2.9 High risk workers

2.9.1 Immediate psychiatric hospital treatment | 2.9.2 Workers threatening self-harm | 2.9.3 Worker threatens self-harm over the phone (for Agent staff) | 2.9.4 Notified by a letter or email | 2.9.5 Notified by a THP or IME | 2.9.6 Notified by a third party | 2.9.7 Manage abusive or threatening situations | 2.9.8 Manage suspicion or disclosure of abuse | 2.9.9 Safety & security - third party providers

If there is a genuine threat to life, Agents can pay the cost of emergency treatment for high risk Accepted high risk claims are managed in the 0-78 weeks, 78-130 weeks and 130+ weeks segments. workers.

If a request for emergency hospitalisation, such as psychiatric care, is made and the treatment would prevent harm to the life of the worker or others, the Agent must:

accept liability for the requested number of days, where the request is for less than 10 days or
accept liability for a limited period of 10 days, where the request is for more than 10 days and refer the file to WorkSafe’s Clinical Panel.

Note: If the request is for an extension and the total number or days exceeds 10, the Agent must refer the file to WorkSafe’s Clinical Panel.

Providing approval for a limited period will allow enough time for the Agent to fully assess liability without risk The probability of the worker not returning to work is known as the risk or risk factor. For example: if a worker is likely to return to work, the claim is categorised as low risk. to life.

Definition of high risk workers

High risk workers are defined as those that are either:

making real threats of suicide or self-harm
threatening harm to others including staff of an Agent, WorkSafe or third party (IME/IIA Independent impairment assessment/HLA Hearing loss assessment).

See: Safety & security issues

Note: The threat may be either directly related or ‘incidental’ to the claim.

Escalation process

Agents must ensure that appropriate internal escalation processes are in place to ensure the timely resolution of requests for emergency treatment of high risk workers.

Novus at-risk process

Record a threat of suicide or self-harm or harm to others in Novus. Add the At-Risk process to the claim.

Debriefing and counselling

It is important that staff have an opportunity to debrief after dealing with a situation of this nature.

Access to counselling is provided for staff exposed to or taken a telephone call from a worker threatening self-harm.

2.9.1 Immediate psychiatric hospital treatment

Agent process

Follow these steps to assess liability for psychiatric inpatient hospitalisation.

Step	Agent action
Agent contacted	THP The THP calls Agent to request acceptance of liability for immediate hospital treatment. Worker of third party If the worker or a third party calls, contact the THP to request them to contact the worker to assess the current situation. The THP will advise if hospitalisation is required.
Check if similar treatment required in the past	Check if there is evidence on file that similar treatment has been required in the past. Calls to the Agent may be received from a: treating health practitioner (THP) worker or third party.
Seek specialist medical advice	If similar treatment has not been required in the past, immediately refer the request to either the Medical Advisor or if not available the: a suitably qualified person (injury management) or Claims Operations Manager or State Manager (or equivalent titles). The Medical Advisor or suitably qualified person (injury management) must immediately contact the THP to: advise them of their concerns request them to contact the worker to assess the situation.
Receive assessment from THP	The THP advises the Agent if hospitalisation is required. If the professional opinion of the THP is that the worker is not at risk, a detailed file note should be made. No further action is required. If the THP is of the view that a real threat to the life of the worker or others exists, a suitably qualified person (injury management) is to advise the THP that the Agent will pay the cost of hospital treatment for up to 10 days to allow enough time to fully assess liability decisions without risk to life.
Confirm approval in writing	The THP should also be advised that during the period of hospitalisation they are required to provide a detailed report to the Agent so the liability can be assessed. Fax or email standard letters to the THP and admitting psychiatric hospital on the same day. A copy of the letter is kept on file. For requests less than 10 days use: the PSYINP6 letter to the treating health practitioner and admitting psychiatric hospital the PSYINP7 letter to the worker and For requests greater than 10 days use: the PSYINP1 letter to the treating health practitioner and admitting psychiatric hospital the PSYINP2 letter to the worker.
Obtain history of medical and treatment issues	During the period of admittance the Medical Advisor/suitably qualified person (injury management) needs to obtain a detailed history on unresolved medical and treatment issues affecting liability determination from the THP. Consult with a suitably qualified person (technical) and a suitably qualified person (injury management)/Medical Advisor to assess the liability issues. If liability is not being accepted, provide adequate notice to the THP so that alternative arrangements can be made.

