Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Child Abuse Negl. 2020 May 18;110(Pt 3):104540. doi: 10.1016/j.chiabu.2020.104540

Secondary trauma and impairment in clinical social workers

Stephanie E Armes 1, Jacquelyn Lee 2, Brian Bride 3, Desiree M Seponski 4
PMCID: PMC7671948  NIHMSID: NIHMS1595805  PMID: 32439158

Abstract

Background:

Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative affect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers’ distress and impairment due to their work.

Objective:

The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539).

Method and results:

A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (β = .08, p < .01; 95% CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (β = .05, p < .05; 95% CI = .02, .09). Results indicated that the model accounted for 25% of the variance in significant distress and impairment (R2 = .25, p < .001) and 5% of the variance in STS (R2 = .05, p < .05).

Conclusions:

Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.

Keywords: Secondary traumatic stress, distress and impairment, clinical social workers

Social work is a rewarding and challenging profession, with those in the workforce frequently exposed to high volumes of clients experiencing ongoing trauma and violence. Clinicians working in child welfare and child protective services are responsible for assessing and preventing risk and maintaining the safety of children and adolescents. Research suggests service providers addressing child abuse and neglect may experience a myriad of negative effects as a result of their work in the field. While many report satisfaction with their work, clinicians working in child welfare are at risk of developing secondary traumatic stress as a consequence of their work (STS; Bride, Jones, & Macmaster, 2007; Dagan, Ben-Porat, & Itzhaky, 2016; Sprang, Craig, & Clark, 2011). Secondary traumatic stress may pose a challenge to workforce resiliency if it places clinicians at risk for further distress or functional impairment. Since exposure to traumatic material may be normative for workers, a better understanding of the role of STS is needed to ensure workforce sustainability. Subsequently, it is important to explore how the risk of secondary traumatic stress may contribute to significant distress and impairment in clinical social workers. This paper examines the relationship between personal and professional exposure to trauma, STS, and distress and impairment in a national sample of clinical social workers. For the purpose of this study, STS refers to the occurrence of posttraumatic stress symptoms following indirect exposure to traumatic events experienced directly by another. More specifically, we define STS as intrusion, avoidance and hyperarousal symptoms that result from a professional relationship with one or more traumatized persons (Bride, 2007; Bride et al., 2004).

Prevalence

Research indicates varied prevalence and clinically significant levels of STS depending on the sample, publication year, and measures used to assess STS (Elwood, Mott, Lohr, & Galovski, 2011). Reports from a national sample of social workers revealed a STS prevalence of 15.2% (Bride, 2007). A state-wide mixed methods study focused on licensed clinical social workers in Montana revealed a higher prevalence, with 35.7% of the sample reporting clinical levels of STS (Caringi et al., 2017). A similar prevalence rate (34%) was identified in a sample of child protective service workers in Tennessee (Bride et al., 2007). Compared with non-psychiatric patients, a national sample of child protective service workers scored higher for PTSD symptoms (Cornille & Meyers, 1999). However, this sample of child protective service workers scored lower for potential PTSD symptoms than a comparative sample of outpatient psychiatric patients (Cornille & Meyers, 1999), indicating elevated levels of distress in clinical social workers. The majority of the prevalence studies we list conceptualized STS as being an experience of intrusion, avoidance, and hyperarousal symptoms, and even used the same measure of STS, with the exception of the Cornille and Meyers (1999) study that used a different measure of STS. Thus, the prevalence of STS, as measured by the Secondary Traumatic Stress Scale (STSS; Bride et al., 2004) has consistently ranged between roughly 15-35% in previous samples of clinical social workers, depending on the sample and location of the study. The variances in prevalence rates previously reported illustrate Elwood et al.’s (2011) concern that while research demonstrates a high prevalence of STS, a paucity of research exists in examining impairment associated with STS symptoms.

