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Striking balance, enjoying challenge : how social workers in child protection stay on the high wire Nordick, Wendy Gale 2002

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STRIKING B A L A N C E , ENJOYING C H A L L E N G E : HOW SOCIAL WORKERS IN CHILD PROTECTION STAY ON THE HIGH WIRE by W E N D Y G A L E NORDICK B.S.W., University of Victoria in affiliation with the University College of the Cariboo A THESIS SUBMITTED IN PARTIAL F U L F I L L M E N T OF THE REQUIREMENTS FOR THE DEGREE OF M A S T E R OF SOCIAL W O R K In THE F A C U L T Y OF G R A D U A T E STUDIES School of Social work and Family Studies We accept this thesis as conforming to the required standard Dr. Richard Sullivan Faculty of Social Work U B C Dr. Mary Ann Murphy Faculty of Social Work OUC THE UNIVERSITY OF BRITISH C O L U M B I A April 2002 Copyright Wendy Gale Nordick, 2002 STRIKING B A L A N C E , ENJOYING C H A L L E N G E : HOW SOCIAL WORKERS IN CHILD PROTECTION STAY ON THE HIGH WIRE by W E N D Y G A L E NORDICK B.S.W., University of Victoria in affiliation with the University College of the Cariboo A THESIS SUBMITTED IN PARTIAL F U L F I L L M E N T OF THE REQUIREMENTS FOR THE DEGREE OF M A S T E R OF SOCIAL W O R K In THE F A C U L T Y OF G R A D U A T E STUDIES School of Social work and Family Studies We accept this thesis as conforming to the required standard Dr. Richard Sullivan Faculty of Social Work U B C Dr. Mary Ann Murphy Faculty of Social Work OUC THE UNIVERSITY OF BRITISH C O L U M B I A April 2002 Copyright Wendy Gale Nordick, 2002 JUL 23 2002 15=44 FR 00 £04 822 8656 TO 812503142359 P.02/03 in presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, 1 agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by Ms or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. The University of British Columbia Vancouver, Canada Department Date DE-6 (2/88) JUL 1? 2022 12:52 604 822 9S87 PAGE.02 Abstract Social work scholars have documented the vicarious trauma, burnout and compassion fatigue experienced by social workers involved with abused children with the attendant effects of high absenteeism and worker turnover. However, a mysterious phenomenon exists in child protection. Certain workers not only avoid burnout and survive in their jobs, they thrive. The purpose of this thesis is to describe exploratory research findings, which begin to explain how some career child protection workers avoid burnout, survive and thrive in a chaotic system. The author, using grounded theory methods, reviews the literature and describes the interviews of six "healthy" child protection workers who defy the stress of their work. The research also describes the interviews of two workers who had succumbed to stress. It is discovered from the data that child protection workers balance on a high wire of challenge and like it! Ten sub-processes describe how this balance is achieved despite the difficult work. Risk factors and warning signs threaten their balance, but workers apply two additional processes to steady their balance. In addition, a rare occupational gift is revealed; these career child protection their labour and provide a labour of love. This study has limitations. As a result, only a tentative discussion on policy implications for educators, supervisors, administrators and practitioners is presented. This discussion explores factors that may contribute to decreased absenteeism, increased job satisfaction and perhaps most important, better service to children and families. ii Table of Contents ABSTRACT ii TABLE OF CONTENTS iii LIST OF TABLES v LIST OF FIGURES vi ACKNOWLEDGMENTS vii CHAPTER 1 INTRODUCTION 1 LITERATURE REVIEW . . . . 3 RATIONALE 6 ORGANIZATION OF SUBSEQUENT CHAPTERS 10 CHAPTER 2 METHODOLOGY 11 RATIONALE/ USE OF QUALITATIVE RESEARCH 12 QUALITATIVE RESEARCH 14 ACCESS TO WORKERS 17 DESIGN 17 PILOT STUDY 18 MAJOR RESEARCH. 21 ETHICAL CONSIDERATIONS 21 DATA COLLECTION . . . . 22 DATA ANALYSIS 23 LIMITATIONS OF THE STUDY . . . 25 CHAPTER 3 RESULTS 28 THE SAMPLE 28 BALANCING ON THE WIRE . . . 29 EMBRACING RISKS AND CHALLENGES. 30 MEANING AND PURPOSE OF THEIR WORK . 32 EXPECTING THE UNEXPECTED . 35 KEEPING EXPECTATIONS REALISTIC . 38 APPLYING INVESTIGATIVE AND INTERPERSONAL SKILLS . . . . 3 9 ACHIEVING COMPETENCE AND CONFIDENCE 41 LEARNING ABOUT SELF . . . . 43 FINDING SUPPORT FROM OTHERS AND SUPERVISION 50 MAINTAINING AN IMPORTANT LIFE OUTSIDE OF iii WORK 59 DEBRIEFING THE T R A U M A 61 E M B R A C E PROCESS . . . . 64 RISK FACTORS 67 W A R N I N G SIGNS 73 TRANSITION POINT PROCESS . . . 76 EQUILIBRIUM PROCESS . . . . 80 CHAPTER 4 THEORETICAL IMPLICATIONS OF RESULTS . 85 RESILIENCE THEORY . . . . 96 CHAPTER 5 E M E R G I N G POLICY A N D PRACTICE IMPLICATIONS A N D CONCLUSION 99 POLICY IMPLICATIONS DISCUSSION . 99 RECOMMENDATIONS FOR FURTHER R E S E A R C H . 103 CONCLUSION 106 REFERENCES 108 iv List of Tables Table 1: Research Elements 18 Table 2: Sub-processes of Balancing on the Wire 30 Table 3: Embrace Process Examples . . . 66 Table 4: Risk Factors . . 68 Table 5: Warning Signs . . . 73 Table 6: Regaining the Footing: Transition Point Examples 78 Table 7: Theoretical Model . . . . 95 v List of Figures Figure 1: Embrace Theory Figure 2: Transition Point Process Figure 3: Equilibrium Process Theory vi Acknowledgments With profound gratitude, I acknowledge the people whose assistance made it possible for me to complete this work. First, I thank the social workers who participated in the research by sharing their experiences with me in private interviews, and in focus groups. Their time, honesty and insight were most valuable. I also wish to thank my key informants, three Ministry of Children and Family Development social workers who recommended their colleagues for interviewing. I thank my thesis advisor Dr. Mary Ann Murphy for her infectious enthusiasm, ideas and sound guidance from project conception to completion and to my second reader, Dr. Richard Sullivan, for his rigor, experience and constructive feedback that assisted in flushing out critical issues. They both modelled fine social work educators. In addition, I wish to thank my external examiner, Dr. Marilyn Callahan whose expertise in grounded theory resulted in defining the categorical processes within the findings. I wish to thank my brother, Glenn Nordick who served as my editor, via email, and my friend, Satwinder Paul who provided the expertise in thesis construction. Finally, I wish to thank my family. To my parents, Ed and Maybelle Nordick who instilled a thirst for learning and whose unconditional love has sustained me. To my precious children: Richard, Tanya, Brett, Carla and Lisa for their support, patience and sacrifice during my studies and to my good husband, Bi l l , whose faith in my ability provided the emotional support necessary to move this project to completion. vii 1 "This is a team that is in to adrenalin and we're very flexible." (Gerald, line 377-378). "Social workers who have been around for a while.. .are in tune with who they are they balance whatever they need.. .whatever works for them to create that balance." (Larry, line 222-224, focus group). ".. . i f you have people who are willing to train you then you are going to survive or have the ability to prosper, right?" (Gerald, line 486-488)^ Social work scholars have documented the vicarious trauma, burnout and compassion fatigue experienced by social workers involved with abused children and their families. Social workers are considered an occupational group at above risk of burnout (Jayaratne & Chess, 1984; Pines & Kafry, 1978). Burnout is the term used to describe the effects of the difficult work and is defined as "a syndrome of emotional exhaustion and cynicism that occurs frequently among individuals who do 'people work' of some kind. A key aspect of the burnout syndrome is increased feelings of emotional exhaustion" (Soderfeldt, Soderfeldt & Warg, 1995, p. 639). Despite the occupational risk, veterans of child protection do emerge. Certain workers not only avoid burnout and survive in this environment, they thrive. • Jayaratne & Chess (1994) suggested that research must be conducted within each field of practice to understand the "nuances and idiosyncrasies of the particular group" (p. 452). As well, Bowman & Stern (1995) suggest that careful consideration be given 2 to the study of context specific strategies for coping with occupational stress. This research makes that attempt. Literature focuses on stressors that disable or contribute to job dissatisfaction and high turnover rates in child protection workers. Yet a mysterious phenomenon exists in child protection work contributing to the research question: what, conversely, explains the career child protection worker who not only avoids burnout and survives but thrives? The purpose of this research is to determine how some workers avoid burnout, survive and thrive despite the difficult nature of this work using a empowering, strengths perspective approach. The author, using grounded theory methods, reviews the literature on the subject, reports the results of the interviews with six protection workers who appear to defy the stress of their work and describes the reflections of two workers who were absent from work due to stress. As will be pointed out in the literature review, workers in this occupation face numerous job pressures. Yet, it is discovered from the data that these child welfare workers balance on a high wire of challenge and like it! These data demonstrate that the workers who successfully balance enjoy the challenge of the work and are open to its complex experience. The data demonstrates that those workers who survive and thrive are effective at simultaneously balancing a number of factors. Ten sub processes articulate how this balance is achieved and maintained despite the difficult work. They are: embracing the risks and challenges, finding meaning and purpose in their work, expecting the unexpected and organizing to avoid chaos, keeping expectations realistic, applying investigative and interpersonal skills, achieving 3 competence and confidence, learning about self and self-awareness, finding support from others/supervision, maintaining an important life outside of work and debriefing the trauma. Further the successful workers can sense danger coming and respond to it, thereby avoiding a fall. These dangers are risk factors and warning signs. In addition, a rare occupational gift is revealed; these career child protection workers love their labour and provide a labour of love. The results of this study are corroborated by research findings from other social work studies and other similarly challenging occupations. New results emerge that deal with the workers' beliefs about the use of sick time. Suggestions are made for further areas of research. The emerging implications of these findings for human resource management, social work education and training and direct social work practice are discussed. Literature review The complex and demanding nature of child protection work, including the public visibility and responsibility, the organizational context in which it occurs, and the gendered nature of the profession may make it arguably one of the most difficult occupations known. Workers are surrounded by reminders of the feared public stigma of "baby snatchers" and know only too well that errors or accidents are subject to close public scrutiny (Anderson, 2000). In fact, workers are "pilloried" i f a child dies or becomes injured in their care (Callahan, 1991). Further, the deprofessionalization of social work in some localities undermines worker confidence (Drover, 1998; Green, 1988; Veeder, 1990; Rock, 1990), while the systemic nature of abuse may contribute to feelings of futility. A 1992 estimate by the Canadian National Clearinghouse on Family Violence 4 (2000) indicated that 40,000 Canadian children were living in foster care or other settings, some due to intervention by child protection authorities. Davoren in Anderson (2000) reports that most workers agree that "knowing a child may be seriously injured or neglected, or even die, i f the worker misjudges the parents' capacity to care for the child is their greatest burden (p. 840)." Barbara Dane (2000) articulated the effects of this burden and the critical incidents witnessed by workers as burnout, counter transference, and vicarious traumatization, while McSwain, Robinson, & Panteluk (1998) add a fourth effect they call "critical incident stress." These critical incidents (Plante, 1996) experienced directly or vicariously, contribute to over-involvement (Koeske & Kelly, 1995) or compassion fatigue (Anderson, 2000), which erode professional detachment. Inexperience (Streepy, 1981) may also contribute to burnout in child protection work. Child welfare research seems to have a particular focus on systemic and bureaucratic deficits and appears mainly descriptive in nature (Waldfogel, 2000; Ramsey, 2000; Seita, 2000). A much smaller body of work has focused on stress, burnout and job satisfaction (Ramanathan, 1990; Vinokur-Kaplan et al., 1994; McLean & Andrew, 2000; Koeske & Kelly, 1995; Koeske & Koeske, 1989; Arches, 1991; Anderson, 2000). In addition, workers believe that agency and office working conditions, organizational structures and management (Anderson, 2000) are often additional sources of stress that contribute to job dissatisfaction (Vinokur-Kaplan, Jayaratne, & Chess, 1994). These stressors may directly impact productivity, performance and retention (Ginsberg, 1998; Graef & Hi l l , 2000). As well, the interface between work and home I 5 life with a predominately female workforce (Anderson, 2000; Vinokur-Kaplan, Jayaratne, & Chess, 1994; Stats Canada, 1998) who serve a predominately female clientele (Swift, 1995) may contribute to role conflict, role overload and role strain (Mastekaasa & Olsen, 1998; Canadian Fitness & Lifestyle Research Institute, 1998). Female child protection workers may be further disempowered by the relative position of their gender (Callahan, 1991). Workloads (Koeske & Koeske, 1989), low pay and long hours, paperwork and case recordings that "consume 50% or more of workers' time" (Anderson, 2000) also contribute to burnout. Technology may also be a factor in burnout (DiLeonardi &Yuan, 2000) as a lack of technological savvy undermines worker confidence. Some literature focuses on coping strategies among child protection workers. Distancing increased worker resistance to burnout (Kaplan, Turner, Norman & Sullivan, 1996; Wallace & Brinkerhoff, 1991; Pines & Maslach, 1978) while critical Incident Support Debriefing (Mitchell & Everly, 1989) also assisted workers to achieve distance. Avoidant behaviour was also a recognized coping strategy (Gibson, McGrath & Reid, 1989). Colleague support (Koeske & Koeske, 1989; Gibson, McGrath & Reid, 1989; Beardslee, 1989), team support (Masson, 1990) and supervision (Mor Barak, Nissly & Levin, 2001) were found to increase resilience for child protection workers. The use of creative capabilities (McNeely, 1984), spirituality (Russell, 2001), striking balance between work and home life and exercise (Health Canada, 1998) were positive coping strategies. Self-confidence (Rutter, 1987), the ability to be introspective (Masson, 1990), having autonomy in the work (Arches, 1991) and finding the work challenging (Siefert, Jayarante & Chess, 1991) also helped workers survive and thrive. • 6 Job experience is also a factor for survival in social work (Egan, 1993). Resilience theory (Rutter, 1987) has also contributed, in a general way, to understanding how people survive in difficult circumstances The nature of the work and its organizational context can lead to high levels of stress, burnout, job dissatisfaction and high turnover. This results in overburdened staff and staff shortages caused by attrition that may result in poor service to children and families. This leaves children at risk. Understanding of how workers in this occupation withstand or overcome this pressure may make a positive contribution to this field of practice. Rationale Four reasons exist for further investigation into this question. First, without some insight into this question, human resource departments continue to face burgeoning administration costs as child protection workers leave or use sick days to manage growing symptoms of mental illness brought about by burnout (Koeske and Kelly, 1995). Second, this lack of retention of workers has implications for the quality of direct practice to children and families. Judy Gillespie, a child welfare specialist at the Okanagan University College in Kelowna, B.C. reported the implications of a high staff turnover in child protection. High turnover results in "an overburdening of existing staff and staff shortages that may result in poor service and poor continuity of service to our client families, leaving children at risk" (J.Gillespie personal communication to M . A . Murphy, April 2002). Third, insight may contribute to better understanding of personal suitability and 7 lead to enhanced standards of practice in selection, training and education. Perhaps more elusive, is the possibility that certain social workers may lend a contagious esprit de corps or leadership to the office, thus boosting job performance and morale and creating "organizational conditions by which motivational energy can be released to achieve goals and outcomes that benefit both the individual and the organization" (Vinokur-Kaplan et al., 1994, p. 94). Combined economic and social benefits support the worth of this study. Current research has tended to describe the pathology of child protection work and organizational health rather than focus on what process helps some workers avoid burnout in this difficult environment. Only rarely does the literature take a strengths perspective and ask high functioning employees how they avoid burnout and stay healthy, despite the challenges of their work and the demands of the system. The Canadian Association of Social Workers (CAS W) has launched a study entitled, "Creating Conditions for Good Practice." This project has evolved out of the association's desire to advocate for work environments that support and encourage social workers in child welfare settings. CASW and their member organizations report a growing awareness that social work practice in child welfare has become increasingly complex and demanding: practitioner morale is low, caseloads are too large, there is a shortage of qualified social workers, many practitioners are poorly paid, attrition rates are high and there is a major image problem regarding child welfare work (Canadian Association of Social Workers, 2001). This research is not yet complete but contains the beginnings of a focus on what constitutes good practice. 8 In February 2001, the then British Columbia Ministry for Children and Families conducted an employee survey called the Organizational Health Survey. This survey tool was intended to be a "snapshot" of the "health" of an organization. It contained eleven separate scales designed to gather information on organizational problems, improve effectiveness, develop change strategies and assess the impact of programs. This survey may be a provincial example of research with a focus on health rather than the pathology of the workplace. A U.K. study reported by McLean & Andrew (2000) found that absence from work with stress-related physical symptoms was taken for granted as a coping mechanism by social workers. Much of the depression experienced by people comes from the stress experienced in the workplace. The cumulative effects of such stress cause a person to approach what Johnson & Indvik (1997) called a coping threshold. Those who succumb, cross the threshold into disability. According to Statistics Canada, absenteeism, in general, has increased from an average of 8.2 days per year in 1980 to 9.3 days in 1997. In total, full time employees lost an estimated 66 million workdays in 1997, with 25-30% of short-term disability claims based in psychological problems (Bohuslawsky, 1998). Health Canada's Workplace Health System Needs Assessment (1990) revealed that one in five workers missed over one week of work as a result of sickness, injury or disability. One third of these employees, or 6% of all workers, missed in excess of five work weeks. Direct payroll claims for disability in Canada was about $11.1 billion and the economic burden of illness in Canada in 1993 was estimated at $85.1 billion (Campolieti, 2001). Absenteeism was found to be higher among women than men (78% versus 63%) and 9 given that for every 100 women graduating from post secondary programs in social service there are only 71 men (Stats Canada, 1998), this impacts employers of social workers. Replacement labour was viewed to be about 75% as effective. Stress and burnout result in decreased job performance and inferior work (Vinokur-Kaplan et al., 1994). Job turnover continues to be a concern in child protection and Anderson (2000) cites a study conducted in the Texas Department of Protective and Regulatory Services where annual turnover rates were in excess of 30% while Graef & Hi l l (2000) estimate job turnover costs $10,000 per vacancy in 1995 dollars. "Human capital lies within a person. Hence it is not easily transferable; it can be gained only by investing in a person over a long period of time" (Mor Barak, Nissly & Levin, 2001, p. 3). If people leave, this investment is lost and added to the loss of the employee in separation costs, replacement costs and new employee training costs ( Mor Barak et al., 2001). Conclusion Current literature does not explain how some workers avoid burnout, survive and even thrive in a challenging, chaotic system. Through interviews and focus groups, this study presents research on child protection workers to articulate how child protection workers survive and thrive. The findings are of interest to both workers and employers. They have potential to enhance training, decrease stress, absenteeism and turnover, and have implications for policy and direct social work practice. 