Evidence in Action

A quarterly research brief from the Center on Trauma and Children

Volume 1, Issue 2 
April 2013 

 

Important Terms:

 

Secondary traumatic stress is defined as the presence of symptoms of Post-traumatic Stress Disorder precipitated by exposure to traumatic material indirectly, usually through the retelling of trauma experiences by clients or patients or via exposure to graphic details of a traumatic event.

 

The term compassion fatigue was coined by Charles Figley (1995) in an attempt to describe STS in a less stigmatizing manner, but generally refers to specific behaviors and emotions that result from indirect exposure to trauma.   Figley talked about this as the inevitable "cost of caring".

 

Vicarious trauma refers to the disruption in one's sense of safety, control, intimacy, and trust as a result of cumulative exposure to traumatic material over time (Pearlman & Saakvitne, 1995).  

 

Burnout, which is characterized by emotional exhaustion, job dissatisfaction and withdrawal, is also work-related but not linked to direct or indirect exposure to traumatic material.

 

Compassion satisfaction refers to the potential fulfillment or pleasure helping others work through trauma can provide for a professional.

 

CTAC Investigates the Problem of Compassion Fatigue In Different Professional Groups
  

Several decades of research reveals that harmful consequences to a worker's sense of well-being and effectiveness may manifest as a result of exposure to the recounting of traumatic experiences during the course of professional service. Compassion Fatigue (CF) or Secondary Traumatic Stress (STS), terms that are used interchangeably in the literature, have been described as an "occupational hazard" for certain types of workers (Hopkins, Cohen-Callow, Kim & Hwang, 2010; Van Hook, & Rothenberg, 2009; Conrad, Kellar-Guenther, 2006).  These conditions can lead to professional distress, increased absenteeism, and poor workforce retention. If service providers are to effectively protect and treat trauma-exposed children, their psychological well-being must also be recognized and protected.

 

This issue of Evidence in Action highlights research done at the UK Center on Trauma and Children which explores the phenomenon of CF and STS in a variety of populations: mental health professionals, health care  personnel, child welfare workers and researchers. The results of each study are summarized to provide easy access to this research related to CF and STS in each population subgroup. The citations are provided for those who want to read the full articles, and a set of Translational Tips, or implications for practice, appears at the end of the article. These tips are designed to facilitate the development of CF- and STS-informed organizations and practices in a variety of workplace settings.

 

All of the studies use the Professional Quality of Life Scale (Pro-QOL) by Stamm (2005). This 30-item instrument measures compassion fatigue, burnout (BO) and compassion satisfaction (CS) on three 10-item subscales. The ProQOL has been found to have adequate alpha reliability and test validity (Stamm, 2005).


    

Mental Health Professionals

A study published in the Journal of Loss and Trauma by Sprang, Clark, and Whitt-Woosley (2007) investigated factors that impact a mental health professional's quality of life. The Pro-QOL was used to measure compassion fatigue, burnout, and compassion satisfaction. The final sample consisted of 1,121 mental health providers ranging in age from 23- 81 (mean age = 45.22) and just over 30% male. More than 13% of the sample reported both burnout and compassion fatigue and 48.3 % reported compassion satisfaction. Results indicated female gender was associated with higher levels of CF; psychiatrists also reported higher levels of CF than their non-medical counterparts. Therapists with self-identified specialized training in trauma work reported higher levels of CS than non-specialists. Most rural providers reported increased levels of burnout but had no difference on compassion fatigue or compassion satisfaction as compared to their peers in urban and urban-influenced locations. Three hierarchical regression analyses indicated that female gender, young age, a higher educational degree, less clinical experience, and higher percentage of clients with PTSD on clinician caseload predicted higher levels of CF and BO. Only an increase in age was a significant predictor of CS.

    

Craig and Sprang (2010) conducted a national replication of this state-wide study, also investigating the impact use of evidence based practices has on compassion fatigue, compassion satisfaction and burnout in licensed clinical social workers and psychologists who self-identified as trauma specialists. Published in Anxiety, Stress & Coping, this study examines a random national sample (N=532), 34% male, ranging in age from 27-83 (mean age = 53.2). The 19-item Trauma Practices Questionnaire (Craig & Sprang, 2007) was used to measure the use of evidence based practices. Three, six-step hierarchical regression analyses were conducted with criterion variables CF, BO and CS and age, gender, licensure, years of experience, type of mental health organization in which the clinician works, specialized trauma training, percentage of individuals with PTSD on clinician caseload and use of evidence based practice by the clinician as predictor variables. Results indicated that in the sixth and final step only percentage of clients with PTSD on caseload and use of evidence based practices were significant predictors of compassion fatigue: CF increased as the percentage of PTSD on the clinician's caseload increased and decreased as use of evidence based practices by clinicians increased. BO decreased as age, specialized trauma training, and use of evidence based practices increased and BO increased when percentage of individuals with PTSD on the caseload increased and with specific type of mental health organization worked at by the clinician with inpatient clinicians being significantly higher than all other organizational settings. Only years of clinical experience and use of evidence based practices by the clinician significantly predicted compassion satisfaction, with CS significantly increasing as years of clinical experience and use of evidence based practices increased.

 

Child Welfare Professionals

Sprang, Craig and Clark (2011) in a study in Child Welfare described predictors of secondary traumatic stress and burnout in a national sample of helping professionals, with a specific focus on the unique responses of child welfare workers. Specific worker and exposure characteristics were examined as possible predictors of these forms of occupational distress in a national sample of 669 professionals in an online survey including the Pro-QOL. E-mail and home mailing addresses were secured from licensure boards and professional membership organizations in six states from across the country that had high rates of child related deaths in 2009. Being male, young, Hispanic, holding rural residence, and endorsing a lack of religious participation were significant predictors of STS. Similarly, being male and young predicted high burnout rates, while actively participating in religious services predicted lower burnout. Working as a child welfare worker was significantly more likely to predict CF and BO compared to all other types of behavioral health professionals.

