URJHS Volume 7

Work-related Stress in Division of Youth and Family Caseworkers:
Determining Whether a Cognitive Behavioral Intervention Will Decrease Stress

Beth Purdy
Monmouth University

Abstract

The purpose of this research was to decrease the level of work-related stress in New Jersey Division of Youth and Family caseworkers using a cognitive behavioral journaling intervention. The participants were four females working with the division for five years at the Red Bank (New Jersey) office with a bachelor’s degree in social work. The pretest measuring the participant’s stress was given on a Monday of a five-day workweek followed by the cognitive behavioral intervention. The intervention ended Friday of that same week and was followed by a posttest. The results showed no significant change in the participant’s level of work-related stress. However, implications for practice, policy, and research regarding work-related stress are discussed.

Introduction

For most people, a good work ethic is important to not only them but also their employers. This includes being at your job during the scheduled hours, completing work tasks and established goals, and working with other people, such as other coworkers, clients, patients, or customers. However, in some workplaces these requirements are not easily met. Most jobs have very demanding requirements of their employees; completing numerous tasks on a strict time schedule often requires employees to stay at their jobs after hours or skip lunch (American Institute of Stress, 2007). In addition, employees often have to work with unpleasant people, whether other coworkers or clients. As a result, employees may suffer physically, emotionally, or mentally through experiencing work-related stress (Anderson, 2007). Sometimes employees feel stressed because they are trying as hard as they can to be successful at their jobs. Due to demanding pressures they cannot complete work tasks, so they continue to feel insufficient in their job and ultimately lack motivation. This stress and lack of motivation will significantly affect their work performance and only set them back more. With a successful intervention, work-related stress may be reduced, and employees may find the motivation they need to continue working efficiently (Anderson, 2007).

Pre-existing empirical research

In 2000, the annual “Attitudes In The American Workplace VI” Gallup Poll, sponsored by the Marlin Company, discovered that 80 percent of workers felt stress on the job; half said they needed help learning how to manage stress; and 25 percent have felt like screaming or shouting because of job stress. The same year, the 2000 Integra Survey (International Association for Human Values, 2004) found that 65 percent of workers said that workplace stress had caused difficulties, more than 10 percent described these as having major effects, 10 percent said they work in an atmosphere where physical violence has occurred because of job stress, 62 percent had yelled at coworkers because of workplace stress, 19 percent had quit a previous position because of job stress, and one in four have cried because of workplace stress. At the end of the day, 44 percent reported having “stressed-out” eyes, and 34 percent stated they had difficultly sleeping because they were too stressed. In addition, 12 percent had called out sick because of job stress, and over half frequently skip lunch because of the stress of job demands (American Institute of Stress, 2007). The Bureau of Labor Statistics found that because of stress, anxiety, or a related disorder, workers take time off work for the sum of about 20 days in one working year (Rossi, Perrewe, & Sauter, 2006).

Importance of the Problem

It is important that more studies be conducted on work-related stress. Work-related stress is affecting workers emotionally, mentally, and more importantly, physically (Kivimaki, Leino-Arjas, Luukkonen, Riihimaki, Vahtera, & Kirjonen, 2002). It also affects the coworkers of the stressed individual; work-related stress has been shown to have a positive correlation with workplace violence (Hogh & Mikkelsen, 2005). Worker’s stress not only affects the individual worker but the nation as a whole. Industrial countries, such as the United States and Sweden are showing rising levels of stress in their workers, which ultimately has an effect on the country’s economy (Karasek & Theorell, 1996).

Rational for the Intervention

As caseworkers for the New Jersey State Division of Youth and Family Service (DYFS), people are working, on a daily basis, with clients whom have several needs ranging from economic, educational, medical, and emotional. A DYFS caseworker has an average caseload of 10 to 15 clients and works a five-day workweek. Their jobs require them to make monthly visits to the clients’ homes, maintain clear and logical case notes, attend court hearings, give random drug screenings, respond to crises, remove children from unsafe homes, and find emergency placements for abused and neglected children. They are often required to stay after hours, sometimes until as late at 3:00 a.m., until they are sure their clients are safe and their needs are being met. With such a demanding job, it is no wonder more and more DYFS caseworkers express feelings of being stressed, burned out, and overworked (several DYFS workers, personal communication, 2007).

As the workload and demand from clients increase, it is understandable that the level of stress in a caseworker increases as well. Work-related stress not only affects DYFS workers but also has been noticed in a number of employees in Western countries over the past decades (van der Klink, Blonk, Scheme, van Dijk, 2001). It ends up costing the economy in workers absenteeism, loss of productivity, and health care expense. The clients also lose out; the more stressed workers are feeling, the less likely they are to perform their jobs at full potential (van der Klink, et al., 2001).

To help alleviate work-related stress in DYFS workers, an intervention could be introduced in which workers can manage their stress and continue to carry on their clients’ cases in a professional manner. In a study conducted by van der Klink et al. (2001), a cognitive behavioral stress relief intervention was most effective and well liked among employees. The outcome variables showed an increase in quality of work life, enhanced psychological resources and responses, and reduced complaints. It was suggested that this is the most effective and useful form of intervention and treatment when working with employees seeking stress relief (van der Klink et al., 2001).

Importance and implications of this study for social work practice

Regarding social work practice, it is important this study be conducted because a majority of caseworkers in DFYS show increased work-related stress. It is also important to the agency because it is currently going through a reform initiative ( Department of Children and Families, 2007). In 2006 Children’s Rights, Inc. sued the State of New Jersey because it felt that the state was not doing its part to ensure the protection and well-being of children. In July 2006 an agreement was reached that included a modified settlement of the class-action litigation that focused on improving the longstanding problems in the State’s child welfare system, such as workers having too big of a caseload. If caseworkers are feeling stressed, the likelihood that they are able to meet the requirements of ensuring children’s safety and needs is low, which puts their clients in danger ( Department of Children and Families, 2007).

Hypothesis statement

With the implementation of a Cognitive Behavioral Intervention, DYFS caseworker work-related stress will decrease.

A Cognitive Behavioral Intervention will help DYFS caseworkers to decrease their level of work-related stress by making the workers aware of their feelings and thoughts that lead to stressful actions and reactions. Making the workers notice the thoughts and feelings that lead them to feel stressed will enable them to have a better control of these feelings. They also will be able to better identify what triggers their stress, so they can learn to avoid these things. If they can figure out what makes them stressed in the workplace, they can address the issue before it causes them to feel stressed.

Literature Review

Target Problem

It is important that more studies be conducted on work-related stress. Worker’s stress not only affects the individual worker but the nation as a whole (Karasek, 1990). Industrial countries, such as the United States and Sweden, are showing rising levels of stress in their workers, which is causing more workers to call out sick, obtain compensation due to stress, or leave the job all together. The nations end up suffering as more workers are claiming compensation related to stress. Even when workers decide to leave a job due to stress, the U.S. economy loses, currently adding up to $150 billion loss per year ( Karasek & Theorell, 1996).

Work-related stress does not only affect an individual mentally and emotionally but physically as well. In a study by Kivimaki et al. in 2002, the correlation between work-related stress and cardiovascular disease was tested. In a group of 812 employees, who were medically examined and found to have no signs of cardiovascular disease at baseline prior to the study, 73 had died over a 25-year period due to cardiovascular causes (Kivimaki et al., 2002). In other studies, nursery school cooks were found to have a correlation with job stress and epicondylitis; blue-collar working men reported an increase of physician visits with an increase of work-related stress; and taxi drivers were found to have a decrease in interleukin production (Kawakami & Haratani, 1999).

In addition to affecting the nation and the individual’s physical health, job stress has been shown to have an effect on an individual’s level of violence in the work place. The more stressed a person becomes, the more violent they may become; they may use acts of violence at the workplace as a way to relieve stress. A study by Hogh and Mikkelsen (2005) looked at 1,857 Danish adult employees over one year. The findings showed that there was a significant correlation between work-related stress and violence in the workplace. Victims of violence in the workplace suffer as well, not only physically but also mentally, “Exposure to violence at work is a potent psychosocial stressor, which may have severe negative effects on the mental health and well-being of employees” (Hogh & Mikkelsen, 2005).

Population

This study focused on caseworkers in DYFS, which is New Jersey’s child protection and child welfare agency within the Department of Children and Families. Workers are required to ensure the safety, permanency, and well-being of children and support families by investigating allegations of child abuse and neglect and, if necessary, arranging for the child’s protection and the family’s treatment. They work with community agencies to provided services to children and families regarding counseling, parenting skill classes, substance abuse treatment, in-home services, and foster care and residential placement (Department of Children and Families, 2007).

Employees at DYFS first start out as Family Service Specialist Trainees. Their job requires them to perform field and office work; collect, analyze and record significant facts; respond to child abuse and neglect referrals; respond to the requests for child welfare services; conduct in-home visits; and arrange residential or foster care placements. During the first twelve months of employment, trainees are required to attend a comprehensive inservice training program in addition to performing their field and office casework duties (Department of Children and Families, 2007). They must have a bachelor’s degree from an accredited college, preferably one in Social Work; a valid New Jersey driver’s license; and the ability to read, write, and speak English. Employees are selected by submitting a resume and cover letter to the Department of Children and Families. The annual salary upon hiring is $43,446.12, which is raised to $45,445.00 after a six-month working test period (Department of Children and Families, 2007).

A study conducted by Juby and Scannapieco in 2007 found that child welfare caseworkers struggle to maintain their workloads with extremely high caseloads and continuously increasing paperwork. They are directly impacted by supervisor support and resource availability. The more support workers have from their supervisor, the more resources they have available to them. In addition, the worker’s ability to maintain workload management is hugely related to availability of resources (Juby & Scannapieco, 2007).

Theoretical Intervention

According to Poorman (2003), cognitive-behavioral theory takes into consideration thinking processes that include individual decisions. It has been shown that humans think about, remember, consider, imagine, and plan behaviors. The process happens before and during a particular behavior and has an affect on the behavior. The focus of cognitive-behavioral theory is to find, challenge, and alter the problematic thoughts that lead to problematic behaviors, ultimately changing the problem behavior (Poorman, 2003).

Larsen, Schwartz, Whiteside, Khandker, Moore, & Abramowitz (2006) conducted a study that used a cognitive behavioral intervention of thought control strategies in parents’ reporting of postpartum obsession. The parents of newborn babies, in the study, were given a cognitive behavioral intervention to stop them from having feelings of distress and anxiety over their child’s health. It was found that connecting obsession severity to more use of punishment and worries were consistent with cognitive-behavioral models of obsessive-compulsive disorder (OCD). The excessive use of thought control strategies preserve mistaken interpretations of normal intrusive thought, which ultimately leads to obsession distress.

An effective intervention to assist workers while at work is needed due to the awareness of work-related stress and its impacts on poor job performance, decreased productivity, and increased mental, emotional and physical tolls on employees. Because DYFS workers appear to have an increased likelihood of stress due to the nature of their job functions and duties, this intervention would be even more necessary for them. To address these issues, this paper will explore the use of a cognitive behavioral therapeutic intervention and its effects on DYFS caseworkers.

Methods

Client Description

The convenience sample was selected based on their familiarity with the researcher and their willingness to participate in the study. Additionally, they all have about the same number of cases, have worked for about the same number of years at the agency, and are all in early adulthood. The sample was four DYFS caseworkers in Red Bank, New Jersey. They were all females ranging from the ages of 25-35. They had been working with the division for at least five years and had a caseload or at least 10 clients or more.

Subjects who are in middle to late adulthood were not included in this study. It may be possible that they had more work-related stress because they were older and were assumed to have been in the work force longer, therefore their stress might be more related to the length of years they have been working, rather than the actual work they have been doing. Caseworkers who have worked in the agency for more than five years have also been excluded in this sample because it could be possible that their work-related stress could come from the number of years they have worked at the agency, rather than the workload they were currently carrying.

Research Design

This multiple baseline design examined the stress levels of four caseworkers at the New Jersey State Division of Youth and Family Services (DYFS), using a pretest, intervention, posttest design.

Participants in this study answered a ten-question Likert survey that measured their level of stress. After their stress was measured, a cognitive behavioral stress relief intervention was introduced and used throughout the following workweek. At the end of the workweek, the same survey was given to the participants. The results from this survey were compared to the previous one to determine if the intervention reduced the workers level of stress.

The length of time required from participants was approximately 10-15 minutes per day for 7 days—Day one: 10-15 minutes for stress level pretest; Day two – four: 10-15 minutes for cognitive behavioral stress relief exercises; Day five: 10-15 minutes for stress level posttest.

Study Setting

A majority of DYFS caseworkers suffered from work-related stress as a result of the many demands in their jobs. They work on a daily basis with clients that have several needs ranging from economic, educational, medical, and emotional. They have an average caseload of 10 to 15 clients and work a five-day workweek. Additionally, they are required to make monthly visits to the client’s homes, maintain clear and logical case notes, attend court hearings, give random drug screenings, respond to crises, remove children from unsafe homes, and find emergency placements for abused and neglected children. They are often required to stay after hours until they are sure their clients are safe and their needs are being met. The researcher made this observation over a seven-month time period.

The problem of work-related stress was selected for intervention because of the effects stress has on one’s life, as well as how work-related stress can affect the lives of the clients the workers serve. The outcome measures were work-related stress after a cognitive behavioral theory intervention. Cognitive behavioral intervention was chosen because previous studies determined that the cognitive behavioral approach was not only the most effective but also the most liked by the participants. Data were collected at the desks of the participants in the agency. The data collection instrument was a 10-question survey using a Likert scale, created by the researcher. The survey information was analyzed by the Statistical Package for Social Sciences (SPSS), which was password protected and only known by the researcher. The surveys were placed in a locked filing cabinet behind a locked door, to which only the researcher had access. Frequencies and descriptive statistics described the survey results. Additionally, the researcher conducted t-tests of the pretest and posttest information. Data entered into the software package were stripped of any identifying information and only aggregate information was included. Data will be stored for a minimum of three years, after which they will be shredded and destroyed. The researcher developed the questionnaire and intervention, and this was the first time they were used. Therefore, the reliability and validity were unknown.

Outcome Variables, Measures, Intervention

The variables used in this study were stress, work-related stress, and cognitive behavioral theory.

Stress was defined as a specific response by the body to a stimulus of fear or pain that disturbs or interferes with the normal physiological equilibrium of an organism, either physical, mental, or emotional strain or tension (Health and Safety Executive, 2008). Work-related stress was defined as excessive pressure at the work place (Health and Safety Executive, 2008). Cognitive behavioral theory was defined as finding negative thoughts, working with them, and changing the problematic thoughts that results in a change in behaviors (Poorman, 2005).

Results

Although all paired sample t-test result were not statistically significant (p > .05), pairs 1, 3 and 8 may provide substantive results.

Table 1. Pre- and Post-test Paired Sample t-test Results

	M	s.d.	t	df	p
Pair 1 In the last work week how often have you been upset because of something that happened unexpectedly at your job?	-.500	.577	-1.732	3	.182
Pair 2 In the last workweek how often have you felt nervous at your job?	.000	.816	.000	3	1.000
Pair 3 In the last workweek, how often have you felt stressed at your job?	.500	.577	1.732	3	.182
Pair 4 In the last work week, how often have you felt confident about your ability to handle your personal problems at work?	.250	.500	1.000	3	.391
Pair 5 In the last workweek how often have you found that you could not cope with all the things that you had to do at work?	-1.000	2.160	-.926	3	.423
Pair 6 In the last workweek, how often have you been about to control irritations at your job?	.000	.816	.000	3	1.000
Pair 7 In the last workweek, how often have you felt that you were on top of things at your job?	.000	.816	.000	3	1.000
Pair 8 In the last workweek how often have you been angered because of things that were outside your control?	-.500	1.000	-1.732	3	.182
Pair 9 In the last workweek, how often have you felt difficulties at work were piling up so high that you could not overcome them?	-5.00	1.000	-1.000	3	.391

Conclusion

This study showed that DYFS caseworkers do exhibit work-related stress within their jobs. However, the cognitive behavioral journaling intervention that was used did not show a significant decrease in the participant’s level of work-related stress. Participants were able to complete the pretest and posttest and make at least one journal entry. However, participants stated in their journals that they either did not feel stressed the week the intervention took place, or they felt so stressed that they thought there was no way their level of stress could ever change, ultimately making the journaling exercise irrelevant to them. There were substantive results in pair 1 in which participants disclosed that they became upset very often because of something that happened at their job unexpectedly, in pair 3 in which participants rated that they felt stressed very often at their job, and in pair 8 in which participants rated that very often they felt angered because of something that happened at their job.

Limitations

The small sample size made it difficult to draw any inferences regarding the results. The results must be taken at face value and cannot be generalized to the population. Additionally, the sample was selected by the researcher, which may have influenced the results, either statistically or substantively. Additionally, the intervention took place over the course of one workweek. It is unlikely that a person would change a behavior in that amount of time.

The strengths of the study are that the participants learned a way in which they could possibly treat their work-related stress. Although the intervention did not show significance in one workweek, it may have different results if it is used over a longer course of time. It showed that more studies need to be conducted regarding potential interventions to assist DYFS workers in decreasing their stress levels.

Implications for Practice

For social workers in the child welfare field, it is important that they are aware of their work-related stress and ways they can decrease this stress. Ensuring that workers have some tools at their disposal in which to reduce this stress is critical. Findings from this study suggested that some workers felt so stressed that doing the intervention alone was too much for them. Although the cognitive behavioral journaling intervention did not have a significant decrease in the workers level of stress, it did help the participants to recognize times in which they were feeling stressed, upset, and angered because of their job. This may become helpful to the participants in the future. Now that they have identified how their jobs make them feel, they can work on identifying what behaviors they exhibit when these feelings arise.

Implications for Policy

Many people feel stressed at work because they are overworked. They often work overtime, some without pay, either because the job requires it or because they must work over time in order to make ends meet. More improvements need to be made on labor policies, such as how many hours a person should be required to work in a day.

Implications for Research

More research is required in the area of work-related stress and ways to help workers relieve stress. In the study conducted by van der Klink et al. (2001), a cognitive behavioral intervention was used. However, the difference in their intervention was that the process lasted ten weeks. Also, participants met with the researchers four times in those ten weeks to measure their progress and make sure the intervention was not causing more harm than good (van der Klink et al., 2001).

Although this study did not show change, further studies should be conducted on work-related stress. A new intervention should be developed using cognitive behavioral intervention but with a tactic other than journaling or with a combination of approaches, such a counseling. Also, the intervention should take place outside of the workplace, as the environment of the workplace may be too stressful to make a difference in the participant’s level of work-related stress. However, the research with work-related stress needs to look at the bigger picture, the work industry itself, in order to make a significant difference in people’s level of work-related stress (van der Klink et al., 2001).

References

American Institute of Stress. (2007). Job stress. Retrieved March, 24, 2008, from http://www.stress.org/

Anderson, J. M. (2007). Depression, stress and work: How occupation can affect mental health. Journal of Controversial Medical Claims, 15(1), 6-15.

Health and Safety Executive. (2008). Work-related stress. Retrieved April 27, 2008, from http://www.hse.gov.uk/stress

Hogh, A., & Mikklesen, E. G. (2005). Is sense of coherence a mediator or moderator of relationships between violence at work and stress reactions? Scandinavian Journal of Psychology, 46(5), 429-437.

International Association for Human Values. (2004). Integra survey. Retrieved March 24, 2008, from http://www.apexcourse.org/stress_integra.htm.

Juby C., & Scannapieco, M., (2007). Characteristics of workload management in public child welfare agencies. Administration in Social Work, 31(3) 95-109.

Karasek, R. A. (1990). Lower health risk with increased job control among white collar workers. Journal of Organizational Behavior, 11, 171-185.

Karasek, R. A., Theorell, T., (1996). Current issues relating to psychosocial job strain and cardiovascular disease research. Journal of Occupational Health Psychology, 1(1) 9-26.

Kawakami, N., & Haratani, T. (1999). Epidemiology of job stress and health in Japan: Review of current evidence and future direction. Industrial Health, 37, 174-186.

Kivimaki, M., Leino-Arjas, P., Luukkonen, R., Riihimaki, H., Vahtera, J., & Kirjonen, J. (2002). Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. British Medical Journal, 325, 1-5.

Larsen, K. E., Schwartz, S. A., Whiteside, S. P., Khandker, M., Moore, K. M. & Abramowitz, J. S. (2006). Thought control strategies used by parents reporting postpartum obsessions. Journal of Cognitive Psychotherapy: An International Quarterly, 20(4) 435-445.

Poorman, P. B. (2003). Microskills and theoretical foundations for professional helpers. Boston: Allyn and Bacon.

Rossi, A. M., Perrewe, P .L., & Sauter, S. L. (2006). Stress and quality of working life: Current perspectives in occupational health. Charlotte, NC: Information Age Publishing.

State of New Jersey Department of Children and Families. (2007). About the division of youth and family services. Retrieved March 24, 2008, from http://www.state.nj.us/dcf/divisions/dyfs/index.html

Van der Klink, J. J., Blonk, R. W., Scheme, A. H., van Dijk, F. J. (2001). The benefits of interventions for work-related stress. American Journal of Public Health, 91(2) 270-276.