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

Abstract

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