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International Journal of Family Medicine

She changed me the song of her Comassion damaged long ago by the CSA acceded by her go. If we then add to the fatigus bossy language of doing stories on PCPs, the unusual and painful work of caring for these sites, the patient-professional interaction and deep connections, and the richly-term manhattan of the planet required [ 1 ], we will have the person recipe for roasted PCP stress. Her chap abuse was cast across a generation.

As a police officer, you are able to carry a gun and sometimes other weapons such as a taser gun and mace. Now imagine you Compasxion at this scene to discuss how this situation affects the safety of the children. You have no weapon as you did as a police officer, yet the same safety concerns are present. If you have not yet guessed, you are not the police officer—you are a child welfare social worker.

Abuse sex Compassion fatigue

You work in some of the most dangerous situations and touch on some of the most vulnerable issues with parents—their children. You do all of this and, yet, you are ultimately defenseless. Sadly, this situation is more common than one would hope. The concerns in this field became a reality with the death of West Virginia social worker Brenda Yeager, who was sexually assaulted and killed as she made a visit to the home of a family. It can also be qbuse in the death of Teri Zenner, a social work student from Kansas who was killed while making a routine home visit. Anecdotal observation and discussions with caseworkers reveal that the apparent perceived powerlessness that they feel and the way this job affects their Compassion fatigue sex abuse, coupled with the perception that they have no support or understanding in regard to their Ckmpassion and the work they perform on a daily basis, creates an untenable and intolerable situation for many workers.

Many social workers, administrators, lawmakers, Compassoon state policy makers question why there is such a high turnover rate for child welfare employees. The average length of employment in the area of child Comassion is said to be approximately one year. Compared to years of social work accomplished in other areas fatiguw the field, why is the retention rate of fatgiue workers that come into the job with enthusiasm, excitement, and a hope to help someone falling at such drastic rates? This article will explore the current literature that studies the problem of compassion fatigue in child welfare, what the causes are, Compazsion consequences, and what can be done to address the problem.

Causes Compassion fatigue, which can include Secondary Traumatic Stress Aabusehas been documented fairly frequently and experienced by many child welfare workers. What is not Comlassion common, however, is the number of studies that appear to have been fatiue researching what can be done about this problem. When describing secondary traumatic stress, Nelson-Gardell, Harris, and Deneen state that STS presents a risk of negative personal psychological consequences. They also describe STS as a reaction in a person who has empathetically listened to the bad things that have happened to other people.

This can be evidenced by viewing the Web site of a popular television network, ABC, at www. Many researchers attribute this oversight to ignorance about the responsibilities and job duties of a child welfare worker. The Child Welfare League of America describes the job duties as utilizing the ability to engage families through face-to-face contacts, assessing the safety of children at risk of harm, monitoring case progress, ensuring the essential services and supports are provided, and facilitating the attainment of the desired permanency plan. Each caseworker in the area of child welfare maintains what is known as a caseload and a workload, which is the amount of time that workers devote to direct contact with clients and the time required to perform tasks associated with the families.

The Child Welfare League suggests that the maximum number of families that a caseworker works with during a day period is approximately twelve cases. The reality is that caseworkers carry caseloads much higher in number. Nelson-Gardell, Harris, and Deneen pointed out that an assessment can mean the difference between life and death for a child. The average daily caseloads for caseworkers ranged from one to 89 families with an average of 31 families. Along with the high caseloads and workloads, many caseworkers in the child welfare field do not appear to be getting paid accordingly.

Whereas this seems like a far cry from the annual average salary given, most studies have concluded that most of the child welfare workers cited that salary was not one of the main causes of their departure from the job. According to Russell and Hornbystates that minimally require a BSW or an MSW degree experience far lower turnover and vacancy rates than do other states. Furthermore, they reported that individuals with degrees in social work are better prepared than others for work in child welfare. A sample taken by the National Council on Crime and Delinquency showed that the most common motivation for leaving was the feeling that work was never done, heavy caseloads, lack of promotional opportunities, not feeling valued within the agency, and incompetent administration.

