Mixed Methods Exploration of Provider, Relational, and Organizational Factors Associated with Secondary Traumatic Stress Among Clinical Social Workers: What Harms and What Helps?

Background and Purpose: While many clinical social workers experience compassion satisfaction, the associated challenges place providers at increased risk for secondary traumatic stress (STS; Newell & MacNeil, 2010). STS describes the phenomenon of helping professionals experiencing posttraumatic stress symptoms in response to the indirect traumatic content they experience via work with clients (Bride, 2004). Although prevalence studies have yielded varied findings due to variations in measurement and methodology, a recent study found nearly 50% of clinical social workers reported clinically elevated STS (Holmes et al., 2021). STS is associated with negative consequences for clinicians, including functional impairment and poorer physical and mental health (Armes et al., 2020), and is associated with reduced quality and effectiveness of client services (Sprang et al., 2021). Provider-level factors associated with STS are most often targeted in prevention and intervention efforts (Molnar et al., 2017), while less attention has focused on organizational factors despite evidence suggesting these factors impact experiences of STS (Bride et al., 2023). We applied Bronfenbrenner’s Social Ecological Model to an organizational context and used an explanatory sequential mixed methods design to explore relationships between STS and provider and organizational factors, identify significant predictors of STS, and explore providers’ experiences related to STS. Methods: For the quantitative strand, mental health providers (N=879) completed a cross-sectional online survey querying them about STS, provider factors (coping, life events, self-compassion, self-care, wellbeing, demographics), and organizational factors (workload, setting, indirect trauma exposure, leadership, safety, workplace discrimination, culture, burnout, and compassion satisfaction). Standardized scales measured key independent variables, and the Secondary Traumatic Stress Scale-DSM-5 (Bride, 2017) was used to measure STS. Descriptive statistics and bivariate analyses were conducted to better understand the sample, and binary logistic regression determined factors that best predict STS status. Focus groups with a subset of clinicians (N=39) delved deeper into quantitative findings, and the resulting data were analyzed using thematic analysis (Braun & Clark, 2006). Results: Significant relationships between STS and several factors across levels of the ecological system were identified. Binary logistic regression results indicated a model with five predictors was most statistically reliable in distinguishing those with and without clinically elevated STS [-2 LL=220.72, χ² (5)=778.428, p<.001, Nagelkerke R²=.791]. The model correctly classified 90.5% of cases, and significant organizational factors included culture, safety, and experiences of workplace discrimination, while leadership approached significance (p=.054). Qualitative analysis yielded five themes: realities of mental health profession, incongruence between values and work expectations and requirements, cumulative stress, navigating occupational stressors, and organizations as facilitators or barriers to wellbeing. Implications: Findings suggest provider and organizational factors impact experiences of STS among clinicians with some differences among subgroups revealed that demand further attention. Both qualitative and quantitative data indicate efforts to improve organizational safety, equity, and transparency may be particularly successful in addressing STS. We offer strategies and considerations for providers, supervisors, and agency leaders to promote transformational change and combat occupational hazards.