ISSUE 134 APRIL 2010 BACK

CARE WORKERS

“Aggression: Just part of the job?” “The psychological impact of aggression on child and youth workers

Kim Snow

Abstract: This pilot study examines the psychological impact of client aggression on child and youth workers. Using a structured interview format, the experiences of subjects were assessed according to the diagnostic criteria of post-traumatic stress disorder. Results suggest that client aggression is a significant factor in child and youth care practice.

Aggressive behaviour by clients has long been recognized as an aspect of child and youth work (Redl and Wineman,1952,1957; Trieschman, Whittaker, and Brendtro, 1969; Wineman, 1949). Since these early writings, many others have put forth their views of the etiology of aggressive behaviour by children and youth. More recently, writing about aggression has become a popular topic in child and youth care journals. Mullen (1983) provided a model of behavioural characteristics and internal ego dynamics typically observed during incidents of aggression. Willock (1986) postulated that aggressive behaviour is related to underlying narcissistic vulnerability. He furthered this argument in 1987 with an explication of the “devalued self.” Others have asserted that cognitive distortions are at the root of aggressive behaviour (Lochman and Lampron, 1986; Oyserman and Markus, 1990; Slaby and Guerra, 1988).

Given the extent of the literature, one would anticipate that the field would have produced several studies on the effects of aggression on child and youth workers. However, there is very little that looks at the impact this work can have on personnel. Kingsley and Cook-Hatala (1988) studied job stress and satisfaction of child care workers. They found that 50% of their sample identified job conditions, including abuse by children, as a major concern. Hunter (1989) began to look at this issue by identifying the frequency of restraints and the feelings evoked as a result of this type of intervention. In a submission to the Ontario Ministry of Community and Social Services, the Canadian Union of Public Employees (1989) outlined the hazardous working conditions their members face. They cited insufficient staff /child ratios to safely handle a child's acting out, inappropriate placement of children to settings, underfunding, poorly designed facilities, and the use of untrained part-time staff members as factors contributing to a dangerous workplace. They went on to say, “We believe that the extent and gravity of safety issues facing social service workers should warrant an extensive public review...” (p. 4). Included with their submission were 30 incident reports of violence towards workers gathered at a conference on violence in the workplace. In July 1992, the Child and Family Services Advocacy Office (Finlay, 1992) began investigating complaints of abuse of children at the Thistletown Regional Centre, Syl Apps Campus. This lengthy and disturbing report outlines the potential for institutional abuse when unqualified and poorly supported staff are expected to provide “treatment” to highly dysfunctional aggressive children and youth. The Workers” Compensation Board of Ontario does not have a classification for child and youth workers. A representative of the Board stated that claims coming from child and youth workers would likely be classed amongst several categories, including (but not limited to) correctional worker, social worker, counsellor, and day care worker. As an example, the data for social workers was compiled. The social worker category is comprised of “social workers and related occupations, community welfare workers and others in social work and related fields.” During 1991, there were 111 individual incidents of violence towards social workers that resulted in claims to the Workers” Compensation Board.

The present study attempts to identify the psychological impact of aggressive behaviour on child and youth workers. Lacking other studies specific to child and youth work, the author used the aforementioned re search to guide this study. The author hypothesizes that assault is a common experience of child and youth workers, psychological distress is experienced as a result of the assaults, and few supports are provided to assaulted workers. A semi-structured interview was developed based on this hypothesis. Diagnostic criteria for post-traumatic stress disorder (modified) is used as a measure of psychological distress. Data on the frequency of assault and the intensity of fear and intimidation were gathered. As well, respondents were asked to comment on their experiences of being supported following an assault and to generate ideas to improve responsiveness to assaulted workers.

Post-traumatic stress disorder is a stress response characterized by “reexperiencing the traumatic event, avoidance of stimuli associated with the event or numbing of general responsiveness and increased arousal.” “The most common traumata involve either a serious threat to one’s life or physical integrity” (American Psychiatric Association, 1984, p. 247). Horowitz, Wilner, Kaltreider, and Alvarez (1980) studied the signs and symptoms of post-traumatic stress disorder. Of their sample, half had “sustained personal injuries including violence, accidents and illness” (p. 87). Their results confirmed “clinical impressions of the importance and wide prevalence of episodes of intrusive ideas and feelings in states of distress precipitated by serious life events” (p. 85). Sonnenberg (1988) linked post-traumatic stress disorders to victims of violence, finding this to be a common response to victimization. Post-traumatic stress disorder is recognized in the DSM III-R (American Psychiatric Association, 1984) as indicative of psychological distress including physiologic reactivity.

