Vicarious Trauma and Disaster Mental Health

Understanding Risks and Promoting Resilience

Gertie Quitangon, Mark R. Evces, Gertie Quitangon, Mark R. Evces

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317644897
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Vicarious Trauma and Disaster Mental Health focuses on the clinician and the impact of working with disaster survivors. Floods, hurricanes, tornadoes, mass shootings, terrorism and other large-scale catastrophic events have increased in the last decade and disaster resilience has become a national imperative. This book explores vicarious traumatization in mental health providers who respond to massive disasters by choice or by circumstance. What happens when clinicians share the trauma and vulnerability from the toll taken by a disaster with the victims they care for? How can clinicians increase resilience from disaster exposure and provide mental health services effectively? Vicarious Trauma and Disaster Mental Health offers insight and analysis of the research and theory behind vicarious trauma and compares and contrasts with other work-impact concepts such as burnout, compassion fatigue and secondary traumatic stress. It proposes practical evidence-informed personal strategies and organizational approaches that address five cognitive schemas (safety, esteem, trust, control and intimacy) disrupted in vicarious trauma. With an emphasis on the psychological health and safety of mental health providers in the post-disaster workplace, this book represents a shift in perspective and provides a framework for the promotion of worker resilience in the standard of practice in disaster management.

Section IV Managing Vicarious Trauma in Disasters

DOI: 10.4324/9781315761343-14

10 How Do We Measure Vicarious Trauma?

Kate St. Cyr

DOI: 10.4324/9781315761343-15

Introduction

There are a number of self-administered tools that assess symptoms of vicarious trauma, secondary traumatic stress, or compassion fatigue available for clinicians. This section of the book provides an overview of a number of existing tools that have been used to measure symptoms of vicarious trauma and similar concepts (e.g., secondary traumatic stress) among mental health professionals who work with victims of trauma. It also provides some information pertaining to the development of the scales and their psychometric properties, whenever possible, as well as their scoring instructions.

A Guideline for Using These Measures

One expert suggests that mental health professionals and others who work with victims of trauma complete a self-assessment tool upon commencement of employment, if possible, and (Richardson, 2001). This way, the original assessment scale can be used as a baseline for comparison to follow-up questionnaires.

Some of the tools presented below can be administered by an organization to its employees or they can be self-administered. Many of these tools have also been used in published research, some more psychometrically sound than others. Regardless of the intention behind its use, once a tool is selected, it is best to use the same measure for repeat administrations so that changes in responses can be tracked longitudinally.

Measures of Vicarious Trauma and Similar Concepts

Compassion Fatigue Self-Test

The Compassion Fatigue Self-Test (CFST; Figley, 1995) was one of the first measures developed to measure compassion fatigue, and continues to be one of the most commonly used measures, albeit in a revised form (Bride, Radey, & Figley, 2007). A number of revisions to the scale have been made since its initial development and, as such, several versions of the scale exist. The original version, developed by Charles Figley in 1995, is a 40-item self-report measure consisting of two subscales: compassion fatigue (23 items), which measures secondary traumatic stress; and burnout (17 items). A total score is also calculated. Examples of items assessed in the CFST include “I have flashbacks connected to those I help,” “I wish I could avoid working with some people I help,” and “I find it difficult separating my personal life from my helper life.” Respondents are asked to rate how frequently they experience each item on a scale of 1–5, where 1 = rarely/never and 5 = very often. Compassion fatigue subscale scores of 26 and lower indicate extremely low risk, scores between 27 and 30 suggest low risk, scores between 31 and 35 indicate moderate risk, scores between 36 and 40 indicate high risk, and scores 41 and above indicate extremely high risk. Burnout subscale scores of 36 and lower indicate extremely low risk while scores between 37 and 50 indicate moderate risk, scores between 51 and 75 indicate high risk, and scores 76 and higher indicate extremely high risk (Figley, 1995). Estimates of the internal reliability of the scale and subscales are good to excellent (Cronbach’s alpha = 0.84 for the compassion fatigue subscale, 0.83 for the burnout subscale, and 0.90 for the total scale; Jenkins & Baird, 2002); and internal consistency estimates from the subscales and combined scale range from 0.86 to 0.94 (Figley, 1995; Figley & Stamm, 1996).

