Received: 19 July 2024 Accepted: 4 March 2025

DOI: 10.1111/1440-1630.70009

FEATURE ARTICLE

Workplace violence experienced by occupational therapists

who visit people in their own homes

Atticus Maddox | Lynette Mackenzie

Faculty of Medicine and Health, School of

Health Sciences, University of Sydney, Abstract
Sydney, New South Wales, Australia Background: Workplace violence is a common experience for many health
professionals. However, little is known about the experience of occupational
Correspondence
Lynette Mackenzie, Faculty of Medicine therapists, specifically those that visit people in their own homes, and experi-
and Health, School of Health Sciences, ence violence in that context. Home visiting is a fundamental component of
Discipline of Occupational Therapy, Level
7, Susan Wakil Building, University of
practice for many occupational therapists and often takes place with the occu-
Sydney, Sydney, NSW 2006, Australia. pational therapist being alone. This study aimed to explore the experience of
Email: [email protected] this group of occupational therapists, their responses to workplace violence
Funding information such as reporting, and the impact of their experience on their wellbeing.
This research received no specific grant Method: A cross-sectional online survey was distributed among occupational
from any funding agency in the public,
therapists via NSW Health services and Occupational Therapy Australia with
commercial, or not-for-profit sectors.
snowball sampling and links on Twitter, LinkedIn, and Facebook. The survey
gathered information on demographics, work organisation, exposure to work-
place violence, and strategies used to respond to this. Wellbeing was measured
using the Abbreviated Maslach Burnout Inventory and the Kessler Psychologi-
cal Distress Scale.
Results: A total of 101 surveys were returned: 97% (n = 97) were female, the
mean age was 39 years, 52% (n = 52) were located in capital cities, and most
worked in disability care (47%, n = 47) or aged care (46%, n = 46) and worked
full time (60%, n = 60). Only 5% (n = 5) identified that they never worked
alone. Of those who experienced violence at least occasionally, 74% (n = 74)
reported verbal aggression, 27% (n = 27) physical aggression from clients or
family members, 20% (n = 20) physical aggression using objects, 43% (n = 43)
verbal sexual aggression, 46% (n = 46) unwanted sexual attention, and 3.2%
(n = 3) sexual assault. Moderate to very high distress was exhibited by 26%
(n = 26) of respondents, and 71% (n = 71) exhibited moderate to high emo-
tional exhaustion.
Consumer and Community Involvement: As the target participants were
occupational therapists, consumer and community involvement was not
sought.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2025 The Author(s). Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.

Aust Occup Ther J. 2025;72:e70009. wileyonlinelibrary.com/journal/aot 1 of 14

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Conclusion: This study has demonstrated the exposure of occupational thera-

pists to risks when visiting clients in their homes and identifies the need for
risk management, training, and support for occupational therapists working in
this environment.
PLAIN LANGUAGE SUMMARY
Occupational therapists often visit people in their own homes to assess their
needs and provide interventions. The home is an important environment as this
is where functional activities take place. However, occupational therapists can be
at risk of workplace violence from clients and their families, especially if they visit
clients alone. Clients may be upset and frustrated by their situations and could
strike out. We know very little about workplace violence experienced by occupa-
tional therapists, and this study used an online survey to explore how commonly
this occurs, the type of incidents experienced, the actions that occupational thera-
pists took following the incident, and how these experiences affected their well-
being. We found that workplace violence included verbal attacks and physical
and sexual violence. Overall, 76.2% of participants reported any kind of violence.
The most frequent type of violence was verbal abuse followed by unwanted sex-
ual attention, verbal sexual abuse, and physical violence with and without
objects. Three participants reported a sexual assault. However, fewer participants
took actions following the incidents such as reporting it informally or formally.
This means that workplace violence is likely to be underreported by occupational
therapists. We also found that occupational therapists who were exposed to work-
place violence reported higher distress, higher cynicism, and lower professional
accomplishment, suggesting a risk of burnout. As employers are required to pro-
tect the health and safety of their employees, these findings are very important,
and the occupational therapy profession should also address them.

