Reducing Child Welfare Worker Stress: Inventory and Intervention Implementation Guide guide final.pdf ·  · 2013-02-043 Reducing Child Welfare Worker Stress: Inventory and Intervention

Reducing Child Welfare Worker Stress:

Inventory and Intervention

Implementation Guide

By Michelle Levy, John Poertner, and Roxanne Emmert Davis

Kansas Workforce Initiative

University of Kansas School of Social Welfare

January 2013

Table of Contents

Introduction………………………………………………………………………………………………….3

Before You Begin………………………………………………………………………………………..…4

Step 1: Engaging Participants………………………………………………………………………..6

Step 2: Administration of the Child Welfare Worker Stress Inventory…………..7

Step 3: Exploration of Specific Stressors with Workers……………………………....10

Step 4: Exploration of Targeted Strategies for Stress Reduction……………….…13

Step 5: Reviewing Implementation of Interventions…………………………………..15

Appendices

Appendix A: Development of the Child Welfare Worker Stress Inventory…..16

Appendix B: Example of Initial Report…………………………………………………………17

Appendix C: Facilitator Guide for the Staff Discussion…………………………………18

Appendix D: Excerpt from a Solution Focused Report………………………………….21

Appendix E: Decision Making Matrix…………………………………………………………..22

Printable Copy of Child Welfare Worker Stress Inventory…..………………………..23

This guide was made possible through a cooperative agreement between the University of Kansas School of Social Welfare and the U.S. DHHS/ACF Children's Bureau, Grant Number 90CT0150. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Children's Bureau

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Reducing Child Welfare Worker Stress: Inventory and Intervention Implementation Guide

Introduction

Worker stress is a major concern for child welfare agencies. As a child welfare

administrator, manager, or supervisor, you know all too well how chronic stress can contribute to your staff becoming overwhelmed, burnt out and even leaving the agency. Although it may seem like stress is inherent in child welfare work, there are ways that you and your agency can help reduce stress experienced by staff. This Guide outlines a multistep process to identify what workers find stressful and suggestions on how to implement organizational strategies to reduce workplace stress.

Why Address Workplace Stress?

As your experience likely confirms, Hopkins, Cohen-Callow & Hwang (2010) found that stress contributed more to job withdrawal, work withdrawal, job search behavior and exit from the organization than any other factor. Stress has been connected to emotional exhaustion and depersonalization among child welfare workers (Anderson, 2000; Boyas & Wind, 2010). Many studies have also linked child welfare work stress to turnover or intention to quit (Boyas, Wind & Kang, 2012; Hopkins, Cohen-Callow & Hwang, 2010; Mor Barak, Levin, Nissly & Lane, 2006; Nissly, Mor Barak, & Levin, 2005). Though the presence and impact of stress in child welfare have been documented, surprisingly little is known about exactly what child welfare workers find stressful about their work. What Does Research Tell Us about Reducing Stress?

To date, the majority of the efforts to reduce worker stress have focused on teaching self-care and coping strategies. Many employers across a broad sector of worksites routinely offer stress management training and tips to their workforce. Research shows there may be some impact of stress management interventions on individual outcomes. For example, cognitive behavioral approaches and relaxation have been shown to be effective in helping workers cope with workplace stress (Dollard et al., 2005). Yet evidence suggests that stress management by itself produces only short-term improvements in self-reported well-being (Caulfield, Chang, Dollard, Elshaug, 2004).

Changes in workers’ capacity to manage stress are likely to be temporary unless

accompanied by corresponding organizational changes related to stressors in the work environment (Cooper & Cartwright, 1997). While there is a need to identify strategies that have an enduring impact in teaching workers to better manage stress, there is a concurrent need to examine what child welfare agencies can do to effectively prevent some of the contributors to stress in child welfare. Research shows that interventions at the organizational level, particularly in combination with individual-focused strategies, can be effective (Semmer,

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2011; Awa, Plaumann, & Walter, 2010; and LaMontagne et al., 2007). Given the community context of child welfare work, community or systems level interventions are also likely to be useful.

Overview of the Inventory and Intervention Process

Informed by the research literature, the Kansas Workforce Initiative developed a process to facilitate tailoring stress reduction interventions to specific sources of child welfare worker stress. This Implementation Guide outlines that process, and is intended to be used by child welfare administrators, managers or supervisors who are interested in addressing stress within their work units or programs. Briefly, this process includes:

1. Engaging participants, including a facilitator, in understanding the purpose

of the process 2. Administration of the Child Welfare Worker Stress Inventory (referred to as

the “stress inventory” in this Guide) 3. Clarification of specific stressors with workers 4. Exploration of targeted strategies for stress reduction 5. Reviewing implementation of interventions

This Guide will provide you with the necessary tools and knowledge to complete this process with a unit, program, or department. Each step in the process is detailed in this Guide. What Can I Expect as a Result?