Method
Subjects
Twenty child and youth workers (16 females, 4 males) volunteered to participate in the study. The subjects were self selected, responding to a request for subjects sent to various child mental health agencies and a local university. Subjects were required to have a minimum of four years” post-graduate experience. This was required as an attempt to ensure that subjects were career child and youth workers, not simply temporarily in the field. The mean age of the subjects was 33.55 years (SD 5.4818). All held a community college diploma in child and youth work, and 35% were continuing their education at university. They had a mean of 12.5 years of experience working in the field (SD 5.5678). Their experience included working at a mean of 4.9 agencies (SD 2.1250) in a mean of 6.35 types of programs (SD 1.8715) (residential, day treatment, rural, etc.). Table 1 shows the current titles of the subjects. Lacking data on the typical demographics of trained child and youth workers, the sex and employment position of the subjects was an attempt to reflect the population in Ontario.

Table 1
Current title (Question 5)
 
CYW
Student
Supervisor
Manager
Educator
70%
5%
10%
10%
5%

Design
A semi-structured interview was designed to gather information on characteristics of subjects, frequency of assault and intimidation, degree of psychological distress, and subjects” comments on the topic (see Appendix 1). Questions 17, 18, and 21 specifically gather data on post-traumatic stress disorder. Question 17 examines symptoms of re-experiencing trauma. To meet the criteria of experiencing this symptom, respondents are required to exhibit at least one of the four symptoms. Question 18 examines symptoms of avoidance or numbing of responsiveness. To meet the criteria for experiencing this category, subjects are required to exhibit at least three of the seven symptoms. Question 21 examines the symptoms of increased arousal. To meet the criteria of experiencing this symptom, subjects are required to experience two of the seven symptoms. For this study, subjects that met the criteria in each of the three categories were deemed to have experienced psychological distress. The DSM III-R (American Psychiatric Association, 1984) outlines each of these categories (and the same number of symptoms to meet the criteria) and a requirement that the symptoms have a duration of at least one month. As this study is retrospective, the information concerning duration was not gathered. This study does not attempt to diagnose subjects as having post-traumatic stress disorder. Rather this diagnostic criteria is used as a means of identifying psychological distress.

Procedure
Subjects were interviewed using the questions outlined in the semi-structured interview (Appendix 1). All interviews were audiotaped, and confidentiality was assured. The subjects were encouraged to relate stories or to comment at any time during the interview. For this pilot study, definitions were loosely defined in order to gather a wide range of responses. Pretests of the interview found that child and youth workers were reluctant to describe patient action as assault and that they deemed being bitten, kicked, and scratched to be simple job hazards. Assault was therefore defined by the investigator as “any time you were physically harmed as a result of intentional client action.” Weapons were defined as “any object being hurled towards you.”

Results
The volume of data gathered from the interviews was substantial. Due to the semi-structured nature of the interview, more data was obtained than directly asked for. This paper will focus on the data obtained as a result of directly asked questions. The remaining data will be analyzed and reported in future papers.

Assaultive incidents
Questions 7 (a) to (f) were used to determine the frequency of assaults on subjects. This question was difficult for subjects to answer and demonstrated a flaw in the research design. Subjects found it difficult to remember the number of times they were hit, often commenting that it was “too often to count.” Ninety percent of the sample reported having been hit by a client using a open hand. Table 2 indicates the number of times a subject was hit by a client using a open hand. The data is presented in ranges based on the lowest range a subject indicated. For example if a response was “between 25 and 50,” the response was included in the range of 20-30.

Three quarters of the sample reported having been hit by a client using a closed fist. It is interesting to note that in the frequency ranges, all the respondents indicating that they had been hit with a closed fist 90 to 100 times were male. Table 3 shows the number of times subjects were hit by a client using a closed fist.

Table 2
Number of Times Hit (Open Hand)

Percentage of Respondents
  0
1-10
10-20
20-30
30-40
40-50
50-60
60-70
70-80
80-90
90-100
10%
35%
30%
25%
0%
0%
5%
0%
0%
0%
5%


Table 3
Number of Times Hit (Closed Fist)
Percentage of Respondents
0
1-10
10-20
20-30
30-40
40-50
50-60
60-70
70-80
80-90
90-100
25%
55%
5%
5%
0%
0%
0%
0%
0%
0%
10%

All of the subjects reported being kicked. Many respondents chose to count only those incidents in which they were kicked very hard. As well, many subjects commented that they were frequently kicked in the process of physically restraining a child, rather than directly being kicked. Table 4 shows the frequency in which subjects reported being kicked.

