Client Aggression Research Articles

The effects of adherence to professional identity, workplace aggression, and felt accountability on child protection workers' professional quality of life

BackgroundChild protection workers (CPWs) are exposed to physical and psychological violence initiated by clients. The consequences associated with exposure to this type of trauma and others are compounded by the anxiety generated by the feelings of being accountable and the constant scrutiny and monitoring CPWs are under. Previous research suggests that acting according to one's professional values can help protect against the effects of trauma exposure and the anxiety associated with being held accountable when situations devolve into crises. Methods and objectivesUsing path analysis, this study sought to investigate how this complex intersection between client aggression, felt accountability, and professional identity among 310 CPWs is related to their professional quality of life (ProQol). ResultsResults show that adherence to professional identity was strongly and positively associated with ProQoL scores (β = −0.42, p < .001). Felt accountability and exposure to psychological violence (but no other forms of violence) were consistently and negatively related to ProQoL scores (β = −0.42, p < .001/β = −0.20, p < .001). The impact of felt accountability on ProQoL scores can be partially explained by lowered adherence to professional identity. This suggests that the current way CPWs are held accountable and evaluated comes at odds with their professional values. ConclusionThe article ends with a discussion on how organizational changes surrounding accountability can be anxiety-inducing for some CPWs who increasingly feel overwhelmed by the complexity of their cases. Organizations must therefore reflect on how they can better embody the values of their clinicians.

Comparative effectiveness of in-person vs. remote delivery of the Common Elements Treatment Approach for addressing mental and behavioral health problems among adolescents and young adults in Zambia: protocol of a three-arm randomized controlled trial

BackgroundIn low- and middle-income countries (LMIC), there is a substantial gap in the treatment of mental and behavioral health problems, which is particularly detrimental to adolescents and young adults (AYA). The Common Elements Treatment Approach (CETA) is an evidence-based, flexible, transdiagnostic intervention delivered by lay counselors to address comorbid mental and behavioral health conditions, though its effectiveness has not yet been tested among AYA. This paper describes the protocol for a randomized controlled trial that will test the effectiveness of traditional in-person delivered CETA and a telehealth-adapted version of CETA (T-CETA) in reducing mental and behavioral health problems among AYA in Zambia. Non-inferiority of T-CETA will also be assessed.MethodsThis study is a hybrid type 1 three-arm randomized trial to be conducted in Lusaka, Zambia. Following an apprenticeship model, experienced non-professional counselors in Zambia will be trained as CETA trainers using a remote, technology-delivered training method. The new CETA trainers will subsequently facilitate technology-delivered trainings for a new cohort of counselors recruited from community-based partner organizations throughout Lusaka. AYA with mental and behavioral health problems seeking services at these same organizations will then be identified and randomized to (1) in-person CETA delivery, (2) telehealth-delivered CETA (T-CETA), or (3) treatment as usual (TAU). In the superiority design, CETA and T-CETA will be compared to TAU, and using a non-inferiority design, T-CETA will be compared to CETA, which is already evidence-based in other populations. At baseline, post-treatment (approximately 3–4 months post-baseline), and 6 months post-treatment (approximately 9 months post-baseline), we will assess the primary outcomes such as client trauma symptoms, internalizing symptoms, and externalizing behaviors and secondary outcomes such as client substance use, aggression, violence, and health utility. CETA trainer and counselor competency and cost-effectiveness will also be measured as secondary outcomes. Mixed methods interviews will be conducted with trainers, counselors, and AYA participants to explore the feasibility, acceptability, and sustainability of technology-delivered training and T-CETA provision in the Zambian context.DiscussionAdolescents and young adults in LMIC are a priority population for the treatment of mental and behavioral health problems. Technology-delivered approaches to training and intervention delivery can expand the reach of evidence-based interventions. If found effective, CETA and T-CETA would help address a major barrier to the scale-up and sustainability of mental and behavioral treatments among AYA in LMIC.Trial registrationClinicalTrials.govNCT03458039. Prospectively registered on May 10, 2021

Understanding health outcomes following workplace aggression: A social exchange perspective.

