Labors of Advocacy: Compassion Satisfaction and Wellness among Hospital-Based Intervention Program Caseworkers

By: Violence Intervention Advocacy Program @ Boston Medical Center


Compassion fatigue is prevalent in many health professions, and for Violence Intervention Programs, the importance of recognizing risk factors and implementing pro- active self-care plans for all staff is imperative. Other health care professionals, such as surgeons and nurses, have been heavily overrepresented in research projects and subsequent wellness programs to combat vicarious traumatization, while frontline violence interventionists have been overlooked. Compassion fatigue is the process of change that happens as a result of working with populations that have experienced traumatic events. Over time, this process can lead to vicarious traumatization and burnout, as well as negative changes in capacity for emotional energy and empathy, loss of compassion for clients, and hypervigilance.
Staff members of Violence Intervention programs come in contact with enormous amounts of trauma daily. Many staff members are committed to this type of work due to similar personal experiences with both violence and trauma. While recognizing this as an asset to relationship development and trust building with clients, it also makes staff extremely vulnerable and susceptible to vicarious trauma and burnout.

VIAP recently conducted a cross sectional study to better understand the scope of this phenomenon. The instrument used was the 5th version of the Professional Quality of Life survey, which is a 30 item Likert Scale Survey which asks about various aspects of work. The survey measures compassion satisfaction, pleasure derived from work as well as the subscales of compassion fatigue, which are secondary traumatic stress and burnout. VIAP distributed this survey and an online link at the 2018 HJA conference in Denver, Colorado. In addition to questions on work, the survey asked about demographics: age, race and ethnicity, gender, whether the participant works in the community or in the hospital, whether they work in a direct care or supervisory role, and how long they’ve worked in this field. The final sample ended with 93 participants. Scores showed that there is a high prevalence of compassion satisfaction regardless of any demographic. This means that generally participants who are exposed to vicarious trauma are still able to derive high pleasure from their work despite the risk of compassion fatigue. Research also showed that burnout and secondary traumatic stress scores were the highest among the lowest and highest age groups. It shows a general pattern of burnout and secondary traumatic stress rates decreasing as age increases. An explanation for this is that people are entering this workforce early and are getting immediately overwhelmed by the type of work and leave early. The people who remain are not better at handling their trauma as they get older. We hypothesized that there may not be enough supports in the first 5 years of working and that those who could’ve received an intervention, instead chose a different job career and decided not to do this work long term, which is why data showed see a huge spike of secondary traumatic stress at 6-10 years of working and a lower rate for 10+ years. Overall this could suggest that instead of having resources available to them that could help with their compassion fatigue, participants left the field altogether.

Historically, “helpers” are the very folks that do not practice what they preach. In VIAP, all staff create self-care plans, and an important component of accountability is sharing self-care plans with others. We spend a great deal of time with co-workers and peers, and they are the ones who can most easily recognize when someone is affected by something or out of sync in the workplace. Exposing yourself to co-workers inevitably makes you feel more vulnerable, but it also allows you to grow and learn about each other, and teaches you how to manage the vicarious trauma most effectively. Striving to be pro-active versus reactive is key to any self-care plan, and having a variety of options to choose from will increase the odds of minimizing vicarious trauma and burnout.

We at the Boston Medical Center Violence Intervention Advocacy Program are committed to being ambassadors of well-being and self -care, recognizing that without it, our quality of client services is compromised. Vicarious trauma and burnout are occupational hazards of the work. Self-care plans and education regarding signs and symptoms are necessary tools to sustain ourselves.