STRESS REDUCTION INTERVENTION RELATED TO WORK ISSUES-Research Paper

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Workplace stress, burnout and coping: a qualitative study of the

experiences of Australian disability support workers

Megan J. Judd BPsych MPsych1, Kate P. Dorozenko BPsych(Hons) PhD2 and Lauren J. Breen BSc(Hons) GradCertEd

PhD 1

1 School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia and

2 School of

Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia

Accepted for publication 27 October 2016

Correspondence Dr Lauren J. Breen School of Psychology and Speech Pathology Curtin University Perth, WA 6102, Australia. E-mail: [email protected]

What is known about this topic

• Disability support workers (DSWs) are a group at risk of high levels of workplace stress and burnout.

• The National Disability Insurance Scheme will intensify the challenges of attracting and retaining this workforce.

• Characteristics of the clients, the organisation and the DSWs themselves contribute to workplace stress and burnout.

What this paper adds

• Stress and burnout among DSWs is complex and cannot be explained by examining factors in isolation.

• Positive experiences are crucial to lessening the impact of the challenges of disability support work, and ‘buffer’ against workplace stress and burnout.

• Organisational support is an important aspect of managing stress and preventing burnout, and interventions must adopt a macro perspective.

Abstract Disability support workers (DSWs) are the backbone of contemporary disability support services and the interface through which disability philosophies and policies are translated into practical action. DSWs often experience workplace stress and burnout, resulting in a high turnover rate of employees within the non-professional disability service workforce. The full implementation of the National Disability Insurance Scheme in Australia is set to intensify the current challenges of attracting and retaining DSWs, as the role becomes characterised by greater demands, ambiguity and conflict. The aim of this study was to explore DSWs’ perceptions of enjoyable and challenging aspects of disability support work, sources of stress and burnout and the strategies they use to cope when these issues arise. Twelve DSWs workers providing support for adults living with intellectual and physical disabilities were interviewed. Thematic analysis revealed a superordinate theme of ‘Balance’ comprising three sub-themes: ‘Balancing Negatives and Positives’, ‘Periods of Imbalance’, and ‘Strategies to Reclaim Balance’. Participants spoke of the rewarding and uplifting times in their job such as watching a client learn new skills and being shown appreciation. These moments were contrasted by emotionally and physically draining aspects of their work, including challenging client behaviour, earning a low income, and having limited power to make decisions. Participants described periods of imbalance, wherein the negatives of their job outweighed the positives, resulting in stress and sometimes burnout. Participants often had to actively seek support and tended to rely on their own strategies to manage stress. Findings suggest that organisational support together with workplace interventions that support DSWs to perceive the positive aspects of their work, such as acceptance and mindfulness-based approaches, may help to limit experiences of stress and burnout. The further development and evaluation of emotion-focused workplace therapies, and interventions that consider organisational (macro) factors is suggested.

Keywords: community care, disability studies, service provision, stress and coping, support workers, workforce issues

Introduction

Launched in 2013, the National Disability Insurance Scheme (NDIS) holds the promise of revolutionising

disability services in Australia. Underpinned by a human rights approach and guided by person- centred principles, the NDIS will enable people with permanent and significant disability to access

Health and Social Care in the Community (2017) 25(3), 1109–1117 doi: 10.1111/hsc.12409

individualised support to assist them to pursue their goals and aspirations (Commonwealth of Australia 2013). The success of the NDIS, however, depends largely on having a workforce that is sustainable and appropriately skilled to implement the scheme and fulfil the vision of the NDIS. Disability support work- ers (DSWs) are the backbone of contemporary disabil- ity support services and the interface through which disability philosophies and policies that champion social inclusion are translated into practical action (McConkey & Collins 2010, Harries et al. 2015). In Australia, it is estimated that 58,200 workers provide disability services directly, and non-professional employees, including DSWs, represent three quarters of all disability workers (Martin & Healy 2010). Typi- cal of the community services sector, DSWs tend to be women and of an older age profile (Martin & Healy 2010). DSWs fulfil a wide range of tasks to support people with disabilities in core areas of everyday living and facilitate social inclusion (McConkey & Collins 2010).

