Risk For Secondary Traumatic Stress Research Articles

Secondary traumatic stress, burnout and compassion satisfaction among Flemish foster care workers during the COVID-19 lockdown

This study examines secondary traumatic stress (STS), burnout and compassion satisfaction (CS) in Flemish foster care workers (FCW) during the COVID-19 lockdown. Even though child welfare workers are at increased risk for STS and burnout, these constructs have not been studied in FCW so far. Additionally, the COVID-19 measures severely impacted Flemish FCW’s work, personal and client environment, possibly stimulating the onset of STS and burnout and weakening CS. Moreover, this study aims to identify the work, client and personal factors determining high levels of STS and burnout and low levels of CS among FCW during the lockdown. STS, burnout and CS levels from 434 Flemish FCW were inquired with the Professional Quality of Life Scale. Low mean levels of STS and moderate mean levels of burnout and CS were reported during the lockdown. FCW who experienced a negative impact of COVID-19 measures on their work, had a high amount of worrisome placements due to birth parents in their caseload and low emotional stability are an at-risk group for both STS and burnout during the lockdown. CS was strongly determined by the impact of the COVID-19 measures on work and personality traits. Emotional stability determined the three outcome variables, making this a key characteristics for FCW during the lockdown. Consequently, during adverse circumstances, foster care agencies should pay extra attention and offer additional support to those FCW they estimate emotionally less stable and who struggle with the birth parents in their caseload.

Caring for Patients From a School Shooting: A Qualitative Case Series in Emergency Nursing

IntroductionEmergency nurses are at risk for secondary traumatic stress, compassion fatigue, and burnout as a result of witnessing the trauma and suffering of patients. The traumatic events perceived as being most stressful for emergency nurses involve sudden death, children, and adolescents. Multicasualty, school-associated shooting events are, therefore, likely to affect emergency nurses, and recent reports indicate an increase in multicasualty, school-associated shootings. This research is necessary to learn of emergency nurses’ experiences of caring for patients from a school shooting event in an effort to benefit future preparedness, response, and recovery. This manuscript describes these experiences and provides opportunities for nurses, peers, and leaders to promote mental health and resilience among emergency nurses who may provide care to patients after such events. MethodsA qualitative case series approach, a theory of secondary traumatic stress, and the compassion fatigue resilience model guided the research. The emergency nurses who provided care to patients who were injured during a 2018 multicasualty, school-associated shooting in the Southeastern United States were invited to participate. ResultsThe themes identified by this research with 7 participants were preparation and preparedness, coping and support mechanisms, and reflections and closure. DiscussionThe results identified through this research may be translated to policies and practice to improve emergency nurses’ welfare, coping, resilience, and retention. Patient outcomes may also be improved through planning and preparedness.

Exploration of factors associated with secondary traumatic stress in foster parents

The role of caring for traumatized individuals has been widely recognized as having inherent risks for secondary exposure to trauma and associated distress. Child welfare work in particular has been found to be an occupation where indirect exposure to trauma is especially prevalent as are related experiences of secondary traumatic stress (STS) and burnout (Bride, Jones, & Macmaster, 2007; Nelson-Gardell & Harris, 2003). Given that rates of trauma exposure for children in foster care range from 80 to 93 percent and repeated or chronic exposures are common, it is assumed that foster parents are also at significant risk for STS (Lipschitz, Winegar, Hartnick, Foote, & Southwick, 1999; Stein et al., 2001; U.S. Department for Health and Human Services, 2013). As child welfare and foster care systems move toward implementation of trauma informed care, the potential for secondary traumatic stress (STS) in foster parents should be examined yet there has been minimal research in this area to date. This study analyzes the STS experiences of foster parents from one state’s child welfare system (N = 1213). Descriptive analysis of their experiences as well as an examination of factors associated with the development of STS was conducted and confirmed the significance of STS this sample of foster parents. Hierarchical regression analyses of risk and beneficial factor models accounted for 23.2 and 46.5 percent of the variance in STS symptoms respectively. Implications and strategies for foster care systems regarding points of prevention and intervention based on this research are provided.