2.9.2 Workers threatening self-harm

Agents may be notified of workers threatening self-harm by one of the following methods:

the worker via a telephone call
the worker via a letter or email
the worker's THP via a telephone call or medical report
a third party (eg a relative, friend, employer or co-worker) via a telephone call.

2.9.3 Worker threatens self-harm over the phone (for Agent staff)

Follow these steps if a worker threatens self-harm over the phone.

Step	Agent action
Identity worker and other information	When a worker on the phone is threatening self-harm: identify the worker and address them by name develop a rapport by showing empathy towards the worker express your concerns about the worker’s health and safety obtain information about the current location of the worker and their contact phone number, to enable emergency services to reach the worker promptly, if required obtain as much information from the worker as you can about the reasons why they are threatening self-harm. You may use the Critical Incident Notification form to record this information.
Get someone to help	Raise the attention of a second person to help you with the telephone call. Do not hang up from the worker. Provide the second person with relevant details and direct them as to how they can help you. The second person can: search for worker’s contact details search for worker’s primary THP contact details contact the worker’s THP if required contact emergency services/Police, if required.
Worker's safety is at immediate risk	If you are concerned with the worker’s immediate safety or if you feel that the worker may have already harmed or injured themselves: contact the emergency services/Police and request they attend the worker immediately. (You may ask the second person to contact the emergency services/Police while you keep talking to the caller). If, possible keep talking to the worker until the emergency services/Police arrive. Do not counsel the worker about their problems/issues.
No immediate risk to the worker's safety	If there is no immediate risk to the worker’s safety: advise the worker you are concerned for their health and safety and will be referring the matter to their primary THP, so that the worker can get appropriate help during this difficult time. (You may ask the ‘second person’ to contact and report the matter to the THP) if you are unable to contact the primary THP, try to contact another THP if the worker’s, eg treating psychiatrist or psychologist. Do not counsel the worker about their problems/issues. Emergency hospitalisation If the THP, Police or Ambulance Service request emergency hospitalisation for the worker, approve this hospitalisation in line with High risk workers. Help the worker If you identify an issue that the worker has cited as the cause or as contributing to their current state, which you can help them with, within the boundaries of your Agent role (eg pay outstanding weekly payments) inform the worker you will do so. Ensure you give the worker details of expected timeframes and expected outcomes/solutions. Action plan If you managed to diffuse the immediate threat of self-harm, make an action plan with the worker what to do next. This may include: contacting the worker's primary THP contacting another THP of the worker's, eg Psychiatrist/Psychologist contacting a support service. Only hang up from the worker when you feel it is safe to do so.
Record / report telephone call	Once of the above have been undertaken: activate the ‘At Risk Process’ in Novus and record as much information as possible about the telephone conversation and report the call to the designated Manager in your agency. Advise the suitably qualified person (injury management)/Medical Advisor or Team Manager in accordance with your Agent's internal procedures.
Follow up action	Call the THP after the initial phone call to check on the current status of the worker. Ask the THP if it is okay to contact the worker and check on the worker personally. If appropriate, call the worker to check on the current status. Record the outcome of the conversations with the THP and if appropriate the worker in Novus.

2.9.4 Notified by a letter or email

Escalate notification

If you are informed of a worker’s intent to self-harm via a letter or email, escalate the information received to a suitably qualified person (injury management)/Medical Advisor or Team Manager in line with your Agent’s internal procedures.

Contact the primary THP

A suitably qualified person (injury management)/Medical Advisor contacts the worker's primary THP and advises that a letter has been received indicating worker’s intent to self-harm:

inform the THP that you are concerned for the worker’s health and safety and as such you are referring the matter to them so that appropriate help could be provided
ask the THP if it is appropriate to contact the worker to check on the worker personally
if appropriate, contact the worker and inform them about the action taken to help them during this difficult period.

