Population-Based Study of Magnitude and Risks for Educators School Violence: Population-Based Study of Magnitude and Risks for Educators

RESEARCH TEAM MINNESOTA EDUCATORS’ STUDY Susan Goodwin Gerberich, PhD Nancy M. Nachreiner, PhD Andrew D. Ryan, MS Steven J. Mongin, MS Timothy R. Church, PhD Patricia M. McGovern, PhD Mindy S. Geisser, MS Denise Feda, MS, PhD Candidate Starr Kelley Sage, MPH, PhD Candidate Evette Pinder, MPH, PhD Candidate Gavin D. Watt, BA

MINNESOTA EDUCATORS’ STUDY BACKGROUND AND SIGNIFICANCE

Work-Related Violence 900 work-related homicides annually (1993-1999) (Duhart, 2001) 516 in 2006 (Bureau of Labor Statistics, www.bls.gov) Fourth major cause of all occupational fatality 1.7 million non-fatal work-related acts of violence (1993-1999); 12.5/1,000 persons (Duhart, 2001; Bureau of Labor Statistics, www.bls.gov) Estimated cost: 4.2 billion dollars per year, $250,000/episode lost work time (Albrecht, 1997)

Minnesota United States Rocori High School September 2003 2 fatalities Red Lake High School March 2005 10 fatalities, including 1 teacher and numerous non-fatalities United States • 1979-2005, 60 events identified by media • 2006-2007, 32 events http://www.schoolsecurity.org/trends/school_violence 06-07.html

MINNESOTA EDUCATORS’ STUDY PURPOSE OF THE STUDY • Identify the magnitude and related consequences of physical and non-physical work-related violence against educators • Identify specific risk factors for work-related physical violence against educators

MINNESOTA EDUCATORS’ STUDY METHODS

MINNESOTA EDUCATORS’ STUDY STUDY COHORT Kindergarten-12th grade licensed teachers (n = 116,661) identified in the Minnesota licensing databases, as of January 01, 2003 PILOT STUDY 300 teachers randomly sampled to test all study phases SCREENING SURVEY 26,000 teachers randomly sampled from population ELIGIBLE COHORT Cohort of 6,469 eligible teachers, based on screening survey

MINNESOTA EDUCATORS’ STUDY PHASE 1: INITIAL COMPREHENSIVE STUDY STUDY DESIGN PHASE 1: INITIAL COMPREHENSIVE STUDY 6,469 Educators Determine the magnitude and consequences of work-related violence for a one-year period of time

MINNESOTA EDUCATORS’ STUDY PHASE 2: CASE-CONTROL STUDY STUDY DESIGN PHASE 2: CASE-CONTROL STUDY Cases (n=372): Persons who reported being physically assaulted and worked as educators in Minnesota during a 12-month study period Controls (n=1,116): Persons who did not report being physically assaulted and worked as educators in Minnesota during a 12-month study period Identify specific risk factors for work-related physical assault, based on exposures one-month prior to the assault for cases and a randomly assigned period for controls

MINNESOTA EDUCATORS’ STUDY CONTACT PROCEDURES AND DATA COLLECTION STUDY DESIGN CONTACT PROCEDURES AND DATA COLLECTION • Comprehensive and Case-Control mailed surveys: (cover letter, including informed consent information, specially designed surveys, and stamped, return envelopes) • Up to four follow-up mailings to optimize response rates • Validation of injury and exposure information

MINNESOTA EDUCATORS’ STUDY STUDY DEFINITIONS Work-related violence: intentional use of physical force or emotional abuse, against an employee, that results in physical or emotional injury and consequences Physical Assault: occurs when you are hit, slapped, kicked, pushed, choked, grabbed, sexually assaulted, or otherwise subjected to physical contact intended to injure or harm Non-Physical Violence: threat; sexual harassment; verbal abuse; and bullying

MINNESOTA NURSES’ STUDY STUDY DEFINITIONS NON-PHYSICAL VIOLENCE includes: threat; sexual harassment; verbal abuse; and bullying. Threat: occurs when someone uses words, gestures, or actions with the intent of intimidating, frightening or harming you Sexual Harassment: occurs when you experience any type of unwelcome sexual behavior (words or actions) that creates a hostile work environment Verbal Abuse: occurs when another person yells or swears at you, calls you names, or uses other words intended to control or hurt you Bullying: is defined as repeated acts of intimidation or coercion

MINNESOTA EDUCATORS’ STUDY ANALYSES Descriptive analyses to estimate incidence and identify consequences of work-related violence Multivariate analyses to estimate the effect of specific exposures on violence, i.e., to identify “risk and protective factors” Analyses controlled for numerous factors to minimize bias and adjustments were made for non-response in the presence of unknown eligibility.

MINNESOTA EDUCATORS’ STUDY CONCEPTUAL MODEL FOR WORK-RELATED VIOLENCE TEACHERS Personal Characteristics: Demographics (gender; age; race; marital status; socioeconomic status) Body Mass Stress Education, including specialty training Illness/injury history, including assaults Violence management/conflict resolution training Work-related Characteristics Work experience Job type Workload; hours worked/week Student contact/week (hours; numbers) OTHERS Co-workers: Demographics (age; gender; race) Number/types of staff Interaction/support Students Number/types Mental status/impairment History of assaultive behavior • Other relevant behaviors/activities ENVIRONMENT Facility: Type/Level/Size of School • Area socioeconomic status Location • Physical design/attributes (openness; visibility; crowding; lighting; barriers; room configurations) Security (systems; personnel; access controls; parking; responsiveness) Administration/ Management Administration attitude Tolerance of violence Support for employees Employee assistance/resources Support/resources for students Policies/protocols PHYSICAL ASSAULT

MINNESOTA EDUCATORS’ STUDY COMPREHENSIVE STUDY RESULTS

MINNESOTA EDUCATORS’ STUDY COMPREHENSIVE STUDY RESPONSE RATES TOTAL OVERALL 84% Full survey 78% One page survey 6%

Physical Assault Rates* MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR Physical Assault Rates* Persons with at least one event/Participants Rates (95% C.I.) TOTAL (425/5107) 8.3 (7.6, 9.1) Male (83/1222) 7.3 (6.0, 8.9) Female (342/3885) 8.7 (7.8, 9.6) *Adjusted for non-response

Non-Physical Violence Rates* MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR Non-Physical Violence Rates* Persons with at least one event/Participants Rates (95% C.I.) TOTAL (1970/5103) 38.4 (37.1, 39.8) Male (438/1222) 36.2 (33.6, 39.0) Female (1532/3881) 39.3 (37.8, 40.9) *Adjusted for non-response

Non-Physical Violence Rates* Persons with at least one event MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR Non-Physical Violence Rates* Classification Persons with at least one event Rates (95% C.I.) Threat 957 20.6 (19.5, 21.8) Sexual Harassment 212 4.5 (3.9, 5.1) Verbal Abuse 1,576 32.9 (31.6, 34.3) Bullying 550 11.6 (10.7, 12.6) *Total Exposed = 4,731 Responders to Full Survey Rates adjusted for non-response

Relationship to Victim: Student 560 (95) 61 (100) Employee 9 (2) 3 (5) MINNESOTA EDUCATORS’ STUDY PERPETRATOR CHARACTERISTICS: PHYSICAL ASSAULT Characteristics (Multiple responses possible) Specific Assault 587 events Number (%) Ongoing 61 events Relationship to Victim: Student 560 (95) 61 (100) Employee 9 (2) 3 (5) Parent, Visitor, etc. 5 (1) 0 (-) Gender: Male 453 (77) 54 (89) Impaired: Yes 463 (79) 56 (92) Impairment-Specific Assault: 77% due to disability/developmental delay; Injury/illness and alcohol/drugs both <1% Majority of events involved single perpetrators

Relationship to Victim: Student 82 79 65 54 Employee 14 10 34 31 MINNESOTA EDUCATORS’ STUDY PERPETRATOR CHARACTERISTICS NON-PHYSICAL VIOLENCE Characteristics (Multiple responses possible) Verbal Abuse 1576 events % Threat 957 events Sexual Harassment 212 events Bullying 550 events Relationship to Victim: Student 82 79 65 54 Employee 14 10 34 31 Parent, Visitor, etc. 23 17 2 Gender: Male 86 67 Impaired: Yes 39 41 29 Note that for the non-physical violence, much greater proportions of parents, visitors, trespassers, and others are more likely to be involved than in physical assault cases IMPAIRMENT: Like the physical assaults, the non-physical impairment is associated with disability/developmental delay.

MINNESOTA EDUCATORS’ STUDY SYMPTOMS AND FEELINGS POST-EVENT Symptoms/Feelings (Multiple responses possible) None Specific Assault 587 events % 24 Ongoing Assault 61 events 20 Anger 36 34 Fear, Anxiety, Stress 28 30 Stress-related physical symptoms 9 15 Difficulty concentrating 3 Difficulty sleeping 10 18 Withdrawal from contact with people 4 5

(Multiple responses possible) None % 9 12 4 Anger 59 58 71 MINNESOTA EDUCATORS’ STUDY SYMPTOMS AND FEELINGS POST-EVENT (Continued) Symptoms/Feelings (Multiple responses possible) None Verbal Abuse N=1576 % 9 Threat N=957 Sexual Harassment N=212 12 Bullying N=550 4 Anger 59 58 71 Fear, Anxiety, Stress 37 43 33 55 Stress-related physical symptoms 18 16 29 Difficulty concentrating 10 11 19 Difficulty sleeping 20 21 32 Withdrawal from contact with people 7 6 5

MINNESOTA EDUCATORS’ STUDY WORK-RELATED CONSEQUENCES OF VIOLENCE (Multiple responses possible) Single Assault 587 events Number (%) Ongoing 61 events Changes in Work - TOTAL 46 (7.8) 11 (16.4) Restriction or modified work 25 (4.3) 10 (16.4) Change for Student 14 (2.4) 2 (3.3) Quit work 13 (2.2) Transfer: Voluntary /involuntary 9 (1.5) 1 (1.6) Leave of absence 1 (0.2) Other 5 (0.9)

MINNESOTA EDUCATORS’ STUDY WORK-RELATED CONSEQUENCES OF VIOLENCE (Multiple responses possible) Verbal Abuse 1576 events N (%) Threat 957 events Sexual Harassment 212 events Bullying 550 events Changes in Work - TOTAL 207 (13.1) 140 (14.6) 32 (15.1) 136 (24.7) Restriction or modified work 63 (4.0) 46 (4.8) 11 (5.2) 44 (8.0) Quit work 48 (3.1) 31 (3.2) 4 (1.9) 38 (6.9) Transfer: Voluntary /involuntary 75 (4.8) 49 (5.1) 16 (7.6) Leave of absence 16 (1.0) 15 (1.6) 1 (0.5) 8 (1.5) Other 17 (1.1) 8 (0.8) 2 (0.9) 12 (2.2)

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY 372 Cases Physical Assault (at least one physical assault event) 1,116 Controls No Physical Assault

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: RESPONSE RATES OVERALL FULL LENGTH SURVEYS ONLY Percentage Percentage TOTAL 84 78 Cases* 85 80 Controls 83 78 *Of the 299 case respondents, 290 were student-perpetrated