It’s likely that you have some ideas about what your workers find stressful though you might also be surprised to hear what they say is contributing to it. It’s not easy to hear about the role that you or your agency may play in what workers perceive as contributing to their stress. It is important to remember throughout this process that these perceptions (whether or not supported by facts) have a powerful influence on the experience of stress.

As a supervisor or manager within an organization, you may feel like there are limits to what you can do to influence change. While there will always be aspects of the work that are out of your control, keeping others in the agency informed about the day-to-day reality of front-line staff is an important responsibility that is within your purview. This includes advocating for feasible organizational changes that might alleviate worker stress. Just the process of talking about stress and acknowledging it can make a significant difference.

BEFORE YOU BEGIN

Undertaking this process requires a meaningful commitment of time and resources and a genuine desire to understand your staff’s experience of stress in the workplace. The process also entails managers taking a leadership role in defining organizational changes which will

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reduce stress. Therefore, before you begin this process, we recommend that you engage in a brief assessment of readiness.

Some critical questions that you might consider include:

Is the time right for this process?

Does my agency support this process?

What is my attitude about workplace stress?

How do I feel about my capacity to address workplace stress?

To help in assessing your readiness, take a few moments to consider the following statements and record your responses to them.

Where Am I Now? / Am I Ready? Agree

Disagree

1. Stress is just a part of this work, if staff can’t deal with it then this is

probably not the job for them.

2. I think I have some idea of what is stressing my staff but I would like to

know more.

3. I already know what my staff is stressed about and there’s really

nothing I can do about it that will make a difference

4. I am confident that I can help staff reduce stress

5. My staff is stressed about everything. There is not much I can do.

6. I am committed to working with staff to reduce stress.

7. There is too much going on right now to focus on this.

8. I’m open to considering what I can do differently to help my staff.

9. I’d like to make things better for my staff but I don’t have any control

over the things that could make it better like reducing caseloads.

10. I would like for my staff to tell me what would make it better.

As you read the statements you probably noticed the odd-numbered statements are different from the even-numbered ones. If you reacted affirmatively to the even-numbered questions you might be ready to implement the stress inventory. On the other hand, if you reacted affirmatively to the odd-numbered questions, this may not be the time to undertake this process. If you are ready to proceed it may also be helpful to think about how others in your organization might respond to the readiness statements. Others may not be as ready as you. If others are not as ready, it does not mean that you shouldn’t go forward. It may indicate that you will need to do some additional work to bring them along on your journey.

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Who Should Be Involved? An important initial consideration is determining who will be involved in the process. It is critical that you understand that the intent of this process to identify and address stressors for a small group of workers, not individual workers. If you are an agency administrator or manager responsible for several different programs, you will likely want to go through this process separately with each program or unit. Since stress can vary greatly according to the type of work, the stress inventory should target work units that have similar job functions or responsibilities. For example, if you and a colleague both supervise the same types of workers, you may choose to have your units to participate in this process together. In the alternative, foster care case managers and child protective investigators would go through the process separately. While this process can be initiated by an agency administrator, program manager, or supervisor, for simplificity’s sake, this Guide will refer to this person as a manager. Introducing the Process to Staff It is important that the manager thoroughly explain the process to staff and encourage their participation. The manager should describe the overall process to staff including what you hope to gain. In addition, expectations for staff members’participation during the various steps need to be clarified. Staff will be particularly interested in knowing how the information will be collected and what will be done with the information that they share. Utilizing a Facilitator You will want to utilize a facilitator to assist with some or all of the steps in this process. The facilitator could be someone from outside your agency, or it could be someone internal from another department. Some agencies that have participated in this process indicate that an outside facilitator is critical to obtaining honest and forthright information, particularly during the staff discussion group phase that occurs subsequent to the stress inventory. Your local university may be a resource for identifying a facilitator. You will want to share a copy of this Guide with the chosen facilitator. Role of the Facilitator Understanding the role of the facilitator is a key to realistic expectations of this process. The facilitator’s job is to 1) provide a forum, after completion of the stress inventory, for staff to openly clarify their concerns and discuss ideas for change, and 2) serve as a conduit for relaying that information to the manager or administrator. The role of the facilitator is not to create consensus regarding staff suggestions, make specific recommendations or have the answers for how to reduce stress within the agency . However, they may help managers or others interpret

Step 1: Engaging Participants

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workers’ feedback or guide a discussion about potential responses the agency could develop to address stress reduction.

What is the Child Welfare Worker Stress Inventory?