Table 4
Number of Times Kicked

Percentage of Respondents
0
1-10
10-20
20-30
30-40
40-50
50-60
60-70
70-80
80-90
90-100
0%
20%
40%
15%
0%
0%
15%
0%
0%
0%
10%

Subjects reported that they had frequently had objects hurled toward them. Every respondent had been hit by clients using weapons. Table 5 shows the number of times each type of weapon was mentioned. Furniture was the most frequently cited, including chairs, couches, lamps, tables, and so on. Sports equipment was the second most frequently mentioned, including hockey sticks, baseball bats, balls, and so on. Kitchen equipment, books, and knifes were tied as the third most frequently mentioned weapons.

Table 5
Types of Weapons

Number of Times Reported
Metal
Kitchen equipment
Kitchen utensils
Wood
Knives
Books
Toys
Glass
Food
Office supplies
Office equipment
Stones
Clothing
Sports equipment
Furniture
Cleaning supplies
Miscellaneous

3
8
6
6
8
8
6
4
5
4
4
4
5
11
14
4
3

All subjects had been spit at by clients. Most subjects reported that they had been spit at more times than they could count. Responses ranged from being spit at 5 to 100 times. The methodological flaw of this question makes it impossible to interpret how often child and youth workers are spat at. Of the sample, 95% reported being verbally assaulted at work. Again, this question was asked in such a way that subjects had difficulties defining how often, but 60% reported being verbally assaulted daily, 15% weekly, and 15% frequently.

Forty percent of the subjects reported being off work as a result of physical aggression toward them by a client: 15% reported being off work once, 10% twice, 10% three times, and 5% eight times. This time off ranged from one to five days. Unfortunately, the subjects were not asked if they should have taken time off work. Several people reported that they needed time, but were unable to take it. It would also be interesting to determine if sick days increase following assaultive incidents. This result is also interesting when it is compared to the 75% of the subjects that reported needing medical attention as a result of client action: 45% received medical attention once, 20% twice, 5% three times, and 5% four times. Many people also indicated that there were times they needed medical attention but did not receive it. Of the subjects needing medical attention, 45% received treatment at an emergency department, and the remainder were seen by their own physician. Subjects needing medical attention tended to have multiple injuries including bruising, rug burns, cuts, and bites. Several subjects required stitches or had back or neck injuries, and one had wood embedded in a leg. The interviewer was shown scars by several subjects that were results of work with aggressive clients. Three subjects have permanent injury as a result of patient action (knee damage, chronic back and neck pain).

Fear and intimidation
Few subjects reported having nightmares as a result of fear or intimidation. Nightmares were experienced by 30% of the sample as a fesult of physical aggression toward them. Having nightmares as a result of fear or threat of physical aggression was reported by 30%. Feeling fearful of imminent personal (physical) danger at work was reported by 90% of the sample, and 85% reported feeling fearful of the potential for personal physical danger at work.

Symptoms of psychological distress
Ninety percent of the sample met the criteria of having one or more symptoms of re-experiencing the trauma, while 75% reported recurrent and intrusive distressing recollections of an incident. Recurrent and distressing dreams were reported by 10%. The experience that an incident was reoccurring was reported by 25%. Events, places, sights, or smells triggered memories for 65% of the sample. Table 6 illustrates the number of symptoms in this category reported by subjects.

Table 6
Number of Symptoms (Re-experiencing Trauma)
 
Zero
One
Two
Three
Four
10%
20%
55%
15%
0%

 The criteria for avoidance or numbing of responsiveness requires that the subject experience three or more symptoms. This criteria was met by 75% of the sample. Trying to avoid thoughts or feelings associated with an incident was reported by 40%. Avoiding activities or situations that arouse recollections of an incident was reported by 60%. The inability to recall aspects of an incident was reported by 50%. Difficulties maintaining interest in usual activities was reported by 75%. Feeling detached or estranged from other people was reported by 65%, and 40% found it difficult to experience a full range of feelings following an incident. Table 7 shows the number of symptoms reported by the subjects.

Table 7
Number of Symptoms
(Avoiding or Numbing of Responsiveness)
 
Zero
One
Two
Three
Four
Five
Six
Seven
0%
15%
10%
15%
10%
30%
20%
0%

Increased alcohol intake, commonly believed to be equated with emotional distress, was reported by 60% of the sample following incidents. One quarter of the sample reported using drugs or increasing the frequency of drug use following an incident.

