Drivers and Manifestations of Secondary Trauma Among Service Providers Working with Refugees: A Mixed Method Study from Istanbul, Turkey

Background and purpose: Since the onset of displacement from Syria in 2011, agencies supporting refugees in Turkey rapidly expanded to cover the needs of displaced Syrians and strained the capacities of those providing services to them. In addition to challenges in addressing the needs of clients, individuals engaging in direct care with high client volumes with extreme exposure to trauma, such as service providers working directly with refugees, are the most vulnerable to secondary traumatic stress (STS) associated to their work. However, few programs exist to address STS among service providers, despite the dire need to address STS and mental health among this population. The purpose of this analysis is to understand the symptoms and severity of STS, as well as the nuanced presentation and transformation of STS among service providers engaged in service delivery to Syrian refugees in Turkey.

Methods: Data used for the present analysis came from the Providers ASPIRE study – a sequential mixed-methods study examining prevalence of and correlates to mental health among service providers (18 years and older) working directly with Syrian refugees in Istanbul, Turkey. Quantitative surveys (N=104) and qualitative interviews (n=28) were completed in 2018 in 17 civil society organizations (CSOs) and public agencies. Focusing on STS findings, data were integrated using the narrative approach whereby qualitative findings from the interviews were woven with descriptive findings from the quantitative data.

Results: With STS outcomes from little to no STS (45.19%, n=47) to high or severe STS (17.31%, n=18), there exists a range of STS among providers (mild or moderate STS: 37.50%, n= 39). Moreover, the quantitative STS outcomes also indicated a fairly consistent presentation of avoidance (mean: 1.85; SD: 1.07), intrusion (mean: 1.86; SD: 0.92), and arousal (mean: 1.88; SD: 1.01); the providers interviewed for the qualitative component reported having experienced symptoms congruent with STS symptoms of intrusion, avoidance, and arousal. Work-related drivers, such as gaps in supervision, heavy caseloads, and lack of experience, emerged as potential drivers of STS from the qualitative findings.

Conclusions and implications: These findings reinforce previous research identifying STS among service providers working with refugees and highlight potential avenues to mitigate the influence of exposure to secondary trauma on STS outcomes. Through leveraging existing models of supervision and organically developed peer support systems available to some providers, intervention may be developed to better equip service providers who work directly with refugees with capacities to identify and cope with STS, and inform social change to support providers.