Risk of Secondary Traumatic Stress in Treating Traumatized Military Populations: Results from the PTSD Clinicians Exchange.

This study examined risk factors for secondary traumatic stress (STS) in behavioral health clinicians and whether access to the Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange website mitigated STS risk. A diverse sample of clinicians (N=605) treating traumatized military populations in Department of Veterans Affairs (VA), Department of Defense, and community practice settings were randomized to a newsletter-only control group or the exchange group. The exchange website included resources for treating PTSD and promoting clinician well-being. Online surveys were administered at 0-, 6-, and 12-months postrandomization. Regression analyses were used to examine the link among risk factors, exchange access, and STS. Baseline clinician demographics, experience, total caseload, appeal of evidence-based practices (EBPs), and likelihood of adopting EBPs if required were not linked with STS at the 12-month assessment period. Providing care at the VA, more burnout, less compassion satisfaction, greater trauma caseload, less openness to new EBPs, and greater divergence from EBP procedures were linked with greater STS. Only burnout and divergence were associated with STS after accounting for other significant STS risk factors. Exchange and control group clinicians reported similar STS levels after accounting for burnout and divergence. Given that burnout was linked with STS, future intervention may use techniques targeting burnout and STS (eg, emotion regulation strategies). Research exploring the link between divergence from EBPs and STS may inform EBP dissemination efforts and STS interventions. Finally, results highlight the need for research optimizing STS intervention efficacy among clinicians treating military populations.

Secondary Traumatic Stress, Mental State, and Work Ability in Nurses-Results of a Psychological Risk Assessment at a University Hospital.

Psychological risk assessment is a legal obligation for companies and part of occupational safety and employment protection in Germany. However, data from psychological risk assessments in nursing staff are scarce, although this population is at increased risk for secondary traumatic stress by patient experienced trauma. Therefore, our study aimed at examining the frequency of reported secondary trauma events, secondary traumatic stress, and its possible consequences for psychological well-being and work ability in nurses. N = 320 nurses (n = 280 female) were assessed at a University Hospital in Germany as part of the psychological risk assessment. Secondary traumatic events, secondary traumatic stress, and symptoms of depression and anxiety were measured using self-report questionnaires (PHQ-2, GAD-2), and work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). Of 320 nurses, 292 (91.2%) experienced secondary trauma, and 74 nurses (25.3%) reported secondary traumatic symptoms. Nurses with secondary traumatic symptoms reported higher depression (p < 0.001) and anxiety scores (p < 0.001) compared to nurses without secondary trauma experience, and to nurses with secondary trauma experience but without secondary traumatic stress (both p < 0.001). Further, nurses with secondary traumatic stress reported significantly reduced work ability, social support and control over work, and increased emotional strain and labor time. Nurses with secondary traumatic stress may be at increased risk of developing major depression and anxiety disorders, and particularly need support in overcoming secondary traumatic experiences. Psychological risk assessment is a useful tool to identify groups at risk, and pave the way to implement strategies to improve mental well-being and prevent work ability in high risk groups.

The impact of emotional labor and workaholism in health care professionals’ secondary traumatic stress

