Security Protocols

Intoxication
The Suitcase Clinic will not provide services to any clients under the influence of drugs and alcohol if their intoxication is disruptive. Smoking is prohibited inside the drop-in centers (if this becomes an issue, a sign should be posted where all clients can read it).

The Clinic Coordinators will use his/her discretion in enforcing the above rule, while remembering the following principles:

The potential behavior problem posed by an intoxicated client should be used to assess whether he/she can be seen, as we are concerned with safety, rather than moral judgment;
Our goal is to offer clients health and social services, not deny them;
An intoxicated client may be difficult to evaluate accurately;
We should maintain a consistent policy to the clients. This may conflict with 1 and 2, and the Clinic Coordinators must use discretion in balancing these two goals.

Any client who appears to the Clinic Coordinator to be under the influence of alcohol or drugs, and who is seen at the clinic, must be:

Informed of our stated policy against seeing patients under the influence;
Warned that his/her condition may interfere with assessment by medical, optometric, chiropractic, or social services staff;
Told that an exception is being made for him/her.

The Clinic Coordinator must fill out a case form for each client turned away under the Intoxication Policy, including a description of the client’s reaction to the denial of services. This form will be included in the client’s record, and the incident should be reporting at debriefing and the next Planning Committee meeting.

The Clinic does not discriminate against clients because of lifestyle. Drug use outside of Clinic is not grounds for denying services to individuals. All social information is confidential. Any client seen by the health group, or any volunteer, who discusses recreational use of alcohol, tobacco, or drugs, must be advised by a health worker that these substances are harmful to their health. They must also be asked if they would like any information on health effects or quitting, unless the health worker feels that this discussion would jeopardize their relationship with the client. This discussion should take place in a non-judgmental, serious manner as a part of the client’s interview.

Abuse
All cases of child abuse, domestic violence and elder abuse must be reported to the appropriate law enforcement agency. Volunteers that suspect abuse or are told by clients of abusive relationships must report this information. Student volunteers should consult with volunteer professionals or more experienced volunteers prior to initiating the reporting services.

Section 11166 of Article 2.5 of the California Penal Code requires “any child care custodian, medical practitioner, non-medical practitioner, or employee of a child protective agency who had knowledge of or observes a child in his/her professional capacity or within the scope of his/her employment, whom s/he knows or reasonably suspects has been the victim of child abuse shall report the known or suspected instances of child abuse to a local law enforcement agency by telephone as soon as possible and shall prepare and send a written report thereof within thirty-six (36) hours of receiving the information concerning the incident.”

Section 11160-11163 (Chapter 992 of 1993-AB 1652), Chapter 19 of 1994 (AB74 X) and Chapter 147 of 1994 (AB-2377) of the California Penal Code states that reporting of physical injuries caused by gun, assaultive or abusive behavior is mandatory for health practitioners. Injuries must be reported to the local law enforcement agency by telephone as soon as possible and in writing within two days.

Sections 15630 (a)(1)(2) and 15633 (a)(b) of the California Welfare and Institutions Code, Chapter 11, Division 9 mandates the reporting of incidents that reasonably appear to be physical abuse of a person 65 or older, or a person who as a “dependent adult” is between 18 and 64 who has physical or mental limitations which restrict his/her ability to carry out normal activities or to protect his/her rights, including, but not limited to persons who have physical or developmental disabilities or whose physical or mental abilities have diminished because of age. Health practitioners must report by telephone to the local law enforcement agency or the county adult protective services agency as soon as possible and submit a written report within two working days of the telephone report.

There is a continuum of behaviors considered abusive, ranging from verbal denigration to physical injury and death. While sometimes signs of abuse are present, there are often no observable indicators. Domestic violence should be suspected if any of the following are observed in clients:

Injuries to the neck, face or throat;
Injuries to the chest, breast, abdomen, or genitals;
Bilateral distribution of injuries;
Evidence of rape or sexual assault;
Multiple injuries in various stages of healing;
Pregnant women with any injury (esp. to breast or abdomen);
Explanation of injuries that is inconsistent with type of injury;
Psychological distress (suicidal ideation, depression, anxiety, and/or sleep disorders);
Excessive worry about a relatively minor injury or seemingly calm;
Numb reaction to serious injury;
Controlling or aggressive partner who answers question for client.