The criteria of experiencing two or more symptoms of increased arousal was reported by 85% of the sample. Difficulties falling or staying asleep was reported by 75%. Irritability or outbursts of anger was experienced by 75%, and 80% reported difficulties concentrating. Hypervigilance was reported by 55%. Exaggerated startle response was cited by 50%, and physical symptoms to psychological triggers were reported by 40%. Table 8 shows the number of symptoms of increased arousal reported by subjects.

Table 8
Number of Symptoms (Increased Arousal)

 
Zero
One
Two
Three
Four
Five
Six

10%
5%
5%
20%
20%
25%
15%

As mentioned earlier, three categories (re-experiencing trauma, avoidance or numbing of responsiveness, and increased arousal) are indicative of psychological distress. In this sample, 75% met the criteria in each of the three categories. This appears to support the hypothesis that child and youth workers experience psychological distress as a result of their work with aggressive clients.

Response to assaulted workers
Of the sample, 70% felt it was their fault that they were injured or assaulted. This may reflect an additional symptom of psychological distress, or a response to the systems in which they work. For example, 55% of the sample identified others with whom they work as making them feel that it was their fault they were injured or assaulted. This group identified the following as making them feel it was their own fault: supervisors /employers 53.33%, other disciplines (social workers, teachers, etc.) 20%, co-workers 20%, and parents 6.67%. When asked if child and youth workers coming into the field should expect to be assaulted at some point in their career, 95% said yes. It should be noted that many subjects took exception to the phrase “expect,” preferring to state that it is very likely they will be assaulted.

The subjects were very clear about the support that injured and assaulted workers need from their employers and co-workers. Having a designated person or therapist available to be supportive and assist the worker in exploration of feelings was desired by 90% of the sample. Three-quarters of the sample felt that workers” feelings and stress reactions need to be validated in a caring, non-judgemental, non-blaming manner. Being relieved from duties or given time off to recuperate with pay was identified by 65% of the sample. A management policy of zero tolerance of assault on staff in most settings was identified by 40%, including ensuring that children are appropriately placed in facilities. Thirty percent of the sample identified that staff need the support of working with other qualified child and youth workers. A safe physical plant and adequate crisis support was identified by 25% of the sample. Ongoing training was identified by 20%, and most felt that the emphasis should be on psychopathology rather than physical intervention. Several people commented on the expectation that child and youth workers will be assaulted as part of their job, and therefore are not viewed as requiring support. As one person commented, “We react strongly when other disciplines get hurt, but not when a CYW gets hurt.”

After they were injured or assaulted, 35% of the sample felt that they were given the necessary supports. Comments included, “I was emotionally responded to,” “No blame, just support,” “Provided time off with pay, medical coverage and access to the trauma team,” “They took me to the hospital and when I returned, I was on a reduced work load.” Fifteen percent of the sample felt that they only sometimes received the necessary supports. Comments included, “Co-workers are supportive, not management,” “Responses from supervisors ranged from “you had it coming to you” to “it must have been very difficult to deal with–,” and “Good supervisors give workers good responses, poor supervisors lack empathy and understanding.” The remaining 50% of the sample felt they had not received adequate supports when they were injured or assaulted. Comments included, “I was off two weeks, no one even called to see if I was ok,” “There was no support from the supervisor,” “Just part of the job-no discussion,” “Employers blame workers,” “Not taken seriously, left alone, people react by withdrawing,” “Employers too distant, not sensitive, not supportive,” and “More concerned with clients than injured staff.”

It is worth noting that several subjects commented that it is the system that is the problem, not the clients. There was general acceptance that some aggressive acting out is bound to occur in this work. However, the problem is exacerbated by a crisis-driven system that is under-funded and that inappropriately places children in programs based on the availability of space, rather than appropriateness to their need.

Reducing the frequency of aggression/assault
Subjects were clear and articulate about their thoughts on what the field could do to reduce the number of assaults on child and youth workers. The most common response, cited by 85% of the sample, was a change in program policies and philosophies. Overall, it was felt that programs tolerate too much aggression, resulting in clients fulfilling the expectation of becoming aggressive and assaultive. A philosophy of cathartic release through aggressive acting out still remains at a management level. This high level of tolerance has contributed to the minimization of the impact that aggressive incidents have on staff and clients. Non-child and youth workers lack the training and understanding of the impact that assaultive behaviour has on the therapeutic relationship between staff and clients. Policies need to include a plan to reduce the emphasis on physical restraints with a goal of an eventual ban in a majority of settings.

