Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives.

The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.

The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review.

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.

Untangling secondary traumatic stress and vicarious traumatization: One construct or two?

OBJECTIVE: This study examined whether secondary traumatic stress (STS), defined by the expanded DMS-5-TR's depiction of traumatic stress which includes negative mood/cognition symptoms, fully captures the reactions of indirect trauma exposure or if vicarious traumatization (VT) is still a useful and separate construct to assess for. METHOD: An online survey was completed by 613 professionals working with individuals who experienced trauma. Correlations and network analysis were used to explore the overlap and distinctiveness of STS and VT reactions. RESULTS: High levels of STS and indirect trauma exposure were found in the current sample. A greater dose of daily indirect exposure was associated with a majority of STS and VT domains, and having less professional experience was associated with all STS and VT domains. Results of the network analysis suggested that STS and VT still continue to be unique yet related constructs. CONCLUSIONS: Although the negative mood/cognition addition to STS may not fully capture or replace the phenomenon of VT, these additional STS symptoms may further connect the two constructs. This indicates that current measures of STS may capture some but not all of the cognitive impacts of indirect trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Principles for secondary traumatic stress-responsive practice: An expert consensus approach.

OBJECTIVE: Though research on secondary traumatic stress (STS) has greatly increased in the past decade, to date the field lacks a coherent set of guiding principles for practice that behavioral health providers and organizations can use to mitigate the occurrence and impact of STS. As such it is important to identify effective strategies, grounded in research and professional experience, to reduce the occurrence and impact of STS among behavioral health professionals and organizations. METHOD: We conducted a four-stage modified Delphi survey. Thirty-one international STS experts were invited to participate, with a minimum of 19 responding in each round. Thematic analysis was conducted on qualitative data, which was incorporated into revisions of the principles. RESULTS: Consensus was achieved on 14 principles, seven targeted at individual professionals, and seven targeted at organizations. CONCLUSIONS: This is the first effort to delineate principles for practice intended to reduce the occurrence and impact of STS in individual and organizational practice in behavioral health services. The principles are intended to inform best practices for individuals and organizations providing services to persons and communities who have experienced trauma and thereby improve the quality and effectiveness of services to traumatized populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis.

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment.

Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth's mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress. METHODS: This is a study of 130 youth ages 7-18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic. RESULTS: A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment. IMPLICATIONS: The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth's response to pandemic conditions.

Analysis of implementation drivers of secondary traumatic stress (STS)-informed organizational change and experiences of STS and burnout in child welfare.

BACKGROUND: STS and burnout (BO) are significant problems for child welfare professionals (Bride, 2007; Craig & Sprang, 2010). A challenge for at-risk professions is to understand how both individuals and organizations can address the potential impact of these conditions. OBJECTIVE: This study explores the influence of organizational factors on individual experiences of STS and BO in child welfare settings. PARTICIPANTS AND SETTING: Study participants were 382 child welfare professionals in the United States who were participating in an organizational assessment of STS and related activities. METHOD: The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) tool (Sprang et al., 2014) was administered to evaluate the use of policies, practices and training activities that address STS and BO (Sprang et al., 2014). The National Implementation Research Network's (NIRN) implementation framework was applied to the STSI-OA and domain activities loaded onto the three implementation drivers of competency, organization and leadership (Sprang, Ross, & Miller, 2018). Regression analyses were conducted to determine the strength of associations between the implementation drivers of STS informed organizational activity and individual ratings of STS and BO. RESULT: Increased use of STS-informed activities affiliated with all three implementation drivers was significantly associated with lower individual STS and BO scores. STS-informed activities associated with the organization driver seemed particularly effective for addressing STS. CONCLUSION: This study supports the utility of the integrated framework for enacting STS-informed change in child welfare contexts. Recommendations for organizations and future research are provided.

The role of secondary traumatic stress breakthrough champions in reducing worker trauma and improving organizational health using a configurational analysis approach.