This study explored health outcomes following workplace aggression among social workers in Israel. Grounded in the social exchange theory, a relationship-based perspective was used to explain the mechanism through which exposure to workplace aggression results in employee outcomes. Reports of employees and managers were analysed with respect to the impact of varied forms of aggressive behaviours perpetrated by clients and co-workers on posttraumatic stress and somatic symptoms. The intervening effects on symptoms of two forms of perceived organisational support, organisational procedural support and interpersonal co-worker support operationalised as team trust were examined. Overall, 548 employees and 89 managers in 31 social services departments completed self-report questionnaires. Results revealed positive associations between exposure to both co-worker and client aggression, and posttraumatic stress and somatic symptoms. Importantly, while perceived organisational support is often equated with social support, this study found that two elements, organisational procedural support and team trust, had differing impacts on somatic and posttraumatic stress symptoms following WPA. Specifically, team trust was negatively associated with symptoms, while organisational procedural support showed no effect. This study has important implications for timely prevention measures to deal with workplace aggressions and valuable directions for future studies.

Effect of a suite of aggression management modules on health professions student knowledge, skills and confidence: an investigator-blinded, parallel-group randomised controlled trial protocol

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Incidents of aggression are increasing in healthcare. Students are at higher risk of being on the receiving end of client aggression due to their lack of experience. Students also do not feel prepared to manage these situations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Students of health professions in the School of Primary and Allied Health Care will be eligible and contacted within lectures/via the learning management system Moodle. A randomised controlled trial (RCT) will be conducted to evaluate a suite of online aggression management modules for health professions students prior to entering their clinical years of study. If students are able to undertake face to face simulations they will be assessed by academic staff members using the English modified de-escalating aggressive behaviour scale (EMDABS). Mock clients will assess the students using the consultation and relational empathy (CARE) measure. Students will complete a self-assessment using the confidence with coping with patient aggression instrument and a knowledge questionnaire.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conlusions: &lt;/strong&gt;This RCT will provide novel information on the effectiveness of delivering a suite of online aggression management modules to health professions students. There are three separate modules each of approximately 30 minutes duration such that the attention of students is maintained. The three modules are: 1. Recognising and preventing aggression-the basics, 2. Responding to aggression-the basics, 3. Aggression in healthcare-the basics (Case study).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration number: &lt;/strong&gt;This trial has been registered with the Australian and New Zealand clinical trials registry (ANZCTR) ACTRN12621000382875.&lt;/p&gt;

Manifestations and Preconditions of Child Rights Protection—Specialists’ Aggression towards Caregivers and Child in the Situation of Child Removal from the Family

Numerous studies have focused on the issue of client aggression against various help professionals. Much less attention has been paid to the opposite phenomenon—the aggression of help professionals towards clients, especially aggression of child rights protection specialists (CRPS). Comparative analysis of four perspectives (CRPS, parents, children, and police officers) was performed in order to reveal the manifestations and preconditions of CRPS aggression towards parents and children during the process of removing a child from a family. The manifestations of psychological and physical CRPS aggression were alluded to by all groups of research participants. The preconditions can be classified as being related to the behavior of the child and parents, the employee’s personality traits, competencies and psychological states related to a specific work situation, and institutional, inter-institutional, social, and political contexts. Based on our research results, suggestions can be made on how the procedure of removing a child from an unsafe family environment can be improved, such as by making it less harmful for children, more constructive for the whole family, and making the CRP system operate in such a manner that it does not create preconditions for CRPS to transgress the boundaries of professional relations.

Supervisor support and emotional labor in the context of client aggression

Because of the nature of their mandate, child protection workers (CPWs) are at risk of experiencing physical and psychological forms of aggression at the hands of service users. For this reason, it is important that CPWs receive the support they need to ensure their resilience. This study sought to analyze how CPWs seek, receive, and perceive the support from their supervisors after experiencing service user aggression. Researchers interviewed 30 CPWs at three different time points (less than 1 month after the aggression, and then 2 and 6 months later) to assess how their needs for support evolved over time and how supervisors adapted in response. Researchers identified three dimensions: 1) receiving proactive and urgent care;2) making sense of the aggression together; and 3) building a relationship of trust. Findings suggest that supervisor support efficacy is greatly influenced by the quality of the supervisor/CPW relationship.