The Child Welfare Worker Stress Inventory is a 35 item instrument designed for workers to respond to the degree that they found each item stressful in the last month. This allows workers the ability to identify specific job stressors rather than try to assess their overall feeling of stress. Individual items are scored on a scale from 1 to 4 with ‘Never Stressful’ designated as 1 and ‘Almost Always Stressful’ designated as 4. The items with the highest average score are targeted for further exploration and possible intervention. Items with very low average scores may identify potential strengths or assets for the work unit which may be useful in shaping interventions. A copy of the survey in its entirety begins on the following page. A copy suitable for photocopying is also included at the end of this Guide. Additional information on the development and use to date of the Inventory is described in Appendix A.

Administering the Inventory

There are several options for administering the inventory depending upon available resources.

Identify someone outside the work unit to administer the inventory. This might be someone in another unit or an outside consultant. This allows management to assure individual workers confidentiality of responses so that they can be as honest as possible.

If possible have the inventory entered into an on-line format such as Survey Monkey. Only the person responsible for administration of the survey should have access to the individual survey results.

If on-line administration is not possible the inventory can be copied and handed to workers with an envelope for workers to deposit their completed inventory. This envelope should be given to the person responsible for administration of the survey. Ideally this is not the manager who oversees the work unit participating in the survey. Regardless of the method of administration, it is helpful for the manager to alert staff

that the survey is coming and encourage their participation. This notice should inform staff about confidentiality of the process and explain how the results will be used and reported. It is also important to send reminders. Weekly reminders for a period of three weeks should catch most workers who might have been busy or out of the office for an extended time. If less than half of the unit’s staff respond to the survey then caution should be taken in proceeding. Typically, the manager’s support should be sufficient to obtain a good response rate.

Step 2: Administration of the Child Welfare Worker Stress Inventory

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Child Welfare Worker Stress Inventory

Thinking about your job over the past month, please indicate how often you have felt stress due to the following:

Item Never Stressful

Sometimes Stressful

Frequently Stressful

Almost Always Stressful

Lack of resources for families

Conflicts with legal system (judge, DA, etc.)

Insufficient time to complete work

Lack of opportunity to talk with others about work

Inadequate information to do the job

Working with difficult or uncooperative families

Stakeholders devaluing the work I do (courts, mental health, schools, etc.)

Required non-social work tasks, such as clerical work

Lack of support from immediate supervisor

Being held accountable for things over which I have no control

Talking with families about emotional matters

Testifying in court

Case related documentation

Being blamed for something that goes wrong

Feeling unsafe

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Feeling unprepared to help families with their problems

Disagreements about cases

Insufficient staff to cover cases

Inadequate training for the job

Death or serious injury of a child

Responsibility for the lives of children and families

Interpersonal conflicts (non-case related)/office politics

Work intruding on family/home time

Making difficult decisions

Lack of discretion in doing the job

Families not recognizing my efforts

Others telling me what to do

Being on call

Fear of making a mistake

Reorganization or agency changes

Violent or threatening family members

Press/media coverage that reflects on what I do

Constantly changing job responsibilities

Families getting treated unfairly

Travel

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Scoring the Inventory and Reporting Results

Each item is given a numerical value (Never Stressful =1; Sometimes Stressful =2; Frequently Stressful = 3; Almost Always Stressful = 4). Find the mean for each item (add up the numerical values for each item and divide the total by the number of responses for that item). The larger the item mean, the more stressful it is for workers. Survey responses can be loaded into an Excel file using the formula for average to calculate means.

The survey administrator should create a report that lists all of the inventory items in

order from highest mean to lowest. The three items with the largest means are targeted as “top stressors” for further exploration. The items with the lowest means are identified as “least stressful” and in some cases may be perceived as possible resources to alleviate stress. For example, if stakeholders are low on the list of stressors, it’s possible that they might be employed as a resource in some way to address stress. In reporting the results, it is important to consider the response rate. If most workers in a unit respond to the inventory, you can have confidence in the results. If less than half of the workers in the unit respond caution should be taken in using the results.

The survey administrator will share the report with the program manager. In addition to the ordered list of inventory items, it will also be helpful to create a short one page summary that highlights the highest and lowest stressors. See Appendix B for an example of such a report. Managers may wish to share this report with their staff and supervisors prior to the next step in the process.

Why is Further Exploration Needed?

The individual stressors identified in the inventory are rather global in nature. Before deciding on organizational changes to address a stressor, and to provide clarification and context, it is necessary to explore with workers what it is about the item that they find stressful. For example, consider ‘Fear of making a mistake’ is identified as a highly stressful item. There are a variety of possible explanations for this being stressful. It may be that a supervisor is frequently pointing out mistakes. It may be that there are forms that are not being completed properly and the information system automatically sends back forms for correction. Alternatively, it may be fear of placing a child in a home and that a disruption will occur. These are just a few possible explanations for workers finding fear of making a mistake to be stressful.

Step 3: Exploration of Specific Stressors with Workers

Scoring example “Being on call” = 3.9

Survey #1 marks Almost Always Stressful = 4 Survey #2 marks Almost Always Stressful = 4 Survey #3 marks Frequently Stressful = 3 4+4+3 = 11/divided by 3 responses = 3.9

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In addition to increasing understanding of the common stressors, LaMontagne and Keegel (2010) emphasize the importance of meaningful participation of the groups targeted by an intervention. Involving workers in examining stressors as well as weighing in on organizational and individual efforts to reduce stress are likely to be more effective, in part, because organizations and the staff experiencing the stress are unique and require carefully tailored interventions. In addition, involving those experiencing the stress is itself an intervention that promotes a sense of job control and mutual support among workers, supervisors and managers. Some agencies have also found it helpful to conduct a separate facilitated discussion of top stressors with supervisors of the work unit to capture their perspectives. Supervisors may also be involved in defining targeted responses for stress reduction (Step 4 of this process). Clarification of Stressors – A Facilitated Discussion As noted, a critical element in understanding identified stressors is the opportunity for stress inventory participants, and perhaps supervisors, to clarify their experience and perceptions of stress on the job. An effective approach to this is a facilitated group discussion that allows forthright feedback and clarification. In order to allow workers the freedom to thoroughly discuss what they find to be stressful, the meeting should not include management or supervisors. Generally, about two hours is sufficient for the discussion. Note: The purpose of this part of the process is not to generate consensus on how to deal with identified stressors, but to gain clarity regarding staff’s experience of stress and elicit a list of potential solutions to share with management.

The facilitator (and notetaker) may be selected from within the agency but not connected to the work unit or it may be someone from outside the agency. A useful way to engage participants if utilizing an internal facilitator is to suggest two to three potential facilitators/notetakers and ask the group to select from those candidates. The purpose of the meeting and the role of the facilitator needs to be clearly outlined to participants prior to the meeting, with an emphasis on confidentiality of responses and explanation regarding how the information will be utilized A Facilitator Guide for the Staff Discussion is included in Appendix C.

Creating a Solution-focused Report Following the discussion, the facilitator and notetaker will work together to prepare a solution-focused report summarizing findings from the discussion to share with the work unit manager and with meeting participants. The purpose of the report is to 1) confirm with participants the facililtator’s understanding of the discussion, and 2) provide a basis for discussion and planning with supervisors, managers, administrators and staff.

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A suggested format for the solution-focused report is to organize it by the top stressors. Each stressor is followed by a positive statement(s) about the workers’ intentions or interest regarding the particular stressor, which is likely shared by management. For example, in the case of the stressor “Stakeholders devaluing the work I do”, the statement might be “Staff would like to have a positive working relationship with community stakeholders.” Staff suggestions and solutions for changes in policy or practice to reduce the particular stressor are listed next. Workers solutions are followed by how the stressor feels to workers primarily using their words. In the example of the stakeholders stressor, this might be a comment like “you feel beat up after court…it’s like we can’t do anything right.” An excerpt from a solution-focused report is included in Appendix D. Presentation of Findings to Management

Agencies have told us that a face-to-face meeting between the facilitator and manager is a good way to initially receive the report so that the facilitator can provide clarification where there may be questions or concerns. To begin this step, the facilitator (and possibly the notetaker) meets with management to present the solution-focused report of the top stressors. The purpose of this meeting is not to assess the staffs’ comments and proposed solutions but to relay the information shared by workers. It is generally difficult for anyone to welcome information that can be perceived as a threat to our competence or job performance. The face-to-face meeting provides an opportunity to help normalize the concerns of staff.

When management reviews the report that clarifies workers’ perspective of the major stressors, they may notice that the perspective of workers is significantly different from that of the organization. It is important to keep in mind that workers’ elaborations in the exploration of a stressor are based on their experiences and perceptions. An emotional response to a stressor may contribute to making it appear larger or feel as if it happens more frequently than is actually the case. Perceptions have a powerful influence on the experience of stress. It is not unusual that management’s response might include disagreeing with the workers’ perspectives. Differences in perspective can arise because the organization or manager has data that appears to differ from what workers are experiencing, or they can simply be differences of opinion.

Getting on the Same Page

In the case of significantly divergent perspectives between workers and management, an additional step may be needed to share and reconcile perspectives. Reconciliation can start with a meeting between workers and management to share data and seek clarification. You may wish to use the facilitator to lead this meeting. This is not intended to be a confrontational meeting but a simple sharing of data and perspectives. For example, workers might report that caseloads are very high with an average of 25 while the organization data system may indicate that the average is 17. There may be several possible explanations for this discrepancy. It may be that the data system and the workers are counting cases differently (e.g. children vs. families). Another possible explanation could be that workers are retaining cases that are technically closed. Agency policy might require a case to be closed based upon prescribed

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length of service but the case worker might not think that the family is ready so keeps the case open with little or no additional contact. The goal of comparing organization and worker perspectives is not to “change the workers’ mind” but to reconcile the different perspectives in order to help inform the direction of stress reduction strategies.

More often, however, worker and management perspectives are similar. In this case, you are ready to move to exploring targeted solutions.

Beyond Stress Management Training

A number of researchers suggest that organizations use a systems approach or public health model to respond to workplace stress (Blewett, Shaw, LaMontagne & Dollard, 2006; Cooper & Cartwright, 1997; LaMontagne and Keegel, 2010; LaMontagne, Keegel, Louie, Ostry & Landsbergis, 2007). This approach typically characterizes intervention strategies as primary, secondary and tertiary. Primary interventions are proactive and seek to prevent stress by reducing risk factors, particularly through changes in the work environment or the organization. Reassigning tasks that make up the job is an example of a primary intervention. If a job is redesigned so that known stressors are reduced or eliminated, workers are less likely to experience stress in the first place. Secondary interventions are aimed at modifying a worker’s response to a stressor. In this case, workers have experienced the stress and are helped to modify their reaction to the stressor through knowledge, skills or resources. Stress management training is an example of a secondary intervention. Tertiary interventions are reactive and treat the worker for adverse effects of stress. At this level, workers are experiencing a negative consequence(s) as a result of the stress such as fatigue or substance abuse and need to be treated for these effects. Employee assistance programs are an example of an intervention at this level.

Interventions can be further categorized according to whether they are directed toward workers, the organization or the community. An example of a worker- or individual-oriented intervention is training that teaches coping skills and other stress management techniques. Individual-focused interventions are most often secondary level strategies directed at modifying individuals’ responses to job conditions. Interventions employed at the organizational level can also be primary or secondary in nature through these types of strategies are more commonly primary. A change in agency overtime policy to reduce work-family conflict is an example of a primary approach to prevent job stress while mandatory time off after the death of a child represents secondary stress prevention at the organizational level. Interventions at the community or systems level are most likely to be primary, for example, working with a judge to clarify expectations across cases.

Step 4: Exploration of Targeted Strategies for Stress Reduction

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The process outlined in this Guide encourages managers to look beyond stress management training to identify primary interventions or organizational changes that will prevent or reduce workplace stress.

Exploring Targeted Solutions This part of the process can occur in a variety of ways depending upon the preferences or work style of the unit. Some agencies have found it helpful to have the manager review the report with supervisors first; others prefer to share it with the entire unit at once. A review of solutions identified by workers can be a good place to start exploring organizational- and worker-focused stress reduction strategies. This may simply involve clarification and adding detail to proposed solutions or using proposed strategies as a springboard to other ideas.

For example, consider the case of “insufficient time to complete the work,” being a stressor. There is no shortage of possibilities for intervening at the organizationtal level. Examining the demands of the job in relation to available resources, such as support staff or technology may result in selecting an intervention such as a job re-design. In addition to altering job demands or the organization of work, other types of preventive, proactive interventions at the organizational level can target work conditions (workload, work time, processes and rewards), role clarity (clarifying goals and expectations) or participation in decision-making. (Blewett, Shaw, LaMontagne, & Dollard, 2006).

If a community or systems factor

is contributing to the stressor, such as spending a great deal of time waiting for a court hearing, management could meet with court staff to brain storm potential solutions. For example, a special office might be set up just for child welfare workers with wireless computer access so that confidential paper work could be done.

ORGANZIATIONAL STRESS REDUCTION STRATEGIES SUGGESTED BY THE LITERATURE

According to LaMontagne, A.D. & Keegel, T.G. (2010) the following are research-based organizational interventions to reduce work stress:

job redesign – identify the job tasks and consider changing some by improving technology, transferring some to another position, or eliminating some tasks.

clarify goals and expectations – written goals and expectations can help keep workers on track.

role clarity – child welfare work is so complex that reminding workers of their role can help them stay focused.

strengthen social ties – team building can result in workers being more supportive of others and reduce work stress

ergonomic changes – the environment makes a difference – work stations might be candidates for updating

workload reduction – time studies can help assess workload and suggest reductions in caseloads or work tasks similar to job design above

reduce interpersonal conflict – interpersonal

conflict doesn’t usually go away by itself – engage in conflict reduction efforts.

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In conjunction with organizational and community interventions, worker-focused strategies to address time to complete the work might include time management training, workload management, or prioritizing tasks. Another alternative might be to address the cognitive and emotional demands related to the stress of time to complete the work.

In addition to strategies suggested by workers, or in the case where the unit may be

struggling with identification of possible strategies, it might be helpful to take a look at the suggestions from the literature or other resources. Two good places to start are the National Child Welfare Workforce Institute www.ncwwi.org and the Kansas Workforce Initiative www.kwi.ku.edu.

Obviously some of the suggested solutions will be more feasible than others. Finding

some “quick fix” items as well as longer-term strategies can help the unit to build momentum for change. In thinking about where to start, some agencies have found it helpful to use the decision-making matrix included in Appendix E. Some agencies have found it helpful to assign members of the group to follow-up on particular ideas or strategies, such as gathering more information on a particular issue and reporting back to the group. Encouraging the staff to be active participants in exploring and implementing solutions helps to involve and empower the entire unit.

If you are at Step 5 you have completed a great deal of work. This is not an easy process. However it is highly rewarding to engage with workers in a stress reduction effort around an area of their work that they find very stressful. Now it is just a matter of monitoring the organizational changes and making small modifications based upon worker feedback.

Periodically ask workers how the changes are working.

If needed and possible make modifications to organizational changes. It is also a good idea to think about going through this process periodically. With child welfare work being inherently stressful an annual assessment of the top worker stressor can lead a process of continued organizational improvement. This may result in less worker burnout, turnover and increased worker effectiveness.

Step 5: Reviewing Implementation of Interventions

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Appendix A: Development of the Child Welfare Worker Stress Inventory

This process uses a job demands - resources model of work stress (Demerouti, Bakker, Nachreiner and Schaufeli (2001)). In this model, work stress is understood in the context of job demands and the available resources both individual and organizational. Dollard, LaMontagne, Caulfield, Blewett and Shaw (2007) define job demands as things that have to be done and refer to those physical, social, or organizational aspects of the job that require sustained physical and/or psychological effort that erode energy and can therefore lead to physiological and/or psychological health costs. Based in part on this model, LaMontagne and Keegel (2010) suggest that any attempt to address job stress needs to start with an assessment of job demands or risk factors. A thorough understanding of job-related demands gives direction to administrators in implementing appropriate strategies to ameliorate stress in the workplace.

Researchers with the Kansas Workforce Initiative scanned the literature looking for a tool to identify sources of stress in child welfare work. Unable to find such a tool, they developed the 35-item Child Welfare Worker Stress Inventory. The Inventory was based on the following work domains which outline areas of job-related stressors for a range of professions:

Work demands (workload, job insecurity, insufficient time to complete scheduled work tasks, work-home conflict, relocation demands)

Emotional demands (patient severity or type; traumatic work experiences; violence; emotional labor; professional isolation due to institutional racism; demanding patients; customer related social stressors; lack of patients, peer, community understanding of work; unrealistic expectations)

Job control (low skill discretion)

Support (unsupportive line manager)

Rewards (lack of appreciation by others, lack of career development)

Effort-Reward Imbalance (high imbalance between effort expended and rewards received)

Role (role conflict, role ambiguity, general role issues)

Interpersonal conflict (interpersonal conflict, bullying) (Dollard et al., 2005. pp. 21-22)

In addition, the Inventory was developed using the 57-item Expanded Nursing Stress

Scale (ENSS) which measues the degree of stress experienced in various aspects of nursing. This scale was referenced since nursing and child welfare share parallel stressors including challenges in working with individuals and families, high workloads and daily multidisciplinary collaboration. Subscales of the ENSS include: Death and dying, conflict with physicians, inadequate emotional preparation, problems with peer support, problems with supervisors, workload, uncertainty concerning treatment, patients and families and discrimination.

To date, the Child Welfare Worker Stress Inventory has been administered with more than five agencies that provide foster care and family preservation services.

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Appendix B: Example of Initial Report

Stress Inventory Findings for Agency A The Stress Inventory includes 35 aspects of child welfare work that workers might find stressful. A copy of the inventory is attached. Invitations to participate in the inventory were sent to the 120 front-line staff working in foster care at Agency A. After three reminder e-mails, 72 responses were received. That is a 60% response rate. The following were the top three stressors. That is they had the highest average score.

Insufficient time to complete work

Conflicts with the legal system

Being held accountable for things over which I have no control The following items were the identified as the least stressful and may be resources that can be used to alive ate stress.

Lack of support from immediate supervisor

Testifying in court

Violent or threatening family members Reducing Workplace Stress Many employers routinely offer stress management training and tips to their workforce. Research shows these approaches can be effective but typically produce only short-term improvements in self-reported well-being (Caulfield, Chang, Dollard, Elshaug, 2004). Organizational approaches to reducing stressors along with equipping individuals to better cope with stress are most promising. Some examples of research-based organizational interventions to reduce work stress include:

Job redesign Strengthening social ties

Clarify goals and expectations Ergonomic changes

Role clarity Workload reduction

Work time Reduce interpersonal conflict The inventory is intended to identify common sources of stress to encourage beginning an exploration of shared interests and strategies for reducing workplace stress.

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Appendix C: Facilitator Guide for the Staff Discussion

Preparation for Meeting with Agency Staff In collaboration with the manager initiating this process, prepare for a meeting with the group or groups of workers who have participated in completing the stress inventory. In order to allow workers the freedom to thoroughly discuss what they find to be stressful, the meeting should not include management or supervisors. Allow about two hours for the discussion depending upon the size of the group. The purpose of the meeting and the role of the facilitator needs to be clearly outlined to participants prior to the meeting, with an emphasis on confidentiality of responses and clear explanation regarding how the information will be utilized. This information can be outlined by management in an e-mail that includes a copy of the inventory results. The e-mail can include an introduction of the facilitator and a notetaker if one is utilized. Some facilitators also like to send a brief meeting reminder and welcome to participants which contains a short reiteration of the purpose of the meeting. Selection of Meeting Space If possible, arrange for a room in which all participants are able to see and hear each other, preferably seated at tables. Light refreshments help create a relaxed environment. Flip charts or white boards may be helpful for listing the identified stressors and for focusing the discussion. Plan for Recording the Discussion Select a notetaker to record the discussion. This helps the facilitator focus on managing the discussion and group dynamics. It can also help to ensure a comprehensive documentation of the issues. The notetaker, like the facilitator, needs to be someone without a connection to the participants. Role of Facilitator A primary role of the facilitator is to create an atmosphere in which participants may speak candidly about the primary stressors identified in the inventory. This can be achieved by:

explaining the process to the participants

clarifying the role of the facilitator

explaining the parameters of confidentiality (for example, “…names will not be attached to comments in any report generated from the discussion”)

encouraging an atmosphere where they may speak freely without fear of retribution

eliciting from participants a set of ground rules such as “no interruptions”, “one person speaks at a time”, etc.

Facilitator Preparation for Discussion Prior to the meeting, it is important for the facilitator to prepare a discussion outline. This outline is created by taking each of the top three stressors and developing questions to elicit more information about each stressor including contributing factors as well as potential solutions. A detailed sample discussion outline is provided below. It is typically not necessary to

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ask each specific question during the discussion but the outline can help to ensure that a comprehensive discussion of the stressor has occurred.

Overview of Meeting Process (A detailed sample discussion outline is provided below.) Open the meeting by reminding the workers of the top stressors they reported and asking workers to explore the meaning of the top stressor for that work unit. For example; “Tell me about fear of making a mistake.” It is important to be as open and non-judgmental as possible to allow workers to explore the stressor from their perspective. Once responses for the top stressor are exhausted, move on to another stressor. Involving staff in suggesting constructive solutions to their identified stressors is a powerful approach to creating staff investment in change. As a way to conclude the discussion, ask participants to suggest strategies for addressing each stressor. One approach is to encourage participants to generate ideas that they think may be feasible within the constraints of the agency and community. Or, if time permits, a straightforward brainstorming process can be utilized with all responses considered and noted with no judgment regarding feasibility. Either way, it’s important to prepare participants by providing a brief set of guidelines often used in discussions of this type such as “keep an open mind to new ideas”, “everyone participates”, “don’t judge suggested solutions”, “no idea is a bad idea”, “build on others’ ideas”, etc. Although effective facilitation in this part of the process dictates that ideas are accepted without judgment, a “reality check” can be built in as a final step. If this step is used, it is important to let participants know in advance that there will be opportunity at the end to do a quick review of the “doability” of the list of ideas.

Sample Discussion Outline

Identified Stressor: Insufficient Time to Complete Work

1. What is typical work day for you? What do you do? About how many hours you work in a typical day? Do you typically spend additional time at home doing work-related tasks?

2. How is it decided what you do each day? How do you prioritize daily? As the day evolves, how do you decide what is most important to do?

3. Is it clear what is expected of you (responsibilities, priorities and quality of work)? 4. How is work shared among team members? 5. Are there any rules or guidelines for managing workload (e.g. limit on number of hours

worked, evening or weekend coverage)? Are there unwritten rules or expectations around hours worked or managing time?

6. What type of support is provided for completing work? What type of support would help you get the work done?

Ideas for Solutions 7. What ideas do you have to deal with this issue? 8. How would you re-design your job if you could? 9. There are several aspects of workload that can be stressful. I’m going to read a list and

then would like you to think about this question: If you could focus on the most stressful aspect of workload, what would that be?

Caseload/case composition (number of children in home, etc.)

Case tasks – home visits, meetings, court

Case communications – phone calls

Paperwork

Other administrative demands (required meetings)

Inadequate resources

Meeting deadlines

Interruptions/unexpected demands

Emotional toll of the work What would help?