College training and hiring standards were identified by 80% of the sample. Subjects identified the need for system-wide mandatory hiring of workers with diplomas in child and youth work. Workers without training lack the skills necessary to anticipate, contain, and de-escalate aggressive situations, posing a hazard to safety. The training at the college was also seen as in need of expansion. Subjects felt that the curriculum needs to place more emphasis on psychopathology, counter-transference, assessment skills, and group dynamics. Subjects also felt that the colleges need to work more closely with the agencies to keep abreast of trends. Many people commented that the colleges promote the philosophy that being assaulted is part of the job. College training should focus on encouraging child and youth workers to find alternatives to physical intervention. Students should be helped to understand that they need to be and feel safe in order to provide a therapeutic milieu for their clients.

Support and supervision was identified by 75% of the sample as needing improvement. Qualified supervisors need to be hired and trained to provide support and guidance to frontline staff. Supervisors of child and youth workers must hold a CYW diploma and have a variety of frontline experience. Programs working with aggressive clients need support groups for staff to deal with the countertransference issues that emerge. Supervision practices need to get away from a policing or theory X model and move towards a human resource, support model.

Restructuring the children's mental health system to incorporate ranges and levels of intrusive intervention was identified by 50% of the sample. It was felt that the current services were inadequate and that aggressive and “hard to serve” children in particular are being inappropriately placed. Services to families need to be expanded, and services need to be provided that range from the least to the most intrusive. Systems need to be flexible so that clients can move through the system to the level of intervention they need. Staffing experience levels need to match the level of disturbance. Currently, residential programs (where subjects reported the most serious assaults) are staffed by the least experienced staff, but house the most disturbed clients. High-risk programs need to have increased staff /client ratios and crisis support systems in place.

Other categories were identified as means of reducing the number of assaults on child and youth workers. Mandatory continuing education and training was identified by 45% of the sample. Increased status, recognition, and public awareness of child and youth workers and children's mental health services were identified by 40%. Safety precautions including liaison between mental health workers and police, standards of physical plant, and mandatory ministry reviews of critical incidents were identified by 25%. Educating the media and society at large about the cycle of violence and children's responses to our increasingly violent society was identified by 10%. Ensuring that the children's right to refuse treatment does not conflict with what’s in their best interest was identified by 10%.

Subjects who chose to make additional comments on aggression and assault viewed aggression as a societal problem. Following is a summary of the themes that emerged in these responses. Society’s tolerance and expo sure to aggression has been steadily increasing. Children are exposed to excessive violence on television and film. Stress on families has increased and parents have little time to spend with their children. Child and youth workers, too, have become overly tolerant and desensitized to aggression. Changes need to occur at a macro level. Government and society alike need to begin to address this problem through primary prevention efforts. Many subjects felt child and youth workers had a role in advocating and promoting programs aimed at addressing society’s attitudes and behaviours around violence. Advocacy was also deemed necessary to increase the status and awareness of children's mental health issues.

Discussion
The data gathered for this study were obtained retrospectively. The subjects were asked to think back throughout their career to answer the questions posed in the interview. In particular, the subjects were encouraged to remember and discuss highly emotional and troublesome events. It is quite likely that the subjects” memories and perceptions of particular incidents were distorted over time. This represents a methodological flaw inherent in this type of research. As well, this study was designed as a pilot study. The sample size is too small to generalize on its own. Rather, it is intended, with support of existing research, to determine if there is a need for future research. As such, caution needs to be used in drawing conclusions from these data. However, much can be gleaned from examining these results and exploring the implications of this data. This study highlights the need for another study to be conducted over several years (in a variety of settings) to more fully explore this area. That the hypothesis is supported within this pilot study further reinforces the need for attention being devoted to this area.

The hypothesis that aggressive acting-out by clients is commonly experienced by child and youth workers is supported by these data. All subjects had been physically assaulted by clients at some point in their career. Further, 90% of the sample had felt fearful at work that they were at risk of physical danger. Another 85% had felt fearful about the potential for physical danger at their workplace. All subjects had been hit with and had weapons thrown at them in the course of their career. That 75% of the subjects needed medical attention further highlights the seriousness of this issue. As well, 95% of the sample said that graduate child and youth workers are likely to be assaulted at some point in their career. These data support other research that has been carried out in Ontario. Hunter (1989) concluded that “it remains obvious that dealing with out-of-control behavior in youth is a fact of life for frontline staff” (p. 150). In their submission to the Ministry of Community and Social Services” young offenders residential system review, the Canadian Union of Public Employees (1989) argued that staff safety is a concern in all children's services programs in which their members work. Their report has a 20-page appendix of reports of violence against workers by clients. Assaults on child and youth workers are not a new problem, nor are they likely to completely go away. As such, it is time that the field endeavour to understand the impact this aggressive behaviour has on its service providers and develop services to support them.

