Secondary Traumatic Stress: Caring For The Workforce That Provides Care For Traumatized Children And Families

Dr. Vilma Reyes, Assistant Clinical Professor at UCSF, Department of Psychiatry in the Child Trauma Research Program.

Carmen Rosa Noroña, LCSW, Ms.Ed., CEIS Child Trauma Clinical Services and Training Lead at Child Witness to Violence Project, and Associate Director of the Boston Site Early Trauma Treatment Network at Boston Medical Center

Recent changes in immigration policy are creating new and intense challenges, including increased trauma, for infants, toddlers, preschoolers, and their families. In addition, each year more than 10 million children in the United States endure the trauma of abuse, natural disasters, and other adverse events.

As noted in an earlier blog from the BUILD Initiative series on the provision of trauma-informed care as it relates to immigration and US immigration policies, while supporting children and families who have experienced trauma needs to be our utmost priority, working with them can be triggering and overwhelming for providers. According to the National Child Traumatic Stress Network, “For therapists, child welfare workers, case managers, and other helping professionals involved in the care of traumatized children and their families, the essential act of listening to trauma stories may take an emotional toll that compromises professional functioning and diminishes quality of life.” In fact, studies show that from 6 to 26 percent of therapists working with traumatized populations, and up to 50 percent of child welfare workers, are at high risk for vicarious trauma and secondary traumatic stress (STS). We must bolster early care and education professionals in ways that help them to support the well-being of children and families who have experienced trauma without the professionals themselves suffering trauma in the process. In our July 11, 2019 webinar, A Trauma-Informed Approach to Working with Providers and Families, we discussed strategies for supporting providers as well as the need for reflective supervision. We review some of that information here.

Recognizing Signs of Secondary Trauma

The first step is for supervisors and administrators of early care and education programs and services to recognize the warning signs of STS. As the National Child Traumatic Stress Network notes, symptoms can echo those of post-traumatic stress disorder (PTSD)—providers and teachers might:

• Become hypervigilant.
• Experience intrusive thoughts.
• Avoid reminders of past clients.
• Feel numb or detached.

Staff experiencing such symptoms may become short-tempered with children, parents, or colleagues, “sometimes in response to things that seem benign to others, or avoid answering calls from or asking detailed questions of new clients whose experiences may remind them of former clients’ trauma stories.” All of this can lead to less than the ideal level of care that the children and families need.

Reflective Practice and Supervision: An Effective Tool

Early care and education supervisors and administrators have the challenging task of developing and maintaining high-quality practice in a trying environment. It is up to them to ensure the development of work environments in which providers and teachers can offer meaningful care to the children and families they serve despite the trauma the children and families have experienced. Reflective practice and supervision has been identified as an effective tool toward this end. Research tells us, “it is an approach whose practices allow for increased self-reflection, and consequently self-awareness. Centering on the relationship between the supervisor and supervisee, the approach helps to create work environments in which providers can offer meaningful care to the families they serve because they feel ‘seen,’ supported, and valued by their organizations.”

The approach utilizes a variety of strategies including:

• Regularly scheduled meetings.
• Reflective questions.
• Creative thinking.
• Collaborative problem solving to address case-related challenges and build worker skill, competence, and confidence.

As ZERO TO THREE advisor Rebecca Shahmoon-Shanok, notes, “When it’s going well, supervision is a holding environment, a place to feel secure enough to expose insecurities, mistakes, questions, and differences.”

Caring for Teachers and Providers

Agency and organizational leaders must understand secondary traumatic stress, its effects on staff, and how to both prevent and treat it. According to the US Department of Health and Human Services, “STS can decrease staff functioning and create challenges in the working environment” including “increased absenteeism, impaired judgment, low productivity, poorer quality of work, higher staff turnover, and greater staff friction.”

The effects of STS should be managed at the individual level as well. The Treatment and Services Adaptation Center advises that it can be addressed through the practice of self-care through “regular exercise, a healthy diet, and sufficient sleep” and that “activities such as yoga or meditation can be helpful in reducing general stress.” Further, “It is important for staff to take time away from the stress-inducing situation. Spending time with family or friends, or focusing on a project or hobby can help.”

Managing STS is particularly important given the additional stressors that providers who have the language capacity and other skills that allow them to work with immigrant families may experience as a result of inequities, such as:

• Receiving supervision by someone who does not speak the language in which the providers are serving the families.
• Being asked to take multiple roles (interpreters, case management).
• Having little or no input into programmatic changes.
• Not having access to leadership roles.

Conclusion

The secondary trauma experienced by early care and education professionals must be acknowledged and these professionals must be given tools to prevent and mitigate its effects. The support they are provided will both ease the emotional toll that may have resulted from listening to deeply distressing stories of trauma and help them to ensure positive outcomes for the children and families who have lived the harsh details of those stories. Please refer to our July 11 webinar for further details on this urgent topic.