Secondary Traumatic Stress A Fact Sheet for Child-Serving Professionals

Transcription

1 Secodary Traumatic Stress A Fact Sheet for Child-Servig Professioals We are stewards ot just of those who allow us ito their lives but of our ow capacity to be helpful... 1 Each year more tha 10 millio childre i the Uited States edure the trauma of abuse, violece, atural disasters, ad other adverse evets. 2 These experieces ca give rise to sigificat emotioal ad behavioral problems that ca profoudly disrupt the childre s lives ad brig them i cotact with childservig systems. For therapists, child welfare workers, case maagers, ad other helpig professioals ivolved i the care of traumatized childre ad their families, the essetial act of listeig to trauma stories may take a emotioal toll that compromises professioal fuctioig ad dimiishes quality of life. Idividual ad supervisory awareess of the impact of this idirect trauma exposure referred to as secodary traumatic stress is a basic part of protectig the health of the worker ad esurig that childre cosistetly receive the best possible care from those who are committed to helpig them. Our mai goal i preparig this fact sheet is to provide a cocise overview of secodary traumatic stress ad its potetial impact o child-servig professioals. We also outlie optios for assessmet, prevetio, ad itervetios relevat to secodary stress, ad describe the elemets ecessary for trasformig child-servig orgaizatios ad agecies ito systems that also support worker resiliecy. How Idividuals Experiece Secodary Traumatic Stress Secodary traumatic stress is the emotioal duress that results whe a idividual hears about the firsthad trauma experieces of aother. Its symptoms mimic those of posttraumatic stress disorder (PTSD). Accordigly, idividuals affected by secodary stress may fid themselves re-experiecig persoal trauma or otice a icrease i arousal ad avoidace reactios related to the idirect trauma exposure. They may also experiece chages i memory ad perceptio; alteratios i their sese of self-efficacy; a depletio of persoal This project was fuded by the Substace Abuse ad Metal Health Services Admiistratio (SAMHSA), US Departmet of Health ad Huma Services (HHS). The views, policies, ad opiios expressed are those of the authors ad do ot ecessarily reflect those of SAMHSA or HHS.

2 resources; ad disruptio i their perceptios of safety, trust, ad idepedece. A partial list of symptoms ad coditios associated with secodary traumatic stress icludes 3 Hypervigilace Hopelessess Iability to embrace complexity Iability to liste, avoidace of cliets Ager ad cyicism Sleeplessess Fear Chroic exhaustio Physical ailmets Miimizig Guilt Clearly, cliet care ca be compromised if the therapist is emotioally depleted or cogitively affected by secodary trauma. Some traumatized professioals, believig they ca o loger be of service to their cliets, ed up leavig their jobs or the servig field altogether. Several studies have show that the developmet of secodary traumatic stress ofte predicts that the helpig professioal will evetually leave the field for aother type of work. 4,5 Uderstadig Who is at Risk The developmet of secodary traumatic stress is recogized as a commo occupatioal hazard for professioals workig with traumatized childre. Studies show that from 6% to 26% of therapists workig with traumatized populatios, ad up to 50% of child welfare workers, are at high risk of secodary traumatic stress or the related coditios of PTSD ad vicarious trauma. Ay professioal who works directly with traumatized childre, ad is i a positio to Secodary Traumatic Stress ad Related Coditios: Sortig Oe from Aother Secodary traumatic stress refers to the presece of PTSD symptoms caused by at least oe idirect exposure to traumatic material. Several other terms capture elemets of this defiitio but are ot all iterchageable with it. Compassio fatigue, a label proposed by Figley 4 as a less stigmatizig way to describe secodary traumatic stress, has bee used iterchageably with that term. Vicarious trauma refers to chages i the ier experiece of the therapist resultig from empathic egagemet with a traumatized cliet. 13 It is a theoretical term that focuses less o trauma symptoms ad more o the covert cogitive chages that occur followig cumulative exposure to aother perso s traumatic material. The primary symptoms of vicarious trauma are disturbaces i the professioal s cogitive frame of referece i the areas of trust, safety, cotrol, esteem, ad itimacy. Burout is characterized by emotioal exhaustio, depersoalizatio, ad a reduced feelig of persoal accomplishmet. While it is also work-related, burout develops as a result of geeral occupatioal stress; the term is ot used to describe the effects of idirect trauma exposure specifically. Compassio satisfactio refers to the positive feeligs derived from competet performace as a trauma professioal. It is characterized by positive relatioships with colleagues, ad the covictio that oe s work makes a meaigful cotributio to cliets ad society. Secodary Traumatic Stress: A Fact Sheet for Child-Servig Professioals The Natioal Child Traumatic Stress Network 2