The NDIS will require a substantial expansion of the disability sector workforce. It is anticipated that the workforce will need to more-than-double in size between now and the full implementation of the scheme in 2019–2020 (Commonwealth Department of Social Services 2015). The role of DSWs is also expected to transform under the individualised and consumer-led funding model of the NDIS (Common- wealth Department of Social Services 2015; Harries et al. 2015). The skill set of DSWs will need to be expanded to include brokering, planning and advo- cacy, and DSWs will have less defined responsibilities (Commonwealth Department of Social Services 2015; Harries et al. 2015). Furthermore, more people with disabilities are likely to elect to receive support in their home, which will involve DSWs working in less controlled and more isolated environments (Harries et al. 2015).

There is a high turnover rate of employees within the non-professional disability service workforce and it is suggested that staff leave the disability sector because of stress and burnout, for financial reasons or because there are limited career pathways (Productiv- ity Commission 2011; Kozak et al. 2013, Harries et al. 2015). Additionally, it has been noted that women employees dominate the sector; feminised workforces tend to be undervalued and underpaid (Cortis & Meager 2012) and the low wages common in this sec- tor contribute to low morale among the workforce and problems attracting and retaining employees. Hewitt and Larson (2007) also suggested that DSWs may become financially dependent on working over- time, and a vicious cycle of exhaustion and poor

performance can result. Given the current challenges of attracting and retaining DSWs are set to intensify as the NDIS rolls out, it is imperative to understand and mitigate their experiences of stress and burnout so that they can continue to offer quality services for people living with disability.

Demands of disability support work

DSWs are an occupational group at risk of high levels of burnout (Harries et al. 2015). Burnout is a psycho- logical response to workplace stress and is a common occurrence among people who work within health and community services. The most-cited theoretical conceptualisation of burnout is that advanced by Maslach (1982), who described burnout as a combina- tion of emotional exhaustion (feeling drained and worn out without the resources to ‘reload’), deperson- alisation (having a detached and negatively tinged response to clients) and a reduced sense of personal accomplishment (feelings of inadequacy and thoughts of no longer achieving anything meaningful in the workplace). Within human services (including disabil- ity support work), the interpersonal demands of the helping role are seen as the major source of stress, and when these demands exceed available resources, burn- out may result (Maslach 1999, Devereux et al. 2009).

There is an abundance of research on the factors associated with DSWs’ experiences of stress and burnout, and these may include client characteristics, characteristics of the organisation and characteristics of the DSWs themselves (Hastings & Horne 2004). Challenging client behaviours, such as aggression, self-harm and sexual behaviours, are typically associ- ated with the workers’ experience of stress (Robert- son et al. 2005, Dilworth et al. 2011, Hensel et al. 2012). Characteristics of organisations that contribute significantly to staff stress and burnout include higher job demands, role conflict and role ambiguity, and lower job control, support, performance feedback and role clarity (Vassos & Nankervis 2012, Vassos et al. 2013, Harries et al. 2015). These findings are par- ticularly relevant given the NDIS is likely to create working conditions for DSWs which are characterised by greater role ambiguity and conflict. Staff variables associated with workplace stress include maladaptive coping strategies, particularly wishful thinking and avoidance (Devereux et al. 2009, Noone & Hastings 2010) and staff cognitive styles, with Rose et al. (2013) noting that it is the interpretation of challenging cli- ent behaviour by staff, rather than the behaviour alone that contributes to stress and burnout.

A significant limitation of the literature exploring the experiences of DSWs is the tendency to focus on

M. J. Judd et al.

negative stressors and outcomes, rather than those pos- itive aspects of staff roles and relationships that sup- port well-being (Hastings & Horne 2004, Devereux et al. 2009, Hastings 2010). In a rare example, Hastings and Horne (2004) surveyed 101 support staff from ser- vices for adults with intellectual disabilities and reported that staff perceived a range of positive aspects of their work and its impact, including being more sen- sitive and accepting of difference, and affection given and received. Perceptions of a positive contribution were associated with an increased sense of personal accomplishment, which may protect against stress and burnout (Maslach 1982, Hastings & Horne 2004). Another more recent study by Hickey (2014) reported that prosocial motivation, the desire to engage in work that is beneficial to others, moderated DSWs experi- ences of burnout (Hickey 2014). A small number of interventions designed to promote coping among this workforce have shown promising results (e.g. Innstrand et al. 2004, Noone & Hastings 2009, 2010).

DSWs provide an essential service for people liv- ing with a disability. Their work is undervalued (Cor- tis & Meager 2012), but increasingly important given the introduction of the NDIS. Without knowledge of how DSWs’ experience their work, including those aspects that support them in their work, it will be dif- ficult to assist them to manage stress and prevent burnout. The aim of this study was to explore DSWs perceptions of enjoyable and challenging aspects of disability support work, sources of stress and burn- out, and the strategies they use to cope when these issues arise.

Methods

Research design

This research was qualitative and based on semi- structured interviews with DSWs. A qualitative approach was well suited to this research as it enables the lived experience of the social world to be captured, and provides an in-depth, contextualised account of personal experiences (Liamputtong 2009). This approach also allows for a more nuanced under- standing of the complex interplay of factors in dis- ability support work, including those positive aspects of DSWs roles that may serve a protection function and mitigate workplace stress and burnout.

Interview materials and procedure

The study was approved by the Curtin University Human Research Ethics Committee. Participants were recruited using a combination of sampling strategies

(Drauker et al. 2007). We emailed local disability ser- vices employing DSWs to ask them to distribute an attached flyer to their DSWs. One service agreed to display the flyer in their staffroom and this strategy yielded three participants. The remaining participants were recruited by snowball sampling from these par- ticipants and the first author’s own contacts in the field. All of the participants worked for disability ser- vices that provided supported employment for people living with intellectual and physical disabilities.

Interviews occurred in quiet, mutually suitable locations. All participants received a participant infor- mation sheet and signed the consent form. A semi- structured interview guide was developed and included a range of questions designed to explore the enjoyable and challenging aspects of disability sup- port work as well as the sources of work stress and burnout. Additional questions were incorporated to investigate the participants’ perceptions of aspects inside and outside of their work environment that they found supportive when feeling stressed or burn- out. The guide contained a range of specific probes that were designed to guide the interviewer when pressing the participant for more information about a particular topic. Each interview was audio recorded, transcribed verbatim and labelled using a numerical code (ranging from DSW1 to DSW12) to protect the identity of the participants.

Analysis

Data collection and analysis occurred concurrently to allow for further exploration of emerging ideas in the subsequent interviews. Thematic analysis was chosen to analyse the transcripts (Braun & Clarke 2006) and they were manually coded by the first author and checked by the last author. This process entailed familiarisation with the data, generating codes, searching for themes, reviewing themes, and defining and naming themes. The interviews continued until all authors agreed that data saturation at the theme level had occurred. At the time of the study, the first author was employed as a DSW on a part-time basis, the second author had recently completed a PhD on disability and identity, and the last author has never been employed in the disability sector. This dynamic of an insider and outsider perspectives to the research facilitated a rigorous approach to data interpretation (Mauthner & Doucet 2003).

Findings

Twelve participants (six men and six women) were recruited for the study. On average, the participants

Experiences of Australian disability support workers

had 5 years of experience as a DSW, ranging from 10 months to 11 years. The mean age of the partici- pants was 30 years, and ranged from 22 to 48 years (Table 1).

An analysis of the interviews with DSWs uncovered a superordinate theme, ‘Balance’, that was reflected in all participant interviews. This theme captured their efforts to focus on equilibrium in both the workplace and between work and life and was therefore central to their employment experience. ‘Balance’ comprised three sub-themes and these are presented below.

Balancing negatives and positives

The participants spoke of the rewarding, uplifting and joyous times in their job. These were times when the DSW received commendations from their col- leagues and management and appreciation from their clients. Other rewarding times included the variety of activities, feeling empowered, learning life lessons and making a difference. One participant thought that the most rewarding aspect of her job was when the client showed an appreciation for the work she had done for them:

One of the most rewarding things for me personally is when you’re with a client and then they know you and they know your name and it’s like at the end of the day they say, ‘Oh thanks for a lovely day’. That’s one of the most rewarding things that I get from the job. (DSW9, PT, 2 yrs 6 mths exp.)

Other positive experiences were when the DSW could watch their clients learn new skills and achieve their goals. One participant remarked that seeing the client in a state of happiness was a positive experi- ence. He also explained that for him:

Making them happy and getting them to do things they wouldn’t usually do on a day-to-day focus . . . [to] put a smile on their face puts a smile on mine . . . that’s generally how it goes . . . The money is poor but money is not every- thing in the world; I’d rather be happy than have lots of money. (DSW3, FT, 8 yrs exp.)

Despite these positives, each participant described stressful, challenging and emotionally and physically draining aspects of their work. Negative aspects of their work included communication barriers with the clients, lack of power to make decisions, earning a low income, conflicting priorities between DSWs and management and client behaviour (e.g. violence, con- tinuous crying and screaming). In particular, some participants described the hardest times being those when a client passes away. A participant explained that watching a client’s health decline and coping with their death was the most difficult aspect of her work:

When you get close to certain clients and, um, they might deteriorate quite badly and you see that happen before your eyes and sometimes you might lose them, and obviously that’s been the hardest for me to accept that and deal with that, you know sort of inevitable but it’s still difficult. (DSW2, FT, 5 yrs exp.)

A number of participants reported that an aspect of disability support work involves a high degree of duty of care for the client. One explained that some- times this involves ‘having eyes in the back of your head’. Ensuring that the client is safe requires a sig- nificant input of physical and mental energy. Another participant described a situation where a client was injured.

I have been in situations where people have been run over and those kinds of things. So if you are not concentrating or you make the wrong decisions someone can actually die, someone could get injured, a big fight could go down, something can happen; you have to be very really, really vigilant all the time. . .. (DSW6, PT, 10 yrs exp.)

The participants also spoke of times where their safety was compromised because of their client’s behaviour:

There’s also like dealing with violent behaviours. With your job, things can just turn really quickly. It can go from this really happy environment to someone, you know, is on the floor trying to strangle you. (DSW7, PT, 6 yrs exp.)

A common concern of the participants was the amount of knowledge required to navigate the day- to-day challenges of the job. Some participants explained that having a lack of experience and knowledge about the client they are supporting can lead to stress. A participant commented that over the

Table 1 Demographic characteristics of the sample

Participant

code

Age

(years) Sex

Length of time

working as a DSW

Employment

status

DSW1 51 F 8 years Full time

DSW2 52 F 5 years Full time

DSW3 28 M 8 years Full time

DSW4 29 M 7 years Full time

DSW5 21 M >1 year Part time DSW6 33 M 10 years Part time

DSW7 24 F 6 years Part time

DSW8 19 M >1 year Part time DSW9 27 F 2 years 6 months Part time

DSW10 26 M 2 years 3 months Part time

DSW11 22 F 4 years 6 months Part time

DSW12 28 F 4 years 9 months Full time

M. J. Judd et al.

years he has continued to gain knowledge about his job and the clients he works with. He believed that because of his wealth of knowledge he experiences less stress:

I know the job back-to-front now so I really don’t have stress levels like that anymore. (DSW4, FT, 7 yrs exp.)

However, other participants spoke of being bur- dened by ample knowledge and experience. This was because they were often called to provide advice and assistance to other staff and relied upon to work with challenging clients:

And sometimes what can be stressful is that you’re actually working with a client and staff who know that you have handled situations are coming to you all the time, when really they should be going to team leaders or management staff. They fall back on the staff [who] are already busy. . .. (DSW12, FT, 4 yrs 9 mths exp.)

A number of the participants agreed that finding a balance between the positive and negative times and a balance between work hours and personal hours helped to make life less stressful:

I did have a break where I did have a couple of clients dur- ing the week where I had the break. A heavy day, a light day, and it could break it up so it gave it an up-and-down, up-and-down [pattern], you know, and it gave you the weekend to get over it. (DSW1, FT, 8 yrs exp.)

