Prevalence & Effects of Client Violence on Social Workers: Implications for Safety Training

1. Prevalence and Effects of Client Violence on Social Workers:Implications for Keeping Social Workers Safe National Association of Social Workers Florida Conference June 11, 2010 Pam Criss, PhD, LCSW Southeastern University

2. Purposes of Training • To understand what personal and organizational factors may be related to client violence toward social workers • To discover how social workers are affected when they have encountered client violence • To discover how much safety training is occurring with social workers, where training occurs and whether the training has a beneficial effect. • To discuss implications for social workers and their agencies, with particular emphasis on safety training

3. U.S. Statistics for Social Services and Health Care Bureau of Labor(BLS) statistics 2000 - 48% of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services (OSHA, 2004). BLS also reports that the violent assault injury rate for health care and social services is seven and a half times the rate for the overall private sector.

4. Reasons for increased risk to mental health professionals • Increased use of hospitals for the care of acutely disturbed individuals • Increasing numbers of chronically mentally ill people being released from hospitals without follow up care • Long waits for agency services • Low staffing rates • Low staffing rates may lead to working in isolation in agencies (OSHA, 2004)

5. Reasons for increased violence towards mental health professionals • Solo work at remote locations • Prevalence of handguns • Increased membership in gangs • Increased presence of drugs and alcohol (OSHA, 2004)

6. Reasons for increased violence towards social workers(Weinger, 2001) • Cuts in services/provisions • Increasing violence in society • Social control role for social workers – social workers are often in a position where they must set limits for clients and/or to report when clients have failed to meet court ordered requirements

7. Reasons for increasing violence towards social workers • Negative image of social workers –representatives of unwanted authority (Aren’t you the ones who take children out of their homes?)

8. NASW Center for Workforce Studies • Almost 5000 licensed social workers in the U.S. responded to the survey (135 from Florida; 4 BSW social workers replied) • 47% had some concern about their personal safety • The report concludes that “ a profession cannot successfully retain its workforce when issues of personal safety go unaddressed” (p. 35).

9. Prevalence of Client Violence against Social Workers • More than 20 studies on client violence toward social workers in the U.S. within the past 30 years. • National prevalence rates for social workers’ exposure to violence indicate that between 65% and 86% of social workers have encountered client violence at some time during their career (Beaver, 1999; Ringstad, 1995).

10. Practice exercise: Recording the numbers of client violence incidents that have occurred to you Please complete the form regarding numbers of client violence incidents that you have experienced directly or indirectly in the past year.

11. Client Violence Rates for Social Work Students • Prevalence rates for social work students’ exposure to violence in their practicum have ranged from 21% to 54% (Knight, 1999; Mama, 2001).

12. Client Violence towards Social Work Students (Criss, 2009) • Participants • Random sample of 1500 social work students from NASW national membership, with equal numbers of BSW and MSW students • Oversampled students of ethnic/racial minority groups – 1/3 of BSW and MSW students • 45.25% response rate (N = 667) • 595 students met inclusion criteria (completed or currently in field placement)

13. Prevalence of Direct Client Violence towards Social Work Students41.7% (n = 248) - Experienced some type of client violence

14. Total Number of Incidents of Client Violence Towards Social Work Students

15. Vicarious exposure to client violence • In study of 273 child protection social workers, Horwitz(2006) found that vicarious exposures to traumatic workplace events were more highly associated with trauma effects than were direct events.

16. Prevalence of Indirect Exposure to Client Violence towards Social Work Students60.2% (n = 361) Witnessed and/or heard about some type of client violence

17. Total Number of Indirect Incidents of Client Violence Experienced by Social Work Students (n = 361)

18. Failure to report client violence • When social workers are harmed by clients, they may often fail to report the incidents. • One study indicated that 8% of violent incidents were reported only verbally and only 29% were recorded appropriately (Norris, 1990).

19. Reasons for failing to report violence • Concern about how the worker will be perceived by co-workers and supervisors • Fear of criticism, rather than support • Fear that management might see them as unable to cope, being inadequate, or as unprofessional (Brown, Bute, and Ford, 1986; Norris, 1990; Spencer & Munch, 2003). “ I needed to be told that I hadn’t failed.” (Littlechild, 1997, p. 236)

20. Reasons for failure to report violence • Perception that violent incidents are part of the job • Tendency to feel that social workers should be able to take care of themselves, so they may report only the most severe incidents. • Social workers do not enter the profession thinking that they will become victims of the very people they hope to help. (Star, 1984)

21. Reasons for failure to report violence • Afraid that if they report the violence, their relationship with their client will deteriorate or that their client will face prosecution (Rowett, 1986; Star, 1984). • Both assaulted and non assaulted social workers may picture assaulted social workers as poorly functioning social workers. The non assaulted workers may see the assaulted workers as being more provocative, incompetent, authoritarian, and inexperienced (Macdonald & Sirotech, 2001; Rowett,1986).

22. Reasons for failure to report violence • Norris points out that, like child abuse, victim disclosure must occur in order for the problem to be understood and reasonably addressed. He states that “the key to knowing how to protect social workers from the most unpredictable of attacks, without imposing protective measures that destroy the helpful aspects of social work, lies in overcoming the problem of under-reporting” (p.131).