STS in Child Welfare

Personal and professional factors of child welfare workers have been explored in the literature focused on STS. A history of personal trauma has been associated with STS in several samples, including a sample of child protective service workers (Bride et al., 2007). Less active coping attempts, such as using denial as a coping mechanism, was shown to be positively associated with STS in a sample of child abuse investigators (Bourke & Craun, 2014). Pertaining to professional factors, literature has found child welfare workers to have a significantly higher exposure to child trauma than social workers in social services (Dagan et al., 2016), indicating an increased risk of being exposed to trauma through their work than social workers in different fields. For example, one sample of child protective service workers with high caseloads also reported high levels of STS (Bride et al., 2007). Additionally, child abuse investigators reporting high difficulty in processing their trauma exposure were more likely to have high STS scores (Bourke & Craun, 2014). These findings point to the complex nature of the clinical work and provide evidence for personal and professional factors affecting STS experienced by child welfare workers.

While longevity in the field of child welfare may involve other risks, research indicates that increased time in the field is inversely associated with STS. More years of work experience were negatively correlated with STS in a sample of child protection workers (Dagan et al., 2016) and inversely associated with child welfare workers’ reports of their intentions to leave their jobs (Itzick & Kagan, 2017). This inverse relationship between years of experience and lower STS may be due to reports of mastery workers reported in relation to their jobs (Dagan et al., 2016). However, the literature does not provide a clear explanation as to how some child welfare workers can experience mastery by remaining in their work, while others may develop STS due to increased trauma exposure. Research has only recently considered how STS may lead to additional negative outcomes, over and above the symptoms of STS. For example, Itzick and Kagan (2017) explored the negative outcomes of intentions to leave in child welfare social workers practicing in Israel.

Negative Outcomes of STS

Secondary traumatic stress can lead to further negative outcomes directly affecting the clinician. STS partially mediated the association between clinical social workers’ exposure to trauma through their work and lower perceptions of their physical health (Lee, Gottfried, & Bride, 2018). Lowered perceptions of health may also be linked to an increase in unhealthy habits. Increased tobacco and alcohol use were positively associated with increased STS in a sample of child abuse investigators (Bourke & Craun, 2014). Likewise, Griffiths, Royse, and Walker (2018) found that an increase in stress due to child protection work was associated with workers’ perceptions of increases in unhealthy habits and poor physical and mental health. A sample of telephone crisis workers indicated that psychological distress from their work was positively associated with impairment at work one week later (Kitchingman, Caputi, Woodward, Wilson, & Wilson, 2018). The extant literature supports an increase in distress, impairment, and unhealthy habits due to child welfare workers’ exposure to stress and trauma, and their STS, through their work.

Secondary trauma may negatively affect the workforce, as STS has been linked to higher employee turnover. For example, higher STS levels were negatively associated with child protective service workers’ reported intentions to stay in their work (Bride et al., 2007). While this finding could apply to many helping professionals, a comparison of child welfare workers and health care social workers in Israel found that child welfare workers reported significantly higher intentions to leave than health care social workers (Itzick & Kagan, 2017). These workers also reported higher levels of fear that they would be subjected to violence through their work, pointing to unique factors of child welfare work that may heighten workers’ risks for trauma and secondary trauma (Itzick & Kagan, 2017). In a study spanning five different child welfare agencies, child welfare workers’ reports of STS were positively and significantly associated with their intentions to leave their work (Middleton & Potter, 2015). In addition to the high prevalence of STS reported in child welfare workers across the literature, positive associations of psychological and physical distress, development of unhealthy habits, and turnover intentions caution that the experience of STS is personally and professionally costly to child welfare workers and the overall workforce. This paper extends the exploration of STS by including an investigation of significant distress and impairment across seven domains. Additional knowledge about the domains of distress and impairment related to STS can aid in prevention efforts by developing purposeful, targeted interventions at each domain.

Purpose and Hypotheses

The purpose of this paper was to explore the effects of trauma exposure through clinical social workers’ jobs on their STS and self-reports of functional impairment. This study explored STS, distress and impairment, and personal characteristics in a national sample of clinical social workers. The following hypotheses were tested:

  1. Exposure to trauma through work will be positively and significantly associated with STS and distress and impairment.

  2. Work with young children will be positively and significantly associated with STS and distress and impairment.

  3. STS will mediate the association between exposure to trauma and distress and impairment.

Method

Procedure

Data for this study are part of a larger national sample of clinical social workers. Recruited through a mailed survey, the sample consisted of clinical social workers in the US who self-identified as currently licensed and employed in a direct practice capacity (N = 539). After obtaining university IRB approval, a survey was mailed at random to a national sample of clinical social workers. The potential participants were invited to complete the survey and were provided an addressed envelope to return the survey once complete. A total of 2,500 surveys were mailed to potential participants, with 731 surveys being returned, yielding a response rate of 29.4%. Of those surveys, the data used for this paper is only from the 539 participants who reported being in a direct practice capacity as a clinical social worker.

