Male Victims of Sexual Abuse: Impact and Resilience Processes, a Qualitative Study.

The increasing prevalence of sexual abuse calls for exceptional awareness of its multidimensional impact on the mental, sexual, and social wellbeing of male adults. This study aims to deepen the overall understanding of sexual abuse consequences; to highlight some common resilience factors; and to strengthen therapeutic and social support. In this qualitative research, we conducted seven semi-structured interviews with male victims of sexual violence. The data were analysed with the interpretative phenomenological analysis. They shed light on the great suffering linked to sexual violence, and on seven themes which are seemingly pillars of resilience: bond to others, bond to the body, making sense of things, expression, rediscovering oneself, institutions, and finally, learning and commitment. The exploration of these themes reveals several avenues for adjusting care, most of which imply the importance of raising awareness so that spaces receiving the victims' word can emerge.

The effects of adherence to professional identity, workplace aggression, and felt accountability on child protection workers' professional quality of life.

BACKGROUND: Child protection workers (CPWs) are exposed to physical and psychological violence initiated by clients. The consequences associated with exposure to this type of trauma and others are compounded by the anxiety generated by the feelings of being accountable and the constant scrutiny and monitoring CPWs are under. Previous research suggests that acting according to one's professional values can help protect against the effects of trauma exposure and the anxiety associated with being held accountable when situations devolve into crises. METHODS AND OBJECTIVES: Using path analysis, this study sought to investigate how this complex intersection between client aggression, felt accountability, and professional identity among 310 CPWs is related to their professional quality of life (ProQol). RESULTS: Results show that adherence to professional identity was strongly and positively associated with ProQoL scores (ß = -0.42, p < .001). Felt accountability and exposure to psychological violence (but no other forms of violence) were consistently and negatively related to ProQoL scores (ß = -0.42, p < .001/ß = -0.20, p < .001). The impact of felt accountability on ProQoL scores can be partially explained by lowered adherence to professional identity. This suggests that the current way CPWs are held accountable and evaluated comes at odds with their professional values. CONCLUSION: The article ends with a discussion on how organizational changes surrounding accountability can be anxiety-inducing for some CPWs who increasingly feel overwhelmed by the complexity of their cases. Organizations must therefore reflect on how they can better embody the values of their clinicians.

Psychological First Aid Intervention after Exposure to a Traumatic Event at Work among Emergency Medical Services Workers.

Psychological First Aid (PFA) is a promising early intervention for managing mental health symptoms and providing psychosocial support after exposure to a traumatic event (TE) among high-risk organizations such as Emergency Medical Service (EMS). However, recipients' experience with PFA remains understudied. This study aimed to explore the perception of EMS workers (n = 13) who received PFA administered by a peer helper using a qualitative inductive approach. Findings from a thematic analysis indicated that the PFA intervention addresses EMS workers' immediate needs in congruence with Hobfoll's five essential principles to enhance coping and recovery after a TE. Specific components of the intervention, such as its time-sensitive nature and the closeness with peers, were especially appreciated by EMS workers. The PFA intervention appeared to have a beneficial impact on recipients, regarding the reduction of stigma, the increase of help-seeking behaviors, and the decrease of organizational difficulties. In conclusion, the PFA intervention offered by peer helpers is appreciated by recipients and is a beneficial first step toward supporting EMS workers in the aftermath of workplace trauma. These qualitative findings contribute to the current literature by informing further research about PFA intervention in other high-risk organizations and quantitative studies aiming to test PFA's efficacy in such settings.

Investigating the cyclical hypothesis of client aggression as a 'loss spiral': Can child protection worker distress lead to more client aggression?

Working in a stressful environment, child protection workers (CPWs) are often victims of psychological and physical acts of aggression perpetrated by their clients. This can be emotionally distressing for CPWs. Previous authors have suggested that this distress could place CPWs at greater risk for subsequent victimisation if they become emotionally unavailable to their clients. This study sought to investigate whether the distress experienced after an act of client aggression or other types of potentially traumatic events could indeed predict subsequent victimisation over time. Using cross-lagged panel analysis, researchers administered standardised questionnaires to 173 CPWs who had experienced an act of client aggression or other type of potentially traumatic event in the month prior. Participants were asked to fill out additional questionnaires 2, 6 and then 12 months later. Researchers found that CPW distress did in fact predict subsequent victimisation at the 2-month time point only. Researchers then conducted a generalised linear model analysis to test the influence of sociodemographic variables and the moderating influence of supervisor support. Supervisor support did not moderate the relationship between initial distress levels and increased aggression 2 months later. The study concludes by examining how the emotional distress of CPWs can negatively impact clients and how organisations can best provide support, in part, by rethinking aggression prevention.

Systematic Review and Meta-Analysis on Acute Stress Disorder: Rates Following Different Types of Traumatic Events.

Studies investigating rates of acute stress disorder following exposure to a traumatic event report widely varying results, even when examining the same types of traumatic events. The first purpose of this systematic review and meta-analysis was to describe rates of acute stress disorder following five different types of traumatic events. The second goal was to assess the methodological and trauma-related factors influencing these rates. Between May 2017 and October 2019, studies were identified by searching through the PsychINFO, PubMed/Medline, OVID, CINAHL, Scopus, and PILOTS databases. Records were included if (1) participants were 16 years old and over, (2) the assessment was completed within 30 days of the event, (3) a standardized assessment instrument was utilized, (4) the type of traumatic event was specified, and (5) the acute stress disorder rate was reported. The list of traumatic events used for the search strategy was based on the Diagnostic and Statistical Manual of Mental Disorders and was complemented by those listed in the Life Events Checklist and the National Comorbidity Survey Replication. Seventy-three samples from 70 studies totaling 20,065 participants met inclusion criteria. Results revealed that rates of acute stress disorder ranged from 14.1% for war-related trauma to 36.0% for interpersonal trauma. Interpersonal trauma was significantly more likely to lead to acute stress disorder than other types of events, except for disaster-related trauma. Differing assessment instruments, types of exposure and geographical locations, and the intentional nature of certain events contributed to heterogeneity in rates within each type of traumatic event.

Factors associated with reunification and placement move for children placed in kinship care under the age of thirteen.

BACKGROUND: When a child needs to be placed in substitute care by child protection services, social workers are encouraged to use kinship care (KC), mainly because of the greater stability associated with it. However, current state of knowledge on reunification and placement stability is essentially based on studies that combined children in KC and children in other types of substitute care setting. OBJECTIVES: This paper aims to describe longitudinally the placement trajectory of children placed in KC and to identify the factors associated with the type of exit from KC (move to another substitute care setting or reunification). METHOD: All children in a Québec child protection services agency who started a KC placement in 2014-15 under the age of 13 are observed for three years (N = 172). Data come from the child's casefile and from telephone questionnaires with the caseworker at the beginning and at the end of placement (or at the end of observation if the child has not exited). RESULTS: Several children remained in the same KC setting during the observation (39%). The others were reunified (34%) or moved to another substitute setting (27%). Multivariate regression analyzes indicated that reunification was mostly determined by higher frequency of parent-child contacts, less registrations in clinical programs and absence of parental mental health problems, while placement move was mostly associated with placement beginning as provisional measure, higher frequency of parent-child contacts and presence of parental mental health problems. CONCLUSIONS: This study highlights determinants of stability and permanency that may be specific to kinship placements.

Adherence to Psychological First Aid after Exposure to a Traumatic Event at Work among EMS Workers: A Qualitative Study.

Managing post-traumatic stress reactions in the first few days after exposure to a potentially traumatic event in the course of one's work remains a challenge for first responder organizations such as Emergency Medical Services (EMS). Psychological First Aid (PFA) is an evidence-informed approach to reducing initial distress and promoting short- and long-term coping strategies among staff in the aftermath of exposure. PFA provided by peer helpers is considered a promising solution for first responder organizations. Unfortunately, first responders may encounter stigma and barriers to mental health care. Therefore, a deeper investigation is needed regarding adherence over time to implemented PFA intervention. The purpose of this study is to qualitatively explore factors that influence adherence to PFA intervention of recipients and peer helpers. EMS workers (n = 11), working as PFA peer helpers for one year, participated in semi-structured interviews. Data were analyzed using thematic analysis; intercoder reliability (κ = 0.91) was also used. Researchers identified four themes and 11 subthemes influencing adherence to PFA intervention: (1) individual perceptions and attitudes of peer helpers and recipients about pfa intervention; (2) perceived impacts on peer helpers and recipients; (3) organizational support to pfa intervention; and (4) congruence with the occupational culture. Study findings herein suggest that it is conceivable to act on various factors to improve adherence to PFA intervention among peer helpers and recipients within EMS organization. This could lead to enhanced understanding of the challenges involved in sustaining a peer led PFA program for first responders.

Worker and perceived team climate factors influence the use of restraint and seclusion in youth residential treatment centers: Results from a mixed-method longitudinal study.

BACKGROUND: Restraint and seclusion (R&S) are controversial methods of intervention aimed at protecting children from immediate harm in residential treatment centers (RTC). Previous studies have mainly focused on situational factors and youth characteristics to predict its use. OBJECTIVES: This study sought to evaluate the role other potential predictors could play in the decision to use R&S, namely characteristics of residential workers and their perceived team climate. METHODS: For two months, a total of 132 residential workers from different RTC in the greater Montreal area completed weekly diaries of standardized questionnaires. Using an explanatory sequential design (i.e., mixed methods), this study aimed at exploring the role of residential workers' characteristics (e.g., exposure to client aggression, stress and fatigue) and aspects of their perceived team climate (e.g., order and organization, communication and openness) as predictors of R&S use. Survey results were later also presented to four focus groups for discussion. RESULTS: Results indicated that exposure to verbal violence from youths was associated with the increased use of R&S. Meanwhile, perceived communication and openness were associated with lower rates of R&S use. Participants shared that repeated exposure to verbal violence diminished their level of tolerance while teamwork provided them with the emotional space needed to focus on the needs of youths and find alternatives to R&S. CONCLUSION: This study sheds light on the complex role of human emotions in the decision to use of R&S. Specifically, intense momentary emotions during crisis interventions had a greater influence on the use R&S than chronic states, such as fatigue.

Construct Validity of the Professional Quality of Life (ProQoL) Scale in a Sample of Child Protection Workers.

The Professional Quality of Life (ProQOL) scale is one of the most widely used measures of compassion satisfaction and fatigue despite there being little publicly available evidence to support its validity. This study, conducted among a sample of 310 child protection workers, assessed the construct validity of this measure using confirmatory factor analysis (CFA) and bifactor modeling. The CFA failed to confirm the adequacy of the three-factor structure proposed by Stamm (2010). In response, a bifactor model postulating a factor structure with a general factor in addition to independent factors (compassion satisfaction, job burnout, and secondary traumatic stress) was proposed, highlighting the unidimensionality of the ProQOL while allowing for each subscale to be used separately. Moreover, this bifactor model of the ProQOL was moderately correlated with the Posttraumatic Disorder Checklist, r = -.427, p < .001, and strongly correlated with scales of well-being at work, r = .694, p < .001, and psychological distress at work, r = -.666, p < .001, thus supporting the ProQOL's convergent validity. No associations were found between the ProQOL and the Life Event Checklist, which supports the ProQOL's discriminant validity. Overall, the results indicated that compassion satisfaction and compassion fatigue represent higher and lower levels of the same construct rather than two different constructs. Researchers and clinicians could therefore compute a single score to rate professionals' individual levels of professional quality of life.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Validez de Constructo del instrumento de medición de Calidad de Vida Profesional (ProQoL) en una muestra de trabajadores de protección infantil ESCALA DE CALIDAD DE VIDA PROFESIONAL: VALIDEZ DE CONSTRUCTO La escala de Calidad de Vida Profesional (ProQoL en su sigla en inglés) es una de las medidas más ampliamente usadas de compasión satisfacción y fatiga por compasión, a pesar de que hay escasa evidencia disponible públicamente que soporte su validez. Este estudio, realizado en una muestra de 310 trabajadores de protección infantil, evaluó la validez de constructo de esta medición usando análisis confirmatorio de factores (CFA, por su sigla en inglés) y modelado bifactor. El CFA no confirmó la idoneidad de la estructura de tres factores propuesta por Stamm (2010). En respuesta, se propone un modelo bifactor que postula una estructura factorial con un factor general junto a factores independientes (compasión satisfacción, agotamiento laboral y estrés traumático secundario), destacando la unidimensionalidad de la ProQoL mientras permite el uso por separado de cada subescala. Más aún, este modelo bifactor de la ProQoL estuvo moderadamente correlacionado con la Lista de Chequeo de Trastorno Postraumático, r = -.427, p < .001, y fuertemente correlacionado con escalas de bienestar en el trabajo, r = .694, p <.001, y malestar psicológico en el trabajo, r = -.666, p <.001, apoyando por tanto la validez convergente de la ProQoL. No se encontraron asociaciones entre la ProQoL y la Lista de Chequeo de Eventos Vitales, lo cual apoya la validez discriminante de la ProQoL. En suma, los resultados indicaron que la compasión satisfacción y la fatiga por compasión representan niveles más altos y más bajos del mismo constructo más que dos constructos diferentes. Los investigadores y los clínicos podrían por lo tanto calcular un único puntaje para calificar los niveles individuales de calidad de vida profesional de los profesionales.