 

Healthcare Professionals

A current study (Silman and Sprang) examines CF and BO responses of healthcare providers throughout North America who experienced the H1N1 or SARS pandemic. Healthcare professionals have been asked to complete an online survey which includes the CF and BO scales of the Pro-QOL. Respondents are from 38 states, the District of Columbia, Mexico, Canada and several other countries; the majority (79%) are hospital-based, nearly all (81.8%) experienced the H1N1 pandemic, and 75% have experience with quarantine or isolation.   Respondents are largely female (92%), white (70%), married (70%), and ranging in age from 22-66 (mean age = 37.5). Stepwise regression is utilized to explore the contribution of age and race, urbanity, number of children in the home, degree of religious activity, experience with quarantine or isolation and reported tension in balancing work and family responsibilities to total CF and BO scores. Results indicate that age and race, number of children in the home, religiosity and work-family tension were significant variables for both compassion fatigue and burnout scores. Being non-white, older and having children in the home increased both CF and BO scores, as did reporting higher degrees of tension between work and family responsibilities. Increased participation in religious activities lowered both CF and BO scores. Qualitative responses indicate healthcare organizations are generally not well-attuned to these risks for workers and current mechanisms of support are perceived as ineffective, inaccessible or stigmatizing to workers. 

  

Researchers

To date, there are no known studies of the incidence of compassion fatigue among researchers studying traumatized populations, and only limited information about the emotional effects of conducting social science research in general. A current CTAC study (Whitt-Woosley and Sprang) explores variables pertinent to social science researchers that may influence responses to vicarious exposure to trauma by examining levels of secondary traumatic stress, compassion satisfaction, and burnout as measured by the ProQOL-R-IV (Stamm, 2005). A group of social scientists (N=104) engaged in both qualitative and quantitative research completed an online survey for this study. Descriptive statistics reveal that 86.5 percent of respondents experience exposure to secondary trauma through their work as researchers, and 63.4 percent report moderate to extreme distress associated with this exposure. Significantly higher levels of STS, BO and general distress are being reported by the researchers studying trauma exposed populations and in those engaged in qualitative versus quantitative research. Risk factors for experiencing these conditions include the combination of trauma exposure through research, being a qualitative researcher and spending more hours per week engaged in research activities. Protective factors for STS and BO include feeling a sense of connection to others, having sustaining beliefs and experiencing work satisfaction. A qualitative analysis is also included in the study regarding respondents' descriptions of their emotional experiences conducting research with traumatized populations. The two most frequently cited themes reference the distressing nature of researching abuse victims and working with child subjects. Additional themes include the distressing nature of research focusing on war and humanitarian efforts, experiencing intrusive symptoms associated with the research, the interaction between personal and work experiences including triggers regarding one's own trauma history, similarities to the researchers' family situations, and a feeling of responsibility but being unable to help distressed or victimized study subjects.

 

These studies suggest that there are a number of risk factors for STS that professionals working in the field of trauma should be aware of.
They include:
  • Being young
  • Being non-white
  • Having less clinical experience
  • Having a higher percentage of clients with PTSD on caseload
  • Doing inpatient work
  • Working in high exposure positions (child welfare, psychiatry)

 sad

  

Evidence in Action:

Implications for Professionals at Risk for Compassion Fatigue 

 

The following strategies may help reduce the risk and incidence of secondary traumatic stress, compassion fatigue and burnout in professionals, and reduce attrition, turnover and early exit from the

field of child welfare.

 

  • Professionals working with traumatized populations should have training in the use of evidence-based practices
  • Clinicians should have supervision and support to develop their skills and reduce attrition; this is especially important for clinicians and professionals with noted risk factors who may be more vulnerable
  • The percentage of clients with PTSD on caseloads should be limited and balanced by other types of cases
  • All types of professionals working with traumatized populations should be aware of and educated about STS, CF and BO and preventive measures
  • Organizational support networks that center on self-care and relationship building and offer psychological support (e.g. Balint groups and EAP services) should be institutionalized; private practitioners should seek consultative and supervisory support from colleagues
  • Agencies and response organizations should identify and address practical support needs (e.g., child care assistance, flexible scheduling) of professionals working with trauma, and recognize that particular high-risk groups (e.g., workers with children, those who are young or those who live in rural areas) may require active intervention and prevention efforts.

"That which is to give light must endure burning."

Viktor Frankl, Man's Search for Meaning

 

 

Citations

Craig, C. D., & Sprang, G. (2010). Compassion satisfaction,   

     compassion fatigue, and burnout in a national sample of trauma

     treatment therapists. Anxiety, Stress & Coping, 23, 319-339.

Silman, M. & Sprang, G. (2011). Compassion fatigue health 

      providers following a pandemic event. Manuscript in progress.

Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion fatigue,

     compassion satisfaction, and burnout: Factors impacting a

     professional's quality of life. Journal of Loss and Trauma,

     12, 259-280.

Sprang, G., Craig, C., & Clark, J. (2011). Secondary traumatic stress and

     burnout in child welfare workers: A comparative analysis of occupational

     distress across professional groups. Child Welfare, 90, 6, 149

Whitt-Woosley, A., & Sprang, G. (2013). Emotional experiences of social

     science researchers.  Manuscript in progress.

 

 

The Center on Trauma and Children (CTAC) is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

Visit our website: