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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Case 2: Acute Traumatic Event (Child Death)

Since 1995, the ChildTrauma Academy has had a special project with the Texas Department of Protective and Regulatory Services (TDPRS) focused on the impact of traumatic events on caseworkers and TDPRS staff. This project developed a Critical Incident Response Team and put in place a Secondary Trauma Prevention Project. As part of this Program project, the ChildTrauma staff responds to incidents that have profound impact on caseworkers. In response to these events, a stress debriefing is arranged to take place as soon as possible after the incident. These debriefings are a modification of the traditional Critical Incident Stress Debriefing approach developed by Mitchell and co-workers. Over the years, the ChildTrauma Academy has modified this approach to better meet the specific needs of the professionals involved and the incident. A typical response is described below.

The ChildTrauma Academy received a call from a Child Protective Services supervisor stating that an eighteen-month-old child in the protective custody of the department had suddenly died. The child was being cared for by foster parents and had died in the middle of the night, apparently as the result of a previously known medical condition. The supervisor reported that several caseworkers and the foster parents were really struggling over the loss of this child. A debriefing was scheduled for the following morning. CTA staff flew to a rural community in Texas to meet with the caseworkers and supervisor.

At the beginning of the two-hour debriefing, attended by approximately 8 people, CTA staff talked about the purpose of the debriefing and emphasized the importance of maintaining confidentiality about what was talked about in the session. The debriefing process was described as an opportunity to talk about their thoughts and feelings related to the death and also an opportunity to offer support to each other.

Each of the participants began by talking about how they were involved in the case. Slowly, the history of the childís involvement with the social service system began to unfold. As the debriefing progressed, participants were given the opportunity to share with each other how "special" and "unique" this little boy had been to them. The foster mother needed to talk about how "guilty" she felt for not maintaining an around the clock vigil with this child. The foster father said that he knew that he was not supposed to view this child as his own, but he found that impossible. He also talked about how painful it was to be prohibited from attending the funeral by the biological parents. He desperately wanted to place a marker on this childís grave - "to show that he had really meant something to the people he came in contact with." The caseworkers universally talked about how unique this child was. As they talked, everyone cried. What made this debriefing especially successful was that not only did people have an opportunity to talk about what they were thinking and feeling, but also because they had an opportunity to be supportive of each other.

At the conclusion of the debriefing, all participants left saying they felt better for having had the opportunity to talk and express their support and for gaining the support of their peers

As part of the Critical Incident Response Program, a post-debriefing critique was administered. The goal of this survey is to see whether the services provided actually are perceived to be a benefit to the worker. Over the last five years, responses from more than 800 caseworkers participating in more than 30 separate critical incident debriefings show that more than 85% of the participants found the debriefing opportunity very helpful. More objective data are being collected to see whether or not these interventions actually improve measures of worker motivation and effectiveness. Preliminary impressions, however, would suggest that this relatively simple, responsive intervention following a traumatic incident can be a very useful, if not necessary, component of a child protective systemís program structure.


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