KEYWORDS
aggression, distress, physical assault, professional efficacy, sexual harassment, workplace
violence

1 | INTRODUCTION
Key Points for Occupational Therapy
The International Labour Organisation (2003) defines • Instances of workplace violence ranging from
workplace violence as ‘any action, incident, or behaviour verbal attacks to physical and sexual violence
that deviates from reasonable conduct in which a person occur involving occupational therapists who
is assaulted, threatened, harmed, or endangered in their visit clients in their own homes.
work or as a direct result’ (p. 4). This can include verbal • Despite the proportion of occupational thera-
aggression (swearing, yelling, insults, criticism, threats, pists reporting these events, a relatively low
and derogatory racial comments), physical aggression proportion of participants took actions in
(being hit, grabbed, thrown objects, pushed, kicked, spat response to the violence.
at, patient damaging property, patient self-harm, being • Workplace violence resulted in increased dis-
touched inappropriately, brushed up against, poked, tress, lower professional efficacy, and increased
slapped, elbowed, hair pulled, bitten, head butted, cynicism in the workplace, suggesting that
pinched, scratched, and purposefully urinated on), and more attention needs to be given to this issue
non-verbal aggression (threatening gestures, threatening within the occupational therapy profession.
look, sexually suggestive gestures, sexually suggestive
looks, and attempted rape) (Kerr et al., 2017 p. 459;
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MADDOX and MACKENZIE 3 of 14

Parr & Cetrano, 2024; Tonso et al., 2016). For the However, it is not possible to estimate how many of
purposes of this study, this definition is applied to the these occupational therapists regularly visit people in
behaviours of clients and their families encountering their own homes. Occupational therapists commonly
occupational therapists in their homes. Therefore, this conduct home assessments to identify and facilitate
study excludes workplace aggression such as bullying changes needed to improve patients’ safety and indepen-
and harassment from co-workers or managers (Demir dence across a range of specialities, for instance, ageing,
et al., 2014; Scanlon & Piersol, 2021). brain injury, and mental health (Harper et al., 2022).
Workplace violence is highly prevalent especially for Home visits may take place prior to discharge from hos-
health-care workers who often work in stressful environ- pital, or from within the community for more longer-
ments where clients and their carers are in a vulnerable term clients with ongoing needs (Lockwood et al., 2015).
situation due to their physical and psychological needs One study reported that 28% of patients admitted from a
(Spelten et al., 2020). Prevalence studies suggest that private residence, and less than 5% of patients admitted
15%–75% of health workers experience verbal aggression from low-level residential care facilities received a pre-
and up to 29% will report physical aggression in medical discharge home visit following a fractured hip
practice settings over a 6- to 24-month period (Hills & (Lockwood et al., 2017). Home visiting often involves
Joyce, 2013). Reasons for workplace violence may relate to working in isolation and homes are not regulated envi-
client distress and frustration, substance misuse and abuse, ronments. There is also a high dependence on the quality
intoxication, and mental health conditions, such as of relationships between the occupational therapists and
dementia, anxiety, schizophrenia, suicidal ideation, and the client and their family for positive clinical outcomes
issues with communication between clients and their fam- in the home setting. The client may feel vulnerable
ilies and health care practitioner (Spelten et al., 2020). The because of functional needs and their dependence on
majority of the research conducted in the health-care field decisions made by the occupational therapist, and the
relates to the nursing profession (Camerino et al., 2008), occupational therapist may also feel vulnerable due to
especially in emergency departments (Morphet their work being largely invisible and behind closed
et al., 2014), and in one study, nurses were significantly at doors (Maddox & Mackenzie, 2023).
higher risk of experiencing violence compared with occu- As little is known about workplace violence experi-
pational therapists and physiotherapists in a geriatric ward enced by Australian occupational therapists, and as the
context (Mullan & Badger, 2007). General practitioners environment of visiting clients in their own homes is
(GPs) also work in community settings and occasionally unique, this study aimed to explore the experience of this
undertake home visits. Both GP and non-GP staff experi- group of occupational therapists and their responses to
ence workplace violence often attributed to access to workplace violence in terms of their wellbeing.
desired services that the GP assesses they cannot provide
such as driving licence renewal or demands for certain
drugs (Magin et al., 2008). 2 | METHOD
Available research on workplace violence that may
include occupational therapists has focused on a variety As part of a larger study of a range of health workers in
of health settings across international contexts (Demir the community (community nurses, homecare workers,
et al., 2014; Dyrkacz et al., 2012; Swain et al., 2014). Spe- and so on), a cross-sectional online survey was piloted
cific locations of where workplace violence took place electronically with six occupational therapists known to
include brain injury units (Beaulieu, 2007; Kerr the authors. It was then distributed among occupational
et al., 2017), hospital settings such as elderly care wards therapists who regularly visited clients in their own
(Mullan & Badger, 2007), and mental health services homes via NSW Health services and Occupational Ther-
(Tonso et al., 2016). However, there is little research apy Australia with snowball sampling and links on Twit-
reported on workplace violence in community settings ter, LinkedIn, and Facebook. The survey gathered
where occupational therapists visit people in their own information on demographics, work organisation, expo-
homes. The Dyrkacz et al. (2012) Canadian study of occu- sure to workplace violence, and strategies used to
pational therapists reported that half of their sample who respond to this. Wellbeing was measured using the
reported workplace violence worked in the community. Abbreviated Maslach Burnout Inventory (Shaya
A large proportion of the occupational therapy workforce Health, n.d.; Maslach & Leitner, 2008) and the Kessler
works outside of institutional settings. This was estimated Psychological Distress Scale (Kessler et al., 2002).
at 70% including community health centres, private prac- Ethical approval was gained from NSW Health
tice, and out-patient settings (Australian Health Practi- (ACCESS/19/NEPEAN/4) with site specific approval
tioner Agency, 2020). from Nepean Blue Mountains Local Health District,
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 of 14 MADDOX and MACKENZIE