Emergency hospitalisation

If the THP, Police or Ambulance Service request emergency hospitalisation for the worker, approve this hospitalisation.

See: Immediate psychiatric hospital treatment

Recording notification

Record as much information as possible.

Follow up action

Call the THP after the initial contact to check on the status of the worker.

Ask the THP if it is appropriate to contact the worker and check on the worker personally.

If appropriate, call the worker to check on their current status.

2.9.5 Notified by a THP or IME

A treating health practitioner (THP) may be a general practitioner, surgeon, specialist, psychiatrist, physiotherapist Registered physiotherapist means a person registered under the Health Practitioner Regulation National Law to practise in the physiotherapy profession (other than as a student)., chiropractor, etc or an independent medical examiner (IME) or a Medical Panel Under the legislation, unless inconsistent with the context or subject-matter — Medical Panel means a Medical Panel constituted under Division 2 of Part 12 member.

Escalate notification

Contact the primary THP

A suitably qualified person (injury management)/Medical Advisor contacts the relevant health professional immediately and refers the matter to the worker's primary THP so that appropriate care and help can be provided.

Emergency hospitalisation

If the THP, Police or Ambulance Service request emergency hospitalisation for the worker, approve this hospitalisation.

See: Immediate psychiatric hospital treatment

Record information

Record as much information as possible - this may be of use at a later date.

Follow up action

A suitably qualified person (injury management)/Medical Advisor contacts the health professional again to check on the status of the worker.

2.9.6 Notified by a third party

If you are informed by a third party of a worker's intent to self-harm:

obtain details of the third party – name, contact telephone number and details of their relationship to the worker
obtain details of the threats and ask the third party if they know why this situation has developed
inform the third party of the next steps – referral to the worker’s THP, referral to Police or Ambulance Service.

The third party caller informs that worker’s safety is at immediate risk

If the caller is concerned with the immediate safety of the worker or if the worker has already harmed or injured themselves:

contact the emergency services/Police and request they attend the worker immediately. (You may ask a second person to contact the emergency services/Police while you keep talking to the caller)

ask the caller, if possible, to stay with the worker until the emergency services/Police arrive.

Emergency hospitalisation

If the worker's primary THP, Police or Ambulance Service request emergency hospitalisation for the worker, approve this hospitalisation.

See: Immediate psychiatric hospital treatment

Escalate notification

Escalate the information received from the third party to a suitably qualified person (injury management)/Medical Advisor or Team Manager in accordance with your Agent’s internal procedures.

Contact the primary THP

A suitably qualified person (injury management)/Medical Advisor contacts the worker's primary THP so that appropriate care and help can be provided.

Recording notification

Record as much information as possible about the telephone conversations with the THP, Police and Ambulance service.

Follow up action

A suitably qualified person (injury management)/Medical Advisor contacts the THP again to check on the status of the worker.

2.9.7 Manage abusive or threatening situations

A threatening situation exists whenever someone’s personal safety is at risk, or when there is a reasonable belief that it may be at risk. Situations include:

receiving an abusive telephone call
a threatening letter or bomb threat
where someone is being physically threatened or assaulted or behaving suspiciously or
where there has been an intruder.

Managing a threatening or aggressive situation

A threatening or aggressive situation may be identified by one of the following methods:

