CHILD WELFARE WORKERS: AN INNOVATIVE APPROACH FOR INTERACTING WITH SECONDARY TRAUMA.

CHILD WELFARE WORKERS: AN INNOVATIVE APPROACH FOR INTERACTING WITH SECONDARY TRAUMA. SOCIAL WORKERS are all familiar with the problems of child abuseand neglect, which span back in time for hundreds of years. The firstdocumented case of child abuse intervention was in 1875 in New York City New York City:see New York, city. New York CityCity (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. (Costin, Karger & Stacy, 1996). Since then, child welfare workers(CWW CWW Compressed Work WeekCWW City West Water (Australia)CWW Church Without Walls (various religious organizations)CWW Columbus Water Works (Columbus, Georgia, USA)) have been assigned the critical role of protecting the safety ofchildren who are reported for suspected abuse. Little is known about theemotional impact of chronic exposure to trauma on CWW when theyintervene and directly observe the effects of abuse and neglect ofchildren, and hear the affect-laden experiences described by clients. This article will report on two focus groups that were used togather data to begin to understand the stressors faced by the workers.The author integrated five themes that emerged from the focusgroups--(1) Secondary Trauma; (2) Child Fatalities;. (3) Successful andDifficult Cases; (4) Organizational Stress and Burnout BurnoutDepletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage. ; and (5)Spiritual and Religious Beliefs--in developing a two-day curriculummodule entitled, "Stress Inoculation inoculation,in medicine, introduction of a preparation into the tissues or fluids of the body for the purpose of preventing or curing certain diseases. The preparation is usually a weakened culture of the agent causing the disease, as in vaccination against Training: Reducing SecondaryPsychological Trauma Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to Post Traumatic Stress Disorder, damage can be measured in physical changes inside the brain and to brain chemistry, which affect the person's of Child Welfare Workers." The training wasconducted at the New York University New York University,mainly in New York City; coeducational; chartered 1831, opened 1832 as the Univ. of the City of New York, renamed 1896. It comprises 13 schools and colleges, maintaining 4 main centers (including the Medical Center) in the city, as well as the Shirley M. Ehrenkranz School ofSocial Work in collaboration with a staff member of a large,metropolitan child protective agency. Emphasis was on both didactic andexperiential learning. This article summarizes the study findings and reports on thedevelopment of the curriculum framework. Examples used in the curriculumare provided and the challenges of using this approach are discussed.Teaching CWW about the impact of secondary trauma and coping techniquescombined with self-care, can thus address the needs of this invisiblepopulation. Theoretical Overview Although there are gaps in the literature about assisting CWW withthe painful issues they confront daily, burnout, countertransference countertransference/coun��ter��trans��fer��ence/ (koun?ter-trans-fer��ens) a transference reaction of a psychoanalyst or other psychotherapist to a patient. coun��ter��trans��fer��encen. ,and vicarious vicarious/vi��car��i��ous/ (vi-kar��e-us)1. acting in the place of another or of something else.2. occurring at an abnormal site.vi��car��i��ousadj.1. traumatization are important concepts that offer someinsight into CWW's experiences of working with child maltreatment child maltreatment'…intentional harm or threat of harm to a child by someone acting in the role of a caretaker, for even a short time…Categories Physical abuse, sexual abuse, emotional abuse, neglect…', the last being most common. .These concepts emerged in the focus groups, and subsequently wereintegrated into the training model, with a particular focus on copingwith the impact of trauma. Burnout CWW who intervene with the maltreatment maltreatmentSocial medicine Any of a number of types of unreasonable interactions with another adult. See Child maltreatment, Cf Child abuse. of children and theirfamilies face stressors that may produce difficult job experiences.Extensive social work research on the concept of burnout in socialworkers has shown high rates of burnout, particularly among CWW (Kern,1980; Maslach, 1982). The burnout literature takes a broad look atworker stress, recognizing organizational, personal, and clientvariables, which together contribute to burnout. Jayaratne, Scess, andKunkel (1986) examined burnout in 75 female child care workers. Theworkers were given the Maslach Burnout Inventory and a questionnairedealing with work stress, strain, psychological health and emotionalsupport. The results indicated that burned-out workers exhibited highlevels of anxiety, depression, irritation, somatic somatic/so��mat��ic/ (so-mat��ik)1. pertaining to or characteristic of the soma or body.2. pertaining to the body wall in contrast to the viscera.so��mat��icadj. complaints, and lowerlevels of job satisfaction. Much of the burnout literature, though,fails to address issues specific to work with trauma victims andperpetrators, and the workers' psychological reactions to thisdifficult work. Several theoretical writings on burnout in CWW provide importantinsights into the phenomenon. Daley (1979) found that, due to deadlinesand large caseloads, many workers were