Central Coast Local Health District, South-Western iii. Action taken following incidents.
Sydney Local Health District, Northern NSW Local iv. Health and wellbeing using the Abbreviated
Health District, and Mid-North Coast Local Health Maslach Burnout Inventory ‘aMBI’ (Maslach &
District who agreed to distribute the survey to employees Leitner, 2008).
of NSW Health. The University of Sydney (2018/1004)
gave ethical approval to approach occupational therapists The aMBI has been used to capture psychometric
who were members of Occupational Therapy Australia, properties of occupational burnout among other health-
or were contactable through Twitter, LinkedIn, and care providers (McManus et al., 2004; Shaikh
Facebook. Snowball sampling was also approved. Ethics et al., 2019). The aMBI is a 9-item tool with three sub-
approval involved participants giving informed consent scales: (i) emotional exhaustion, (ii) personal accomplish-
to participate, and they had the right to withdraw from ment, and (iii) depersonalisation. Each of the three
the study at any time. Approval was given for the data subscales are represented by three items that are ranked
storage and confidentiality arrangements for the study. A using a Likert scale, with a range of 1–7. Emotional
participant information statement was provided to exhaustion is defined as ‘emotional depletion due to job
potential participants outlining the ethical management demand and continuous work-related stress’, personal
of the study which made clear the intention to publish accomplishment is defined as ‘the degree of
the results of the study. personal competence, achievement, and satisfaction with
work’, and depersonalisation is defined as ‘impersonal
responses toward the recipient service’ (Shaikh
2.1 | Positionality statement et al., 2019, p. 2). Higher scores of emotional exhaustion
and depersonalisation and lower personal accomplish-
A.M. is a lawyer with expertise in workplace law and ment scores are indicative of occupational burnout.
completed PhD studies in workplace violence experi- Higher scores of emotional exhaustion and depersonali-
enced by homecare workers and community-based sation are also considered precursors to impaired mental
health professionals. L.M. is an occupational therapist health and well-being, in addition to compromised pro-
and academic with experience in community-based prac- fessional ability. MBI validity has been studied more than
tice and research. for other assessments as it is the most commonly used in
practice and is considered the gold standard for measur-
ing occupational burnout. In a review, the MBI had the
2.2 | Setting most complete validation, with seven psychometric prop-
erties assessed. However, there is debate about whether
This study was conducted at the University of Sydney the dimensions of emotional exhaustion, depersonalisa-
and collected data from the workplaces of occupational tion, and personal accomplishment are related to occupa-
therapists who self-identified that they visited people in tional burnout (Shoman et al., 2021).
their own homes.
v. Health and wellbeing using the Kessler Psychologi-
cal Distress Scale ‘K-10’ (Kessler et al., 2002).
2.3 | Participants
The K-10 was selected as it is a useful tool to measure
A convenience sample of occupational therapists who mental health in general adult populations. It is a
worked in a variety of settings and visited people in their 10-item, self-reported inventory that is widely used by
own homes was invited to participate, regardless of clinical psychologists and general practitioners. Each
whether they had experienced workplace violence or not. item is represented by a 5-point Likert scale. Results indi-
cate levels of anxiety and depression at a point in time.
Outcomes are calculated on a cumulative scoring system.
2.4 | Data collection Values of 20 or above indicate a mild mental health
impairment. Scores ranging from 25 to 29 are likely to
The survey consisted of the following: have a moderate mental health problem. On the other
hand, scores of 30 or more are indicative of a severe men-
i. Demographic information including: age, gender, tal disorder. Psychometric properties of the K10 have
postcode, education, and employment details. been investigated internationally and with different
ii. Frequency of exposure to challenging and violent groups. Australian evidence indicates that the K10 corre-
behaviour and unwanted sexual attention. lates well with the General Health Questionnaire, and
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MADDOX and MACKENZIE 5 of 14