23. Which gender of social workers experiences more client violence?

24. Prevalence of Client Violence- Gender • Several studies indicate that males are at higher risk of encountering client violence than females (McLean, 2000; Newhill, 2006; Jayarante, Croxton, & Mattison, 2004; Ringstad, 2005; Beaver, 1999). • Two contradictory findings: Males had more physical assault, threats of physical harm, and threat of property damage, but females experienced more verbal abuse (Song,2005) • Male social workers in Israel didn’t experience more physical threats and assaults, though American males did. (Guterman, Jayarante,& Bargel, 1996)

25. Male social work students experienced significantly more client violence than female social work students (Criss, 2009).Males (n = 68, 11.4%), Females (n = 525, 88.5%)

26. Do older social workers or younger social workers experience more client violence?

27. Prevalence of Client Violence-Age • Younger workers in agency settings have been found to be at greater risk of physical threat, threat of lawsuit, verbal abuse and sexual harassment (Jayarante et al., 2004; Jayarante, 2005, Ringstad, 2005) • Younger workers also significantly more like to report knowing co-workers who had experienced physical threats • Younger student social workers more likely to view social work as a dangerous profession and expressed some discomfort working in inner city (Knight, 1996)

28. In national study, younger social work students did not experience more client violence, though those who were aged 25-30 experienced significantly more threats of lawsuit (Criss, 2009).

29. Do more experienced workers or less experienced workers have more exposure to client violence?

30. Prevalence of Client Violence- Job experience • Early client violence study showed that workers with 11 or more years of experience were assaulted or threatened at a ratio of 1:4 compared with workers with less than 11 years experience (Bernstein, 1981) • Less experienced workers have been found in other studies to have more exposure to client violence (Privatera, 2005; Beaver, 1999) • Less experienced social worker in U.S. had more violent incidents, though not true with less experienced workers in Israel (Guterman et al., 1996)

31. Prevalence of Client Violence- Job experience • One conflicting finding- “Professionally seasoned MSW’s” experienced more client violence that “less experienced student clinicians” (Tully, Kropf, and Price, 1993)

32. NASW Workforce Study (2006)

33. Student with no experience or less than 2 years experience had less direct exposure to client violence than students who had 3-5 years experience. Those with 3-5 years experience had significantly more verbal abuse and total client violence (Criss, 2009)

34. Do social workers of minority ethnic groups or races experience more client violence than white social workers ?

35. Prevalence of Client Violence- Ethnicity/Race • There has been little research on how social workers of ethnic minorities in the U.S. are affected by client violence. • Some evidence that social workers of ethnic minorities in the U.K. are disproportionately affected by client violence (Butt, 2000, as cited in Brockman, 2002) • One study found that non-White social workers worried more about future exposure to workplace violence, though they experienced less than White participants (Budd, Arvey, & Lawless, 1996)

36. Prevalence of Client Violence- Ethnicity/Race • Another study showed that African American social workers were significantly less likely to have fear of all types of client violence (Jayarante, Croxton, and Mattison, 2004) • Yet another study found that ethnic minorities were significantly more likely than White social workers to view the community around a school as dangerous (Astor, 1998) • One epidemiological study of several U.S. national workplace violence studies showed that African American and Hispanic workers had higher frequencies/rates of workplace violence (Kraus, 1996)

37. Native American social work students were significantly more likely to experience verbal abuse and total client violence, whereas students of mixed racial/ethnic heritage were more likely to experience threat of lawsuit and property damage.(Criss, 2009)

38. Do BSWs or MSWs experience more client violence?

39. Prevalence of Client Violence- Social Work Degree • Only two studies have reported on client violence rates with BSW social workers vs. MSW social workers. • Both found that social workers with a BSW experienced more client violence (Beaver, 1999; Privitera, Weisman, Cerulli, Tu, & Groman, 2005)

40. MSW students experienced more of every type of violence, except physical assault. They were significantly more likely to experience threat of physical harm, verbal abuse, and total client violence.MSW (n = 340, 57.1%), BSW (n = 248, 42.2%) (Criss, 2009)

41. Does client violence occur more often in an office, at a home visit or in some other place?

42. Prevalence of Client Violence-Place of Violence • A study of probation officers, about half of whom were social workers, found that they were more likely to be verbally threatened and physically intimidated in the office (Rapp-Paglicci, 2004) • One study of child welfare workers found that different types of violence happened in different places: • Threats- Client’s home • Property damage- Office • Actual attacks- Wide array of places (Newhill & Wexler, 1997)

43. Prevalence of Client Violence-Place of Violence • Two student social work studies found that incidents of violence were more likely to take place in an agency (Mama, 2001; Tully et al., 1993) • A small study of child welfare workers (n=31), 61.3% of the social workers had been threatened while on a home visit, whereas 94% had heard of a coworker being involved in a client violence situation (Castellanos, 1998)

44. Client violence during home visits • Another study with a small sample size of 15 home visiting social workers found that 93% had experienced client violence and none of them felt completely safe (Vergara, 2006) • A student study found that 48% of MSW students were concerned about their personal safety at least sometimes when making home visits. Of those, 30.1% had actually encountered verbal threats during a home visit and 45% were physically threatened during a home visit (Schwarzmueller, 1998)

45. Every type of client violence except physical assault was experienced by social work students more often in an office setting.

46. Of social work students who made home visits, those who made 11 or more home visits experienced more of every type of violence and significantly more threats of lawsuit.

47. What time of day is client violence more likely to occur to a social worker?

48. Time of day of client violence • Student study found that almost 40% of students were concerned for their personal safety during evening hours (Knight, 1999) • Another student study found that 33% experienced physical threats during evening hours (Schwarzmueller, 1998) • Analysis of seven national (non social work) studies indicated that occurrence of homicide and nonfatal assault is more frequent in the afternoon and evening hours than late morning or early afternoon hours (Kraus, 1996)

49. Social work students experienced client violence much more often during daytime hours.

50. Those social work students who worked 51-75% of their practicum hours during the evenings were significantly more likely to experience physical assault than those who worked up to 50% of their hours during the evening or those who worked almost all of their hours during the evening (Criss, 2009)