3 hear the recoutig of traumatic experieces, is at risk of secodary traumatic stress. That beig said, risk appears to be greater amog wome ad amog idividuals who are highly empathetic by ature or have uresolved persoal trauma. Risk is also higher for professioals who carry a heavy caseload of traumatized childre; are socially or orgaizatioally isolated; or feel professioally compromised due to iadequate traiig. 6-8 Protectig agaist the developmet of secodary traumatic stress are factors such as loger duratio of professioal experiece, ad the use of evidece-based practices i the course of providig care. 7 Idetifyig Secodary Traumatic Stress Supervisors ad orgaizatioal leaders i child-servig systems may utilize a variety of assessmet strategies to help them idetify ad address secodary traumatic stress affectig staff members. The most widely used approaches are iformal self-assessmet strategies, usually employed i cojuctio with formal or iformal educatio for the worker o the impact of secodary traumatic stress. These self-assessmet tools, admiistered i the form of questioaires, checklists, or scales, help characterize the idividual s trauma history, emotioal relatioship with work ad the work eviromet, ad symptoms or experieces that may be associated with traumatic stress. 4,9 Supervisors might also assess secodary stress as part of a reflective supervisio model. This type of supervisio fosters professioal ad persoal developmet withi the cotext of a supervisory relatioship. It is attetive to the emotioal cotet of the work at had ad to the professioal s resposes as they affect iteractios with cliets. The reflective model promotes greater awareess of the impact of idirect trauma exposure, ad it ca provide a structure for screeig for emergig sigs of secodary traumatic stress. Moreover, because the model supports cosistet attetio to secodary stress, it gives supervisors ad maagers a ogoig opportuity to develop policy ad procedures for stress-related issues as they arise. Formal assessmet of secodary traumatic stress ad the related coditios of burout, compassio fatigue, ad compassio satisfactio is ofte coducted through use of the Professioal Quality of Life Measure (ProQOL). 7,8,10,11 This questioaire has bee adapted to measure symptoms ad behaviors reflective of secodary stress. The ProQOL ca be used at regular itervals to track chages over time, especially whe strategies for prevetio or itervetio are beig tried. Secodary Traumatic Stress: A Fact Sheet for Child-Servig Professioals The Natioal Child Traumatic Stress Network 3

