Article Image

Cost of Caring for the Professional Managing Childhood Trauma

Op-Med is a collection of original articles contributed by Doximity members.

Effectively managing the vicarious trauma experienced by healthcare professionals who are on the frontline supporting children exposed to abuse was the focus of the presentation entitled ‘When their Stress Becomes your Fatigue’ at this year’s American Academy of Pediatrics National Conference & Exhibition in Chicago, IL.

Tom Bradach from Illinois Chapter, American Academy of Pediatrics, Chicago, IL, gave the poster presentation, and Juanona Brewster, MDiv, Senior Director, Child Development Initiatives, at the American Academy of Pediatrics, Chicago, spoke to Doximity about the issues around vicarious trauma.

Unfortunately, although many children deal with toxic stress, trauma, and mental health problems under the care of healthcare professionals, most providers do not recognize issues around their own wellbeing or they report feeling unprepared to address this within a clinic setting.

Part of the problem, noted the speakers, lies in identifying compassion fatigue as an occupational hazard that comes from working with children, families and even colleagues who have been affected by adverse childhood experiences (ACEs), (vicarious) trauma, and toxic stress.

“Compassion fatigue is the cost of caring and is an occupational hazard,” asserted Ms Brewster, who discussed ways to mitigate the effects of vicarious trauma for healthcare professionals. “Compassion fatigue is not your imagination and it is not happening to you because you can’t do your job. If you identify your own compassion fatigue or that of a colleague, you are being very self-aware.”

Reflecting the selfless nature of work that involves caring for others who are experiencing serious life-changing issues, she added that, “When struggling with compassion fatigue, caring people forget why they do the work that they do, become cynical about those they serve, and lose track of the value of who they are and what they bring to the world.”

Adverse Childhood Events affect later life

Early experiences during childhood, both positive and negative, have a tremendous impact on future violence victimization and perpetration, as well as lifelong health and opportunity.

The field of ACEs has been the focus of a number of landmark studies. One of the most notable pieces of research was the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, which is one of the largest investigations of childhood abuse and neglect and later-life health and well-being.

The original ACE Study was conducted from 1995 to 1997 and data were collected from over 17,000 Health Maintenance Organization members from Southern California. They received physical exams and completed confidential surveys regarding their childhood experiences, current health status and behaviors. Major findings of the study included that almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The study repeatedly found a graded dose response relationship between ACEs and negative health and well-being outcomes across the life course.

The research also found that as the number of ACES increased, so too did later life problems e.g. alcoholism and alcohol abuse, chronic obstructive pulmonary disease, depression, suicide attempts, unintended pregnancies, to name a few.

Vicarious trauma

Professionals who work with childhood trauma can take on some of the physiological, psychological and emotional consequences of the abuse, and the damage experienced by professionals who empathize with their patients is often termed vicarious trauma, secondary trauma, compassion fatigue or simply, burnout.

The speakers pointed out that it was necessary to review the need for provider self-care, before the provider can consider using trauma-informed interventions for children and families.

Of note, reported Mr Bradach, there is a personal cost to working with traumatised children and without mitigation of the emotional consequences of this type of work, the professional’s wellbeing as well as their ability to work effectively will be adversely affected. Vicarious trauma can either accumulate over a long period of time or be triggered by a one-off episode with a patient. Whichever the source of the problem, the speakers pointed out that it is important to ensure professionals working in these scenarios have effective supervision and peer support. In some situations which are particularly serious, an externally-run, intensive help might help the professionals to move on to continue their work without vicarious trauma.

Insights into what professionals can do to incorporate protective factors into the environment, in order to build a supportive, healing, and nurturing atmosphere for children and families were also discussed in the session.

Ms Brewster provided some practical suggestions to help professionals become more resilient and manage vicarious trauma. “While we offer many tools and some coaching on self-care to minimize or prevent compassion fatigue, if we had to give one piece of advice for self-care it is to not isolate yourself,” she told Doximity.

“Certainly learning to find ways to rest, eat properly, exercise, etcetera are important, but as with most techniques for building resilience, the key is having access to caring, supportive people. They can always help us to remember who we are why we are vital.”

‘When their stress becomes your fatigue: the cost of caring’ was presented 11:30 AM — 12:30 pm, Friday, September 15, 2017.

By Becky McCall, contributing writer for Doximity

All opinions published on Op-Med are the author’s and do not reflect the official position of Doximity or its editors. Op-Med is a safe space for free expression and diverse perspectives. For more information, or to submit your own opinion, please see our submission guidelines or email

More from Op-Med