Work stress much more than a necessary evil

Stress higher in adult developmental centers

A report recently issued by the National Institute for Occupational Safety and Health (NIOSH) counsels that employers should not "dismiss job stress associated with working with people with developmental disabilities as a necessary evil that employees simply must accept as part of their job." Instead, recommends the agency, "They should take a proactive approach to the issue by 1) hiring a consultant to evaluate the extent to which employees view job stress as a problem; and 2) implementing intervention strategies that will alleviate sources of stress." (NIOSH Health Hazard Evaluation Report No. 2002-0218-2881).

Many states or counties operate centers that provide direct care to individuals with severe mental and development disabilities where employee duties may include helping to feed, clean, or otherwise assist some of those individuals with personal care and personal hygiene. Workers who take on those duties may not only be under significant stress, but may also be at risk of exposure to saliva and other body materials through biting or scratching behaviors.

At one such center in Ohio, such behaviors prompted concerns from employees about work-related stress and exposures to infectious disease agents. At the request of employees, NIOSH conducted an assessment, which led to the recommendations that appear both in the NIOSH report referenced above and also in a case study, "Job Stress and Infectious Disease Risks in an Adult Developmental Center," which was published in Applied Occupational and Environmental Hygiene (2003; 18:561-565). The report is available at

Other stress recommendations

The NIOSH report included several other recommendations regarding stress, including:

  • Stress evaluation methods that include holding group discussions with employees or using an employee survey. Regardless of the method used, information should be obtained about employees’ perceptions of job conditions and their levels of stress, health, and satisfaction.
  • To reduce job stress associated with providing services to people with developmental disabilities, employees should be trained by a consultant experienced in the use of adaptive coping strategies, (i.e., active problem-solving approaches).
  • Management should view job-stress prevention as a continuous process that uses evaluation data to refine or redirect intervention strategies.

Other concerns addressed

The NIOSH report also addressed concerns about infectious agents. The NIOSH report authors recommended that:

  • The center follow Occupational Safety and Health Administration regulations and Centers for Disease Control and Prevention guidelines for managing occupational exposures to bloodborne pathogens.
  • Management provide different sizes of disposable gloves to decrease the possibility that the glove might tear because it is too small; assess the circumstances associated with the ability to identify circumstances in which any disposable glove might tear occasionally; and in those situations, provide employees the option of wearing double gloves or thicker gloves.

"In Ohio and other states that delegate responsibility to local agencies for the health and safety of workers who provide services to people with developmental disabilities, consideration should be given as to whether an increased level of oversight and direct assistance to local boards of Mental Retardation and Developmental Disabilities are needed," concluded the authors of the Applied Occupational and Environmental Hygiene article.