10 Organization of subsequent chapters Chapter Two details the methodological approaches used in this study. Chapter Three presents the results of the study while in Chapter Four the writer discusses the theoretical implications of the findings. Chapter Five involves a discussion of the findings, the implications for policy and practice, recommendations for further research and concluding comments. 11 Chapter 2 MethodoloRy This chapter outlines the how the research question was determined, the rationale for the research method, describes the methodology and identifies the ethical considerations. Determination of the Research Topic In the search for a relevant and suitable research question to satisfy the University of British Columbia Master of Social Work thesis requirements, the researcher met with the then Ministry for Children and Family Development District Supervisor to discuss their research needs. During this discussion, it became apparent that the District Supervisor and their human resource department personnel were curious what made some workers survive and thrive despite their difficult work. They did not seem to know why some workers remained and performed well, while other workers burned out very quickly. This burnout had consequences in terms of costs, training, worker morale and retention. As a disability consultant for large insurance companies, much of the researcher's caseload was mental health with a diagnosis of depression resulting from job burnout. These clients worked in a variety of occupations. The researcher often wondered why some workers were unable to sustain working in a job while other workers survived very well in a similar work environment. Therefore, the research question appeared to be a suitable fit between researcher interest and academic curiosity. The Ministry was interested in findings of the research as they sought solutions to high turnover rates. 12 Rationale for Selection of the Research Method A strong rationale exists for choosing a qualitative research methodology (Creswell, 1998). First, while this is an area of social work practice that dominates intellectual attention in terms of resource utilization, we know very little about this phenomenon. Second, while evaluating the research potential of this study, a preliminary and informal discussion was conducted with the researcher's social work colleagues who practiced in child protection. They appeared very receptive to this study. Third, qualitative studies allow us a detailed view of the topic using a narrative approach to understanding the experience of workers. These narratives provide data, and using grounded theory, this illuminates our understanding of how workers avoid burnout, survive and thrive. Good research outlines it's ideological and theoretical perspectives along with a conceptual framework. A postmodern (Bryson, 1993; Mullaly, 1997) ideological paradigm (Ristock, 1993; Dominelli & McLoed, 1989; Bricker-Jenkins & Hooymann, 1986; Donovan, 1985), with its focus on initial ambiguity, allows for a path of discovery (Denzin & Lincoln, 1994) and for details or findings to be obtained from the research inductively through the emerging data. These details or findings may be analyzed by using existing theoretical perspectives or may modify existing theory. Social construction is the process by which the social workers attach and construct meaning to their difficult work and "stresses the social aspects of knowing and the influence of cultural, historical, political and economic conditions" (Payne, 1997, p. 31). Social construction, or the meaning they give their work, may be a contributing factor to workplace health. 13 Modernism Critical theory has two competing perspectives: modernism and post-modernism. Modernism developed during the period of Enlightenment when philosophical thinkers pressured the social control order of Middle Age feudalism with a science that demanded objectivity, facts, replicity and rules. This project, called modernity, sought freedom from the oppression of people and thought to liberate them from irrationalities of "myth, religion, superstition and the arbitrary use of power that characterized the Middle Ages" (Mullaly, 1997, p. 109). Modernity persisted until a rival perspective, post-modernism, began to take hold during the 1980's and 90's. However this "break from Enlightenment" actually began with the philosophical writings of Nietzsche, Heidegger and Foucault (Mullaly, 1997). Nietzsche's maxim, " A l l credibility, all good conscience, all evidence of thrust comes only from the senses" (Nietzsche, 1991, p. 452) hammers a wedge into rationality and acknowledges that truth may be found in a variety of ways as the world teams with diversity, multiplicity, pluralism and conflict rather than sameness, unity, monism and consensus (Mullaly, 1997). This new way of seeking truth is referred to as postmodernism. Qualitative research methods were now given credence as an approach to finding "truth." Post modernism There does not appear to be much agreement on when civilization entered the postmodern era. In fact some modernists do not recognize postmodernism and even among postmodernists there is disagreement about when the era begins. However, Harvey (1989) contends it emerged between 1968 and 1972 as "there was a notable shift in sensibility, practices, and discourse formations, which distinguishes a post-modern set of assumptions, experiences and propositions from that of a preceding period" (Harvey, 1989, p. 39). Postmodernism finds truth in relativism; what is true for one is not true 14 for the other or what is true in one culture is not true in another culture. No group should define the reality or experience of another group (Mullaly, 1997). The acceptance of postmodernism is becoming widespread and, rather than competing with modernism, it is often now viewed as complimentary, particularly in research, where both approaches have validity. Similarly, Potter & Wetherell (1987), argue that language orders our perceptions and instructs our behaviour, so examination of our perceptions is critical to understanding human behaviour. Therefore, postmodern research emphasizes the sensitivity of the interview, where the subjects not only answer questions prepared by the interviewer, but themselves formulate, in dialogue, their own concepts of their lived world (Kvale, 1996). The advent of post modernity allowed qualitative research, steeped in social construction theory, to develop credibility as a science. Further, applying this critical approach means reassessing whose voices -individually or collectively - are joined to express experience of naming and knowing which is the emphasis of postmodernism. Social Construction and Qualitative Research With postmodernism there were now new ways to determine reality. Scientific external observation and clinical experimentation on human subjects began a shift to a social science focusing on language; its power, discourse, meanings and processes achieved through questioning and conversation with the subjects. Parton and O'Bryne (2000) asserted this approach emphasizes the processes through which people define their identities and environments. By participating in their social world, interacting with others and assigning meaning to aspects of their experience, they construct their social reality. Qualitative research is a "uniquely sensitive and powerful method for capturing the experiences and lived meanings of the subject's everyday world"(Kvale, 1996, 70). 15 This explicit use of constructionist methodology, which analyzes and tries to make transparent what is happening, is central to social work practice. This transparency is attained through interpretive work and, according to Strauss & Corbin (1994), ".. .the interpretations must include the perspectives and voices of the people whom we study .. .(and) researchers must assume the further responsibility of interpreting what is observed, heard or read" (p. 274). This research strives to better understand the phenomena of child protection workers who avoid burnout, survive and thrive in a difficult environment. At the same time, it is difficult to quantitatively measure the experiences, processes, meanings, and power dynamics involved. Therefore, qualitative research, with its focus on language and meaning, is a defensible vehicle for exploring the phenomenon. Grounded Theory In 1967, two sociologists, Barney Glaser and Anslem Strauss, were the first to articulate grounded theory research, a form of qualitative research. They believed this approach would contribute toward "closing the embarrassing gap between theory and empirical research" (Glaser and Strauss, 1967). Since then, though they have quarreled over the development of grounded theory, both have continued to research and write in this methodological approach which has gained popularity in sociology, nursing, education and other social science fields (Creswell, 1998). These quarrels have centered on Glaser's emergent theory belief while Strauss and Corbin (1990) have developed a schema for conceptualization of the emergent data (Kendall, 1999). These debates continue. Glaser believes that using Strauss' prescribed categories of a central phenomenon, causal conditions, strategies, conditions, context and consequences limits the researcher's ability to allow categories to emerge from the data. 16 What remains consistent to both their work in grounded theory is that their writings have objectivist underpinnings but also give voice to their respondents, representing them as accurately as possible. Constructivist grounded theory takes a "middle ground between postmodernism and positivism.. .The power of grounded theory lies in its tools for understanding empirical worlds" (Denzin & Lincoln, 1994). Grounded theory is used to develop sociological explanations of social interactions. Grounded theory can produce two types of theory, substantive or formal. Theory is judged on its adequacy, on its ability to fit the phenomenon under study, to provide understanding, to be general enough to cover a range of situations but not so abstract that it loses its relevance in the context (Wells, 1995). The standard definition of grounded theory is provided by Strauss and Corbin (1990): A grounded theory is one that is inductively derived from the study of the phenomenon it represents. That is, it is discovered, developed and provisionally verified through systematic data collection and analysis of the data pertaining to that phenomenon. Therefore, data collection, analysis, and theory stand in reciprocal relationship to one another (p. 23). According to Creswell (1998) ".. .the centerpiece of grounded theory research is the development or generation of a theory closely related to the context of the phenomenon being studied" (p.56). Strauss & Corbin (1994) believe that theory is a plausible relationship among concepts. In grounded theory, this theory is articulated near the end of the study and can assume three forms: a narrative statement, a visual picture or a series of hypothesis or propositions (Creswell, 1998). 17 Access to Workers for the Study Creswell (1998) believes that interviews play a central role in grounded theory, and recommends twenty to thirty individual audio taped interviews. For this project only nine workers were interviewed. A considerable amount of time was spent negotiating access to this population through a Regional District Manager. Access appeared possible prior to the provincial election. However, with a change in government ideology and post election downsizing rumors, this same Regional District Manager of the now Ministry for Children and Family Development (MCFD) believed that worker morale had been affected. This made the research untimely and had the potential to bias the findings. As a result, the researcher accessed workers on an informal basis using key colleague informants in a snowball approach. This lack of formal access to a large number of child protection workers through the then M C F D significantly reduced the number of participants for this study. A further barrier to a study of Creswell's recommended proportions was the researcher's own limitations in terms of time and resources. Design Four sequential elements form the basis of the research design (see Table 1): 1. Pilot study and focus group 2. Main study, and a focus group 3. Data analysis 4. Writing the findings • 18 Table 1: Research Elements Research Steps Research Stages Step One Literature Review - September 2001 Pilot Study of 5 workers - October 2001 Focus Group - November/December 2001 Step Two Personal Interviews of 4 workers- January 2001 Focus Group- February 2002 Step Three Data Analysis using grounded theory February/March 2002 Step Four Documentation/Writing of Research findings February- May 2002 Step One, the pilot study, was conducted and completed under separate ethical approval from the University of British Columbia Behavioural Research Ethics Board through the Social Work Research Qualitative Methods Course SOCW 554. This pilot study assisted in the process of developing selection criteria for subsequent worker interviews and providing some preliminary concepts for the research. Step Two of the research was approved by the University of British Columbia Behavioural Research Ethics Board approval number B01-0591. Step One: Pilot Study For the purposes of the research, health was defined using the World Health Organization's Constitution definition of health ".. .a state of complete physical, mental 19 and social well-being and not merely the absence of disease" (Health Canada, 2001). Achieving a sample of "healthy workers" was therefore purposive. Deirzin & Lincoln (1994) advise that sampling in qualitative work is purposive rather than random, so selection focused on achieving an "information rich" (p. 73) sample. In Step One, five workers were carefully selected through key informants using a snowball sampling of select child protection social workers in British Columbia. Child protection workers were selected based on the following criteria, self-report and i colleague referral: Must have worked in child protection longer than three years Must be deemed by a peer to be a healthy worker 3. Self identify as healthy and satisfied with their job and 4. Seen by peers to contribute to office morale Eight questions formed the basis of the semi-structured interviews. These f o u n d a l i o n questions were designed to launch researcher and participants into discussion on critical issues of how they survive and thrive in their work. They were: 1. Why do you think you have been successful in surviving and thriving while doing the difficult work of child protection? 2. What are your values around health? 3. Can you describe your self-care? 4. Can you articulate i f there are internal resources that keep you well? 5. What keeps you from getting sick? 20 6. Can you recognize symptoms of stress in yourself? 7. Do you know if there are any factors that place your health at risk? 8. If so, how do you deal with them? Written for the pilot study, these questions were not changed for the main study, as they appeared to elicit information explaining the, phenomenon of surviving and thriving. In addition, the following descriptive data was collected from each worker: gender, length of service, age, classification of job and education. This information forms the demographic profile of the workers. However, during the pilot study interviews, it was revealed that two of the workers who had self-reported as healthy and deemed excellent workers by their peers, had actually been off on a stress leave at some point in their career in child protection. This inadvertent twist led to interesting and informative comparisons that helped corroborate and confirm study findings, and is a tool for validity. As a result of this twist, two additional criteria were added for the main study: 5. Must not have been on sick leave for burnout/stress. 6. Must hold a minimum of a Bachelor of Social Work as an educational requirement (this requirement was added to avoid confounding variables such as an Arts degree). This purposive sample was based on the above criteria, self-report and impressions of colleagues. If peers believed a worker met these criteria subjectively, and if workers agreed they met the criteria, they were deemed appropriate for the study. Interviews were conducted in the homes of participants or in mutually agreed upon restaurants. Two of the five interviewees later became focus group participants. 21 Three were excluded from the focus group as two had been on disability and one did not show up. A 90-minute focus group was held in the home of the researcher to test research questions and to confirm/validate the preliminary findings of the pilot study. Workers in the focus group helped to clarify the preliminary findings and deemed the research questions appropriate to glean pertinent information. Focus group questions centered on the data. Following careful analysis and coding, the researcher itemized the major findings and groupings on poster paper and presented them to the group. These findings led to discussions that either confirmed or further clarified the ideas, concepts, comparisons and properties discovered in the data. Step Two: major research This section highlights the major research. In addition to the pilot study data, interviews were conducted with four more workers and a second focus group was added due to the small number of participants in the pilot study focus group. With the pilot study completed, the remaining research involved one hour interviews with four workers using the revised criteria followed by a 90-minute focus group attended by two of the workers. One worker's interview was excluded from the data as his interview revealed a disgruntled attitude toward his employer that suggested that he did not really meet selection criteria number three: healthy and satisfied with their job. One worker was unable to attend as a result of a child protection emergency. Ethical Considerations Denzin & Lincoln (1994) state that most ethical concerns surrounding research relates to harm, consent, deception, privacy and confidentiality of the data. For both studies, a rigorous approach to full and informed consent was taken to ensure clear 22 understanding of the limits of confidentiality and anonymity in both the interviews and the focus groups. The substantial ethical concern of this research was protecting the confidentiality and anonymity of the workers. Pseudonyms were given to all participants and used in the report of the findings as a way to mitigate any harm to the participants and to protect their anonymity and confidentiality. Participation was voluntary with no penalty for refusal to participate. Participants were largely unaware of other participants in the study, but those participating in the focus group did not have the luxury of this protection. The privacy of the participants will be maintained through locked storage of the raw data for no less than five years. As well, the data will be stored without identifying evidence. A l l participants signed the consent forms and all interviews were audio taped. Data collection Bernard (1994) recommended a semi-structured interview for grounded theory. As mentioned above, data collection occurred over a four-month period based on eight questions honed from the pilot study. These questions probed workers for clues to explain why they survive and thrive at their work. This semi-structured interview style allowed for more freedom within the interview. The researcher used the written questions as an interview guide. Once consent was given by the participants, crafted, systematic and explorative open-ended questions allowed the participants to "tell their story" (Denzin & Lincoln, 1994, p. 74) in a way that Kvale (1996) describes as an art form. The second collection method is a focus group. A focus group's usefulness is to confirm the findings (Denzin & Lincoln, 1994) of the study. Literature search, interviews and focus groups were the sources of information that identified major 23 themes and patterns, conceptual links and maps of any relevant dimensions from categorized and coded data (Creswell, 1998). Audiotapes of the focus group sessions and select information were entered and analyzed. This concludes the description of the research design. Data Analysis Evidence of rigor is required in qualitative research. Rigor is measured in time and the extensiveness of the research Twelve hours of audio taped interviews documented the eight interviews and two focus groups. The researcher transcribed all audiotapes verbatim. It took over 45 hours to transcribe, summarize field notes, identify in-vivo codes and categorize data. Manual analysis was conducted without the assistance of computer-aids. First, to manage the data, all tapes were placed in marked envelopes, along with the transcript and the consent forms. Computer files were created to organize the data. A white board and coloured paper were used as additional management tools. Second, each line of transcribed data was numbered and read for a general review of all information. Using reflective notes and memos, the interviews were summarized. Third, relying on a hermeneutical approach, the text was broken into small and separate parts to determine understanding and meaning within the text (Kvale, 1996). Strauss & Corbin (1990) recommend fracturing the data into these small pieces of text to identify categories, properties and dimensions. These small pieces of text were cut apart with scissors and placed in piles with similar meanings. Piles with over a 50% representation (more than four papers in a pile) were used as categories or open codes. 