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Client and worker satisfaction in a child protection agency
Pergamon
Child Abuse & Neglect, Vol. 19, No. 8, pp. 897-905, 1995 Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0145-2134/95 $9.50 + .00
0145-2134(95)00052-6
CLIENT AND W O R K E R SATISFACTION IN A CHILD PROTECTION AGENCY HELEN R. WINEFIELD Department of Psychiatry, University of Adelaide, Adelaide, South Australia JILLIAN A . B A R L O W Department of Psychology, University of Adelaide, Adelaide, South Australia
Abstract---Client and staff satisfaction with the workings of a multidisciplinary child protection agency were investigated using interviews and standard questionnaires. The goal was to discover the nature and strength of the helping relationship between service-recipients and providers. Current clients (N = 24) expressed a great deal of satisfaction with the staff and services. The agency staff (N = 21, with 11 employed at least half-time to work directly with families) were relatively satisfied with their jobs, and showed little evidence of the burnout which has been recognized as a risk for child protection workers. They were able to relate empathically to clients and felt enthusiasm for the work. Taking account of possible bias in both sets of answers, there is still evidence that the agency is succeeding in creating a necessary precondition for therapeutic change: the development of accepting and positive worker-client relationships. Key Words-~Child protection, Prevention, Treatment. Client satisfaction, Helping relationship.
INTRODUCTION T H E T A S K O F evaluating the quality o f child protection services has been r e c o g n i z e d as both very important and very difficult (Dubowitz, 1990; F i n k & M c C l o s k e y , 1990). P r o b l e m s in defining what parental behaviors constitute abuse or neglect, and difficulties in assessing preventive efforts, are a m o n g the m a n y which have retarded the d e v e l o p m e n t o f cost-effectiveness f o r m u l a e in this area. A l t h o u g h their existence w o u l d assist both p o l i c y - m a k e r s and child protection w o r k e r s to specify the outcomes o f services and target the most responsive client groups, such f o r m u l a e r e m a i n elusive. The study reported here was part o f an evaluation o f a multidisciplinary child protection service that has preventive and therapeutic goals, rather than being confined to assessment. The present p a p e r focusses on the most reliably quantified c o m p o n e n t o f the study, and also that which has been least studied b y others, n a m e l y the nature and strength o f the worker-client relations. The need to explore w o r k e r - c l i e n t relations arises from the evidence that abusive and neglectful parents are often e m o t i o n a l l y d e p r i v e d or d a m a g e d (Oates, 1985; Polansky, Chalmers, Buttenwieser, & W i l l i a m s , 1981). A trusting relationship with professionals is therefore both m o r e difficult to establish and also more critical as a precondition for new learning, than it might be for other service recipients. This project was funded by the Department of Family and Community Services, South Australia. Received for publication January 4, 1994; final revision received November 16, 1994; accepted November 20, 1994. Reprint requests should be addressed to Dr. Helen R. Winefleld, Department of Psychiatry, University of Adelaide, Adelaide, South Australia 5005. 897
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Daro and Mitchel (1992) summarized the effectiveness of 14 child abuse prevention programs in the greater Philadelphia area. Programs varied in their length and multimodality, but had served 1,078 parents. Child Abuse Potential Inventory scores dropped by an average of 11 points, with greatest gains in high-risk parents and continuing improvements during the following 6 months, and 70% of parents were rated by staff as having benefitted from the services. In a qualitative investigation, others from the same center reported on the outcomes of intervention in 3 l of the parents at highest risk of physical abusiveness, from six different programs (George, Jones, & McCurdy, 1992). Interviews of mothers at high risk of abusing found that what they valued most about the programs was the reduction in their extreme social isolation, rather than the teaching about how to be a better parent. The relationship with the caseworker was the key to outcome for these young, single, poor women. Where trust was established and simple acts of kindness performed, which seemed like "going the extra mile," learning and psychological change could occur--not a surprising finding in view of the severe emotional deprivation often found in maltreating parents. An important implication is that the nature of the worker-client relationship is crucial to program success and should be assessed from the perspective of both parties. Therefore the present study investigated client perceptions of their relationships with agency workers, not only as a measure of client satisfaction, but as an indicator of the likely strength and power of the helping relationships thus developed. The other side of the client-worker relationship also deserves exploration. The value of monitoring staff perceptions follows from two facts: (a) staff have valuable first-hand experience of how, when, and how well the programs work, and (b) there are real risks of staff burnout in child protection work (Fryer & Miyoshi, 1989; Fryer, Poland, Bross, & Krugman, 1988; Hall, 1984; Stevenson, 1992), and staff with low job satisfaction may not relate warmly and empathically to clients. Fletcher (1982) described various ways in which child protection work may result in feelings of "anxiety, mistrust, competitiveness and anger" (p. 239). Sometimes workers have not resolved issues of emotional deprivation in their own pasts, and many are not given adequate training, either before or after they begin the work. Some have unrealistic expectations of what should be achievable, leading to defensiveness, helplessness, and loss of self-esteem. The end result is not only risk to the worker's mental health but, where intra-group conflicts develop that can mirror those of the abusive family, an impaired capacity for judgment and effective helping. The job satisfaction (and possible burnout) of service-delivery workers is important to assess for the sake of both parties: the deliverers and the clients. If workers are frustrated or overwhelmed they are probably unable to relate warmly and consistently as the clients need them to, as well as being at personal risk of illness and depression (Maslach, 1982). In addition, the service delivery workers may have valuable ideas about the process of service delivery and any potential for improvements. A detailed description of the goals, methods and outcomes of the programs offered by the agency is beyond the scope of this paper. We wish rather to focus upon one confined aspect of the overall evaluation, which has critical theoretical and practical implications as outlined above. This paper reports an assessment of the strength of the client-worker therapeutic alliance, from both sides. The project involved several steps: (1) measure clients' satisfaction with child protection workers, (2) measure workers' attitudes to clients, and to the job in general, (3) explore factors contributing to any worker burnout and make recommendations about staff development.