Participants

The majority of the sample was female (N = 433; 80.5%), Caucasian (N =493; 91.5%), had an average of 27.60 years of practice experience (SD = 7.66; range = 0-45 years), and an average of 21.14 years working with trauma through their clinical work (SD = 10.27; range = 0-43 years). Nearly half the sample reported being personally exposed to trauma during their childhood (N = 251; 46.6%) and more reported personal exposure as adults (N = 321; 59.6%). Some of the sample reported they worked in child and family welfare (N = 31; 5.8%) and in school social work (N = 45; 8.3%). See table 1 for more information about the sample.

Table 1.

Demographic Information (N = 539)

M SD Frequency % Range
Female 433 80.5
Age 58.49 8.01 27-83
Years’ Experience 27.6 7.66 5-45
Years of Trauma Experience 21.14 10.27 0-43
Race
 White 493 91.5
 African American 18 3.4
 Hispanic/Latino 11 2.1
 Asian 5 0.9
 American Indian/Alaskan
Native 3 0.6
 Other 6 1.1
Exposed to trauma in childhood 251 46.6
Exposed to trauma in adulthood 321 59.6
% Caseload Trauma Survivors 39.02 29.6
% Caseload PTSD Diagnosis 25.36 23.8
% Caseload Discuss Client
Trauma 35.85 30.65
Weekly hours addressing trauma 9.91 9.35 0-55
% Caseload Children under 13 9.71 21.54
% Caseload Adolescent 13-17 12.41 22.26
Work in Child/Family Welfare 31 5.8
Work in School Social Work 45 8.3
Secondary Trauma 27.96 8.63
Distress/Impairment 0.71 0.88
Open in a new tab

Measures

Trauma exposure.

Trauma exposure was measured with four items designed to tap different aspects of social workers’ indirect trauma exposure through their work. Three out of the four items were percentages scored from 0-100 and included: the percentage of trauma survivors on the caseload, the percentage of clients who met the criteria for PTSD on the caseload, and the percentage of the caseload with whom trauma is being addressed. In the fourth item, participants reported the number of hours they spent weekly addressing their clients’ trauma. These four items demonstrated good internal consistency for the present sample (α = .82).

Secondary Traumatic Stress Scale (STSS).

Secondary traumatic stress was measured with the Secondary Traumatic Stress Scale (STSS; Bride et al., 2004). The STSS is a 17-item measure of secondary trauma with items corresponding to diagnostic criteria for PTSD in the Diagnostic and Statistical Manual- IV (DSM-IV; APA, 2000). Participants reported how true each statement was for them in the past seven days on a 5-point Likert scale (1= never, 5 = very often). The STSS has demonstrated excellent construct validity and reliability (Bride et al., 2004) and demonstrated good internal consistency for the present sample (α = .91). Sample items include, for example, “I felt emotionally numb,” and “I had trouble sleeping.” The STSS was designed to measure the “core” DSM-IV-TR (APA, 2000) criteria for PTSD. That is, it was designed to measure intrusion (Criterion B), avoidance (Criterion C), and hyperarousal (Criterion D). A limitation of the STSS, as well as other extant measures of STS, is that it does not capture the distress and impairment (Criterion E) that may result from the aforementioned symptoms (Sprang, Ford, Kerig, & Bride, 2018).

Distress and Impairment.

Because the construct of distress and impairment are not captured by the STSS, we used the Functional Impairment from Secondary Trauma Scale (FISTS: Bride, Lee, & Miller, 2016) to measure this construct. Participants completed seven items based on a 5- point Likert scale (0 = None, 4= A great deal) measuring how much significant distress or impairment resulted from their work with trauma clients. Each item corresponded to a different life domain of functioning, including social, occupational, familial, sexual, psychological, emotional, and physical functioning. These seven items showed excellent internal consistency for the present sample (α = .95).

