Outcomes of Aggression and Victimization in Social Welfare Services.

This study examined two significant phenomena that occur in the workplace, aggression and victimization, and their outcomes. The study's participants were 470 social workers employed by social welfare services in Israel. The examined outcomes were stress symptoms, emotional exhumation, and decline in quality of service climate. The associations between aggression, victimization, and their outcomes were examined via linear regression during Stata 14. The study found that the similar outcomes of aggression and victimization are stress symptoms and emotional exhaustion, while service climate (decline in quality) was associated only with victimization. While most studies have examined mainly victimization outcomes, the current study examined both aggression and victimization outcomes. This article sheds light on the similarities and the difference of outcomes between aggression and victimization and explicates the phenomena of workplace aggression from two important and complementary aspects of aggression and victimization. It is important to refer to either aggression or victimization while considering workplace aggression. Authors recommend for further studies to continue to investigate both aggression and victimization while researching workplace aggression outcomes.

The religious implications of being sexually abused by a rabbi: Qualitative research among Israeli religious men.

BACKGROUND: Clergy perpetrated sexual abuse (CPSA) is a widespread phenomenon, with many consequences for the victims. To the best of our knowledge, no research has focused on the religious consequences for Israeli Jewish religious men who were sexually abused by rabbis in their adolescence or emerging adulthood. OBJECTIVE: To describe the implications of CPSA for the religious faith, practice, and attitude towards rabbis among sexually abused Israeli religious men. METHODS: Based on a constructivist-phenomenological paradigm, semi-structured in-depth interviews were conducted with eight formerly and/or currently still religious men who had been abused by rabbis. RESULTS: Three main themes regarding religious consequences, emerged from the findings: the impact of CPSA on the religiosity of the victims; the effect of being sexually abused by a rabbi on victims' attitudes toward other rabbis; and the process of finding a new rabbi after the abuse. CONCLUSIONS: This preliminary study opens a window onto the complex nature of this type of sexual abuse and its religious consequences. The unique findings regarding the range of religious implications are not consistent with previous studies about Christian victims. These findings contribute to the understanding of this distinctive form of abuse, for establishing intervention techniques that will assist the victims and for additional research.

Judgements of physicians, nurses, and social workers regarding suspected Child maltreatment in community health care services.

This study investigated how physicians, nurses, and social workers in community health care services make judgements about possible child maltreatment in ambiguous situations. We examined the influences of social biases (i.e., perceptions linking ethnicity, gender, and family socioeconomic status to child maltreatment) and belonging to distinctive occupational groups (i.e., physicians, nurses, and social workers) on professionals' assessment of suspected child maltreatment, intention to consult with others, and reporting. We used an experimental survey design including vignettes presenting a child's history inspired by real-life clinical cases. Data were collected from 397 health care professionals-170 physicians, 179 nurses, and 48 social workers-employed at community health care clinics in northern Israel. Findings show that the child's gender and family socioeconomic status had significant effects on assessment of possible child maltreatment. Also, professionals' occupational group had significant effects on assessment of child maltreatment and intention to pursue consultation. Another key finding was the significant effects of judgements about child maltreatment assessment, consultation, and reporting on one another. The study reinforces efforts to improve health care professionals' management of suspected child maltreatment that include the development of clinical decision support systems that use routinely collected electronic medical record data.

Understanding health outcomes following workplace aggression: A social exchange perspective.

This study explored health outcomes following workplace aggression among social workers in Israel. Grounded in the social exchange theory, a relationship-based perspective was used to explain the mechanism through which exposure to workplace aggression results in employee outcomes. Reports of employees and managers were analysed with respect to the impact of varied forms of aggressive behaviours perpetrated by clients and co-workers on posttraumatic stress and somatic symptoms. The intervening effects on symptoms of two forms of perceived organisational support, organisational procedural support and interpersonal co-worker support operationalised as team trust were examined. Overall, 548 employees and 89 managers in 31 social services departments completed self-report questionnaires. Results revealed positive associations between exposure to both co-worker and client aggression, and posttraumatic stress and somatic symptoms. Importantly, while perceived organisational support is often equated with social support, this study found that two elements, organisational procedural support and team trust, had differing impacts on somatic and posttraumatic stress symptoms following WPA. Specifically, team trust was negatively associated with symptoms, while organisational procedural support showed no effect. This study has important implications for timely prevention measures to deal with workplace aggressions and valuable directions for future studies.

An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives.

