Discussion 2: Self-Care

A Study of Adverse Childhood Experiences, Coping Strategies, Work Stress, and Self-Care in the Child Welfare Profession Kyuho Lee, Yuk C. Pang, Jo Ann L. Lee, and Janet N. Melby

Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA

ABSTRACT This mixed-method study examines child welfare professionals’ adverse childhood experiences (ACE) and coping strategies they use to mitigate work stress. Survey data are from 104 child welfare services professionals in a Midwestern state. Participants reported high stress levels and frequent unhealthy coping strategies. Their ACE scores were higher than those of the general population. Quantitative analyses showed that the relativity of ACE to their career choice and unhealthy coping strategies also predicted their work stress. Qualitative analysis revealed challenges these workers face in self-care when dealing with work stress. Implications for child welfare staff, supervisors, and educators are suggested.

KEYWORDS Adverse childhood experiences; child welfare profession; self-care; work stress; workforce/workplace issues in human service organizations

Child welfare professionals’ work stress poses the potential of negative outcomes for their personal and professional lives and for their clients. Child welfare professionals experience emotional and physical exhaustion, poor physical health, and mental health problems when exposed to the prolonged trauma of others (Collins & Parry-Jones, 2000; Jones, 2001). Due, in part, to the frequency and intensity of their exposure to secondary trauma, child welfare professionals may experience burnout, which may ultimately lead to job turnover (Nissly, Mor Barak, & Levin, 2005). In addition, they may struggle to provide effective care for their clients, reducing the quality of services (Shapiro, Burkey, Dorman, & Welker, 1997; Silver, Poulin, & Manning, 1997).

The impacts of Adverse Child Experiences (ACE) and coping strategies on individuals’ physical and mental health have been well reported (e.g., Anda et al., 2004; Schüssler-Fiorenza, Xie, & Stineman, 2014). However, little research has specifically examined child welfare professionals’ ACE or the implications of ACE for their personal and professional lives over time. ACE may influence child welfare professionals’ susceptibility to work stress, which could lead to diminished quality of services delivered to children and families (Esaki & Larkin, 2013). Research about effects of ACE on child welfare professionals could lead to the development of strategies to minimize the potential impact of ACE on their sense of well-being and to improved services to families.

In this study, a life-course perspective is used to explain the influence of child welfare profes- sionals’ early life experiences on their current work-related stress. In addition, investigators exam- ined the use of coping strategies reported and the ability to implement and routinely practice these strategies. In the sections below, we review the existing literature regarding child welfare profes- sionals’ work stress, adverse childhood experiences, and self-care coping strategies.

Work stress

Although child welfare professions often feel rewarded by their work, child welfare settings are considered stressful work environments (Kim, 2011; Lizano & Mor Barak, 2012). Kim argued that,

CONTACT Janet N. Melby [email protected] Department of Human Development and Family Studies, Iowa State University, Ames, IA 50011, USA. This article not subject to US copyright law.

HUMAN SERVICE ORGANIZATIONS: MANAGEMENT, LEADERSHIP & GOVERNANCE 2017, VOL. 41, NO. 4, 389–402 http://dx.doi.org/10.1080/23303131.2017.1302898

frequently, child welfare professionals take on very difficult cases with enormous amounts of responsibility. Child welfare professionals’ work-related stress may arise from large caseloads, critical and complex issues with clients, and lack of time to perform duties (Johnson, 2014). In addition, their limited autonomy (Lloyd, King, & Chenoweth, 2002) and lack of resources (Johnson, 2014) were found to increase the amount of work stress in their job setting. Frequent interaction with clients who are often experiencing traumatic life events or circumstances seems to add to the child welfare professional’s stress. In fact, statistics indicate that the rate of lifetime traumatic experiences for individuals involved in child welfare services is much higher than the general population.

Adverse childhood experiences

Numerous studies document various negative effects of adverse childhood experiences (ACE) on well- being in adulthood since Felitti and his colleagues (1998) first introduced the concept. ACE experiences include verbal, physical, sexual abuse, and family dysfunction (e.g., an imprisoned, mentally ill, or substance-abusing family member; domestic violence; or absence of a parent because of divorce or separation). Using samples from the general population, researchers found that these experiences can disrupt neurodevelopment (De Bellis et al., 1994; Yates, 2007), which in turn can lead to negative social, emotional, and cognitive development. ACE also affects the adoption of health-risk behaviors followed by disease, disability, and social problems (Anda et al., 2004; Schüssler-Fiorenza Rose et al., 2014).