Background: Emerging research has demonstrated that organizational efforts at becoming secondary traumatic stress (STS)-informed can improve the overall well-being of the workforce, especially when implementation activity by a champion team is high. Questions remain, however, regarding the mechanisms that enable these improvements. Method: This study uses configurational analysis to determine necessary and sufficient conditions to produce reductions in STS symptoms in workers as well as organizational improvements toward being more STS-informed in a cohort survey of 6,033 professionals working with individuals exposed to trauma representing 52 organizations. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) was used to measure professional's perceptions of how well the unit addressed secondary trauma in the workplace, and the Secondary Traumatic Stress Scale (STSS) assessed traumatic stress symptoms in respondents. Champions' activity was scored using the categories suggested by Shea. Results: For the STSS outcome, either a STSI-OA positive increase of 10 or more points or high levels of champion problem-solving were independently sufficient for an improvement in the outcome. The STSI-OA model had two pathways: high levels of peer engagement via the scaling up of innovations using PDSAs or the combination of facilitation of peer knowledge and skills together with working in a child welfare organization. Either pathway was sufficient by itself to yield the STSI-OA outcome. Conclusions: Identifying and cultivating the champions' use of problem-solving and peer engagement strategies can transform the threat posed by indirect trauma exposure into an opportunity for shared experience and healing. Plain Language Summary: Organizational champions are individuals or teams that strive to promote change within their workplace. These champions are integral to spreading innovative ideas and strategies and creating organization-wide changes ( Powell et al., 2015). However, little is known about the processes or specific strategies that make champions successful. One area in which champions are needed is in improving organizations' response to and understanding of secondary traumatic stress (STS), among those in helping professions that are indirectly exposed to trauma through the traumatic stories of those they work with. In fact, research has shown that organizational efforts to address STS improve the well-being of individual professionals within that organization ( Sprang et al., 2021). The present study sought to better understand what champion-related processes or conditions led to organizational change in addressing the effects of indirect exposure and improving symptoms related to STS. Results showed that organizational change in addressing STS and champions' problem-solving strategies resulted in reductions in individual professionals' STS symptoms. Furthermore, champions' use of peer engagement or sharing of knowledge among peers in child welfare settings led to improvements at an organizational level. These results show that organization-level change can have a direct impact on individual well-being and there are specific champion activities that can promote this change. Specifically, results demonstrate a need to identify and support champions' use of problem-solving and peer engagement strategies to turn the individual and organizational threat posed by indirect trauma into an opportunity for shared healing.

Using Project ECHO to Keep Professionals Well at Work: Individual and Organizational Outcomes.

OBJECTIVE: The toll of COVID-19 stress on the mental health of the workforce has been well-documented. The present study examined the use of the Project ECHO framework to provide practices and resources on stress management and emotion regulation to increase individual and organizational health and well-being. METHODS: Three independent ECHOs were designed and conducted over an 18-month period. Data was collected on the implementation of new learning and comparisons of organizational efforts toward being more secondary trauma responsive from baseline to post initiative, using cloud-based survey methods. RESULTS: Findings suggest that the use of micro-interventions at the organizational level improved over time in the areas of resilience-building and policy-making, and that individuals were actively integrating skills related to managing their stress. CONCLUSIONS: Lessons learned adapting and implementing ECHO strategies in the midst of a pandemic are offered, as well as how to cultivate wellness champions in the workforce.

Parenting stress and children's trauma symptoms over the course of TF-CBT: Examining differences between relative and foster/adoptive caregivers.

BACKGROUND: Through Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the gold standard in children's trauma treatment, caregivers participate in sessions parallel to the child. However, much of the research examining the impact of this caregiver involvement has focused on biological or relative caregivers, despite the high prevalence of trauma and trauma symptoms among youth in foster care and high rates of parenting stress among foster/adoptive caregivers. OBJECTIVE: The current study examined differences among relative and foster/adoptive caregivers' levels of parenting stress throughout the course of TF-CBT and how these differences were associated with child trauma symptoms throughout treatment. PARTICIPANTS AND SETTING: Participants were 130 caregiver-child dyads (84 = foster/adoptive; 46 = biological/relative) who completed TF-CBT in either an academic-based clinic or an associated mental health agency. Providing clinicians were trained in TF-CBT, participated in case consultation, and received ongoing clinical supervision. METHODS: Children and caregivers completed baseline measures prior to beginning treatment and termination measures at the completion of treatment. RESULTS: Prior to treatment, foster/adoptive caregivers reported greater dysfunction in their parent-child interactions and relative caregivers reported greater personal stress. These differences were not seen at treatment termination, and significant reductions in child trauma symptoms and caregiver parenting stress were evidenced from pre to post treatment. Significant covariation between child trauma symptoms and relative caregiver parenting stress at termination was also found. CONCLUSIONS: There were different profiles of parenting stress for relative versus foster/adoptive caregivers, but treatment completion attenuated group differences in parenting stress over the course of treatment.