Periods of imbalance

Despite attempts to find the balance, the participants explained that periods of imbalance, wherein the neg- atives outweighed the positives, were common occur- rences. During times of stress, the participants described physical reactions of feeling hot, sweaty and tense. Some of the participants explained that stress at work results from a build-up of negative events that eventually tip the day out of balance. A participant believed that stress developed when unex- pected events compounded throughout the day. She explained that these events have an impact on time management:

We would have a certain amount of time with a client or picking a client up and you’ve only got an hour and traffic or they’ve had a seizure or whatever and now you’re run- ning late and it’s, it’s stressful trying to get them back because you know even if you give them to someone else then their day is behind. And you know and it’s a chain reaction it continues. (DSW11, PT, 4 yrs 6 mths exp.)

The participants also spoke of having racing thoughts and a lapse in concentration when they feel stressed at work. Others spoke of losing their

patience with clients and feeling withdrawn. A partici- pant explained that at one point in her career she was so overwhelmed with stress that she made a medication error:

I actually was so stressed I had a medication error myself. I actually forgot to give, give medication . . . because I was just so stressed and had so much stuff to do. (DSW9, PT, 2 yrs 6 mths exp.)

A number of participants reported having experi- enced burnout and went on to explain that having an imbalance between work and life (e.g. working 6 days a week) and an overload of demanding and challenging tasks (e.g. working numerous days with clients who displayed challenging behaviours) resulted in their burnout. Participants who did not report experiencing burnout supported this idea when they considered colleagues who they felt had experienced burnout. When reflecting upon the expe- riences of her colleagues, a participant considered that it is the DSWs, who have children and work full time that are prone to experiencing what she per- ceived to be burnout:

The people who work full-time in there I think are suscepti- ble to burnout . . . and it’s to do with behaviour quite strongly of copping a lot of negatives and criticism and that sort of thing and never getting the positives and the thanks and or gratitude. (DSW2, FT, 5 yrs exp.)

Participants who reported that they had experi- enced burnout described feeling tired, thinking nega- tively, not wanting to go to work, losing passion for their role and lacking patience for their client. One participant, who had been employed as a DSW for the past 8 years, said that she had experienced burn- out three times. She said that for her, burnout occurred when she was overloaded with work:

I didn’t want to talk to anyone, and I didn’t want to talk about work, so that was definitely a sign for me, it’s not my normal personality. I am very proud to talk about my work normally, but I didn’t want to talk about work . . . and I have had probably three occasions where that had been like that over the 8 years. (DSW1, FT, 8 yrs exp.)

The least experienced participant, who did not report that she had experienced burnout, reflected on what it was like for her colleagues. She explained that colleagues affected by burnout lose passion for their job, which in turn affects the way the client is sup- ported:

If you’ve lost your passion in this, you don’t you can’t look at the clients in the same way anymore. And they become more of a hassle and more of a job, whereas if you come in

Experiences of Australian disability support workers

and you’re passionate about what you do and you love the clients like they are your friends or your family even then it’s not really a job. (DSW8, PT, >1 yr exp.)

Strategies to reclaim balance

The participants predominantly described what they do as individuals to manage their experiences of stress and burnout, rather than what their organisa- tion did or could do to support them. This focus on their personal strategies of stress management appeared to be due to an absence of formalised work- place stress management strategies. Overwhelmingly, however, the participants agreed that the support of their colleagues helped to reduce their experiences of stress. The participants explained that talking with a colleague or a member of management gave them the opportunity to debrief and ask for advice or help when coping with a challenging situation. A partici- pant explained that having the time to debrief with a colleague about a stressful situation was helpful:

I find generally the people in this field are very empathetic and gentle people so generally you get the support of your fellow support workers they will generally show a lot of support of any incident happening. (DSW2, FT, 5 yrs exp.)

A number of the participants explained that their position does not allow for a lunch break. However, in times of stress, the participants spoke of leaving their client with a colleague so that they could take a short break. It was common for the participants to use short breaks to find a quiet place, take a few breaths, and try and put the situation into perspective:

If I’m feeling stressed in work at that moment, sometimes I take a 10 minutes break or just get out of the situation go out and gather my thoughts. (DSW10, PT, 2 yrs 3 mths exp.)

