Vol. 10, No. 3
June 2005

Traumatic Stress and Child Welfare Workers

Sarah (not her real name) began as a child protective services investigator. Though it was often hard, she enjoyed the work. She saw the stress as just a part of the job, a job she did well.

Years went by before she experienced her first trauma reaction.

At first she didn’t know what was going on. She had a full-blown panic attack in the midst of a meeting. She began to shake and sweat. She felt dizzy. Her heart was pounding and she couldn’t catch her breath. Sarah says: “I thought I was dying.”

Something in the meeting—she’s still not sure what—caused the attack.

She called her physician that day. After examining her, the doctor referred her to a mental health professional, who eventually diagnosed her with PTSD.

During treatment Sarah concluded her PTSD was caused by several traumatic incidents she experienced years before as an investigator. “I never processed those events,” Sarah says. “I never dealt with those feelings.”

With the help of her therapist and some time, she made a complete recovery, but the experience has made her a passionate advocate for worker self-care. For agencies and child welfare workers, she says, traumatic stress and the need for self-care are truly the “elephant in the room.”

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Everyone familiar with child welfare understands that exposure to trauma is an inherent part of working with maltreated children. Yet sometimes—as a system and as individuals—we choose to deny this fact.

When we do, it is often with the best intentions. We know that experiencing or hearing about trauma doesn’t change the fact that there are families and children out there who need help right away. In the context of client needs and agency turnover it can be easy to convince ourselves that taking the time to step back and deal with our reactions is a luxury we simply cannot afford.

Yet the costs of this choice can be high. Unresolved trauma reactions can hurt workers’ physical and mental health. This impacts turnover, morale, and general agency function, which in turn affect an agency’s ability to help clients achieve positive outcomes.

For agencies and individuals interested in helping staff deal with trauma in a healthy way, a good starting place is a basic knowledge of posttraumatic stress disorder (PTSD) and secondary traumatic stress.

PTSD
In the course of their work, child welfare professionals may be exposed to real or perceived threats to their lives and the lives of others. Threats may come in the form of violent family members, car accidents, drive-by shootings, or other street violence. Just like other people, most child welfare workers will have short-lived reactions to these threats, reactions similar to the teen reactions described elsewhere in this issue. With support from their colleagues and families, most of these workers will recover without formal assistance.

However, traumatic events will trigger various mental disorders, including PTSD, in a few child welfare workers. Agencies and supervisors must know that it is very normal for a worker to exhibit short-term problems (e.g. poor sleeping and eating, lack of enthusiasm) after a traumatic event.

However, if these symptoms persist for more than a month it is vital that the worker receive treatment from a mental health professional with training and experience in treating trauma (Child Trauma Academy, 2002). To ensure workers get the help they need, agencies must cultivate a work culture that normalizes (and does not stigmatize) the need for mental health services. Timely diagnosis and treatment of PTSD are crucial; one of the best treatments is Cognitive Behavioral Therapy (CBT).

Some organizations engage the services of professionals to offer critical incident stress debriefing (CISD) after traumatic events. CISD is a specific, structured group process that has been widely used with EMS providers, disaster relief workers, etc. However, most studies show individuals who receive this type of debriefing fare no better than those who do not (McNally et al., 2003).

This is not to say that voluntary one-on-one or small group discussions with people who want to talk about their reactions to trauma are not helpful. At the very least, being open to talking about trauma can send the message that the agency cares about employee well-being. They may also help get an agency or work unit "up and running" again after a traumatic event.

Because it teaches them to recognize, avoid, and respond to work-related dangers, safety training may be another way for agencies to reduce workers’ risk of developing PTSD. See <www.ilrinc.com> for well-developed worker safety training materials. See also Practice Notes, v. 3 n. 2, “A Look at Safety in Social Work.”

STS
Due to the nature of their work, child welfare workers are perhaps even more at risk for secondary traumatic stress (STS). Secondary trauma, also referred to as compassion fatigue (Figley, 1995) and vicarious traumatization (Pearlman & Saakvitne, 1995), is defined as indirect exposure to trauma through a firsthand account of a traumatic event. The vivid recounting of trauma by the survivor causes trauma reactions in the helping person.

Symptoms of STS closely resemble those of PTSD, and can include increased fatigue or illness, emotional numbing, social withdrawal, reduced productivity, feelings of hopelessness, despair, re-experiencing, avoidance, and hyperarousal (Nelson-Gardell & Harris, 2003; Zimering et al., 2005).

Incidence. As with PTSD, most professionals will find that the reactions they have to clients’ traumatic stories will decrease on their own after a short while. Only a small percentage of individuals will develop full-blown STS (Zimering et al., 2005).

The few studies that have been done on STS in child welfare workers suggest the incidence of the disorder in this population is relatively high. For example, a 1999 study of CPS workers in the South found that up to 37% of respondents were experiencing clinical levels of emotional distress associated with STS (BPNP, 2002).

Possible Risk Factors. Findings from Schauben and Frazier (1995) suggest that the more trauma survivors a helping professional has in her caseload, the more symptoms of STS she is likely to have herself.

Nelson-Gardell and Harris (2003) hypothesize that a worker’s ability to empathize with clients may itself be a risk factor for STS. They suggest that although empathizing with a traumatized client helps the worker understand the client, the empathic connection may actually transmit the client’s trauma to the worker.

A worker’s personal history may put him at increased risk of developing STS. According to one study, having been abused or neglected as a child increases one’s risk of STS. The study found a history of emotional abuse or neglect made individuals most vulnerable (Nelson-Gardell & Harris, 2003).

Other studies found no correlation between personal trauma history and STS symptoms in mental health providers (Zimering et al., 2005).

Impact. In addition to affecting workers, trauma reactions may interfere with the ability of helping professionals to serve their clients (Bride, et al., 2003; Zimering et al., 2005). Untreated trauma reactions can also damage a worker’s personal relationships.

Identification and Treatment. If workers exhibit symptoms of PTSD or STS for more than one month they should consult a qualified mental health professional. To access tools that may help gauge symptoms related to secondary traumatic stress, see the next article, "Assessing Worker Distress."

Preventing STS
Pearlman and Saakvitne (1995) identified four areas they say are important to the prevention of STS in mental health providers:

• Professional strategies (e.g., balanced caseloads, accessible supervision)
• Agency strategies (e.g., sufficient release time, safe physical space)
• Personal strategies (e.g., respecting your limits, taking time for self-care)
• General coping strategies (e.g., self-nurturing, seeking connection)

Thus far, no studies have evaluated the effectiveness of these prevention strategies (Zimering et al., 2005).

Additional strategies for addressing traumatic stress include:

• Administrators and staff develop-ers should factor in STS and PTSD when thinking about developing and retaining staff (Nelson-Gardell & Harris, 2003).
• Agencies should ensure employee health plans cover mental health services.
• Supervisors must help workers establish boundaries between themselves and their clients, give them a chance to talk about how they’ve been affected by trauma, and help them recognize the need to find balance in their work and personal lives (Child Trauma Academy, 2002).
• Workers should know and use stress management techniques. For more on this, visit this issue at <www.practicenotes.org>.

Caveat
Direct and indirect exposure to trauma can negatively impact practitioners and the services they deliver. However, work with trauma survivors can also be immensely rewarding. Professionals who are vigilant about taking care of themselves and who receive consistent support from their supervisors and others often find that working with trauma victims enables them to grow personally and professionally (Zimering et al., 2005).

References for this and other articles in this issue