24 These small open codes were analyzed for implicit and explicit meanings while reflective memos were written to ask questions to muse and speculate about the data (Creswell, 1998). This comparative approach is especially useful in the phenomenon of surviving and thriving as it evaluates the interactions of basic social process (Wells, 1995) between workers experience, home-life, work environment and their colleagues. These small, rich meanings or pieces of text were described, classified and interpreted for context and categories. Corbin and Strauss (1990) outline the coding process used for this study. Sub categories or properties that demonstrated multiple perspectives about the categories were described. The white board was useful to document the categories that emerged which were given "in vivo" labels (words of the participants). However, these codes were frequently moved and rearranged during the analysis as new categories were formed or new relationships emerged, a process called axial coding. The researcher used the Glaser (1992) method for axial coding which allows the emergent data to develop the broader concepts. Fourth, analysis sought multiple meanings from the data and progressed to the larger meaning, representations, propositions, processes, properties, relationships and dimensions, a process called selective coding that connects the categories. Core status criteria were identified as: a) a categories centrality in relation to other categories b) frequency of occurrence in the data c) its inclusiveness and the ease with which it related to other categories d) the clarity of its implications toward a general theory e) its movement toward theoretical power f) its allowance for maximum variation in terms 25 of dimensions, properties, conditions, consequences and strategies (Strauss, 1987). Based on the coding process, a central phenomenon was identified. Data from the focus groups were transcribed and analyzed in a similar way, but the analysis was further aided by Krueger's (1994) process of analyzing focus group results which include: consideration of the words, context, internal consistency, frequency and intensity of concepts, the specificity of responses and looking for the "big ideas." The focus group confirmed in some instances, conceptual relationships around developing ideas. This provided clarification and regrouping of data as instructed by the focus group. These steps in data analysis led to a set of findings and theoretical propositions that comprise a grounded theory of how some workers not only avoid burnout and survive, but also thrive in their difficult work. Limitations of the study There were five limiting factors of the study: researcher's lack of experience in the context of child protection, small sample size which affected the requirement for data saturation and generalizability of the study, timing of the study, a lack of collateral evidence and there may be a gap in making a link between the worker's experiences and their changing work environment. First, the researcher has never worked in child protection. While this is perhaps a limitation in terms of fully understanding the meanings articulated by workers, this limitation does provide the strength of objectivity (the researcher did not imbue the findings with her own subjective experience). The second limitation was sample size. The sample size was nine. Creswell 26 (1998) recommends the researcher determine when the categories are saturated and suggests this occurs at approximately 20-30 interviews. Saturation occurs when no new data can be found either through additional sampling or from analysis. Due to the limited number of participants, the researcher did not achieve saturation of data. With each interview, new data continued to be revealed. This was inadequate to reach data saturation, a requirement of good grounded theory methodology. While it is possible that the analysis of the existing data neared saturation, rewriting or memoing in an expanded, analytical form may reveal gaps or new relationships (Denzin & Lincoln, 1994). Data saturation is required in order to offer generalized statements and recommendations for policy and practice implications. Morse (1999) makes an argument that supports generalizability in qualitative research. His premise is that as each participant is purposively selected they contribute to emerging theory. This type of selection ensures comprehension and is complete, thereby benefiting all scenarios in a larger population. Eisenhardt (1989) reports that when findings rest on a very limited number of cases that theory building can be tied to existing literature from other case study research. This tie enhances the internal validity and generalizability of the emerging theory developed in this research. Many of the findings existed in previous literature and will be discussed more fully in the chapter on theoretical implications. The third limitation is that at the time of the interviews, workers were somewhat apprehensive about the status of their jobs due to a change of government. This was compounded by the belief the new government presented a different ideological perspective toward social programs. This may have affected the responses to questions. 27 Fourth, the researcher was unable to collect collateral evidence to meet the requirement of triangulation due to the lack of access to Ministry data. Desired collateral evidence would have included retention/disability statistics and access to the voice of the clients who received interventions by these workers. As the research is not triangulated, this is a limitation of the research. Overall, the research is limited to making emergent and tentative suggestions regarding theory, recommendations and conclusions based on the limitations of the methodology. The literature on resilient child protection workers is limited and somewhat dated; therefore despite the limitations of the study, these findings contribute to the literature on the processes that describe how healthy workers cope with and neutralize the effects of their stressful work. 28 Chapter 3 Results "We are adrenalin junkies" (Larry, line 318-319, focus group). This chapter introduces the sample used for the study. This researcher identifies the overarching process of "balancing on the wire" and the ten sub-processes that identify how it is done, how the workers stay on the wire and how they achieve balance. Sample In total, the data from eight interviews and two focus groups contributed to the study. The gender distribution was five females and three males for the individual interviews and an equal gender representation during the focus groups. These workers reside in two different regions of British Columbia. The mean age of the participants was 43 years of age and the mean time of employment in child protection was 12.25 years. The longest period of service in child protection was sixteen years while the "rookie" of the group had seven years in child protection. A l l held a Bachelor of Social Work degree (BSW), five held Bachelor of Arts degrees before completing their BSW, one held a Bachelor of Science before completing their BSW, and one also held a master's degree in Education. The provincial government of British Columbia employed these workers in the following capacities: Mary, Charlene, Dora and Mavis were child protection social workers while Gerald was a child protection investigator. Rory held a special position in child protection. Janice 29 was a child protection team leader, and Larry had very recently moved from child protection social work as a result of career advancement (names used are pseudonyms). These workers had diverse family of origin experiences: middle class, poverty and difficult experiences in childhood. They all believed their particular life experiences contributed to their ability to do their work, " my background was one of poverty and my home life was somewhat abusive, so I think I have an understanding that that side of life was not a real surprise to me" (Mary, line 52-55). Larry's experience contributed to his tolerance on the job. " I was born in Europe.. .and my father spoke four languages and so did my I guess you know when I sort of peel back the onion and go back through my life, all things influenced who I am right now in terms of tolerance..." (Larry, line 369-375). Balancing on the Wire "This is a team that is in to adrenalin and we're very flexible (Gerald, line 377-378). "Social workers who have been around for a while.. .are in tune with who they are ... .so they balance whatever they need.. .whatever works for them to create that balance" (Larry, line 222-224, focus group). The overarching question in this research study is: how do child protection workers avoid burnout, survive and/or thrive in this difficult work environment? The central phenomenon of this research is that workers in child protection balance on the high wire and like it! They enjoy the challenges of their work and employ ten sub processes to 30 maintain that balance. These sub processes are grouped under attitudes, skills and supports required (see Table 2). Table 2: Sub Processes of "Balancing on the Wire" Attitudes Skills Supports 1. Embracing risks & challenges 5. Applying investigative and interpersonal skills 8. Finding support from others and supervision 2. Finding meaning and purpose in their work 6. Achieving confidence and competence 9. Maintaining an important life outside of work 3. Expecting the unexpected and organizing to avoid chaos 7. Learning about self and self awareness 10. Debriefing the trauma 4. Keeping expectations realistic 1. Embracing risks and challenges Workers articulated that the job presented opportunities for a sense of excitement and challenge they sought in their lives. This excitement affects the whole of the worker and contributes to their sense of job satisfaction. This excitement included challenges and the provocative nature of the job. In addition, they relished in a cheeky form of structuralism called creativity. Gerald (line 262) and Mary (line 212-213) both described themselves as "adrenalin junkies" while Mary provided a more detailed description of this concept. "We thrive on the adrenalin rush, although we are not risk takers in the sense of extreme sports" (line 246-248). Gerald described the investigative work as the "thrill of the chase" (line 700) and described his team as ".. .a team that is into adrenalin.. .1 get bored, you know, with routine" (line 377-379) while Janice reported, "'s never boring, you know you can go to work and have a day planned and its going to end up totally different, there is some excitement in the job, it is certainly not humdrum" (line 397-399). Workers appeared to enjoy going to a home and not knowing what to expect behind the door, " get the adrenalin rush but you still feel confident, that I mean you probably knock on the door and stand to the side if you've never been there before... so we are adrenalin junkies" (Larry, focus group, line 316-319). They loved the challenge of not knowing what their day might bring. Workers enjoyed the provocative aspects of their job. They found it challenging, interesting, important, different and difficult. Rather than finding the work overwhelming and sad, they found challenge in making change for families and in keeping children safe. "I enjoy the job that I do, um it's challenging, there is no day that is the same, I enjoy helping families and helping kids um improve their quality of life, um so a lot of job satisfaction that way..." (Gerald, line 33-36). Janice stated, " is a difficult job, but I enjoy the work. I think that it is an important job the workers do..." (line 35-37). There is some allure about the challenge of work in child protection and this allure may move the worker into the realm of thriving. Creativity is another important dimension of their challenge. This creative approach to social work was a way to "get around policy" in creative, legitimate ways. Larry agrees that certain standards have to be met, but that creative social work can enhance solutions. "Certainly standards need to be met, and I don't disagree with that, but I also strongly believe that social workers by virtue of the work they do, have to be creative..." (line 69-71) and ".. .help families in spite of the system" (focus group, line 165). 32 Mary agreed that creative social workers may have greater job satisfaction. "Ya, I take great satisfaction when I can get something too that is not in policy or get some money out for my families" (focus group, line 172-173). Dora did as well, "...when you are faced with those blocks that um the government or the legal system puts in front of you how can you get around it to meet the needs of the child.. .and a good attribute is the creativity part..." (line 526-529). Rory chuckled as he also expressed this creativity ".. .1 found ways around it and realized things like it is sometimes better to seek forgiveness than permission" (line 347-350). Workers embraced the challenges of the job. They appeared to thrive on the provocativeness of the job, the non-routine nature of the work and the variety the work offered. They used their creative abilities to challenge bureaucracy. This challenge allowed them to be authentic to a generalist social work practice model. This process of embracing risks and challenges allowed workers to thrive. 2. Finding Meaning and Purpose in their Work There was a strong correlation between longevity on the job and ability to remain focused on the purpose of their work - to keep children safer. "Most of us feel that we've left children somewhat safer and that is a source of satisfaction" (Mary, line 359-361). Workers expressed altruistic reasons for doing the work. "I believe in what I do, I don't do it for the pay cheque. I support the values of child protection..." (Mavis, line 11-12). These workers drew strength from the fact that they worked for a government ministry that believed all children deserved a safe home environment, a sense of well-being and protection and that families belonged together as much as possible. The 33 workers shared these Ministerial values and they felt a heartening congruence of values between their personal values and that of the Ministry. As Gerald said, ".. . congruence... your personal values and the values of the organization you are working for" (focus group, line 432-437). However difficult the work, however disgruntled, however discouraged, they harkened back to the deeper values that drew them to the work in the first place. When their work became extremely difficult, they hearkened back to their purpose; they summoned strength from their raison d'etre, their reason for being: is the very strong social workers who retain their internal.... maintain their purpose regardless, regardless of what the system is doing by way of controlling their movements...the tighter the controls are, the more internalized the values become.. .they work hard at retrieving their own values, they need to retrieve the purpose of why they became social workers...but they've managed to retain something of significance to them, that core reason why they are social workers to begin with... (Larry, line 468-479). This meaning and purpose to their work was applied through their interventions with children and families. Charlene reported she does not assess families through just a protection lens: ...there is a balance to protection work...if you look at everything with a protection lens, I am sure we would have far more children in care i f we don't look at things with that balanced look.... I believed that parents try really hard and they just have difficult times in their lives and we should be far more supportive of the people..." (line 421-430). 34 She practices from a strengths perspective, " . . . i f we look at the strengths that people have, that guides you..." (line 597). Larry appeared to prioritize the protection of children over administrative demands. "I don't think that child protection workers, in particular, are awfully threatened by not getting the paperwork done, they feel more of an internal personal need to ensure the safety of the children... "(Larry, focus group, line 279-281). Dora's interventions supported her beliefs about family. "I truly believe the kids should remain at home as long as possible..." (line 447-448). Rory portrays a powerful description of his intervention philosophy toward in child protection. .. .a parent and child bond is something that is almost sacred, sacrosanct and you have got to do everything you possibly can to preserve that...I guess there is an ethical responsibility to really go to the limit to ensure that we can do what we can to maintain a child in his is really easy to fall into a punitive kind of approach...moralistic sort of approach to people of bad and good, bad and evil, incompetent and competent...I think the worker really has to strive to find that grey area.. .that is going back to where the client is and understanding their stories...You begin to get stigmatized after a while, dealing with the hundredth family in which alcohol or drugs is an issue and these kids are being destroyed by their this is really hard not to develop that kind of sense that this is just another addict family...I think it takes a lot of strengths to just step outside of that and (ask), so what is important about this family? (line 275-320). 35 Workers performed their work with a spirit of love, compassion and caring. Their advocacy for children's safety gave their work meaning and purpose. It was a labour of love. 3. Expecting the unexpected and organizing to avoid chaos Workers appeared to possess a mental "on their toes" attitude that allowed them to manage the adaptability, autonomy, planning/organizing, overtime and caseload balancing required for the job. Workers believed they needed the ability to adapt to their environment and to possess the flexibility necessary to change. Larry pointed out ".. .so how a social worker or anyone adapts to their environment is really important.. .then I think we may be a little bit closer to what causes survivorship in social work" (line 266-270). Rory listed flexibility as a personal attribute " .. .you think it is your time to go home, all of a sudden you get a phone call and it is going to take two hours of your time and I think there is an inherent need for flexibility..."(line 577-580). Gerald believes without the flexibility you will not survive in child protection. "Um, there are people who you say you have to go out and they look at their day timer and say, I am booked for two weeks, I can't. You are not going to survive on my team" (line 369-372). Adaptability and flexibility contribute to survivorship. Autonomy and flexibility of schedule appeared to be an important provision of the job. ". . . autonomy, flexibility, like there is that for me, you know, like I tend to come in a little later and leave a little later" (Focus group, line 634-635). Charlene put it this way: 36 I am most productive in the morning; so I generally try and stay at the office, get paperwork done etc. In the afternoon, I hate the afternoon that is when I wil l do my home visits.. .1 am in control of that, I am not batted around by my schedule (line 255-265). Strong organizational skills at home and at work provide the routine and structure necessary to work in a chaotic and difficult environment. Organization took the form of planning, overtime and balancing of caseload. Well-planned casework and home life decreased vulnerability to stress: .. .so rather than get sick, I get more organized. I have to be organized at home and at work. I keep my home reasonably clean and keep the laundry and shopping up so that this does not overwhelm me.. .organization keeps me from feeling overwhelmed.. .this helps me to be prepared at work. I don't have to worry about other things. I like routine and structure (Mary, line 396-402). Larry concurs: .. .what organization is to me is having control over my environment, I get stressed when I don't feel that I have that control.... i f I have a chaotic day, I can manage that pretty well because of anything else I know is controlled, especially in the kind of work that we have.... it is still crisis management, so i f everything else is pretty much organization and controlled...