Therefore, considering the intersection of ACE scores of the child welfare worker and the ACE score of their clients, it is important for the present study to expand previous research by examining the potential effect of ACE on child welfare professionals’ work-related stress and the impact it may have on the services provided to children and families.

Some research has noted that adverse childhood experiences (ACE) may be associated with child welfare professionals’ career choice (Biggerstaff, 2000; Olson & Royse, 2008; Sellers & Hunter, 2005). It is suggested that their ACE helps them to understand the suffering of others better and becomes an important factor in their career selection. Therefore, child welfare professionals as a group, may have higher ACE scores than the general population. In fact, 70% of child service providers experienced at least one of the eight ACE categories (Esaki & Larkin, 2013). Child welfare profes- sionals’ ACE score may be considered proportionately higher than the general population’s percen- tage of having any ACE (Centers for Disease Control and Prevention, 2009) from five states (Arkansas, Louisiana, New Mexico, Tennessee, and Washington) and Iowa (Gudmunson, Ryherd, Bougher, Downey, & Zhang, 2013) which was 55% and 59%, respectively.

In addition to the association of ACE and career choice, for some child welfare professionals, adverse childhood experiences can have other negative impacts on the accumulation and manifesta- tion of work-related stress. Nelson-Gardell and Harris (2003) found that among child welfare professionals who had experienced abuse in their childhood increased the risk of responding negatively to secondary traumatic stress. However, very few studies on ACEs have analyzed data regarding the association between ACE and work-related stress with data from child welfare professionals. Interestingly, Howard et al. (2015) reported that child welfare professionals with higher ACEs had lower rates of burnout, which is contrary to the general findings of most studies that have shown that ACE has a negative impact on individuals. However, burnout is an extreme level of stress, which may not reflect child welfare professionals’ work-related stress well. It is possible that an individual experienced high levels of work stress but did not report that she or he experienced an extreme level of stress owing to, potentially, the individual’s resiliency. Therefore, the present study examines the effect of ACE on work-related stress.

Self-care and coping strategies

When attempting to understand child welfare professionals’ stressors in the workplace, one cannot ignore the important role of self-care in child welfare practice. The current research defines self-care

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in numerous ways. Self-care is a process, ability, or engagement in behaviors that would promote certain positive outcomes such as a positive lifestyle or stress relief (Lee & Miller, 2013). Other researchers defined self-care as managing important individual functions such as sleep, diet, exercise, and rest (Jordan, 2010).

Furthermore, self-care includes behaviors related to intrapersonal work, interpersonal support, professional development and support, and recreational physical activities (Carroll, Gilroy, & Murra, 1999). These different definitions of self-care illustrate the complexity of self-care and its important role in peoples’ lives.

A study by Acker (2010) found that coping strategies utilized by social workers was significantly related to their burnout rates. Because coping styles and strategies have various conceptualizations, classifying copings is not a simple work. For the present study, we sorted various coping strategies into two categories according to their outcomes and desirability and referred to them as positive coping strategies and negative coping strategies. Positive coping strategies include seeking external supports such as social or emotional support (Maslach, 2001; Weinbach & Taylor, 2011). Negative coping strategies include behavioral disengagement (e.g., reduction of the activities related to stressful tasks) and mental disengagement (e.g., engaging in activities such as alcohol and drug abuse, daydreaming, and excessive sleeping), which may bring long-term negative health outcomes after temporary distraction or relief from stress (Carver, Scheier, & Weintraub, 1989). Denial of reality also brings poorer results by allowing the severity of the situation to increase, whereas it provides short-term alleviation of distress or pain (Carver et al., 1989).

Contributions of this study

As mentioned above, the associations among child professionals’ ACE and their coping strategies on work-related stress have not been addressed in the existing research literature. It is important to address these associations based on existing literature regarding how ACE can impact work stress beyond the effect of coping strategies. Therefore, this study addresses a gap in the literature regarding the influences of child welfare professionals’ adverse childhood experiences (ACE) and coping strategies on their work-related stress. We also explore child welfare professionals’ difficulties in practicing self-care against work-related stress with a qualitative method. Therefore, the research questions of the study are:

(1) What are the levels of child welfare professionals’ work-related stress and ACE? (2) What are the challenges of self-care? (3) What coping strategies do child welfare professionals use for their work-related stress? (4) Do child welfare professionals’ ACE and coping strategies predict their work-related stress?