Introduction: Secondary Traumatic Stress (STS) of healthcare professionals (HP) is a negative feeling driven by fear, “suffering” and work related trauma that can be direct (primary) trauma or occurs after the secondary exposure to people who have experienced extremely or traumatically stressful events. Several researchers have supported the relationship between STS, work addiction and emotional labor (EL). EL is the process of regulating both feelings and expressions to achieve organizational expectations, or, planning, and control needed to express organizationally desired emotions during interpersonal transactions. Aim: To investigate the impact of emotional labor and work addiction on healthcare professionals’ STS. Methods: A cross sectional study was conducted in a convenience sample of 231 HP, working in 3 public and 2 private hospitals. They completed a questionnaire that included: a) demographic/occupational characteristics, b) the Discrete Emotions, Emotional Labor Scale (DEELS), c) the Professional Quality of Life Scale (ProQOL), and d) the Bergen Work Addiction Scale. Data analysis was performed using the statistical package SPSS 24.0 Results: The sample consisted of 231 HP (77.9% nursing personnel and 22.1% physicians). Participants reported median levels of STS and low levels of work addiction. HP expressed more often emotions of happiness (mean=4.29) and less often emotions of fear (mean=1.85). As far as it concerns HP’s emotions that they hide but feel, they expressed more often emotions of frustration (mean=4.02) and less often emotions of happiness (mean=2.60). Emotions that HPs are expected to show but feel different, expressed more often the feeling of satisfaction (mean=2.55) and less often the feeling of fear (mean=2.08). Findings indicate that years of experience and age predict high risk for STS. In addition, STS was positively associated with work addiction (p=0.000) and the frequency (p=0.000) HPs express their feelings. Conclusions: HP’s expression of feelings, differ from what they really felt and was found to be positively associated with increased levels of STS. Findings highlight the importance of HP’s empowerment, psychological support, as well as the need for educational interventions to increase their resilience to STS.

Identifying compassion satisfaction, burnout, & traumatic stress in Children’s Advocacy Centers

BackgroundLittle research exists examining burnout related to the multidisciplinary team (MDT) working in a Children’s Advocacy Center (CAC) setting. ObjectivesTo measure compassion satisfaction, burnout, and secondary traumatic stress (STS) among CAC MDT professionals; identify work and worker characteristics that may impact compassion satisfaction, burnout, and STS; understand professional and personal impacts of occupational stress; and explore coping responses. Participants and settingA cross sectional survey was sent electronically to child abuse professionals working in CAC settings across the United States. MethodsDemographics and work characteristics were collected. Participants completed the Professional Quality of Life (ProQOL) to evaluate compassion satisfaction, burnout, and STS and answered open-ended questions regarding professional and personal impacts of occupational stress. Upon completion, participants received their ProQOL scores and additional stress management resources. ResultsA total of 885 participants completed the ProQOL (mean age = 42.07; 85% female). Overall mean scores were average for compassion satisfaction, high average for burnout, and in the top quartile for STS. All three scales differed significantly by MDT professional role (ps < 0.001 to 0.01) and employment length (ps < 0.001 to 0.003). Child welfare workers had significantly higher burnout scores than all other professions except law enforcement and prosecutors and significantly lower compassion satisfaction scores than most others. Professionals providing on-call services had significantly higher burnout (p < 0.001). ConclusionsThese results contribute to our understanding of MDT professions who might be at higher risk for burnout and STS and help inform future interventions to support the MDT.

An evolutionary concept analysis of secondary traumatic stress in nurses

The purpose of this article is to provide conceptual clarification of secondary traumatic stress (STS) in nurses. As an empathetic helping profession, nurses are at increased risk for STS. Interchangeable usage of related terms among multidisciplinary literature has resulted in lack of conceptual clarity resulting in conflation of terms. Conceptual clarity is necessary for a foundation for further research on treatment. Rodgers' evolutionary model of concept analysis. Nurses are predisposed to STS due to exposure, empathy, bonding, and personal factors. Essential attributes were found to be posttraumatic stress disorder-like symptoms, biological symptoms, social symptoms, and psychological symptoms. Resultant consequences included an altered worldview, interpersonal difficulties, and decreased occupational commitment. This concept analysis, the first focusing on STS, provides conceptual clarity and a concept map of STS within the nursing population.

Relationship between Adverse Childhood Expierences (ACEs) and resilience in Agents of Protection

Background Exposure to chronic stress in childhood through Adverse Childhood Experiences (ACEs) is well-known to negatively impact physical and mental health. Few studies have examined ACEs among the professionals who work with child abuse survivors (agents of protection), but evidence suggests that childhood trauma increases symptoms of post-traumatic stress disorder (PTSD) and the risk of secondary traumatic stress (STS) in a variety of agents of protection. We hypothesize …

Exploring the Feasibility of Supporting UK Partners Living Alongside Veterans with PTSD: A Pilot Study of the Together Programme (TTP)

Background Romantic partners living alongside veterans with Post Traumatic Stress Disorder (PTSD) appear at increased risk of secondary traumatic stress (sPTSD) and common mental health difficulties (CMD) compared to the general population. The severity of symptoms implies the need for structured, bespoke and evidence-based interventions. Objective The aim of this study was to explore the feasibility of offering a community support programme (The Together Programme, TTP) for military partners. TTP was developed based upon a number of US programmes and consisted of 10 hours of group-based support delivered over a five-week course. 56 participants engaged in TTP over a year at nine locations across the UK and were followed up three months later. Methods Measures of CMD, sPTSD, alcohol use and relationship satisfaction were used to assess benefits. Data were also collected on attendance and participant feedback. Results Significant reductions were observed for symptoms of sPTSD and CMD at follow up. 51/56 (90.1%) participants completed TTP. The majority of participants reported positive experiences. However, several individuals stated wanting more sessions and that barriers such as work, and family commitments made it difficult to attend. Conclusions Whilst limitations exist, the data presented suggests cautious optimism for the efficacy of offering a structured programme of support to address the needs of military partners living alongside PTSD.

Rethinking professional quality of life for social workers: Inclusion of ecological self-care barriers

ABSTRACTThis study conducted a survey among social workers in a mid-Atlantic state in the U.S. and examined the relationship between self-care behaviors, self-care barriers and compassion satisfaction, burnout, and secondary traumatic stress (STS) from an ecological perspective. The study found that social workers had a moderate level of compassion satisfaction, low risk of burnout, and low risk of STS. Bachelor-degree social workers had higher levels of burnout and lower levels of compassion satisfaction than others. Multiple regression results showed that self-care behaviors and self-care barriers did not predict compassion satisfaction. Self-care behaviors and self-care barriers were significantly associated with the level of burnout. Self-care barriers significantly contributed to STS, while self-care behaviors did not significantly decrease STS. This study implies that promoting self-care behaviors and decreasing self-care barriers can promote higher levels of professional quality of life. In addition to social workers’ individual-level self-care activities that are often stressed in prior research on STS and burnout, employers, supervisors, family members, and community members play a critical role in promoting a manageable work-life balance for social workers, thereby allowing them to use more self-care behaviors, while reducing barriers to self-care and ultimately reducing risk of burnout and STS.

Are parents at a higher risk for secondary traumatic stress?: How interviewing child victims impacts relationships with forensic interviewer's friends and family.

Forensic interviewers are at a heightened risk for secondary traumatic stress (STS) due to their frequent interactions with victims of child maltreatment (Bonach & Heckert, 2012). To date, however, few studies have examined the negative effects of this work on interviewers' social and emotional well-being. The present study seeks to explore the effect of STS on the relationships of forensic interviewers, including those with friends, family, and their respective children. Data are derived from a sample of 367 forensic interviewers (FIs) recruited from across the United States. The current study used a cross-sectional research design to obtain qualitative and quantitative data from an online survey of certified forensic interviewers. Personal-level predictors of STS included interviewers' sex (β = 0.11, p = 0.02), trauma history (β = 0.13, p = 0.004), and frequency of socializing with family members outside of work (β = -0.12, p = 0.01). Work-related predictors included the frequency of direct (β = 0.10, p = 0.04) and indirect exposures to graphic details of child maltreatment (β = 0.09, p = 0.05), burnout (β = 0.58, p = 0.000), and years of experience investigating crimes against children (β = 0.10, p = 0.03). Factors such as parental status and external social support were not significantly associated with STS in the qualitative analysis. Forensic interviewers experience both positive and negative effects of exposure to crimes against children, with work-related factors being particularly impactful on the potential for STS.

