Client Violence Against Youth Care Workers: Findings of an Exploratory Study of Workforce Issues in Residential Treatment

Abstract

Residential treatment centers (RTCs) for youth are plagued by high turnover of youth care workers who provide round-the-clock treatment and supervision to youth with severe affective and behavioral problems. This article presents findings from a 15-month ethnographic study of workforce issues in one RTC related to youth care workers' exposure to client violence (CV). Findings are based on 65 semistructured interviews and 490 hours of participant observation with consenting employees. Participants reported CV incidents, including punching, kicking, biting, hair pulling, choking, threats or assaults with a weapon, and other physical and sexualized violence. Workers viewed CV as an inevitable aspect of youth care work that could be reduced-though not eliminated-through proper use of de-escalation and behavior management techniques. Participants reported that exposure to CV sometimes resulted in serious physical injury and/or missed work, as well as substance abuse, anxiety, sleep disturbance, and memory loss. Participants reported that CV was the most difficult part of their jobs and cited it as a reason for leaving or wishing to leave youth care work. We conceptualize youth care workers in RTCs as a vulnerable class whose biopsychosocial well-being must be protected to better serve the vulnerable youth in their care. To that end, we suggest directions for future research on CV in residential treatment and propose measures RTCs can take immediately to better understand and prevent CV in their organizations.

User violence in mental health services: Adaptation of an instrument. Healthcare-workers’ Aggressive Behavior Scale-Users-Mental Health Version (HABS-U-MH)

“…Workplace violence has been defined as incidents in which personnel suffers abuse, sexual harassment, threats, or attacks in work-related circumstances, which explicitly or implicitly endanger their safety, well-being, or health. One of its classifications would be: hostile behavior such as psychological violence (verbal abuse, intimidation, harassment, and threats) and physical violence (use of force against persons or property, which produces material, physical, sexual, or psychological damage) [4–6].…”

A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes

“…Analyzing fatal events with multiple and complex causes would ideally include direct access to participants, autopsies, the location of the fatality, the events that triggered the restraint, and the culture and climate of the organization, including the levels of physical and verbal aggression (see Bystrynski et al, 2021;Geoffrion et al, 2021;Smith et al, 2017). In addition, variation and shifts in state-level regulations and oversight policies would also help explain fatality rates over time.…”

“…Physical or mechanical restraints (hereafter referred to as restraints) within children's out-of-home care settings are used to contain a child's acute physical behavior that is likely to cause injury to themselves or those around them. As safety interventions, restraints are never to be used as coercion, discipline, convenience, or retaliation (American Academy of Child & Adolescent Psychiatry, 2002;Centers for Medicare & Medicaid Services, 2008); but when restraints are employed, agency personnel, either alone or in a team, are asked to make a rapid series of consequential choices, under pressure, and within situations that are charged with anger, panic, aggression, counter-aggression, and violence (see Bystrynski et al, 2021;Geoffrion et al, 2021;Smith et al, 2017). Depending on the conditions that surround these events, the outcomes could range from a constructive engagement with learning and growth (Steckley & Kendrick, 2008) to emotional harm and resentment (Mohr et al, 2003), including the potential for serious injury or death (Aiken et al, 2011;Nunno et al, 2006Nunno et al, , 2008Weiss et al, 1998).…”

Safety in Residential Youth Facilities: Staff Perceptions of Safety and Experiences of the “Basic Training Program in Safety and Security”

“…This corresponds with the finding of Pelto-Piri et al (2020) that improving staff competence in the use of de-escalation techniques can help prevent aggression and violence. Smith et al (2017) conclude that client violence can be reduced if de-escalation and behavior-management techniques are used properly. Our findings support this conclusion.…”

“…According to interviews with staff members working within a child and adolescent psychiatric inpatient unit, episodes of physical aggression were common and linked to problems with work attendance and other professional, as well as emotional, sequelae (Dean et al, 2010). These issues may create physical and mental health complications, increased stress levels, lower work satisfaction, lack of safety, anxiety, distress, fear, anger, and hostility, as well as power struggles between staff and youth (Lombart et al, 2020;Miller, 1986;Nyttingnes et al, 2018;Smith et al, 2017;Steckley, 2018;Woodcock & Fisher, 2008). Y.…”