It is crucial that guardians of children presenting for actually or suspected abuse be interviewed in private about the circumstances of the child’s abuse and neglect, as well as about any abuse the guardian her or himself has experienced. The following may be indicators of domestic violence in this setting:

Concerns about the child’s behavior;
Mother’s partner is hypervigilant, controlling, and verbally abusive, accuses the mother of neglect or incompetence;
Mother has obvious injuries.

NOTE: Do not ask questions in front of children.

The frequency and severity of previous assaults are often good indicators of current and future danger. Threats are as important as actual assaults, especially if weapons are present in the home. However, the best indicator of current danger is the client’s own assessment. Ultimately, it is the women’s decision whether or not to leave the relationship. Be non-judgmental if she decides to remain in the relationship, and keep the door open for future support.

If she decides to leave the relationship, it is important to discuss the client’s immediate safety needs. Ask her where she will go when she leaves the Suitcase Clinic and whether anyone is waiting for her outside. Ask if she feels safe. If not, she needs a plan of action that might include staying with a friend or family member, or going to an emergency shelter. Help her to develop a safety plan.

Medical records are important in cases involving abuse for two reasons: records of past traumas can help providers identify battering, and careful recording of the present injury will be helpful to a battered woman should she need to prove a history of battering for prosecution or custody disputes. If the woman denies that she has been battered, the provider cannot state that the injuries are the result of battering, but can note that the patient’s explanation was inconsistent with injuries presented (always inform the patient of the way in which an opinion is documented).

California Welfare and Assembly Bill 1652, requires any medical or non-medical practitioners, to report domestic abuse of adults and children.

Procedure: Any medical or non-medical practitioner who has knowledge of, observes, or suspects and adult and/or child to be a victim of physical abuse, or who has injuries which are consistent with abuse must do the following:

Report abuse to the local law enforcement agency immediately, or as soon as possible, by telephone;
Prepare and send a written report of the abuse within 36 hours of receiving the information;
Document in the chart statements for the client a description of physical injuries (if any), action taken, and follow-up.

If the client is seeking the services of medical, chiropractic, social or legal, than the service provider is required to report the incident. However, if the client has come for other services then the caseworker must report the incident. Before the caseworker reports the incident, it must be discussed with a service provider or Clinic Coordinator to determine the course of action.

* Medical Practitioner means a physician, surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, or any other licensed health professional.

Suicide

There is one suicide attempt every two hours and twelve minutes;
There is one successful suicide completion for every twenty-five attempts;
More people die from suicide than from homicide. In 2001, suicide was the 11th leading cause of death in the United States;
Men successfully complete suicide four times more often than women do, partially because men have greater access to weapons than women do. Suicide is the eighth leading cause of death for all US men;
Women attempt suicide during their lifetimes two to three times more often than men do;
Suicide attempts and completions, along with depression, are both present in unusually high numbers amongst the low income and homeless populations.

Risk Factors and Warning signs

Evidence of depression;
Increased or decreased sleeping;
Changes in eating patterns;
Isolation;
Mood change;
Extreme sadness;
Loss of interest;
Changes in personal hygiene;
Destructive behavior;
Anger, aggression and violence;
Irritability;
Vocalizing suicide as an option;
Saying goodbye;
Giving away possessions;
Sudden happiness. As if a weight has been lifted, a solution to problems is found within suicide;
Increase in drug and alcohol usage.

Four-step Intervention Technique:

Ask. Take all suicidal talk seriously. If you suspect someone is going to harm themselves, take immediate action. Directly ask if they are suicidal. Asking does not cause a person to commit suicide.
Why? Listen to their response. Be able to say things like “I’m worried about you when you leave here,” and build a relationship. Commend them for opening up to you. “Maybe you’re telling me this because there’s a part of you that doesn’t want to die.” “Thank you for telling me, can we talk about that part that wants to live?”
Plan. Asses their means and access to means, find out how they plan to implement their suicide.
Contract. Ask them to promise to call someone before they follow through with their plan. This can be you if you feel comfortable with it, a suicide hotline if you are not. Make a plan to meet them again at the drop-in center next week to check in with them.

Sexual Harrassment
1. Verbal

Direct. “Would you give me a massage tonight?” “Wow, you look hot!” “Can I come home with you?” Response: It is often hard for people to respond directly to sexual harassment, but the best way to address it is to be direct and to the point. Tell the person that the request/comment is inappropriate and that you do not appreciate it. People will usually not be offended since they realize they are being inappropriate. Your warning will usually be sufficient to stop the behavior. However this is often hard to do. You can leave the situation and tell a Clinic Coordinator if you feel uncomfortable.
Overheard. Two people conversing about a third party. “Dude, you’re so lucky to work here, there are so many hot girls.” Response: “I heard what you said about someone and I don’t think it was appropriate.” Please always address the issue, and if you don’t feel confident, have someone else do it for you. We must make it clear that this type of behavior is not appropriate.