Enhancing Resilience Among Providers of Trauma-Informed Care: A Curriculum for Protection Against Secondary Traumatic Stress Among Non-Mental Health Professionals

ABSTRACTAlthough the call to create trauma-informed services for youth has been clearly sounded, a relatively neglected part of this effort is the need to prepare non-mental health professionals to carry out trauma-informed programming in ways that protect them from secondary traumatic stress (STS). To this end, this article introduces Resilience for Trauma-Informed Professionals, a curriculum that introduces participants to techniques designed to promote resilience in the face of exposure to trauma-related material. Based on the existing evidence base regarding risk and protective factors for STS, six core elements targeted by the curriculum are described—appraisals, self-efficacy, emotional awareness, affect regulation, resilience, and prevention—as they are implemented across three stages: pre-exposure preparation, coping in the presence of trauma, and recovery in the aftermath of exposure.

Trauma-informed supervision in deployed military settings

ABSTRACTUniformed mental health care providers often practice in extremis; that is, in difficult and dangerous contexts defined by deployment to combat theaters, isolated practice settings, and exposure—directly and indirectly—to traumatic experiences. Frequent exposure to client trauma heightens the risk of secondary traumatic stress and compassion fatigue among military health care providers. Supervision for military interns, residents, and junior practitioners must be competent, caring, and trauma-informed. In this article, we describe the unique characteristics of clinical practice in deployed military settings, including the unique professional and ethical quandaries for both practitioners and their clinical supervisors. We then offer a framework for trauma-informed supervision in deployed military settings, including several specific recommendations for supervisors in these contexts.

Professional quality of life of adult protective service workers

ABSTRACTAdult Protective Services (APS) workers are exposed to substantial occupational hazards and job stress, but these stressors are underdocumented. Therefore, we sought to describe APS workers’ work environments and responses to occupational hazards and stressors, including compassion fatigue, burnout, and secondary traumatic stress. Survey data were gathered with closed-ended questionnaires administered to APS workers in an urban setting. Virtually all workers (97%) reported exposure to one or more environmental hazards in their work, and 80% reported hazard exposure in the past month. Workers also reported mixed responses to their work environment and to experiences with supervision. A sizable minority (22.7%) was at high risk for burnout, 24.6% were at risk for secondary traumatic stress, and 19.9% reported low compassion satisfaction. The results document multiple stressors in APS work. The APS partner is committed to ongoing efforts to better support its staff, and these findings can inform future efforts to enhance supervisor support and worker self-care, to minimize burnout and secondary traumatic stress.

Teaching Trauma: A Model for Introducing Traumatic Materials in the Classroom

niversity courses in disciplines such as social work, family studies, humanities, and other areas often use classroom materials that contain traumatic material (Barlow &amp; Becker-Blease, 2012). While many recommendations based on trauma theory exist for instructors at the university level, these are often made in the context of clinical training programs, rather than at the undergraduate level across disciplines. Furthermore, no organized model exists to aid instructors in developing a trauma-informed pedagogy for teaching courses on traumatic stress, violence, and other topics that may pose a risk for secondary traumatic stress in the classroom (Kostouros, 2008). This paper seeks to bridge the gap between trauma theory and implementation of sensitive content in classrooms of higher education, and presents a model of trauma-informed teaching that was developed in the context of an undergraduate trauma studies program. Implications and future directions for research in the area of trauma-informed university classrooms are discussed.