Investigating the cyclical hypothesis of client aggression as a 'loss spiral': Can child protection worker distress lead to more client aggression?

Working in a stressful environment, child protection workers (CPWs) are often victims of psychological and physical acts of aggression perpetrated by their clients. This can be emotionally distressing for CPWs. Previous authors have suggested that this distress could place CPWs at greater risk for subsequent victimisation if they become emotionally unavailable to their clients. This study sought to investigate whether the distress experienced after an act of client aggression or other types of potentially traumatic events could indeed predict subsequent victimisation over time. Using cross-lagged panel analysis, researchers administered standardised questionnaires to 173 CPWs who had experienced an act of client aggression or other type of potentially traumatic event in the month prior. Participants were asked to fill out additional questionnaires 2, 6 and then 12months later. Researchers found that CPW distress did in fact predict subsequent victimisation at the 2-month time point only. Researchers then conducted a generalised linear model analysis to test the influence of sociodemographic variables and the moderating influence of supervisor support. Supervisor support did not moderate the relationship between initial distress levels and increased aggression 2months later. The study concludes by examining how the emotional distress of CPWs can negatively impact clients and how organisations can best provide support, in part, by rethinking aggression prevention.

Nursing Care in Schizophrenia Clients With Focus Study Risk of Violent Behavior

There are around 20 million people worldwide suffering from schizophrenia. In Indonesia there is an increase in the number of schizophrenic clients, which were originally 1.7 per 1000 to 7 per 1000 population of Indonesia where Central Java is in the fifth position of mental disorders. The symptoms of schizophrenia are divided into 2 categories, positive and negative. Positive symptoms that can appear in schizophrenic clients, one of which is the risk of experiencing behavioral disorders, namely violent behavior. Violent behavior can result in loss of individual control so that it has the potential to hurt oneself, attack others and damage the environment. The purpose of this study is to describe nursing care from assessment to evaluation of schizophrenic clients with a focus on the study of the risk of violent behavior through interventions to control spiritual anger with murrotal ayat kursi. This research includes field research using descriptive analytic methods through case exposure with the nursing process approach. Research subjects are schizophrenic clients with risk of violent behavior. In this study using the instrument aggression questionnaire to measure the level of client aggression. The results showed the provision of nursing care to schizophrenic clients with the risk of violent behavior through intervention to control spiritual anger with murrotal ayat kursi showed improvement in the condition of the client which has a significant influence on mental status decline and aggression scores.

Third-party aggression and emotion work among nurses: Testing a moderated mediation model.

Client aggression is increasingly a stressor in the workplace. This study aims to analyze how and why these experiences may trigger burnout. Focusing on health care workers, we tested a moderated mediation model of the relationship between exposure to third-party (patients and/or relatives) verbal aggression and burnout with the goal of assessing the mediation effects of emotion work and the moderating effects of personal resources (i.e., perceived self-efficacy in communication with patients) and job resources (job control, role clarity, social support by colleagues and by supervisors) on this relationship. A purposive sample of 356 nurses was recruited from four hospitals in northern Italy. A structured, self-report questionnaire was used to collect data. Mediated and moderated mediation regression models with PROCESS were used to test the hypotheses. As postulated, emotion work mediated the relationship between patient third-party aggression and nurses’ burnout. Role clarity and supervisors’ support were found to reduce the harmful effects of emotion work triggered by third-party aggression. Unexpectedly, perceived self-efficacy in communication did not have a buffering effect in the tested model. These results offer a novel approach to designing preventive actions aimed at cultivating resources to counter the impact of perceived exposure to client aggression on well-being.