Keeping children and youth in trauma treatment: Examination of an alliance building dropout management program.

Evidence-based treatments exist to address traumatic stress related symptoms for children, however dropout from trauma-focused treatment remains a concern. This study examined use of an alliance building dropout management program for a group of children ages 3-17 who received an evidence-based trauma-focused treatment. Logistic regression analysis was conducted to examine the relationships between child gender, race, ethnicity, age, guardianship, externalizing behaviors, participation in a dropout management program and the dose of treatment received. The final model was significant and participation in the dropout management program as well as a child's placement in foster care were significant individual correlates with full completion of treatment. Use of an Alliance Building Dropout Management program may help decrease overall dropout over and above the contribution of other variables known to impact treatment completion.

An Investigation of Secondary Traumatic Stress and Trauma-informed Care Utilization in School Personnel.

Trauma-informed practices in schools are designed to address the impacts of trauma on students and increase supports for school personnel who are delivering this care The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43, 142-147, Mendelsonet al., 2015. Research has established that professionals trained to implement the approach may have secondary traumatic stress (STS) reactions that could interfere with successful implementation (Stevens al., 2020). In this study it was hypothesized that increased use of trauma-informed care strategies would be associated with decreases in total STS scores, as well as all STS subscale scores at the end of a system's transformation initiative, controlling for sex, age, education, years worked in schools, and exposure to student trauma awareness at baseline. The Trauma Sensitive Schools Checklist (TSSC) and the Secondary Traumatic Stress Scale (STSS) were used to measure study outcomes in a sample of 205 school personnel at baseline and follow up. Statistically significant improvement in STSS scores and TSSC score were noted from Time 1 to Time 2. As hypothesized, improvements in TSSC scores were associated with decreased levels of STS over time, controlling for the covariates. However, the symptom domains of intrusion and arousal impacted this relationship in a differential manner than avoidance and alterations in cognitions and mood. This study provides evidence that increased use of trauma-informed care practices can positively impact the STS levels of school personnel, though special attention should be paid to those with high levels of intrusion or arousal.

"My Bad Experiences Are Not the Only Things Shaping Me Anymore": Thematic Analysis of Youth Trauma Narratives.

The purpose of this study was to better understand how youth with poly-trauma histories appraise and make meaning of their traumatic experiences within the trauma narrative and processing components of Trauma-focused Cognitive Behavioral Therapy (TF-CBT), and to explore the results of the meaning-making process. Thematic analysis was employed to explore the trauma narratives of youth (N = 16) ages 8 - 16 that were created during TF-CBT. Participants experienced a mean of 5.38 types of trauma that predominantly included various forms of child maltreatment. With regard to how youth appraise and interpret their traumatic experiences, four themes emerged, including I Am Not Safe, which denotes a lack of physical and psychological safety; It's My Fault, which symbolizes misattributions of responsibility; I Am Changed, which captures alterations in systems of meaning; and Why Did This Happen to Me?, which denotes the struggle to comprehend why the traumatic events occurred and their significance. With regard to the products of the meaning-making process, three themes emerged, including Now I Know, which denotes reappraisals; I Am Safe/r, which signifies increases in perceptions of safety, and I Can Do It, which includes the participant's perceptions of growth. Results from this study provide a deeper understanding of youth's experiences during these components of treatment, and illuminate the meaning-making process. Findings can help guide clinical-decision making, and highlight the importance of explicitly attending to specific components of the meaning-making process during trauma narration and processing.

Labor trafficking of children and youth in the United States: A scoping review.