Demographic Information.

Additional personal and professional demographic information was included for the present study. For professional demographic information, participants responded to two questions asking the percentage of their caseload (0-100) that comprised of children under age 13 and adolescents aged 13-17. Participants reported their years of experience in the social work field. Personal demographic information included two categorical questions (1= no, 2 = yes) asking whether participants had themselves personally experienced trauma during childhood or adulthood. Participants were provided a list of potential traumatic events that they may have experienced, witnessed, or been confronted with involving threats of physical safety for self and others in order to consistently operationalize their experiences of trauma. For example, the list included and reminded participants that their experiences may not be limited to, traumatic events such as military combat or torture, physical and sexual assault, crime victimization, domestic violence, or natural/man-made disasters. Participants were informed not to consider divorce, failure experiences, or stress at school or work as part of their trauma experience.

Analyses

Initial analyses were completed using SPSS 25 (SPSS, 2018). The trauma exposure variables were all positively and significantly associated with STS and distress and impairment. Distress and impairment was positively and significantly associated with STS. Years of experience was negatively associated with both STS and distress and impairment, but the association was only significant for the distress and impairment variable (see table 2).

Table 2.

Correlations of study variables (N = 539)

1 2 3 4 5 6 7 8 9
1 % Caseload Trauma Survivors 1
2 % Caseload meet PTSD criteria
% Caseload Addressing Client		 .64** 1
3 Trauma .67** .61** 1
4 Weekly hours addressing trauma .55** .51** .62** 1
5 Caseload % Child Under 13 −.05 .01 −.07 −.09* 1
6 Caseload % Adolescent 13-17 .06 .05 .10* .03 .23** 1
7 Years Experience −.05 −.07 −.001 −.03 −.04 −.05 1
8 Secondary Trauma .13** .14** .14** .152** .13** .08 −.05 1
9 Distress/Impairment .16** .12** .18** .11* .08 .07 −.09* .45** 1
Open in a new tab
**

p< .01

*

p < .05

Additional analyses were conducted in Mplus 8.1 (Muthén & Muthén, 2018). First, trauma exposure through social work practice was examined using a confirmatory factor analysis. A latent construct of trauma exposure was modeled including: percentage of client caseload who meet the criteria for PTSD, percentage of caseload who are trauma survivors, percentage of caseload with whom client trauma is addressed, and hours spent weekly addressing clients’ trauma. All factors loaded onto the latent construct at the p < .001 level, and factor loadings were between .70-,84. Model fit statistics indicated good model fit for the latent construct of trauma exposure (χ2(2) = 7.2, p = .03; RMSEA = .07; CFI = .99; SRMR = .01).

Next, a structural equation model (SEM) was conducted using the latent construct of trauma exposure as an exogenous variable, with the distress and impairment variable used as the endogenous variable. Additionally, the social workers’ STSS scores, years of experience in social work, whether they had experienced trauma in childhood or adulthood, the percentage of their caseload with children under age 13, and the percentage of their caseload with adolescents aged 13-17 were included as exogenous variables in the model. A bootstrapped analysis using 1,000 draws was computed in Mplus to test for indirect effects from trauma exposure to distress and impairment through STS. The final model demonstrated excellent model fit (χ2(32) = 40.98, p = .13; RMSEA = .02; CFI= .99; SRMR= .03; see figure 1).

Figure 1. Structural Equation Model of Distress and Impairment (N = 533).

Figure 1.

Open in a new tab

Note: χ2(32)= 40.98, p = .13; RMSEA = .02; CFI = .99; SRMR= .03; ***p < .001, **p < .01, *p < .05, +p < .10; All factors loaded on to the latent construct of trauma exposure at the p < .001 level

Results

Initial correlations indicated that STS and distress and impairment were positively and significantly associated (r = .45, p < .01). The percentage of caseload who were trauma survivors was positively and significantly associated with STS (r = .13, p < .01) and distress and impairment (r = .16, p < .01). The percentage of client caseload meeting criteria for PTSD was positively and significantly associated with STS (r = .14, p < .01) and distress and impairment (r = .12, p < .01). The percentage of caseload with whom trauma was addressed was positively and significantly associated with STS (r = .14, p < .01) and distress and impairment (r = .18, p < .01). Weekly hours spent addressing trauma was positively and significantly associated with STS (r = .15, p .01) and distress and impairment (r = .11, p < .05). For additional correlations, see table 2.