In 1996, Stamm and Figley adapted the CFST to include a compassion satisfaction subscale. This revised measure consists of 66 items, and includes a number of positively oriented items such as “I feel that I might be positively ‘inoculated’ by the traumatic stress of those I help” and “I have thoughts that I am a success as a helper” that were not included in the original version. Respondents rate how frequently they experienced each of the items in the past seven days. Higher scores on the compassion fatigue and burnout subscales indicate higher risk of experiencing compassion fatigue or burnout; whereas higher scores on the compassion satisfaction indicate greater potential for compassion satisfaction. The revised CFST demonstrated good internal consistency in study samples (alpha = 0.87 for both the compassion satisfaction and compassion fatigue subscales, and 0.90 for the burnout subscale; Stamm, 2002). Further revisions to this iteration of the measure led to the development of a renamed scale—the Professional Quality of Life (ProQOL) measure, which is discussed in detail later in this chapter.

Another revised version of the CFST—the Compassion Fatigue Scale-Revised (CFS-R)—was developed by Gentry, Baranowsky, and Dunning in 2002. This shortened version of the CFST consists of 22 items measuring compassion fatigue/secondary traumatic stress and another 8 items measuring burnout, for a total of 30 items. Respondents rate how frequently they experience each item using a 10-point scale, where 1 = “Never/Rarely” and 10 = “Very often.” Higher scores on the subscales are indicative of increased symptoms of secondary traumatic stress and burnout. Items measured in this scale include “I have difficulty falling or staying asleep” and “I have had first-hand experience with traumatic events in my childhood” (Gentry et al., 2002). However, because of concerns related to the psychometric properties of the CFS-R, it was again revised, this time by Adams, Boscarino, and Figley (2006). The subsequent version, renamed the Compassion Fatigue-Short Scale (CF-Short Scale), is a 13-item measure that measures secondary traumatic stress (8 items) and burnout (5 items) using the same 10-point scale as the CFS-R. Items measuring secondary traumatic stress included in this scale include “I have experienced intrusive thoughts after working with especially difficult clients/patients”; items measuring burnout include “I have a sense of worthlessness, disillusionment, or resentment associated with my work.” Internal reliability estimates for the CF-Short Scale were good to excellent (Cronbach’s alpha—0.80 for the secondary trauma subscale and 0.90 for both the burnout subscale and the combined total scale; Adams et al., 2006).

Impact of Event Scale

The Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979) and the Impact of Event Scale—Revised (IES-R; Weiss & Marmar, 1997) are tools that were designed to measure traumatic stress symptomatology related to a specific traumatic experience; however, both have been widely used to assess compassion fatigue among mental health service provides (Bride et al., 2007).

The original 15-item IES consists of two subscales, based loosely on the B and C criteria of a PTSD diagnosis: intrusion and avoidance. The intrusion subscale contains seven items assessing the frequency of intrusive thoughts and images as well as dreams related to the traumatic experience in question. Examples of items included in the intrusion subscale are “Pictures about it popped into my mind,” “I had waves of strong feelings about it,” and “I thought about it when I didn’t mean to.” The 8-item avoidance subscale assesses endorsement of concepts such as emotional numbing, engagement in avoidance behaviors, and denial. Items included in the avoidance subscale are “I stayed away from reminders of it,” “I was aware that I still had a lot of feelings about it, but I didn’t deal with them,” and “I felt as if it hadn’t happened or wasn’t real” (Weiss, 2004). Both subscales use a relatively uncommon scoring system, a 4-point Likert-type scale where 0 = “not at all,” 1 = “rarely,” 3 = “sometimes,” and 5 = “often,” to assess frequency of symptoms over the past week. A combined score of 26 or higher was suggested by the authors of the scale as a reasonable cut-off for clinically significant reactions. In the initial report of the measure, test-retest reliability was adequate (0.87 for the intrusion subscale and 0.79 for the avoidance subscale); and data supported the existence of two unique clusters of symptoms (Cronbach’s alpha = 0.79 for intrusion and 0.82 for avoidance; Horowitz et al., 1979).