(line 39-44). 37 This planning ahead and solid organization appeared to prevent workers from feeling overwhelmed. However, when casework becomes unmanageable, a reasonable amount of overtime can correct the feeling of being overwhelmed and restore a sense of control. This was a common theme but workers cautioned that overtime had to be limited to reasonable amounts: .. .but sometimes our offices get so hectic and there is files and mess all over the place and I can't live with that very long... I will have to come in and do some overtime and I've always thought it was just me being a control freak.. .(focus group, line 50-53). Larry felt overtime was a necessary evil as well: .. .even though they are not provided with overtime, or given extra time of back fill to catch up, that's why they are driven to, that's my opinion, belief, is they are driven to put in the extra time to be organized so that they can cope with their job (focus group, line 58-60). Overtime becomes a self-preservation strategy to be prepared for when work becomes chaotic. Mary's comment pins down the motivation for the overtime. "Ya, and even when I come in and do that overtime, I am not really doing it for the system, I am doing it so that I can cope" (focus group, line 63-64). Overtime is a coping strategy that maintains organization. 38 Workers appear to become adept at balancing their caseload between too heavy and too light in two ways. They do this by keeping inactive cases open longer than they should to play "catch-up" on their more active cases and by assertively asking the supervisor for a more balanced caseload: I had to learn that the faster I worked to close cases, the more work I was given.. .1 have learned that the really active files, I work hard at and I don't close the less active cases, until some of the more active files become stable. I have learned to balance my caseload (Mary, line 374-381)...We have the ability to go to the supervisor if we have too many cases (Mary, line 280-281). Caseload balancing was critical to "survivorship." In tandem with caseload balancing was the need for planning, organization, adaptability, flexibility and overtime which prepared workers for chaos. This expecting the unexpected through organization helped with "survivorship." 4. Keeping expectations realistic Workers in this study were pragmatic and realistic about the difficult work, the poverty and client choices. Mary's words describe this realistic attitude: I don't think I went into this with the idea that I was going to save the world.. .1 know there are going to be children die no matter what social workers do, but 39 that is something that is going to happen, I know that I am going to make mistakes, I don't think I beat myself up too much about the mistakes I have made, although sometimes that is worse than other times.. .we display empathy but not sympathy and have an attitude to encourage clients to get on with life (line 129-265). Charlene pointed out that in order to survive, she had realistic expectations of the change process. " .. .(I) realize that people make decisions, they might be terrible decisions but they are their decisions and we simply have to accept that... everyone's life is so different" (line 475-481). This quote also demonstrates an obvious respect for the self-determination of clients. Gerald's perspective was "I am smart, I have a lot of common sense" (line 37-438). Veteran child protection workers appeared to be pragmatists with a strong sense of realism that some aspects of their work were out of their control. 5. Applying Investigative and Interpersonal Skills Workers applied strong analytical and assessment skills using their cognitive abilities to gain knowledge and understanding; they seemed to have a penchant for facts and investigation. Gerald states, " Maybe I am more analytical and logical... we tend to logically seek out truth rather than explore feelings.. .but more like police, more like investigators, wanting to find out more, with more inquiring minds" (Mary, line 142-266). Gerald's experience was similar. ".. .people on my team are cop wanna be's. We are investigators, we are the guys that like to root around in you know, get the dirt, not 40 believing everything that people said um you know, kind of cynical, digging for facts" (Gerald, line 352-359). Larry's point of view is: ...(a) protection worker actually does investigative work at the outset, they ask lots of questions as to what is going on, what the problem is, the specifics of the background, all the usual technical questions...basically all the assessment stuff, but more so the role of the child protection worker.. .is to find out exactly what is going on and what needs to be done... I think it is the role of the ministry worker to determine as much as they are able, what actually is going on there and to minimize or eliminate the risk to the child and if that means removing a child temporarily, that is what the social worker has to do. But that is just the beginning .. .of the family work (line 6-35). A strong investigative approach assists the worker to obtain the knowledge and information necessary to make sound decisions that are in the best interest of the child. This knowledge leads to sound logic. Sound logic also has another function -influence. "So, i f I get people on my side, i f I am reasonable enough with my plan and logical, then other people are going to buy into that" (Mavis, line 287-289). Logical, rational and confident thinking contributes to more effective use of persuasion and influence. This investigative skill was supplemented with their ability to remain somewhat detached or aloof from their work. They described themselves as not "touchy feely," having empathy rather than sympathy for clients. Workers who preferred logic to emotion had an ability to separate themselves from their clients. Mary's self-41 attribution illustrates this. " I have been more able to cope with it. I think that I have been able to be a little bit detached"(line 227-128). Workers stressed that strong interpersonal skills were required to do the job well. Gerald states: You need an ability to be able to communicate with people at different levels... one moment I am talking with the judges and the lawyers right and an hour later I am back on the streets talking with you know, three year olds or confronting a drunk, so having an ability to adjust your style (line 389-395). Rory also expressed the importance of good interpersonal skills. "The other thing is as well, there (are) some real social skills and communication skills, being able to relate with some ease with people and begin able to communicate fairly clearly with some immediacy" (line 381-384). Strong interpersonal skills are linked to survival. The work of child protection demands investigative skills, an ability to detach and the application of strong interpersonal skills. 5. Achieving Competence and Confidence Workers believed in their own ability to create change through social problem solving. This was a strong theme articulated by the workers. ". . . we develop a feel on how to act. Competence is important" (Mary, line 300-301). Mavis suggested that as her confidence grew, so did her competence: I think the other thing is having the confidence to do this job, because I think that is where people are going to make mistakes, cause i f you are afraid to do 42 your job, that could be a real problem.. .just believing in what I am doing and that I am doing a good job... (line 184-196). Gerald reports, ".. .you need to have a lot of confidence in yourself. If you start doubting your own abilities or your own self worth, then you are not going to survive in this" (line 416-418). Experience leads to increased confidence in one's professional judgement. When workers were unclear how to proceed, they competently trusted their instinct or followed practice ethics and had the professional confidence to carry this out: In my practice, I do what is ethically right and if that fits with policy, great, i f it does not, I practice according to my ethics. This is ok with my supervisor. The supervisor tells you to do what you feel is the right/best thing to do.. .learn to trust that gut feel. I didn't learn to trust it right away, it took a couple of years to trust that gut feeling, learning to trust that gut intuition. Of course we practice according to policy- our movements are guided by the protection concerns in the Act, but we develop a feel on how to act (Mary, line 284-300). Charlene's voice was telling. ".. .(ethical practice has) been solely what makes me want to throw in the towel or keep on going" (focus group, line 454-455). Workers in the study, when forced to choose between ethics and policy, choose what they perceive to be the most ethical decision. This exhibits strong competence as a social worker and the confidence to carry out difficult, ethical decisions that may be unpopular with management. 43 6. Learning about self and self- awareness Those interviewed reported strong self-analysis and self-awareness. "We have to be very, very self-aware" (Charlene, line 291-292). Janice called herself insightful: I try to look at all sides of things and I am only too willing to change my mind and I used to think that meant I was kind of wishy washy, but it doesn't.. .1 am willing to look at different sides, different perspectives and I am not always right...(line 457-465). Larry believes introspection is necessary. ". . . some people are more introspective, I suppose and maybe it comes down to personality types early on, some people really think deeply about issues and problems and are more introspective in that way" (line 167-170). Introspection and subsequent self-awareness appears to increase one's ability to see both sides of a problem and to be fully aware of one's own operating biases and assumptions. With this understanding, better solutions are developed. Workers had the self-awareness to recognize that good self-care was important. Self-care is defined as a strong and determined ability to ensure their health for the purpose of prevention and correction. "Well, I think that a lot of it would have to do with my lifestyle, and it seems that I am either working or taking care of myself (Mary, line 23-25). Self-care had four properties: exercise, nutrition, spirituality and boundaries. Exercise was reported as a critical factor in self-care: 44 Outside activity, is what exercise, I am not a gym person, but I like to be out.. .the last four to five years that has turned into golfing, we do a lot of golfing .. .1 like to be outside and that breaks up the stress from being in the office (Dora, line 22-26). Rory reported, "I planned to do a couple of mountain climbs..." (line 130-131) while Mary stressed, ".. .physical exercise has been a really important part.. .1 belong to a gym pretty well ever since I started doing social work.. .the last couple of years I have started running..." (line 77-82). Workers in this study recognized the utility of exercise's properties of invigoration and participated on a regular basis. Good nutrition was reported essential to good self-care. "I always take my lunch to work" (Mavis, line 72) and Mary stated, "I eat properly" (line 88). Workers were proactive about meeting their nutritional needs. Most workers identified and relied on some form of a deity, or balance of mind, body, spirit that appeared inextricably woven with good self-care. Janice's words are powerful: I think that social workers, a lot of social workers are guided by some real strong spiritual beliefs.. .some real deep connectiveness to religion, certain belief systems and social work does um, mirrors, or social work practice is reflective of a lot of 45 certain religious beliefs I think the helping of other people, the golden rule.... my best coping strategy.. .go for a walk, think, pray, pray and then pray some more. I shouldn't say that facetiously, but I know, talk to an inner spirit or talk to God about it or whatever (line 760-773). In the focus group, Charlene confirmed that spirituality ".. .was a strong one for me" (line 400-401). The practice of spirituality in this study wove social work values and spiritual values in a way that empowered and strengthened workers in stressful times, thus promoting resilience and healing. In tandem with this spiritual strength was a concept of self- actualization: .. .it is just a will that I have, onward, upward, every moment, everyday. I am going to make life the best that I can and when I am old, I want as few regrets as possible, so I take life very seriously and I want to be in charge of my life rather than just being batted about. Sail on, not drift on (Charlene, line 497-502). Healthy workers insisted on strong boundaries between work and home life, "...and just trying to find that balance between own life and work" (Janice, line 153). Mavis too, asserted, "I have to have very firm boundaries between work and home" (line 56-57). Charlene's voice clarifies this point: .. .is to give it 110% while you are there, but keep your personal, your time boundaries on it. You can only do, what you can do, go at it hard, have fun while 46 you are doing it and then get out of there. A motto that I have is that I work to live, I don't live to work... (line 217-222). These boundaries did not just include geographical boundaries from the workplace, but also emotional boundaries. ".. .1 have the ability when I am at work, I am at work and when I am not, I am not (Charlene, line 447-449). Strong boundaries warded off burnout. Gerald also expressed that while he enjoyed discussing his work with his wife, he needed to set time frames to refrain from allowing work to intrude on his home time: ... we can spend the entire evening talking about what happened in the day and then, first off you can't get to sleep you wake up in the morning and you, What happened? I am still at work, so we have to put that structure in there.. .we have like fifteen minutes or there is a brief time frame... (then) that is enough...boundaries (Focus group, line 104-119). Firm self-imposed boundaries were a major factor in keeping wellness in and illness out for these workers. These workers demonstrated a strong sense of self-awareness which correlates with their ability to care for themselves. Workers were also self aware of their beliefs about illness and described how these beliefs impacted the way they coped on the job. The data revealed that workers beliefs about illness were divided and strong attitudes emerged about using sick time or Short Term Indemnity Plan (STIP). Three of the workers were of the attitude that you did not take time off work for illness unless 47 very i l l ; their personal values stated that you must cope, no matter what. This contrasted with two other workers who believed that STIP, here and there, was a positive coping strategy to avoid lengthy disability claims. Mary and Dora had similar beliefs about illness. "I saw myself, I mean you always cope, you don't have (a) choice. So for me to not cope with anything, it is just not a way I think. You either cope or you lose your mind so I always coped" (Mary, line 68-72). Dora's values about illness were similar: I'm never sick. When I say I'm never sick, I don't think that I have taken a sick day in maybe two or three years, I did injure my foot and had to go on crutches and took a couple of days off because I couldn't walk, couldn't drive... no, even if I was sick, you have a cold... I still go and if I feel nauseated with the flu.. .1 just take gravol and go to work... (Dora, line 538-558). Gerald, in contrast to Dora and Mary, believes that taking a mental health day occasionally is useful and therapeutic: .. .1 need a day to balance myself, i f I am not feeling balanced, and I need to sit down and go whew, take some time, think about what's going on um, then I need to do that and that is part of awareness, that is part of my own self awareness.. . i f they get to the point where they have lost that, they need to be able to take some time to rejuvenate and recharge themselves, it doesn't mean they can't do the job, right? ".. .this ministry has invested eleven years...of mentoring and training into me, if I turned around tomorrow and said, that's it, I am gone... that is bad 48 investment... So you know, I don't see that as being a negative thing, I see that as actually being proactive and positive (line 479-506). Janice too, believes that use of STIP is therapeutic: .. .because I have seen other workers that happens to and they are sitting in their office and they are crying because they can't do it anymore. They can't take one more sad story, they can't take one more crappy life for a child, you know they just can't take one more.. .you just have to go away for a while and then come back and somehow, that gives you distance... (line 280-287). Use of STIP provided distancing and in this case appeared to have the same effect as a critical care factor; it had a restorative effect. A l l workers who agreed to participate in the study had been identified by their peers as excellent child protection workers. In addition, they had self-identified as healthy workers with high job satisfaction but two workers had actually taken a disability leave for short periods of time for stress related symptoms. This was unknown to the researcher and was revealed during the interview. These interviews were telling: I think that it was one thing to that I have recognized that this did happen to me, I don't want to have happen again.. .people do come across crisis in their lives there is nothing wrong with that (Rory, line 430-443). 49 Janice too, had two stress leaves in her lengthy career and reported: ... we were dealing with a difficult client at the time who took a lot of time and energy... and I think it is just sometimes it just gets overwhelming and you just have to walk away from it and take off.. .it was something that happened, like you know, had to happen at that time in my life (Janice, line 194-215). She has since returned to work and continues to be a much-respected social worker by her peers and her community. Rory returned to work after his sick leave and requested a voluntary demotion: I took two or three weeks off um just thought about what it is I wanted, where I wanted to be, what I needed to feel good about what I was doing an um, I just realized that I needed to pull back a little bit and um realized that social work was more than (promotions), and once I realized I don't need that, I don't need that to define myself, and define how I do social work, it was like this huge weight had lifted (Rory, line 32-42). Both Janice and Rory returned to their difficult work of child protection, having reassessed the what, where, why and how of their work. They appeared to return fresh and with renewed purpose. Some workers used or believed that STIP was useful for an occasional mental health days and for longer periods to provide distancing and detachment. Use of STIP then, is a valid coping strategy, as well as a risk factor. As well, flex days were a significant contributor to job satisfaction and worker health: Gerald: For the most part I get an extra day off every second week. 50 Charlene: That is a huge one Gerald: I mean that is the mental health and all the rest of it" (Focus group, line 641-645). Clearly, these workers have a strong sense of self and correlating beliefs about how to care for themselves. This self-awareness helped workers survive. 7. Finding support from others and supervision The people that child protection workers rubbed shoulders with contributed to their job satisfaction. They reported they had fun and laughed at work, "...we have such fun, there is not a day that I go to work that I do not have good laughs" (Charlene, line 742-743). They found satisfaction in working in interdisciplinary teams. "I enjoy the camaraderie and the fun of the team and the other workers, I really enjoy um, knowing and relating to other professionals in the community" (Charlene, 278-281). They found the collegiality essential to job satisfaction. "So I think the camaraderie and the peer support is a huge part of what makes workers resilient or whatever word you use, you know, able to continue in this work for a long time with job satisfaction (Charlene, 28-131) and they enjoyed working with their families and clients: I enjoy meeting people and I meet really interesting people at this job, and you can learn from people and i f you can keep it in mind that that you can learn from your clients and the people you work with .. .have something to offer also, that is good (Janice, line 389-393). 