Method

In this study, the research questions were investigated using a mixed methods approach. Quantitative and qualitative data were collected using separate email surveys. The quantitative data were obtained from 10 sessions of one-day self-care training (The “U” in Trauma Informed Care) delivered to 254 child welfare professionals who worked in social service agencies throughout Iowa. The child welfare professionals voluntarily participated in this program as part of their work- related professional development from October to December in 2013. An electronic questionnaire on participants’ work stress was sent to all 254 participants 30 days after the training. For the qualitative study, another follow-up electronic survey on their stress coping strategies, self-care difficulties, and ACE was sent to all 254 child welfare professionals in February 2014. To increase participation rates, anonymous surveys were administered.

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Participants

Among the 254 participants of the self-care training, about 51% (n = 130) of the participants responded to the first questionnaire for the quantitative study. Of the responses, data from 104 participants were analyzed, as they had complete data on the basic information such as their age, gender, service years, coping strategies, ACE scores, and work stress. For the qualitative study, 20% (n = 51) of the participants responded to the email questionnaire.

Measurement

Dependent variable Child welfare professionals’ work stress, the dependent variable of the study, was measured with a single question: How would you rate your level of work stress? (1 = very low to 5 = very high).

Independent variables Participants’ coping strategies in dealing with their work stress were assessed by selected items in the COPE inventory (Carver, 2013; Carver et al., 1989). The COPE inventory includes 52 items to measure 14 categories of an individual’s coping behaviors in stressful events. To lessen child welfare professionals’ burden of participation, we selected a representative item for each coping strategy: items with the highest factor loading within each category provided by Carver et al. were used. The items include, “I take additional action to try to get rid of the problem” (active coping); “I try to come up with a strategy about what to do” (planning); “I put aside other activities in order to concentrate on this” (suppression of competing activities); “I force myself to wait for the right time to do something” (restraining coping); “I ask people who have had similar experiences what they did” (instrumental social support); “I try to get emotional support from friends or relatives” (emotional social support); “I look for something good in what is happening” (positive reinterpreta- tion and growth); “I learn to live with it” (acceptance); “I seek God’s help” (turning to religion); “I get upset and let my emotions out” (focus on and venting of emotions); “I refuse to believe that it has happened” (denial); “I give up the attempt to get what I want” (behavioral disengagement); “I turn to work or other substitute activities to take my mind off things” (mental disengagement); and “I drink alcohol or take drugs, in order to think about it less” (alcohol-drug disengagement). The four-point Likert-type response scale ranged from 1 (I usually do this a lot) to 4 (I usually don’t do this at all).

Carver et al. (1989) suggested that active coping, planning, and suppression of competing activities were associated with one factor, which we called positive coping strategies. Through an inter-item reliability test, we chose another three items (one each for denial, mental disengagement, and alcohol- drug disengagement) for negative coping strategies. The Cronbach’s alpha coefficients were .70 (positive coping) and .65 (negative coping).

Child welfare professionals’ ACE scores were measured using eight items and categorized according to the number of the ACE that they experienced (0, 1, 2–3, and 4 or more)

(Felitti et al., 1998). The eight questionnaire items included questions asking participants’ personal experiences such as physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Participants calculated their ACE scores and reported the total score for the survey.

Relativity of ACE with career choice was measured by a single question in the follow-up survey: “Now that you know your ACEs score, and are looking back to when you began working in human services, do you believe your score had any bearing on your decision to work in this field?” (1 = strongly disagree to 5 = strongly agree).

Control variables Participants’ age was coded with years, and gender was entered as a dichotomous variable (0 = female, 1 = male). The length of time the participant worked as a child welfare professional was coded in the number of years.

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Analytic strategy

Descriptive analyses were conducted to identify characteristics of the participants including demo- graphics, ACE scores, stress levels, and their positive/negative coping strategies. Participants’ ACE scores were compared with other samples: general population from Iowa and the other five states (Arkansas, Louisiana, New Mexico, Tennessee, and Washington) where the Center for Disease and Prevention conducted research on ACE. Finally, a blockwise multiple regression analysis was computed to examine whether participants’ ACE score, the relativity of ACE to career choice and positive/negative coping strategies against work stress predicted child welfare professionals’ work stress. Additionally, moderation effect of coping strategies on the association between work stress and its significant predictors was tested. We entered interaction terms created by multiplying significant predictors together in the last model. Mean centering was used for interaction terms to prevent multicollinearity. A pairwise deletion method was computed for dealing with missing data. IBM SPSS 22.0 was utilized to conduct the analyses.