sensitivity and specificity data show that a score of TABLE 1 Characteristics of the sample (N = 101).
19 indicates mental health concerns: sensitivity 71% and Mean 95% CI Range
specificity 90% (Andrews & Slade, 2001). Sunderland
Age 39 36.96–41.04 23–67
et al. (2012) demonstrated that the K10 had a unidimen-
sional structure when used in a large epidemiological n %
sample of the Australian general population, which indi- Gender
cates that the K10 measures non-specific psychological Male 4 4
distress. Female 97 96
State (n = 100)
vi. A selection of items from the Multidimensional
New South Wales 85 85
Coping Inventory (Endler & Parker, 1990) measured
Victoria 6 6
how participants coped with a violent incident
defined as task-oriented coping, emotion-oriented Western Australia 4 4
coping, and avoidance-oriented coping. South Australia 3 3
Australian Capital Territory 1 1
The survey was launched on the RedCap secure Queensland 1 1
online platform using a link provided to participants. A
Location (n = 98)
copy of the survey is available at https://hdl.handle.net/
Capital city 52 53
2123/32819. The survey was piloted prior to distribution
to check the time taken to complete it and to determine Regional 32 33

if the items were understood. No changes were deemed Rural 14 14

to be necessary. All responses were non-identifiable. Areas of practice identified (N = 101) participants could select
all that applied
Aged care 47 38.8
2.5 | Data analysis Disability 48 39.7
Palliative care 10 8.3
Data were loaded into SPSS 30 (2024). All submitted sur-
Mental health 16 13.2
veys were included. Due to the sensitive nature of the
Work tenure (N = 101) participants could select all that applied
survey participants were not forced to answer each sur-
vey item. Missing data was identified for each figure and Full-time 61 56.5
table. Descriptive statistics were used to describe each of Part-time 33 30.6
the variables measured in the survey. Sub-groups within Casual 1 0.9
the data were compared to determine any important dif- Self-employed 13 12.0
ferences such as exposure to different incidents and expo-
Works alone (N = 101)
sure compared to no exposure. Scores were compared on
Always 38 37.6
the standardised measures related to the exposure to cer-
tain types of workplace violence using independent t-tests Often 49 48.5
(two-tailed). Occasionally 9 8.9
Never 5 5.0

3 | R E SUL T S

At total of 101 surveys were returned by occupational participants experienced any type of workplace violence,
therapists from New South Wales, ACT, Western and 73 (72.3%) participants experienced sexually related
Australia, South Australia, Victoria, and Queensland (see workplace violence incidents (verbal, unwanted attention
Table 1). Most participants worked in aged care (46.5%, and assault). Figure 1 outlines the specific types of inci-
n = 47) or disability care (47.5%, n = 48) and worked full dents. A total of 76.6% (n = 72) of study participants
time (60.4%, n = 61), and 5% (n = 5) identified that they reported exposure to verbal violence, and the next cate-
never worked alone. gory experienced by participants was unwanted sexual
A total of 94 participants answered the items about attention (45.7%, n = 43). Regrettably, three (3%) partici-
their exposure to a range of forms of workplace violence. pants reported a sexual assault. Five (5%) participants
Exposure was summarised to include occasional exposure indicated they had experienced an injury, and 13 (13%)
to exposure very often. For instance, 79 (76.7%) reported they had consulted a health professional
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
6 of 14 MADDOX and MACKENZIE

FIGURE 1 Exposure to workplace violence (N = 94).

FIGURE 2 Workplace violence experienced by client type (N = 101).

following a workplace violence incident, but no one Figure 3 examines action taken following a workplace
reported lodging a workers compensation claim. violence incident and relatively low proportions of partic-
When analysed by workplace type, Figure 2 indicates ipants reported any of the suggested actions in response
that most participants at each workplace reported verbal to the incident. The greatest proportion of participants
aggression from 70% (n = 7) in palliative care to 100% taking any action was only 65% (reporting an incident of
(n = 16) in mental health settings. There was also a high physical violence) meaning that quite high proportions
proportion of participants reporting verbal sexual vio- of participants did not take the identified actions. For
lence and unwanted sexual attention across workplaces. instance, completing formal incident reports were not
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MADDOX and MACKENZIE 7 of 14

FIGURE 3 Action taken by type of workplace violence incident experienced.

