NDARC Technical Report No. 138 (2002)
EXECUTIVE SUMMARY
Introduction: Since it was established in 1986, the National Drug and Alcohol Research Centre (NDARC) has conducted numerous and diverse research projects involving large numbers of research participants. During this time, the number of staff employed by the Centre has expanded and many new staff members have varying experience with populations of drug and alcohol users when they commence at NDARC. Many participants in NDARC’s research studies have criminal histories, psychiatric conditions and a range of physical health problems. In March 2001, a Safety Committee was established to examine the safety issues specific to interviewing drug and alcohol users and to develop a practical set of guidelines to deal with such issues.
The aim of this report is to document the issues considered by the Committee, including recommendations for training and the development of the NDARC Safety and Interviewing Protocol. The report is intended for use as a resource and training manual for NDARC staff and a resource and review of interview safety issues for the drug and alcohol field.
Overview of safety issues: Drug and alcohol research participants come from a range of backgrounds and represent a broad spectrum of people. Many research participants are drawn from populations that could be considered ‘high risk’ in terms of interviewer safety, including:
- Participants who are drug dependent and are compelled to continue drug use. This compulsion raises safety issues for drug and alcohol researchers;
- Unemployed drug users with significant drug expenditure, who may feign eligibility to enter a study to obtain reimbursement for participation. Dealing with recalcitrant participants is stressful and can result in aggression being directed toward the interviewer;
- Drug users who engage in criminal activity, who may use aggression, intimidation or violence to obtain property. Thus, interviewing can result in opportunistic theft accompanied by aggression;
- Those with comorbid mental health disorders, although they typically pose little threat. Nevertheless, psychotic and delusional symptoms, such as paranoia or hallucinations, may be experienced during intoxication and/or withdrawal from some drugs, and may be associated with aggression and/or violence; and
- Populations with a high prevalence of blood-borne viral infections (BBVI) such as HIV, hepatitis C and hepatitis B. The risk to interviewers is largely manifest through needle stick injury, though the risk is compounded in situations where there is the potential for violence. Other infections such as hepatitis A should also be considered.
Adequate training of interviewers is imperative to ensure that risks to staff are minimised. Training of interviewers is almost ubiquitous in drug and alcohol research, because it is considered an essential component of ensuring methodological rigour. However, regardless of the extent of an interviewer's experience with the target population, an interviewer's lack of familiarity with specific research methodologies and interview schedules can frustrate even tolerant, cooperative research participants. Thus, project specific training should be undertaken by all interviewers. General safety training should be administered to all interviewers prior to their first contact with research participants, and should address issues generic to all interview situations.
Interview locations: The choice of interview location is an important component of ensuring interviewer safety. An appropriate interview location is one in which (1) the safety of the interviewer is never under threat; and (2) the integrity of the interview is never compromised. Characteristics of good interview locations are those:
- which are within the confines of an agency, provided that agency staff are aware of the occurrence of the interview and are well within earshot or vision;
- in which the interviewer feels secure and comfortable;
- which are familiar to the interviewer and have been utilized previously;
- which are generic fast food restaurant chains where little attention will be attracted;
- which are in well-lit, busy locations with substantial public thoroughfare; and
- in which the anonymity and confidentiality of the participant will not be compromised.
Guidelines on violence: Violence experienced by researchers can take different forms ranging from verbal abuse through to physical assault. Violence can be difficult to predict, however, the risk of violence is increased when the participant is:
- a young, intoxicated male;
- a person withdrawing from (or coming off) a drug;
- a highly agitated person;
- an angry person;
- an acutely deluded, manic or paranoid; or
- a person with a history of violence.
Participants should be assessed physically and psychologically for intoxication, this can be done by assessing:
- Gait – stooping, rigid
- Pupils – pinned or dilated
- Speech – slurred, slow, fast or erratic
- Smell – alcohol on the breath, unwashed of bingeing
- Clothes – dirty and dishevelled
- Hair and skin – dirty or untidy
- Level of consciousness
- Orientation
- Memory
- Judgement
- Mood – aggressive, forceful etc
- Comprehension
- Perception – hallucinations, paranoia
Opportunities for violence can be reduced by:
- having pairs of interviewers enter the field together;
- ensuring that agency staff are fully informed about the project and are always on the premises when interviewing occurs and;
- never interviewing a potentially violent person alone;
- fully documenting episodes of aggression and/or violence;
- ensuring the interview room is a medium to large size with two doors;
- not sitting too close to the participant and not placing the participant between you and the door (if only one door);
- keeping a reasonable distance between the interviewer and participant and placing yourself at risk to protect property or money;
- terminating the interview if you feel anxious about possible assault, or that you have lost control of the interview; and
- calling the police (and informing the participant) if necessary.
When a violent event occurs, the injured persons need to be comprehensively supported (both physically and psychologically) at the time of the event. Debriefing and support counselling should be offered.