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METHOD
Subjects All current, past, and waiting-list clients of the child protection agency in question (N = 84) were potential subjects for this study. However, not all could be contacted or agreed to participate. Those who were interviewed did not differ significantly from those who were not, in source of referral or in referral for substantiated abuse or being at "high risk," when differences were rested statistically (by chi-square). Table 1 shows the participation rates for different categories of client family. This paper will confine itself to the largest and most fully-studied group of clients, namely those who were currently participating in the agency's programs. The average age of the 24 parents (one per family) who were interviewed and currently attending the program (and having done so for at least 3 months), was 30.3 years (range 22-48). All were women, 23 being the mother of the referred child and one the grandmother. One mother had permanent part-time work and another had casual work, while the rest were unemployed. There were 58 children in the current client families, of whom 32 or 55.2% were boys. Initial assessments by agency staff showed that 9 children were being physically abused and 7 were at risk, 11 were being emotionally abused and 6 were at risk, 3 were being sexually abused and 1 was at risk, and 4 were being neglected with 5 at risk. The agency did not accept referrals primarily concerned with sexual abuse. At the time of the evaluation, the 24 current client families reported having spent an average of 12 months in contact with the agency, which was located in a very economically depressed part of the metropolitan area. Families had received the full range of agency interventions: counselling (for 21), parent education (14), health services (11), family support services (8), psychological assessment (6), physiotherapy (4), occupational therapy (4), speech therapy (3), the developmental program (4), organization of services (8), health screening only (3), medical/ pediatric service (11 ), parent-child play group (8), parent activity group (8), parents' therapeutic discussion group (4), payments for child care (5), payment for other services (3), transport (9), and the school-holiday program (1 1). Staff at the agency had a variety of disciplinary backgrounds: two in administration/clerical, one psychologist, three social workers and a trainee, two teachers, two nurses, one early childhood worker, two family support workers, one occupational therapist, one physiotherapist, one speech pathologist, one pediatrician. Three volunteers were also part of the agency's operations; they carried no caseload but assisted staff for example by transporting clients. No staff member declined to be interviewed, giving a total of 21 participants. Eleven of these (the psychologist, social workers, teachers, early childhood worker, nurses, and family support workers) were employed at least half-time, to work directly with families, and will be desig-
Table 1. Participation Rates for Different Categories of Clients a
Interviewed Current Clients Short-Term Clients Waiting list New (<3 months) Dropouts (<3 months) Ex-Clients Totals
Uncontactable b
Refusal
Total
24 (72.7)
7 (21.2)
2 (6.1)
33
4 (28.6) 2 (40.0)
9 (64.3) 2 (40.0) 7 (77.8) 18 (78.3) 43 (51.2)
I (7.1) I (20.0) 1 (I 1.1) 1 (4.4) 6 (7.1)
14 5 9 23 84
1 (11.1)
4 (17.4) 35 (41.7)
a Figures in parentheses are percentages. "Includes no phone, no fixed address, repeated failures to attend.
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nated the Core Child Protection (CCP) workers. CCP workers had active caseloads of 5 - 1 5 families (average 7.3), The staff were mainly women (76.2%), as were the CCP workers (81.8%). The manager of the agency was a woman, who also carried a caseload. The average age of all staff was 39.5 years, with a range from 29 to 57 years; for CCP workers the average age was 40.5 years with the same range. Staff experience in their field of work averaged 12.0 years (10.9 for CCP workers), with a range of 3 to 29 years, and they had been employed by the agency, which had been accepting referrals for only 19 months, for an average time of 14.6 months (with 15.5 months for the CCP workers). Measures
Questions about client satisfaction with their relations with up to three staff members were adapted from Fryer, Bross, Krugman, Denson, and Baird (1990), Shireman, Grossnickle, Hinsey, and White (1990), and measures of client satisfaction with health care. They asked clients to rate staff members for attentiveness, warmth, knowledge, availability, and helpfulness, using six items; details are shown in Table 2 below. Standardized questionnaires for staff measured global job satisfaction and burnout. The 16item Job Satisfaction scale by Warr, Cook, and Wall (1979) includes ratings of the respondent's satisfaction with physical conditions, relations with co-workers, autonomy, pay, promotion opportunities, and industrial relations. It was supplemented by seven questions concerning burnout taken from Maslach (1982) and Melville (1980), which are shown in Table 3 below. Interview questions for staff asked about sources of satisfaction and dissatisfaction with work at the agency, ideas for constructive change, and views on efficiency. Procedures
Subjects were requested to participate in the ongoing evaluation of the agency, being assured of the independence of the evaluator (who was not on the staff of the agency or any of the sponsoring parent agencies), and of the confidentiality of their replies. Structured interviews were then carried out, all by the same member of the research team, at home or at the agency for the clients and at the agency for the staff, accompanied by standardized questionnaires. The interviewer read the standardized questions to clients and recorded their responses, while the staff members read and completed their questionnaires during the interview. RESULTS Quantitative information and summaries of the responses to open-ended questions will be presented where they relate to this paper's focus. Table 2. Current Client's Satisfaction with Agency Staff
Items (all answered in relation to an individual worker) ( 1) (2) (3) (4) (5) (6)
Is interested in me as an individual, not just another case Treats me in a friendly way Knows a lot about children and families Is always there when I need her or him Answers all my questions Helps me to be a good parent
Percent Who Agree (rating 3 or 4)
Mean Rating
72.7 95.6 74.4 69.8 88.9 84.4
3.3 3.7 3.3 3.1 3.5 3.3
Note: Ratings on a 4-point scale where 1 = strongly disagree; 2 = disagree a little; 3 = agree a little; 4 = strongly
agree. N = 43-45.
Satisfaction with child protection
901
Table 3. Staff Burnout Item
Uncertain
Any Burnout
(l) I feel emotionally drained by this work (2) If pay and conditions were the same, I would just as soon leave child protection work (3) I've become more callous toward people since I took this job (4) I don't really care what happens to some clients (5) My work involves a great deal of wasted effort on my part (6) I have accomplished many worthwhile things in this job (7) I can easily understand how my clients feel about things
0.0
38.1
9.5 4.8 4.8 9.5 14.3 23.8
0.0 4.8 4.8 14.3 4.8 14.3
Note: Figures are percentages of all staff of the agency (N = 21) whose response to each item indicated uncertainty
(the middle point of five on the rating scale) or any degree of burnout (tend to agree/disagree or strongly agree/ disagree, depending on the wording of the item).
Client Satisfaction with Staff Table 2 shows the questions used and the percentage of answers expressing satisfaction. Answers about an individual showed acceptable internal consistency, as shown by alpha coefficients of .69 for the first worker (rated by 22 clients), and .87 for the second worker (rated by 15 clients). For each of the items, over half the clients gave the maximum possible rating (4 on the 4-point scale), except for staff availability where 44% gave the maximum rating. The greatest satisfaction was expressed for staff friendliness (where 80% of clients gave maximum ratings).