2. Unspoken/Physical

Excessive staring. Response: Again, be direct. Don’t talk until they stop staring – say “my eyes are here”, or just flat out tell them to stop staring.
Inappropriate touching. Response: “I’m not comfortable with you touching me like that.” “Please ask my permission before touching me.”
Sitting too close. Response: move and if they ask why, say you are more comfortable with a larger distance, or that you like more personal space.

3. Offering Gifts

For our clients who have little, giving of anything – big or small, means a lot and may signal that the relationship means something else to them. You can address it directly. “I feel as if you may be attracted to me. Because of this I cannot accept this gift,” or indirectly, “Suitcase Clinic policy prohibits us from receiving gifts from others.”

If you do not fee comfortable doing any of these, ask a Clinic Coordinator for help in addressing the problem.

Remember:

Sexual harassment can occur between client and caseworker, client and client, caseworker to caseworker;
Can be male to female, female to male, male to male, female to female, not only between a man and a woman;
Be aware of language and dress – dress smart and be aware of the context, be ‘professional’;
Don’t give out your contact information. Give them the Suitcase Clinic number if you want: (510) 643-6786;
Be cautious about being alone with people. Do not leave a Suitcase Clinic drop-in center alone;
Always contact a Clinic Coordinator if you feel any sort of discomfort. You are in charge, and if it makes you uncomfortable it warrants attention and action;
Be an ally. Observe and/or intervene as an ally for the person being harassed. We are all volunteers, and sometimes the person being harassed may just be caught so off guard they may be unable to react;
Any type of sexual harassment is not appropriate, and must be responded to. By not responding, you leave the door open for it to continue in the future. People must be aware the clinic is not an appropriate place for behavior like that;
Bring up uncomfortable situations at debriefing so that everyone can be aware. We’re all students and the whole thing is a learning process. By sharing we can all learn from your experience;
It is always best to be direct. People often fear that being direct could be conceived as rude. Clients usually respond best to direct language, they get the point and they then know it is not okay to continue with the behavior in the future. The longer you let it drag on, the more they will continue to do it. The direct responses do not infringe on your relationships with the client – in fact, they usually build respect and a stronger relationship, not just revolving around your appearance.

Disciplinary Protocol
All steps are to be taken with confidentiality, sensitivity, and compassion as top priorities; however, if any part of the process is not cooperated with, persons in contempt will be asked to take a leave from the Suitcase Clinic until the problem is resolved. In the case of inappropriate actions by a client. In the event the protocol is not effective or the actions are criminal in nature, contact the police immediately.

A warning from the Coordinator (ie. Clinic, SHARE, Medical, etc.)–this warning can be verbal or in a written paragraph–the type of warning (written or verbal) is up to the discretion of the Coordinator/“decision making team” (defined below). The content of these warnings is also up to the Coordinator’s discretion, and will be tailored to the specific incident in question. A warning should be used as the first step, and act as the lowest form of disciplinary actions. All warnings need to be noted in the log book, and if written, should be attached to the client’s file;
Meeting with social services: in a case where a warning has proven ineffective, but when suspension is too big a consequence, the client/person involved will be asked to meet with social services to discuss the issue of concern. A client/participant can be asked to meet with social services even if this is their first disciplinary action;
Suspension from Suitcase Clinic grounds: To be used in cases where the action of the client/participant is severe enough to constitute removal from a Suitcase Clinic drop-in center. Such instances involve (but are not excluded too): assault (verbal/physical), sexual harassment, repeating actions that have been given warnings etc. Suspension from a Suitcase Clinic drop-in center must be written (form of document discussed below) and must be approved by the “decision making team”–which is made up of (but not limited too) : the Clinic Coordinator, social services, the Coordinator of the service involved, and an Advisory Board member needs to be contacted (preferably an adviser close to the issue–for example, if the incident happened in SHARE, an appropriate adviser would be a former SHARE Coordinator). Suspensions carried out/given to the client or participant by a Clinic Coordinator and social services–if either is unavailable, suspensions must involve two people;
Document of Suspension: Below is what the document of suspension must contain (the below information does not pertain to documentation for warnings). This document must also be approved by the “decision making team,” and may not include names of participants/advisers without their permission. This document should also be kept on file at the Suitcase Clinic drop-in center in question. Permanent suspensions are NOT allowed at any time.

