There are an increasing number of adults with cognitive impairment displaying responsive behaviours that require personal support services to remain safely at home. Responsive behaviours can include screaming, wandering, grabbing, restlessness, agitation, pacing, resisting care, verbal and/or physical aggression. Personal support workers (PSWs) working with persons with responsive behaviours tend to work alone in a variety of unfamiliar settings, which increases their risk of experiencing workplace violence.

This study aims to determine whether the implementation of a rapid response algorithm for managing workplace violence: a) resolves concerns relating to clients’ responsive behaviours; and b) decreases perception of risk due to caring for clients displaying responsive behaviours among PSWs. A cross-sectional survey at a large home care provider in Ontario, Canada was conducted. Data were collected pre-implementation and at 6 months and 1-year post from PSWs caring for adult clients with responsive behaviours. Supervisor experience in supporting PSWs that reported a workplace violence incident was also collected through bi-weekly check-ins at 6 months and semi-structured interviews at 1-year post-implementation.

A total of 752 PSWs (96.6% female, 67.7% 40-59 years old, and 55.2% worked more than 5 years at VHA) completed the survey across all three phases. More than half of the participants (53.9%) had cared for an adult client with cognitive impairment in the last 6 months who was physically or verbally aggressive or violent and 24.9% reported being harmed while caring for these adults pre-implementation. At 1-year post, 54.1% reported having cared for these clients in the last 6 months with 26.8% reported being harmed. Although risk of being harmed on a scale of 1 (low) to 10 (high) was reported to be 4.93 pre-implementation and 4.99 at 1-year post, no statistically significant differences were found when comparing the two. Interestingly, those working less than 1 year had a higher statistically significant risk perception than others.

At 6 months post, a total of 22 workplace violence incidents (95.5% type II) were reported. The most reported type of aggression was physical (n=15) followed by verbal aggression (n=5) or both (n=1). More than half of the incidents (68.2%) were resolved at the time of data collection. Incidents were most likely to get resolved at the level of supervisor follow-up with the PSW (60%) or through a joint visit (40%).

Interviews with supervisors showed a range of varying experiences in using the algorithm in practice with most supervisors agreeing it was a valuable resource. Training/education was identified as a key strategy for risk mitigation. Supervisors also felt that the algorithm should be shared continuously as a refresher and would be especially helpful for less experienced staff. Suggestions for refining the algorithm included reference to external resources available and the role of the homecare in mitigating incidents.

While no difference in risk perception was found 1-year post, our results suggest that PSWs who have worked for less than 1 year have higher risk perception and may require additional supports. Accessible and mandated training for such PSWs could be beneficial. Additionally, increased awareness of the algorithm is needed, especially among newly hired PSWs and supervisors and a regular ongoing communication campaign could close this gap. In the future, the algorithm should also be refined to include external supports available to handle workplace violence incidents, the role of the homecare funder in mitigating incidents, and COVID-19 specific information to stay relevant to the ever-changing circumstances of the pandemic.