Mental health professionals are frequently presented with situations in which they must assess the risk that a client will cause harm to themselves or others. Troublingly, however, predictions of risk are remarkably inaccurate even when made by those who are highly skilled and highly trained. Consequently, many jurisdictions have moved to impose standardized decision-making tools aimed at improving outcomes. Using a decision-making ecology framework, this conceptual paper presents research on professional decision-making in situations of risk, using qualitative, survey, and experimental designs conducted in three countries. Results reveal that while risk assessment tools focus on client factors that contribute to the risk of harm to self or others, the nature of professional decision-making is far more complex. That is, the manner in which professionals interpret and describe features of the client and their situation, is influenced by the worker's own personal and professional experiences, and the organizational and societal context in which they are located. Although part of the rationale of standardized approaches is to reduce complexity, our collective work demonstrates that the power of personal and social processes to shape decision-making often overwhelm the intention to simplify and standardize. Implications for policy and practice are discussed.

Applying intersectionality theory to understand female Arab art-therapists' experiences with child maltreatment mandatory reporting.

This study moved away from the usual empirical and moral discussion about all-encompassing child maltreatment mandatory reporting outcomes toward a much more detailed and nuanced investigation of its implementation in a minority group. We focused on female Arab art-therapists in Israel working in their community. Twelve female Arab art-therapists participated in semi-structured interviews. Data were analysed using grounded theory. Participants' extreme vulnerability was an emergent quality of analysis and facilitated intersectional framing to account for the findings. The convergence of gender, ethno-culture and occupational status constituted unique obstacles to reporting. Participants described an array of systemic barriers to reporting, some of which could jeopardise their safety and that of their family and job. They raised doubts about the benefits of reporting outweighing the harm. Creating a climate in which reporting is possible and acceptable is the responsibility of the society, rather than that of individuals.

Whose fault is it? Attribution of causes of patient violence among exposed and unexposed community-based family physicians.

Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community-based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community-based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient-initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property-related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician-patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP.

Ethics Review Boards for Research With Human Participants: Past, Present, and Future.

The debate around ethics review boards (IRBs) has assumed an increasingly central place in academic practice and discourse. In this article, we summarize a unique workshop (study-group) that convened at the University of Haifa, attended by 27 academics from around the globe, representing nine countries in four continents. The participants presented data and points of view, which served as the basis for an open, interdisciplinary discussion. The group developed a set of recommendations, including working toward a transition from a review system to an advisory and validation system; focusing on respectful research approach to participants, rather than "ethical" research; building a procedure that focuses on feedback, rather than the process itself; recognizing that a unified examination need not necessarily be standardized; and constructing a feedback procedure in which researchers can respond to the review of their research.

Assessing, Consulting, Reporting Heuristics in Professional Decision-Making Regarding Suspected Child Maltreatment in Community Healthcare Services.

This study investigated child protection decision-making practices of healthcare-professionals in community-health-services. We examined the effect of heuristics in professional judgments regarding suspected maltreatment, as affected by the child's ethnicity, gender, and family socioeconomic-status, as well as the healthcare-worker's workload-stress, and personal and professional background. Furthermore, we examined how these variables influence judgments regarding suspected maltreatment and intentions to consult and report child-maltreatment. We used an experimental survey design including vignettes manipulating the child's characteristics. Data was collected from 412 professionals employed at various community-health-service-clinics of the largest health-management organization in northern Israel. Findings show that all subjective factors have a significant effect on suspected child-maltreatment assessment, which appears as a significant predictor of later decisions regarding consultation and reporting. This study lends support to prior research indicating that healthcare-professionals' decisions may incorporate biases, and suggests how the effects of these biases' are mediated through a sequence of decisions. Recommendations focus on providing regular consultation opportunities for practitioners.

Cigarettes versus water-pipes: Differences and similarities in factors predicting the use of cigarettes and water-pipes among young male adults according to the planned-behaviour theory.

Cigarette and water-pipe smoking are responsible for substantial harmful health consequences. However, studies have often examined these two types of smoking in separate study samples. Thus, this study examined differences and similarities among factors predicting cigarette and water-pipe smoking according to planned-behaviour theory within the same sample. Two hundred and twenty-one young Arab Israeli male adults (N = 221) completed demographic, self-esteem and planned-behaviour questionnaires. The study findings demonstrated that perceived ability to control one's water-pipe use was significantly higher than perceived ability to control one's use of cigarettes. With regard to attitudes, norms and intentions, no significant differences were found between cigarette and water-pipe use. Hierarchal multiple regressions showed that being Muslim, self-esteem, negative attitudes and negative norms contributed to the explained variance of both cigarette and water-pipe smoking. Self-control contributed to the variance in cigarette smoking, but not water-pipe smoking. The findings make an important contribution to our understanding of the differences and similarities in the factors predicting cigarette and water-pipe use among young male adults. Theoretical and clinical implications are discussed.

Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals' reporting of child maltreatment.

BACKGROUND: Healthcare professionals working at community-based services have a crucial position in raising concerns about possible child maltreatment. Yet, barriers exist to healthcare professionals adhering to mandatory reporting rules and regulations. OBJECTIVE: The current study investigated the various forms by which healthcare professionals working in community services manage mandatory reporting, their reasoning and experience with formal requirements. The study has utilized the decision-making-ecology model as a conceptual framework. PARTICIPANTS AND SETTING: The study was carried out in the largest district of the largest health-management organization in Israel, across fourteen sites located at seven cities. Eighteen healthcare professionals of various occupational groups participated in in-depth semi-structured interviews. RESULTS: The results reveal that out of the of 52 recent cases that have been suspected for possible child maltreatment, only 58 % were reported as legally required. Yet, about half were reported in delay. Practitioners were more likely to report after additional evidence accumulated and increased the level of suspicion or after failing to manage the issue by other means of support. The analysis identified multiple factors that combined to impact the decision-making regarding reporting. Those were clustered around the individual case, healthcare professional, organizational setting, and external context. CONCLUSIONS: Our results emphasize the importance of workplace-environmental conditions in promoting optimal reporting behaviors, including working in multi-disciplinary teams, availability of rapid expert consultation, provision of emotional-support, and reciprocal exchange of information with child-protection-services.

Providing Health Care in the Shadow of Violence: Does Emotion Regulation Vary Among Hospital Workers From Different Professions?

Research into violence against health care staff by patients and their families within the health care services shows a rising frequency of incidents. The potentially damaging effects on health care staff are extensive, including diverse negative psychological and physical symptoms. The aim of this qualitative study was to examine how hospital workers from different professions reacted to patients' and visitors' violence against them or their colleagues, and how they regulated their emotional reactions during those incidents. The research question was as follows: How do different types of hospital workers regulate the range of their emotional reactions during and after violent events? Participants were 34 hospital workers, representing several professional sectors. Data were collected through in-depth semistructured interviews, which were later transcribed and thematically content analyzed. Five themes were revealed, demonstrating several tactics that hospital workers used to regulate their emotions during incidents of violent outbursts by patients or visitors: (1) Inability to Manage Emotion Regulation, (2) Emotion Regulation by Distancing and Disengagement Tactics, (3) Emotion Regulation Using Rationalization and Splitting Tactics, (4) Emotion Regulation via the Use of Organizational Resources, and (5) Controlling Emotions by Suppression. Hospital workers who experienced dissonance between their professional expectations and their emotional reactions to patients' violence reported using various emotion regulation tactics, consequently managing to fulfill their duty competently. Workers who did not experience such dissonance felt in full control of their emotions and did not manifest responses of emotion regulation. Others, however, experienced intense emotional flooding and failed to regulate their emotions. We recommend developing health care staff's awareness of possible emotional implications of violent incidents, for themselves as people and for their intact functioning at work. In addition, we recommend further development of health care staff training programs for coping with violent patients and enhancement of formal and informal organizational support.

European Social Work Research Association SIG to Study Decisions, Assessment, and Risk.

PURPOSE: The increasing interest in professional judgement and decision making is often separate from the discourse about "risk," and the time-honored focus on assessment. METHOD: The need to develop research in and across these topics was recognized in the founding of a Decisions, Assessment, and Risk Special Interest Group (DARSIG) by the European Social Work Research Association in 2014. RESULTS: The Group's interests include cognitive judgements; decision processes with clients, families, other professionals and courts; assessment tools and processes; the assessment, communication, and management of risk; and legal, ethical, and emotional aspects of these. This article outlines the founding and scope of DARSIG; gives an overview of decision making, assessment, and risk for practice; illustrates connections between these; and highlights future research directions. DISCUSSION: Professional knowledge about decision making, assessment, and risk complements knowledge about effectiveness of interventions. CONCLUSION: DARSIG promises to be a useful mechanism for the purpose.

Attitudes Toward Domestic Violence and Corporal Punishment Among Former Soviet Union Immigrants in Israel.

The study regards attitudes of Russian immigrants in Israel toward wife abuse and corporal punishment. The sample consisted of 1,028 participants, based on a multistage cluster sampling. The study used a questionnaire related to immigration, acculturation, and attitudinal issues. The findings indicate a dual-causal model, in which corporal punishment attitudes contribute to wife abuse attitudes and vice versa. However, the effect of attitudes supporting corporal punishment was stronger than the effect of wife abuse attitudes, indicating that the attitudinal system as a precursor of violent behavior is already merging the two types of violence.

Reflexivity: The Creation of Liminal Spaces--Researchers, Participants, and Research Encounters.

Reflexivity is defined as the constant movement between being in the phenomenon and stepping outside of it. In this article, we specify three foci of reflexivity--the researcher, the participant, and the encounter--for exploring the interview process as a dialogic liminal space of mutual reflection between researcher and participant. Whereas researchers' reflexivity has been discussed extensively in the professional discourse, participants' reflexivity has not received adequate scholarly attention, nor has the promise inherent in reflective processes occurring within the encounter.

From violence to hope: the construction of professional knowledge in treating imprisoned male batterers in Israel.

The treatment of incarcerated batterers has not been as thoroughly studied as that of men who take part in community treatment programs. The current study describes and analyzes the "practice wisdom" of professionals in a special unit that focuses on treating batterers in an Israeli prison. The analysis is based on in-depth semistructured interviews aimed at facilitating a self-reflective process among the participating social workers. In understanding the construction of tacit knowledge by the social workers, we observe four major dialectical themes in their construction of their practice knowledge: (a) the dialectics of behavior modification and psychodynamic change, (b) the paradoxical use of authority in the service of treatment, (c) the multiple meanings of gender, and (d) the question of change--what really makes the difference? While such opposites might never be fully reconciled, the tension and changes can contribute to construction of professional knowledge.

Between rigidity and chaos: worldviews of partners experiencing intimate partner violence.

The goal of this article was to examine the worldviews of cohabiting or married men and women who experienced domestic violence in their relationships. The study was based on content analysis of in-depth interviews with 48 men and women (24 couples), who were living together after experiencing at least one violent event in their relationships over the previous 12 months. Using constructivist grounded theory, the authors examined the deep structure of the ways by which partners living with intimate partner violence constructed their world. The men and women under study constructed heuristic models in two major life domains-psychological processes and how the world works overall. The analysis has revealed two axes resulting in four worldviews. The two axes were the construction of the world and the construction of the mind. Constructions of the mind ranged from chaotic to deterministic. Constructions of external reality ranged from static to fluid and uncontrollable. The theoretical model developed suggested four different types of basic worldviews. The suggested typology was examined in relation to existing typologies in the field of intimate partner violence and in relation to future research and interventions.

Power relations and reciprocity: dialectics of knowledge construction.

In this article we suggest a theoretical framework of knowledge construction by employing the concept of dialectics to power relationships between researcher and participants. Power distribution in research is perceived as dichotomous and asymmetrical in favor of the researcher, creating unequal power relations that make exploitation possible. Acknowledging such exploitation has led to a critical stance and attempts to bridge gaps through egalitarianism and empowerment of participants. Some scholars have focused on shifting expert knowledge differentials between researcher and participants throughout the research project. Others have evaluated such gaps as a source of knowledge construction. In the present work we applied a dialectical approach to understanding research relationships, suggesting reciprocity as their defining attribute, regardless of symmetry or asymmetry and as a source of knowledge construction. In this article we recommend avoiding a taken-for-granted attitude, because we see it as a direct obstacle to the construction of knowledge.

From the "greenhouse" to reality: challenges faced by graduates of in-prison batterers intervention program.

Beit-Hatikva (BH) is a special unit within the Israeli prison system, and houses violent men who were sentenced to prison time for domestic violence. The goal of BH is to bring about behavioral and identity changes. The study explores the lived experiences of BH graduates. Twelve BH graduates were interviewed using an in-depth qualitative interview, at least one year following their release from prison. Interviewees were asked about meaningful experiences they underwent following their release from prison. Going out to the reality of life outside of BH, the graduates encounter narratives that challenge the BH narrative of changed identity and transformation. Focusing on their past, their stigma as ex-convicts, and disregarding their past normative achievements, this external and challenging societal narrative attempts to draw the graduate back into old patterns of thinking and behaving, challenging them to face temptations, provocations, expectations, and assumptions of social reality.

Client aggression toward social workers and social services in Israel--a qualitative analysis.

The aggressive behavior of clients toward employees in service organizations is an alarming phenomenon, which harms employees and damages the organization itself. Employees all over the public sector, especially in social service departments, are continuously exposed to aggressive behavior by clients. The focus of the current study is on understanding the short- and long-term implications of aggressive client behavior on social workers and the organization in which they operate. A qualitative approach was used to understand the perspective of the workers exposed to aggressive client behavior as well as its organizational implications. In-depth interviews were conducted with the 40 participants between February and May, 2009. The participants included district managers, agency managers, supervisors, social workers, and administrators, in 17 agencies all over the country. The study findings identified negative impacts of client aggression on several levels and on several focal areas. On the emotional, cognitive, and behavioral levels, both short-term and long-term consequences can be seen, which affect not only the attacked individual but also resonate throughout the organization. Individual events may diffuse to affect other levels of the service process by role-learning, imitation of behavior, and by noticing that the organization provides incentives for client aggression, while providing disincentives for assertiveness and self-protective actions on the part of workers.