Secondary Traumatic Stress in Social Science Researchers of Trauma-Exposed Populations

ABSTRACTThere is an expanding research database regarding secondary trauma exposure among helping professionals across disciplines and settings. However, there is limited research on the incidence of secondary traumatic stress in social science researchers studying traumatized populations. Various disciplines engage in this area of research, which exposes them to the details of aversive events, especially those engaging in qualitative research. This study explores the impact of such exposure by measuring indicators of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction in a group of 104 researchers. Findings revealed high rates of exposure to traumatic material and a subset of researchers at risk for STS. Regression analyses revealed potential risk factors for STS and BO, and qualitative analysis was conducted to further explore the effects of this work on researchers from multiple disciplines.

Cultivating a Trauma Awareness Culture in the Addictions.

Research evidence points to the high prevalence of trauma exposure and post traumatic stress among addicted individuals, their families and the professionals responsible for their treatment. The purpose of this review is to enhance understanding of the continuing effects of trauma and its impact on the lives of people with addiction problems as well as on the professionals who strive to provide support and care for them. Review of twenty eight articles on traumatic experiences in individuals and families facing addiction problems as well as on traumatic stress in addiction professionals. Eligibility criteria were: publication in a peer-reviewed journal dating from 1990 to present; articles written in the English language; quantitative or qualitative design aiming to explore the lived experience of trauma and the recovery process from it. It is argued that for service providers to be able to help patients restore purpose and meaning in the recovery process, it is important to be aware of the trauma dynamics implicated in the long history of the addiction problems. Professionals' difficulty to process their emotions may lead to disengagement or overinvolvement and the adoption of maladaptive roles. Strong and unexpected emotional reactions in the professional may be a clue to the presence of masked trauma. Ongoing training on trauma dynamics, self-care and clinical supervision may deepen professionals' understanding of the impact of trauma on their work culture and protect them from the risk of secondary traumatic stress.

The Prevalence of Compassion Fatigue among Veterinary Students in Australia and the Associated Psychological Factors.

Compassion fatigue, compassion satisfaction, and other characteristics such as mindfulness and mental health stigma have not been investigated in veterinary students. The aims of this study were twofold: first to determine the prevalence of compassion, satisfaction, burnout, and secondary traumatic stress among Australian veterinary students and second to investigate the association between these factors and self-stigma, coping, empathy, and mindfulness. A cross-sectional online survey consisting of demographic questions and four validated psychological measures sampled 828 students, with a response rate of 31% (255/828). We obtained a usable sample of completed surveys from 193 of 828 (23%) veterinary students from six of the seven Australian veterinary schools. Bivariate correlations and multiple regression analyses were used to examine associations between the psychological predictors and the outcome variables. Approximately 30% of veterinary students were at high risk of burnout, 24% were at high risk of secondary traumatic stress, and 21% reported low compassion satisfaction. High empathic concern, low personal distress, female gender, and employment history at a veterinary clinic were associated with high compassion satisfaction. High dysfunctional coping, low nonjudgmental and acting-with-awareness mindfulness, and lack of previous employment at a veterinary clinic were associated with high burnout. High dysfunctional coping, low acting-with-awareness mindfulness, high self-stigma, and high personal distress were associated with high secondary traumatic stress. As a result of these findings, certain emotional characteristics can be identified as targets for intervention to minimize the frequency and potentially negative impact of compassion fatigue and burnout in veterinary students.

Secondary traumatic stress and secondary posttraumatic growth in a sample of Dutch police family liaison officers.

This study investigated secondary traumatic stress (STS) and secondary posttraumatic growth (SPG) in a sample of Dutch police family liaison officers (N=224). Our study had two aims: (a) to identify potential risk and protective factors for STS and (b) to investigate the association between STS and SPG. None of the risk (caseload and a personal trauma history) and protective factors (age, work experience, and support by supervisors and coworkers) identified in previous research correlated with STS. However, a small positive association was found between STS and SPG. In the discussion section we warn against the use of interventions that aim to prevent STS until more is known about risk and protective factors for STS and provide directions for future research.