51 People they met in their work, whether clients, peers or other professionals contributed to the child protection workers job satisfaction. Collegiality was important to safety and security for workers for many of the same reasons that supervision was valued: debriefing, the colleague understands the trauma of the work and can assist in decision-making. Colleagues were important for debriefing, for when a "worker is involved in a situation, that is ugly, that is difficult especially because it involves children, to be able to immediately come back to an environment, where all ears are open to be able to talk about that" (Charlene, line 45-49). Dora stresses the need for debriefing with colleagues. ".. .you know to stay there with them and just let them talk and just let them talk, it doesn't matter what they say, just let them talk" (line 150-152). This closeness with colleagues can dispel anxiety and leave workers feeling safer. Further, colleagues understand what the worker is going through. "I think a strong factor in being able to deal with it is the strong peer support, which has to do with the camaraderie.... that we are among a group of people who are also dealing with the same kind of work, and I think there is much healing in that and it helps us to keep things in perspective (Charlene, line 38-45). Dora recognized the importance of a colleague understanding the feelings in a difficult situation: ".. .you know what it feels like, you know there is nausea there, you are feeling light-headed and I think if you have had those feelings..." (Dora, line 147-149). Dora's feelings indicate a disequillibrium within herself, yet finds work colleagues understand this disequillibrium. Similar experiences increase empathy. 52 Colleagues can challenge the worker and put things in perspective, thus promoting better decision-making: .. .then your colleague can say, no, I don't, you know, I think you need to consider these other things and look at it from this other perspective and feel safe and that's where the safety comes in, when the colleague feels safe and challenging.. .a dialogue about a potential decision (focus Group, line 254-257). This checking out potential decisions with colleagues appears to provide a sense of security that the decision about to be made is reasonable and accurate. Workers described the need to feel safe and secure at work (emotionally and physically) and i f neglected, to ask for assistance to increase their need for safety. Larry pointed to Maslow's needs at the base level of safety and security: He warned (that) i f people don't feel safe in their environment, it is very difficult to work on anything else. If you are safe you can be more efficient, productive, and then can move up the needs hierarchy. An intelligent knowledge based organization will focus on how to assist workers to self-actualize" (Larry, line 782-790). Supervision Supervision directly or indirectly influenced all aspects of the findings and may be the key to retention and a primary contributor to health. Supervision appeared to 53 mitigate many of the risk factors workers face and served to strengthen critical care factors. Even these veteran workers needed supervision, when they wanted and needed it. Workers stressed and re-stressed the values of good supervision. Once workers recognized burnout symptoms, supervision was critical to assist workers in finding balance and to reduce anxiety in their work thus preventing them from crossing the coping threshold into burnout. Two contrasting stories by Gerald and Rory demonstrate the stark reality of the strength of supervisory support: Um, I got to the point where the expectations and demands were coming on to me were too much and I was starting to not meet those demands, right? Um, I went into my manager's office, at that point actually, when it snapped was I was being a supervisor, acting as a supervisor, I was doing my own caseload.. .and (two protocols) and I had this one case that was just right there and needing a lot of attention and I walked into my managers and I said, I pointed to it and said, this is too much, you are making decisions on this case that I don't agree with. If you want to be the case manager here, take the case away. I am this close to quitting. At that point he said, Whoa, just wait a minute, let's talk about that and that's what helped.. .so I didn't do the protocols or the public speaking I should (have done) and I was able to shed some of that onto other people (Gerald, line 622-641). Gerald's manager supported him and sick time was avoided. On the other hand, Rory's supervisor lacked insight and empathy into the seriousness of the problem: 54 I had a discussion with one of my bosses at that time around what was happening and it was clear there was no support, there was none and um, sounds like you've got some decisions to make and there was no sense of what are we going to do to help with this situation, it was more, you are in a fix, you fix it, so then.. .1 mean if the person you report to is not, is not a person who is going to be sympathetic, that is really going to add to the stress, ya, because you have no where to turn...(Rory, line 520-532). Inevitably, Rory filed a STIP claim for two to three weeks. His manager may have contributed to his taking STIP time. It appears that management support may be critical to assisting workers to mitigate the symptoms of burnout and find solutions other than sick leave. Managers need special training in handling the sensitive work of recognizing burnout and learning to assist workers to balance their workload. However, one worker pointed out that management's agenda may not be to provide support. "I think this Ministry really supported people to give far more than their thirty-five hours per week (by) putting pressure on them and I think that... needs to be heard more. It has cost us all in the long run..." (Janice, line 224-228). Virtually all workers indicated that they relied on supervision or believed it to be important to remaining at their work. The properties of supervision fell into four main categories: atmosphere, availability, support and training. Supervisors created the atmosphere in which workers did their work. This atmosphere created a climate where workers felt emotionally and physically safe and secure. A warm and embracing atmosphere was important to workers. One worker 55 described how the atmosphere was welcoming to her and how her supervisor let her know she was "thrilled" to have her on her team and she immediately felt a sense of belonging. "I had very close supervision. I had a sense from day one that the team was delighted to have me on board" (Charlene, line 141-143). Good supervisors were supportive, enthusiastic and promoted a sense of fun and levity in the office. They were approachable, diplomatic and practiced from a strengths perspective providing positive, legitimate feedback. Finally, the atmosphere had to be one of safety. Workers needed to feel they could complain to their supervisor. "We have the ability to go to the supervisor if we have too many cases and we feel secure and treated with respect" (Mary, line 280-282). In addition workers needed to feel secure enough to bring mistakes or uncertainty to the supervisor and to expect constructive feedback, rather than reprimands. As Gerald reported, supervision is helpful to emotional safety and security in the event of a mistake or confusion: If we've made a human mistake.. .1 know I am not going to get hung out to dry by my manager on that, I will have a meeting with him and he will say, What did you learn? How could we have done this better? Use it as an educational tool (line 193-199). In the case of uncertainty "I can go to my manager .. .Why am I stuck on this one? .. .1 know I am going to be supported on it" (Gerald, line 205-210). Good supervision allowed workers to be honest with their mistakes and concerns. The 56 availability of the supervisor appeared to be a paramount feature in safety and security of the worker. Workers needed to know that their supervisors were available. "Good supervisors are essential. When we come in and we are upset, we debrief (Mary, line 274-276). Workers believed that the best supervisors adopted an "open door policy" (Mavis, line 116) that provided for regular, weekly supervision that was undisturbed: Supervisors have to make it a priority to be available regularly and on an adhoc basis.. .new workers sort of need constantly to be able to just call down the hall and to have a supervisor or senior worker, so it has to be regular when they know that every week they have an undisturbed sufficient block of time and an open door policy.. .otherwise they feel like they flounder, we don't like that situation, none of us feel we like that situation and I think it just erodes, it erodes (Charlene, line 403-415). This open door policy and regular supervision was enhanced by access to pager message systems and policy directives that the workers needs come first: .. .the supervision in this region is amazing...Like I don't know, they are onsite for you at all times, they have pagers and let me tell you they put you first, the put the workers first, there is none of this, I am not available all afternoon.. .like there is a pager, um, she'll call you back right way... (Mavis, line 117-123). The availability of supervision was seen to shape the development of the workers. 57 Emotional and psychological support from a supervisor was important, at the outset of the career, but even these veteran social workers required continual support: .. .the emotional support of your workers is as important as teaching them what forms to fill out, policy and procedures and I think if we can well support, well support new workers in the field, I think we are going a long way to have them solidly and happily grounded (Charlene, line 164-168). In the pilot study focus group, Larry clarified, ".. .say I made a decision to remove a child or whatever, that there is support for that decision that is made, in other words, I am a professional, I have made a decision and I have a supervisor that supports that decision" (focus group, line 243-245). After the death of a child on her caseload, Charlene's manager walked into her office and said, "Charlene, you do good work. This is not a problem. We will get through this" (line 355-357). She cites this powerful management support as critical to getting her through this career low. Workers in the study reported that training, process education and boundary development education by their supervisors was important to their success as child protection workers. ".. . i f you have people who are willing to train you then you are going to survive or have the ability to prosper, right?" (Gerald, line 486-488). Their supervisors helped them prioritize and assess their cases and supervisors knew the files as well as the workers did, thus they problem solved in pairs and teams. "I never make decisions in isolation" (Mavis, line 47). 58 Workers needed a supervisor who was knowledgeable about the processes, such as court process or ministry protocols and who instructed them in the process. "I know exactly when I have to consult, it is laid out for you, that is the best thing they ever came out with was the practice standards..." (Mavis, line 143-146). Understanding the process of the work was linked to safety: .. .understanding the process.. .that the court says that a child is not in need of protection or that the child can go home, then at least I have done what I can and I many not agree with it, but at least I know I have done what I needed to do in order to do the protection of that child... (Mavis, line 186-191). Supervisors who explained the processes involved in the work provided emotional safety and security. With this training came assistance for workers to learn to set reasonable boundaries for themselves. Mary reported that supervision assisted her to learn how to achieve balance at work: I know I am close to burning out when I am not eating as well, when I don't have as much going on outside, when I am not focusing on my relationships. I have had to work .. .to develop more balance in my life. I think the shift came from experience; it is a trap for new workers to fall into. Good supervision helped me make the shift. I had one supervisor tell me that I needed to get more balanced and I am now working more efficiently (Mary, line 559-567). 59 Workers needed to know that the supervisor would advocate for them to have a physically safe working environment: working in pairs, ensuring physical safety on cases with violence potential, and to ensure occupational health in terms of ergonomic equipment or adaptations they may need to do the job: .. . i f there is an issue around um, ergonomics or this factors, then you need to talk to the supervisor and the supervisor says, You don't do it, or .. . i f I am going out on an investigation and I am not too sure about it, you know I've got a buddy, you know we are partnering up, you know that is an accepted practice on our that is part of the psychological security (Gerald, line 562-597) As Mavis pointed out " guards (are) needed when there is someone really violent and there is threats, we are supported in making reports to the R C M P i f we have been threatened" (line 96-99). Supervision ensured that workers felt emotionally and physically safe and secure at work. Collegiality and good supervision may be a key to what makes a "good workplace" and may be some of the factors that differentiate between surviving and thriving at this work. 8. Maintaining an important life outside of work Workers related a strong ability to recognize their own needs and their ability to adapt their environment to meet those needs. They maintain boundaries and participate in extra curricular activities both at work and at home. These workers seemed to recognize it was unrealistic to expect the workplace to 60 completely fill their needs. Therefore, workers participated in extra-curricular activities both at work and at home. "I think having a lot of external focuses, things to keep me occupied and busy, things to keep me motivated..."(Rory, line 128-129). They did this as a protective strategy for prevention and as a coping strategy when they noticed signs of burnout. Workers request and participate in extra projects such as newsletters, committees that invigorated them or participate in some professional development. "I take on extra projects from Victoria and I have started to write a curriculum for supervisor training and that kind of thing gives me a lot of satisfaction and I always need to have other challenges in my life." (Larry, line 594-597). Gerald also finds ways to meet his own needs: .. .with one of my colleagues and we were creating a tracking tool.. .that will track the cases.. .you know that is above and beyond what we are doing, but it is the team that is really enjoying and moving other things to make the job easier, to try and make the job more efficient, so the work environment is very healthy (line 162-169). Workers availed themselves of opportunities to participate in extra curricular opportunities at work that met their need for variety and contributed to the overall good of the organization. This extra curricular need also took place in their personal life. They participated 61 in activities outside of the workplace that meet their needs. "I do other things and i f I don't get the successes and things I need at work, I get them from other places, like Toastmasters.. .1 taught myself a computer based program..." (Larry, line 585-590). Dora enjoys crafts ".. .you know like I quilt as well and do crafts, so my mind is always kind of going" (line 529-530). Extra curricular activities, both within and outside the work place, are ways that workers compensated for work environments that did not always meet their personal needs. These activities help workers survive. 9. DebriefinR the trauma Distancing or detachment was described as an emotional separation or strong boundary development. This appears to be a strong aspect of critical care. This distancing or detachment was a letting go of the anxiety and worry. This distancing did not, however, imply a lack of concern. One of the most valuable coping strategies to achieve distance, this includes immediate and formal debriefing, immediate informal debriefing with colleagues and as a last resort, debriefing with a significant other. Healthy workers find a way to debrief, even when the workplace does not provide formal opportunities. Janice and Dora explain how it achieves distancing: .. .1 believe that when you do this job for a long time, those kind of bad scenarios or the difficulties you see families living in and children living in, (they) all sort of form some part of your psyche or whatever, and you need to be able to talk about that and get rid of that and to be able to put that somewhere else (line 130-136). 62 While talking and debriefing is important for distancing, Dora explains how this may also have an impact on retention of workers. She relates a significant personal experience: I had been involved with a situation with the RCMP where a twelve year old committed suicide in front of me and the RCMP did the debriefing immediately and it went all night from when the child passed away til, I guess, it was like four or five in the morning.. .it happened early in my career.. .it kept me going, it kept me working in this field instead of getting up and walking away, it was the process he took me through, because i f he wouldn't have, I think I would have quit (Dora, line 122-159). Dora's experience demonstrates that debriefing is essential to provide distance and resolution and that it may be most critical when the worker is inexperienced. The immediacy of the debriefing appears to have major significance for distancing and the ability to persevere with the work. Formal debriefing was viewed as the swiftest method to achieve resolution and distance from a traumatic event. Gerald experienced both formal and informal debriefing in his career and reported: .. .it is the only time that debriefing (formal) came along and out of it, again, it let me know the rest of the team was experiencing the same feelings and 63 thoughts that I was and I wasn't going crazy and we were able to say, ok, we are going to do business as usual.. .ya (without formal debriefing) it would have taken a little longer, but we would have got there, again, that is partly because of the level of skill on the team and the relationship that people have. I would trust that I could express myself or be honest about how I was actually feeling or the doubts that I had about my own competencies as a result of that action and know that people would a) keep it in confidence and b) be able to understand that's where I was at that point (line 289-317). Debriefing normalizes the feelings of the workers and formal debriefing may be more essential when the team is inexperienced or have not been working together in a cohesive unit for a period of time. Gerald's description of debriefing may provide additional clues to how distancing helps detach from difficult situations: (Debriefing) seemed to mitigate the isolation and the poor supervision, i f people knew they had easy access to a supervisor, easy access to a team mate, they felt less isolated and they were able to detach a lot faster from any emotion that would come up around the job (Gerald, line 19-23). However, when the office was unable to provide opportunities to debrief, workers utilized their spouse or significant other to debrief: try to distance yourself between what has happened, um, it i f doesn't go away, what I do is sit down and talk with a spouse and he knows after we went through that then it goes, like for me, the stress, the tension will lessen (Dora, line 64 189-192). The workers in this study exhibited a strong reliance on their partners to debrief when they had insufficiently debriefed at work. "I have a supportive spouse and a stable relationship. This has helped to manage my stress and although the work is confidential, I can debrief at home too, although colleagues are best for this" (Mary, line 410-414). A n assumption can be made that a positive supportive partner and home life may be a strong source of support to workers. Debriefing to distance took place formally, informally and with significant others. Threaded throughout the findings was a distinct need to distance; workers needed distance from the clients, the sights of the job, the sad stories, their colleagues and the feelings that the difficult work invoked. This distancing provided the detachment and/or the objectivity necessary to cope. This distancing warded off trauma, stress and burnout. Workers did this through debriefing with supervisors, colleagues and spouses. Off duty, they avoided their colleagues and strove for separation between work and home life. Embrace Process Distancing, therefore, is a protective factor and considered critical to care but what is the process of this distancing? One small clue emerged from the data that initially, the researcher deemed insignificant and merely a matter of semantics. Here is the clue: .. .my belief is that i f you debrief, then you embrace what has happened and then you will be ok with it (Larry, focus group, line 297-298). 