BACKGROUND: Child labor trafficking is a largely unexplored and unpublished phenomenon in the United States. OBJECTIVE: To 1) characterize the state of the science on child labor trafficking, and 2) identify empirical information regarding risk and protective factors, and physical/behavioral health needs of labor-trafficked children/adolescents. METHODS: This scoping review involved an electronic review of five databases; the search was restricted to studies in English or Spanish and published between Jan 1, 2010-Oct 16, 2020. The search yielded 1190 articles; 48 studies qualified for full review and 8 met inclusion criteria (US-based study addressing risk factors/vulnerabilities for child labor trafficking; protective factors; health impact; or health/behavioral healthcare). RESULTS: Only one study had sufficient sample size to compare sex to labor trafficking among minors; some did not separate data by age group or by type of trafficking. A few shared data from a common source; one was a single case review. Findings suggested that sex and labor trafficking may share common risk factors (e.g., prior child maltreatment and out-of-home placement) as well as within group differences (e.g., labor trafficked children had less prior child welfare involvement than those involved in sex trafficking and were more likely to be younger, male, Black or non-white, and Hispanic). Multiple physical/behavioral health symptoms were reported and may be useful items for a healthcare screen. CONCLUSIONS: Child labor trafficking research in the U.S. is in its infancy, although the results of this review point to opportunities for screening and case conceptualization that may be useful to practitioners.

The impact of COVID-19 and experiences of secondary traumatic stress and burnout.

OBJECTIVE: This study examines the relationships between multiple COVID-19 related stressors and experiences of secondary traumatic stress (STS) and burnout (BO). METHOD: This sample (N = 550) of professionals and caregivers from a foster care system in the United States completed an online survey regarding their experiences of COVID-19 related stress in multiple domains (disruptions in routines, income/employment, food access, medical/mental health care access, access to social support, worries about COVID, family conflict/violence, and COVID diagnoses). The survey also included established measures of STS and BO. RESULTS: A subset of COVID-19 stressors was found to account for 27.4% of the variance in STS and 24.7% of the variance in BO scores in regression analyses. Significant correlates for STS included worries about COVID, family conflict/violence and food access, while only worries about COVID and family conflict/violence were significant in the model testing BO. Part of the sample (N = 64) had participated in a related 2019 study of STS and BO and were included in comparison analyses of these conditions before and during the COVID-19 pandemic. Results for T1 and T2 comparisons yielded significant increases in STS related symptoms of intrusion and alterations in cognitions and mood, with differences in total STS scores trending toward significance. No significant differences were found in BO scores. CONCLUSIONS: These findings and associated implications are discussed for groups of caregivers and helping professionals with preexisting high levels of indirect trauma exposure in a pandemic context. This study provides some guidance on how to identify those at risk for increased distress in their helping roles and considerations for implementing support strategies during a pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Foster care during the COVID-19 pandemic: A qualitative analysis of caregiver and professional experiences.

BACKGROUND: Research is needed to facilitate better understanding of how different groups have been impacted by COVID-19, especially those in already strained service systems such as foster care. These inquiries will support further response, recovery and preparedness efforts. OBJECTIVE: This qualitative study addressed how professionals and caregivers in foster care described being affected by COVID-19 in order to support future research and planning for foster care systems in this pandemic context. PARTICIPANTS AND SETTING: A sample of foster parents and foster care professionals (N = 357) from a mostly rural, southeastern state in the U.S. participated in the study. METHODS: Qualitative analysis was conducted of 357 open-ended responses regarding the impact of COVID-19 from a survey distributed in August 2020. RESULTS: The coding process resulted in the identification of 15 distinct themes: Isolation & Loss of Social Support, Work Changes/Stressors, School Issues, Childcare Issues, No Impact/Positive Changes, Financial Problems, Fear of Contagion, Negative Child Welfare Impacts, Mental Health Problems/Stress, Loss of Faith/Trust & Societal Frustrations, Health & Mental Healthcare Access Issues, PPE & Testing Issues, Grief & Loss, and Marital Problems. Secondary impacts rather than direct physiologic effects of the virus were primarily reported. CONCLUSIONS: This study underscores the various challenges facing foster care systems, and how the pandemic context is exacerbating many of these issues. Further research is needed to ensure the implementation of adequately complex and nuanced responses that target needs and avoid creating further problems for foster care.

Sexual Violence Perpetration as a Risk Factor for Current Depression or Posttraumatic Symptoms in Adolescents.

Sexual violence perpetration (SVP), including coerced, physically forced, and alcohol- or drug-facilitated unwanted sex, occurs frequently in adolescence and may represent a risk factor for future perpetration. Sexual violence victimization (SVV) has been found to be a risk factor for increased rates of depression and posttraumatic stress disorder (PTSD); however, the associations of SVP with depression or posttraumatic stress symptoms (PTSS) have been less well described. This study examined associations between symptoms of depression and PTSS with SVP in the prior 12 months among high school students. In this cross-sectional analysis, a representative sample of public high school students (ninth-12th grades) completed self-reported surveys on peer SVP and SVV within the past year. Among 16,784 students completing surveys, 7.2% disclosed SVP against another high school student in the past 12 months; 64.4% of students disclosing SVP also experienced SVV. Both SVP and SVV, alone or in combination, were associated with a greater likelihood of symptoms of depression or PTSS. These associations were similar by sex and sexual minority status (e.g., lesbian, gay, bisexual, transgender, and queer [LGBTQ+]). These findings highlight the need for continued primary prevention efforts. Additional screening to recognize adolescent SVP can allow both early treatment of depression and PTSD and address the individual risks of SVP to reduce subsequent repeated sexual assaults.

Gender differences in the PTSD symptoms of polytraumatized youth during isolated phases of trauma-focused cognitive behavioral therapy.

OBJECTIVE: Gender differences in the development and severity of PTSD have long been observed, but much less is known about gender differences within the context of trauma-focused treatment. This study investigated gender differences in the PTSD symptoms of polytraumatized youth during Trauma-focused Cognitive Behavioral Therapy (TF-CBT). METHOD: The sample included child welfare-involved youth ages 7-18 (N = 138) who experienced a mean of 4.78 types of trauma and received TF-CBT at a trauma treatment clinic. Mixed ANOVA analyses assessed gender differences in PTSD symptoms from baseline to termination of treatment. PTSD symptoms were then mapped according to the phase of treatment, and factorial ANOVAs examined gender differences during isolated phases of TF-CBT. Potential interactions with sexual violence history were considered. RESULTS: Significant reductions in overall PTSD, intrusive, avoidance and arousal symptoms were found from baseline to termination of TF-CBT for the entire sample, although females reported higher symptom levels across all PTSD symptom domains. Significant gender differences were also revealed during some, but not all, phases of treatment, with variations among PTSD symptom domains noted. CONCLUSIONS: Findings suggest TF-CBT is effective in reducing PTSD in youth with poly-trauma exposure, irrespective of gender. Gender differences in symptom severity were revealed, however, and indicate the need to attend to gender within the context of treatment. Findings also suggest the use of measurement-based care, and specifically attending to symptom fluctuation in PTSD symptom domains during treatment, can help inform clinical decision making and individualize treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Diagnostic and Translational Utility of the Secondary Traumatic Stress Clinical Algorithm (STS-CA).

Current tools available to assess secondary traumatic stress (STS) do not account for whether the symptoms are functionally related to indirect trauma, determine functional impairment caused by the STS symptoms, and/or consider the duration of the disturbance. This prevents delineation of various expressions of traumatic stress related to indirect trauma that may constitute the phenomenon of STS. The STS Clinical Algorithm (STS-CA) was developed to make these distinctions, so that interventions can be tailored to need. This study investigates the following: (1) the diagnostic concordance between the STS-CA findings and scores on the Secondary Traumatic Stress Scale (STSS); (2) reasons for diagnostic discrepancies between the STS-CA and the STSS assessments. Three trained interviewers used the STS-CA to guide the determination of clinical outcome (N = 181) in a diverse group of helping professionals. There was 100% agreement between the CAPS and the STS-CA, and fair agreement (κ =.426, p = .000) between the STS-CA and the STSS. The STS-CA demonstrated more sensitivity in classifying positive cases, and specificity in delineating those with atypical cluster presentations or little to no functional impairment that prohibited a post-traumatic stress disorder diagnosis than the STSS. Effective treatment of STS requires proper identification and the delivery of protocols that are tailored to the unique ways that STS manifests. This study provides some insights into the utility of the STS-CA in guiding this process and creates STS categories to organize and classify intervention strategies.