Effect of trauma-informed care on hair cortisol concentration in youth welfare staff and client physical aggression towards staff: results of a longitudinal study

BackgroundProfessional caregivers working in child and youth welfare institutions are frequently faced with the complex mental health issues, emotional needs and challenging coping strategies of clients with cumulated traumatic experiences, leaving them prone to developing high levels of stress, burn-out and compassion fatigue. Trauma-informed care (TIC) is a milieu-therapeutic approach that aims to promote the self-efficacy and self-care of youth welfare staff by guiding them to a better understanding of their own and their clients’ stress symptoms and countertransference. Despite increasing efforts to implement TIC practices, and more widespread recognition of their value in youth welfare systems, there is a lack of studies evaluating the effectiveness of this approach. The aim of this study was to assess the effects of TIC practices in youth welfare institutions on both the physiological stress of staff members and clients’ physical aggression towards their caregivers. .MethodsData was obtained from a longitudinal study investigating the effectiveness of TIC in 14 residential youth welfare institutions. Our sample consisted of 47 youth welfare employees (66.0% female) aged from 23 to 60 years (M = 37.4, SD = 10.4 years). Hair cortisol concentration (HCC) and occurrences of client physical aggression were assessed at four annual measurement time points (T1 to T4).ResultsParticipants in five institutions employing TIC practices (intervention group) showed significantly lower HCC at T4 than staff members from institutions who did not receive training in TIC (control group), indicating reduced physiological stress levels. At T4, the intervention group reported significantly less physical aggression than the control group.ConclusionsTIC might be a promising approach for reducing the emotional burden of employees and institutions should invest in training their staff in TIC practices. More research is necessary, to investigate the benefits and efficacy of TIC, both to youths and staff members, and to foster a better understanding of which specific factors may contribute to stress reduction.

How Accounting Professionals Cope with Client-Initiated Workplace Aggression

Accounting professionals experience client-initiated workplace aggression, and prior research suggests the mechanisms used to cope with workplace aggression can influence the extent to which such aggression detrimentally affects work quality. We survey 163 accounting professionals to examine the mechanisms accountants use to cope with client-initiated workplace aggression. We focus on three types of coping mechanisms grounded in psychology theory – active, passive, and retaliatory – and we examine how frequently each are used. We also examine how these coping mechanisms are associated with different types of client aggression and accountant ranks, and with self-perceptions of work quality. Encouragingly, and different than findings in broader workplace coping research, our results show that accounting professionals most often try to take action to address the situation, but they also commonly passively cope by ignoring or resigning themselves to the status-quo. Given the importance of interaction in an accountant-client context, coping passively can have a significant negative influence on work quality. Interestingly, accountants tend to cope more passively (and less actively) as they experience more work-related negative acts. Further, we find that partners generally cope differently than staff, seniors, or managers and certain coping mechanisms appear better-suited to avoid adverse effects of client-initiated aggression (e.g., active - talking to the perpetrator) than others (e.g., passive - just accepting the situation). Avenues for future research are discussed.

Coping with stressful situations in social work before and after reduced working hours, a mixed-methods study

ABSTRACT Little is known about how reduced working hours relate to social work stressors, coping and work-life balance. An exploratory mixed methods study was therefore performed at a Swedish social service agency participating in a quasi-experimental trial of work-time reduction by 25%, with proportionally reduced workload, and retained full-time pay. Social workers that reduced their working hours reported less emotional exhaustion (n = 28, p < 0.05) on the Maslach Burnout Inventory-Human Services Survey, and less reactivity in stressful situations connected to time urgency and irritation (n = 28, p < 0.05) on the Everyday Life Stress Scale. In interviews, the social workers described that despite using effective, problem-focused coping behaviour at work, both before and after work-time reduction, high caseload remained a central stressor, creating time conflicts that exacerbated stressful situations involving emergencies, practical setbacks, client aggression, report deadlines, and managerial stress. In contrast, the work-time reduction was described as fully resolving time conflicts and stress during free-time in situations that involved finding time for friends, household chores, rest, exercise and childcare. Results suggest that reduced working hours lowered emotional exhaustion and situational reactivity by increasing free-time recovery opportunities and decreasing total daily exposure to work stress, but future trials should also compare reduced work-time with reduced caseload.

Burnout symptoms in forensic psychiatric nurses and their associations with personality, emotional intelligence and client aggression: A cross-sectional study.