Mandatory reporting: Information about plans to seriously hurt oneself or others, child abuse or other risk of harm could be revealed during an interview. In these cases the risk to self or others must be further evaluated, and additional assistance and referral may be required. Any incidents (whether reportable or of concern) should be reported to senior project staff, at the time they occur.
If information is revealed that a participant has plans to seriously hurt themselves, the interview should be stopped and the participant informed that a crisis clinic or a mental health professional or other authorities can be called, as needed or required by law. If significant depressive symptoms are disclosed these should be discussed with the participant, immediately if possible, and more information should be obtained.
If information is revealed that a participant has plans to seriously harm others, the seriousness of the participant’s plans should be evaluated to determine appropriate subsequent action. This may include making referrals and calling a crisis clinic, a mental health professional, or other authorities as necessary to protect other individuals and/or the participant.
If a young person discloses abuse or other risk of harm you are required by law to make a report to the Department of Community Services (DOCS). A young person is “at risk of harm” when they experience the following or when it is likely that one of these things will happen to them:
- their basic needs are not met (e.g., food, shelter, clothing);
- their psychological needs are not met or they are being treated in a way that could lead to psychological damage;
- they do not have access to required medical care;
- they are experiencing physical or sexual abuse or ill-treatment;
- there is domestic violence at home that could result in physical or psychological damage to the young person; and
- they are homeless and this has put them at risk.
Before reporting any of these issues it is important that you obtain as much information as possible to satisfy yourself that the problem is reportable. Before proceeding the matter should be discussed with your supervisor.
If this information is revealed, stop the interview and inform the participant that this issue will be discussed further (after the interview or at that point). The participant should be informed that you are required to make a report to the DOCS. Alternatively, inform the participant that they may report their circumstances themselves, though this needs to be done at time of the interview.
Biological sampling: Care should be taken whenever collecting or handling biological samples. There are four main types of samples collected at NDARC: urine, hair, capillary blood spots and venous blood. Staff undertaking these procedures should be fully trained. In all cases the following procedures should be followed:
- samples clearly labelled prior to specimen collection;
- hands washed before and after collection;
- gloves should be worn;
- dispose of waste in a biohazard bin or sharps container if appropriate;
- biological samples should be stored in a designated fridge which does not contain food (housed in the data archive room);
- spillages should be cleaned with bleach;
- in the case of hair sampling, round-tipped scissors should be used;
- Biological waste should be disposed of in a clearly marked contaminated waste bin and emptied regularly; and
- in the case of blood sampling all sharps should be disposed of in a sharps container which is emptied regularly.
In the case of venous blood sampling staff will also need to be accredited in venipuncture. Before commencing a study involving venipuncture the University’s Bio-Safety Officer in the Risk Management Unit should be contacted. Staff must also be familiar with the University’s protocols and policies on biological safety and infection control.
In the event of needle stick injury or the exposure to blood or blood products the University’s Emergency Action Protocol for Needle Stick Injury must be followed:
- Immediately wash affected area thoroughly with soap and water.
- Report incident and go to the University Health Centre or Casualty Department of the nearest public hospital within two hours.
- Complete incident report.
- Contact NSW Health Needle Stick Injury Hotline (1800 804 823).
Development of safety protocols: All institutions undertaking face-to-face interviews and field research with potentially problematic research participants should consider protocols specifically designed to maximise interviewer security. Safety protocols should be institution specific, and ratified by the institution management. Protocols must be comprehensive, yet flexible enough to accommodate a diverse range of research activities. A number of generic principles should be considered in the design of a safety protocol:
- Basic precautions can be taken in four main areas: vaccination, ensuring personal details of interviewers is known, use of mobile telephones, and adequate training and supervision.
- Acceptable interview procedures would include whether and under which conditions a researcher can go into the field alone; the number of people necessary for an interviewing team; requirements for visits to participants' homes; and issues to consider when choosing interview locations.
- Support: interviewers should feel confident about interviewing, and know that their supervisors will support them if they decide to terminate an interview due to potential or actual safety breaches.
- A logbook should be established in which the location and details of interviewers’ appointments are recorded. An interview 'monitor', a colleague who will be contactable for the duration of the interview, should be appointed to monitor the interview.
- Protocols should not be restricted to interviews conducted outside the Centre. Guidelines and precautions to ensure the safety of interviewers conducting interviews within the research institution should also be considered.
- An emergency procedure should be devised; particularly what course of action an interview monitor should take if the interviewer does not check in when expected.
- It should be mandatory for interviewers to report adverse events via a standardised written incident reporting mechanism.
- Protocols should include a specification of disciplinary action that will be taken in the case of a breach of the protocol.
Based on these points, a protocol was developed for NDARC in May 2001 and fully implemented at the beginning of 2002.