This study also finds that child and youth workers experience psychological distress as a result of assaultive behaviour by clients. Three-quarters of the sample met the criteria in each of the three categories (re-experiencing trauma, avoiding or numbing of responsiveness, and increased arousal) indicative of experiencing psychological distress. Symptoms of re-experiencing the trauma were reported by 90%. To meet this category’s criteria, subjects need only experience one such symptom. However, in this sample, 70% experienced two or more symptoms. This concurs with Horowitz’s et al. (1980) finding that intrusive ideas and feelings were commonly experienced by subjects with post-traumatic stress disorder. Avoiding or numbing of responsiveness was reported by 75% of the sample. Further, 85% of the sample experienced symptoms of increased arousal. An increase in alcohol intake following incidents was reported by 60% and drug use by 25%. This presents a rather dismal picture of the impact this work has on our treatment providers.

This study also confirmed the hypothesis that few supports are available for assaulted child and youth workers. Having a person available to process through feelings was identified as a necessary support for assaulted workers by 90% of the sample. Hunter (1989) also found that staff experienced a variety of troublesome feelings when managing aggressive behaviour, which they also wanted the opportunity to work through. Seventy percent of this sample felt it was their fault that they were injured or assaulted. Furthermore, 55% identified others who had made them feel it was their own fault. This study found that 75% of the sample met the identified criteria of experiencing psychological distress.

Not worked through, these feelings will at the very least impede on the quality of treatment provided to those in care. Likely, they will be acted out, in one manner or another, within the milieu. The abuse reported at Thistletown Regional Centre’s Syl Apps campus is perhaps a tragic example of what can happen when support is not provided for workers who work with aggressive clients. That the workers hired at Syl Apps were primarily untrained simply highlights a system that provides little support to its treatment programs. A program that claims to provide treatment or care for some of the hardest-to-serve clients in Ontario must hire qualified workers. It is incomprehensible that the Government of Ontario would allow untrained, poorly supported workers to be charged with the responsibility of caring for and treating these youth. Not only is the disregard the government has for its troubled children morally reprehensible, but it contradicts the principles of international law, as outlined in the “Convention on the Rights of the Child.” Although not the only violation, the situation at Syl Apps and other programs (based on these data) are in direct violation of article 3, subsection 3 (United Nations, 1991):

State Parties shall ensure that the institutions, services and facilities responsible for the care and protection of children shall conform with the standards established by competent authorities, particularly in the area of safety, health, in the number and suitability of their staff, as well as competent supervision. (p. 3)

These data, the CUPE report (1989), and the office of the Child and Family Service Advocacy report (Finlay, 1992) suggest that the “State” is not meeting its obligation to provide institutions and services that comply with standards around safety, the number and suitability of staff, and competent supervision.

That assaulted workers” stress reactions and feelings should be validated in a caring, non-blaming, supportive manner was cited as a necessary support by 75% of the sample. Relief from duties or reduced work load was deemed necessary by 65%. Interestingly, 75% of this sample needed medical attention, yet only 40% had time off from work. One would expect that victims of violence would at the very least be afforded support, counselling, and time to heal. However, 65% of this sample did not receive the necessary supports when they were injured or assaulted.

Clearly, supports are not in place for workers or children in the Ontario child welfare and health care system. Supports that are in place within programs are provided in a haphazard manner, usually as a result of indi vidual efforts. Subjects frequently recalled incidents with considerable emotion, even though in some cases many years had passed. The sheer number of stress symptoms reported in this study warrants increased attention to this matter. However, given that child and youth workers are charged with the care and treatment of vulnerable children, this matter requires urgent system-wide intervention. Caring for these children is at the best of times emotionally and physically demanding. However, if workers feel abused, blamed, and unsupported, they cannot possibly provide the level of support and care these children require. As long as workers in Ontario are being victimized and revictimized by the system in which they work, the quality of care for these vulnerable children will remain inadequate.

