| Although notable gains have been made in the development and dissemination of evidence-
based treatments (EBTs) to address post-traumatic stress (PTS) and related sequalae, far less
progress has been made in predicting and ameliorating clinicians’ reactions to client-presented
traumatic material, particularly secondary traumatic stress (STS). Prior research has identified
several STS risk and protective factors, both at the intra- and inter-personal levels, amongst
mental health clinicians. Still, most of this research has been conducted either with non-
specified mental health clinicians or adult-focused clinicians. Only one known study has
examined STS among child-focused clinicians, exclusively, and this study only evaluated a
training program to reduce clinicians’ STS. Therefore, the current study sought to fill gaps in the
above literature by (1) focusing on child-focused clinicians; (2) examining overall STS and
specific symptom categories (i.e., arousal, avoidance, and intrusion); (3) investigating the
relation between clinician-reported STS and self-efficacy specific to trauma-focused EBPs,
rather than general clinician self-efficacy; (3) examining the relation between clinician-reported
STS and clinician adherence to trauma-focused EBPs, rather than clinician attitudes towards
EBPs broadly; and (4) exploring how organizational support of clinician-experienced STS may
be protective. To address these aims, survey data were collected online from 135 mental health
clinicians who predominately provided trauma-focused treatment to youth. These participants
completed the following measures: demographic and professional-role questions, the
Secondary Traumatic Stress Scale, the TF-CBT Clinical Skills Questionnaire, the TF-CBT
Practices Scale, the Trauma Systems Readiness Tool, and the Professional Quality of Life
Scale’s Compassion Satisfaction subscale. Relations between tested predictor variables (i.e.,
clinician trauma-caseload, self-efficacy with trauma-focused EBPs, adherence to trauma-
focused EBPs, organizational support of clinician-experienced STS, and compassion
satisfaction) and outcome variables (i.e., overall STS, as well as arousal, avoidance, and
intrusion symptoms) were examined with multiple univariate and multivariate regression
analyses. Collectively, analyzed variables significantly predicted clinician-reported overall STS;
R2 = .21, R2adjusted = .18, p < .001; with higher trauma caseload ( = .26; sr = .25, p < .01) and
lower compassion satisfaction ( = -.42; sr = -.34, p < .001) significantly increasing risk of overall
STS symptoms to a small-to-moderate and moderate degree, respectively. The overall model
also significantly predicted all three symptom domains of clinician-reported STS; namely:
arousal symptoms; R2 = .13, R2adjusted = .07, p = .02; avoidance symptoms; R2 = .18, R2adjusted
= .13, p < .001; and intrusion symptoms; R2 = .26, R2adjusted = .21, p < .001. More specifically,
greater compassion satisfaction significantly predicted lower STS arousal, avoidance, intrusion
symptoms to a moderate degree (i.e., Arousal [f = .23, p = .01], Avoidance [f = .31, p < .001],
Intrusion [f = .35, p < .001]); whereas, greater trauma caseloads significantly predicted greater
STS intrusion–but not arousal or avoidance–symptoms to a moderate degree (f = .37, p < .01).
In contrast, clinician-reported self-efficacy with trauma-focused EBPs, adherence to trauma-
focused EBPs, and organizational support of clinician-experienced STS (per TCSQ, TPS, and
TSRT scores) did not significantly predict reported overall or domain-specific STS symptoms.
Such results are notable because 1) they are the first to be observed with this population (i.e.,
community therapists treating trauma-affected youth), 2) they are some of the first to suggest
that risk and protective factors may differ in their influence over specific STS domains, and 3)
they inform potential approaches to preventing and/or ameliorating STS symptoms, such as
balancing clinicians’ percentage of trauma cases in their caseload and engaging in individual
and organizational practices that bolster compassion satisfaction.
Keywords: secondary-traumatic stress (STS), burnout, self-efficacy, adherence,
compassion satisfaction, evidenced based practices/treatments (EBPs/EBTs) |