Date of the incident;
Summary of what happened (who was involved, what was implied/perceived from the action, why that action is inappropriate for the Suitcase Clinic drop-in center in question);
Disciplinary action (tailored suspension–including the steps for re-admittance to Suitcase Clinic drop-in center in question, guidelines for actions: i.e. no contact with Suitcase Clinic personnel–define the terms of suspension.);
Consequences for violating suspension (i.e. if violated the suspension will be extended b. police action via an R.O.).

Internal Assessment
All steps are to be taken with confidentiality, sensitivity, and compassion as top priorities; however, if any part of the process is not cooperated with, persons in contempt will be asked to take a leave from involvement with the Suitcase Clinic until the problem is resolved:

Position Conduct Assessment
This applies to all violations of official policy as enumerated on suitcaseclinic.org by any volunteers acting as agents of the Suitcase Clinic, i.e. excessive absences, poor attitude, inappropriate comments, failure to fulfill assigned role, etc.

Officers (any action while acting as an officer):

Anyone—client, officer, student, provider, or volunteer—should confront the officer in question directly or notify a Clinic Coordinator of their complaint. Any officer informed of a complaint (by any of the above) must relay it to a Clinic Coordinator, making it clear that it is not their personal complaint;
The Clinic Coordinator must inform the officer in question of the complaint and email a brief record of the complaint to an Administrative Coordinator, who must then print and place the record in a confidential Administrative Log to be held in the current Instructor of Record for Health and Medical Sciences 98/198’s office. In the event that it is a Clinic Coordinator in question, Coordinators can elect to have a meeting among themselves or involve an Administrative Coordinators. A resolution must be reached. If a resolution is not reached, the officer does not abide by the resolution, or new complaints occur:
The Administrative Coordinators must organize a meeting with the current Instructor of Record for Health and Medical Sciences 98/198, the Division Head of the officers in question’s division, and one Administrative Coordinator. A resolution must be reached. In the case the officer in question refuses the assessment or does not abide by the resolution:
The officer’s position will be free in the next election or another action will be taken under the discretion of the current Instructor of Record for Health and Medical Sciences 98/198, including leave or permanent removal from involvement with the Suitcase Clinic if necessary.

Volunteers and Providers (any action while volunteering of providing service):

Anyone—client, officer, student, provider, or volunteer—should notify Clinic Coordinators of the complaint. Any officer informed of a complaint (by any of the above) must relay it to a Clinic Coordinator, making it clear that it is not their personal complaint;
Clinic Coordinators must address the complaint and take appropriate action to resolve it, including removal from involvement with the Suitcase Clinic if necessary. Coordinators must then email a brief record of the complaint and resolution to an Administrative Coordinator, who must then print and place the record in a confidential log to be held in the current Instructor of Record for Health Medical Sciences 98/198’s office.

Personal Conduct or Violations Assessment
This applies to boundaries among all Suitcase Clinic volunteers, officers, service providers, clients, and students as individuals, especially sexual harassment, theft, and violence.

The P.C.V.A. (Personal Conduct or Violations Assessment) Committee must be comprised of the current Instructor of Record for Health and Medical Sciences 98/198, the Clinic Coordinators of the involved drop-in center, and the three Administrative Coordinators, excluding any persons involved or accused of violations.

Any involved party should notify the police immediately with a full report, and a Crime Assessment Report should be completed by coordinators before any persons leave the site. Committee members present on-site of the incident will question any others present and write a confidential record including copies of the above reports;
Any involved party must notify the P.C.V.A. Committee, naming all participants and giving a complete report. The report must be typed and put in the current Instructor of Record for Health and Medical Sciences 98/198’s log. All information is strictly confidential among Committee members;
The Committee Administrator must notify all Suitcase Clinic volunteers of the event in non-specific terms (no names or revealing details of any kind) of the instance, reminding them of the protocol;
The Committee must carry out and document an investigation, questioning any member of the Suitcase Clinic in a confidential interview if necessary, particularly utilizing the Volunteer Coordinators, division heads, and UGSIs and reach a conclusion. At this point the may present a change in Suitcase Clinic policy to address the issue and/or remove any individual sufficiently proved to be guilty of misconduct from clinic permanently.

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