The participants were divided as to whether it was beneficial to raise problems with management. Some participants said that after raising an issue with management it was never adequately resolved. Others felt uncomfortable to ask for help, while some expressed concerns about a lack of privacy when they raised an issue. One spoke of initially feeling ashamed to ask management for help, but found that it was a positive experience:

I didn’t know how to do a particular thing and I was get- ting a little bit worried. They gave me a step-by-step proce- dure in how to overcome the particular problem, and yeah, it was good. (DSW5, PT, >1 yr exp.)

The majority of the participants said that having other interests outside of their work, helped to reduce

stress and balance work and life. The participants spoke of exercising, studying, finding hobbies and being in nature. One participant, who spends much of his time outside of work training for marathons, prioritised finding a balance in his life:

I find that, that’s what I want to find in life, so I only work three-and-a-half days a week in this field because I see peo- ple burn out. I started off doing more shifts [but] I couldn’t keep that up – I tried – and so with work, going out and socialising, with my exercise, relaxing at home, I try and find an even balance, so I stay human. (DSW10, PT, 2 yrs 3 mths exp.)

Discussion

The aim of this study was to explore DSWs’ percep- tions of enjoyable and challenging aspects of their work, sources of stress and burnout, and the supports they use to cope when issues arise. This research is important as disability services transform to fulfil the vision of the NDIS and meet the challenges of attract- ing and retaining DSWs and providing quality, per- son-centred services. The participants described a number of negative aspects of their work, including a lack of decision-making power, earning a low income, lack of management insight into the high expectations for care and constant pressures due to staff shortages, challenging client behaviour, and the death of clients, reinforcing previous literature (Robertson et al. 2005, Rose et al. 2010, 2013, Dilworth et al. 2011, Gray-Stanley & Muramatsu 2011, Mutkins et al. 2011, Hensel et al. 2012, Gray & Muramatsu 2013, Kozak et al. 2013, Vassos et al. 2013). In spite of the negative work experiences, the participants spoke of many positive rewards, ranging from simply put- ting a smile on the client’s face to assisting them in achieving their goals. The data suggest that these positive factors have the potential to negate the nega- tive aspects of disability support work. That is, the easy and enjoyable times were crucial to lightening the impact of challenging times and were a ‘buffer’ against the impact of negative factors.

All of the participants spoke of experiencing stress and a few described experiencing what they consid- ered to be burnout (Maslach 1982). Stress and burn- out were described by participants as occurring when the negative aspects of disability support work were perceived to outweigh the positives. This is an impor- tant finding because it suggests that stress and burn- out among DSWs is a complex problem that cannot be explained by factors in isolation and is under- pinned by each worker’s subjective perception and interpretation of the positive and negative factors.

M. J. Judd et al.

This finding echoes the research that it is the worker’s interpretation of challenging client behaviour, rather than the behaviour alone, that contributes to stress and burnout (Rose et al. 2013).

The participants described experiencing difficulty performing to their full potential when stressed. Sometimes the effects were minor, such as feeling withdrawn or lacking the motivation to socialise with clients. However, there was the possibility for major incidents to occur when stressed, such as making an error with a client’s medication. The participants in this study often had to seek support actively (rather than their organisation providing support to them) and tended to rely on their own strategies to manage stress and burnout. The participants agreed that sup- port from their colleagues and management helped them to cope when they were feeling stressed or burnt out. This finding corresponds with current liter- ature, which recognises that support from colleagues and social networks is valuable in managing stress and preventing burnout (Gray-Stanley & Muramatsu 2011, Mutkins et al. 2011, Rose et al. 2013). The partic- ipants reported that obtaining a short break, acquir- ing help when working with particular clients or a difficult task, and time to debrief and vent concerns relieved a stressful situation. Outside of work, the participants engaged in activities such as exercise, study and hobbies to try to achieve some work–life balance and reduce stress.

Implications and future directions

The study highlights the complexity of disability sup- port work and the provisions required to manage stress and prevent burnout. It is evident that there are negative aspects to employment as a DSW; however in spite of these, the participants in this study explained that there are many positive rewards that keep them returning to work each day. We echo calls made by Hastings (2010) who argued that those posi- tive experiences and aspects of disability support work, including and the possibility of satisfying, recip- rocal relationships between support staff and their cli- ents, warrant further exploration in the literature.

It is evident that DSWs require support in order to perform the job well. This study suggests that helping DSWs to perceive positive experiences as outweigh- ing the negative will help to limit their experience of workplace stress and burnout. Workplace stress inter- ventions and therapies that are emotion-focused, rather than problem-focused in nature may be benefi- cial (Bond & Bunce 2000, Noone & Hastings 2009, 2009b). Noone and Hastings (2009b) described a short acceptance and mindfulness-based workshop

intervention for intellectual DSWs which aimed to enhance workers’ psychological resilience by promot- ing the emotional willingness or acceptance of unpleasant or emotions. The results of this interven- tion were encouraging, particularly for non-profes- sional staff and those who reported the greatest stress at pre-intervention, with Noone and Hastings (2009b) reporting a reduction in workers’ distress, despite no change in perceived work stress. The authors sug- gested that acceptance and mindfulness-based approaches may be especially beneficial to workers who encounter difficult situations in their daily work that do not lend themselves to easy solutions, such as supporting clients who display challenging or violent behaviours. The development and evaluation of workplace intervention approaches that seek to enhance positive aspects of disability support work are suggested areas of future research (Hastings & Horne 2004, Devereux et al. 2009).

The DSWs in this study reported having to actively seek support or use their own stress manage- ment strategies, rather than these being offered by their organisations. There is considerable evidence to suggest that organisational support is an important aspect of managing stress and preventing burnout among DSWs (Gray-Stanley & Muramatsu 2011, Mut- kins et al. 2011, Gray & Muramatsu 2013, Rose et al. 2013). Supervisors are expected to provide mentoring to DSWs and opportunities for training and profes- sional development (Hewitt et al. 2004). When super- visors are not present or adequately trained, organisations have difficulties recruiting, supporting and retaining DSWs (Hewitt et al. 2004). To success- fully address workforce challenges and meet the demands of the NDIS, it is crucial that organisations respond to the training and support needs of supervi- sors too (Hewitt et al. 2004). Furthermore, few sup- port interventions designed to reduce workplace stress adopt a macro perspective and consider aspects such as job design, managerial support, and other organisational features (Devereux et al. 2009). This is a potential avenue for future research.

Study strengths and limitations

The study’s qualitative design facilitated an in-depth analysis of DSWs’ experiences of workplace stress and burnout and the coping strategies used to miti- gate these. The exploration of both the enjoyable and challenging aspects of disability support work is also a strength of the study, with some researchers critical that the latter garners the most attention in the recent literature (Hastings & Horne 2004, Hickey 2014). Just over half of the participants in this study were

Experiences of Australian disability support workers

employed as a DSW on a part-time basis. While the data did show an association between stress and years of experience as a DSW, the small sample did not yield obvious differences in stress experiences between DSWs who worked full versus part time, and this could be explored in future studies. All of the participants were employed at agencies providing supported employment services for adults with intel- lectual and developmental disabilities. While the experiences of DSWs employed in these settings is topical, given the increased demand for supported employment and diverse employment options that is expected to accompany the roll out of the NDIS (National Disability Services 2013). DSWs are employed across a range of settings and there are dif- ferences between these settings in terms of client needs, duties, hours of work and rate of pay. In that respect, the results of this study may not be transfer- able to those populations. Finally, participants in this study self-reported experiences of burnout, and it is possible that understandings of what constitutes burnout may differ between participants.

Conclusion

DSWs play an integral role in supporting people liv- ing with a disability. The implementation of the NDIS will require a significant expansion of the disability services workforce and the reshaping of existing DSW roles. However, given that there is a high exit rate from this sector, it may be difficult to attract and retain workers necessary to support the scheme’s operation. DSWs are a fundamental part of the move- ment to extent the rights of people living with a dis- ability and it is more important than ever to understand what can be done to support them.

Source of funding

This project received no institutional, private or corporate financial support.

Conflict of interest

The authors report no declarations of interest.

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