Results from the SEM indicated that the latent construct of trauma exposure through work with trauma clients was positively and significantly associated with STS (β = .17, p < .001) but was not significantly associated with distress and impairment. The percentage of children under 13 in the social workers’ caseloads was positively and significantly associated with STS (β = .12, p < .01) but was not significantly associated with distress and impairment. STS was positively and significantly associated with distress and impairment (β = .45, p < .001). Personally experiencing trauma in childhood (β = . 11, p < .05) and in adulthood (β = .05, p = .098) were positively and significantly associated with distress and impairment. This association approached the p < . 10 level for personal experiences of trauma in adulthood. Personal experiences of trauma in childhood and adulthood were not significantly associated with STS.

Two indirect effects resulted from the bootstrapped analysis, indicating that STS partially mediated these associations. First, there was an indirect effect from trauma exposure to distress and impairment through STS, meaning that higher trauma exposure through work was positively associated with higher distress and impairment through high levels of STS (β = .08, p < .01; 95% CI = .03, .12). The second indirect effect was from percentage of children under 13 in social workers’ caseload to distress and impairment through STS (β = .05, p < .05; 95% CI = .02, .09). This result indicated that STS mediated the association between the percentage of a caseload with children under 13 and distress and impairment. The variables in the model contributed to 25% of the variance of distress and impairment (R2 = .25, p < .001) and 5% of the variance in STS (R2 = .05, p < .05).

To test whether years of experience and trauma exposure were associated, a covariance was added into the final SEM model. Results indicated a small (β= −.04) negative association between years of experience and trauma exposure, but this association was not significant. It could be that some participants may have modified their work setting over time in order to decrease their trauma exposure from their work setting. As the sample was not longitudinal, further exploration of trauma exposure, experience over time, and increased STS or distress and impairment cannot be addressed in the present paper. Future research should consider longitudinal effects of increased trauma exposure, more detailed measure of clinicians’ personal trauma history, years of experience, and their development of STS.

Some domains of significant distress and impairment could have been affected more than others, depending on participants’ personal factors and professional setting. To test whether each distress and impairment item was associated with STS or trauma exposure, a separate model was conducted testing all seven of the distress and impairment items. These items were used instead of the one (continuous) mean variable that was included in the original model. The new model results showed that none of the seven individual distress and impairment items was significantly associated with trauma exposure. All seven distress and impairment items were positively and significantly associated with STS at the p < .001 level. A second bootstrap analysis was conducted to test for indirect effects. Findings showed significant indirect and positive effects from trauma exposure to each distress and impairment item, through STS. These findings were significant at the p < .001 level, and indicated that STS mediated the association between trauma exposure and distress and impairment in social, occupational, familial, sexual, psychological, emotional, and physical functioning (all seven FISTS domains measured). This model was less parsimonious. As such, the original model using a continuous mean score of distress and impairment has been maintained throughout the paper (see figure 1). While the model with all seven individual distress and impairment variables was less parsimonious, these results indicate that STS is the mechanism of distress and impairment across personal, interpersonal, and professional domains when social workers are exposed to trauma through their work environment.

Discussion

The present study examines distress and impairment, a variable absent in the related extant literature, and highlights the role of STS in worker distress and impairment. Trauma exposure through work was not directly associated with distress and impairment. Instead, STS mediated the association between trauma exposure and distress and impairment. From these results, STS could be one unique mechanism contributing to clinical social workers’ further psychological distress or impairment in social, occupational, familial, sexual, psychological, emotional, and physical functioning domains of their lives.