Qualitative analysis to identify the themes related to challenges to self-care against work stress followed the quantitative analyses; answers to the open-ended questions were organized into codes and analyzed for patterns of each participant’s responses using In Vivo coding. With this coding process, participants’ responses were summarized in a shortened form as codes for further data analysis later on. The codes represented words or phrases that were from the actual language in participants’ responses (Saldana, 2009). These patterns were then sorted into thematic categories by researchers. For sorting codes into categories, the frequent occurrence of codes with similar view- points and relatedness of a particular topic were considered for sorting certain codes into a specific category. Codes with comments on the same topic (e.g., high caseload, lack of time) were highlighted with the same color to differentiate content categories among a large amount of code. Next, the categories were then sorted into themes based upon the relationships between categories.

Results

Findings from the quantitative analyses

A series of quantitative analyses were conducted to identify the characteristics of participants, especially their stress levels, ACE score, and coping strategies. The associations between the main predictor variables of child welfare professionals’ work stress were explored, followed by the blockwise multiple regression analysis.

Descriptive sample characteristics Of the 104 participants who responded to the first survey on their work stress and ACE, 88.3% were female, whose average age was 42.9 years (SD = 2.98), and average employment period in a social service position was 14.8 years (SD = 6.84). See Table 1 for the summary statistics for the study variables for the sample population.

Participants were employed by the Iowa Department of Human Services (DHS) as child welfare professionals (61.8%) and DHS supervisors, managers, or administrators (10.8%) and as non-DHS community providers (27.5%). All the participants had at least a college-level education. Participants’ ACE is presented in Figure 1. Their mean ACE scores were higher than the general population. Only 22.6% of the participants reported a score of 0 on the ACE, whereas 36.1% of the five states’ general population and 45.0% of the Iowa general population replied that they did not have any adverse experience. The highest percentage of participants (31.0%) scored 4 or more, which is two times greater than scores for the five states (12.5%) and Iowa (14.0%).

Most participants reported their work-related stress as either high/very high (61.5%) or moderate (29.8%), and only 8.7% described their work stress as low/very low (see Table 1). Considering the possible range of the response is 1 to 5, the fact that the mean stress level of child welfare professionals was 3.7 indicates their stress level is high in this group.

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The results of descriptive analyses on child welfare professionals’ coping strategies against work stress showed that they are more likely to use negative coping strategies than positive strategies. The detailed information about their strategies is presented in Table 2. The result of frequency analysis suggested that the top three of the 14 coping strategies frequently used by child welfare professionals were all negative ones. Nearly 70% of child welfare professionals replied that they used alcohol or drugs “a lot” when they experienced work stress.

Combining the responses, a lot and medium, and ranking participants’ strategies from most- to least-used, the two most used were alcohol-drug use (96.1%) and denial (I refuse to believe that it has

Table 1. Summary statistics for the study variables (N = 104).

Characteristic n (%) M SD

Age (years) 42.9 2.98 Gender (female) 92 (88.5) Years of service 14.8 6.84 Stress level 3.7 0.89 Very low 1 (1.0) Somewhat low 8 (7.7) Moderate 31 (29.8) Somewhat high 4 (42.3) Very high 20 (19.2)

ACE score 2.6 1.15 1 19 (22.6) 2 21 (25.0) 3 18 (21.4) 4 (and more) 26 (31.0)

Positive coping 22.88 4.12 Negative coping 12.93 1.84 Relativity of ACE with career Strongly disagree 4 (4.0) Disagree 17 (16.8) Neutral 40 (39.6) Agree 30 (29.7) Strongly agree 10 (9.9)

Note. Percentages may not total 100 due to rounding.

Figure 1. ACE score comparison.

Note. Iowa score is from Gudmunson et al. (2013), and the five states’ score is from the Centers for Disease Control and Prevention (2009). The five states are Arkansas, Louisiana, New Mexico, Tennessee, and Washington.

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happened; 94.2%); the two least used were acceptance (I learn to live with it; 26.0%) and planning (I try to come up with a strategy about what to do; 13.5%).

Predictors of child welfare professionals’ work stress Table 3 presents the result of blockwise multiple regression analyses on child welfare professionals’ work stress. Model 1 examined the effects of background variables and the relation of ACE with career choice of child welfare professionals. The relation of ACE with career choice positively predicted work stress, whereas participants’ age, gender, and years of service in child welfare did not significantly predict child welfare professionals’ work stress. This result indicated that child welfare professionals who chose their jobs because of their adverse experiences in their childhood showed higher work-stress levels than those who did not.