An updated report on the psychometric properties of the original IES was published by Sundin and Horowitz in 2002. Using unweighted averages from 18 published research papers, they found that the alpha coefficient for the intrusion subscale was 0.86 and that for the avoidance subscale was 0.82. The same paper included a review of factor analyses for the original IES. This review found that, of 12 studies, 7 supported the two-factor structure of the scale while 3 found that numbing and avoidance better existed as separate factors, for a total of 3; data from the remaining two studies supported a single-factor scale (Sundin & Horowitz, 2002).

Despite the demonstrated utility of the IES, its failure to assess the third concept of traumatic stress symptomatology, hyperarousal, led to the eventual development of the IES-R (Weiss & Marmar, 1997). Designed to maintain compatibility with the original scale, the IES-R initially used the same scoring system, and only one of the existing items was modified from its original wording (a single item assessing frequency of experiencing difficulty falling or staying asleep was separated into two unique items). In addition, six new items assessing symptoms of hyperarousal, such as anger and irritability, trouble concentrating, and hypervigilance, were created and added to the scale, for a total of 22 items. Examples of items included in the hyperarousal subscale are “I was jumpy and easily startled,” “I had trouble falling asleep,” and “Reminders of it caused me to have physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart” (Weiss, 2004). After assessing the psychometric properties of the IES, a small number of additional changes were made to the measure: (1) respondents were no longer asked to report how frequently they experienced each of the items, instead they were asked to indicate the degree of distress associated with each item over the past seven days; (2) the scoring scale was revised, so that 0 = “not at all,” 1 = “a little bit,” 2 = “moderately,” 3 = “quite a bit,” and 4 = “extremely”; and (3) instead of summing each of the items to obtain a subscale score, the mean of the responses for each subscale was used so that it was presented using the same scoring system as the items. Unlike the original IES, no cutoff scores of clinical significance were established (Weiss & Marmar, 1997).

Internal estimates of consistency for the IES-R, when used for individuals who have directly experienced trauma, are good (0.89 for the intrusion subscale, 0.84 for the avoidance subscale, and 0.82 for the hyperarousal subscale; Weiss, 2004). The IES-R has also been published in a number of languages (e.g., French, Spanish, and Japanese, among others); and the psychometric properties for many of these translated versions support their use. It has also been translated, though not formally published, in Italian and Dutch (Weiss & Marmar, 1997).

Professional Quality of Life Scale

As previously mentioned, the Professional Quality of Life Scale (ProQOL; Stamm, 2010) was developed as a result of revisions made to the CFST, and has continued to be adapted over time. Typically used for research and to monitor or self-monitor professional quality of life, the most recent version, ProQOL Version 5, is a 30-item self-report questionnaire consisting of three subscales, each of which measure distinct constructs: compassion satisfaction, compassion fatigue, and burnout. Each subscale consists of 10 items; respondents are asked to indicate how frequently they have experienced each of the items in the past 30 days using a scale of 1 to 5, where 1 = “Never” and 5 = “Very often.” Examples of items included in the compassion fatigue subscale are worded positively and include such statements as “I feel invigorated after working with those I help” and “I believe I can make a difference through my work.” Items included in the compassion fatigue scale, which measures secondary traumatic stress or vicarious trauma, include “I feel depressed because of the traumatic experiences of the people I help” and “I avoid certain activities or situations because they remind me of frightening experiences of the people I help.” Finally, items assessed in the burnout subscale include “I am not as productive at work because I am losing sleep over traumatic experiences of a person I help” and “I feel overwhelmed because my case [work] load seems endless” (Stamm, 2010).

Each of the subscales is scored separately; there is no total score. Subscale totals are derived by summing each item; five items on the burnout subscale must be reverse-scored before calculating the subscale total (Bride et al., 2007). The ProQOL uses percentiles to establish potential for compassion satisfaction and risk for compassion fatigue and burnout, using a mean of 50 and a standard deviation of 10 for each of the scal...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Contributors
• Series Editor Foreword, Charles R. Figley
• Acknowledgments
• Introduction
• Section I Understanding Vicarious Trauma
• Section II Understanding Disasters
• Section III Understanding Vicarious Resilience
• Section IV Managing Vicarious Trauma in Disasters
• Section V Navigating Resources on Vicarious Trauma and Disasters
• Appendix
• Index