The Cost of Caring:
Secondary Traumatic Stress and the Impact of Working with High-Risk Children and Families

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Lesson 1: Introduction to Secondary Trauma

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Trauma is not limited to domestic or sexual violence. We live in a world prone to floods, hurricanes, and earthquakes, not to mention other sorts of natural disasters. Without warning, people die or are injured every day in cars on our nation's streets and highways.

Despite wonderful technological advances in medicine, people still experience life-threatening medical conditions and painful procedures. The media provides us with a picture of escalating community violence, drug abuse, and other dangers. Even from an adult perspective, the world can be a very frightening place!

Three Case Examples

There are hundreds of different ways in which professionals and caregivers can be impacted by trauma. We will present three examples to  illustrate key elements that may be common to many of the situations confronting professionals working with traumatized or maltreated children.

Case 1: Duress in unusual circumstances: Working with the Branch Davidian Children.

For many weeks, caseworkers and supervisors from the Texas Department of Protective and Regulatory Services (TDPRS) had been working overtime under tremendous duress. The small regional division had been suddenly and dramatically thrust into the public eye in one of the most high-profile child protection issues of the last decade – the Branch Davidian assault and siege. In the three days following the ATF raid, 21 children were released into the care of the state. The local Child Protective Service units mobilized; the State sent supervisory assistance and the entire staff were besieged by press, public and other agencies (e.g., FBI and Texas Rangers). The staff worked hard to find shelter and services and to create disposition plans for these 21 children. This immediate crisis phase - the first weeks following the raid – was followed by a five-week period of "unknown." The TDPRS and the partnering clinical treatment team prepared for the release of the other Branch Davidian children (at least 40 more) still in the compound not knowing when or how the remaining children would be released. While media pressures continued; so did the efforts to help the 21 released children, screening and briefing the children's families as well as trying to find healthy, safe placements. The staff was overworked, overwhelmed and over-exposed.

Through video, family interviews and review of case material, the clinical team came to know the children and some family remaining in the compound. The expectation was that the situation would be defused and these children would become the responsibility of TDPRS and the partnering clinical team. Over the six weeks spent in Waco, the clinical team came to know the 21 released children very well. By the time of the final assault and the fire, the TDPRS and clinical staff had been emotionally drained. The horror of the fire left so many of the team with sense of helplessness and frustration. The senseless loss of life and the continuing confusion about motivations on all sides added to the distress. The tasks of telling the children, facing the press, the sudden decompression of the chronic tension related to the anticipation of the other children being released all added to the distress of the staff. Many of the staff were devastated. Emotions ranged from profound sadness to anger to relief to guilt. The staff was listless, numb, exhausted and had a difficult time focusing on any other work. The TDPRS and clinical team were experiencing secondary trauma.

The impact of chronic duress and atypical circumstances can be devastating. These situations reveal the "fault lines" in an organizational structure and magnify any of the typical personality or supervisory issues that are often a common part of any organization. In these situations, the immediate response tends to bring people together; however, with bad outcomes, or if the duress is chronic, temporary alliances and accommodations can fray. With exhaustion, tension and frustration,arrise individual and systemic problems. Extended duress and unusual circumstances include natural and man-made disasters (e.g., floods, hurricanes, school shootings, plane crashes) will transiently bring out the best in most people but often leave a wake of destruction and pain for the survivors and surviving community (e.g., the Columbine High School shootings, the Oklahoma City bombing). In these situations, as time passes, the pain of senseless loss can easily be turned on others or haunting guilt can be turned internally. The rates of trauma-related symptoms can be astounding. A study of the Oklahoma City community demonstrated that more than 50% of the community experienced residual trauma-related emotional and behavioral symptoms one year after the bombing.

In the case of the TDPRS staff working with the Branch Davidian children, informal and formal actions led to the long process of coping. Probably the most effective approaches were individual. Caseworkers and the other professionals talked with each other on an informal basis and drew upon their existing personal and professional support systems. A series of community services for the Branch Davidians were helpful to some. Several ‘debriefing’ and educational events about secondary trauma that were provided but, for the most part, talking with and supporting each other were the major healing processes. To this day, many of the participants have strong emotional feelings when talking or thinking about the Branch Davidian children or the assault, siege and fire. Ten years after this tragic event, individual members of the treatment team report episodic intrusive ideations, permeating anger or sadness when reminded of the event and active efforts to avoid reminders of the entire event. Clearly the "cost of caring" for these healers was high.


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