3: Manage individuals of concern. Once you have assessed that someone may potentially pose a threat, your team will need to decide what to do in order to manage the threat.  Interventions can range from watching and waiting to getting local law enforcement involved.  Again, the multidisciplinary resources on your team will be key in developing the threat management plan. Just like the assessment stage, management strategies can be simple and short or can end up being an ongoing process for years. The management stage can be just as critical as the assessment stage. If your team makes a misstep in how they decide to manage the threat, the consequences can be disastrous. Educating your team about possible management strategies is key.

Training Your Team

Training your Threat Assessment Team is the key to the team’s success. There are a variety of resources out there to tap for training. You may be lucky enough to have a local consultant, law enforcement resource or other resource to get this training done. Your budget resources will dictate what type of training your team will complete, but don’t skip this most important step if you want your team to be successful. Here are some resources that I personally know of for training:

Association of Threat Assessment Professionals (ATAP). ATAP is a national organization that focuses on the assessment and management of threats. They run regular training sessions every year in multiple locations. Check out their website to see if there is a local chapter or resource near you.

Gavin de Becker Advanced Threat Assessment Academy (ATA). Gavin de Becker, who is a nationally recognized expert on threat assessment and management, runs a firm called Gavin de Becker & Associates. His firm operates the ATA, which offers at least a couple of sessions a year in California. As a graduate of the ATA, I can say that this is an amazing training experience, but it comes with a big price tag, especially if you’re not on the West Coast.

Advanced Data Risk Management (ADRM). Dan O’Neill, a colleague of mine, wrote the book on campus threat assessment teams- literally. Dan co-authored the book, The Handbook for Campus Threat Assessment & Management Teams, which is a great resource for anyone looking to develop a TAT. His consulting firm, ADRM, can help organizations looking to form TATs- from inception to training.

There are many other resources out there for TAT training, these are just three that I feel are some good resources or starting points for your search. You should ultimately determine which training best suits your team.

Additional Reading

Here are some other good resources to educate yourself and your team about TATs and threat management and assessment:

• Threat Assessment: An Approach to Prevent Targeted Violence
• Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence
• Protective Intelligence & Threat Assessment Investigations: A Guide for State and Local Law Enforcement Officials
• Balancing Safety and Support on Campus: A Guide for Campus Teams

Kickoff!

Now that you have a launching point for your team, it’s time to get to work on assembling your own TAT. The TAT will hopefully become a key piece of your overall workplace violence prevention program. If your team can identify and prevent just one individual’s violent intentions from coming to fruition, the time and energy invested in your TAT will have been worth it. Time go get started!

I’d love to hear from you if you have some experience with developing a TAT within your own institution…

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