Staff Job Satisfaction The Job Satisfaction Scale's 16 items were scored 1-7, giving a range for the total of 16 to 112. The alpha coefficient of internal reliability with this sample was high (.89), showing that staff tended to have a consistent attitude to all aspects of their work. The average for all staff equaled 83.6 (SD = 16.1), with three workers clearly expressing dissatisfaction by scoring at or below 60 (average item score in the "dissatisfied" range). The items about which most dissatisfaction was expressed referred to pay (8 moderately to extremely dissatisfied), promotion opportunities (6), and "the way your organization is managed" (6). On the other hand the items about which most satisfaction was expressed referred to the respondent's immediate boss, and the hours of work (13 in each case claimed to be very or extremely satisfied). Two of the three individuals expressing clear job dissatisfaction were CCP workers. Overall, CCP staff scored similarly to the whole group, with an average score equal to 77.6 (SD = 11.5). Correlations were computed to see whether job satisfaction could be predicted from other worker-characteristics, for all staff. There was no significant relationship between workers' job satisfaction or burnout scores and the length of time they had been in that occupation or at the agency. However, there was a statistically significant relationship between job satisfaction and caseload (r = - . 6 0 , p < .05), such that workers with high caseloads tended to have lower satisfaction.
Staff Burnout Table 3 shows responses to standardized items to assess worker burnout. When the responses of CCP workers were compared with those of the others, there were no differences in the distribution. The item with the largest percentage of responses indicative of burnout was " I feel emotionally drained by this work," with which 38% of staff agreed to some extent. With items all scored so that high score represents high burnout, the possible range of scores
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H. R. Winefield and J. A. Barlow
is 7 to 35. There is a low alpha coefficient of internal reliability (.20), showing that responses across items were not consistent. The whole staff averaged a Burnout score of 13.8 (SD = 2.8), and the CCP subset averaged 14.0 (SD = 2.5).
Qualitative Information from Staff Interviews Themes in the answers to open-ended questions in the staff interviews are summarized here; verbatim answers are available upon request from the first author. The volunteers were a contented group who gained satisfaction from their contribution, if anything would have liked to make a greater contribution, and were happy with their relations with the paid staff. There was considerable satisfaction among the paid staff from moving towards realistic goals, in the context of good relations both among workers and between workers and clients. They commented that progress can be slow and difficult to measure, and the inadequacy of resources can be frustrating. Some workers expressed a sense of professional isolation and dissatisfaction with the internal arrangements at the agency; some feel overloaded with work while others felt they could contribute more. The multidisciplinary nature of the agency workforce was seen as both stimulating and as a challenge to communication between people from a variety of professional backgrounds. The variety of services and models of service delivery was definitely seen as a primary strength of what the agency offered its clients. Some staff members felt that teams themselves should be multidisciplinary, without as at present keeping the disciplines in separate teams; others valued the support from members of their own group. More orientation to this aspect of the internal organization, and less need for attention to administrative details, was requested. There was almost unanimous consensus that the preservice training with which workers enter the agency is not adequate preparation for the specialized work of child protection, especially in dealing with the emotions aroused in workers. Supervision within the agency was regarded very positively and communication between coworkers was largely harmonious, given the difficulties of different backgrounds and of time pressure, but some aspects of the management decision-making process (which partly occurred outside the agency), seemed to require attention.
DISCUSSION By focussing on the relationship between clients and staff at a multidisciplinary child protection agency, we aimed to capture information about the necessary preconditions for beneficial change. Despite the small absolute numbers of people involved, the participation rates were sufficient to enable the conclusion that helping relationship were being established. While confidentiality requirements in this field often prevent evaluation being attempted or the results published, these positive findings may encourage researchers and decision-makers to build upon the present project and attempt larger-scale studies.
The Clients As Table 1 shows, there were very few outright refusals to participate. It must be assumed that some of the "uncontactable" clients may have elected not to take part but not to refuse either. For example, one current client consented to participate but then failed on several occasions to keep arranged appointments, finally declining the offer of a taxi ride into the agency for the interview. However, the client population is geographically very mobile and includes many nonowners of telephones, so much of the uncontactability was genuine. Other
Satisfaction with child protection
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nonattendances were probably due to forgetfulness or poor planning rather than a deliberate decision not to help, but it remains true that reasons for nonparticipation, and therefore possible biases in the results, can only be the subject of speculation. The possibility also remains, despite our careful explanations of the independence of the evaluation and the confidentiality of the results, that some clients may have feared that negative reports on the staff might have negative consequences for them. Cooperation was considerably better than in the postal survey in Iowa by Fryer, Bross, Krugman, Denson, and Baird (1990). The latter survey excluded all cases closed more than 2 months before, which should have helped to reduce loss of contact, but still only got a 25% response rate. Shireman, Grossnickle, Hinsey, and White (1990), as in the present survey, found that about half their child protective service clients were uncontactable; then 43% of the others (compared with 7% in this evaluation) refused to be interviewed. It is gratifying although not surprising that the current clients expressed very positive attitudes to agency participation. Again, one may speculate that results may have been different in a program where sexual abuse cases were accepted. It was desirable to explore the attitudes of premature dropouts and even more, of graduates from the program, but unfortunately numbers were too few to analyze statistically. Again the reasons for uncontactability cannot be known for certain, but it would make sense psychologically for exclients to want to put this stressful period of their lives behind them. Interestingly, the four exclients who were interviewed expressed largely positive attitudes to the agency, even though all had left before completing the program which staff felt they required. One of the prime preconditions for prevention of further abuse is being met, in that parents trust the staff and feel valued and cared for. This emotional support builds a helping relationship within which therapeutic change in behavior can be motivated.
The Staff There is little evidence for burnout and disillusionment, or of work dissatisfaction, in the agency workforce. Current staff had been at the agency a relatively short time (19 months maximum, since it started), which may be relevant to the likelihood of burnout. The two or three workers who are suffering occupational stress and no longer feeling enthusiastic and hopeful about their work, may seek other employment. However, Fryer and Miyoshi (1989) reported that emotionally exhausted workers were less likely to leave child protection when jobs were scarce, as is the case currently in this state. While the departure of stressed staff may prevent demoralization spreading through the agency, it represents a loss to the agency of that person's training and experience, and consequent time spent training a replacement. Continuity of services to families could also be lost unnecessarily. Staff job dissatisfaction was higher when caseloads were higher. The direction of causality is not certain, but it seems likely that workers who "cannot say n o " to requests for help are at risk of becoming over-stressed. Perhaps it is the supervisor's job to remain vigilant for this possibility, and perhaps too, an outside therapy consultant and trainer could reduce the risk that individual workers accept more responsibilities than they can realistically cope with. It would seem to be cost-effective for agencies to maintain adequate staffing levels so that caseloads remain reasonable and staff burnout and possible turnover stay low. The staff in this agency were relatively mature in age, and decision-making was in principle democratic, although how that ideal operated in practice would need extensive specific observations to ascertain. The supervision and day-to-day quality of interpersonal relations among the staff were experienced as very positive, but training was widely perceived as inadequate for the demands of the work. Fryer, Poland, Bross, and Krugman (1988) found that 20 or more hours of formal training in child abuse prior to starting work in the field was associated with
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greater confidence and job satisfaction, and that membership in a multidisciplinary team was a particularly positive influence. As noted by Oates (1985), multidisciplinary teams need good direction, to avoid the hazard of every member feeling that responsibility for the family lies with another member of the team. As service quality is often assessed by clients in terms of the personal interaction between client and provider, the providers need to be carefully selected, trained, and encouraged (Heskett, Sasser, & Hart, 1990). A major unmet need appears to be for specific training for staff in child protection work, especially the emotions that it arouses in workers, and what is realistic progress to expect. Some staff feel the need for specialist training in therapeutic methods. With increasing time since the pre-implementation training period, and with staff turnover, it is necessary to plan and resource an ongoing program of professional training. As much of the reward to staff in child protection comes from feeling effective in improving conditions for children, it is important for staff morale to keep up the mechanisms for feedback from clients to staff, and bilaterally between the staff and the management committee. There would be advantages therefore if evaluation could become ongoing and internal, in order to guide decision-making and to increase understanding of the process and outcomes of service delivery. Clear procedures for internal review and self-assessment would enable the development of a structure for recognition (both personal and public) for work excellence. Criteria for excellent work need development, however, and will remain controversial pending clarification. Acknowledgement--Tbe authors are grateful to all the participants for their cooperation.
REFERENCES Daro, D., & Mitchel, L. (1992). Evaluation of the William Penn Foundation Child Abuse Prevention Initiative: Client impact study. Chicago, IL: NCPCA. Dubowitz, H. (1990). Costs and effectiveness of interventions in child maltreatment. Child Abuse & Neglect, 14, 177-186. Fink, A., & McCIoseky, L. (1990). Moving child abuse and neglect prevention programs forward: Improving program evaluations. Child Abuse & Neglect, 14, 187-206. Fletcher, L. (1982). Battered professionals. In K. Oates (Ed.), ChiM abuse: A community concern (pp. 239-245). London: Butterworths. Fryer, G. E., Bross, D. C., Krugman, R. D., Denson, D. B., & Baird, D. (1990). Good news for CPS workers. Public Welfare, Winter, 38-41. Fryer, G. E., & Miyoshi, T. J. (1989). The relationship of child protection worker attitudes to attrition from the field. Child Abuse & Neglect, 13, 345-350. Fryer, G. E., Poland, J. E., Bross, D. C., & Krugman, R. D. (1988). The child protective service worker: A profile of needs, attitudes, and utilization of professional resources. Child Abuse & Neglect, 12, 481-490. George, S., Jones, E., & McCurdy, K. (1992). The William Penn Foundation Prevention Initiative: An in-depth study of high risk mothers. Chicago, IL: NCPCA. Hall, S. (1984). A view of community based services. In F. Maas & S. Sach (Eds.), Community based services for children and families (pp. 110-113). Melbourne: Institute of Family Studies. Heskett, J. L., Sasser, W. E., & Hart, C. W. L. (1990). Service breakthroughs. New York: Free Press. Maslach, C. (1982). The cost of caring. Englewood Cliffs, NJ: Prentice Hall. Melville, A. (1980). Job satisfaction in general practice: Implications for prescribing. Social Science and Medicine, 14A, 495-499. Oates, K. (1985). Child abuse and neglect: What happens eventually? Sydney: Butterworths. Polansky, N. A., Chalmers, M. A., Buttenwieser, E., & Williams, D. P. (1981). Damaged parents: An anatomy of child neglect and its prevention. Chicago, IL: University of Chicago Press. Shireman, J. F., Grossnickle, D., Hinsey, C., & White, J. (1990). Outcome study of protective services: Comparison of interviews and records as data sources. Child Welfare, 69, 167-179. Stevenson, O. (1992). Social work intervention to protect children: Aspects of research and practice. Child Abuse Review, 1, 19-32. Warr, P. B., Cook, J., & Wall, T. (1979). Scales for the measurement of work attitudes and psychological well-being. Journal of Occupational Psychology, 52, 129-148.
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R~sum~---Dans cette 6tude, on a enqu~t6 sur le niveau de satisfaction des usagers et du personnel par rapport au travail qu'ex6cute une agence pluridisciplinaire de protection des enfants. On s'est servi d'entrevues et de questionnaires normalis6s. Le but 6tait de connaitre la nature et la puissance de la relation aidante entre les usagers et les dispenseurs des services. Vingt quatre usagers ont exprim6 beaucoup de satisfaction ~ l'6gard du personnel et des services. Le personnel de l'agence (au nombre de 21, dont 11 travaiilaient h temps partiel avec ies families) s'est montr6 relativement satisfait de la situation de travail e t a d6montr6 peu de signes d'6puisement professionnel, lequel menace les travailleurs en protection de l'enfance. Ceux-ci manifestaient une relation empathique avec leurs clients et d6montraient de l'enthousiasme vis-h-vis de leur travail. En tenant compte des inexactitudes dans les r6ponses, il est clair que cette agence a r6ussi h assurer une condition essentielle h l'action th6rapeutique, soit de permettre qu'il se d6veloppe une relation positive et r6ceptive entre le travailleur et le client. Resumen----Se investig6 la satisfacci6n del cliente y del personal con los trabajos de una agencia de proteccion infantil multidisciplinaria utilizando entrevistas y cuestionarios estandarizados. El objetivo era descubrir la naturaleza y la fuerza de la relaci6n de ayuda entre los receptores y proveedores de servicios. Los clientes actuales (N-24) expresaron mucha satisfaccion con los servicios y con el personal, El personal de la agencia (N = 21, con I l empleados por lo menos a medio tiempo para trabajar directamente con las familias) estaban relativamente satisfechos con sus trabajos, y mostraban pocas se~ales del agotamiento que ha sido reconocido como un desgo para los que trabajan en la protecci6n infantil. Tomando en cuenta posibles prejuicios en las respuestas de ambos grupos, atln existen pruebas de que la agencia tiene 6xito en crear una necesaria pre-condicion para el cambio terap6utico: el desarrollo de relaciones positivas de aceptaci6n entre el personal y el cliente.
Child Abuse & Neglect, Vol. 19, No. 8, pp. 897-905, 1995 Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0145-2134/95 $9.50 + .00
0145-2134(95)00052-6
CLIENT AND W O R K E R SATISFACTION IN A CHILD PROTECTION AGENCY HELEN R. WINEFIELD Department of Psychiatry, University of Adelaide, Adelaide, South Australia JILLIAN A . B A R L O W Department of Psychology, University of Adelaide, Adelaide, South Australia
Abstract---Client and staff satisfaction with the workings of a multidisciplinary child protection agency were investigated using interviews and standard questionnaires. The goal was to discover the nature and strength of the helping relationship between service-recipients and providers. Current clients (N = 24) expressed a great deal of satisfaction with the staff and services. The agency staff (N = 21, with 11 employed at least half-time to work directly with families) were relatively satisfied with their jobs, and showed little evidence of the burnout which has been recognized as a risk for child protection workers. They were able to relate empathically to clients and felt enthusiasm for the work. Taking account of possible bias in both sets of answers, there is still evidence that the agency is succeeding in creating a necessary precondition for therapeutic change: the development of accepting and positive worker-client relationships. Key Words-~Child protection, Prevention, Treatment. Client satisfaction, Helping relationship.
INTRODUCTION T H E T A S K O F evaluating the quality o f child protection services has been r e c o g n i z e d as both very important and very difficult (Dubowitz, 1990; F i n k & M c C l o s k e y , 1990). P r o b l e m s in defining what parental behaviors constitute abuse or neglect, and difficulties in assessing preventive efforts, are a m o n g the m a n y which have retarded the d e v e l o p m e n t o f cost-effectiveness f o r m u l a e in this area. A l t h o u g h their existence w o u l d assist both p o l i c y - m a k e r s and child protection w o r k e r s to specify the outcomes o f services and target the most responsive client groups, such f o r m u l a e r e m a i n elusive. The study reported here was part o f an evaluation o f a multidisciplinary child protection service that has preventive and therapeutic goals, rather than being confined to assessment. The present p a p e r focusses on the most reliably quantified c o m p o n e n t o f the study, and also that which has been least studied b y others, n a m e l y the nature and strength o f the worker-client relations. The need to explore w o r k e r - c l i e n t relations arises from the evidence that abusive and neglectful parents are often e m o t i o n a l l y d e p r i v e d or d a m a g e d (Oates, 1985; Polansky, Chalmers, Buttenwieser, & W i l l i a m s , 1981). A trusting relationship with professionals is therefore both m o r e difficult to establish and also more critical as a precondition for new learning, than it might be for other service recipients. This project was funded by the Department of Family and Community Services, South Australia. Received for publication January 4, 1994; final revision received November 16, 1994; accepted November 20, 1994. Reprint requests should be addressed to Dr. Helen R. Winefleld, Department of Psychiatry, University of Adelaide, Adelaide, South Australia 5005. 897
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H.R. Winefieldand J. A. Barlow
Daro and Mitchel (1992) summarized the effectiveness of 14 child abuse prevention programs in the greater Philadelphia area. Programs varied in their length and multimodality, but had served 1,078 parents. Child Abuse Potential Inventory scores dropped by an average of 11 points, with greatest gains in high-risk parents and continuing improvements during the following 6 months, and 70% of parents were rated by staff as having benefitted from the services. In a qualitative investigation, others from the same center reported on the outcomes of intervention in 3 l of the parents at highest risk of physical abusiveness, from six different programs (George, Jones, & McCurdy, 1992). Interviews of mothers at high risk of abusing found that what they valued most about the programs was the reduction in their extreme social isolation, rather than the teaching about how to be a better parent. The relationship with the caseworker was the key to outcome for these young, single, poor women. Where trust was established and simple acts of kindness performed, which seemed like "going the extra mile," learning and psychological change could occur--not a surprising finding in view of the severe emotional deprivation often found in maltreating parents. An important implication is that the nature of the worker-client relationship is crucial to program success and should be assessed from the perspective of both parties. Therefore the present study investigated client perceptions of their relationships with agency workers, not only as a measure of client satisfaction, but as an indicator of the likely strength and power of the helping relationships thus developed. The other side of the client-worker relationship also deserves exploration. The value of monitoring staff perceptions follows from two facts: (a) staff have valuable first-hand experience of how, when, and how well the programs work, and (b) there are real risks of staff burnout in child protection work (Fryer & Miyoshi, 1989; Fryer, Poland, Bross, & Krugman, 1988; Hall, 1984; Stevenson, 1992), and staff with low job satisfaction may not relate warmly and empathically to clients. Fletcher (1982) described various ways in which child protection work may result in feelings of "anxiety, mistrust, competitiveness and anger" (p. 239). Sometimes workers have not resolved issues of emotional deprivation in their own pasts, and many are not given adequate training, either before or after they begin the work. Some have unrealistic expectations of what should be achievable, leading to defensiveness, helplessness, and loss of self-esteem. The end result is not only risk to the worker's mental health but, where intra-group conflicts develop that can mirror those of the abusive family, an impaired capacity for judgment and effective helping. The job satisfaction (and possible burnout) of service-delivery workers is important to assess for the sake of both parties: the deliverers and the clients. If workers are frustrated or overwhelmed they are probably unable to relate warmly and consistently as the clients need them to, as well as being at personal risk of illness and depression (Maslach, 1982). In addition, the service delivery workers may have valuable ideas about the process of service delivery and any potential for improvements. A detailed description of the goals, methods and outcomes of the programs offered by the agency is beyond the scope of this paper. We wish rather to focus upon one confined aspect of the overall evaluation, which has critical theoretical and practical implications as outlined above. This paper reports an assessment of the strength of the client-worker therapeutic alliance, from both sides. The project involved several steps: (1) measure clients' satisfaction with child protection workers, (2) measure workers' attitudes to clients, and to the job in general, (3) explore factors contributing to any worker burnout and make recommendations about staff development.
Satisfaction with child protection
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METHOD
Subjects All current, past, and waiting-list clients of the child protection agency in question (N = 84) were potential subjects for this study. However, not all could be contacted or agreed to participate. Those who were interviewed did not differ significantly from those who were not, in source of referral or in referral for substantiated abuse or being at "high risk," when differences were rested statistically (by chi-square). Table 1 shows the participation rates for different categories of client family. This paper will confine itself to the largest and most fully-studied group of clients, namely those who were currently participating in the agency's programs. The average age of the 24 parents (one per family) who were interviewed and currently attending the program (and having done so for at least 3 months), was 30.3 years (range 22-48). All were women, 23 being the mother of the referred child and one the grandmother. One mother had permanent part-time work and another had casual work, while the rest were unemployed. There were 58 children in the current client families, of whom 32 or 55.2% were boys. Initial assessments by agency staff showed that 9 children were being physically abused and 7 were at risk, 11 were being emotionally abused and 6 were at risk, 3 were being sexually abused and 1 was at risk, and 4 were being neglected with 5 at risk. The agency did not accept referrals primarily concerned with sexual abuse. At the time of the evaluation, the 24 current client families reported having spent an average of 12 months in contact with the agency, which was located in a very economically depressed part of the metropolitan area. Families had received the full range of agency interventions: counselling (for 21), parent education (14), health services (11), family support services (8), psychological assessment (6), physiotherapy (4), occupational therapy (4), speech therapy (3), the developmental program (4), organization of services (8), health screening only (3), medical/ pediatric service (11 ), parent-child play group (8), parent activity group (8), parents' therapeutic discussion group (4), payments for child care (5), payment for other services (3), transport (9), and the school-holiday program (1 1). Staff at the agency had a variety of disciplinary backgrounds: two in administration/clerical, one psychologist, three social workers and a trainee, two teachers, two nurses, one early childhood worker, two family support workers, one occupational therapist, one physiotherapist, one speech pathologist, one pediatrician. Three volunteers were also part of the agency's operations; they carried no caseload but assisted staff for example by transporting clients. No staff member declined to be interviewed, giving a total of 21 participants. Eleven of these (the psychologist, social workers, teachers, early childhood worker, nurses, and family support workers) were employed at least half-time, to work directly with families, and will be desig-
Table 1. Participation Rates for Different Categories of Clients a
Interviewed Current Clients Short-Term Clients Waiting list New (<3 months) Dropouts (<3 months) Ex-Clients Totals
Uncontactable b
Refusal
Total
24 (72.7)
7 (21.2)
2 (6.1)
33
4 (28.6) 2 (40.0)
9 (64.3) 2 (40.0) 7 (77.8) 18 (78.3) 43 (51.2)
I (7.1) I (20.0) 1 (I 1.1) 1 (4.4) 6 (7.1)
14 5 9 23 84
1 (11.1)
4 (17.4) 35 (41.7)
a Figures in parentheses are percentages. "Includes no phone, no fixed address, repeated failures to attend.
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H.R. Winefield and J. A. Barlow
nated the Core Child Protection (CCP) workers. CCP workers had active caseloads of 5 - 1 5 families (average 7.3), The staff were mainly women (76.2%), as were the CCP workers (81.8%). The manager of the agency was a woman, who also carried a caseload. The average age of all staff was 39.5 years, with a range from 29 to 57 years; for CCP workers the average age was 40.5 years with the same range. Staff experience in their field of work averaged 12.0 years (10.9 for CCP workers), with a range of 3 to 29 years, and they had been employed by the agency, which had been accepting referrals for only 19 months, for an average time of 14.6 months (with 15.5 months for the CCP workers). Measures
Questions about client satisfaction with their relations with up to three staff members were adapted from Fryer, Bross, Krugman, Denson, and Baird (1990), Shireman, Grossnickle, Hinsey, and White (1990), and measures of client satisfaction with health care. They asked clients to rate staff members for attentiveness, warmth, knowledge, availability, and helpfulness, using six items; details are shown in Table 2 below. Standardized questionnaires for staff measured global job satisfaction and burnout. The 16item Job Satisfaction scale by Warr, Cook, and Wall (1979) includes ratings of the respondent's satisfaction with physical conditions, relations with co-workers, autonomy, pay, promotion opportunities, and industrial relations. It was supplemented by seven questions concerning burnout taken from Maslach (1982) and Melville (1980), which are shown in Table 3 below. Interview questions for staff asked about sources of satisfaction and dissatisfaction with work at the agency, ideas for constructive change, and views on efficiency. Procedures
Subjects were requested to participate in the ongoing evaluation of the agency, being assured of the independence of the evaluator (who was not on the staff of the agency or any of the sponsoring parent agencies), and of the confidentiality of their replies. Structured interviews were then carried out, all by the same member of the research team, at home or at the agency for the clients and at the agency for the staff, accompanied by standardized questionnaires. The interviewer read the standardized questions to clients and recorded their responses, while the staff members read and completed their questionnaires during the interview. RESULTS Quantitative information and summaries of the responses to open-ended questions will be presented where they relate to this paper's focus. Table 2. Current Client's Satisfaction with Agency Staff
Items (all answered in relation to an individual worker) ( 1) (2) (3) (4) (5) (6)
Is interested in me as an individual, not just another case Treats me in a friendly way Knows a lot about children and families Is always there when I need her or him Answers all my questions Helps me to be a good parent
Percent Who Agree (rating 3 or 4)
Mean Rating
72.7 95.6 74.4 69.8 88.9 84.4
3.3 3.7 3.3 3.1 3.5 3.3
Note: Ratings on a 4-point scale where 1 = strongly disagree; 2 = disagree a little; 3 = agree a little; 4 = strongly
agree. N = 43-45.
Satisfaction with child protection
901
Table 3. Staff Burnout Item
Uncertain
Any Burnout
(l) I feel emotionally drained by this work (2) If pay and conditions were the same, I would just as soon leave child protection work (3) I've become more callous toward people since I took this job (4) I don't really care what happens to some clients (5) My work involves a great deal of wasted effort on my part (6) I have accomplished many worthwhile things in this job (7) I can easily understand how my clients feel about things
0.0
38.1
9.5 4.8 4.8 9.5 14.3 23.8
0.0 4.8 4.8 14.3 4.8 14.3
Note: Figures are percentages of all staff of the agency (N = 21) whose response to each item indicated uncertainty
(the middle point of five on the rating scale) or any degree of burnout (tend to agree/disagree or strongly agree/ disagree, depending on the wording of the item).
Client Satisfaction with Staff Table 2 shows the questions used and the percentage of answers expressing satisfaction. Answers about an individual showed acceptable internal consistency, as shown by alpha coefficients of .69 for the first worker (rated by 22 clients), and .87 for the second worker (rated by 15 clients). For each of the items, over half the clients gave the maximum possible rating (4 on the 4-point scale), except for staff availability where 44% gave the maximum rating. The greatest satisfaction was expressed for staff friendliness (where 80% of clients gave maximum ratings).
Staff Job Satisfaction The Job Satisfaction Scale's 16 items were scored 1-7, giving a range for the total of 16 to 112. The alpha coefficient of internal reliability with this sample was high (.89), showing that staff tended to have a consistent attitude to all aspects of their work. The average for all staff equaled 83.6 (SD = 16.1), with three workers clearly expressing dissatisfaction by scoring at or below 60 (average item score in the "dissatisfied" range). The items about which most dissatisfaction was expressed referred to pay (8 moderately to extremely dissatisfied), promotion opportunities (6), and "the way your organization is managed" (6). On the other hand the items about which most satisfaction was expressed referred to the respondent's immediate boss, and the hours of work (13 in each case claimed to be very or extremely satisfied). Two of the three individuals expressing clear job dissatisfaction were CCP workers. Overall, CCP staff scored similarly to the whole group, with an average score equal to 77.6 (SD = 11.5). Correlations were computed to see whether job satisfaction could be predicted from other worker-characteristics, for all staff. There was no significant relationship between workers' job satisfaction or burnout scores and the length of time they had been in that occupation or at the agency. However, there was a statistically significant relationship between job satisfaction and caseload (r = - . 6 0 , p < .05), such that workers with high caseloads tended to have lower satisfaction.
Staff Burnout Table 3 shows responses to standardized items to assess worker burnout. When the responses of CCP workers were compared with those of the others, there were no differences in the distribution. The item with the largest percentage of responses indicative of burnout was " I feel emotionally drained by this work," with which 38% of staff agreed to some extent. With items all scored so that high score represents high burnout, the possible range of scores
902
H. R. Winefield and J. A. Barlow
is 7 to 35. There is a low alpha coefficient of internal reliability (.20), showing that responses across items were not consistent. The whole staff averaged a Burnout score of 13.8 (SD = 2.8), and the CCP subset averaged 14.0 (SD = 2.5).
Qualitative Information from Staff Interviews Themes in the answers to open-ended questions in the staff interviews are summarized here; verbatim answers are available upon request from the first author. The volunteers were a contented group who gained satisfaction from their contribution, if anything would have liked to make a greater contribution, and were happy with their relations with the paid staff. There was considerable satisfaction among the paid staff from moving towards realistic goals, in the context of good relations both among workers and between workers and clients. They commented that progress can be slow and difficult to measure, and the inadequacy of resources can be frustrating. Some workers expressed a sense of professional isolation and dissatisfaction with the internal arrangements at the agency; some feel overloaded with work while others felt they could contribute more. The multidisciplinary nature of the agency workforce was seen as both stimulating and as a challenge to communication between people from a variety of professional backgrounds. The variety of services and models of service delivery was definitely seen as a primary strength of what the agency offered its clients. Some staff members felt that teams themselves should be multidisciplinary, without as at present keeping the disciplines in separate teams; others valued the support from members of their own group. More orientation to this aspect of the internal organization, and less need for attention to administrative details, was requested. There was almost unanimous consensus that the preservice training with which workers enter the agency is not adequate preparation for the specialized work of child protection, especially in dealing with the emotions aroused in workers. Supervision within the agency was regarded very positively and communication between coworkers was largely harmonious, given the difficulties of different backgrounds and of time pressure, but some aspects of the management decision-making process (which partly occurred outside the agency), seemed to require attention.
DISCUSSION By focussing on the relationship between clients and staff at a multidisciplinary child protection agency, we aimed to capture information about the necessary preconditions for beneficial change. Despite the small absolute numbers of people involved, the participation rates were sufficient to enable the conclusion that helping relationship were being established. While confidentiality requirements in this field often prevent evaluation being attempted or the results published, these positive findings may encourage researchers and decision-makers to build upon the present project and attempt larger-scale studies.
The Clients As Table 1 shows, there were very few outright refusals to participate. It must be assumed that some of the "uncontactable" clients may have elected not to take part but not to refuse either. For example, one current client consented to participate but then failed on several occasions to keep arranged appointments, finally declining the offer of a taxi ride into the agency for the interview. However, the client population is geographically very mobile and includes many nonowners of telephones, so much of the uncontactability was genuine. Other
Satisfaction with child protection
903
nonattendances were probably due to forgetfulness or poor planning rather than a deliberate decision not to help, but it remains true that reasons for nonparticipation, and therefore possible biases in the results, can only be the subject of speculation. The possibility also remains, despite our careful explanations of the independence of the evaluation and the confidentiality of the results, that some clients may have feared that negative reports on the staff might have negative consequences for them. Cooperation was considerably better than in the postal survey in Iowa by Fryer, Bross, Krugman, Denson, and Baird (1990). The latter survey excluded all cases closed more than 2 months before, which should have helped to reduce loss of contact, but still only got a 25% response rate. Shireman, Grossnickle, Hinsey, and White (1990), as in the present survey, found that about half their child protective service clients were uncontactable; then 43% of the others (compared with 7% in this evaluation) refused to be interviewed. It is gratifying although not surprising that the current clients expressed very positive attitudes to agency participation. Again, one may speculate that results may have been different in a program where sexual abuse cases were accepted. It was desirable to explore the attitudes of premature dropouts and even more, of graduates from the program, but unfortunately numbers were too few to analyze statistically. Again the reasons for uncontactability cannot be known for certain, but it would make sense psychologically for exclients to want to put this stressful period of their lives behind them. Interestingly, the four exclients who were interviewed expressed largely positive attitudes to the agency, even though all had left before completing the program which staff felt they required. One of the prime preconditions for prevention of further abuse is being met, in that parents trust the staff and feel valued and cared for. This emotional support builds a helping relationship within which therapeutic change in behavior can be motivated.
The Staff There is little evidence for burnout and disillusionment, or of work dissatisfaction, in the agency workforce. Current staff had been at the agency a relatively short time (19 months maximum, since it started), which may be relevant to the likelihood of burnout. The two or three workers who are suffering occupational stress and no longer feeling enthusiastic and hopeful about their work, may seek other employment. However, Fryer and Miyoshi (1989) reported that emotionally exhausted workers were less likely to leave child protection when jobs were scarce, as is the case currently in this state. While the departure of stressed staff may prevent demoralization spreading through the agency, it represents a loss to the agency of that person's training and experience, and consequent time spent training a replacement. Continuity of services to families could also be lost unnecessarily. Staff job dissatisfaction was higher when caseloads were higher. The direction of causality is not certain, but it seems likely that workers who "cannot say n o " to requests for help are at risk of becoming over-stressed. Perhaps it is the supervisor's job to remain vigilant for this possibility, and perhaps too, an outside therapy consultant and trainer could reduce the risk that individual workers accept more responsibilities than they can realistically cope with. It would seem to be cost-effective for agencies to maintain adequate staffing levels so that caseloads remain reasonable and staff burnout and possible turnover stay low. The staff in this agency were relatively mature in age, and decision-making was in principle democratic, although how that ideal operated in practice would need extensive specific observations to ascertain. The supervision and day-to-day quality of interpersonal relations among the staff were experienced as very positive, but training was widely perceived as inadequate for the demands of the work. Fryer, Poland, Bross, and Krugman (1988) found that 20 or more hours of formal training in child abuse prior to starting work in the field was associated with
904
H.R. Winefield and J. A. Barlow
greater confidence and job satisfaction, and that membership in a multidisciplinary team was a particularly positive influence. As noted by Oates (1985), multidisciplinary teams need good direction, to avoid the hazard of every member feeling that responsibility for the family lies with another member of the team. As service quality is often assessed by clients in terms of the personal interaction between client and provider, the providers need to be carefully selected, trained, and encouraged (Heskett, Sasser, & Hart, 1990). A major unmet need appears to be for specific training for staff in child protection work, especially the emotions that it arouses in workers, and what is realistic progress to expect. Some staff feel the need for specialist training in therapeutic methods. With increasing time since the pre-implementation training period, and with staff turnover, it is necessary to plan and resource an ongoing program of professional training. As much of the reward to staff in child protection comes from feeling effective in improving conditions for children, it is important for staff morale to keep up the mechanisms for feedback from clients to staff, and bilaterally between the staff and the management committee. There would be advantages therefore if evaluation could become ongoing and internal, in order to guide decision-making and to increase understanding of the process and outcomes of service delivery. Clear procedures for internal review and self-assessment would enable the development of a structure for recognition (both personal and public) for work excellence. Criteria for excellent work need development, however, and will remain controversial pending clarification. Acknowledgement--Tbe authors are grateful to all the participants for their cooperation.
REFERENCES Daro, D., & Mitchel, L. (1992). Evaluation of the William Penn Foundation Child Abuse Prevention Initiative: Client impact study. Chicago, IL: NCPCA. Dubowitz, H. (1990). Costs and effectiveness of interventions in child maltreatment. Child Abuse & Neglect, 14, 177-186. Fink, A., & McCIoseky, L. (1990). Moving child abuse and neglect prevention programs forward: Improving program evaluations. Child Abuse & Neglect, 14, 187-206. Fletcher, L. (1982). Battered professionals. In K. Oates (Ed.), ChiM abuse: A community concern (pp. 239-245). London: Butterworths. Fryer, G. E., Bross, D. C., Krugman, R. D., Denson, D. B., & Baird, D. (1990). Good news for CPS workers. Public Welfare, Winter, 38-41. Fryer, G. E., & Miyoshi, T. J. (1989). The relationship of child protection worker attitudes to attrition from the field. Child Abuse & Neglect, 13, 345-350. Fryer, G. E., Poland, J. E., Bross, D. C., & Krugman, R. D. (1988). The child protective service worker: A profile of needs, attitudes, and utilization of professional resources. Child Abuse & Neglect, 12, 481-490. George, S., Jones, E., & McCurdy, K. (1992). The William Penn Foundation Prevention Initiative: An in-depth study of high risk mothers. Chicago, IL: NCPCA. Hall, S. (1984). A view of community based services. In F. Maas & S. Sach (Eds.), Community based services for children and families (pp. 110-113). Melbourne: Institute of Family Studies. Heskett, J. L., Sasser, W. E., & Hart, C. W. L. (1990). Service breakthroughs. New York: Free Press. Maslach, C. (1982). The cost of caring. Englewood Cliffs, NJ: Prentice Hall. Melville, A. (1980). Job satisfaction in general practice: Implications for prescribing. Social Science and Medicine, 14A, 495-499. Oates, K. (1985). Child abuse and neglect: What happens eventually? Sydney: Butterworths. Polansky, N. A., Chalmers, M. A., Buttenwieser, E., & Williams, D. P. (1981). Damaged parents: An anatomy of child neglect and its prevention. Chicago, IL: University of Chicago Press. Shireman, J. F., Grossnickle, D., Hinsey, C., & White, J. (1990). Outcome study of protective services: Comparison of interviews and records as data sources. Child Welfare, 69, 167-179. Stevenson, O. (1992). Social work intervention to protect children: Aspects of research and practice. Child Abuse Review, 1, 19-32. Warr, P. B., Cook, J., & Wall, T. (1979). Scales for the measurement of work attitudes and psychological well-being. Journal of Occupational Psychology, 52, 129-148.
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R~sum~---Dans cette 6tude, on a enqu~t6 sur le niveau de satisfaction des usagers et du personnel par rapport au travail qu'ex6cute une agence pluridisciplinaire de protection des enfants. On s'est servi d'entrevues et de questionnaires normalis6s. Le but 6tait de connaitre la nature et la puissance de la relation aidante entre les usagers et les dispenseurs des services. Vingt quatre usagers ont exprim6 beaucoup de satisfaction ~ l'6gard du personnel et des services. Le personnel de l'agence (au nombre de 21, dont 11 travaiilaient h temps partiel avec ies families) s'est montr6 relativement satisfait de la situation de travail e t a d6montr6 peu de signes d'6puisement professionnel, lequel menace les travailleurs en protection de l'enfance. Ceux-ci manifestaient une relation empathique avec leurs clients et d6montraient de l'enthousiasme vis-h-vis de leur travail. En tenant compte des inexactitudes dans les r6ponses, il est clair que cette agence a r6ussi h assurer une condition essentielle h l'action th6rapeutique, soit de permettre qu'il se d6veloppe une relation positive et r6ceptive entre le travailleur et le client. Resumen----Se investig6 la satisfacci6n del cliente y del personal con los trabajos de una agencia de proteccion infantil multidisciplinaria utilizando entrevistas y cuestionarios estandarizados. El objetivo era descubrir la naturaleza y la fuerza de la relaci6n de ayuda entre los receptores y proveedores de servicios. Los clientes actuales (N-24) expresaron mucha satisfaccion con los servicios y con el personal, El personal de la agencia (N = 21, con I l empleados por lo menos a medio tiempo para trabajar directamente con las familias) estaban relativamente satisfechos con sus trabajos, y mostraban pocas se~ales del agotamiento que ha sido reconocido como un desgo para los que trabajan en la protecci6n infantil. Tomando en cuenta posibles prejuicios en las respuestas de ambos grupos, atln existen pruebas de que la agencia tiene 6xito en crear una necesaria pre-condicion para el cambio terap6utico: el desarrollo de relaciones positivas de aceptaci6n entre el personal y el cliente.