Identifying crime victims vulnerable to persistent depressive symptoms: Results from a secondary analysis.

BACKGROUND: Although depression has been extensively studied in relations to Intimate Partner Violence (IPV) and Childhood Maltreatment (CM), we still know little about its relationship with other types of violent crimes (e.g., physical assault, mugging) or how symptoms evolve over time. METHODS: Using a clinical sample of 132 crime victims, this study sought to map out group-based symptoms trajectories using Latent Growth Curve Analysis (LCGA) over the course of one year. RESULTS: Less than one month after having been assaulted, 30% of the sample reached the severe depression threshold. Symptoms tended to improve over time, with only 8% of participants reporting severe depression one year later. Analyses indicate the presence of three distinct profiles: one marked by severe and stable symptomatology over time (17%), the second characterized by a moderate level of symptoms that decreases exponentially over time (57%) and a third one describing a pattern of minimal depression throughout the year. People who suffered from persistent depression reported significantly lower levels of social support, scored higher on the ASDI and were also more likely to report some type of maltreatment in childhood but not IPV in adulthood, and appeared non-responsive to treatment. LIMITATIONS: Results must be nuanced by the size (i.e., LCGA requirements and attrition) and nature of the sample (i.e., help-seeking victims only). CONCLUSIONS: Although violence is a risk factor for depression, some individuals, especially those with a history of CM, appear to be more vulnerable to severe, persistent and treatment-resistant depression than others.

New ways to get policy into practice.

PURPOSE: Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of "street-level bureaucracy" has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice. DESIGN/METHODOLOGY/APPROACH: This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics. FINDINGS: Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing "assimilist" from "externalist" positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients' personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work. ORIGINALITY/VALUE: A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Violence against child protection workers: A study of workers' experiences, attributions, and coping strategies.

Child protection workers (CPWs) are frequently exposed to client violence, both psychological and physical, in their line of work whether they operate in the community or in residential settings. Despite this known vulnerability, research on the subject has lagged. The current study sought to analyze CPWs' experiences with client violence, their interpretation of it, its perceived consequences and their coping strategies. Specifically, 30 CPWs working both in the community and in residential settings, took part in an in-depth, semi-structured interview. A thematic analysis revealed that CPWs view client violence as a recurring and pervasive problem in their line of work. Residential workers described a greater frequency of violence, especially physical violence. CPWs however perceived violence differently, with some viewing this problem as 'part-of-the-job' while others described client violence as a 'call-for-help' on behalf of clients. Perceived consequences varied in severity and breath. CPWs reported consequences at the psychological (e.g. fear, hypervilence, sadness, nightmares), organizational (e.g. loss of motivation, turnover intention, sick leaves) and clinical levels (e.g. emotional detachment from clients, avoiding clients). CPWs also described numerous coping strategies, some effective while others appeared short-sighted. This study concludes with recommendations with regards to client violence in child protection work.

Workplace violence and the meaning of work in healthcare workers: A phenomenological study.

BACKGROUND: Workplace violence (WPV) has been associated with turnover intentions and reduced job satisfaction, yet the mechanisms behind such associations are still nebulous. Studying the way people make sense of their work in the context of WPV could lead to a better understanding of its consequences. PURPOSE: The objective of this exploratory study is to identify key features of meaning of work (MOW) in a group of healthcare workers and explain how these features can change following an act of WPV. METHODS: Researchers recruited 15 healthcare workers (11 women - 4 men) who had previously been the victim of a serious physical or sexual assault by a patient. A phenomenological approach was used. RESULTS: Two main themes were identified: MOW and relationships with others and MOW and relationship with the self. WPV might have the potential to trigger negative changes in the way some workers perceive their colleagues, their patients and their organisation. It can also interfere with their sense of self-accomplishment; all workers however, were still able to find positive meaning in 'contribution' and 'autonomy'. CONCLUSION: WPV has the potential to change certain aspects of MOW that could help explain why WPV is associated with lowered job satisfaction, compassion fatigue, and higher turnover. Also, finding meaning through contribution and autonomy can be a form of resilience.