Step	Agent action
Confronted face-to-face	If you are subject to actual or threatened abuse, violence or harassment: stay as calm as possible (try not to panic or show any sign of anger, confrontation, or confusion, remain professional, try to reduce tension or aggression and don’t raise your voice) try lowering your voice instead of raising it do not stare adopt passive gestures and comply with reasonable requests summon help (if you are not in immediate danger and if it is safe to do so. If you are in immediate danger call for help immediately. If fitted, use the duress alarm) keep out of reach (move persons to a safe place if possible) if you can safely leave (make your way to another location where help is readily available) do not hinder the person's departure (if they wish to leave – allow them to do so. Never abuse or ridicule) call the Police on 000 Record as much information as possible escalate the incident to a suitably qualified person (injury management)/MA or Team Manager in accordance with your Agent’s internal procedures notify WorkSafe Security of the incident as soon as possible on 03 9641 1000 complete a WorkSafe Security Incident Report and fax to WorkSafe Security on 03 9656 9377.
Confronted by telephone	obtain identifying information from the worker (name/address/claim number) listen sympathetically and try to develop a rapport with the worker by showing empathy towards the worker do not argue if the worker becomes abusive or threatening, advise them that you will be terminating the call and hang up if the worker is making threatening calls persistently, advise them that you will report this to the Police and call Police on 000 escalate the incident to a suitably qualified person (injury management)/MA or Team Manager in accordance with your Agent’s internal procedures notify WorkSafe Security of the incident as soon as possible on 03 9641 1000 complete a WorkSafe Security Incident Report and fax to WorkSafe Security on 03 9656 9377.
Notified in writing	if you are informed of a worker’s intent to threaten, harm or abuse others via a letter or email, escalate the information received to a suitably qualified person (injury management)/MA or Team Manager in accordance with your Agent’s internal procedures notify WorkSafe Security of the incident as soon as possible on 03 9641 1000 complete a WorkSafe Security Incident Report and fax to WorkSafe Security on 03 9656 9377
Advised by a healthcare professional	if you are informed of a worker’s intent to threaten, harm or abuse others by a medical practitioner, escalate the information received to a suitably qualified person (injury management)/MA or Team Manager in accordance with Agent’s internal procedures notify WorkSafe Security of the incident as soon as possible on 03 9641 1000 complete a WorkSafe Security Incident Report and fax to WorkSafe Security on 03 9656 9377.
Notified by a third party	if you are informed of a worker’s intent to threaten, harm or abuse others by a third party (eg a relative, friend, employer or co-worker), escalate the information received to a suitably qualified person (injury management)/MA or Team Manager in accordance with Agent’s internal procedures notify WorkSafe Security of the incident as soon as possible on 03 9641 1000 complete WorkSafe Security Incident Report and fax to WorkSafe Security on 03 9656 9377.

Additional help

It is important staff have an opportunity to debrief after dealing with a situation of this nature.

Agents must provide access to counselling for staff that have been exposed to or taken a telephone call from a worker threatening harm to others.

2.9.8 Manage suspicion or disclosure of abuse

Abuse is a violation of an individual's human and civil rights by any other person or persons.

Abuse can be:

physical
sexual
financial
neglect of life necessities
emotional or psychological
restraint or restrictive practices
a child witnessing abuse (such as domestic violence).

A worker's service provider, friend or family member may be the person inflicting the abuse.

Becoming aware of abuse

Suspected abuse

Abuse of a worker may be suspected during any claims management activity.

Partial disclosure

Abuse of a worker may be partially disclosed by the worker, a representative or a witness.

Partial disclosure may be vague, subtle or be given in small pieces of information.

For example the worker states that a staff member / carer at their residence visits them at night or that the person is 'mean' or 'not nice' or 'cares too much'.

Full disclosure

Abuse of a worker may be fully disclosed by the worker, a representative or a witness.

Full disclosure will be evident by the person talking about what happened.

Child abuse

You may form a belief on 'reasonable grounds' that a child (under the age of 16 years) or young person (under the age of 18 years) is in need of protection after becoming aware that their health, safety or wellbeing is at risk.

Note: To assist you to form an opinion on 'reasonable grounds' - see: information provided by the Department of Heath & Human Services: Opinion Formed on Reasonable Grounds.

If, on reasonable grounds, an opinion is formed that any person under the age of 16 years (ie a worker or their child/ren) is experiencing:

sexual abuse, the matter must be reported to Victoria Police (see section below: Reporting abuse to Victoria Police)
other types of abuse, you must contact DHHS Department of Health and Human Services’ Child Protection Services local office (www.dhs.vic.gov.au).