FIGURE 4 Perceptions of participants related to workplace violence.

done for up to 63%. When analysed by workplace vio- (52.6.2%, n = 10), sexual verbal violence (45%, n = 18),
lence type, only 65.4% (n = 17) of those who had experi- and unwanted sexual attention (51.2%, n = 21). Only one
enced physical violence (n = 26) reported it, followed by out of three participants who had indicated they had
59.4% (n = 43) of verbal violence (n = 72) and 52.6% experienced sexual assault at work took any of the
(n = 10) of physical violence with objects (n = 19). Rela- actions identified.
tively high proportions of participants indicated they took Figure 4 outlines the agreement of participants with
no action following physical violence with objects several statements related to their behaviours and beliefs
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8 of 14 MADDOX and MACKENZIE

around workplace violence. The highest mean level of incidents result in an incident report being submitted. A
agreement was found for the following statements: neutral mean score was given for the statement ‘I fear I
‘My concerns about personal safety are taken seriously’, will be exposed to future threats at work’, suggesting some
‘I am encouraged to report incidents’, and ‘Incident reports uncertainty about this risk by participants.
are always followed up by managers.’ These data contrast Participant health and well-being was measured using
with data presented in Figure 3 indicating that not all the aMBI (measuring occupational burnout) and the K10
incidents were reported by participants and even fewer (measuring mental health). Table 2 outlines the results of

TABLE 2 Differences in aMBI inventory scores for different workplace violence incidents (N = 93).

Emotional exhaustion scale overall mean score 8.4 (95% CI: 7.83–8.97)

Mean SD t value df P value

Exposed to verbal aggression 8.5 2.67 0.77 92 0.284
Not exposed 8.0 3.16
Exposed to physical violence 8.7 2.71 0.54 92 0.889
Not exposed 8.3 2.82
Exposed to violence (objects) 8.6 2.63 0.39 92 0.836
Not exposed 8.4 2.84
Exposure to verbal (sexual) 8.7 2.34 0.81 92 0.420
Not exposed 8.2 3.08
Exposure to unwanted sexual attention 8.4 2.45 0.05 92 0.964
Not exposed 8.4 3.06
Exposure to sexual assault 7.0 3.00 0.89 92 0.377
Not exposed 8.5 2.78
Meaning of scores for emotional exhaustion: Low (0–16), moderate (17–26), and high (≥27)
Accomplishment/professional efficacy scale overall mean score 11.14 (95% CI: 10.64–11.64)

Mean SD t value df P value

Exposed to verbal aggression 11.00 2.42 0.989 92 0.325
Not exposed 11.59 2.58
Exposed to physical violence 10.08 2.70 2.680 92 0.009a
Not exposed 11.54 2.24
Exposed to violence (objects) 10.00 2.89 2.318 92 0.023a
Not exposed 11.43 2.26
Exposure to verbal (sexual) 10.43 2.52 2.495 92 0.014a
Not exposed 11.67 2.28
Exposure to unwanted sexual attention 10.49 2.21 2.420 92 0.017a
Not exposed 11.69 2.53
Exposure to sexual assault 8.33 1.53 2.048 92 0.043a
Not exposed 11.23 2.43
Meaning of scores for accomplishment/professional efficacy: Low (0–6), moderate (7–12), and high (≥13)
Depersonalisation scale overall mean score 5.36 (95% CI: 4.95–5.77)

Mean SD t value df P value

Exposed to verbal aggression 5.35 2.14 0.127 92 0.899
Not exposed 5.41 1.44
Exposed to physical violence 6.27 2.59 0.283 92 0.006a
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MADDOX and MACKENZIE 9 of 14

TABLE 2 (Continued)

Depersonalisation scale overall mean score 5.36 (95% CI: 4.95–5.77)

Mean SD t value df P value

Not exposed 5.01 1.61
Exposed to violence (objects) 6.37 2.83 2.535 92 0.013a
Not exposed 5.11 1.65
Exposure to verbal (sexual) 5.78 2.20 1.749 92 0.084
Not exposed 5.06 1.79
Exposure to unwanted sexual attention 5.86 2.12 2.277 92 0.025a
Not exposed 4.94 1.79
Exposure to sexual assault 7.33 0.58 1.760 92 0.082
Not exposed 5.30 1.99
Meaning of scores for depersonalisation: Low (≤31), moderate (32–38), and high (≥39)
a
A statistically significant difference (t-test).

TABLE 3 Differences in K10 scores for different workplace violence incidents (N = 92).

Overall mean score 16.13 (95% CI: 14.96–17.30)

Mean SD t-value df P value

Exposed to verbal aggression 16.54 5.68 1.299 91 0.197
Not exposed 14.71 5.66
Exposed to physical violence 16.19 5.21 0.066 91 0.947
Not exposed 16.10 5.91
Exposed to violence (objects) 17.00 5.31 0.746 91 0.458
Not exposed 15.91 5.80
Exposure to verbal (sexual) 18.15 5.09 3.111 91 0.002a
Not exposed 14.60 5.70
Exposure to unwanted sexual attention 17.42 5.30 2.061 91 0.042a
Not exposed 15.02 5.84
Exposure to sexual assault 17.67 3.00 0.473 91 0.637
Not exposed 16.08 2.78