Model 2 evaluated the effect of child welfare professionals’ ACE scores on their work stress. Child welfare professionals’ higher ACE score significantly predicted higher work stress. This model explained 2% of the variance in the child professionals’ work stress.

Model 3 tested the effect of positive and negative coping strategies on work stress. The result showed that child welfare professionals’ more negative coping strategies significantly predicted higher work stress, whereas their positive coping strategies did not. This model explained 4% variance in child welfare professionals’ work stress.

Model 4 evaluated the effects of all the predictors, which were significant in previous models. The result showed that child welfare professioanls’ ACE, the relation of ACE to their career choice, and

Table 2. Child welfare professionals’ coping strategy for work stress (N = 104).

Item

Percentage (%)

Not at all A little bit Medium A lot

Positive coping Active coping 32.7 39.4 25.0 2.9 Planning 48.1 38.5 12.5 1.0 Suppressing competing activities 23.1 48.1 24.0 4.8 Negative coping Denial 1.0 4.8 20.2 74.0 Mental disengagement 11.5 45.2 36.5 6.7 Alcohol-drug disengagement 1.0 2.9 26.9 69.2

Note. Percentages may not total 100 due to rounding.

Table 3. Blocked multiple regression results of child welfare professionals’ work stress on all independent variables.

Model 1 (N = 101)

Model 2 (N = 84)

Model 3 (N = 103)

Model 4 (N = 84)

Model 5 (N = 84)

B β B β B β B β B β

ACE Relativity of ACE to career choice 0.25 .28** .16 .18* .15 .17 ACE 0.21 .26* .20 .26* .17 .22†

Coping strategies Positive coping −0.21 −.15 Negative coping 0.42 .23* .45 .25* .35 .20 Interactions Relativity × Negative −.19 −.15 ACE × Negative .10 .06 Covariates Age 0.12 .14 0.06 .07 0.09 .11 .09 .11 .11 .13 Gender (0 = female) −0.02 −.01 0.11 .04 −0.13 −.05 .08 −.03 .05 .02 Years of service −0.04 −.06 0.01 .01 −0.05 −.08 .03 −.05 .02 .04 Constant 3.56 3.51 3.71 3.31 3.32 Adjusted R2 0.04 0.02 0.04 .11 .10 F 2.09 2.27 1.82 2.69* 2.16

†p < .10. *p < .05. **p < .01.

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negative coping strategies all remained significant. This result indicates that controlling for all the other effects, participants who more strongly agreed that their career choice was related with their ACE, who had experienced more adverse experiences in childhood, and who used more negative coping strategies reported higher levels of stress. This model explained 11% of the variance in child welfare professionals’ work stress.

Finally, Model 5 tested the moderation effect of negative coping strategies on the association of relation of ACE with career choice with work stress and the association between ACE scores with work stress. However, the results showed that there were no significant moderation effects. Previously significant predictors of work stress (i.e., the relativity of ACE to career choice and negative coping strategy) also became nonsignificant after including the interaction terms. Only ACE scores remained marginally significant (β = .22, p = .08). The results indicated that participants with higher ACE scores were experiencing more work stress.

The association between the number of negative coping strategies and work stress did not differ according to the number of ACE or how much ACE influenced their career selection.

Findings from the qualitative analyses

When we examined child welfare professionals’ qualitative responses about challenges they encoun- tered when working on their self-care, we identified the following themes from their responses: high caseload and lack of time, spillover work stress to family life, and supervisors’ lack of awareness of self-care needs. Each of the themes is discussed below.

High caseload and lack of time Participants reported stress from time pressures due to their high caseloads. They also stated that they experienced feelings of guilt when they did not finish their work in time.

(It is stressful in) taking the time to do it. When things get tough, and the job needs to get done, it’s hard to stop and think about how it’s going to affect you that night, or later that week, or even next month.

It has been very busy with work, feeling overwhelmed with all of the cases and just realizing I still need ME time.

Caseload is too high. Traveling way too much to get anything done. Either I will have pretty files that meet federal criteria, or I will have strong relationships with my [caseload] kids and families. Somebody needs to tell me which—cause both cannot be done with my spread-out caseload.

Most workers, including myself, feel guilty or worry that things don’t get done.

