Persistent Impacts of Client Violence: Emotional Health Among Child Protective Services Workers

Background

Almost all child protective services (CPS) workers experience violence from clients during service delivery, or client violence, in some form each year. Studies also document the high consequences of client violence for workers. Physical incidents commonly require medical attention and time away from work. Verbal aggression and threats relate to heightened anxiety, depression, and fear. The trajectories of violence and emotional consequences as early-career workers learn and adjust to their positions are less clear. The study assessed client violence trajectories and emotional health consequences among CPS workers within a stress process framework (i.e., violence creates stress that impacts emotional health).

Methods

The study used data from the Florida Study of Professionals for Safe Families (FSPSF), a statewide, longitudinal cohort study of child welfare workers hired in 2015-16. Workers completed surveys during pre-service training (baseline) with online follow-up surveys every six months for 3.5 years. We used validated measures to examine emotional health—psychological distress, perceived stress, personal burnout—and three types of client violence (yelling, threats, or physical violence) from six months through 3 years (Waves 2 – 7; n = 1,117-1,122 workers and n = 3,459-3,509 observations). Multi-level mixed effects regression models examined emotional health trajectories and the contribution of client violence considering job demands and supports.

Results

Descriptive analyses indicated initial high rates of client violence: over 75% of workers had been yelled at, over one-third had been threatened, and 2.5% (n = 39) had been physically assaulted during the first months of casework. Measures of emotional health were positively correlated with client violence, with stronger relations with yelling or threats (r = .11-.33) than physical violence (r = .03-.09). Although psychological distress was variable over time, general stress and personal burnout were curvilinear, peaking about 18-24 months post baseline. Experiencing threats and yelling both increased stress and personal burnout, and all three forms of violence were associated with higher levels of psychological distress symptoms. Further, although emotional health trajectories changed over time, the effects of violence did not; violent experiences were equally detrimental to emotional health symptoms at each wave of data collection. Workplace characteristics such as time pressure exacerbated the relationship between client violence and emotional health, while supervisor support buffered negative effects of physical violence.

Conclusion & Implications

The Department of Health and Human Services prioritizes protecting workers from client violence. Following the stress process model, results buttress increasing evidence about the harmful impact of client violence on workers’ emotional health and reinforces the importance of proactive and reactive agency efforts. Findings suggest the importance of policies and protocols that delineate how to handle incidents of client violence across various agency personnel, including supervisors, to provide appropriate emotional and tangible support. In addition, workers who experienced both client violence and workplace pressures are particularly vulnerable to poor emotional health. Concerted agency focus on providing additional support, particularly to workers 1-2 years in the job at the peak of emotional health symptoms, may avoid synergistic health declines due to client violence and work demands.