Tell Us About It: Victim Research Convos


In this CVR podcast series, we talk with those doing research and serving victims and learn about the work they've done together.

Tell Us About It, Episode 5: The Vicarious Trauma Toolkit

A convo with Katherine MannersJan 04Time: 19:52

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On this episode of Tell Us About It, we talk with Katherine Manners about the inception of OVC’s Vicarious Trauma Toolkit, which was released in April 2017. Katherine served as a resource coordinator for the VTT, which is a set of tools to help victim service agencies and other first responders address work-related exposure to trauma for their employees. We talk to Katherine about the research that went into the toolkit, how it is being used, and where this area of research might go in the future.

In addition to her work on the VTT, Katherine is a co-founder of Resilience Works, an organization providing consultation and assistance to agencies whose employees are exposed to trauma. She also serves as a consultant and trainer for Organization Resilience International, serving victim services, trauma, and crisis responder programs. She has more than 30 years of organization consulting and training experience in the fields of victim services, homicide bereavement, and resilience.

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Susan Howley: Welcome to Tell Us About It: Victim Research Convos, a podcast from the Center for Victim Research with support from the Office for Victims of Crime. On each episode of Tell Us About It, we talk to researchers and practitioners about their work, the tools being built for use in the field, and how we can work together to build an evidence base for crime victim services. On today’s episode, I talk to Katherine Manners, a resource coordinator who helped build the OVC-funded Vicarious Trauma Toolkit, released last year. The Vicarious Trauma Toolkit is a set of tools to help victim service agencies and other first responder organizations address work-related exposure to trauma for their employees. The first thing I wanted to learn from Katherine wash in a field where terminology can be so broad, how did they even decide that vicarious trauma was what this was going to be about? How did they settle on calling this the Vicarious Trauma Toolkit?

Katherine Manners: That was one of our biggest challenges because there are so many terms that define this phenomena, the impact of work related trauma exposure. So we’ve heard of vicarious trauma, we’ve heard of secondary traumatic stress, compassion fatigue, empathic strain, critical incident stress, et cetera. It went on and on. So that was really one of our biggest challenges was when we were looking at the research, we kept having to expand and expand to find all the literature that’s out there concerning this phenomenon. We settled on vicarious trauma.

Susan Howley: Okay, but it took a while to get to that.

Katherine Manners: It absolutely took a while to get to that end and what we’ve decided is we’ve come up with a model that vicarious trauma is the exposure to work-related trauma and vicarious traumatization is one of the impacts.

Susan Howley: Okay, so they knew what they would call the Toolkit but the challenges around language didn’t stop there. The team had to figure out what language they would use to search for the right content to build the Toolkit. Burnout, for example, was a common term for this phenomenon some years ago, but the team decided not to use it because it’s now widely used for so many different things. I had to ask Katherine how her team even managed to wrap their arms around all these questions of language?

Katherine Manners: Well luckily, we had a huge group of partners that were extremely helpful in vetting all this information. So while Northeastern University was our lead, we worked closely with Boston Area Rape Crisis Center, with the National Center for Victims of Crime, with Beth Israel Deaconess Medical Center, the National Children’s Advocacy Center, and the International Society for Traumatic Stress Studies, in terms of the victim services aspect. But then we also had to call in, very gladly, the International Association of Chiefs of Police, the International Association of Fire Chiefs, and the National Association of State Emergency Medical Officials. I think that having so many partners, on this national level and international level, has really made this Toolkit very robust. But it also complicated the terminology, as we discussed, because, for police, they call it critical incidence stress. We don’t call it critical incident stress in victim services. So we needed to keep broadening our net as we were looking for our resources.

Susan Howley: But even with all that support, the next step sounds like the real challenge. Katherine’s team set about gathering and reviewing a whole bunch of literature on vicarious trauma, specific to four occupations: victim services, law enforcement, fire and emergency medical services. Katherine, tell me a little bit about the process to search for the research literature around vicarious trauma.

Katherine Manners: So after we sort of kept widening our lens in terms of the terms and the terminology, we actually went through three major literature searches. We worked very closely with Muriel Wells, who’s the research librarian at the National Children’s Advocacy Center. She was extremely helpful in determining what we were looking for when we were describing what we needed. So she was able to do extensive searches in a number of places, including PsychNet, Pilots, ProQuest, Ebsco, PubMed, and PsychInfo. It really gave us an accurate sense of the state of the field and the wide variety of disciplines that we were working with. So in addition to that, we had to do an internet search inputting the same terms that we had used for the literature search. Looking at the terms, the disciplines, the strategy areas, to find non-scholarly research and tools, like policies, practices, procedures, and programs, that deal with vicarious trauma. We also looked at other resources, websites, podcasts, and videos.