These quotes from participants consistently reflect child welfare professionals’ limited time for themselves along with their busy schedule at work. They mostly expressed that they are overwhelmed with the caseload they have. At the same time, they feel guilty or worry that things will not be done on time if they take time off from their work for themselves. Due to their work schedule, child welfare professionals often pay less attention to and have less awareness of the impact of their work- related stress on their mental health and well-being.

Spillover of work stress to family life While many child welfare professionals in the present study expressed feeling stressed and over- whelmed about their caseload, another challenge they expressed is the spillover of work stress into their after-work time.

Leaving my work issues at work and not taking them home with me.

When participants were asked to name challenges they have encountered regarding their self-care for handling work stress, they expressed that it was difficult to separate themselves from work even after they get home.

Emergencies always come up, and it is hard to separate yourself.

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These findings showed that their work stress could also interfere with their life after work, which brings their work-related stress home and can lead to family conflict and adverse effects on their relationships with family members.

Lack of supervisors’ support Finally, one of the most frequently mentioned themes was that their supervisors did not recognize the importance of the child welfare professionals’ self-care needs. Here are some of the concerns they expressed:

Taking mental health days off is hard to do when your supervisor hasn’t taken the training and. . . [is not] informed on how trauma affects the home visitors, and those who work one-on-one with families in some way.

Not supported by higher management. You are only a number that can be replaced. Your work is not valued. Constant criticism or micro-management creates more stresses in an already stressful job.

Time constraints and the inability or unwillingness of those above us to accept this as a way of practice. The chaos never stops, and there is not a lot of support.

These quotes from the participants indicate that they often perceive a lack of support from their supervisors regarding self-care to cope with their work-related stress. Their perception that super- visors’ lack of awareness of their work stress can also affect workers’ interactions with the families they serve, which may negatively affect child welfare professionals’ well-being.

Thus, some participants also expressed the great need for future training specifically for the supervisors to increase their awareness of the importance of self-care needs for child welfare professionals, and to create a positive and supportive working environment for child welfare professionals.

Discussion

To help child welfare professionals manage their work-related stress, it is important to understand the level and the source of stressors in their work duties and the difficulties workers experience with implementing positive coping strategies as a part of a self-care plan. This study examined: (1) the levels of child welfare professionals’ work-related stress and ACE; (2) the challenges of self-care; (3) how they cope with their work stress; and (4) whether participants’ ACE and coping strategies predict their work-related stress. A qualitative method was additionally used to address research question 2. The results of the current showed that child welfare professionals were experiencing high levels of work-related stress and, unfortunately, many of them were using negative coping strategies such as alcohol, drugs, or denial. Child welfare professionals’ ACE score was higher than the general population, and their ACE score was associated with higher work stress. Main themes found from the qualitative analysis revealed that they were suffering from high caseload, lack of time, spillover of work stress to family life, and lack of supervisors’ support.

The result that child welfare professionals were experiencing high levels of work-related stress was consistent with previous research on social service employees (Kim, 2011; Lizano & Mor Barak, 2012). Child welfare professionals who directly interact with client children and their families often express high levels of stress due to their caseload and demands with specific time constraints and deadlines. Such busy schedules and expectations bring pressures to child welfare professionals who, consequently, either cannot or are not encouraged to take enough personal time for their own well- being.

Considering the difficulties employees experience in self-care from work, it is not surprising to find that most child welfare professionals were tempted by easy, but negative, coping strategies against work stress such as alcohol and drug use, denial, and behavioral disengagement. Admittedly, the survey did not ask the participants about the objective degree or amount of the copings they employ. For example, although a child welfare professional participant responded that she or he uses alcohol or drugs a lot, it may not mean that they are alcoholic or in danger of drug addiction.

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However, these types of coping strategies were reported as what the employees were using against work stress, which needs to be paid attention to.

In comparison with a general population, the present study found that the sample showed very high ACE scores. This may come from the high proportion of women in the current study; Anda (2007) reported that women’s ACE scores were higher compared with men. However, our female participants showed greater percentages of high ACE scores (2–3: 23.3%; 4 or more: 32.9%) compared with women in the Iowa general population (2–3: 18.2%; 4 or more: 16.1%) and in Anda’s sample (2–3: 24.2%; 4 or more: 31.3%). The fact that about 40% of the child welfare professionals agreed that their adverse experience in childhood affected their decision to work in their field seems to be a plausible factor for their high ACE scores: if ACE is associated with the motivation to become child welfare professionals, they are prone to be a group with high ACE. Previous findings of the association between early family experiences or personal history and career choice in the social work profession (Biggerstaff, 2000; Olson & Royse, 2008; Sellers & Hunter, 2005) support this finding.

The result that child welfare professionals’ ACE scores were related to work-related stress is contrary to Howard et al.’s (2015) previous finding that a higher ACE score was associated with lower rates of burnout. This inconsistency may come from different measurement: We used a single question, and Howard et al. used multiple items from the ProQOL scale to measure burnout. Furthermore, considering that burnout is an extreme form of work-related stress, questions to assess stress and burnout could be different. In other words, not all child welfare professionals who strongly agreed that they experienced stress would experience burnout. Therefore, child welfare professionals’ high ACE score may be associated with low burnout and high work stress at the same time.

Our suggestion that child welfare professionals’ ACE influence their work stress is supported by another result of the current study that participants who more strongly agreed that their career choice was related to their ACE reported more stress from work. This can be interpreted that child welfare professionals who chose their career because of their ACE have a tendency to be over- involved in their clients’ cases. It has been suggested that most workers have a strong need to be helpful to others, which is a strong motivator in their choice of profession: This can lead to over- involvement and poor boundaries that bring about increased work-related stress (Acker, 1999; Egan, 1993). The vicarious effect of clients’ negative experiences on service workers may also explain participants’ work-related stress. Vicarious effects of adverse events happen through the empathic bond between the service provider and recipients (Hernandez-Wolfe, Killian, Engstrom, & Gangsei, 2015). If the service worker experienced adverse events in their childhood, they have the potential to overempathize with clients’ difficulties, which subsequently increases the risk of secondary trauma response and the potential for re-traumatization of the worker if she or he has not dealt with similar trauma. Studies on child welfare professionals’ work-related stress have mostly focused on the associated external factors involved. In the present study, we suggest that service workers’ individual history, especially adverse experiences in childhood, could be an important predictor of their work- related stress.

We did not find that positive coping was a significant predictor of less work stress, which might be due to the true small effect of positive coping strategies or just a statistical power issue resulting from the relatively small sample size of the present study. It is also possible that the objective existence of work stress does not change regardless of the coping strategies they use. However, as expected, more frequent use of negative coping strategies was significantly associated with child welfare professionals’ higher work-related stress. Considering the strategies mentioned by the child welfare professionals, even negative coping strategies might have a short-term effect in relieving stress. However, the finding that a more negative coping strategy use is associated with a higher work-stress level suggests that negative copings increase rather than decrease the stress.

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Child welfare professionals not only struggled to combat the stress related directly to their work, but also experienced challenges in taking the necessary steps to safeguard themselves from the work- related stress. One of the most frequently expressed themes by child welfare professionals was the perception that their supervisors’ lacked awareness of the need for support regarding the importance of self-care among child welfare professionals. Because work environments and interpersonal relationships at work are highly impactful on a child welfare professionals’ well-being (Collins, 2008; Kim & Stoner, 2008; Nissly et al., 2005), the results of the present study suggest the importance of training for supervisors to increase the awareness of stress among child welfare professionals and creating a supportive initiative of encouraging self-care within child welfare practice. Difficulties child welfare professionals experience in resolving work stress are directly associated with their mental health (Lloyd et al., 2002). Needless to say, employees’ mental health is directly related to their well- being. Job satisfaction is reported as a predictor of service workers’ commitment (Lambert, Pasupuleti, Cluse-Tolar, Jennings, & Baker, 2006) and turnover (Freund, 2005), which is also linked to service quality.

Suggestions for future studies

For future studies, we suggest further investigation of the relationships among child welfare profes- sionals’ ACE, coping strategies, and work stress through multivariate analyses. For example, ACE may also influence one’s coping strategies and abilities to manage stress. In turn, stress might influence child welfare professionals’ type of strategies used to cope with their work stress. In addition, longitudinal investigations would clarify these causal relationships.

Furthermore, not all ACE types would have the same impact on individuals. For example, the experience of sexual abuse in childhood might not have the same impact on child welfare profes- sionals as verbal abuse or parents’ divorce. Therefore, considering the types of ACE in the study on the association between ACE and work stress would provide further understanding of the impact of ACE on child welfare professionals. Finally, including data on management or organizational-level characteristics in the model would provide valuable information on service employees’ well-being in work places. For example, whether the employees receive organizational-level self-care programs and their frequency would inform us how organizations protect employees from work stress and countertransference effects.