Introduction Aggressive behaviour of forensic clients is associated with burnout symptoms in nursing staff. The role of staff characteristics as moderators is unclear. Aim We explored the association between type and severity of aggressive behaviour as experienced by nursing staff and staff's burnout symptoms. In addition, the moderating roles of personality characteristics and emotional intelligence (EI) were studied. Moreover, the usefulness of ambulatory skin conductance assessments in detecting arousal related to burnout symptoms was studied. Method A total of 114 forensic nursing staff members filled out questionnaires and wore an ambulatory device. Results Experiencing physical aggression was positively associated with staff's burnout symptoms. Stress management skills, a subscale of EI, but not personality, moderated this relationship. Skin conductance was not associated with burnout symptoms. Remarkably, the association between aggression and burnout symptoms was highest for staff reporting a higher number of stress management skills. Discussion Longitudinal research is necessary to establish causality between client aggression and staff burnout symptoms. In addition, further research is necessary on the validity of the aggression measure used in the current study. Implication for practice Nursing staff who experience physical aggression frequently should receive social support for this, and staff who report high stress management skills should be monitored more carefully after having been confronted with aggression.

Verbal and physical client aggression – A longitudinal analysis of professional caregivers’ psychophysiological stress response and burnout

ObjectiveWe investigated the impact of verbal and physical client aggression on risk of developing high hair cortisol concentration (HCC) as an indicator of chronic stress exposure and burnout in a Swiss population of professional caregivers working in youth residential care. MethodParticipants (n = 121; 62.0% women) reported on client aggression and burnout symptoms and provided hair samples at four annual sampling points. HCC was determined in the first 1.5 cm hair segment. Sociodemographic variables, private stressors, burnout symptoms, and HCC were compared between participants reporting either ‘no aggression’, ‘verbal’ aggression, or ‘verbal + physical’ aggression. Cox proportional hazards regressions were calculated to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association between client aggression and risk of high HCC or burnout over the course of three years. ResultsProfessional caregivers reporting ‘verbal + physical’ aggression had higher HCC, more cognitive burnout symptoms, and greater burden in interpersonal domains. Both ‘verbal’ and ‘verbal + physical’ aggression were positively associated with burnout risk (verbal: HR = 1.83; 95% CI = 1.27–2.65; verbal + physical: HR = 2.44, 95% CI = 1.56–3.84). ‘Verbal + physical’ aggression was positively associated with risk of high HCC (HR = 1.58; 95% CI = 1.07–2.36). ConclusionsThis longitudinal analysis suggested that psychophysiological stress response is primarily associated with combined verbal and physical aggression. The emotional wearing-down associated with verbal aggression should however not be disregarded. Our exploratory findings could have implications for youth welfare policy, clinical child psychiatry, and future research.

The arginine-vasotocin and serotonergic systems affect interspecific social behaviour of client fish in marine cleaning mutualism

Many species engage in mutualistic relationships with other species. The physiological mechanisms that affect the course of such social interactions are little understood. In the cleaning mutualism, cleaner fish Labroides dimidiatus do not always act cooperatively by eating ectoparasites, but sometimes cheat by taking bites of mucus from so-called “client” reef fish. The physiological mechanisms in these interspecific interactions, however, are little studied. Here, we focussed on three neuromodulator systems known to play important roles in intraspecific social behaviour of vertebrates to examine their role in clients' interspecific behaviour. We subjected the client fish Scolopsis bilineatus to ectoparasites and the exogenous manipulation of the vasotocin (AVT), isotocin (IT) and serotonin systems to test how this affects client willingness to seek cleaning and client aggression towards cleaners. We found that a single dose of AVT agonist and a selective antagonist caused clients to seek proximity to cleaners, independently of ectoparasite infection. In contrast, in a direct encounter task, the selective blocker of serotonin 5HT2A/2C receptors, Ketanserin (KET), made client reef fish more aggressive towards cleaners in the absence of cleaners' bites of mucus. IT did not yield any significant effects. Our results suggest that the AVT system plays a role in social affiliation towards an interspecific partner, while the serotonin system affects clients' acceptance of level of proximity to cleaner fish during interactions. These two systems, therefore, were apparently co-opted from intraspecific social interactions to affect the course of interspecific ones also.

