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Aim or purpose

Figley (1995; 2002) first coined the term secondary trauma or the ‘cost of caring’ (p.3, 2002) and it is often used to describe being emotionally affected by another, to the point of personal detriment.Ìý Secondary trauma has in common some of the features of Post-Traumatic Stress Disorder (PTSD) such as recurrent and intrusive thoughts, avoiding activities or places that cause emotional arousal, poor sleep, nightmares and flashbacks; but this is caused by indirect rather than primary exposure (American Psychiatric Association, 2013).Ìý It has been established that those who work in the helping professions are at risk of developing secondary trauma from working with, and alongside, clients who are undergoing physical, emotional and social difficulties, with it often being seen as an occupational hazard in the profession (Bride, 2007; Cocker & Joss, 2016; Owens-King, 2019). Ìý

However, while the research base is clear on the risk and impact of these issues on qualified staff, less is known about the prevalence of secondary trauma on students undertaking placements. It has been argued that secondary trauma can have a more rapid onset than vicarious trauma, which tends to be a more gradual and chronic process (Jenkins & Baird, 2002). Students who are in placement are therefore more likely to be affected by secondary trauma, as they are in a setting on a time limited basis. Student wellbeing is a key issue nationally, with a third of students reporting a serious psychological issue that required professional help, half of respondents admitting to using alcohol and/or other substances to cope, with 87% suffering from anxiety in recent studies.  The rationale for this study therefore is to establish if a sample of students going into placement were affected by secondary trauma and to what extent.ÌýÌý

Design and methodology

This study was designed to explore the prevalence of secondary trauma in two student cohorts going into placement; a sample of students about to embark on their first placement as part of an undergraduate health and social care programme and a sample of postgraduate student social workers at the University of Derby. The study sought to recruit students who had not experienced placement previously, thereby reducing bias in relation to their anticipation of stress, and the impact of previous experiences that could potentially influence their answers in the initial questionnaire.Ìý

Measurement of secondary trauma has been a ‘formidable task’ (Ting et al, 2005, p.180), but one that has been assisted by the development of the Secondary Trauma Stress Scale (STSS), a self-reporting tool which is able to measure 17 items, comprised of three subscales that relate to intrusion, avoidance and arousal; all symptoms that are a feature of secondary trauma (Bride et al, 2004; Bride, 2007; Benuto et al, 2018).Ìý This scale enables specific identification of the phenomena and for it to be differentiated from compassion fatigue and burnout. The study design adopted a repeated measures exploratory design, which tested for differences between baseline STSS scores pre and post-placement scores using the STSS (Bride, 2004).ÌýÌý

The sample consisted of 45 students from University of Derby recruited through opportunity sampling from undergraduate Health & Social Care and postgraduate Social Work programmes. All participants were recruited prior to their compulsory placements, which was part of their programmes, and were asked to fill out a demographic sheet, which collected basic information such as age category, gender, ethnicity and caring responsibilities. Once this form was completed, the participants were asked to complete a baseline STSS prior to starting placement. The placement was organised by the individual programmes at University of Derby and lasted between 24 and 80 days. Upon returning from the placement, the participants were asked to complete the STSS again. One cohort (undergraduates) completed the questionnaire in class and one cohort (postgraduate) completed the questionnaire online due to the wide range of end dates of individual placements on the different programmes.Ìý

Results and findings

The data was analysed using IBM-SPSS 25.Ìý The pre-placement STSS scores (M = 29.18, SD = 1.75) were compared to the post-placement scores (M = 29.03, SD = 1.72).ÌýÌý There was a non-significant effect between the STSS scores before placement and STSS scores after placement (Wilcoxon's T (N = 43) = 244, z = -.374, p =.354, with a small effect size d = .09), such that the placement had no effect on the overall STSS score in students.Ìý Ìý

A post-hoc power analysis revealed a power of 0.68, suggesting that this study was underpowered as a result of small sample size. To achieve a power of 0.80 a sample of 120 participants was needed.

Discussion

The results identified a non-significant difference in the secondary trauma scores before and after placement in undergraduate and postgraduate students. However, as the placement times were 24 days for the undergraduate students and 80 days for the postgraduate students, this meant comparably, undergraduate students who made up 57.8% of the sample were probably much less likely to be affected. Students experienced some stress, which would reflect research findings that concluded students going into placement often experience this due to the demands on them (Barlow & Hall, 2007; Collins, Coffey & Morris, 2010; Harr & Moore, 2011; Harr et al, 2019; Hemy et al, 2016).Ìý However, of the sample, two students were found to have symptoms of secondary traumatic stress (STS) serious enough to meet the threshold of high concern prior to placement commencing. While a more thorough examination of the issue of students already experiencing STS is beyond the scope of this study, a further study of the issue may be useful.Ìý

Goldblatt & Buchbinder (2003) concluded that students going into placement were often ill prepared for the ‘dramatic implications of the learning experience on their personal lives' (p.269).Ìý It found that some trainee therapists were suffering from vicarious trauma (Adams & Riggs, 2008). When exploring why none of our student cohort was found to have scored beyond threshold in STSS in placement, there could be other reasons for this. Research by Grant et al (2015) is relevant, particularly in relation to preparing students for the potential emotional strains of working within the helping profession's; them being able to actively self-care is crucial. Lewis & King (2019) confirm this, noting that good practice includes the teaching of daily self-care practices and strategies, which are essential to prevent issues such as compassion fatigue, burnout and vicarious trauma.ÌýÌý

Placements within health and social care settings are closely supported by practice educators, mentors or on-site supervisors, who can provide an additional layer of support in mitigating some of the overarching effects of stressful situations or experiences that the student may be subjected to.Ìý This potentially limits the possibility for suffering secondary trauma. Additionally, other support mechanisms such as supervision and feedback give a student opportunity to integrate theoretical learning from the University curriculum into direct practice (Wilson and Flanagan, 2019).Ìý This in turn can provide the ability for resilience to be generated as confirmed by Grant and Kinman (2012).ÌýÌý

 It is also important to recognise the role that a University has in supporting resilience via the provision and access to relevant material and resources, most notably being the library, study skills and student well-being. Rising to this challenge is imperative for Higher Education Institutions (HEI), by developing progressive facilities and greater consideration of the impact of secondary trauma within the course content (Owen-King, 2019). This will enable students develop further resilience and self-efficacy to manage the complex nature of social work stress (Kotera et al, 2019). However, programme support prior to and during placement is also pivotal to enable the student to take on new responsibilities; these responsibilities then become a competence, particularly in relation to the placement and the development of oneself (Beesley, 2020).ÌýÌý

Conclusion

The research suggests that students undertaking placements can be presented with a range of challenges. However, there are factors that could impact upon the nature and level of stress experienced, as well as how it could be reduced. These include teaching content, thorough preparation, student involvement and wider HEI services that can protect student (and eventually qualified worker) wellbeing. Placement support and pastoral care in HEI, as well as student knowledge and programme preparation for placements, could provide an opportunity to limit or reduce significantly the impact of stress and traumatisation of students. Ìý

Although no students in this sample suffered secondary trauma in the placement, this is the first piece of specific research on the area, so further studies are required.Ìý Limitations to this included sample size and did not break down information by type of placement, duration or compare length of placement – all important factors.ÌýÌýÌý

References

The full article was published by The British Journal of Social Work in March 2022.