The sample studied represents experienced child and youth workers. In many ways, this study allowed the author to tap into the wealth of knowledge and experience these people have. Collectively, this sample has 250 years of experience in working with Ontario’s troubled children and youth. Their recommendations as to ways the field could reduce the number of assaults on child and youth workers are based on first-hand experience. Four clearly identifiable recommendations emerged out of individual interviews.

The implications of this study are far-reaching. It brings into question societal values, particularly in regards to tolerating aggression within society and the disregard shown to children's mental health issues. Within the social service system, this study identifies a system in which little value is placed on treatment providers or their safety. Ultimately, this compromises care and places children and youth at further risk. Within agencies, it identifies the need for philosophic and policy reviews aimed at providing safe and supportive milieu programs. For professional child and youth workers, the results of this study beg for more research, innovations, and discussions on programs that reduce or safely contain aggressive acting-out. The need is identified for professional organization and advocacy, continued education, a career path, and a strong voice to highlight and identify these issues facing our profession and inhibiting the quality of care for Ontario’s most vulnerable children. These outlined implications are far from exclusive. In fact, this study highlights broad systemic-based problems within the social service system in Ontario. As such, future papers will be written to analyze and discuss the implications of this data at length.
 

Appendix 1

M/F______             DATE_____________

Please fill in the following information:
1) AGE:     18-24; 24-30; 31-35; 36-40; 41-45; 46-50;  51-55;  56-60;  61-65

2) EDUCATION
Please complete the line(s) that most clearly apply to you:

Certificate Received from                                                                                 Date graduated
Diploma Received from                                                                                     Date graduated
B.A. Received from                                                                                              Date graduated
M. A. Received from                                                                                            Date graduated
Ph.D. Received from                                                                                            Date graduated

EXPERIENCE

3) Total number of years experience working in the field ______
4) Total number of agencies worked for during your career______
5) Your current title______________________

6) Check each of the following that you have had experience working in over the course of your career:

Group Home
Residential Treatment Center
Rural Program
School Board
Day Treatment Center
Detention Center
Open Custody
Closed Custody
Family Support
Parent Education
Community Mental Health
Early Intervention
Psychiatric Center
Street Work
Other (please list)

The following questions refer to events that have occurre over the course of your career:

7) Have you ever been hit by a client using a:

a) Open hand                        b) HOW MANY TIMES
c) Closed fist                         d) HOW MANY TIMES
e) Foot (kick)                        f) HOW MANY TIMES

8) Have you ever been hit by a client using a weapon against you?

a) No         Yes                    b) What weapon(s)

9) Have you ever been spit at by a client?

a) No         Yes                    b) How often

10) Have you ever felt in your work that you were being verbally assaulted?

a) No          Yes                    b) How often

11) Have you ever been off work as a result of physical aggression towards you by a client?

a) No         Yes                    b) How many times                    c) For How long

12) Have you ever needed medical attention as a result of physical aggression towards you by a client?

a) No         Yes                    b) How many times
c) in-patient                     emergency treatment                     physician's office
d) Describe

13) Have you ever experienced nightmares as a result of a physical aggression towards you by a client?
No            Yes

14) Have you ever experienced nightmares as a result of fear or threat of physical aggression towards you?
No             Yes

15) Have you ever, in the course of your work, felt the fear of imminent personal (physical) danger?
No             Yes

16) Have you ever, in the course of your work, felt fearful of potential personal physical danger? No             Yes

These questions refer specifically to incidents of physical aggression/ assault towards you. Some of these questions are personal in nature. I remind you that all answers are confidential and will not be identifiable to you.

17)
a) Have you ever experienced recurrent and intrusive distressing recollections of an incident? No             Yes

b) Have you ever experienced recurrent distressing dreams of an incident? No             Yes

c) Have you ever experienced the feeling that an incident was reoccuring? No             Yes

d) Were there events, places, sights, or smells, etc. that triggered a memory of an incident or the experience that it was reoccurring? No             Yes

18)
a) Have you ever tried to avoid thoughts or feelings associated with an incident? No             Yes

b) Have you ever tried to avoid activities or situations that arouse recollections of an incident? No             Yes

c) Have you been unable to recall aspects of an incident? No             Yes

d) Following an incident, has it ever been difficult for you to maintain your usual interest in activities that are important to you?  No             Yes

e) Following an incident, have you ever felt detached or estranged from other people?
No            Yes

f) Following an incident, have you found it difficult to experience a full range of feelings?
No             Yes

g) Following an incident, has it ever been difficult to think about the future? No             Yes

19) Has your alcohol intake ever increased following an incident? No             Yes

20) Have you used drugs or increased the frequency of drug use following an incident?
No             Yes