Note: Scoring for the K10: 10–19 Likely to be well, 20–24 Likely to have a mild mental health disorder, 25–29 Likely to have a moderate disorder, 30–50 Likely
to have a severe disorder.
a
A statistically significant difference (t-test).

the aMBI scores. Overall scores for all participants were significantly associated with experiencing physical
of each of the scales within the aMBI were 8.4 for emo- violence (with and without objects) and unwanted sexual
tional exhaustion interpreted as low, 11.14 for personal attention (see Table 2).
accomplishment/professional efficacy interpreted as The K10 scores for the whole participant sample had
moderate, and 5.6 for the depersonalisation interpreted a mean score of 16.13 (95% CI: 14.96–17.30), indicating
as low. When comparing scores for participants who had that participants were likely to be well. When analysed
experienced workplace violence incidents and those who by incidents of workplace violence, participants who had
had not, lower scores for accomplishment/professional experienced verbal sexual violence and unwanted sexual
efficacy were significant associated with experiencing attention demonstrated significantly higher scores than
physical violence (with and without objects), verbal sex- those who had not, although the higher scores were
ual violence, unwanted sexual attention, and sexual within the range of participants being likely to be well
assault. In addition, higher scores for depersonalisation (see Table 3).
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10 of 14 MADDOX and MACKENZIE

TABLE 4 Response to coping strategy items (n = 94).

Coping statements Strongly agree Agree Neutral Disagree Strongly disagree

After work, I spend a lot of time thinking 10.6%, n = 10 28.7%, n = 27 21.3%, n = 20 28.7%, n = 27 10.6%, n = 10
about distressing incidents
I blame myself when clients become agitated 1.1%, n = 1 13.8%, n = 13 17%, n = 16 42.6%, n = 40 25.5%, n = 24
I tell myself that I should not feel offended by 12.8%, n = 12 45.7%, n = 43 19.1%, n = 18 18.1%, n = 17 4.3%, n = 4
my clients
I am satisfied with the emotional support I can 22.3%, n = 21 47.9%, n = 45 21.3%, n = 20 7.4%, n = 7 1.1%, n = 1
get from others
I try to develop strategies for managing 31.9%, n = 30 44.7% n = 42 20.2%, n = 19 2.1%, n = 2 1.1%, n = 1
offensive or disruptive behaviour
I make jokes about things my clients have said 7.4%, n = 7 36.2%, n = 34 29.8%, n = 28 13.8%, n = 13 12.8%, n = 12
or done
I try to distract myself with music or other 14.9%, n = 14 40.4%, n = 38 24.5%, n = 23 12.8%, n = 12 7.4%, n = 7
activities after work
I drink alcohol, smoke cigarettes or use other 1.1%, n = 1 11.7%, n = 11 7.4%, n = 7 23.4%, n = 22 56.4%, n = 53
substances to help me cope

Participants were also asked about their coping strate- Golubovich et al., 2019; Kerr et al., 2017), and occupa-
gies in relation to workplace violence. Results of these tional therapists separately or as part of the larger work-
items are summarised in Table 4. force sample (Beaulieu, 2007; Mullan & Badger, 2007;
Responses were evenly spread on the item ‘after work, Parr & Cetrano, 2024; Potegal et al., 2022; Swain
I spend a lot of time thinking about distressing incidents’. et al., 2014; Tonso et al., 2016). With the exception of an
Other responses were more clearly related to participants older article (Schneider et al., 1999), research focused on
not blaming themselves for client agitation, not feeling occupational therapy has been done in the
offended by their clients, gaining adequate emotional United Kingdom (Beaulieu, 2007), United States (Potegal
support, developing strategies to manage offensive behav- et al., 2022), and Canada (Dyrkacz et al., 2012). However,
iour, using humour, engaging in activities outside of the research may not have taken place during home
work and not turning to substances to help them cope. visits. Even for those studies located in community set-
tings (Parr & Cetrano, 2024), it was unclear if the inci-
dents of workplace violence occurred when visiting
4 | DISCUSSION clients in their homes.
Of concern was the number of sexual-related inci-
This study sought to explore the level of workplace vio- dents identified by participants, especially the three par-
lence experienced by occupational therapists who visit ticipants who reported a sexual assault. In a client’s own
people in their own homes, either as a hospital-based home, this was likely to be an unwitnessed event and on
occupational therapist doing a discharge home visit, or as the client’s property where clients could perceive they
a community-based occupational therapist visiting people had more power or authority over the visiting therapist.
at home routinely. Given the isolation experienced by These reports could also be related to the high numbers
occupational therapists in this work environment and of female participants in this study sample who may be
potential risks of workplace violence, the results were perceived as more vulnerable by perpetrators. Evidence
important to determine how common such incidents are suggests that women are more at risk of sexual harass-
in practice, what effect they may have, and how they ment (Gale et al., 2006). Dyrkacz et al. (2012) reported
are managed. Previous published research has not one sexual assault in their study of occupational thera-
directly addressed workplace violence experienced by pists, and others reported incidents that met the Cana-
Australian occupational therapists conducting home dian legal definition of sexual assault, such as sexual
visits. Most existing published research investigates the touching and serious threats of sexual assault. Our study
experiences of nurses (Camerino et al., 2008; Morphet did not seek further information about the nature of the
et al., 2014), medical practitioners (Hills & Joyce, 2013), sexual assaults reported; therefore, definitions of the term
care workers (Maddox & Mackenzie, 2023), other allied could not be concluded. A study of US physiotherapists
health staff (Boissonnault et al., 2017; Demir et al., 2014; reported that 84% of their sample indicated exposure to
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MADDOX and MACKENZIE 11 of 14