Healthcare Managers’ Perceptions of Patient Perpetrated Aggression and Prevention Strategies: A Cross Sectional Survey

Patient or client aggression towards staff is a risk in healthcare. Healthcare takes place in a variety of settings, including hospitals, community, and Aged Care facilities. A minimal amount is known regarding the existence of safety and training measures available throughout the broad range of hospital and community healthcare services. A web-based survey of the type and frequency of violence experienced by healthcare staff was sent to unit managers working in mental health and older peoples’ services of District Health Boards, Non-Governmental Organisations, and Aged Care facilities across New Zealand. One hundred and forty-one managers responded to the survey with a response rate of 79.21%. Managers reported high rates of verbal aggression and assaults against staff within their services. A total of 60% of respondents stated that an increase in assaults against staff was due to an increase in violent events and 43.1% related this to increased staff awareness and reporting of violent events to management. Communication skills and de-escalation training were provided across approximately 95% of organisations. The availability of safety measures including panic buttons, personal alarms, use of security personnel, and police assistance were more widely available and accessible within hospital settings and the community sector was found to mostly rely on police for assistance when violence occurs. The perception of violence is high in healthcare. Prevention and management training is provided in public hospital and aged care setting but not so much in NGOs. All areas of healthcare provision could benefit from increased evidence based aggression prevention programmes.

Client aggression towards health service providers in Nepal

&lt;no abstract available&gt;

The Scope of Client Aggression Toward Social Workers in Israel

The phenomenon of client violence toward social workers has been documented in various parts of the world. The goal of this study is to describe the phenomenon and explore the relationship pattern between contextual variables and clients’ aggression. The study encompassed a sample of 645 workers in 34 municipal social service agencies. Of the entire sample, 80% reported being exposed to some form of aggression at least once over the last 3 months. The findings highlight 2 broad axes related to client aggressiveness: frequency and level of aggression. With respect to frequency, we can discern a continuum running from common types of aggressive behaviors to rare ones. The other axis focuses on the level of aggressiveness used, from minor types of client aggression, such as verbal assaults and threats, increasing to more severe ones, such as property damage, and, finally, to physical injury. The routineness of aggression in the work environment lends it the appearance of being normal, and functioning in such an environment desensitizes social workers to clients’ aggressiveness. Also examined and discussed are organizational and personal factors that contribute to the aggressive behavior of clients, including seniority, gender, workload, inadequate service conditions, and coworkers’ aggressive behavior.

The business of care: the moral labour of care workers.

Drawing on a case study conducted in a private residential care home, this article examines the emotional labour of care workers in relation to the moral construction of care and the practical experiences of work. An examination of the company's discursive attempts to construct, manage and demarcate its employees’ emotional labour was carried out alongside an exploration of the carers’ own interpretations of, and enrolment in, the care‐giving role. The potential economic and emotional consequences of these occurrences were a key focus of the inquiry. The study found that carers, encouraged by the company, naturalised their emotional labour, and that this had contradictory consequences. On the one hand it justified the economic devaluation of the carer's work and left her vulnerable to emotional over‐involvement and client aggression. On the other, it allowed the worker to defend the moral interests of those within her care and to see when those interests were in conflict with the economic motivations of her employer.

Client aggression and the disenchantment process among Israeli social workers: Realizing the gap

The professional habitus and values of social work, are challenged when social workers encounter client aggression. The current study was set up to understand the ways by which workers confront and cope with client aggression. In-depth interviews were conducted with 40 social workers in general municipal services. The participants included district managers, agency managers, supervisors, social workers and administrators. We identified a process consisting of four stages: (1) Rationalization, minimization, and denial of client aggression, including self-blame; (2) Emotional reactions, including hurt, anger, helplessness and shame; (3) Reevaluation of one’s beliefs, attitudes and values; (4) Behavioral transformation. The process of going through the four stages is not always linear, and workers may go back and forth between stages. The results are discussed in terms of the gaps between social workers’ values and the reality they are facing. Such gaps serve as an engine of change, explicated by theoretical concepts of social judgment theory.