An assessment of burnout in human service providers.

Burnout is an occupational hazard for human service providers. The chronic emotional stress associated with the provision of human services produces "a syndrome of physical and emotional exhaustion, involving the development of negative self concept, negative job attitudes, and a loss of concern and feelings for clients" (Pines & Maslach, 1978, page 224). Some individuals seem more predisposed than others to burnout. "Feeling" personality types (as classified by the Myers-Briggs Type Indicator) experience a much greater depletion of emotional energy in the face of negative reactions to people than do "thinking" types (Garden, 1987). In addition, those who are more likely to become emotionally involved in their work are more likely to burn out than those who have a more detached workstyle (Freudenberger, 1975).

Leiter (1991) has suggested that burnout may be inevitable for all personality types, due to the conflict between the idealistic "professional mystique" with which aspiring human service providers are endowed during their training and the harsh realities of working in the human service profession. People who enter the human service profession expect their jobs to be full of challenging experiences. They anticipate many emotionally rewarding interactions with grateful consumers, an air of camaraderie among their coworkers, and an administration that allows them autonomy in decision making and rewards their initiatives. All too often, however, they find that their consumers resent them as yet another authority figure in the bureaucratic leviathan. In some work settings, such as child welfare departments, the difficulties in negotiating the legal system, the limited capabilities of the consumers to help themselves, and the emotionally gripping nature of the tragedies of the innocent can make even relatively small caseloads overly oppressive (Jayaratne & Chess, 1984). Instead of new, challenging experiences, many human service providers find that their jobs involve going through the same tedious bureaucratic exercises every day (Freudenberger, 1975; Kafry & Pines, 1980; Pines & Kafry, 1978). Positive feedback, which is an important stress reliever in many situations, is scarce (Kafry & Pines, 1980; Pines & Kafry, 1978; Streepy, 1981). Coworkers and clinical supervisors who are already burned out are not a good source of camaraderie and social support. Staff meetings, which can provide a setting for this badly needed support, are often too technical and clinical to provide a break from the routine (Ursprung, 1986).

Because of the numerous regulations associated with most government agency administrations, individual autonomy is compromised and individual initiatives may be restricted (Cherniss, 1980; Kafry & Pines, 1980; Pines & Kafry, 1978; Raquepaw & Miller, 1989). Not only is the inability to exercise one's own judgements frustrating, but many service providers feel that funds are frequently allocated according to political and statistical concerns, rather than in a manner that maximizes the efficiency with which services are delivered to the consumers (Edelwich & Brodsky, 1980).

Burnout has many undesirable consequences, among them stress-related psychosomatic illness, social withdrawal, substance abuse and the deterioration of significant familial and personal relationships (Freudenberger, 1975; Maslach & Jackson, 1986). In addition, burned out workers have been shown to be more likely to neglect important aspects of their jobs (Quattrochi-Tubin, Jones & Breedlove, 1982), or to demonstrate faulty judgements that may impair the level of service that they provide to their consumers (McGee, 1989). The present study measured burnout in the employees of three human service agencies in northwestern North Carolina, in an attempt to identify specific agencies for whose staff therapeutic interventions might be necessary.

Method

Participants

Participants were recruited from the State Department of Social Services, JOBS Program (DSS), the State Division of Vocational Rehabilitation, Unit Office (DVR) and Goodwill Industries of Northwest North Carolina (GWI). These agencies provide their consumers with evaluation/assessment, counseling, case management, job skills training, job placement and work adjustment programming. In all three agencies, the primary objective of the service providers is to place their consumers in jobs. Surveys were sent to all people from these three agency offices whose activities included direct contact with consumers. Seventeen (77.3%) of the providers from DSS, 15 (71.4%) of the providers from DVR and 15 (75%) from GWI returned completed surveys and all were included in the study wherever possible. Of the 47 participants, 44 were caseworkers and 3 were administrators. A few participants' data could not be used for certain analyses, if the participants' race or consumer population type was unique, producing group size differences that invalidated some of the assumptions underlying the statistical analyses.

Burnout Assessment

Burnout was assessed using the Maslach Burnout Inventory (MBI), which measures three largely independent aspects of burnout (Lee & Ashforth, 1990; Maslach & Jackson, 1981, 1986). The emotional exhaustion (EE) subscale corresponds to the psychological and physiological strain associated with the continual emotional involvement with one's consumers' situations. High scores on the EE subscale have been associated with tension, anxiety, physical fatigue and insomnia. The depersonalization (DP) subscale measures the development of a cynical, dehumanizing attitude toward the consumers. High scores on the DP subscale indicate that the service provider has developed a coping strategy by which he/she attempts to limit the degree to which contact with the consumers drains his/her emotional energy by seeing the consumers as impersonal objects or numbers. The personal accomplishment (PA) subscale measures the service provider's perception of his/her own ability to control his/her situation, and to make a difference in his/her consumers' lives. In contrast to the other two subscales, low scores on the PA subscale indicate feelings of helplessness and underachievement on the part of the service provider.

Procedure

Surveys were distributed to the respective human service providers either by regular mail (DSS and DVR) or intraagency mail (GWI). Participants were assured of their anonymity and asked to complete the MBI, as well as a personal information sheet (age, gender, race, job title, length of service in their present position and in the human service field in general, direct contact hours, hours spent on paperwork, caseload size and primary population served).

Experimental Design

Results were analyzed using the Statistical Package for the Social Sciences--Personal Computer version. Either t tests or analysis of variance (Newman-Keuls post hoc test) were used to evaluate the effects of gender, race or primary population served. The effects of age, length of service, caseload, and time spent in direct contact with consumers versus handling paperwork were determined by the Pearson product-moment correlation.

Results and Discussion

Among the consumer populations included in this study, working with people who are economically disadvantaged appeared to be the least emotionally draining (Table 1). The degree of emotional exhaustion associated with these consumers was slightly to moderately lower than that associated with the other consumer populations. More importantly, there was a tendency to depersonalize these consumers less than consumers with functional disabilities. It is interesting to note the difference in the patterns of EE and DP scores between the four service provider groups. Several researchers have suggested that depersonalization is a coping strategy which develops in response to the emotional exhaustion involved in serving these consumers, and helps minimize the emotional drain on the service provider (Maslach & Jackson, 1986). This suggestion is supported by the frequent finding of a positive correlation between EE and DP scores (Maslach & Jackson, 1986). A positive correlation was found between EE and DP scores in the present study as well (r=+0.61, p[less than].001). However, there was a moderate tendency to depersonalize consumers with physical disabilities, despite there being a low level of emotional exhaustion reported by these service providers. Although it is no doubt true that depersonalization serves as a coping strategy for the service provider, the data from the present study suggest the additional possibility that depersonalization may be an innate aspect of the service provider's response to consumers with overtly visible physical disabilities, independent of the degree of emotional exhaustion involved with serving them.

Table 1
Burnout Scores by Primary Consumer Population

                    Emotional
                    Exhaustion           Depersonalization

Physical            13.7 [+ or -] 4.0    6.0 [+ or -] 3.1
Disabilities           low(*)                moderate

Emotional/          23.3 [+ or -] 4.0    6.7 [+ or -] 6.7
Mental                 moderate              moderate
Disabilities

Economically        11.8 [+ or -] 4.0    3.1 [+ or -] 2.0
Disadvantaged          low                   low

Mixed-Physical      19.1 [+ or -] 11.8   6.2 [+ or -] 5.2
Disabilities           moderate              moderate
plus Economically
Disadvantaged

F(3,37)                3.7                   2.3
                       p<.05                 n.s.

                       Personal
                    Accomplishment

Physical            38.3 [+ or -] 7.8
Disabilities           high

Emotional/          43.0 [+ or -] 4.0
Mental                 high
Disabilities

Economically        39.7 [+ or -] 4.1
Disadvantaged          high

Mixed-Physical      35.1 [+ or -] 10.7
Disabilities           moderate
plus Economically
Disadvantaged

F(3,37)                1.4
                       n.s.

Mean [+ or -] std. dev.
(*) Versus norms for social service workers, Maslach & Jackson,
1986.

The size of the caseload did not have a significant effect on burnout in this study. In addition, the effect of quotas cannot be determined, because DVR was the only agency for which the service providers had objective quotas for the number of consumers placed in jobs per month. However, providers whose activities involved more direct contact with consumers and less paperwork reported a greater sense of personal accomplishment. The personal accomplishment scores showed a positive correlation with the number of direct contact hours per week (r=.3359, p[less than].05), and a negative correlation with the number of paperwork hours per week (r=-0.2475, p=.059). There was also a negative correlation between the emotional exhaustion score and the length of time the provider had been in his/her position (r=0.267, p.05). This probably reflects a predictable tendency for those who do not get as emotionally exhausted to remain in their positions for longer periods of time.

There were no differences between female (n=34) and male (n=13) service providers with respect to either EE, DP or PA scores in the present study. Black (n=8) providers reported significantly lower EE scores than did white (n=37) providers [t(43)=2.34, p[less than].05]. In contrast, however, black providers also reported lower PA scores than did white providers [t(43)=1.8, p[less than].08]. It is difficult to apply any practical interpretation to these contradictory findings, especially given the small sample of black service providers available.

Comments

Identifying specific sources of burnout is important in designing detection/intervention programs that can best keep human service providers functioning well. The data from this study suggest two factors of potential importance. First, service providers who spent more time in direct contact with consumers and less time attending to paperwork had a greater sense of personal accomplishment. This suggests that it might be beneficial to shift some of the agencies' paperwork duties to clerical workers if possible, or that the effort to reduce paperwork that will be part of the emerging changes in the health care system should be applied to the human service fields as well. The other finding from the present study is that service providers tend to depersonalize consumers with overtly observable physical disabilities to a greater degree than consumers who do not have these disabilities. It would be of obvious interest to determine whether this is true of service providers in other agencies or geographic areas. If so, this would suggest that service providers who serve people with overtly visible physical disabilities should be made especially aware of the symptoms of depersonalization and of the need to guard against the tendency to depersonalize their consumers.

References

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