Examining Clinical Supervision As a Moderator of Trauma Work, Secondary Trauma, and Functional Distress in Clinical Social Workers
Numerous studies have documented the occurrence of secondary traumatic stress (STS) in social workers who work with traumatized populations. Indeed, STS is now considered an occupational hazard of such work. Clinical supervision has often been put forth as an important approach to minimize STS and its effects. However, there has been little effort to empirically examine supervision in regards to STS. The purpose of this study was to investigate the moderating role of STS in the development and impact of STS in clinical social workers. The study was guided by two research questions: Does clinical supervision moderate the relationship between exposure to traumatized clients and STS?; and Does clinical supervision moderate the relationship between STS and functional distress in social workers?
The present study used a cross-sectional, self-administered mailed survey design. A survey packet was mailed to random sample of 2,500 NASW members holding a masters degree. A total of 731 responses were returned representing a response rate of 29%, consistent with other studies of NASW members. However, these analyses were limited to 539 respondents whose work involved direct practice at the time of the survey. Exposure to traumatized clients was operationalized as the percentage of respondents’ caseload that met the criteria for PTSD. Secondary traumatic stress was measured with the Secondary Traumatic Stress Scale (17-items; alpha = .92). Functional distress was measured by the Functional Impairment from Secondary Trauma Scale (7-items; alpha = .92). Clinical supervision was measured with the Clinical Supervision Satisfaction Scale (8-items; alpha = .98). Because they have been associated with STS in the past, we also included age, gender, experience (years), and weekly hours worked as control variables. Hayes’ PROCESS macro for SPSS was used to perform moderation analyses.
The percentage of caseloads who met the criteria for PTSD ranged from 0 to 100 with a mean of 25.31 (s.d. = 23.8). STSS scores ranged from 17 to 54 with a mean of 28 (s.d. = 8.67); 15% scored above the “clinical cut-off” of 38. Functional distress ranged from 0 to 22 with a mean of 4.72 (s.d. = 4.96). Satisfaction with supervision ranged from 0 to 63 with a mean of 42.83 (s.d. = 16.06). Mediation analysis revealed that the relationship between social workers’ exposure to traumatized clients and their general health perceptions were fully mediated by STS. More specifically, a higher percentage of clients who meet the criteria for PTSD is associated with higher levels of STS, in turn higher levels of STS are associated with perceptions of poorer health. Supervision did not moderate the relationship between exposure and STS, however, supervision was a significant moderator of the relationship between STS and functional distress.
This study underscores the importance of clinical supervision in reducing the negative impact of STS on clinical social workers. While supervision does not reduce the likelihood of experiencing STS, it does minimize the negative impact of STS on clinician functioning. The implications of these findings for workforce development and service quality will be discussed.