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* SCHOOL EXPOSURES O.R. (95% C.I.) School Location Suburban 1 (--) Rural 1.1 (0.8, 1.5) Urban 2.0 (1.4, 2.8) School Size <50 Students 4.3 (1.7, 11.1) 50 to 200 Students 1.9 (1.0, 3.5) 201 to 500 Students 1.1 (0.8, 1.5) 501 to 1000 Students 1 (--) >1000 Students 0.5 (0.3, 0.8) School Type (reference: public) Public Magnet 3.4 (1.1, 10.7) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* EDUCATOR EXPOSURES O.R. (95% C.I.) Years worked in this school < 3 years 1 (--) 3 to <7 years 1.4 (1.0, 2.1) 7 to <14 years 0.7 (0.5, 1.1) 14 or more years 0.7 (0.5, 1.2) Years as an educator < 8 years 1 (--) 8 to < 15 years 0.6 (0.4, 0.9) 15 to < 25 years 0.7 (0.4, 1.1) 25 or more years 0.4 (0.2, 0.8) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* EDUCATOR EXPOSURES O.R. (95% C.I.) Job Type Full-time contract 1 (--) Part-time contract 0.4 (0.2, 0.7) Substitute 0.5 (0.2, 1.0) Primary Professional Activity (reference: classroom teacher) School social worker 7.3 (2.8, 19.2) Special Education 6.1 (4.2, 8.8) Topic Taught (reference: not taught) Special Education 3.7 (2.5, 5.4) Speech Pathology 2.3 (1.1, 5.1) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* STUDENT CHARACTERISTICS O.R. (95% C.I.) Student Gender Primarily Male 1 (--) Primarily Female 0.3 (0.1, 0.8) Appeared Equal 0.6 (0.4, 0.9) Student race compared to educator Same race 1 (--) Different race 2.5 (1.6, 3.9) Unsure of race 4.0 (1.4, 11.9) Student impairment (reference: not impaired) Impaired due to disability or 2.7 (1.2, 5.7) developmental delay Student age (reference: less than 10 years) 10 years or older 0.6 (0.4, 0.8) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* EXPOSURES O.R. (95% C.I.) Parent/Family/Guardian Involvement Outstanding 0.2 (0.1, 1.0) Very Good 0.4 (0.2, 0.7) Good 1 (--) Fair 1.3 (0.9, 2.1) Poor 2.8 (1.7, 4.6) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* SCHOOL EXPOSURES O.R. (95% C.I.) Sufficient resources (no versus yes) Lack of up-to-date technology 1.4 (1.0, 1.9) Lack of sports equipment/facilities 1.9 (1.3, 2.7) Lack of musical equipment/facilities 1.9 (1.3, 2.8) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES* ENVIRONMENTAL EXPOSURES O.R. (95% C.I.) Easily accessible exits Yes 0.3 (0.2, 0.7) No 1 (--) Physical barriers Yes 1.5 (1.1, 2.2) No 1 (--) Lighting Level Soft light 1.4 (1.0, 2.0) Bright as Daylight 1 (--) *Adjustments for multiple factors, based on causal models, weighting for non-response

MINNESOTA EDUCATORS’ STUDY LIMITATIONS Potential for bias is inherent in any study. However, many strategies have been incorporated to minimize the potential biases, including: • rigorous development and testing of data collection instruments and validation sub-studies • limited recall periods • extensive follow-up to optimize response • adjustment for non-response and control for potentially confounding factors in analyses

MINNESOTA EDUCATORS’ STUDY SUMMARY One of the first comprehensive efforts, using various techniques, to: Identify the magnitude, and consequences of work-related violence against teachers Identify specific risk factors that can serve as the basis for development of relevant prevention and control efforts

MINNESOTA EDUCATORS’ STUDY SUMMARY Violence, both physical and non-physical, is a significant problem among Minnesota educators. Some environmental exposures and other characteristics appear to increase the risk of physical violence: Working in: Urban schools Schools with less than 200 students Public magnet schools Working with: Special education or speech pathology students Students of a different race than the educator Students with disabilities or developmental delays

MINNESOTA EDUCATORS’ STUDY SUMMARY Some environmental exposures and other characteristics appear to increase the risk of physical violence (continued) Having less than 3 to 6 years experience at the school and Working in environments with: Physical barriers Soft versus bright lighting Lack of current technology and sports and music equipment/facilities Fair/poor parent/family/guardian involvement

MINNESOTA EDUCATORS’ STUDY SUMMARY Some environmental exposures and other characteristics appear to decrease the risk of physical violence: Working in schools with >1000 students Working in a school 7 years or longer Working as an educator 8 years or longer Having easily accessible exits Working primarily with female students, or an equal number of male/female students Working with students aged 10 or older Having very good/outstanding parent/family/guardian involvement

MINNESOTA EDUCATORS’ STUDY ACKNOWLEDGMENTS Support for this effort is provided, in part, by the: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Department of Health and Human Services (R01 OH007816); Center for Violence Prevention and Control, University of Minnesota; Regional Injury Prevention Research Center, University of Minnesota; Zayas Graphics