"the Worst Part of My Job": Client Violence Against Youth Care Workers As a Cause of Staff Turnover

Background and Purpose:

Youth care workers provide 24-hour care to emotionally disturbed youth in residential treatment centers (RTCs). Youth in RTCs typically suffer from behavioral and affective disorders that cannot be adequately managed in less restrictive placements, and many have experienced multiple psychiatric hospitalizations and/or criminal justice involvement. Youth care work is varied, unpredictable, and challenging (Baker, Fullmore, & Collins, 2008; Smith, 2014), and the pay is low (U.S. Department of Labor Statistics, 2013). Not surprisingly, staff turnover plagues RTCs (Conner et al., 2003) and threatens the ability of youth to form reliable therapeutic relationships with caregivers. While some have hypothesized that turnover in RTCs is driven by vicarious trauma, compassion fatigue, or burnout (Leon, et al., 2008; Zerach, 2013), little compelling evidence supports any causal model. This study investigates worker perspectives on the causes of turnover, asking: What processes drive turnover among youth care workers?

Methods:

This 15-month ethnographic study of “Promise,” an RTC in the Northeastern U.S., is based on 490 hours of participant observation and 64 semi-structured interviews with consenting Promise workers and management, and the analysis of documents, such as training materials, collected during fieldwork. Participant observation was documented through daily fieldnotes and research memos. With two exceptions, interviews were audio recorded and transcribed. Initial themes were identified during fieldwork and investigated iteratively in subsequent interviews and participant observation. NVivo was used to organize and code data after the completion of fieldwork, allowing the researcher to search for data that supported, challenged, or nuanced themes developed during fieldwork.

Results:

Participants commonly acknowledged that exposure to client violence was an expected part of youth care work. Youth care workers reported having been punched, kicked, bitten, choked, restrained and threatened with a sharp object, and, in one case, sexually assaulted, and that such violence was the most difficult part of their job. While administrators acknowledged that these incidents occurred, they insisted that they were difficult to avoid and minimized their emotional impact on workers. Youth care workers were particularly frustrated by their perception that administrators minimized the effects of client violence and attributed it to poor practice, and that the organization had no formalized processes for assisting workers who had experienced violence on the job.

Conclusions and Implications:

Youth care workers at Promise made a strong causal argument that client violence, in concert with inadequate management response, drives worker turnover. This argument differs from existing academic hypotheses about RTC turnover that are deductively derived from theories of vicarious trauma, compassion fatigue, or burnout. Given that client violence is linked to turnover in other social service contexts (Kim & Hopkins, 2015; Littlechild, 2005), we should view the local theory investigated here as plausible and seek to 1) better understand client violence against youth care workers, and 2) develop and evaluate organizational and individual-level interventions to reduce such violence and mitigate its effects on this vulnerable workforce.