inappropriate sexual behaviour from clients over their workplace environments (Roche et al., 2010), and Parr
career, and 47% during the previous 12 months; however, and Cetrano (2024) reported that health workers in their
their definition was broad and included ‘staring’, ‘sug- study believed that experiencing violence was inevitable
gestive remarks’, ‘date requests’, ‘overtly sexual in their work and was viewed as an ongoing risk.
remarks’, ‘requests for sexual activity’, ‘sexual gestures’, Occupational therapists in particular adhere to a holistic
‘masturbation’, and ‘inappropriate touch’ (Boissonnault approach to intervention that requires therapist-client
et al., 2017). Schneider et al. (1999), in an Australian rapport in the form of a ‘balanced and reciprocal rela-
study of occupational therapists, reported that 20 (13.8%) tionship’ that may dispense with traditional power differ-
experienced severe inappropriate client sexual behav- entials (Schneider et al., 1999, p. 178). This may make
iours. However, neither of these studies indicated the occupational therapists more vulnerable to workplace
occupational therapists were working in client’s homes. violence incidents as part of everyday practice. For many,
Clearly, this is a very serious level of workplace violence talking to colleagues, friends, or family was reported as
faced by occupational therapists. the most used strategy following an incident (Kerr
The physical violence reported by participants is also et al., 2017), but this may not translate to a formal report.
of concern, especially because some participants De-escalation of aggressive behaviour is a common
reported injury as a result. The World Health technique reported in the literature to manage workplace
Organisation (n.d.) estimates that up to 38% of health violence. Using cognitive strategies to talk clients down
workers will experience physical violence at some point require clients to have insight to respond positively, and
in their careers, and men are more likely to be assaulted other interventions such as calming a client, ensuring
(Gale et al., 2006), despite the findings of this study. Our they feel safe, using the client’s name or stepping away
study also found that physical violence and physical vio- from their personal space could be used (Beaulieu, 2007).
lence with objects was reported by more participants A review of effectiveness studies of de-escalation strate-
working with disability care and mental health clients. gies included risk assessment, humour therapy, music,
This was confirmed by an Australian study of mental personalising interventions, workplace culture change,
health settings including occupational therapists where changes to the environment, and an education program.
over a third of participants reported experiencing a However, these studies indicated only low-quality evi-
physical assault in the previous 12 months and six dence of effectiveness (Spelten et al., 2020). Furthermore,
involved a weapon. They also indicated that participants all of the studies reviewed took place in institutional set-
had experienced several incidents during this time tings so are not directly relevant to de-escalating violence
(Tonso et al., 2016). Beaulieu (2007) suggested that experienced in a client’s home.
health workers working with people with dementia and Findings also explored the well-being of participants
brain injuries expect physical aggression and that experi- in terms of distress and work burnout symptoms experi-
ence in areas of practice where this occurs allows health enced associated with workplace violence incidents they
professionals to anticipate such behaviour. Furthermore, were exposed to. While associations were detected with
if health professionals perceive that the aggression is exposure to verbal sexual violence and unwanted sexual
related to the client’s condition rather than being purely attention and distress, as well as lower scores for profes-
intentionally directed at them, they may be more aware sional efficacy being associated with exposure to physical
of any frustration and fear that clients experience that violence, physical violence with objects, verbal sexual
may lead to the incidents. violence, unwanted sexual attention, and sexual assault.
What actions were taken (or not taken) following a Depersonalisation or cynicism was also associated with
workplace violence incident by participants was also of exposure to physical violence, with and without objects
concern. Evasive actions such as transferring the client to and unwanted sexual attention. This is consistent with
another health professional or service or leaving the pre- studies that described health workers having emotional
mises were taken by a lower proportion of participants. reactions to workplace violence experienced. Participants
Reporting incidents informally and formally were also in other studies experienced self-doubt, fear, avoidance,
low. This is in contrast to the perceptions of participants cumulative stress, vulnerability, inadequacy, lower job
about attitudinal statements reported in Figure 4 suggest- satisfaction, losing faith in management, and thoughts
ing that participants agreed that they were encouraged to of leaving their job (Hills & Joyce, 2013; Parr &
report incidents, that concerns about safety were taken Cetrano, 2024; Tonso et al., 2016). Findings about a
seriously and that managers always followed up incident reduction in personal accomplishment scores were
reports. However, for managers to act on incidents of aligned with findings from Roldan et al. (2013) although
violence, these need to be reported. This may be related their study involved heath workers in emergency depart-
to perceptions that violence is to be expected in some ments. Conversely, building resilience as a result of
 14401630, 2025, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.70009 by National Health And Medical Research Council, Wiley Online Library on [27/04/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
12 of 14 MADDOX and MACKENZIE

exposure to workplace violence was also an outcome for therapists conducting home visits as much as possible.
health workers and formed part of their professional The outcomes of this survey suggest that adherence to
identity (Parr & Cetrano, 2024). protocols could be improved. The provision of training is
Prior to this study, very little research was focused on an important adjunct to reduce workplace violence or
risks of workplace violence for occupational therapists by enhance the capacity of occupational therapists to man-
visiting clients in their own homes. The home is a unique age it. This includes debriefing, training in non-verbal
work environment as it is both a client’s home and a and verbal skills, and de-escalation techniques, as well as
place of work, where roles may clash, for instance, client encouraging staff to access support, take time off and
expectations may differ from health worker responsibili- practise self-care techniques or coping strategies
ties (Denton et al., 2002). At the same time, the home is a (Beaulieu, 2007; Hills & Joyce, 2013; Kerr et al., 2017;
setting where clients need to feel a sense of agency and Parr & Cetrano, 2024).
control, especially clients with a disability who are core Future research should include a robust prevalence
clients of occupational therapy (Aplin et al., 2020). These study across Australia to gain generalisable data for the
issues may contribute to an increased risk of workplace profession, including a follow-up period to determine any
violence with some clients. Some strategies health profes- impacts on health and well-being. A qualitative study
sionals have used to manage workplace violence may not would provide much more detail and understanding
be applicable to occupational therapists. For instance, about the circumstances of a workplace violence inci-
GPs are also vulnerable to workplace violence (Gale dent, what initiated it and how the occupational therapist
et al., 2006; Magin et al., 2006, 2008) and have responded dealt with the incident and its aftermath. Interventions
by restricting home visits, vetting clients or not working such as training for occupational therapists in managing
with clients they do not know. If home visits are con- workplace violence should be developed and tested for
ducted, they may restrict the locations of homes by avoid- their effectiveness using a randomised controlled trial,
ing high risk neighbourhoods or not going on home visits and a study of occupational therapy managers supervis-
alone (Magin et al., 2006). Some of these may not be pos- ing those who visit clients in their own home would be
sible for occupational therapists with a community case- needed to determine their strategies for managing work-
load, and as the findings of our study indicated, most place violence.
participants did home visits alone, which may make
them vulnerable. AUTHOR CONTRIBUTIONS
Both authors made substantial contributions to the con-
ception and design of the study, the survey, recruitment,
5 | LIMITATIONS analysis and interpretation of the data, and the drafting
and reviewing of the manuscript. Authors have approved
As with any cross-sectional study, it is only possible to the final version and are accountable for its accuracy.
identify associations rather than causes of threats
to health from exposure to workplace violence. A survey A C KN O WL ED G EME N T S
was an important first step in exploring the frequency of Open access publishing facilitated by The University of
workplace violence experienced by occupational thera- Sydney, as part of the Wiley - The University of Sydney
pists. It relied on self-report that may be subject to recall agreement via the Council of Australian University
bias and volunteer bias may mean that occupational ther- Librarians.
apists who had experience of workplace violence were
more likely to volunteer to participate, thus inflating the C O N F L I C T O F I N T E R E S T S T A TE M E N T
estimates of workplace violence that has taken place The authors have no conflict of interest to declare.
compared to none. However, given the low levels of for-
mal reporting of incidents, this survey may be a more DA TA AVAI LA BI LI TY S T ATE ME NT
reliable record (Hills & Joyce, 2013). As a convenience Data available on reasonable request from the authors.
sample, the results cannot be generalised.
ORCID
Lynette Mackenzie https://orcid.org/0000-0002-1597-
6 | RECOMMENDATIONS 2051

As employers are required to provide safe work environ- RE FER EN CES

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safety protocols are essential to protect occupational psychological distress scale (k10). Australian and New Zealand
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