4 Strategies for Prevetio A multidimesioal approach to prevetio ad itervetio ivolvig the idividual, supervisors, ad orgaizatioal policy will yield the most positive outcomes for those affected by secodary traumatic stress. The most importat strategy for prevetig the developmet of secodary traumatic stress is the triad of psychoeducatio, skills traiig, ad supervisio. As workers gai kowledge ad awareess of the hazards of idirect trauma exposure, they become empowered to explore ad utilize prevetio strategies to both reduce their risk ad icrease their resiliecy to secodary stress. Prevetive strategies may iclude self-report assessmets, Prevetio participatio i self-care groups i the workplace, caseload balacig, use of flextime schedulig, ad use of the self-care accoutability buddy system. Proper rest, utritio, exercise, ad stress reductio activities are also importat i prevetig secodary traumatic stress. Psychoeducatio Cliical supervisio Ogoig skills traiig Iformal/formal self-report screeig Workplace self-care groups (for example, yoga or meditatio) Creatio of a balaced caseload Flextime schedulig Self-care accoutability buddy system Use of evidece-based practices Exercise ad good utritio Strategies for Itervetio Although evidece regardig the effectiveess of itervetios i secodary traumatic stress is limited, cogitive-behavioral strategies ad midfuless-based methods are emergig as best practices. I additio, caseload maagemet, traiig, reflective supervisio, ad peer supervisio or exteral group processig have bee show to reduce the impact of secodary traumatic stress. May orgaizatios make referrals for formal itervetio from outside providers such as idividual therapists or Employee Assistace Programs. Exteral group supervisio services may be especially importat i cases of disasters or commuity violece where a large umber of staff have bee affected. Itervetio Strategies to evaluate secodary stress Cogitive behavioral itervetios Midfuless traiig Reflective supervisio Caseload adjustmet Iformal gatherigs followig crisis evets (to allow for volutary, spotaeous discussios) Chage i job assigmet or work group Referrals to Employee Assistace Programs or outside agecies The followig books, workbooks, articles, ad self-assessmet tests are valuable resources for further iformatio o self-care ad the maagemet of secodary traumatic stress: Volk, K.T., Guario, K., Edso Gradi, M., & Clervil, R. (2008). What about You? A Workbook for Those Who Work with Others. The Natioal Ceter o Family Homelessess. Secodary Traumatic Stress: A Fact Sheet for Child-Servig Professioals The Natioal Child Traumatic Stress Network 4

5 Self-Care Assessmet Worksheet Hopkis, K. M., Cohe-Callow, A., Kim, H. J., Hwag, J. (2010). Beyod itet to leave: Usig multiple outcome measures for assessig turover i child welfare. Childre ad Youth Services Review, 32, Saakvite, K. W., Pearlma, L. A., & Staff of TSI/CAAP. (1996). Trasformig the Pai: A Workbook o Vicarious Traumatizatio. New York: W.W. Norto. Va Deroot Lipsky, L. (2009). Trauma Stewardship: A everyday guide to carig for self while carig for others. Sa Fracisco: Berrett-Koehler Publishers. Compassio Fatigue Self Test ProQOL 5 Rothschild, B. (2006). Help for the helper. The psychophysiology of compassio fatigue ad vicarious trauma. New York: W.W. Norto. Worker Resiliecy i Trauma-iformed Systems: Essetial Elemets Both prevetive ad itervetioal strategies for secodary traumatic stress should be implemeted as part of a orgaizatioal risk-maagemet policy or task force that recogizes the scope ad cosequeces of the coditio. The Secodary Traumatic Stress Committee of the Natioal Child Traumatic Stress Network has idetified the followig cocepts as essetial for creatig a trauma-iformed system that will adequately address secodary traumatic stress. Specifically, the trauma-iformed system must Recogize the impact of secodary trauma o the workforce. Recogize that exposure to trauma is a risk of the job of servig traumatized childre ad families. Uderstad that trauma ca shape the culture of orgaizatios i the same way that trauma shapes the world view of idividuals. Uderstad that a traumatized orgaizatio is less likely to effectively idetify its cliets past trauma or mitigate or prevet future trauma. Develop the capacity to traslate trauma-related kowledge ito meaigful actio, policy, ad improvemets i practices. These elemets should be itegrated ito direct services, programs, policies, ad procedures, staff developmet ad traiig, ad other activities directed at secodary traumatic stress. We have a obligatio to our cliets, as well as to ourselves, our colleagues ad our loved oes, ot to be damaged by the work we do. 12 Secodary Traumatic Stress: A Fact Sheet for Child-Servig Professioals The Natioal Child Traumatic Stress Network 5

