Secondary Traumatic Stress Among Home Visiting Professionals

Objective: This study examined the reliability and factor structure of the Secondary Traumatic Stress Scale (STSS) and the prevalence and correlates of secondary traumatic stress (STS) among home visitors. Method: Survey data were collected between 2015 and 2020 from 301 home visitors with caseloads. Participants completed the 17-item STSS, which assesses intrusion, avoidance, and arousal symptoms using the DSM-IV-TR diagnostic criteria. Internal reliabilities of the scale and subscales were measured and confirmatory factor analyses were performed to validate hypothesized model solutions. Symptom prevalence among the sample was calculated and linear regressions were conducted to examine whether personal and workplace factors were associated with STS. Results: Analyses confirmed that the STSS had sound internal consistency and that both 3- and single-factor measurement models fit the data. Approximately 10% of home visitors met the clinical criteria for PTSD, though prevalence decreased to 8% after omitting an intrusion item that was endorsed by most respondents. Increased exposure to adverse childhood experiences and poorer work environment ratings were associated with increased STS. Non-Hispanic White race was associated with elevated arousal symptoms. No other personal or workplace factors were associated with scores on the STSS full scale or subscales. Conclusion: This study reaffirms that the STSS has sound psychometric properties, but it also raises questions about the prevalence and etiology of STS. Given the likely costs of PTSD to personal well-being and professional efficacy, further research is needed to advance the measurement and prediction of secondary traumatic stress. Clinical Impact Statement Working with clients with histories of trauma can put helping professionals at risk of experiencing secondary traumatic stress (STS). This study found that one in ten home visiting professionals experienced PTSD symptoms as measured by an STS assessment. Higher levels of adverse childhood experiences among professionals were associated with higher levels of trauma symptoms. Findings also suggest that staff who work in organizations with positive work environments experienced lower levels of STS. Given the association between STS and workers' personal histories of adversity, more research is needed to understand the connection between primary and secondary exposure to traumatic events.