Stress

1
Stress Burnout in the AOD Field Prevalence,
Aetiology the Effectiveness of Workplace
Interventions

• Chelsea Todd, PhD Candidate
• National Centre for Education Training on
  Addiction (NCETA), Flinders University
• Prof. Ann Roche, Principal Supervisor
• Assoc. Prof. Malcolm Bond, Co-supervisor

SA Public Health Health Promotion Conference,
Making Research Matter Translating Research
into Health Policy Practice 21
October 2006
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Overview

• The nature of work in health human services
  What do we know about stress burnout? Whats
  being done about it?
• PhD program of work
  Assessing current stress burnout levels AND
  implementing evaluating intervention
• Implications for public health policy practice

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Stress Burnout in AOD Work

• AOD work can involve inherent difficulties
• AOD workers at risk of stress burnout
• Frontline AOD workers (N 1345) (Duraisingam et
  al., 2006)
• Managers in AOD orgs (N 280) (Duraisingam et
  al., 2006)
• Stress burnout in health profs is linked with
• Turnover intention
• Job (dis)satisfaction
• Job performance
• Recruitment retention challenges

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Conceptualising Stress Burnout

• STRESSORS
• client issues
• lack of support
• workload
• lack of autonomy

• STRESS
• psychological
• depression
• anxiety
• somatic

BURNOUT
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Burnout-Engagement Continuum
BURNOUT

• Engagement positive antithesis of burnout
• a persistent, positive affective-motivational
  state of fulfillment in employees that is
  characterised by vigor, dedication and
  absorption (Maslach et al., 2001, p. 417)
• Positively assoc with organisational commitment

ENGAGEMENT
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Burnout - 3 Dimensions (Maslach)
Emotional Exhaustion
Depersonalisation

• Lack of energy
• Emotional resources used up
• Compassion Fatigue

• Detachment from clients
• Negative cynical attitude

Reduced Personal Accomplishment

• Perceived decrease in efficacy competence

(Maslach Leiter,1997)
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Factors Impacting on Stress Burnout
Skinner Roche (2005)
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Antecedents to Stress Burnout
Unfairness
Lack of Control
Insufficient Reward
BURNOUT
Value Conflict
Work Overload
Breakdown of Sense of Community
(Maslach Leiter,1997)
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Consequences of Stress Burnout

• 1. Organisational functioning
• ? Job satisfaction (? work effectiveness, ?
  turnover)
• ? Org commitment (? turnover intent, ? job
  involvement)
• ? Turnover
• 2. Worker health wellbeing
• Depression
• Psychosomatic complaints
• Health problems
• 3. Client outcomes (Garmen et al., 2002)

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Case Study of Burnout

• I am a psychologist, going on my third
  year of employment as a therapist in a
  community mental health center. I have seen
  myself change from an avid, eager, open-minded,
  caring person to an extremely cynical,
  not-giving-a-damn individual in just two and a
  half yearsIve gone through drinking to relax
  enough to go to sleep, tranquilizers, stretching
  my sick leave to its ultimate limit, and so onIt
  hurts to feel like a failure as a therapist in
  terms of not being able to handle the pressure
  
• (Maslach, 1982, p.5)

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Need for Better Intervention Studies

• We know that
• Stress burnout is a problem
• Negative repercussions are great
  for workers, organisations clients
• Intervention strategies have focussed on
  individual
• We also need to intervene at workplace level
• BUT there is a lack of large, high quality
  studies evaluating organisation interventions
  (Edwards Burnard, 2003)

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Research Questions

• Prevalence of stress burnout in AOD workers in
  Australia?
• Contributory factors to stress burnout amongst
  the Australian AOD workforce?
• Effectiveness of X intervention for
  alleviating
• Stressors
• Burnout
• improving
• Job satisfaction
• Intention to remain with organisation

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Theoretical Framework

• Job Demands-Resources Model (Demerouti et al.,
  2001)

• Job Resources
• Autonomy
• Social support

• Job Demands
• Work overload
• Emotional demands
• Cognitive demands

MOTIVATION
STRESS
Exhaustion
Engagement
Bakker et al., 2005
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Study Design

• Participants AOD workers in Australia
• Randomised Controlled Trial
• Pre-post-followup

Follow-up (6-12 month)
INTERVENTION (Random allocation)
Baseline
Post
Intervention
Control
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Baseline Survey

• STRESSORS
• client issues
• lack of support
• workload
• lack of autonomy

BURNOUT

• STRESS
• psychological
• depression
• anxiety
• physical / somatic

• General Health Questionnaire (GHQ-12)

• Copenhagen Psychosocial Questionnaire (COPSOQ)

1. Maslach (MBI) 2. Copenhagen (CBI)
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Burnout Measures

• Maslach Burnout Inventory (Maslach Jackson,
  1986)
• Most commonly used burnout measure
• Emotional exhaustion
• Depersonalisation
• Reduced personal accomplishment
• Copenhagen Burnout Inventory (Kristensen et al.,
  2005)
• Personal burnout
• Work-related burnout
• Client-related burnout

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Outcome Measures

• Turnover intention
• Job satisfaction
• Organisational commitment
• Absenteeism

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Workplace Interventions
Focus of the intervention
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Stress Burnout Intervention
Schaufeli Enzmann (1998)
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Towards a Systems-Focussed Approach
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Identifying Suitable Interventions

• Examples (Cochrane Systematic Review
  Ruotsalainen et al., 2006)
• Role-playing and experiential exchanges
• Mobilizing support from colleagues
• Problem solving and decision-making skills
• Service delivery changes
• Support and advice from supervisors
• Evidence in literature for effectiveness?
• Feasible?
• Informed by baseline survey findings?

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Fixing the Workplace vs. Fixing the Worker
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Policy Practice Implications

• Establishing realistic strategies to implement at
  workplace level to ameliorate negative impact of
  stressors for

• Individuals
• Organisations
• Clients

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Contact Details

• Chelsea Todd
• NCETA, Flinders University
• chelsea.todd_at_flinders.edu.au
• [phone]