6 Refereces 1. Cote, JR. (2009). Foreword. I L. Va Deroot Lipsky, Trauma stewardship. A everyday guide to carig for self while carig for others (p. xi). Sa Fracisco: Berrett-Koehler Publishers, Ic. Available at: Accessed Jue 12, Natioal Ceter for Childre Exposed to Violece (NCCEV). (2003). Available at: Accessed Jue 5, Va Deroot Lipsky, L. (2009). Trauma Stewardship: A everyday guide to carig for self while carig for others. Sa Fracisco: Berrett-Koehler Publishers. 4. Figley, C.R. (1995). Compassio fatigue as secodary traumatic stress disorder: A overview. I C.R. Figley (Ed.), Compassio fatigue: Copig with secodary traumatic stress disorder i those who treat the traumatized (pp. 1-20). New York, NY: Bruer/Mazel. 5. Pryce, J.G., Shackelford, K.K., Price, D.H. (2007). Secodary traumatic stress ad the child welfare professioal. Chicago: Lyceum Books, Ic. 6. Bride, B.E., Hatcher, S.S., & Humble, M.N. (2009). Trauma traiig, trauma practices, ad secodary traumatic stress amog substace abuse couselors. Traumatology, 15, Craig, C.D., & Sprag, G. (2010). Compassio satisfactio, compassio fatigue, ad burout i a atioal sample of trauma treatmet therapists. Axiety, Stress, & Copig, 23(3), Sprag, G., Whitt-Woosley, A., & Clark, J. (2007). Compassio fatigue, burout ad compassio satisfactio: Factors impactig a professioal s quality of life. Joural of Loss ad Trauma, 12, Figley, C.R. (2004, October). Compassio Fatigue Therapist Course Workbook. A Weeked Traiig Course. Gree Cross Foudatio. Black Moutai, NC. Available at: Stamm, B.H. (2010). The cocise ProQOL maual, 2d Ed. Pocatello, ID: ProQOL.org. Available at: Stamm, B.H., Figley, C.R., & Figley, K.R. (2010, November). Provider Resiliecy: A Trai-the-Traier Mii Course o Compassio Satisfactio ad Compassio Fatigue. Iteratioal Society for Traumatic Stress Studies. Motreal, Quebec, Caada. 12. Saakvite, K. W., & Pearlma, L. A., & Staff of TSI/CAAP. (1996). Trasformig the Pai: A Workbook o Vicarious Traumatizatio. New York: W.W. Norto. 13. Pearlma, L. A., & Saakvite, K.W. (1995). Treatig therapists with vicarious traumatizatio ad secodary traumatic stress disorders. I C.R. Figley (Ed.), Compassio fatigue: Copig with secodary traumatic stress disorder i those who treat the traumatized (pp ). New York, NY: Bruer/Mazel. Recommeded Citatio Natioal Child Traumatic Stress Network, Secodary Traumatic Stress Committee. (2011). Secodary traumatic stress: A fact sheet for child-servig professioals. Los Ageles, CA, ad Durham, NC: Natioal Ceter for Child Traumatic Stress. Copyright 2011, Natioal Ceter for Child Traumatic Stress o behalf of Giy Sprag, PhD, Leslie Ae Ross, PsyD, ad the Natioal Child Traumatic Stress Network. This work was fuded by the Substace Abuse ad Metal Health Services Admiistratio (SAMHSA), US Departmet of Health ad Huma Services (HHS), which retais for itself ad others actig o its behalf a oexclusive, irrevocable worldwide licese to reproduce, prepare derivative works, ad distribute this work by or o behalf of the Govermet. All other rights are reserved by the copyright holder(s). About the Natioal Child Traumatic Stress Network Established by Cogress i 2000, the Natioal Child Traumatic Stress Network (NCTSN) is a uique collaboratio of academic ad commuity-based service ceters whose missio is to raise the stadard of care ad icrease access to services for traumatized childre ad their families across the Uited States. Combiig kowledge of child developmet, expertise i the full rage of child traumatic experieces, ad attetio to cultural perspectives, the NCTSN serves as a atioal resource for developig ad dissemiatig evidece-based itervetios, trauma-iformed services, ad public ad professioal educatio.