not able to follow up on cases orsee them through to completion. Often they referred the cases to otheragencies for treatment and did not know the outcomes. Also, the lack oftangible indices of success with cases is frustrating. Much of thedecision making is subjective when it concerns determining the magnitudeof children's pain. Courage and William (1986) described how certain situations canexacerbate worker stress. On the one hand, workers must deal withchildren in acute distress and danger who are victims of violence. Atthe same time, they must confront perpetrators of violence who oftendisplay anger and hostility toward the worker. Freudenburger (1974, 1977) spoke of burnout in terms of exhaustionin relation to interactions with needy clients. He asserted thatovercommitted and overdedicated workers are usually the most vulnerableto burning out. Some workers may have come from similar environments astheir clients, thus seeking to help children in order to heal their ownhurt and pain. By superimposing their own pain upon the child, workerscan be retraumatized with every case. This can result in a worker'soverimmersion in their work, and can lead to exhaustion. In summary, the chronic and acute nature of many child abuse casescan be a strong factor in worker burnout. Workers who feel theclients' problems are unsolvable may also feel that theirinterventions are futile and meaningless, leading to erosion ofself-esteem and sense of professional efficacy. Acuity, or the intensityof the problem and the need for immediate action, can be an additionalstressor for the worker. Countertransference Trauma work requires CWW to tolerate periods of feeling helpless,inadequate, shamed, attacked and abandoned. Given these stressors, theymay feel pained at the exposure of their failings. A commontrauma-linked countertransference has been termed by Kaufmann (1992) asthe "countertransference hostage syndrome." Here the socialworker feels silenced and controlled by the client; options seem closedoff, and the worker has the sense of losing perspective in the face ofthe clients' sense of reality. Other countertransference reactions may include rescue fantasiesand intense preoccupation with clients. Children who have been abusedmay experience the worker in the perpetrator A term commonly used by law enforcement officers to designate a person who actually commits a crime. role. They may also see theworker as using them for their own pleasure or sexual arousal sexual arousalHorny/horniness, randy/randiness Physiology A state of sexual 'yellow alert' which has a mental component–↑ cortical responsiveness to sensory stimulation, and physical component–↑ penile sensitivity, neural response to stimuli, . The CWWcan feel shocked and enraged en��rage?tr.v. en��raged, en��rag��ing, en��rag��esTo put into a rage; infuriate.[Middle English *enragen, from Old French enrager : en-, causative pref. at being perceived as exploitative andharmful. In response, workers may fantasize about punishing clients fortheir misperception mis��per��ceive?tr.v. mis��per��ceived, mis��per��ceiv��ing, mis��per��ceivesTo perceive incorrectly; misunderstand.mis , which can in turn invoke a sense of guilt and leaveworkers wondering if more seasoned colleagues experience suchdifficulties. Pollack and Levy (1989) described anger as anothercountertransference reaction. They discussed it in terms of the mandatedreporter's hostility toward the agency for imposing itself on theprofessional's autonomy and the therapeutic relationship. Two final countertransference themes that occur in working withtrauma survivors are those resulting from the clients' experiences.Working with abused children can destroy one's personal andcultural mythologies--deeply held beliefs about human nature, thesanctity of childhood, and the capacity for evil that exists in all ofus (Wilson, 1981). In response to this assault on their worldview world��view?n. In both senses also called Weltanschauung.1. The overall perspective from which one sees and interprets the world.2. A collection of beliefs about life and the universe held by an individual or a group. , CWWmay deny their clients' experiences in order to safeguard their owncherished beliefs (Newman & Gamble, 1995). While horrifying and painful to hear, clients' stories cansometimes fascinate. For example, the worker may feel curious, aroused,or excited while listening to an account of sadistic sa��dism?n.1. The deriving of sexual gratification or the tendency to derive sexual gratification from inflicting pain or emotional abuse on others.2. The deriving of pleasure, or the tendency to derive pleasure, from cruelty. sexual abuse (Davis& Frawley, 1994). This fascination is often unconscious, but when aworker's "fascination with the forbidden" reachesawareness, he or she may feel shocked, guilty, and ashamed. Ifunattended to, these feelings may be projected onto clients in the formof anger (Newman & Gamble, 1995). In addition, responses to aclient's projection may be particularly troublesome for workers whoare themselves survivors of child abuse, neglect or violence. Copingwith these dynamics can place an additional strain on CWW. Vicarious Traumatization Vicarious traumatization is based on constructivist con��struc��tiv��ism?n.A movement in modern art originating in Moscow in 1920 and characterized by the use of industrial materials such as glass, sheet metal, and plastic to create nonrepresentational, often geometric objects. self-development theory (McCann & Pearlman, 1990b), a theory ofpersonality that describes the impact of trauma on an individual'sdevelopment and sense of self. It integrates psychoanalytic theories,specifically object relations theory and self psychology, withcognitive, developmental and social learning theories. There is anemphasis on adaptation, relation to self and others, and the developmentof a sense of meaning in the world. Vicarious traumatization refers toMcCann and Pearlman s conviction that exposure to trauma material overtime will affect the worker in the same realms that constructivistself-development theory posits trauma affects an individual. Thecumulative effect of this exposure is to change the worker's selfin the same ways that a traumatic event A traumatic event is an event that is or may be a cause of trauma. The term may refer to one of the followiong: Traumatic event (physical), an event associated with a physical trauma Traumatic event (psychological), an event associated with a psychological trauma or context affects anindividual's sense of self. The general signs and symptoms of vicarious traumatization aredecreased sense of energy; no time for one's self; increaseddisconnection from loved ones; social withdrawal; increased sensitivityto violence, threat, or fear--or the opposite, decreased sensitivity,cynicism, generalized despair and hopelessness. These are the endpointsof a gradual erosion of one's beliefs and frame of reference, thatis, changes in identity, worldview and spirituality (McCann &Pearlman, 1990a). The Study Research is beginning to identify the effects of the various kindsof psychological distress psychological distressThe end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology. absorbed by clinicians as they counsel childand adult victims of physical and sexual abuse, accidents, war, andother crimes (Van der Kolk, McFarlane, & Weisbeth, 1997). However,as stated earlier, there is little information available on how directobservation of the effects of abuse and neglect of children and chronicexposure to trauma affects CWW. This study examines the nature ofsecondary trauma and its impact on CWW. Through a training program theresults of the study will be made available to CWW volunteers to addresstheir responses as they interact with trauma. Method Focus groups were identified as a means of data gathering thatwould begin to inform the training model. A focus group format is usefulin obtaining the group's feelings, thoughts, and reactions to aparticular subject (Lydecker, 1986). The interaction of participantsengaging in dialogue provides insight and generates new ideas in arelatively brief period of time (Krueger, 1988; Morgan, 1988). The focus groups, conducted in fall 1997, were run by a teamconsisting of a facilitator (author) with a background in group work,and a senior staff member of a public child welfare agency child welfare agencyChild psychiatry An administrative organization providing protection to children, and supportive services to children and their families who served ascofacilitator. A total of two focus groups were conducted, each sessionlasting three and a half hours. The questioning route as originallydesigned was effective, and no modification or revisions were required.With the permission of the participants, each meeting was audiotaped.Participants were assured of confidentiality. Participants alsocompleted questionnaires requesting demographic data. As each groupconcluded, the facilitators separately recorded additional impressionsof and central ideas from each group. The constant comparison process described by Lincoln and Guba(1985) and Glaser and Strauss (1967) guided the data analysis. Theauthor analyzed each audiotape au��di��o��tape?n.1. A relatively narrow magnetic tape used to record sound for subsequent playback.2. A tape recording of sound.tr.v. using a content analysis procedure(Mostyn, 1985). When enough themes had been elucidated from the text andcoded, all the tapes were listened to again with the coding categoriesin mind, and coded appropriately when a theme recurred. Related themeswere grouped into categories and assembled for data analysis within eachthematic category. In addition, the audiotapes were reviewed by aconsultant, who was working independently with the researchers, to checkfor reliability. The facilitators and the consultant met and debateduntil a consensus was reached about the best assignment of themes. Research Questions The author conducted informal consultation with agency supervisorsand other CWW prior to the focus groups to learn about what issues theyfelt needed to be addressed. The following questions, based onliterature (Danieli, 1994; Farber & Heifetz, 1982; Herman, 1992;Maslach &Jackson, 1981; McCann & Pearlman, 1990a, 1990b; Shannon& Saleebey, 1980) framed the inquiry into the impact of secondarytrauma on CWW. Several background questions were also asked. Thequestions guiding the focus groups included: * What was it like for you when you first started working withabuse and neglect of children? How did this affect you? Describe anychanges that you experienced over your career. * What experiences did you have growing up that may have preparedyou for this work with children and families? How have your experiencesand culture helped you or hindered you in this work? * When the work becomes difficult how have you managed to cope? Doyou cope differently now than when you first began this work? How wouldyou explain this change? What feelings give rise in you? How do you copewith these feelings? * Are there particular cases that affect you more than others? Whatkinds of cases do you feel you are successful/ unsuccessful in dealingwith? Can you describe one that was particularly difficult/successful?Do you find yourself more detached or more involved with clients? * If your case involved trauma to the child, how did it affect youpersonally, professionally, and spiritually? * Tell us about your support system personally and professionally.How helpful are these supports? What would you like to be different tohelp you cope with stress and trauma on the job? * How does repeated exposure to child protective work affect youprofessionally, emotionally, personally and spiritually? * Is there anything else you would like to share or discuss? Sample The sample of 10 CWW was drawn from the five borough offices of achild welfare agency in a diverse metropolitan area. All boroughs wereused since they represented a range of ethnicity and race, as well as avariety of client problems. The sample was obtained through authorcontact with the agency's field office directors, and the directorof the agency's training academy. All field office directorsnotified CWW at their site with a flyer about the study. The flyerrequested volunteers to participate in a half-day focus group where theywould be asked questions about their feelings, thoughts and perceptionsof the work. If interested, volunteers were instructed to contact aliaison person who discussed the project in detail. All participantswere given release time and assured of confidentiality. Once theparticipants agreed, they were given the scheduled dates of the focusgroups. Three people declined to participate due to a time conflict witha mandated court appearance. The nonparticipants did not differ from the10 participants in terms of gender, race or age. The meeting took placeat the Shirley M. Ehrenkranz School of Social Work at New YorkUniversity. All of the participants worked in either the assessment,investigation, or protection units of the agency for at least threeyears. This group represented a change in the agency hiring structure,as they all possessed a degree in a helping profession and had beengiven additional weeks of training. All the workers in the sample madehome visits and investigated and made determinations regarding abuse andneglect. They had the authority to remove children from the home andplace them in foster care when indicated. Counseling, parenting skills,and drug rehabilitation This article is about the process of rehabilitation for substance dependency. For other uses, see Rehab (disambiguation). For other kinds of rehabilitation, see Rehabilitation. For the American rap-rock group, see Rehab (band). were some of the services they offered clients.If abuse or neglect was not found in the initial investigation, theyfollowed the family for a 90-day period or closed the case. The lack of diversity in the group was apparent with anoverrepresentation of African-American workers (6) and anunderrepresentation of Latino (2) and Caucasian (2) workers. Thisparalleled the population of the agency but did not reflect the clientpopulation. Women were the majority of participants (7). The age of thesubjects ranged from 20 to 49. The mean age for the total sample was 35years. The majority (60%) were Catholic. Study group members had anaverage of 4.5-5.0 years of education after high school. Fifty-sixpercent were single and never married, 25% were separated or divorced,and 19% were married. All but one of the respondents held jobs prior totheir work as a CWW. None of the sample knew each other. Findings Content Analysis of Major Themes Coping--Secondary Trauma. Sadness was an emotion described by all10 CWW. All of the workers stated that they initially came to the agencyfrom college and were "gung-ho" and enthusiastic. One maleworker came to the agency four years ago and felt he could help peopleand be a positive force in their lives. He remembered his first removalof a child and how he cried as he drove to the prospective fosterparent's home. "It did not end at that juncture, but feelingsof sadness kept me awake at night and the memory stayed alive and becamerepeated again on the next removal." This process can stir uploneliness and abandonment in the workers as they may reawaken Verb 1. reawaken - awaken once againawaken, wake up, waken, rouse, wake, arouse - cause to become awake or conscious; "He was roused by the drunken men in the street"; "Please wake me at 6 AM." similarexperiences of their own. A 30-year-old Caucasian woman stated that,"It took me three years to get over removing a child from his home.I could not separate my personal from my professional life." All workers reported behavioral changes over time as copingresponses and to avoid further stress. These behavioral changesincluded: 1) detachment; 2) staying busy; 3) accepting one'slimitations; 4) setting limits, and 5) "cutting off." All theCWW felt they could not continue to worry and bring the cases home. One33-year-old Latina described her changes as "detachment withlove" or "sometimes, I ignore and don't give the extrapush for the family to go to drug treatment or counseling." Child Fatalities. Respondents were unanimous in reporting that thedeath of a child is difficult and shocking, but when children die as aresult of maltreatment and neglect, it is a trauma for all concerned.When a child known to the public agency dies, society, the child'sfamily, the press, and the agency often hold the caseworker responsiblefor such tragedies. The CWW stated that they blame themselves forsituations for which they could in no way be responsible. "What didI do wrong?" asked one female worker. "I am programmed tothink there is a deficit in me." The workers reported symptomsparalleling secondary trauma after the death of a child on theircaseload case��load?n.The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.caseloadNoun . The symptoms were inability to concentrate, irritability irritability/ir��ri��ta��bil��i��ty/ (ir?i-tah-bil��i-te) the quality of being irritable.myotatic irritability? the ability of a muscle to contract in response to stretching. ,increased startled response, feelings of vulnerability, anxiety,sleeplessness and intrusive images of the trauma. One 32-year-old African-American male respondent reported afatality fa��tal��i��tyn.1. A death resulting from an accident or disaster.2. One that is killed as a result of such an occurrence. he had experienced one year previously. "To this moment,it flashes in my mind. I picture the child wandering from the strollerand going to the neighbor's swimming pool and drowning. Even thoughI know it was an accident, I can't let the picture go. I could notlisten to the TV reports. I remember how supportive everyone was in theoffice -- but a mother's child has died. I can only imagine thesuffering she experienced." Successful and Difficult Cases. Seven CWW reported establishing andmaintaining a relationship with clients as the greatest sense ofachievement. "When families begin to trust you and follow throughon your recommendations, such as attending parenting classes orenrolling in a substance-abuse program, it is thrilling and it is what Ipictured this work to be." A 20-year-old Latina woman describedworking with a woman who was involved in a three-year abusiverelationship. The client garnered enough support from the worker torelocate to a shelter with her three children. "I feel so goodabout our work together that I am finding difficulty terminating." Organizational Stress and Burnout. All of the participants citedthe agency and office working conditions, as well as the community assignificant stressors. Different views emerged on the need for supportin the workplace to buffer the negative effects of job stress. Six womenand one man felt powerless and angry toward the agency for not providingadequate work conditions. They felt the office settings were similar totheir clients' homes, which were infested in��fest?tr.v. in��fest��ed, in��fest��ing, in��fests1. To inhabit or overrun in numbers or quantities large enough to be harmful, threatening, or obnoxious: with rats and roaches. Two Latina women spoke of the parallel process between theirexperiences and those of their clients. One explains, I accompany the client to the office of Public Assistance. I tell the clerk the agency that I represent. It makes no difference. I sit with the client for four and a half hours waiting our turn. They treat me like a lowlife, just like my clients. Spiritual and Religious Beliefs. Spiritual beliefs played anintegral part in the life experiences of most workers. Spirituality wasoften described as reinforcing CWW's sense that their work hadmeaning. Finding meaning in their work was an important adaptive copingskill A coping skill is a behavioral tool which may be used by individuals to offset or overcome adversity, disadvantage, or disability without correcting or eliminating the underlying condition. Virtually all living beings routinely utilize coping skills in daily life. . Many times when workers talked about the horror they witnessed ontheir jobs, they would spontaneously call upon God to help buffer theirpain and disbelief. One woman described praying before she would go on a field visit orreading a passage in the Bible to give her strength! "Before goingto work, or during lunch time, I stop in a nearby church and ask God togive me strength." Another said, "I give this over to God. Ifeel I can do just so much and He has to do the rest. I pray I beg; I request; I entreat you; - used in asking a question, making a request, introducing a petition, etc.; as, Pray, allow me to go s>.See also: Pray everydayfor guidance and for my clients. If I didn't have a belief system,I couldn't survive this job." There seemed to be a great sense of comfort in believing there wasa higher power that would provide support and reduce some of the burdenthey were experiencing. On the other hand, a few workers questionedGod's work and benevolence BENEVOLENCE, duty. The doing a kind action to another, from mere good will, without any legal obligation. It is a moral duty only, and it cannot be enforced by law. A good wan is benevolent to the poor, but no law can compel him to be so.BENEVOLENCE, English law. as they frequently witnessed the painand suffering of vulnerable children. "It's hard to getcentered," said one man. "Maybe it takes an unusual depth offaith." A strong religious conviction, held by all but two of theworkers, appeared to play a significant role in reducing the burden feltin regard to the enormous pain they had witnessed. The Model Analysis of the focus group findings suggests the necessity ofensuring that CWW are equipped to handle the complex trauma that theyincur as they bear witness to the maltreatment of children. The truetest of bridging research and practice lies in the model'sapplication. The model curriculum framework incorporated the five themesthat emerged during the focus groups. Small group discussions,experiential learning, drawings and relaxation techniques were some ofthe elements that were utilized in the model. It was essential to focuson empowering the work by restoring the worker's disrupted sense ofidentity, world view, and spirituality (McCann and Pearlman, 1990a).Figure 1 illustrates the Conceptual Model of the Research andIntervention. [Figure 1 ILLUSTRATION OMITTED] By synthesizing the findings of the focus groups, collaborativeplanning resulted in the development of a two-day (14 hour) model. Thismodel was designed to prepare CWW with the knowledge, skills andself-awareness needed to face the stress and trauma that occurs duringdaily witnessing of child maltreatment. Day one was designed to providea foundation of knowledge on stress, burnout, countertransference,posttraumatic stress disorder Posttraumatic stress disorderAn anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life. (PTSD PTSDposttraumatic stress disorder. PTSDabbr.posttraumatic stress disorderPost-traumatic stress disorder (PTSD)) and vicarious trauma (Maslach,1982; Pearlman & Saakvitne, 1995; Wilson, Lindy lin��dyor Lin��dy ?n. pl. lin��diesA lively swing dance for couples. Also called lindy hop.[From Lindynickname of Charles Augustus Lindbergh. , & Raphael,1994). Day two provided opportunities for self-evaluation, improvedcoping response, and development of alternative techniques of self-careto assist in reducing the impact of secondary trauma (Figley, 1995).Flyers were distributed in the mailboxes of all CWW in each of the fiveborough offices. Potential participants were notified that a pilottraining model would be offered in the fall, during two working days. The sample consisted of 18 participants including 17Afro-Caribbeans and 1 Caucasian. The mean age was 37, and they all hadbeen employed for three to eight years at the agency. The training wasco-facilitated by the author and a member of the training unit from thepublic child welfare agency. Framework: Stress Inoculation to Reduce the Effects of SecondaryTrauma on Child Welfare Workers This conceptual model integrates knowledge about the effects ofstress and secondary trauma on the self with skills to: (1) assessone's normative stress by expression of symptoms of stress; (2)evaluate a case using the five senses--small group format fordiscussion; (3) identify responses of countertransference-burnout andPTSD; (4) develop knowledge about vicarious trauma utilizing theConstructive Self-Development Model (McCann & Pearlman, 1990b); (5)assess one's coping skills (e.g., prayer, reflection); (6)"Paint Your Picture" in five domains: children and families,supervision, colleagues, agency environment and self; (7) develop apersonal "coping with stress" chart which utilizes the 5dimensions from the pictures and (8) coping techniques: deep breathing,visual imagery, massage, music, prayer and yoga. Based on observation and respondents' feedback, it seems thatthe group provided very effective peer support for one another. Eachworker chose a buddy with whom they discussed their stress at work,exchanged telephone numbers and charted how they could developalternatives for "coping with stress and trauma" in the fivedomains. Soft music was also played during this part of the training. This model provided a framework for understanding the impact ofregularly witnessing the mistreatment mis��treat?tr.v. mis��treat��ed, mis��treat��ing, mis��treatsTo treat roughly or wrongly. See Synonyms at abuse.mis��treat of children. Danieli (1994)states, "our work calls on us to confront with our clients andwithin ourselves, extraordinary human experiences. This confrontation isprofoundly humbling in that at all times these experiences try our viewof the world we live in or challenge the limits of our humanity"(368). The workers gave feedback to instructors and peers during thisexploratory process, and were provided a safe haven 1. Designated area(s) to which noncombatants of the United States Government's responsibility and commercial vehicles and materiel may be evacuated during a domestic or other valid emergency.2. in which toacknowledge the stress and trauma one might unknowingly endure whileprotecting children from maltreatment. Providing constructive feedbackwhile listening to CWW reactions to specific trauma, helped to providethe objectivity and empathy which is so critical for effectiveintervention (McCann & Pearlman, 1990a; Wilson & Lindy, 1994). Context of the Findings Although encouraged by participant evaluations indicating that thetraining intervention was very helpful, several limitations to thisstudy exist and should be noted. Methodological factors limit theinterpretation of data, which affects the generalizability of thefindings to this population. First, the pilot study used a small,nonrandom, convenience sample. Second, the research was exploratory innature. The purpose was to collect data and develop a model based on theperceptions of 10 CWW. The participants could have distorted theirresponses to make themselves appear in the best light. They could havealso inadequately reflected their true experiences. The study did nothave a control group, making it impossible to compare findings. Anobvious bias results from the author's wish to achieve desiredresults. This bias may manifest itself in the use of leading questionsin the focus groups, or nonverbal responses to the CWW comments. Tominimize this type of bias, we informed the subjects that both positiveand negative responses were important for the development of the model. An open-ended questionnaire served as an evaluation tool at the endof the training. Results indicated the need for the followingimprovements: * A six month booster inoculation session to address emergenttrauma issues and solidify self-awareness, knowledge, and skills learnedin the training; * Initiation of small monthly groups where CWW could discuss issuesof trauma and "find words to fit their experiences"; * A spiritual consultant to provide solace and counseling whenchildren die; and * Availability of a group to provide emotional and spiritualsupports when CWW experience "soul sadness." Discussion Although a definitive statement about the model'seffectiveness cannot be made, it does offer promise in that it providedan approach for CWW to respond to secondary trauma offered by no othermodel. The model incorporates three foci: personal identity, worldviewand spirituality. (McCann & Pearlman, 1990a). Other content includestrauma, countertransference and burnout. The author developed the two-day model and presented it for reviewto four child welfare supervisors. Based on their feedback andquestions, (e.g., how one would use the sense simulation and apply it tothe case), the author refined the materials and collaborativelypresented it with a training expert from the public child welfareagency. Since the author facilitated the focus groups with members ofthe child welfare agency, a positive link was established and sustainedthroughout the process. This minimized the turf wars that could haveemerged between "town and gown Town and gown is a term used to describe the two communities of a university town; "town" being the non-academic population and "gown" metonymically being the university community, especially in ancient seats of learning such as Oxford, Cambridge, St Andrews and Durham. ." The collaboration was a vitalpart of the project, and this was evident in the overwhelming responseof the CWW who volunteered for the focus groups and training model. Gaining the training group's confidence and beginning with theknown (i.e., personal stress) (Wilson, 1981) made it easier to discusstrauma, its complexities, and the disruption the CWW may experience intheir core beliefs. Through their interactions with the trainers and oneanother, including role playing role playing,n in behavioral medicine, learning exercise in which individuals assume characters different from their own. The individual may also be asked to simulate a particularly difficult situation and apply the characteristics that are common to his , the workers were assisted inintegrating knowledge, skills and coping responses to offset thedissociation dissociation,in chemistry, separation of a substance into atoms or ions. Thermal dissociation occurs at high temperatures. For example, hydrogen molecules (H2 that can take place when helping children and families withsafety issues, and feelings of well-being. This was further evidencedwhen the participants realized how their sensory experiences had beendisrupted. What CWW often need is not so much expert advice, technicalfixes or precise data, but a "sacred place (Civil Law) the place where a deceased person is buried.See also: Sacred " to gainself-confidence so the pleasures and pain of the work can emerge, andthey can resume their roles as protectors of children. Safety in thegroup encouraged self-awareness of the process of vicarioustraumatization and its potentially serious effects on both the CWW andthe client. Since all practitioners are changed by this work (McCann& Pearlman, 1990b), our best safeguard is self-awareness andcommitment to self-protection. To the extent that the trauma experienceswere replicated in the workers' practice, it provided opportunitiesto explore how they handled stress and experienced trauma each day. Thekey elements in understanding trauma and its impact on the CWW wereemphasized throughout the training, and differential approaches tocoping were examined. Keeping a sense of positive connection to self andothers was modeled in the group. Humor was used to ensure safety andtrust. Perhaps the greatest accomplishment has been creating a heightenedawareness of trauma and its effect on CWW. It would not be prudent tomeasure the degree of change at this point, and future research wouldneed to determine how effective the model is in helping these workerscope with the effects of secondary trauma. This was beyond the scope andpurpose of this pilot study and intervention. The model presented hereis a work in progress that would benefit from additional evaluation ofits implementation. We are working on offering this model to anothergroup who have been in the agency for 7-10 years. Future reports willdescribe the experience of the workers trained in the model. Although the model was assessed on a small group, more rigorousevaluation with a control group, and random sample would be advisable toenhance generalizability. To assess the prevalence of secondary traumaamong CWW, a quantitative survey or other design (e.g., a quasiexperimental design) might be undertaken throughout the country, sinceworkers' experiences will differ based on clientele, staffing,culture, geography and organizational structure. Maslach's BurnoutInventory (MBI MBI Management Buy-InMBI Moody Bible InstituteMBI Mathematical Biosciences InstituteMBI Modular Building InstituteMBI Mechanical Breakdown InsuranceMBI Molecular Biology InstituteMBI Maslach Burnout Inventory (psychometrics)) (1981) can provide additional information about theexperience of stress. The rationale for this work is that it is anessential preface to enabling CWW to cope with trauma and its effects,as they intervene and are painfully exposed to child maltreatment andother family problems. Implications for Social Work Education To seize the opportunities of the 21st century, we must be preparedto grasp its challenges. None is more pressing than an education thatexpands the personal and professional horizons of CWW while offeringinsight into their experience of working with child maltreatment. Toachieve this end, we are in need of systematic and consistent standards,measurements, and accountability. How do we implement these principlesas the coordinates of our compass for the future? Social work educatorsneed to reinvigorate their professional mission by assuming a leadershiprole. This may best be accomplished by offering curricula that helps CWWmeet the current challenge of providing services to clients, while beingaware of the impact of secondary trauma on their sense of self. Learningexperiences are enhanced when CWW are assisted in understanding theirvulnerability to trauma as they intervene, and hear or see the effectsof child abuse and neglect. Although social work educators do not haveimmediate answers to all the questions generated by chronic exposure totrauma on CWW, they are engaged in an academic enterprise where answersto many of the questions can emerge, through research, consultation withchild welfare agencies, and scholarship. One immediate way to implementtraining is to offer advanced workshops to child welfare supervisors tohelp sensitize sen��si��tizev.To make hypersensitive or reactive to an antigen, such as pollen, especially by repeated exposure. them to the theory and impact of trauma. Although this study indicates a prematurity in understanding thedisruption of the core beliefs that CWW are exposed to, clearly some ofthe obstacles they encounter can provide unprecedented opportunities foreducators and agency supervisors to make a significant difference intheir lives. Social work educators and administrators must listen andrespond to the needs of CWW and reclaim their rich heritage as pioneersin this area. The content base of social work must not only focus on thechild and his or her family, but integrate the theoretical perspectivesin regard to trauma which have been discussed into practice andsupervision. For this to happen, social work leaders must become activepartners with local child welfare agencies in a collaborative attempt toeffect change. One approach, currently being proposed by the author indiscussion with a prominent child advocacy Child advocacy refers to a range of individuals, professionals and advocacy organizations who promote the optimal development of children. An individual or organization engaging in advocacy typically seeks to protect children’s rights which may be abridged or abused in a organization, is to develop anational training model on the effects of secondary trauma on CWW. As conditions in child welfare continue to deteriorate, social workinstitutions will be called on to foster interdisciplinary experiencesfor human service professionals as preparation for effective serviceprovision (Lawson & Hooper-Briar, 1994). Contributing professionallynot only in service provision but also in research and policydevelopment challenges universities to become visible and active inpublic service (Bok, 1992). Collaboration also demands some reassessmentof the institutional mission and procedures (Jeavons, 1989). Like anymarriage, a university-agency collaboration requires effort, but it canachieve powerful unity. In terms of social work education, we mustensure that trauma content is infused throughout the curriculum, andthat field experiences are consistent with the changing curricula. 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Countertransference in thetreatment of post traumatic stress. New York: Guilford. Wilson, J. P., Lindy, J. D., & Raphael, B. (1994). Empathic em��path��ic?adj.Of, relating to, or characterized by empathy.Adj. 1. empathic - showing empathy or ready comprehension of others' states; "a sensitive and empathetic school counselor"empathetic strain and therapist defense: Type I and II CTR's. In J. Wilson& J. Lindy (Eds.), Countertransference in the treatment of posttraumatic stress (pp. 31-61). New York: Guilford. Wilson, S. (1981). Field instruction: Techniques for supervisors.New York: Free Press. Accepted: 7/99. Address correspondence to: Barbara Dane Barbara Dane (1927-present) is an American folk, blues, and Jazz singer. External linksHome page Illustrated Barbara Dane discography praised by esteemed jazz critic Leonard Feather, One of Joan Baez' favorites, Mary Travers sounded very similar to the , Shirley M. EhrenkranzSchool of Social Work, New York University, 1 Washington Square North,New York, NY 10003; e-mail: dane@is3.nyu.edu. BARBARA DANE is associate professor, Shirley M. Ehrenkranz Schoolof Social Work, New York University.