2001 Finding Better Ways Conference Presentation Recap
Traumatic Stress, Turnover and Peer Support in Child Welfare
Phillip Howe and Corinne McDonald
Children's Aid Society of Toronto
The issue of staff turnover is perhaps the most important problem facing front-line service delivery in child welfare. Among the contributing factors to worker turnover are stress, including traumatic stress, feelings of job dissatisfaction due to overwhelming accountability requirements, and concern over liability. The Children's Aid Society of Toronto, with approximately 700 staff, is one of the largest board operated child welfare organizations in North America. The Society has been involved in three recent initiatives to better understand the ongoing stressors encountered by child welfare staff and to develop responses to mitigate the impact of stress and retain staff.
Stressors in Child Welfare Research Study
In partnership with the University of Toronto, data was collected from 175 survey respondents and 20 interview subjects researching levels of post-traumatic stress, depression, and other stressors among child welfare staff. Established clinical tools such as the Impact of Events Scale (a scale to measure traumatic stress) and the Beck Depression Inventory were incorporated into the questionnaire.
The findings of this study demonstrate that child welfare staff are exposed to a significant degree of traumatic stimuli. Approximately 20% of staff in all job categories had been victims of assault on the job and 50% had been verbally threatened. One quarter experienced the death of a child for whom they had service responsibility and 1/6 had an adult die. Other traumatic events included group home riots and attending coroners' inquests. In total, 82.7% of respondents reported encountering a traumatic event on the job and 70% of these workers reported significant emotional distress as a result.
Scores on the Impact of Events Scale (IES) corroborated these subjective ratings of emotional distress. The mean score of all respondents on the IES was 29.5. When data for social workers within the agency were reviewed independently, their mean score was 34. These scores are considerably higher than the cut-off point on the IES associated with a diagnosis of Post Traumatic Stress Disorder (26). Seventy-six percent of family service social workers and 87.5% of other social workers scored above 26. Results of the Beck Depression Inventory scored staff within normal ranges. Respondents reported high levels of support from colleagues, family and management. Interestingly, despite high reported levels of support, none of the measures of social support were significantly associated with scores on the Impact of Events Scale. That is, while support may be important in many ways, it does not appear to reduce symptoms of traumatic distress. Levels of social support from family and colleagues were, however, moderately related to depression scores. That is, people with higher levels of support reported lower levels of depressive symptoms.
It is important to consider the impact of staff's post-traumatic distress on worker client interactions, case decision-making and time management. For example, what is the impact of the anxiety and hyper-vigilance characteristic of post-traumatic stress on a worker's decisions when opening a case, apprehending a child, making court recommendations and assessing risk? It is possible that workers operating in an anxious or defensive state will be over-cautious in their choice of interventions. This may result in increased workload and hostile reactions from clients, thus perpetuating two of the stressors ranked highly in the study.
Management IES scores, while below those of front-line staff, also fell above the range associated with PTSD diagnosis. How is this post-traumatic stress manifested in the areas of supervision and policy development, and what influence might post traumatic stress have on the design of procedures and documentation systems considered by most survey respondents as excessive?
There is likely an interactive component among the post-traumatic stress felt by front-line staff, management and clients that significantly impacts the work of the agency. Understanding and then interrupting this cycle may have positive benefits in reducing stress and workload. Reducing staff exposure to traumatic events through improved safety procedures is also critical in order to reduce levels of trauma within the organization.
Study on Staff Retention
The costs of staff turnover include issues of recruitment, training, quality and continuity of service to clients, and staff morale. Utilizing consultation groups, interviews and surveys completed by former staff, and a review of relevant literature, the study on staff retention attempted to understand the reasons staff leave child welfare. Recommendations to reduce worker turnover address philosophical, structural and practical aspects of organizational culture and child welfare practice.
The statistics are alarming. From 1996-2000, terminations in family service more then tripled. Adding internal staff transfers and terminations together, 93% of intake and 79% of family service workers terminated or transferred from their jobs over the two year period including 1999 and 2000. Remarkably, when compared to available statistics from other Ontario Children's Aid Societies, CAST statistics were slightly below average.
Job stress and workload were strongly referenced as critical factors in staff decisions to terminate their employment. Workload volume was perceived by many respondents as beyond their capacity, and contributed not only to dissatisfaction, but also to feelings of vulnerability, frustration toward management and emotional exhaustion. Other major factors influencing staff transfers or terminations included concern for personal safety and well-being, dissatisfaction with adversarial relationships with clients, and the incongruence of high responsibility and low levels of autonomy. Accountability mechanisms, supervisory check-ins, and documentation requirements were perceived to be excessive.