Previous studies identify a positive link between personal trauma history and secondary trauma (Bride et al., 2007; Hensel, Ruiz, Finney, & Dewa, 2015; Ivicic, & Motta, 2017; Sprang, Ford, Kerig, & Bride, 2018). The results from the present study instead found that clinician self-reports of personal trauma history in childhood and as an adult was not significantly associated with STS, but instead, with distress and impairment. There were no indirect effects through STS from having a personal trauma history to distress and impairment. Personal trauma history was examined through two self-report items of trauma experience, asking whether clinicians had experience trauma in either childhood or adulthood. These trauma histories were only significantly associated with distress and impairment, not STS. While a personal experience of trauma in adulthood approached significance at the p < . 10 level, the finding for childhood trauma history was significant at the p < .01 level. It is possible that social workers working with traumatized children or clients with a childhood trauma history may be reminded of their own child trauma history, contributing to heightened levels of distress and impairment across multiple (e.g., personal, professional, interpersonal, etc.) domains.

Studies link the type of professional work and development of STS, with child welfare workers reporting higher levels of STS than social welfare workers in healthcare or general practice (Itzick & Kagan, 2017; Sprang, Craig, & Clark, 2011). The current study could not compare those in social welfare with the rest of the sample, as only 5.8% (n = 31) of the sample reported working in child and family welfare. However, participants reported around 9.71% (SD = 21.54) of their caseload as working with children under age 13, with a large variability across the samples’ caseloads. Participants’ STS scores raised by .12 for every one percentage raise in children on the participants’ caseloads, suggesting that work focused on young children is an unique risk factor for developing STS and distress and impairment. Future intervention work with clinical social workers should consider the ratio of both trauma clients and young children on workers’ caseloads. Child welfare workers may work with a wide range of ages, from young children through adolescents. When it comes to ensuring safety of children, there could be a specific risk for working with children 13 and younger.

Interestingly, years of experience was not significantly associated with STS or distress and impairment, although the association was negative, which is consistent with previous findings (e.g., Dagan et al., 2016). While having more years of experience may be a protective factor for some helping professionals, is was not a significant protective factor for this sample of clinical social workers.

Limitations and Implications

As with all research, findings should be considered in the context of study limitations. The sample used for this study is cross-sectional in nature. Consequently, this paper cannot make inferences about the effects of trauma exposure, STS, and significant distress and impairment over time. Due to the lower response rate (29.4%) and mailed survey recruitment method, the findings from this study cannot be generalized across all social workers. Yet this rate is similar to previous mailed surveys of clinical practitioners (Jordan & Seponski, 2018). Future research should consider the effects of STS on significant distress and impairment over time. Despite these limitations, the data from this study are some of the first focused on a national sample of social workers. The large sample size, focus on multiple factors of exposure to secondary trauma, and focus on functional impairment are all strengths that add to previous literature.

This study found that STS mediated the association between secondary trauma exposure through social work and functional distress and impairment. Further research is critical to understanding how to alleviate distress and impairment resulting from STS. For example, the importance of self-care in preventing STS has been addressed across the literature (Lee & Miller, 2013; Miller, Lianekhammy, Pope, Lee, & Grise-Owens, 2017). As participants reported distress and impairment across multiple personal, interpersonal, and professional domains of life, results from the current study support the importance of developing self-care practices addressing personal and professional factors.

We agree with Miller et al. (2017) that self-care must be re-conceptualized at the organizational level, and include wellness initiatives supported by upper administration, incentives for employee buy-in, and plans for sustainability. Child welfare agencies and social work training programs could require social workers to create self-care plans as part of their required supervision, re-evaluating and modifying (as needed) those plans accordingly over time within the workday. Implementing self-care plans at the agency level may increase the positive benefits of self-care and protect against negative outcomes, without self-care becoming another thing to do outside of work. For example, Miller et al. (2017) found that healthcare social workers who reported higher professional and personal self-care reported excellent health, compared with workers rating their health as good or fair.

Conversely, Griffiths et al. (2018) found that child protective service workers’ perceptions of job stress were associated with unhealthy habits, such as poor eating or substance use. While eating a few unhealthy meals or having a few drinks could be a momentary form of self-care, if further developed into an unhealthy habit this could affect workers’ health, stress, and potential of developing secondary trauma over time. Agencies could thus contribute increased supervision, vacation time or flex hours, and support of personal therapy services for employees as ways to increase their access to professional self-care factors. Lee and Miller (2013) provide a conceptual framework that can be helpful for practitioners in developing a professional (workload/time management, attention to professional development, attention to reactions to work, professional support and self-advocacy, professional development, and revitalization and generation of energy) and personal (physical, psychological and emotional, social, leisure, and spiritual) self-care plan.

