Objective: To examine the association between violence prevention safety climate measures and self reported violence toward staff in state-run residential addiction treatment centers. Methods: In mid-2006, 409 staff from an Eastern United States state agency that oversees a system of thirteen residential addiction treatment centers (ATCs) completed a self-administered survey as part of a comprehensive risk assessment. The survey was undertaken to identify and measure facility-level risk factors for violence, including staff perceptions of the quality of existing US Occupational Safety and Health Administration (OSHA) program elements, and ultimately to guide violence prevention programming. Key informant interviews and staff focus groups provided researchers with qualitative data with which to understand safety climate and violence prevention efforts within these work settings. Results: The frequency with which staff reported experiencing violent behavior ranged from 37% for "clients raised their voices in a threatening way to you" to 1% for "clients pushed, hit, kicked, or struck you". Findings from the staff survey included the following significant predictors of violence: "client actively resisting program" (OR = 2.34, 95% CI = 1.35, 4.05), "working with clients for whom the history of violence is unknown" (OR = 1.91, 95% CI = 1.18, 3.09) and "management commitment to violence prevention" reported as "never/hardly ever" and "seldom or sometimes" (OR = 4.30 and OR = 2.31 respectively), while controlling for other covariates. Conclusions: We utilized a combination of qualitative and quantitative research methods to begin to describe the risk and potential for violence prevention in this setting. The prevalence of staff physical violence within the agency's treatment facilities was lower than would be predicted. Possible explanations include the voluntary nature of treatment programs; strong policies and consequences for resident behavior and ongoing quality improvement efforts. Quantitative data identified low management commitment to violence prevention as a significant predictor of staff reported violence.