21) Have you experienced any of the following after an incident:

a) Difficulty falling or staying asleep: No             Yes
b) Irritability or outbursts of anger: No             Yes
c) Difficulties concentrating: No             Yes
d) Hypervigilance: No             Yes
e) An exaggerated startle response: No             Yes
f) Physical symptoms to psychological triggers of the incident: No             Yes

22) Have you ever felt it was your fault that you were injured/assaulted? No             Yes

23) Have others made you feel that it was your fault that you were injured or assaulted?
a) No             Yes
b) Who? (by discipline or title only)

24) Do you think that people coming into the child and youth care field should expect to be assaulted at some point in their career? No             Yes

25) What supports do you feel injured or assaulted workers need from their employer and coworkers?

26) If you were injured or assaulted, did you receive the supports necessary from your employer and co-workers:
a) No             Yes
b) Explain:

27) What do you think the field could do to reduce the number of assaults on CYW–s?

28) Are there any additional comments that you would like to make in regards to aggression and assault?

THANK YOU FOR YOUR TIME

_________________

References

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Canadian Union of Public Employees, Ontario Division. (1989). Submission to the Ministry of Community and Social Services” Young Offenders Residential Systems Review. Toronto: Author.

Finlay, J. (1992). Report by the Office of Child and Family Service Advocacy: Care of youth at Thistletown Regional Centre Syl Apps Campus. Toronto: Ministry of Community and Social Services.

Horowitz, M.J., Wilner, N., Kaltreider, M.D. and Alvarez, M.A. (1980). Signs and symptoms of posttraumatic stress disorder. Archives of General Psychiatry, 37. pp. 85-92.

Hunter, D. (1989). The use of physical restraint in managing out-of-control behavior in youth: A frontline perspective. Child and Youth Care Quarterly, 18, 2. pp. 141-154.

Kingsley, T.R.F. and Cook-Hatala, C. (1988). A survey of child care workers: Implications for administrators regarding job stress and satisfaction. Child and Youth Care Quarterly, 17, 4. pp. 281-287.

Lochman, J.E. and Lampron, L.B. (1986). Situational social problem-solving and self-esteem of aggressive and nonaggressive boys. Journal of Abnormal Child Psychology, 14. pp. 605-617.

Mullen, J.K. (1983). Understanding and managing the temper tantrum. Child Care Quarterly, 12, 12. pp. 59-70.

Oyserman, D. and Markus, H.R. (1990). Possible selves and delinquency. Journal of Personality and Social Psychology, 59, 1. pp. 112-125.

Redl, F. and Wineman, D. (1952). Controls from within: Techniques for the treatment of the aggressive child. New York: MacMillan.

Redl, F. and Wineman, D. (1957). The aggressive child. Glencoe, IL: The Free Press.

Schowalter, J.E. (1985). Countertransference in work with children: Review of a neglected concept. Journal of American Academy of Child Psychiatry, 25, 1. pp.40-45.

Shamsie, J. and Sykes, C. (1992) Continuity of care for conduct disordered youth: Is collaboration among agencies the answer? Toronto: The Institute for the Study of Antisocial Behaviour in Youth.

Slaby, R.G. and Guerra, N.G. (1988). Cognitive mediators of aggression. Cambridge, MA: Harvard University, Department of Human Development.

Sonnenberg, S.M. (1988) Victims of violence and post-traumatic stress disorder. Psychiatric Clinics of North America, 11. pp.581-590.

Trieschman, A.E., Whittaker, J.K. and Brendtro, L.K. (1969). The other 23 hours: Child care work in a therapeutic milieu. Chicago: Adline.

United Nations. (1991). Convention on the rights of the child. Ottawa: Human Rights Directorate, Department of Multiculturalism and Citizenship, Canada.

Willock, B. (1986). Narcissistic vulnerability in the hyperaggressive child: The disregarded (unloved, uncared-for) self. Psychoanalytic Psychology, 3, 1. pp. 59-80.

Willock, B. (1987). The devalued (unloved, repugnant) self “A second facet of narcissistic vulnerability in the aggressive, conduct-disordered child. Psychoanalytic Psychology, 4, 3. pp. 219-240.

Wineman, D. (1949). Group therapy and casework with ego disturbed children. Social Casework, 30, 3. pp.110-113.

 

This feature: Snow, K. (1994). “Aggression: Just part of the job?” The psychological imapct of aggression on child and youth workers. Journal of Child and Youth Care, 9, 4. pp.11-29.

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