Previous suggestions to further ameliorate STS have included managing the ratio of trauma versus other clients to clinician’s caseloads (Craig & Sprang, 2010; Hensel et al., 2015). While modifying caseloads may be helpful, this is not a practical suggestion for many agencies working in child welfare. In a workforce dealing mainly with trauma, placing additional trauma cases with distressed staff may be difficult to avoid. Instead, agencies must look to innovative approaches and evaluate areas for growth in decreasing STS and distress and increasing workplace resiliency. One method of evaluation could be to use Sprang et al.’s (2018) assessment measuring whether agencies are secondary traumatic stress-informed. This assessment measures key areas of promoting organizational resilience, how the workplace is STS-informed through its policies, practices, and leaders, and whether the organization promotes physical and psychological safety (Sprang et al., 2018). Administering this assessment to all employees on an annual basis may aid in understanding areas agencies perform well in and areas needing room for growth. Child welfare agencies can further increase STS-informed policies by implementing regular screening for STS and distress and impairment in their employees. When clinicians score high in STS or distress and impairment, agencies and educational training programs need to have a plan in place for how they will provide support to their employees and trainees within the agency setting.

While years of experience was not significantly associated with STS or distress and impairment, the association was negative. Seasoned social workers could provide structured yet informal support for new clinicians. Agencies could consider an informal mentorship program matching new and seasoned employees together over and above the supervision new employees may already receive. Taken together, a holistic approach is needed to decrease STS and distress and impairment. This approach could include, but not be limited to, regularly assessing levels of STS and reported distress in employees using standardized measures, evaluating caseloads, promoting professional and personal self-care, providing informal yet structured support, and assessing how STS-informed agencies are.

Conclusion

This study examined trauma exposure, secondary trauma, and significant distress and impairment in a national sample of clinical social workers. The findings indicate that secondary traumatic stress is not the only risk factor in conducting trauma work. Instead, STS acts as a mechanism of trauma transmission from social workers’ employment experiences to their reports of significant distress or impairment in personal, interpersonal, and professional life domains. Study findings uniquely add to the literature by including social workers’ distress and impairment as a negative outcome of secondary trauma. Likewise, personal trauma history and a higher percentage of children under 13 on the clinician’s caseload were found to be significantly associated with distress and impairment. These findings can be used by agencies and supervisors in considering the affects of trauma work on their employees, and point to the need for holistic interventions in agencies employing clinical social workers.

Footnotes

Manuscript proposal for Child Abuse and Neglect Special issue: Research to promote a healthy and resilient child abuse & neglect workforce

