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professionals, psychologists, psychiatrists, clinical nurse specialists or social workers should provide this counseling. Alternatively, the employer may refer staff victims to an outside specialist. In addition, the employer may establish an employee counseling service, peer counseling, or support groups. Counselors should be well trained and have a good understanding of the issues and consequences of assaults and other aggressive, violent behavior. Appropriate and promptly rendered post-incident debriefings and counseling reduce acute psychological trauma and general stress levels among victims and witnesses. In addition, this type of counseling educates staff about workplace violence and positively influences workplace and organizational cultural norms to reduce trauma associated with future incidents. Investigation of Incidents Once these immediate needs are taken care of, the investigation should begin promptly. The basic steps in conducting incident investigations are: 1. Report as required. Determine who needs to be notified, both within the organization and outside (e.g., authorities), when there is an incident. Understand what types of 10 Referenced on the Substance Abuse and Mental Health Services Administration’s website on February 25, 2013 (www.samhsa.gov/nctic). Occupational Safety and Health Administration 2 4 incidents must be reported, and what information needs to be included. If the incident involves hazardous materials additional reporting requirements may apply. 2. Involve workers in the incident investigation. The employees who work most closely in the area where the event occurred may have special insight into the causes and solutions. 3. Identify Root Causes: Identify the root causes of the incident. Don’t stop an investigation at “worker error” or “unpredictable event.” Ask “why” the patient or client acted, “why” the worker responded in a certain way, etc. 4. Collect and review other information. Depending on the nature of the incident, records related to training, maintenance, inspections, audits, and past incident reports may be relevant to review. 5. Investigate Near Misses. In addition to investigating all incidents resulting in a fatality, injury or illness, any near miss (a situation that could potentially have resulted in death, injury, or illness) should be promptly investigated as well. Near misses are caused by the same conditions that produce more serious outcomes, and signal that some hazards are not being adequately controlled, or that previously unidentified hazards exist. 4. Safety and Health Training Education and training are key elements of a workplace violence protection program, and help ensure that all staff members are aware of potential hazards and how to protect themselves and their coworkers through established policies and procedures. Such training can be part of a broader type of instruction that includes protecting patients and clients (such as training on de-escalation techniques). However, employers should ensure that worker safety is a separate component that is thoroughly addressed. Identify the root causes of the incident. Don’t stop an investigation at “worker error” or “unpredictable event.” Ask “why” the patient or client acted, “why” Training for all workers Training can: (1) help raise the overall safety and health knowledge across the workforce, (2) provide employees with the tools needed to identify workplace safety and security hazards, and (3) address potential problems before they arise and ultimately reduce the likelihood of workers being assaulted. The training program should involve all workers, including contract workers, supervisors, and managers. Workers who may face safety and security hazards should receive formal instruction on any specific or potential hazards associated with the unit or job and the facility. Such training may include information on the types of injuries or problems identified in the facility and the methods to control the specific hazards. It may also include instructions to limit physical interventions in workplace altercations whenever possible. Every worker should understand the concept of “universal precautions for violence”— that is, that violence should be expected but can be avoided or