Limitations

The present study has some limitations. First, the use of nonrepresentative sampling of child welfare workers in a Midwestern state prohibits the generalizability of the results. Work stress, coping strategies, and ACE scores of child welfare professionals might vary according to the region. In fact, Gudmunson et al. (2013) suggested that ACE of the general population were lower in Iowa than other states in the United States. Also, Shier and Handy’s (2015) report that service workers’ subjective well- being is influenced by the community they work for implies that their stress levels may differ by region. Future studies are encouraged to utilize a more representative sample. Furthermore, the criteria to work as a child welfare professional may vary by state and by agency. Regarding the sample, the qualitative survey was conducted anonymously to encourage participation, so we were not able to describe this subsample. A caution is needed to interpret the results of the qualitative research: Participants of the qualitative survey may not represent child welfare professionals.

Second, there are limitations in some measurements. Child welfare professionals’ work-related stress was measured by a single item in the present study. Some researchers argue that a one-item question is easier and takes less time (Nagy, 2002), but one-item measurement often represents a validity problem. COPE items were selected from the literature, not from the factor analysis from the current sample. We acknowledge that other items might be more representative of the coping strategies for participants in the current study. Low levels of Cronbach’s coefficients for positive

HUMAN SERVICE ORGANIZATIONS: MANAGEMENT, LEADERSHIP & GOVERNANCE 399

and negative coping strategies for work stress is another limitation of the current study. The fact that some strategies might be positive or negative depending on the context and the personality is to be argued in future research.

Lastly, “alcohol-drug use disengagement” items can cause misunderstanding; alcohol and other drugs can be used together but also can be used separately. It would be beneficial to separate these substance-use coping behaviors for clarity. An additional item asking the amount of alcohol or drugs used would be helpful for future studies.

Implications

The present study has some practical implications for organizational and managerial application. First of all, regarding high levels of employees’ work stress, child welfare organizations could identify ways to reduce employees’ work stress. Employee-reported high caseloads and limited time are a well-known problem, but difficult to resolve. This problem could be lessened by employing more workers, requiring less paperwork, forming an environment where employees can focus on work and be less distracted. Moreover, as found in the qualitative analysis, it is suggested that supervisors focus more attention on employees’ needs for self-care. Strengthening the agency’s employee assistance program (EAP) would be helpful.

Second, the effects of employees’ coping strategies could be intervened by policies such as mandating training or education specific to countertransference, self-care, and positive coping. Effective coping strategies not only can help workers to cope with work stress and to have higher levels of job satisfaction in the field of social service (e.g., Anderson, 2000) but also can help agencies to decrease their turnover rate of their workers (e.g., Lee, Forster, & Rehner, 2011).

Ultimately, this result is even more important in light of prior research showing that the service quality clients are provided can also be influenced by child welfare professionals’ coping strategies.

Lastly, understanding child welfare service employees’ ACE would be beneficial both for indivi- dual workers and supervisors. The current study results suggest that employees with higher ACE scores are more susceptible to work stress. We suggest from the findings of the current study and previous studies that child welfare professionals who had more ACE experienced more work-related stress and that their tendency of overinvolvement in work and high susceptibility to vicarious effects might be the reasons. Employees’ ACE scores should be assessed so that both child welfare professionals and the organizations that employ them can identify and implement ways to prevent and recover from work-related stress. For example, individuals with an awareness of their ACE score and its risks can identify positive supports in their lives, improve their personal resiliency, and begin to discover how to set boundaries to minimize the opportunities for overinvolvement. Supervisors can provide support and possible short-term interventions such as limiting the worker’s exposure to difficult cases for a time, providing opportunities for professional development, and encouraging use of paid time off. Reminding supervisors of the sensitive nature of the information regarding a worker’s ACE score as strictly confidential is obvious. However, it must be iterated to workers as well as their supervisors in order to deter discrimination or stigmatization.

Conclusion

In conclusion, we found several general trends in this study. First, child welfare professionals perceived their work-related stress as high. Second, they also tend to use negative coping strategies to deal with their stress. Most importantly, the present study also found significant relationships among child welfare professionals’ ACE and their work-related stress levels, which implies that understanding child welfare professionals’ ACE would be helpful for their well-being. Considering that their high stress may result in diminished quality of services for clients and their families that receive services, these findings underscore the importance for child welfare professionals to be supported in dealing with their work-related stress.

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Furthermore, these findings begin to address the need to provide child welfare professionals with supportive and individualized self-care training and opportunities to practice these strategies in their professional and personal lives

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