How Does Client Violence Affect Worker Health? Understanding the Attributes and Consequences of Client Violence Among Child Welfare Workers

Background: Almost all child protection services (CPS) workers encounter client violence, or physical and non-physical violence initiated by clients. With their responsibilities of keeping children safe, workers face most identified risk factors for workplace violence, including working alone, in client homes, in disadvantaged neighborhoods, and with unstable clients. Workplace consequences of violence can be grave, including decreased worker productivity, decreased service quality, increased job turnover, and compromised child safety. In addition to affecting work outcomes, violence affects workers’ physical and psychological health, both immediate and long-term. Despite high rates of client violence and its detrimental impact on worker health, few studies explore how experiences of client violence contribute to health. This study uses the work stress model and thematic and narrative analyses to delineate (a) common perceptions and health consequences in workers’ experiences of client violence and (b) how variation in the context of violent incidents influences health outcomes.

Methodology: We recruited participants from a longitudinal study of frontline CPS workers (N = 1,500) hired between September 2015 and December 2016. For the current sub-study, we examined Wave 5 data two years post-hire and included respondents who remained in child welfare (n = 630). Based on exposure to violence respondents reported in the quantitative study, we recruited a random sample of participants; the sample size was 33. Interview length ranged from 20 to 60 minutes (M = 43 minutes). Data analysis consisted of thematic analysis to show patterns in workers’ experiences followed by narrative analysis to uncover plot.

Findings: With the exception of one worker who expressed that she always “got along” with clients, all workers described violent or potentially-violent incidents. Workers commonly discussed three defining attributes of violence: the level of spontaneity; the level of personal attack; and the level of agency support and responsiveness. In attacks perceived as calculated (e.g., deliberate threats via voicemail, reoccurring attacks), workers felt more manipulated, more fearful, and less in control than in spontaneous ones (e.g., midst of removal). When workers perceived attacks as personal (e.g., revealing worker’s home address), workers felt more vulnerable than when they felt under attack as CPS worker (e.g., CPS is “the enemy”). Workers without agency responsiveness and support (e.g., no debriefing, no case reassignment), viewed violence as more troubling than others. Workers typically described one of two narratives: they perceived an attack as calculated, personal, and without agency support which contributed to heightened psychological distress or burnout; or workers perceived an attack as spontaneous, situational, and with agency support resulting in no lasting health consequences.

Conclusions and Implications: Congruent with the work stress model, findings indicated that (a) worker subjectivity is central to defining common attributes of client violence and (b) a worker’s subjective attributes of a violent incident influences its impact on health. The importance of agency responsiveness to workers’ experiences of client violence suggest that agencies could benefit from developing standardized, protocols that provide guidance in classifying incidents as violent and, in responding to incidents, consider how workers perceived the violent situation and their reactions.