Following a number of highly publicized inquests (resulting in more than 400 recommendations), child welfare in Ontario has been faced with the task of integrating massive reforms. An emphasis on accountability and liability has led to increases in documentation and workload. A focus on protection and risk assessment over preventive services, and an increase in apprehensions and court activity, has led to contacts with clients becoming increasingly challenging and contentious.
Addressing staff turnover and the issues behind it cannot be accomplished by just doing things differently. It requires reflection and a significant philosophical adjustment. High workload and job stress are the result of the attitudes and philosophies behind our approach to service, and there are many difficult choices to be made. Do we emphasize tools and quality control measures to ensure good service to clients, if these processes may be linked to higher workload, job dissatisfaction and turnover? What is the balance between "thinking dirty" in our investigative work and offering the clinical support that clients and employees find meaningful?
Feedback from staff who have transferred or terminated from child protection gives clear direction to what is currently wrong in child protection and what measures need to be taken to motivate and retain staff. The current emphasis on risk discovery, liability and accountability is insufficient, both as a conceptualization of child welfare practice and as a philosophical approach to service that will attract and retain quality staff.
The Peer Support Team
The possibility of encountering a critical incident in the course of a child welfare career is high and such incidents can often induce trauma that can be chronic or acute. The Peer Support Team (PST) is a team of 14 internal staff trained in critical incident stress debriefing, the purpose of which is to lessen the impact of traumatic events through ventilation and education.
In its first 3 years of operation, the PST responded to 189 staff who had experienced a workplace trauma. About three-quarters of referrals to the PST involve threats (27%), assaults on staff (25%) or the death of child (12%) or adult (10%). Almost 90% of staff who were offered PST services accepted. Debriefings were generally held in neutral offices but included community settings and staff's own home. Front-line protection workers comprised 62% of those served, followed by child and youth workers (19%) and management staff (10%).
There are presently very few examples of Peer Support Teams within child welfare settings. Until recently, most research on traumatic impact in the workplace has focused on police, firefighters and emergency service personnel. This is surprising, given that child welfare workers operate in an environment that clearly meets the criteria established for high levels of workplace trauma, including contact with traumatized clients, high levels of responsibility, public and media scrutiny, high workload, the utilization of empathy, working alone in the community, and lack of work experience. Studies involving firefighters, police and emergency services personnel have shown that responders are most susceptible to traumatic impact when the work involves children.
Figley's (1995) work on trauma underscores a dilemma for workers in child welfare; the use of empathy is a critical tool in effective helping, yet it is also a key factor in the induction of trauma to the helper. In exploring traumatic events with clients, child welfare staff are exposed to trauma in a more intense way than police and emergency service staff, whose performance of duty does not normally emphasize the utilization of empathy and with whom there are seldom on-going relationships with clients. Since high empathic ability is positively linked with effective casework, this may result in a drain from the field of competent staff.
Work experience, often in short supply on the front lines of child welfare, has been positively linked to resilience to trauma. Experience may mediate traumatic impact and allow the conceptualization of issues from a less interpersonal frame of reference.
Outlining and then adhering to clear operating principles was a critical component in the success of the PST. PST services must be confidential, timely, user friendly, encouraged but not forced, and separate from internal and external reviews. Child welfare staff are exposed to significant amounts of traumatic stimuli and experience high rates of post-traumatic stress. Critical incident debriefing, delivered by peer support teams, is a constructive and supportive organizational response to these events.
The Stressors in Child Welfare study, the Staff Retention Study and the Peer Support Team have provided the Children's Aid Society of Toronto with insights into the types of stressors child welfare staff encounter, their levels of stress, and some of the reasons they leave the field. It also provides information and direction to begin to address these problems in the hopes of reversing the high levels of stress and turnover that reduce our capacity to protect children.
- Figley, C. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B.H. Stramm (Ed.), Secondary traumatic stress: Self care issues for clinicians, researchers and educators. New York: Sidran Press.
- Howe, P., & Milstein, H (2001). Peer support teams: An effective response to workplace trauma. Canada's Children, Spring, 32-35.
- Regehr, C., Leslie, B., Howe, P., & Chau, S. (2000). Stress and trauma in child welfare practice. Canada's Children, Summer, 12-15.
Phillip Howe, MSW
Assistant Director, Toronto Branch
Children's Aid Society of Toronto
15 Huntley Street,
Toronto, Ontario M4Y 2K9
Corinne McDonald, MSW
Human Resource Manager
Children's Aid Society of Toronto
4211 Yonge Street, 4th Floor
Toronto, Ontario M2P 2A9
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