Managing suspected or disclosed abuse

Follow these steps when you:

learn of an incident of abuse to a worker
via a call from the worker or any other person who has become aware of the abuse
via any form of writing from the worker or any other person who has become aware of the abuse or
form an opinion or suspicion of abuse to a worker.

Step	Agent action
Evaluate worker's safety	If you believe the worker is in immediate danger or harm: advise them that you will contact the emergency services and then call 000 Alternatively and without delay, you should: discuss the disclosure and your concerns with your IMA escalate the matter to a suitably trained internal person (SME) notify the service provider/agency, when the person suspected of abuse is employed by a provider, for them to initiate their internal incident procedures (eg: whether that person is immediately removed/transferred from duties).
Conduct during a call	If you are informed of an incident of abuse to a worker via a call from the worker or any other person: obtain identifying information about the worker: name address claim number remain calm, be supportive and don't express your own feelings listen attentively, let them talk as much as they want to don't investigate or imply blame (eg: why didn't you?...you could/should have....) reassure the worker/other person that they did the right thing by reporting this explain that you will need to speak with other people in order to help, check that the worker is okay with that.
Record information	Record and update as much information as possible, such as: notifier's details details of the incident if intervention by emergency services was required for the worker's safety actions undertaken (Agent and/or WorkSafe).
Escalate the matter	If not already done, escalate the matter to a suitably trained person (SME).
Response from SME	The SME will determine and undertake the appropriate response activities, including reporting abuse to Victoria Police.

Reporting abuse to Victoria Police

Child sexual abuse must be reported to Victoria Police

If, on 'reasonable grounds', an opinion is formed by an adult that any person under the age of 16 years (ie a worker or their child/ren or any other child) is or has been experiencing sexual abuse, the matter must be reported to the police on 000.

Note: To assist you to form an opinion on 'reasonable grounds' - see: information provided by the Department of Heath & Human Services: Opinion Formed on Reasonable Grounds.

There are two reasonable excuses for not reporting child sexual abuse to the police:

you believe, on reasonable grounds, that the information has already been reported to the police by another person and you have no further information or
the person fears, on reasonable grounds, for their own safety or that of their child’s safety if they report the abuse to the police and the failure to report is a reasonable response in the circumstances (for example, in the context of family violence).

CA s327

If you believe there is a reasonable excuse for not reporting child sexual abuse, you should consider any ongoing risk to the child and decide whether other action should be taken to protect them (for example, a report to Child Protection Services).

Note: For other types of child abuse, you must contact DHHS ’ Child Protection Services local office.

All other abuse

You may only report other forms of abuse to the police if you have consent from the adult experiencing the abuse - this may be the worker or someone in their support group (ie a spouse Spouse of a person means a person to whom that person is married / partner, home help provider, OR provider etc).

The decision of the adult experiencing abuse must be respected.

Additional help

It is important staff have an opportunity to debrief after dealing with situations that cause stress or concerns.

Agents will provide access to counselling for staff that have been exposed to or taken a telephone call from a worker or other person where abuse has been disclosed.

2.9.9 Safety & security - third party providers

In addition to managing an abusive or threatening situation, if an Agent or self-insurer believes a safety risk may exist for third party providers such as an IME, IIA, Medical Panels or OR Provider, they must discuss these risks with them before confirming an appointment. The third party provider has the option to accept or refuse the referral.

Safety strategies for examination / appointment

When a third party provider accepts an appointment referral, the Agent or self-insurer should discuss safety strategies such as:

arranging for a security guard to attend the rooms at the time of the appointment
arranging for a second provider to be present at the appointment
arranging for a female provider or nurse to attend the appointment (particularly if the worker is female)
having the Agent or self-insurer contact the worker's treating practitioner and / or legal representative to ask them to counsel the worker of the consequences of inappropriate behaviour or
making other arrangements identified by the third party provider.

Unsafe to continue examination / appointment

The third party provider may refuse to commence or continue an appointment if they believe it is unsafe. They should immediately contact the Agent or self-insurer to advise what has taken place and send a written incident report.

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