10. Do you have opportunities to meet with a supervisor or co-workers to talk about work? Would that help?

11. What could go on a “not to do” list?

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Overview of Meeting Process Open the meeting by reminding the workers of the top stressors they reported and asking workers to explore the meaning of the top stressor for that work unit. For example; “Tell me about fear of making a mistake.” It is important to be as open and non-judgmental as possible to allow workers to explore the stressor from their perspective. Once responses for the top stressor are exhausted, move on to another stressor. Involving staff in suggesting constructive solutions to their identified stressors is a powerful approach to creating staff investment in change. As a way to conclude the discussion, ask participants to suggest strategies for addressing each stressor. One approach is to encourage participants to generate ideas that they think may be feasible within the constraints of the agency and community. Or, if time permits, a straightforward brainstorming process can be utilized with all responses considered and noted with no judgment regarding feasibility. Either way, it’s important to prepare participants by providing a brief set of guidelines often used in discussions of this type such as “keep an open mind to new ideas”, “everyone participates”, “don’t judge suggested solutions”, “no idea is a bad idea”, “build on others’ ideas”, etc. Although effective facilitation in this part of the process dictates that ideas are accepted without judgment, a “reality check” can be built in as a final step. If this step is used, it is important to let participants know in advance that there will be opportunity at the end to do a quick review of the “doability” of the list of ideas. More on Facilitating the Discussion One useful resource for facilitators of group discussions is Facilitator’s Guide to Participatory Decision-Making by Sam Kaner which provides strategies for managing common group discussion dynamics. That guide has a table- or chart-format which lends itself to easy review and reference. An issue worth considering that has occurred in these types of discussions is dealing with negative comments about named individuals (agency leadership, the manager, supervisors or others) during the discussion. In this case, it can be helpful to ask participants for examples of behavior to try to identify the issue of concern. For example, a staff person might share an experience about overhearing two supervisors making fun of another worker. Gently probing or helping to “name” the behavior may help the staff to recognize the issue as a lack of professionalism. Reports and feedback to agencies should never identify individuals by name (both who provided the information and the person targeted) or situations that may inadvertently identify individuals within the agency.

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Appendix D: Excerpt from a Solution Focused Report In October 2012, a Child Welfare Worker Stress Inventory was conducted with the foster care unit at Agency A with 38 responses from 42 staff. The inventory identified the top three stressors for workers as: 1) Stakeholders devaluing the work I do, 2) Insufficient time to complete work and 3) Being held accountable for things over which I have no control. To develop a better understanding of the top stressors, a discussion was held with workers in November 2012. This report summarizes the input for participants in that group. Stakeholders devaluing the work I do Staff would like to have a positive working relationship with community stakeholders.

Several staff suggested that an informal meet-and-greet with the local mental health providers might help to start building better relationships. This meeting might also include discussion about expectations for communications.

Staff wondered if the agency attorney might be a resource.

Initial training on the court process was seen as a way to help new employees “get off on the right foot” with the judicial and legal stakeholders

How workers said it feels: “You feel beat up after court…it’s like we can’t do anything right.” “Sometimes the therapists just don’t seem to get it. We need them to focus on what these parents have to do to get the kids home.” Insufficient time to complete work

Staff are committed to completing their work and report using home time in order to catch up on logs and paperwork.

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Appendix E: Decision Making Matrix

Already doing

Interested in doing

How difficult to implement/strengthen? 1= Easily Doable 2= Feasible but with effort 3= Challenging

Building Positive Stakeholder Relationships

Plan meetings with local providers for informal networking and/or clarification of expectations.

1 2 3

Talk with agency attorney about being a resource for problem-solving

1 2 3

Review initial training on the court process with particular focus on how it prepares staff to interact with judicial and legal stakeholders

1 2 3

1 2 3

Managing Daily Tasks

Increase support staff available for scheduling appointments, collecting UAs, faxing reports, assisting families to fill out application forms, and other administrative tasks.

1 2 3

Streamline paperwork through a systemic review of all forms to simplify documentation and eliminate redundancy.

1 2 3

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Child Welfare Worker Stress Inventory

Thinking about your job over the past month, please indicate how often you have felt stress due to the following:

Item Never Stressful

Sometimes Stressful

Frequently Stressful

Almost Always Stressful

Lack of resources for families

Conflicts with legal system (judge, DA, etc.)

Insufficient time to complete work

Lack of opportunity to talk with others about work

Inadequate information to do the job

Working with difficult or uncooperative families

Stakeholders devaluing the work I do (courts, mental health, schools, etc.)

Required non-social work tasks, such as clerical work

Lack of support from immediate supervisor

Being held accountable for things over which I have no control

Talking with families about emotional matters

Testifying in court

Case related documentation

Being blamed for something that goes wrong

Feeling unsafe

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Feeling unprepared to help families with their problems

Disagreements about cases

Insufficient staff to cover cases

Inadequate training for the job

Death or serious injury of a child

Responsibility for the lives of children and families

Interpersonal conflicts (non-case related)/office politics

Work intruding on family/home time

Making difficult decisions

Lack of discretion in doing the job

Families not recognizing my efforts

Others telling me what to do

Being on call

Fear of making a mistake

Reorganization or agency changes

Violent or threatening family members

Press/media coverage that reflects on what I do

Constantly changing job responsibilities

Families getting treated unfairly

Travel

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