Closing the health gap through resource management: A workplace attachment perspective Michael Clarkson-Hendrix, PhD LCSW-R John Carroll-Barbuto, PhD MPA LCSW-R Network for Social Work Management 28th Annual Management Conference June 16, 2017

Background Health inequities continue to exist (Walters et al., 2016) At the same time, the health care workforce is being challenged in retaining workers who are competent and proficient in addressing these injustices (Hyde, 2013) Could a worker’s attachment to their workplace lead to new ideas and change their likelihood of staying?

Purpose Expand the application of attachment theory through the perspective of a workplace-based attachment system View the workplace as a multidimensional attachment figure Relational, Social & Physical Aspects Identify types of workplace attachment Secure, Insecure: Anxious, Insecure: Ambivalent, Insecure: Avoidant (Ainsworth & Bell, 1970; Bowlby, 1988)

Methods In-depth, semi-structured interviews with Veteran health care sector social workers Purposive and snowball sampling (N=13) Mostly female (77% female, 23% male) Worked primarily in behavioral health (77% behavioral health; 23% medical/surgical) Vast majority were direct practitioners (85% direct practitioners, 15% supervisors) Ages ranged from young to middle adulthood

Data collection and analysis Interviews with social workers elicited perceptions of: Connection with their work Motivation to work with Veterans What made them feel secure in their work Times they felt particularly attached to their job Recorded and transcribed verbatim Combination of thematic (Braun & Clarke, 2006; Lofland, Snow, Anderson & Lofland, 2006) and deductive qualitative analysis (Fortune, Reid, & Miller, 2013)

Overall results Three workplace attachment types occurred, which were thematically related and categorized using foundational interpersonal attachment styles (Ainsworth & Bell, 1970; Bowlby, 1988): Secure Insecure: Anxious Insecure: Ambivalent One type was not found to be occurring: Insecure: Avoidant

Results Secure – Affective tie characterized by the worker feeling safe within the workplace Workforce-related meaning and purpose Felt competence Trust Empathy Reward Trust: “I’m in an environment where it’s okay if I get it wrong the first time around, or I take the long way around to get there. But, so basically that it’s okay to fail to a certain extent; that there’s going to be a learning curve for me, and that I don’t lack the insight to know that, but that I promise I will get there.”

Results Insecure: Anxious – Affective tie characterized by worker anxiety about the workplace Concerned about performance Questioning self-confidence Concerned about performance: “I know that I’m a hard worker so nobody can argue that, and I think I’m pretty good at what I do. The part that makes me feel insecure is that I am notoriously late with notes and treatment plans. It just takes me forever.”

Results Insecure: Ambivalent – Affective tie characterized by worker ambivalence about their workplace Questioning personal and organizational investments Wondering about other patient populations or work settings Wondering about other populations and settings: “I don’t see my career at the VA necessarily being forever. I’ve got a lot of other things I can be getting into at some point”

Results Insecure: Avoidant Themes inducted were unrelated to this type of workplace attachment This may have been due to the nature of this type of attachment, in which workers may have avoided participation in the study since they would need to present themselves as a prospective participant

Limitations Non-random and non-stratified sample Single coder Single sector of social workers

Conclusion Three workplace attachment types occurred Secure Insecure: Anxious Insecure: Ambivalent

Implications for managers and leaders Assess the attachment style of staff For workers who demonstrate insecure attachments, reallocate resources to engender security

Implications for managers and leaders Target supportive supervision Assist them in finding meaning and purpose in their job tasks Rekindle memories of rewarding workplace experiences (Mikulincer & Shaver, 2007) Distribute reasonably challenging projects Build their confidence and re-engage them Conduct activities that enroll all team social workers to identify agency missions and renew these commitments publically and routinely Use active listening skills in interactions Develop capacity for empathy for service participants and colleagues

Contact Information Michael Clarkson-Hendrix michael.clarkson-hendrix@fredonia.edu John Carroll-Barbuto jbarbuto@alumni.albany.edu

References Ainsworth, M. D., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41(1), 49–67. doi:10.2307/1127388. Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. doi:10.1191/1478088706qp063oa. Fortune, A., Reid, W., & Miller, R. (Eds.). (2013). Qualitative Research in Social Work(2nd ed.). New York, NY: Columbia University Press. Hyde, P. S. (2013). Report to congress on the nation’s substance abuse and mental health workforce issues. Lofland, J., Snow, D., Anderson, L., & Lofland, L. (2006). Analyzing Social Settings: A Guide to Qualitative Observation and Analysis(4th ed.). Belmont, CA: Wadsworth. Mikulincer, M., & Shaver, P. R. (2007). Boosting attachment security to promote mental health, prosocial values, and inter-group tolerance. Psychological Inquiry, 18(3), 139-156. Walters, K., Browne, T., Spencer, M., Maramaldi, P., Smukler, M., Wheeler, D., … Uehara, E. (2016). Health Equity: Eradicating Health Inequalities for Future Generations (Grand Challenge: Close the health gap No. 19). https://doi.org/10.7895/ijadr.v5i2.223 *This research was conducted at Stratton VA Medical Center, in Albany, NY. The opinions and findings expressed here are not those of SVAMC or the VHA. Michael Clarkson-Hendrix had a VA appointment at SVAMC at the time of this study. John Carroll-Barbuto is an employee of SVAMC at the time of this study. The study was approved by the SVAMC IRB.