SECONDARY TRAUMATIC STRESS: DEVELOPING AND IMPLEMENTING A PROGRAM TO BUILD RESILIENCE IN CHILD MALTREATMENT FELLOWS
Authors: Smith Jennifer , Cho Romy , Martin Christiane , Smith Tanya , DePatie Lana , Schwartz Sarah , Cory Emma 
Published: May 2018

Abstract

BACKGROUND
Fellows in child maltreatment paediatrics (CMP) are at risk of secondary traumatic stress (STS). Contributing factors include inexperience, younger age, lack of mastery, high caseloads, and longer working hours. Literature has previously focused on individual resilience; as understanding about STS evolves, it has been recognized that organizational resilience is important in supporting healthcare professionals.

OBJECTIVES
Our objective was to develop, implement, and evaluate an innovative program to increase resilience to STS among fellows in a child maltreatment training program.

DESIGN/METHODS
A trauma-informed counsellor with expertise in both secondary-traumatic stress and medical education was identified through the University Wellness Office. The counsellor was not a member of the CMP team and facilitated a targeted program that included monthly, small group session for all CMP fellows. Sessions involved low-intensity activities that encouraged self-reflection and focused attention. The counsellor facilitated discussions around difficult cases with active listening, immersion into the affective experience of others, and avoidance of judgment, blame, or criticism. Fellows were encouraged to speak about their own experiences, rather than commenting on the experiences of others. This created a safe environment in which to explore and process difficult material. Evidence-based strategies were offered at the end of each session. An important component of the program was an iterative process of feedback and reflection on the session structure and process. Written reflections were collected from fellows and staff, which were qualitatively analyzed by two reviewers to identify key themes.

RESULTS
Qualitative analysis of individual written reflections identified four major themes, including high satisfaction with program, strategies for prevention and management of STS, bonded fellowship peer group, and feelings of validation from one another. There was unanimous reporting of high levels of satisfaction with the program by both fellows and supervising staff. Fellows described excitedly anticipating sessions and experiencing renewed energy following group sessions. Supervising staff reported seeing fellows apply skills and strategies learned for prevention and management of STS. Between sessions, fellows reported improved STS symptoms and employing preventative self-care strategies. It was reported that the strategies learned assisted fellows in developing a reflection style that was intentional and individualized for their wellbeing. An unanticipated outcome that was unianimously reported by fellows and noted by staff was the fostering of a strongly bonded and supportive fellowship peer group, further increasing perceptions of wellbeing. Fellows reported feeling validation from one another during group sessions and utilizing approaches in real-time informal discussions with team members as difficult clinical cases arose.

CONCLUSION
This targeted program for fellows was developed as an innovative approach to addressing secondary traumatic stress among new learners in the challenging field of child maltreatment paediatrics. It has demonstrated acceptability among fellows and supervising staff with reported improvement in STS symptoms. Future steps will address the broader goal of optimizing organizational resilience among other members of the child maltreatment team.