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

  1. American Psychiatric Association (APA) (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author. [Google Scholar]
  2. American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. [Google Scholar]
  3. Barrington AJ, & Shakespeare-Finch J (2014). Giving voice to service providers who work with survivors of torture and trauma. Qualitative Health Research, 24, 1689–1699. [DOI] [PubMed] [Google Scholar]
  4. Bourke ML, & Craun SW (2014). Coping with secondary traumatic stress: Differences between U.K. and U.S. child exploitation personnel. Traumatology, 20, 57–64. [Google Scholar]
  5. Bride BE (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52, 63–70. [DOI] [PubMed] [Google Scholar]
  6. Bride BE, Jones JL, & Macmaster SA (2007). Correlates of secondary traumatic stress in child protective services workers. Journal of Evidence-Based Social Work, 4, 69–80. [Google Scholar]
  7. Bride BE, Lee J, & Miller S (2016, January). Examining self-care as a moderator of secondary traumatic stress and functional impairment in clinical social workers. Presented at the 20th Annual Conference of The Society for Social Work and Research, Washington, DC. [Google Scholar]
  8. Bride BE, Robinson MM, Yegidis B, & Figley CR (2004). Development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 14, 27–35. [Google Scholar]
  9. Caringi JC, Hardiman ER, Wledon P, Fletcher S, Devlin M, & Stanick C (2017). Secondary traumatic stress and licensed clinical social workers. Traumatology, 23, 186–195. [Google Scholar]
  10. Cornille TA, & Meyers TW (1999). Secondary traumatic stress among child protective service workers; Prevalence, severity and protective factors. Traumatology 5(1), 15–31. [Google Scholar]
  11. Craig CD, & Sprang G (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma therapists. Anxiety, Stress, & Coping, 23(3), 319–339. [DOI] [PubMed] [Google Scholar]
  12. Dagan SW, Ben-Porat A, & Itzhaky H (2016). Child protection workers dealing with child abuse: The contribution of personal, social, and organizational resources to secondary traumatization. Child Abuse & Neglect, 51, 203–211. [DOI] [PubMed] [Google Scholar]
  13. Elwood LS, Mott J, Lohr JM, & Galovski TE (2011). Secondary trauma symptoms in clinicians: A critical review of the construct, specificity, and implications for trauma-focused treatment. Clinical Psychology Review, 31, 25–36. doi: 10.1016/j.cpr.2010.09.004 [DOI] [PubMed] [Google Scholar]
  14. Figley CR (1995). Compassion fatigue as secondary traumatic stress disorder: An overview In Figley CR (Ed.). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, pp. 1–20. [Google Scholar]
  15. Griffiths A, Royse D, & Walker R (2018). Stress among child protective service workers: Self-reported health consequences. Children and Youth Services Review, 90, 46–53. [Google Scholar]
  16. Hensel JM, Ruiz C, Finney C, & Dewa CS (2015). Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. Journal of Traumatic Stress, 28, 83–91. [DOI] [PubMed] [Google Scholar]
  17. Itzick M & Kagan M (2017). Intention to leave the profession: Welfare social workers compared to health care and community social workers in Israel. Journal of Social Service Research, 42, 346–357. 10.1080/01488376.2016.1246402 [DOI] [Google Scholar]
  18. Ivicic R, & Motta R (2017). Variables associated with secondary traumatic stress among mental health professionals. Traumatology, 23(2), 196–204. [Google Scholar]
  19. Jordan LS, & Seponski DM (2018a). Public participation: Moving beyond the four walls of therapy. Journal of marital and family therapy, 44(1), 5–18. [DOI] [PubMed] [Google Scholar]
  20. Kitchingman TA, Caputi P, Woodward A, Wilson CJ, & Wilson I (2018). The impact of their role on telephone crisis support workers’ psychological wellbeing and functioning: Quantitative findings from a mixed methods investigation. PLOS One, 13, 1–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lee JL, Gottfried R, & Bride BE (2018). Exposure to client trauma, secondary traumatic stress, and the health of clinical social workers. Clinical Social Work Journal, 46, 228–235. [Google Scholar]
  22. Lee JJ, & Miller SE (2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society: The Journal of Contemporary Social Services, 94, 96–103. [Google Scholar]
  23. Middleton JS, & Potter CC (2015). Relationship between vicarious traumatization and turnover among child welfare professionals. Journal of Public Child Welfare, 9, 195–216, [Google Scholar]
  24. Miller JJ, Lianekhammy J, Pope N, Lee J, & Grise-Owens E (2017). Self-care among healthcare social workers: An exploratory study. Social Work in Health Care, 56, 865–883. [DOI] [PubMed] [Google Scholar]
  25. Muthén LK, & Muthén B (2018). Mplus. Muthén & Muthén. [Google Scholar]
  26. 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, 149–168. [PubMed] [Google Scholar]
  27. Sprang G, Ford J, Kerig P, & Bride B (2018). Defining secondary traumatic stress and developing targeted assessments and interventions: Lessons learned from research and leading experts. Truamatology, 1–10. [Google Scholar]
  28. Sprang G, Ross L, Miller BC, Blackshear K, & Ascienzo S (2016). Psychometric properties of the secondary traumatic stress-informed organizational assessment. Traumatology, 23(2), 153–164. [Google Scholar]
  29. Spss I (2018). IBM SPSS statistics version 25. Boston, Mass: International Business Machines Corp. [Google Scholar]
  30. Travis DJ, Lizano EL, & Mor Barak ME (2016). “I’m so stressed!”: A longitudinal model of stress, burnout, and engagement among social workers in child welfare settings. British Journal of Social Work, 46, 1076–1095. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES