Affiliations: University of Maryland School of Nursing, Baltimore, MD, USA
Note: [] Address for correspondence: J.A. Lipscomb, University of
Maryland School of Nursing, 655C SNB, 655 West Lombard Street, Baltimore, MD,
21201, USA. Tel.: +1 410 706 7647; E-mail: Lipscomb@son.umaryland.edu
Abstract: Objective: To examine the association between violence prevention
safety climate measures and self reported violence toward staff in state-run
residential addiction treatment centers. Methods: In mid-2006, 409 staff
from an Eastern United States state agency that oversees a system of thirteen
residential addiction treatment centers (ATCs) completed a self-administered
survey as part of a comprehensive risk assessment. The survey was undertaken to
identify and measure facility-level risk factors for violence, including staff
perceptions of the quality of existing US Occupational Safety and Health
Administration (OSHA) program elements, and ultimately to guide violence
prevention programming. Key informant interviews and staff focus groups
provided researchers with qualitative data with which to understand safety
climate and violence prevention efforts within these work settings. Results: The frequency with which staff reported experiencing violent behavior
ranged from 37% for "clients raised their voices in a threatening way to
you" to 1% for "clients pushed, hit, kicked, or struck you". Findings
from the staff survey included the following significant predictors of
violence: "client actively resisting program" (OR=2.34, 95% CI=1.35, 4.05),
"working with clients for whom the history of violence is
unknown" (OR=1.91, 95% CI=1.18, 3.09) and "management commitment
to violence prevention" reported as "never/hardly ever" and "seldom or
sometimes" (OR=4.30 and OR=2.31 respectively), while controlling for
other covariates. Conclusions: We utilized a combination of qualitative
and quantitative research methods to begin to describe the risk and potential
for violence prevention in this setting. The prevalence of staff physical
violence within the agency's treatment facilities was lower than would be
predicted. Possible explanations include the voluntary nature of treatment
programs; strong policies and consequences for resident behavior and ongoing
quality improvement efforts. Quantitative data identified low management
commitment to violence prevention as a significant predictor of staff reported violence.
