Caring for the Caregivers

    • July 24, 2013

Like every Robert Wood Johnson Foundation (RWJF) Ladder to Leadership team, the women who came together to create Project Transformation, a program designed to tackle secondary trauma in health and social workers, shared a passion for giving service and helping others.

But when they began to talk about their work, they realized that they also had something else in common—firsthand experience with the devastating impact that secondary trauma can have on health care providers and organizations.

Healers In Need of Help

Julia Westhoff, MPA, was working at a 24-hour rape crisis center during her 2011 Ladder to Leadership term. No stranger to work-related stress, she had come to Kansas after completing a stint in the Peace Corps in Panama. “Yet, I found myself struggling with chronic pain and developed an excessive fear of people harming my young children while working at the crisis center,” recalled Westhoff, who is now director of Project Transformation.

In her former role of clinical nurse manager at a clinic for the uninsured, Amber Eastabrook, RN, was deeply concerned about the impact of secondary trauma on her staff. “On a daily basis they were working with people who were homeless or patients who were unable to take medication that needed refrigeration because they had no electricity. Many of our patients also had no other source of care,” she explained. “It was enough to wear people down. It can reduce your faith in life. I wanted to help them avoid burn-out.”

As the elder member of the Ladder to Leadership group, Liza Mizell, president and CEO of the Child Protection Center in Kansas City, Mo., had also felt the impact of the stress endured by health and social workers. “You’re naive if you think you can do this work for years and it’s not going to change your life. You quickly learn how terribly cruel people can be.”

Statistics about Jackson County showed that the local child protection agency was experiencing a 35 to 50 percent staff turnover each year. For that reason, the Jackson County child protection social workers were chosen to participate in the Project Transformation pilot.

To conduct the pilot, Westhoff, Eastabrook and Mizell worked with Ladder to Leadership colleagues Krista Allen, a development officer at the Crittenton Children’s Center; Valeri Crenshaw, a clinical supervisor at the Rose Brooks Center; and Julie Donelon, president of the Metropolitan Organization to Counter Sexual Assault.

Easing the Impact of Trauma

The team took a global approach to addressing secondary trauma by focusing on organizational and personal issues. “We wanted to do something comprehensive. A lot of us had been through simple self-care training, but we understood we had to do more,” Westhoff said.

“Our primary goal was to educate people about the existence and definition of secondary trauma, as well as how to deal with it,” said Eastabrook, who is now a renal transplant nurse at St. Luke’s Hospital in Kansas City.

The early symptoms of secondary trauma may include:

  • Chronic physical pain, especially tension in the back or neck, bad headaches or severe stomach problems.
  • Symptoms similar to those associated with post-traumatic stress disorder, such as reliving traumatic events, experiencing negative changes in beliefs or feelings, or feeling anxious.
  • Adopting the same emotional and physical responses as the people who experienced the original, acute trauma.

The team also recognized that many health care workers, especially those in social services agencies, faced the additional stress of being overworked and underpaid. “Many have second jobs and that made it even harder for them to take care of themselves,” Westhoff said.

In some cases, agency efforts to help actually created other problems. “Some agencies offer employee assistance programs, but using the programs may carry a stigma within the agency. In other cases, staff members who do particularly well with very difficult cases are ‘rewarded’ by being given more difficult cases,” she said.

Lessons from the Pilot Study

The team used a curriculum with four modules: 1. Understanding secondary trauma; 2. Self care; 3. What supervisors can do to help; and, 4. What organizations can do to help.

Post-pilot responses revealed that the Project Transformation approach clearly helped the Jackson County child protection workers. Their comments included:

  • “It allowed me to acknowledge that I have secondary trauma and didn’t realize it.”
  • “I learned how to deal with trauma in the workforce and be able to care for myself.”
  • “I now have ideas about how to establish a [secondary trauma] buddy system within the office.”
  • “I’ve learned how we can help ourselves at a low cost.”
  • “I now know how important it is to process your trauma with a supportive person.”
  • “Now I take time to think about how this job affects my life and how to deal with the trauma that comes with it.”

“Recognition of secondary trauma must be part of the agency culture,” Mizell added. “Staff must be given the opportunity to debrief when they are working on particularly difficult cases. And organizations who are concerned about the cost of this type of program should realize that addressing secondary trauma reduces turnover and that cuts costs.”

The Future of Project Transformation

This year, Westhoff received funding to run Project Transformation full time. “We already have a waiting list of people who want the training. We are just taking a step back to find the best way to proceed.”

“Our goal, during our Ladder to Leadership project, was to design a really strong curriculum to take to the community,” Eastabrook added. “The program really opened my eyes to new ways of communicating with people as a nurse and established my confidence in my ability to take an active leadership role in this type of work.”


Related Websites

Learn more about Ladder to Leadership.
For an overview of RWJF scholar and fellow opportunities, visit