65 This small, innocuous quote demonstrates the real process of distancing. Before workers can distance, they must first embrace or immerse themselves in the experience. Embrace is defined in the dictionary as a folding in one's arms, to take up, to surround or enclose (Barnhardt & Barnhardt, 1976, p. 688). When workers carry anxiety and worry, they must be willing and able to embrace their feelings, to take them up, surround himself with the feelings. A worker must go, with authenticity, toward a colleague, supervisor or spouse who acts as receptor and recipient of the embrace. During this embrace the worker can describe the pain, the situation, the feelings, the discomfort and the worry and with arms wide open to healing, embrace it, discuss it and roll in it, dissecting each detail until, like a dog with a bone, there is nothing left and the bone is discarded or buried, perhaps forgotten. This embrace becomes therapeutic with an empathetic listener whose ability to listen can diffuse the feelings. This embrace brings relief and thereafter, allows the worker to put distance between themselves and the event. Embracing the feelings is the process and distancing is the effect (see Figure 1). Figure 1 Embrace Theory Precipitating Factor Process Effect Incident > Embrace ^ Distancing Table 3 highlights some examples from the data to demonstrate this process: 66 Table 3: Embrace Process Examples Incident Embrace Distancing Janice line 131-136 Bad scenarios/difficult families Need to be able to talk about it And then get rid of it Dora line 122-159 Suicide of a child Debriefing Kept me working in the field Gerald line 289-317 Team not supported by administration in a difficult protection case Debriefing let me know that I was not alone in my feelings We are going to go ahead and do business as usual Gerald line 19-2 General incident Easy access to a colleague or supervisor to debrief The were able to detach a lot faster from any emotion Dora, line 189-192 What has happened Sit down and talk to spouse The stress, the tension goes away Mary, line 410-414 General incident I can debrief at home This helps manage my stress Workers believed humour was an effective weapon to ward off potential vicarious trauma, "...we tend to use a lot of black humour to cope" (Mary, line 270-271). However, not all humour was black. ".. . we have such fun, there is not a day that I go to work that I do not have good laughs every day. I won't let a day go by without looking for fun..." (Charlene, line 741-744). The use of humour helped workers cope. Finally, avoidance of "office politics" and negative public media allows workers to focus on their work, thus distancing themselves from negativity. Mavis suggests, "Don't worry, it is not a fact until it happens, don't be involved in office politics..." (Line 50-51). Mary's quote runs along a similar veiri. " . . . rather than the politics and back biting. I try and stay out of this, the dissension within the unit..." (line 304-306). 67 Further, she suggests that to create distance, she is avoidant. "Often when there is media coverage, I just don't read the newspapers for a while." Clearly, avoidance of negativity strengthens workers ability to do their work. In the focus group, Charlene identified another way of avoidance. ".. .the other way that people distance was that they tended to avoid, um, talking about work in the coffee room" (line 71-72). A very common theme articulated by the workers was to maintain a balance between work and other activities: I am not a person who socializes a lot with my team, you know when I am there we are close team member with them, but we seem to kind of go our own way at 4:30 on Friday, we all go and do our own thing, so we are not always talking about the office and what is happening at the office (Dora, line 58-61). Mary reports a similar theme. "Socially, most of my friends are not social workers, I have close friends within the office, but my social life does not revolve around my colleagues" (line 308-311). Social variety appears to provide balance that creates distance and relief from the difficult work. Risk factors: threats to balance The research identified major stressors or risk factors in child protection that can put workers "off balance." They are grouped under the following headings: geography, inexperience, loss of control, and environment (see Table 4). 68 Table 4: Risk Factors: Threats to Balance Geography Inexperience Loss of Control Environment Isolation New graduate Cases Scrutiny • High caseloads • Nature of cases • Specialization • Time required Constraints Size of Territory Lack of training Excessive overtime Lack of file continuity Travel Lack of supervision Poor boundaries Interference from Victoria Geography Geographical location of the work placed significant risk factors upon workers. A n isolated geographical region posed the greatest risk. Many of the workers related experiences where they had worked in isolated geographical locations, locations in which they neared a burnout stage. Often isolated from family and friends, supervision was limited in both quality and quantity, the size of their territory was large and required significant travel to see clients. Three quotes exemplify how geography plays a role in risk for a child protection worker: I think that inexperience leads to burnout. When I first started in child protection, I wasn't able to screen out work I didn't need to do.. .1 thought I had to be 69 everything to everyone. My caseload reached extraordinary proportions, I lived in a remote geographical community, there was limited access to services and I was too constrained, it was too hard... (Mavis, line 15-22). .. .there were workers from mostly isolated kinds of offices, from the day they walked onto the job, they were a one man show, so to speak, they did not have close supervision at all, they were in a stressful working environment, it was rural and isolated, never mind doing a home visit that is ten minutes from your office, we are taking about going out into, I think even dangerous geographical areas... (Charlene, line 150-157). "I got to the point in (name of town) where I said, this is not for me. I am too isolated, I didn't have a lot of family or a lot of support there.. .so I quit" (Gerald, line 526-530). These quotes are poignant and demonstrate the isolation and struggle of workers in remote regions of the province and point clearly to strong risk factors for child protection workers. Inexperience New, inexperienced and unsupported workers were at high risk for burnout and leaving child protection. As Charlene pointed out ".. .but over the years as I have looked at (it), I think the people who are at the highest risk of burnout, are people who are just out of school" (line 204-206). Gerald expressed similar concerns. "If you are just thrown into a caseload without a lot of support, um and you become overwhelmed... you are going to have people leave and get your needs met elsewhere" 70 (line 488-493). Inexperienced workers are at risk of burnout or leaving the work of child protection. Loss of Control Casework presented the risk of workers losing control of their balance. When workers could no longer balance caseloads, the risk of burnout increased. "I had to learn that the faster I worked to close cases, the more work was given. I found I would begin thinking it would be nice to get sick" (Mary, line 374-377). High caseloads presented risks. When several cases became weighty in terms of time commitment required to do the case well, the degree of difficulty/intensity of the cases increased and were contributory to risk. ".. .difficult cases are synonymous with time, heavy time commitment" (focus group, line 201-202). Specialization or narrowing of practice, without some choice in the matter also contributed to risk. ".. .ya, I know I am good with mental health, but I don't want to just be labeled with that, I want to do this and this and this" (focus group, line 193-195). Specialization posed a risk as did several cases with a same focus; i.e. too many sexual abuse cases or too many custody and access cases at one time. ".. .perhaps the cause of my burnout at this particular time has to do with several different families exhibiting very similar characteristics and constantly working with these same sorts of families" (Larry, line 649-652). When workers were unable to balance caseloads, they faced risk of burnout or falling off the wire. These risk factors undermine or erode the protective factors present in healthy workers. 71 A loss of control over their work was also identified as a risk factor. Loss of control was articulated as excessive overtime. ".. .(overtime), it's a risk factor when it is excessive" (Gerald, line 273-274). Poor boundaries between work and home also contributed to risk. "I realize that I put too much stock in work and not enough stock in other things (home life)" (Rory, line 140-143). In cases of an inability to plan ones own schedule, or when the schedule seemed to have control over the work, then signs of burnout manifested themselves. Charlene's voice sums up the lack of control: .. .you see that they are having little enjoyment, day in and day out, but not only are they having little enjoyment, but there is just ongoing, everything is stressful, I mean not saying they articulate it this way, but you watch them in the hallways, you pass their office and you see them and it is constant bewilderment, no sense of being in control of the work that is in front of them, um, never any sense of gee, you know, it is the end of the week, I am more caught up then I was at the beginning of the week, ya, I got a lot done, it is always measured in terms of things I haven't gotten done .. .you listen to them talk and it is almost like a crying... sort of wringing of the hands, anxious, bewilderment, exasperation, um, distracted by work, you know, distracted all the time... (line 540-556). Environment Environmental risks were threats to balance. Rory reported risks for him. ".. .1 think there are some serious potential difficulties because we have so many people, clients and colleagues and bosses and other systemic environments like review agencies asking, what, why, where and putting a lot of scrutiny and demand on you... (line 573-577). Mary reported similar risks for her. ".. .there is no time to do the job, never can do your best and then constantly criticized by the community... Our own 72 management created that expectation within the community" (line 350-356). In the focus group, a dialogue between Mary and Larry articulated an environmental risk. "You can certainly see where we are not feeling safe and secure now as the intake unit transfers their files to the family service and there is some friction around that. It is a real source of stress for us.. .we feel they may criticize us and not respect our judgment..." (line 256-259). Larry responded to this. "Ya, do you think that has something to do with the structured system?.. .You make a decision at some point, ok, I am finished with (this) bit and I am going to transfer over to you, now so, the other person might say, I don't think you are finished with your bit.. .that's where the friction is.. .in the old days, you did it right from start to finish, the whole ball of wax..." (line 262-266). Larry believed environmental risk existed. "Ya, I think so, in the last five years or so the ability for social workers to make discretionary decisions has been incredibly limited. Also, they have had their spending authority reduced.. .so that they require approvals for even minimal spending.. .it narrows what (we) do" (line 62-68). Mavis found these limits also were risks for her. ".. .the actual guiding principles of the legislation and our policy are very humanistic, they make sense, the problem is putting them into practice because of the constraints and the workloads and the politics.. ."(line 267-271). Janice felt these budgetary constraints posed a risk for her. ".. .we have been given budgets we have to live within and it's really very hard to do because they aren't realistic. They don't even start to meet the needs of the kids we deal with..." (line 702-705). A risk for Gerald was when Victoria overruled his team's decision. "...we were told from Victoria, we have heard what you have said, I appreciate what you have said, 73 (but) do this.... The feeling that came across the team was one of disempowerment.. .the playing field had shifted.. .about when we remove children and I didn't know where the bar was anymore..." (line 258-265). Dora described risk as "abuse from Victoria" (line 655). These exposures to risk often precipitated warning signs or symptoms in workers. Warning Signs Once a worker has becomes "off balance," warning signs or symptoms of burnout may present themselves. Nine warning signs were grouped into three dimensions: physical, emotional and behavioural (see Table 5). Table 5: Warning Signs Physical Emotional Behavioural Nervous Habit Fatigue Negative behaviours Lack of self care Overwhelmed Isolation Disturbed Sleep Unable to Distance Anxiety/Worry Physical Dimension Physically, there appear to be three indicators of risk: disturbed sleep, nervous habits and a lack of self-care. Disturbed sleep. Disturbed sleep was a very strong indicator of approaching burnout. "I was having difficulty sleeping.. .1 was going through a period where I would 74 stay awake a couple of hours during the night, like wake up and then stay awake..." (Janice, line 193-229). Disturbed sleep appeared to be the first signal or clue to burnout. Nervous habits. Nervous habits appear to be warning signs of potential burnout. "I chew the inside of my cheeks, my muscles get tight, I have a great desire to smoke and then I see that I don't want to go to work" (Mary, line 388-391). Lack of self-care. Workers reported they began to neglect self-care. "I know that I am close to burning out when I am not eating as well" (Mary, line 59-60) and "you need to look after your bodies, eat well, you know, and i f you are not doing that then you start to spin out of control and that's when burnout (occurs), when things aren't balanced" (Gerald, line 645-638). Emotional Dimension Emotionally, there are four signs of risk: fatigue, feeling overwhelmed, an inability to distance, and anxiety/worry. Fatigue. " the end of the day, I was absolutely exhausted.. .1 felt like there was just no energy.. .1 felt like there was just no energy for that..." (Rory, line 72-75). Overwhelmed. Workers often described feelings of being overwhelmed as a clue to burnout. They described it as: "...feeling unorganized, overwhelmed and not on top of things" (Mary, line 368-369). 75 Unable to distance. Workers described images and thoughts of work that won't leave the mind, "...sometimes there is just too many of them (horrible family situations) and you can't move out of that" (Janice, line 253-254). Anxiety/Worry. Worry and anxiety over difficult cases was a warning sign. ".. .dealing with difficult clients, that can be the kind of thing that keeps a worker up at night, eats away at the lining of their stomach..." (Charlene, line 301-303) or as Dora states, " Sometimes the stuff just won't, just won't go away and it goes around your head and around" (line 571-573). Workers seemed unable to neutralize anxious and worried feelings and this served as a warning sign of potential burnout. Behavioural Behaviourally, there are two signs of risk: negative behaviours and isolation. Negative behaviours. Negative behaviours began to surface when stress was high. ".. .even when I am really stressed and feel like coming home and slugging back a couple of stiff ones..." (Mary, line 85-87). Isolation. This is one of the most common and visible signs of burnout. "...when I am at work and I see people's doors close and I am walking down the hall and see people's doors close, that to me is a warning sign that they are shutting down, they don't want to talk to anybody, they are overwhelmed" (Dora, line 597-600) or as Rory stated: "I cocooned, quite honestly, I cocooned..." (line 72-73). Larry notes: "they 76 just tend to become more isolated in their work when they are demoralized..." (line 482-484). Isolation was a strong symptom of burnout. Once warning signs are noticed, coping strategies are implemented to deal with the pressure of risk factor exposure. These coping strategies provide a protective factor. Recognition of the warning signs and analysis of what is creating the warning signs are necessary variables in the prevention of burnout, but alone, they are insufficient in preventing burnout. Transition Point Process The data demonstrates there are actually three variables that transit a worker from potential burnout back to health: recognition, analysis, and action. The author proposes to call this process the Transition Point Process. Transition, in the dictionary, is defined as a change or passing from one condition to another (Barnhart & Barnhart, 1976). This process of change from potential burnout to health is illustrated. Figure 2 illustrates where the transition point is for healthy workers and how they restore themselves and in contrast, how the susceptible worker encounters burnout. 77 R 9 U R E 2 Child Protection Workers I Transition Point Process burnout / disability protective protective factors Health factors (Start) Critical Care Factors First, workers must have the ability to quickly recognize and acknowledge when they are at risk. This recognition happens when warning signs began to surface. Mary reports, "I recognize it in the physical signs. I chew the inside of my cheeks, my muscles get tight, I have a great desire to smoke and then I see that I don't want to go to work " (line 388-391). A l l workers seemed to recognize when warning signs presented themselves. However, this recognition was insufficient to stop the impending danger of 78 bumout. Workers had to take the next step. Step two of the process requires workers to spend considerable time analyzing what risk factor was creating the warning signs and what aspect of critical care needed attention. "I got to the point.. .where I said, this is not for me. I am too isolated, I didn't have my family or a lot of support..." (Gerald, line, 526-528). Gerald was able to analyze why he was having symptoms. Once workers had analyzed the problem and received insight, they were then able to apply step three of the process; they were then able to take urgent corrective action based on this analysis. Larry articulated this three step process very well: Having the ability to recognize when you are starting to burnout.. .that's a transition point. Then I know I have to do something, so I recognize that and identify that I have to do something, what will I do, that's the decision.. .but it is the recognizing that, first of all I am sliding into burnout and what is causing it.. .what will I do about it.. .will I start swimming every day or will I go for walks at lunch time or will I start socializing more.. .1 need to get out with my friends.. .(line 645-663). Table 6 provides evidence that there are really three variables: recognition, analysis and action that help a worker transit from potential burnout to health. Table 6: Regaining the footing: Transition Point Theory Examples Recognition Analysis Action Larry, line 39-44 I get stressed When I don't have control I get organized Mary, line 396-402 I feel overwhelmed Things are not organized I get organized at home Mary, line 50-53 focus group. Our office gets hectic and things are a mess I can't live like that very long I have to come in and do some overtime Larry, line 58-60 Not catching up Need extra time to Do some overtime 79 focus group be organized Gerald, line 162-169 Decreased job satisfaction Need to make the job easier Create a tracking tool Dora, line 22-26 Feeling stressed I need outside activity Go golfing Gerald, line 104-119 focus group I can't get to sleep I have spent too much time talking about things to my wife I keep a fifteen minute limit on discussing work at home Mary, line 559-567 I am not eating well, not much going on outside, not focusing on my relationships I have to develop more balance in my life I am now working more efficiently Larry has not experienced burnout. However, Janice did and her experience contrasts with Larry's: It was really strange, I was going through a period where I would stay awake a couple of hours during the night, like wake up and then stay awake and I think you wind up becoming anxious and then that builds.... I could feel it and feel it and feel it... (line, 227-224). Janice did not appear to analyze the cause of her sleeplessness and as a result did not take corrective action. Analysis was not present and burnout resulted. As pointed out in an earlier chapter, Rory recognized he was in trouble, analyzed the source of the problem, but when he did not receive management support, he used a negative coping strategy, isolation, rather than using a critical care variable. He isolated and "cocooned" (line, 72). 80 Workers who recognized their symptoms and analyzed what was going on inside for them embraced their feelings. This analytical embrace led to solutions that worked. Janice noted her feelings and symptoms but did not seem to move toward them (or embrace them) to learn the cause. Rory's offer of embrace was met with resistance from his manager. Transition Point Process demonstrates the importance of the three variables: recognition, analysis and change which are brought about through moving toward the uncomfortable feelings and embracing them with an analysis, rather than moving away from the discomfort. Without this transition point process, workers are more vulnerable to cross the coping threshold into disability (Johnson & Indvik 1997). Paradoxically, those workers who embrace, rather than avoid the warning signs, find remedies. Equilibrium Process In addition, workers maintained their balance through a process of establishing equilibrium. The Equilibrium Process has five dimensions that maintained worker equilibrium: Prevention, Restoration, Proximity, Immediacy and Re-focus and explains how and why this process made a difference to workers (see Figure 3). 81 Preventative Healthy social workers appear to recognize the significance of balancing and did not wait for risk factors to implement this critical care. Mary's words provide an example of this prevention. "I would say that I probably work out three, four times a week" (line 78-79). Workers use balancing processes to prevent the effect of risk factors. Balancing, therefore, has a preventative property, which maintains a protective shield. Restoration However, when the protective shield is exposed to risk, balancing, i f initiated quickly following exposure is a powerfully effective corrective measure that can mitigate the effects of harm and return a worker to within the protective shield. Mary explains how her exercise restores her: .. .once you start to sweat and the old endorphins kick in, you are like a new 82 person.... I noticeably feel better and I run at noon, I have lots of energy for the is like wiping the slate clean" (Mary, line 103-110). Restored, Mary is able to resume her work. This evidence demonstrates that applying a balancing process has a restorative effect upon the worker's ability to continue their work. Immediacy The immediacy of implementing a coping strategy following risk exposure appears to have a significant impact on the ability to restore a worker to equilibrium. The following example demonstrates that value of immediacy, "that debriefing immediately.. .what kept me going, it kept me working in this field instead of getting up and walking away." Immediate use of a coping strategy appears to provide a restorative effect upon workers and may prevent the loss of the worker to the occupation. Regularity. The regularity of the use of coping strategies appears to affect the durability of balance. If a worker has neglected their coping strategies for some time, then implements it after exposure to risk, they are less likely to have swift restorative effect than if they had been using critical care all along. The researcher had a hunch about the importance of proximity and presented it to the focus groups for validation: .. .and the proximity of critical care, so i f you had neglected your running for a long period of time, for instance and you were hit with a risk factor, a stressful event, you may not be as quickly able to get back to feeling good if you haven't been doing your run all along (researcher, focus group, line 497-501). Workers agreed, "...that is a good concept" (Larry, focus group, line 502) and "...that is true, excellent" (Charlene, focus group, line 1054). Restoration was not as swift i f 83 previous balancing was not practiced with regularity. Re-focus If warning signs arise due to a stressful event, workers are reminded of the importance of maintaining the sub processes that work for them and make a conscientious effort to re-focus on them. This refocus ensures that future risk is met with resistance: I ' l l start to think, maybe I ' l l get sick to get away from work and I am crying more frequently and not coping and I'm uptight and feeling like I am in a depression, I know that I must refocus on exercise and sleeping good (Mary, line 425-430). When workers come this close to burnout, they double their efforts to ensure they are not so vulnerable to risk in the future. Once workers re-focus, they begin to re-enter into the initial protective phase of equilibrium or homeostasis. When this entire concept of equilibrium was presented to the focus group, Gerald provided some scientific imagery to support this finding: .. .there is an apparatus that you can get that is a closed system, so you have your little beaker with a Bunsen burner, but there is a little pipe that comes up here and then it runs along and it has water on the external side of it, so, the heat boils the solution, it comes up, goes in here, cools down and the liquid comes back into the beaker, it is a closed system. For me, the equilibrium isn't the fact that it is boiling and we are getting things flying off here, because you have a whole pile of different pressures coming out and you are burning off energy, but you also have new stuff coming in and as long as the fluid level maintains the same, and I have that balance that I am doing ok, it is when there is a leak in the hose, and it starts 84 the pressure and the steam starts coming out and I start losing water, then I am having a problem (Gerald, focus group, line 1120-1133). The use of the ten sub processes maintains the "water level" in the nervous system of the worker. This water level can only be maintained through the recognition of a problem, the embrace of that problem and utilization of the processes that enhance function. 85 Chapter 4 Theoretical Implications of Results Eisenhardt (1989) stressed the importance of tying emergent theory to existing literature to enhance the internal validity and generalizability of the theory. This study corroborates or confirms some existing work in literature. Kaplan, Turner, Norman & Stillson (1996) noted that detachment is a positive attribute of child protection workers Kaplan, Turner, Norman & Sullivan (1996) while Wallace & Brinkerhoff (1991) found that distancing increased worker resistance to burnout. "To defend against their disruptive emotions and try to perform efficiently in stressful situations, professionals who were successful in coping maintained a strong sense of caring and concern for their clients but also used various techniques of detachment" (Pines & Maslach, 1978, p. 233). Nursing literature concurred with this finding. "One of the things we have to do as a caregiver, ironically, is to learn to care for ourselves.. .there are times.. .when we have to withdraw from the work after a particularly painful call" (Hudson, 2001, p. 44). Kaplan et al. (1996) reported that realistic workers who understood that best situations for children are often less than ideal were more apt to survive. Rutter (1987) reports, "evidence exists that it is protective to have a well established feeling of one's own worth as a person together with a confidence and conviction that one can cope successfully with life's challenges" (p. 327). Professional confidence was also discussed in literature by Scheafor, Horejsi & Horejsi (1991). They report that a social work professional is "supposed to know when, how, and to what extent exceptions to rules can be made... but there is a professional obligation to act as much as possible in accord 86 with professional practice principles. Practice principles, then, are a combination of knowledge, ethical prescriptions, practice wisdom and common sense. They draw together the art and science of social work." (p. 50). Social workers in this study appeared to practice professional competence by trusting their professional instinct and applying practice principles with confidence. Masson (1990) wrote about the professional value of introspection, "Being professional is not about trying to sit on one's emotions and gut reactions. It is about developing self awareness, about analyzing one's feelings and responses and using them.. .or putting them down in order to proceed with the work" (p.39). Egan (1993) reported that workers relied on the support of others for success in their work. "These results remind us that social work practice is more than a job. It is based on relationships with people" (p. 120). A Workplace Health Promotion (2000) publication states, "The process of communication with others in the same position, the advice that will come as a result and the realization that others share the same feelings, all to help minimize the resentment and emotional pressure which builds up" (p. 3). Beardslee (1989), in his research with civil rights workers, who worked under great stress, found that their closeness to others was a central factor in their being able to sustain themselves. These relationships are at the core of child protection work. Veeder (1990) wrote an article recommending that social work eschew lengthy, close and strict first-line supervision. It was her belief that this type of supervision limited professional autonomy. This was not borne out by this study. Supervision was not seen to circumscribe professional autonomy but rather was viewed as a positive and desirable support that mitigates risk. Turner (1995) wrote that there are few professions 87 where supervision is as highly valued and revered as in the social work profession. The present study seems to confirm Turner's conclusion. Neutralizing anxiety appears to be a significant component of supervisory support. Morrison (1997) wrote that".. .anxiety runs like a vein throughout the child protection process.. .It is present too within the professional system, as child abuse represents not only a crisis for the family, but also for the professional network" (p. 21). When workers were confronted with difficult cases, when they were unsure of decisions, when they were anxious, they need management support to calm the anxiety. Supervisory support is crucial to reduce worker anxiety. In a literature review on retention of workers, Mor Barak et al (2001), point out that there is accumulating evidence that suggests supervisory support is instrumental to worker retention. This study concurs with that contention. Additionally, supervision may be linked to a protective factor known as a community protective factor in resilience literature (Kaplan, Turner & Norman, 1996). As the work environment is a system similar to a community, it can be suggested that supervision may provide the community norms, sense of caring, commitment and mutual necessary to survive and thrive in child protection work. Critical incidence stress debriefing was originally used almost exclusively by emergency workers to deal with the exposure to post traumatic stress associated with their work. It describes the need to vent, normalize and the need to address the underlying issues and grief after a critical incident (Mitchell & Everly, 1989). Venting helps to integrate these new, albeit unpleasant experiences. This integration occurs only with a willingness to embrace the experience. This embrace creates the acceptance and 88 distance that is really a letting go of the potent, destructive worry and feelings associated with the event. Often this serves to bolster self-confidence by confirming the validity of one's actions and feelings surrounding the event. According to the evidence in Table 6, if an incident is causing stress, distancing may not be achieved without the process the worker calls embrace. The importance of other people in support of the resilient worker is consistent with those of Koeske & Koeske (1989) who indicated that social workers who feel emotionally and practically supported by significant others at work and home will more often be able to endure demanding workloads with less impairment than poorly supported colleagues. This study and the findings of Koeske & Koeske (1989) indicated the strong reliance on spousal support or significant others. These findings are contradicted by an older study by Gibson et al's (1989), which indicated very few respondents cited their partner as a source of support. It was their opinion that social workers, "for whatever reason, be it confidentiality or otherwise, do not knowingly burden their families with their work related stress" (p. 14). Gibson, McGrath & Reid's (1989) study indicated that 80% of social work respondents indicated their primary source of support was their primary work group, yet curiously, as pointed out earlier, they do not rely on them outside of the work environment. In addition, Egan (1993) found that relationships with clients contributed to worker's burnout in the hospital setting. With this group of child protection workers, there was no similar finding; workers did not cite their relationships with others as a source of burnout. Shaufeli, Maslach & Marek, (1993) indicate that improving 89 communication in small groups and improving the ability of the individual to give or receive social support within the organization is supported by both clinical and organizational literature. Arches (1991) reported that workers are most satisfied when they have autonomy and Gibson, McGrath & Reid (1989) point out that avoidant behaviour is a well recognized as a coping strategy. McNeely (1984) found that work requiring the use of creative capabilities contributed to job satisfaction. Schaufeli et al. (1993), defined creativity as the "origin of a concept in response to a human need - a solutions that is both satisfying and innovative" (p. 165). As found in this study, this creativity seemed to be a way to meet personal and client needs and prevented workers from feeling demoralized by bureaucratic policy. The concept of maintaining an important life outside of work was supported in literature. Bly (2000) recommends breaking the daily routine with new activities such as volunteering, taking a cruise or building a cedar chest while Malasch (1982) recommends leisure activities. A Health Canada (1998) publication entitled, Juggling Home and Work reported that one out of every ten Canadians report experiencing excess worry, nerves, or stress because they have trouble balancing home and work responsibilities. As well, it reported that those who exercise regularly are less likely to report excess worry or stress arising from juggling work and home life. Robin Russell (2001) has served as the national director for the Society for Spirituality and Social Work. Dr. Russell who teaches an integrative model between practice and spirituality claims that spirituality promotes resilience and healing for social workers and spiritual workshops such as she 90 teaches are intended to "nurture the soul of the practitioner so that she can return to her work with new meaning and purpose." This agrees with the results of this study. Malasch (1982) recommended a coping strategy of being realistic. The workers in this study were realistic about job expectations. She also suggested, "breaking away" (p.93) from work. "When things get particularly difficult or frustrating, it is important to be able to withdraw completely from the situation"(p.96) and recommended a sick day. Some workers in this study used sick time as a coping strategy. In addition, she recommended that workers "know thyself'(p.98). This appeared to be a strong factor in workers being able to recognize signs and symptoms of burnout. She also stresses work life balance that the workers in this study were able to maintain. Similar risk factors were found in literature. Streepy (1981) believed that workers with limited experience are more susceptible to burnout because they lack experiential training. Corcoran (1987) found that as practitioners got older and gained more experience, they were less susceptible to emotional exhaustion. Egan (1993) reported a similar finding; experienced social workers working with AIDS patients burned out with less frequency. Inexperience in the work, without adequate support, appears to be a significant risk factor. Maslow's hierarchy of needs hypothesis suggests that within every human being is a hierarchy of five needs: physiological needs, safety, love, esteem and finally self-actualization. It is reasonable to assume, based on the data, that these workers have sufficient food, water, shelter, safety, love and self self-esteem. Their basic needs are met through their home and work life. They may have begun to self-actualize. Self-actualization is "represented by the drive to become what one is capable of becoming; 91 including growth, achieving one's potential, and self fulfillment" (Robbins, 1989, p. 149). The workers in this study who have survived and thrived seek growth, and strive to meet their own need to reach their full potential and self fulfillment as Maslow's last and highest order: self actualization. Victor E. Frankl (1984) was a Jewish psychiatrist imprisoned at Auschwitz during the World War II. In his famous book, Man's Search for Meaning he may provide clues as to why child protection workers survive and thrive in their work. Curious, he carefully observed the prisoners in these dreadful camps and wondered why some prisoners maintained the will and drive to live and why they had the ability to move beyond their grief and suffering to provide assistance to fellow suffering prisoners. His observations led him to believe the words of the philosopher, Nietzsche, who wrote, "He who has a why to live for can bear almost any how" (p. 97). He deduced that those prisoners who survived and thrived in the camps had some meaning and purpose to their lives despite the conditions in which they lived. Frankl's observations of prisoners in the camp led him to believe that ".. .everything can be taken from a man but one thing: the last of the human freedoms -to choose one's attitude in any given set of circumstances, to choose one's own way" (p. 86). This attitude toward their work and the manner in which the work was done was more important than the job itself. These workers chose an attitude supported by the meaning and purpose of their work, thereby providing them the why to work in child protection and the strength to bear the how. This attitude toward their work and their clients is consistent with the professional values of social work as articulated in the preamble of the British Columbia Association of Social Workers Code of Ethics: 92 The profession of social work is founded on the humanitarian and egalitarian ideals. Social workers believe in the intrinsic worth and dignity of every human being and are committed to the values of acceptance, self-determination and respect of individuals. They believe in the obligation of all people, individually and collectively, to provide resources, services and opportunities for the overall benefit of humanity. Williams (2000) cites a book by Nora Watson called Working, in which Watson thoughtfully pointed out that most of us are looking for a calling, not just a job. She believed that most of us have jobs that are too small for our spirits. Child protection workers who survive and thrive have found this calling or vocation. Human values are "thought to provide individuals with touchstones, perspectives, attitudes, and behaviours to use for interacting with other and evaluating events" (Walsh, 1987, p. 281). Human values, congruent with the organizational values, assisted workers to remain in their difficult work. These workers enjoyed the challenge of the work and this finding agrees with a study by Siefert, Jayarante & Chess (1991) that emphasizes the role of challenge in coping with work stress and burnout. This challenge appeared to provide an element of risk which in turn provided an element of thrill to workers. Limited findings in other literature acknowledged that this thrill seeking/risk-taking element in dangerous and difficult work exists. These risks and thrills provided workers with job satisfaction. Hudson (2001) was an emergency flight nurse who wrote a book entitled, Trauma Junkie: Memoirs of an Emergency Flight Nurse. In this book she wrote "One thing that made the job so interesting was that when I arrived at work each morning, I had no idea what might happen in the next twenty-four hours" (p. 29). Smith (1940), a firefighter, documents the following in his book Firefighters: Their lives in their own words. ". . . the excitement, the chance to do the things that make you feel good, making a rescue, cutting someone out of a car, helping someone out of a window.. .you pull up and it's all fire and you say, "Oh, Man" (p.297). Similarly, in the book, Scarlet Tunic: Inside our Gars- Inside our Hearts: on patrol with the Royal Canadian Mounted Police, Tether (1994) writes, "No one can truly understand what it is like to be a police officer. Few people, fortunately, will ever learn what it is like to be beat up, spit on, and to experience the happiness and the sadness not found in the average occupation.. .1 am proud to be a Member" (p. 14). This researcher was married to a firefighter for many years and remembers his descriptions of the "intense adrenalin rush" that came with a call associated with significant danger. These intense feelings associated with danger may be similar to professional athletes and matadors. Lambert & Wright (2001) wrote and article about Daron Rahlves, an American slalom ski champion: Daron Rahlves guns the engine of his dirt bike and hurtles toward the steep bank above the 70-ft.-wide Little Truckee River in the Sierras of eastern California. Heart racing, he can barely breathe. "You feel a little tingly," he explains later, "and then..." Liftoff. The bike clears the opposite band with 20 feet to spare. . "Once you go, all those funny feelings just slip away, and you feel like you are energized," he says. "Then you pull it off and there's Pfffff, this big release. Welcome to another day in the life of Daron Rahlves, adrenalin addict, reigning world champion.. .those close to him have learned to deal with his constant thirst for thrills. 94 Professional matadors were given psychological tests that indicated they were significantly more thrill seeking and extroverted (Doskoch, 1994). In his book, Career Tests: 25 Revealing Self Tests to Help you Find and Succeed at the Perfect Career, Janda (1999) developed several career tests using different variables. One of the variables is openness to experience scale. A subscale of openness to experience scale is adventurous. Those who scored high on the adventurous sub scale were characterized as ".. .people who love the new and different. Routines are an anathema to them; they look forward to a variety of challenges.. .you should avoid occupations that involve repetitive duties" (p. 178). This spirit of adventure nature may contribute to resilience in the job. Despite causal conditions of a bureaucratic workplace, close scrutiny and negative community perception, all which make child protection work difficult, it was found that workers in this study survive because they balance on the high wire and like it! Their work is conducted within a context of high caseloads, impoverished clients and exposure to traumatic experiences. Workers are further at risk when they live in remote geographical locations, are inexperienced and when they lack control and balance in their lives. Yet, these same workers employ ten strategies or sub processes that mitigate these factors. They include: applying skills, embracing the risks and challenges, expecting the unexpected, keeping expectations realistic, experiencing competence, finding support and enjoyment from people, maintaining an important life outside of work, debriefing the trauma and learning about self. The consequence of these mitigating factors is that workers maintain balance in their lives, survive, thrive, report 95 job satisfaction, appear to self actualise and feel they have meaning and purpose to work. The researcher was not comfortable using the axial coding paradigm of Strauss and Corbin (1990) as it seemed to manipulate findings to fit the paradigm. Instead, the researcher used the Glaser (1992) method. This allowed axial codes to emerge from the data. However, once the axial coding was completed and the theory developed, it did not seem to compromise the data, and indeed seemed useful, to then assign Strauss and Corbin's (1990) paradigm for a visual picture of the phenomena (see Table 7). Table: 7 Theoretical Model for How Child Protection Workers Survive Causal Conditions 1. Bureaucratic work place 2. Client, media and public scrutiny 3. Client poverty and vulnerability of clients 4. Systemic nature of abuse I Central Phenomenon Balancing on the High Wire and Liking it! Context or nature of the work 1. High caseloads 2. Traumatic experiences 3. Public stigma of child protection workers 4. Working conditions 5. Role conflict, role strain, role overload 6. High amount of paperwork 7. Increasing technological requirements 8. High female caseload 96 Intervening Conditions 1. Geography 2. Inexperience 3. Loss of control 4. Imbalance I Strategies 1. Applying investigative and interpersonal skills 2. Embracing the risks and challenges 3. Finding meaning and purpose in their work 4. Expecting the unexpected 5. Keeping expectations realistic 6. Achieving competence and confidence 7. Finding support from others and supervision 8. Maintaining an important life outside of work 9. Debriefing the trauma 10. Learning about self and self awareness i Consequences 1. Balance 2. Surviving 3. Thriving 4. Job satisfaction 5. Job retention 6. Self actualisation 7. Meaning and purpose to work Resilience Theory Resilience theory may be the closest fit to the experience described by some workers, but it lacks descriptive processes that identify how resilience is developed or maintained. Resilience is defined by the Atlantic Health Promotion Research Center as follows: 97 Resilience is the capability of individuals and systems (families, groups and communities) to cope successfully in the face of significant adversity or risk. This capability develops and changes over time, is enhanced by protective factors within the individual/system and the environment, and contributes to the maintenance or enhancement of health (Mangham, McGrath, Reid & Stewart, 2001, p.3). Early resilience research defined resilience using terms such as "invulnerable" and "invincible." However, these terms did not accurately describe the phenomena, because, in the words of Dr. Michael Rutter, they implied an absolute resistance to damage. Rutter went on to explain ".. .no one has absolute resistance; rather, it is more appropriate to consider susceptibility to stress as a graded phenomenon. Some individuals are more resistant than others but everyone has their limits" (Rutter, 1991, p. 1-2). Resiliency theory uses risk factors and preventative factors to further explain resilience. Significant risk factors face child protection workers as highlighted in the literature review. Protective factors are variables that serve to ameliorate or decrease the negative influences of being at risk (Mangham et al., 2001). These protective factors or serve to enhance one's ability to cope; they are not entirely prescriptive or preventative in avoiding burnout and leave us wondering what else contributes to risk protection. Rutter (1987) also pondered this quandary and asserted the search is not just for the protective factors, but also for the development and situational mechanisms or processes involved that produce resilience as described in the Atlantic definition. Current resilience theory does not appear to provide the mechanisms and/or processes 98 through which protective factors promote resilience, but this research provides some useful clues. The ten sub processes explain how workers balance on the high wire. The additional transition point and equilibrium processes further our understanding of how workers maintain balance. The following chapter will focus on a discussion of findings and implications for policy and practice as well as identify recommendations for further research. 99 Chapter 5 Emerging Policy and Practice Implications and Conclusion Previous literature on burnout and turnover in child protection has focused on stress and burnout, and has failed to fully examine what is working for certain child protection workers who survive and thrive despite the difficult work. The continued focus on the symptoms/problems may not be the most effective approach to enhance worker health. This research has focused on what is working for a sample of child protection workers and has revealed significant processes that may assist in the prevention of stress and burnout. As this study has significant limitations based only on emerging data, the researcher puts forth very tentative recommendations that may have implications for policy and practice. This section of the chapter focuses on seven emerging policy and practice implications. Rather than recommendations, they are framed more as discussion issues. Further research is necessary in order to make formal recommendations. Emerging Policy and Practice Implication Discussions 1. Education programs and specific training on "learning about se l f be implemented. Mangham et a l , (2001) recommended that organizations need to foster opportunities for success that include guided opportunities to learn personal competency and development of the ability to overcome adversity. They believed these opportunities might be more valuable than the formal teaching of skills in a class environment. Therefore, education and training programs that promote good self-care may be 100 desirable. This suggestion is supported by Health Canada (1998) as it recommends encouraging employees to use a variety of health promotion strategies such as displaying Canada's Food Guide in the lunchrooms and encouraging exercise through work subsidized programs. This material could also be useful in organizational courses. These concepts of self-care are not new, but there is a sense that workers have re-invented the wheel. Social workers should not have to re-discover commonly known stress management techniques. Rather, they should be taught in a simple, deliberate and comprehensive manner through organizational health and wellness committees. 2. The findings of this research could be introduced as curriculum, particularly in the Child Welfare Specialization (a program concentration within the Bachelor of Social Work program at schools of social work in British Columbia) to assist students to learn and reflect upon the supports required for practice and to evaluate their ability to implement these sub processes. 3. Education and training programs could teach workers to recognize early warning signs in themselves and their co-workers. Advising workers of risk factors and early recognition of warning signs along with how to carefully self assess/self analyze caseload management, home/work balance and use of supervision and team based collegial support should be implemented within university curriculum and within child protection organizations' professional development initiatives. With study duplication and a larger sample size, there may be stronger ability to better predict how the health of protection workers is preserved and thereby improve retention rates for workers. Some front-end evaluation of workers' critical and self-care should prove helpful in determining those susceptible to burnout. 101 4. Debriefing requirements in child protection need enhancing and that relationships between workers need encouragement at the supervisory level. Debriefing with a supervisor or colleague must be acknowledged as critical. Supervisors and workers need training in Critical Incident Stress Debriefing. This more informed application of debriefing may assist workers to be more effective at debriefing a colleague: work units can provide formal debriefing as necessary; and this may assist in unburdening peers who are already coping with their own stressors. Anderson (2000) reports that child protection workers have the same needs for emotional debriefing as law enforcement officers, firefighters, EMS workers, emergency room personnel, and rape crisis workers. Building and developing relationships among workers and supervisors needs to be encouraged and not be viewed as workers wasting their time. ".. .it's almost like, management in Victoria feels that it's frivolous to spend time 'socializing' with each other, but they've lost the concept of that in a different form is debriefing and nurturing of each other and that really needs to happen" (Larry, line 502-503). This research has demonstrated how important collegiality is among workers and between supervisors and workers. Mangham et al. (2001) also recommended that organizations continue to foster a supportive environment that encourages collegiality. Relationships are an integral part of the support for a worker and must be supported by administration through social events on company time (birthday celebrations, fun contests, potluck lunches etc). 5. Workers need to maintain flex days and it is suggested that management build in unpaid leave provisions, which may prevent further sick leave claims. In addition, it is recommended workers maintain some control over their degree of specialization. 102 As the use of STIP appears to be both a coping strategy and risk factor for some workers, administration attention must find ways to train workers to utilize critical care rather than elect the more radical (from the organization's perspective) coping strategy. Flex days must be available to workers to serve as "mental health days" and proactive management will schedule provisions for discretionary annual unpaid leave days. Specialization of work functions and caseload make-up must be negotiated between worker and management. While workers enjoy specialized practice that utilizes their strengths and capacities, they also believe they must have some control to terminate the specialization when they find it is beginning to take a toll on them. 6. Supervision is a critical aspect of human resource management. Supervision is critical and must be promoted by administration. Careful selection of positive, supportive nurturing individuals who can assist workers to self assess, insist on good boundaries with the workload and provide debriefing is important. This supervision must be frequent, adhoc, readily available, structured and supportive. Supervision should work to create a relaxed atmosphere to ameliorate the chronic seriousness of the work as workers identified the need to have fun and levity at work. A feminist approach to supervisory leadership is recommended and is supported by Callahan (1993). These workers describe a preferred style of leadership that promotes caring and empowering workers and is participatory (Chernesky, 1995). This style of leadership seeks to look for ways to build on the strengths of the staff to create a climate in which differences can be expressed and lead to unity rather than separation, to delegate tasks that empower others, to develop horizontal methods for sharing information and solving problems, to provide opportunities to give feedback, to 103 support individuals' personal and familial concerns; and to encourage the formation of social networks that support personal development (Hooyman, 1991). Careful analysis of these workers' description of their supervisor's styles reveals that the approach they have experienced may be an anti-oppressive style of leadership. This style of leadership may also provide the emotional and physical safety and security of the worker. In addition, supervision seemed critical to balancing caseloads. We must ensure that new social workers are put in larger centers with a structured and supervised environment in order to gain experience and learn caseload management (much like apprenticeship). Workers should not move to isolated, high stress areas until it is assessed they will be able to cope. Or, perhaps a roving model of supervision in tandem with supervision via telecommunication could be explored. 7. It is recommended that the results of this study be taken back to veteran child protection workers in the form of a seminar. This will provide an opportunity for workers to continue to test and shape the development of the theory. Eight tentative recommendations for practice and policy have been identified. In addition, the findings of this research generated ten recommendations for further research. Concluding remarks to summarize this thesis follows these recommendations. Recommendations for further research 1. Workers had a particular sense of glee and personal satisfaction especially when they engaged in functional non-capitulation or internal advocacy to meet client needs. Callahan (1993) wrote, "When workers were able to weave their way through the maze of interactions and, through skill and wit, bring some sort of 104 satisfactory outcome for clients, they felt powerful" (p.92). This creative power is a novel approach to structural social work and remains in keeping with the British Columbia Association of Social Workers Code of Ethics (1999) Section 8.2 that states, " It may be required of the social worker to subordinate the employer's interests to the interests of the client" (p. 10). This required role of social workers in the Code of Ethics also refers to the role of an advocate in a generalist practice. ". . . a common goal... is to assure that the services or resources to which an individual client is entitled are, in fact, received" (p. 59). Social workers in this study attempted to obtain what was necessary for clients and they did this in creative ways. This creative structuralism bears further investigation. 2. According to Dr. Jeffrey Mitchell (1983), a critical incident is: .. .any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later.. . A l l that is necessary is that the incident, regardless of the type, generates unusually strong feelings in the emergency workers (p. 36-39). As workers may experience these feelings on a frequent basis, when is formal debriefing required? Which works better - formal versus informal debriefing? This bears further study. 3. Are warning signs visible to colleagues when a worker is beginning to burnout? Do colleagues intervene? Has an organizational mechanism been implemented to support workers when a colleague recognizes burnout in another colleague? A study of peer recognition of symptoms in co-workers may help develop an early 105 recognition system for those workers susceptible to stress. 4. Further study of the importance of self-care may identify what makes a worker more apt to apply good self-care regularly and over a prolonged period of time. 5. While personality has been critically linked to resilience, a more detailed look at how personality and need for adventure is linked to resilience in the context of child protection bears investigation. 6. A postmodern approach to qualitative research asks the question, "whose voices were not included in the research?" As the voice of the client is not heard in this study, it is recommended that further study be undertaken to see how worker health affects practice interventions from client's perspectives and with respect to practice effectiveness. 7. As workers identified remote practice to be a risk factor for the new worker, further research needs to be conducted on workers who survive and thrive in remote practice to identify their specific coping strategies, traits and workplace supports. 8. This entire study needs to be replicated with a much larger sample to include entire teams. Ideally, a stratified sample of district supervisor, managers, workers, team and administration would produce very comprehensive research to determine what contributes to avoiding burnout, surviving and thriving in child protection. As well, this team approach to sampling can contribute to strong research reliability. Research of this magnitude requires funding support to increase sample size to 20 -30 participants for ground theory requirements and needs to further distinguish between personal attributes and job characteristics. 106 9. The workers in the study did not clearly differentiate between the terms surviving, thriving and resilience. It appeared they used the meaning of the terms interchangeably. Additional research could further define the differences between the three terms. 10. There is evidence that strong social work values emerged that assisted workers to avoid burnout, survive and thrive. This may be evidence of the critical importance of Bachelor of Social Work training and of the generalist social work model. Research needs to be conducted that compares professional social workers in child protection against those in child protection who are not professional social workers. 11. Literature discusses a coping threshold that workers cross when they burnout. Can further research identify and articulate, "how much stress is too much" in child protection work? 12. As these workers were studied while the New Democratic Party was in power, it may be useful to undertake a comparison of worker's perception of their work under a completely different child protection system since the election of a Liberal government in British Columbia. Conclusion Existing literature does not fully explain how some workers avoid burnout, survive and even thrive in a challenging, chaotic child protection system. However, this study corroborated some of the findings in literature that provides some reliability in spite of the small sample size. Unique findings on the beliefs of workers regarding sick time were discovered that contribute to the body of literature. The theoretical 107 proposition is that workers who survive in child protection work balance on the high wire and like it while maintaining basic generalist social work values. 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