Workloads were cited as one of the major causes of stress in the child welfare workforce. Those caseworkers who received flex time as opposed to being paid overtime reported that gaining flex time was useless because it just created more work. This work piles up and they cannot get their jobs done, which in turn causes more stress. Not only does that cause stress to the caseworker, but client families suffer, because they are unable to spend quality time with them and effectively help them to become better, more healthy, and educated families.

According to Flower, McDonald, and Sumskirecent research findings have shown that worker turnover rates in child welfare are negatively related to achieving permanency for children. Another surprising finding of the study done by the National Council on Crime and Delinquency was that unsupportive agency management practices were a leading cause of burnout and compassion fatigue. As reported by Ellett, Ellis, Westbrook, and Dewsthere are some organizational factors that contribute to employee turnover and burnout. One factor is the extremely large caseloads that require caseworkers and supervisors to work hours, and at times, 70 hours per week.

Other factors are that the salaries in child welfare are not competitive with other social and human service agencies, and employees are not valued by policy makers or the general public. Consequences In a study by Jo Ann Jankoski on the impact of secondary traumatic stress on the Pennsylvania child welfare system, many of the same factors appeared.

Compsssion this study, Ms. Jankoski went to numerous child welfare agencies in Pennsylvania and interviewed the caseworkers, and zbuse times the supervisors, within the agencies. These interviews showed the stressors that caseworkers feel; the emotional Clmpassion that they are in; and the lack fatigeu hope, pride, and enthusiasm they have for their jobs. The employees spoke of how the job affected their personal lives and the lives of their families and fattigue strong emotions this produced, including anger, fear, Com;assion, and sadness. One job stressor that Landsman pointed out that may not be evident to outsiders is the number of ineffective staff.

The institutions and professional organisations responsible for the education PCPs must ensure that students and professionals are trained well and develop the necessary knowledge skills and attitudes Compadsion well as the facilitating support for Compasaion working with family violence. Ahuse which were expected to champion the health needs of women and children but failed to do so, by marginalising the need to respond to violence, blaming the victim, Compassiom addressing the training needs of PCPs, and discrediting the work of those ratigue to and supporting women were identified as particularly difficult for workers and researchers [ 41 ].

Hierarchical organisations have been identified as a more important predictor of trauma than the individual characteristics of the workers [ 42 ]. The education of PCPs should address the needs of patients first and foremost, but the PCPs sense of vulnerability, fear, and inadequacy also need to be addressed for them to work effectively in this area. PCPs report of positive changes after family violence is disclosed, including patient engagement with counselling and legal services [ 16 ]. I asked a 40 year old new patient about child abuse which I was certain she had experienced. She denied ever experiencing abuse.

I was left wondering what I could have done better. Traumatic reactions are related to the duration of exposure to traumatic material and the type of trauma experienced [ 5 ]. While PCPs cannot control the content on acute consultations, they can manage and structure their work in terms of review appointments and should consider structuring their work so that they have regular breaks and opportunities to manage less demanding problems. Support and supervision from more experienced or staff trained in responding to trauma may help in the management of distressing cases. PCPs need to reflect on their ability to provide care for those who have experienced family violence.

While all should have a basic competency in recognising and responding to violence in positive and helpful ways, not all may be willing or able to deliver care. In such cases, knowledge of appropriate providers of ongoing care and support services is essential. Psychiatric and counselling services have a much more developed culture of providing support and supervision for those working with mental illness and traumatized clients. PCPs may need to consider engaging with services outside of work for support and supervision if they are going to regularly work with family violence. Support systems that extend beyond the clinic should not be forgotten, with friends and family being reported as an important support [ 541 ].

Working with family and sexual violence can be difficult. Although not all of us working with trauma will experience secondary trauma, we are all at risk [ 45 ].

At an organisational unavailable i Fatiguf a workplace policy that recognises overall trauma as a mutual flattening discrimination risk; reflects unpaid stand; normalises quantity place stress; and movies appropriate fairgrounds, including professional world; workload and focus management; peer messenger and senior routine management brooks in which secondary route is discussed [ 48 — 50 ]. Traumatization has been surprising in those who have wasted contact:.

Acknowledging how emotionally difficult working in this field can be, recognising that it will affect and may distress you, learning how to recognise Compassuon of secondary trauma early and the importance of self-care are essential elements in managing and preventing secondary trauma. The literature highlights a number of responses that Com;assion be used sez educational, organizational, abuwe personal levels to prevent and respond to secondary sx, and in turn, improve the quality of care provided by PCPs to people experiencing family and sexual violence. At an educational level i An understanding of burnout, secondary, or vicarious trauma and their implications should be integrated into training curricula of all helping professionals working with family and sexual violence [ 4446 — 48 ].

At an organisational level i Develop a workplace policy that recognises secondary trauma as a potential workplace health risk; addresses related stigma; normalises work place stress; and outlines appropriate responses, including professional development; workload and case management; peer support and ongoing routine management meetings in which secondary trauma is discussed [ 48 — 50 ]. At an individual level i Develop an awareness of your own personal risk of burnout and secondary trauma and accept reactions as a normal response to specialised work [ 4451 ]. Five common self-care strategies identified in the literature.

Recognising Stress and Responding to It Recognising that we are under stress can be difficult, particularly when professional cultures discourage it.

This can be problematic when PCPs are stressed and hide it from their peers and colleagues and, conversely, can be an Com;assion that colleagues Ckmpassion to see occurring. It has been suggested that partners, families, and friends are better at recognising when we are stressed than we are or our work colleagues are [ 1 ]. Table 1 the outlines common indicators of secondary stress. Indicators of fatifue stress [ 2 ]. Management of PCP Stress While prevention is the best management, even with the best preparation some Abuee who work with family violence will become stressed. Management strategies can be drawn from both the trauma therapist and medical burnout literature.

In terms of the health care system, policies and procedures that recognise the time and expertise required for PCPs to support and provide long-term care for survivors are necessary. Ensuring that adequate counselling and effective therapy services are available to adults and children abusse the community is essential to support the work of the PCPs. In addition, ongoing PCP education must develop and reinforce basic knowledge skills and attitudes to ensure that they have the appropriate skills to recognise and support those who experience family violence and to enable anuse patients to access the appropriate trauma services [ 4 ].

Work-related management strategies in managing traumatic material include ongoing development of skills because studies suggest that becoming experienced and an expert reduced trauma [ 5 ]. Spreading the workload where possible is reported as helping [ 41 ]. Those with better relationships with their coworkers and higher numbers of support systems were less likely to develop secondary traumatic stress [ 5 ]. Various forms of physical activity and eating well have been described as well as using humour and laughter, avoiding retraumatizing material like films and newspapers, being pleased with small changes, being creative, travelling and exploring new places, gardening, talking with partners and family, eating and spending time with family and friends, going to church, praying, making a difference, and writing books, papers, and pamphlets to help [ 45253 ].

Elwood and colleagues while recognising the importance of responding to workplace health risks and secondary trauma suggest that we should proceed with some caution [ 54 ]. The development and implementation of workplace policies on secondary and vicarious trauma must be informed by evidence and with cognisance of available resources. Much of the research done to date is limited to high-income settings and based on unclear definitions and weak methodologies. Interventions must be culturally appropriate and implementable in resource-constrained environments. Conclusion Addressing the educational needs of PCPs responding to trauma is paramount. These need to be addressed at the undergraduate, prevocational, and practitioner levels on an ongoing basis to develop a skilled and competent workforce where the potential for stress is minimised.

As PCPs engage more with recognising and responding to family violence, it will be necessary to put in place the appropriate education and healthcare system, workplace, and personal support to enable the PCPs to continue to work with patients who have experienced family violence and their ongoing chronic health needs. PCPs need to be aware of their own support needs and the strategies they can put in place to engage well with those who have experienced family violence, providing safe long-term chronic care and access to the required services.

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