Susan Howley: So then after you identified this mountain of research and materials, how did you organize a way to really sift through those and figure out what was applicable, what was strong, what should you be incorporating into your work?

Katherine Manners: One other method that we used to search for tools was a massive, 84,000 person survey, that we sent out to the field through our national partners, in which we asked them about terminology. We asked them about prevalence. We asked them about symptomology and organizational practices. We also asked them to send us any policies, practices, procedures, that they used in their organizations that they found effective. So we were left with thousands of pieces of information that we had to sift through. So some of what we did for the literature was we consulted with the CDC Continuum of Evidence of Effectiveness. It is a tool that can be used to determine the effectiveness and evidence base of literature. So they have three levels, broken into seven different categories, but the three levels are: Best Available Research, and that talks about the sort of typical rigorous research design, randomized controlled trials, quasi experimental designs, that sort of thing; Experiential Evidence, which is based on professional insight and understanding, skill and expertise of the clinician or the provider; and Contextual Evidence, factors addressing usefulness, feasibility to implement, and acceptance. So when you put those three things together, we measured each piece of literature that came our way and ended up with 21 articles that were well supported or supported. 255 fell in the middle range for the most part, that’s promising direction or emerging direction. And then we only had two in the unsupported or harmful column, and unsupported means that just the experiment was done, it just didn’t support the hypothesis.

Susan Howley: As you heard, the team didn’t limit its searches to traditional research. Their own searches, as well as the survey, yielded a massive amount of online content. They used in evaluative tool called the CARS checklist to look at websites and website sources, gauging the credibility, accuracy, and reasonableness of the website’s information, as well as the support of sources. And when it was all said and done?

Katherine Manners: We were left with about 500 resources that are in the Toolkit and we had to decide how are we going to organize all this information? It’s great that it’s there for people to access, but if they don’t know what they need, how do they know what to access? So we’ve engaged in the simultaneous process of creating a survey tool that organizations could use that helped to determine what are the pillars of a healthy organization or a vicarious trauma informed organization? So in addition, we collected all of the organizational survey tools that we could find. We found 12 that were particularly relevant to our disciplines, to the law enforcement, fire, EMS, or victim services. And by using those survey tools, in addition to the research that we got, we categorized our information into these five areas.

Susan Howley: The five areas that Katherine’s team identified are related to the organizational health of an agency. They are the organization’s leadership and mission, its management and supervision, its employee empowerment and work environment, its training and professional development, and its staff health and wellness. How did they come up with these five pillars?

Katherine Manners: When we started trying to organize the Toolkit and trying to determine what are the basic things that an organization should have in order to be vicarious trauma informed, we consulted with a couple of different experts in the field, researchers. From the organizational psychology field, we worked with a researcher who was an expert in the Star Model by Jay Galbraith, which provides a framework for organizational design. He also introduced us to the Philips Model for Team Effectiveness that looks at the team level and concerns itself with communication, relationships, environment, that sort of thing. We also had another researcher that was teaching us about the relational coordination theory that also focuses on an organization’s shared goals, mutual respect, transfer of knowledge, communication, basically the relationship between coworkers. They were instrumental in helping us pull together the concept of the five pillars, and they helped us to determine what were the real essential aspects of a healthy organization. Not just a vicarious trauma informed organization, but in any organization, what is it that you need in order to create a healthy environment for the staff?

Susan Howley: So let’s take one of those areas for example. I know that in the victim services section, one of the main areas is leadership and mission. What does the research tell us about the connection between leadership and mission and let’s say the protection or building the resiliency of your employees against vicarious trauma?

Katherine Manners: So the role of the leadership is to convey and uphold the mission and we find that in vicarious trauma informed organizations, the mission is integrated into strategies, values, operations, and practices within the organization. The leadership maintains a clear vision that supports and articulates the mission and regularly models and promotes open and respectful communication with their staff.

Susan Howley: So what sort of research is out there that can link leadership and mission to staff resilience?

Katherine Manners: So some of the research focuses on how leadership can sustain staff by anticipating and responding to their needs, by showing appreciation, and creating safe forums for communication. Particularly, a piece of literature around victim services determined that advocates who received more support from their supervisors, their co-workers, and their work teams, they experienced lower levels of secondary traumatic stress.

Susan Howley: That gave me a solid idea of how this Toolkit could be used, how an organization could leverage these resources to become vicarious trauma informed. But with hundreds of resources reaching across the five pillars of organizational effectiveness, how does an organization know where its greatest needs are or where to start? Well as Katherine hinted already, her team created a survey tool for organizations. It’s called the Vicarious Trauma Organizational Resilience Guide or VTORG. It’s a survey that organizations can use to determine their strengths and weaknesses when it comes to vicarious trauma.

Katherine Manners: There are many ways that the VTORG can be administered to your agency. You could have a small group of people take the VTORG that come from a range of different levels within your agency, if you have a particularly large agency. You can do an agency-wide, put it on SurveyMonkey or some other tool and do it that way, or with a management team, although you wouldn’t get the perspective of the ones lower down to be able to get a complete picture. So that’s one way. And then once you tally up your scores, you can see where your strengths are in your agency and what you’re doing really well and those things can continue to be upheld, but it also shows you what your gaps are. And once you figure out your gaps, you can determine some priority areas that you want to address initially and go straight to the tools in the Toolkit to start enacting some of these things for your agency.

Susan Howley: Katherine also told me that evaluation of the effectiveness of the VTORG is still underway, but the results are promising. Which made me think: how could this Toolkit continue to evolve to be even more comprehensive and effective, and what does the future research in this area look like?

Katherine Manners: One of the things that we really need to agree on is a familiar term, and that will really help the research move along. I think we’ve really been hindered by calling it so many different things. So if we could settle on a single term that would be helpful. The other thing I see is that recently the Diagnostic Statistical Manual that is published by the American Psychiatric Association came out with their new version – version 5 in 2013 – in which they expanded the definition of post-traumatic stress disorder to include those of us who work in the trauma field. They specifically talk about the repeated or extreme exposure to aversive details of trauma, usually in the course of professional duties. And they specifically count out those exposed to media, TV, movies, etc. It must be work-related. So I think that that will open up avenues to research, to people being curious about that. I think another under-researched area is in the positive effects of vicarious trauma exposure. There’s increasing research on the positive effects on trauma survivors themselves but not so much on the trauma workers. So that is a growing edge of research.

Susan Howley: I think I know what you’re saying. I’ve heard a little bit about that the victim services field is starting to talk about the positive impacts of trauma, so that an individual victim or survivor might look back a few years after the event and talk about how they are now a stronger person, or they have a different world view, or they’ve grown through the terrible event that they suffered. And so do you think we might see something similar to victim service providers?

Katherine Manners: Exactly. There are some groups out there that have started doing some research into this phenomenon, and it is certainly something that resonates with the victim services community. People do recognize that they have an appreciation for their good fortune. People are feeling that it helps them to stay engaged and more motivated in the work, gives them a more positive outlook on life.

Susan Howley: Katherine, if in five years, you get an opportunity to create the Vicarious Trauma Toolkit 2.0, what would you hope to find in the research literature?

Katherine Manners: I think I would be happy to find less new literature on the prevalence of vicarious trauma. I think we are ready to move beyond the idea that this exists, that this is a thing, and we’re ready to start talking about so what do we do about it. There’s been a lot of literature on the efficacy of self-care and that’s something that people talk about and rely upon a lot. However, self-care is not the only answer. And organizations are growing increasingly aware of their responsibility to their staff to provide strategies and policies and procedures within their agencies that help protect them and help to deal with the aftermath of trauma exposure. So I’m looking forward to more evidence-based strategies, seeing some more on that. And I’m also looking forward to seeing more research on the positive impact of the work, because I think there can be an overemphasis, at times, on how hard this work is, how difficult it is. And it certainly is and we’re not in it for the money, clearly, but we are definitely in for it because it feeds us in another particular way that I think we should pay attention to and honor.

Susan Howley: It’s a wonderful thought. We’ve been talking with Katherine Manners about the research underpinnings of the Vicarious Trauma Toolkit. You can find this Toolkit on OVC’s website, at Katherine, thank you so much for your time today. It’s been a real pleasure.

Katherine Manners: Thank you.