Risk of Developing Compassion Fatigue in Refugee Service Workers

The Social Work Grand Challenge that this problem is addressing is Close the Health Gap. Refugee Service Workers of the Consulate of El Salvador are at the frontline witnessing survivors recount heart-wrenching stories of trauma (Lusck and Terrazazs, 2015). These Refugee Service Workers are at risk of developing compassion fatigue (Hu, 2018). Charles Figley coined the term Compassion Fatigue which is defined as “the suffering of clients and the natural consequence resulting from knowing about a traumatizing event experienced or suffered by a person’ (Figley, 1995, p.

7). Harr (2013) noted that work stress that is related to compassion fatigue can potentially exacerbate chronic illnesses which can result in high absenteeism, negative productively, and increased turnover rates.

Our current healthcare system has focused their primary attention on individual behavioral health care that they have neglected to support and protect refugee service workers from the psychological and physical injuries of working with survivors of trauma. According to Newman (2012), an ideal way of enhancing health outcomes is by developing and sustaining work environments that protect individuals from the psychosocial hazards from working with trauma survivors. Work “environments play a major role in influencing the health and well-being of Americans” (Newman, 2012, p.ii27). My capstone is aimed at closing the health gap by integrating a training program that reduces the impact of compassion fatigue and integrates a self-care framework for the refugee service workers within the Consulate Offices of El Salvador in the United States. The proposed innovation is aimed at disrupting the norm within the consulate offices by shifting the paradigm to more a systemic, global approach for a healthier working environment.

Just the act of listening to someone recount stories of trauma can potentially compromise a person’s emotional state and impact the quality of life (Hu, 2018). Refugee Service Workers spend at least 5-6 hours per day in a consular setting supporting immigrant seeking assistance. The proposed solution is a program that aims at increasing the awareness of the signs and symptoms of compassion fatigue and understanding the five domains associated with self-care (Hu, 2018). Specifically, this innovation will assist Refugee Service Workers to learn the specific causes, symptoms, risk and protective factors associated with compassion fatigue. Furthermore, participants will learn of the five domains related to self-care which are Cognitive, Spiritual, Financial, Social, and Physical. Also, not only will this innovation help educate others of the impact of this occupational hazard, but it will also assist Refugee Service Workers to increase their level of compassion of self and consumers they serve (Hu, 2018).

The purpose of this capstone is to examine whether if compassion fatigue is present in Refugee Service Workers and if there are specific variables that reduce the impact of compassion fatigue has on Refugee Service Workers. This specific capstone will utilize a measure to examine levels of compassion fatigue and explore life satisfaction and work. The research questions for this capstone are as follow:

Question 1: What is the association between compassion fatigue and risk factors among refugee service workers in a trauma-exposed working environment?

Question 2: How does learning the signs and symptoms of compassion fatigue and the use of self-care affect the levels of compassion satisfaction?

Question 3: Are there specific factors that lessen the risk of compassion fatigue?

To investigate the first research question of this capstone, a correlational analysis will be conducted to examine the relationship between compassion fatigue and risk factors. As far as the second and the third research question, a multiple linear regression analysis will be utilized to examine three areas: levels of compassion fatigue among refugee service workers, examine if there are factors that can lessen the impact of compassion fatigue and the impact of compassion fatigue.

Identify and Explain the Research Design

The type of research design that this capstone will consist of is a Randomized Pretest-Posttest Control Group Design. Fifty Refugee Service Workers from the Consulate of El Salvador in Los Angeles, California will be randomly assigned to 1 of 2 groups (intervention group or control group) of this capstone project. The pre-test will be administered to both groups which will consist of the Professional Quality of Life Scale (ProQol) which was developed by Stamm (2005) to measures the levels of compassion fatigue. This specific instrument between the risk factors and compassion fatigue among refugee service workers in a trauma-exposed working environment and will further assist to capture possible variables that can potentially reduce the impact of compassion fatigue. The intervention group will receive a three-week training that will teach each worker the symptoms and signs of compassion fatigue, the five domains of self-care and learn the implementation process of self-care plans. After three months, the ProQol survey will be administered to both of the groups: intervention and control group to determine levels of compassion fatigue and the effectiveness of the training program.

Strengths and limitations of the selected design

The selected design consists of an array of strengths and limitations. This capstone will rely on self-reporting of the ProQol survey which consists of positive and negative implications. According to Sinkowitz-Cochran (2013) self-reporting surveys assists researchers and practitioners reveal information that can either create or improve programs in the helping profession. Also, it is important to note that on the other hand that all self-reporting surveys contain measurement error. For instance, a self-reporting survey can potentially lead to participants either under-reporting or over-reporting (Sinkowitz-Cochran, 2013). Therefore, it is highly recommended that after the self-survey is administered that an actual brief interview is conducted to ensure the accuracy of the data.

Control the Threats: Internal validity

History: The intervention and control group experienced the same events. Therefore, there are no specific events that can influence a change in the intervention group. Prior to the implementation of the capstone project, an analysis of external events will take place to determine if there any factors that can influence the results of the program. Maturation: Maturation is considered a threat to the internal validity of the program. There is a possibility that the mental and physical status of a participant can waver, therefore, the post-test will be administered within one month from the intervention being completed. Regression: participants placed in each of the group will not be selected based off of extreme scores of the survey. Selection: All participants have an equal opportunity of either entering the intervention or control group. Experimental Mortality: To ensure there is no bias, the same amount of participants will be part of the intervention and control group. Testing: both groups received the same pre-test, this can be a possible threat to the internal validity of the capstone program as it can convey knowledge to participants. Instrumentation: the measurement of the program will not change therefore this would not be considered an actual threat.

Sampling

The sample in this capstone will be Refugee Service Workers from the Consulate of El Salvador in Los Angeles, California. The consulate office host approximately 200 members, 50 of those employees are Refugee Service Workers. Each Refugee Service Worker are natives from Central America, primarily El Salvador. The consulate office is committed to safeguarding the rights of its citizens. The type of sampling that this capstone will utilize is probability which will consist of a random selection. The benefit of random sampling is that everyone within this setting has an equal chance of being part of the intervention group. Also, another advantage is that this form of sampling represents the actual target of the population and prevents sampling bias. Random selection is important to the validity externally as the results can be generalized to the rest of the population.

Where specifically will you obtain your sample and how? Will there be criteria for inclusion and exclusion into the study? What is the sample size? What is the recruitment approach?

Each Refugee Service Worker is assigned a number, afterward, 25 numbers are chosen out of a hat. Specifically, numbers 1 through 50 are placed in small pieces of paper and are folded into squares. The hat is shaken and 25 numbers are randomly pulled out of the hat. The inclusion criteria consisted of Refugee Service Workers who are full-time status, worked for at least one consecutive year, no more than three years. Whereas the exclusion criteria consist of Refugee Service consist of those individuals who work on a part-time basis which is once a week and those who have less than one year working as a Refugee Service Worker, and those who are either are scheduled or submitted a transfer to another consulate office within the next three to six months.

The Consulate Office of El Salvador has an annual professional development retreat for this staff at the beginning of every fiscal year. The way that this program will be embedded is through their annual professional retreat for their staff members. The Administer of the Consulate Office will be providing an in-service presentation to their staff two weeks prior to the retreat to discuss the new program within the retreat. Those who are not in the retreat will continue to be part of their professional development training. Refugee Service Workers will be informed that although this is part of their professional development, their participation is voluntary. Online consent to participate will be embedded in professional development training. Those who consent to be part of the program will receive a link.

The ethical considerations to take into account is that in the event that participants are exhibiting symptoms of a possible mental health condition, resources for the Employee Assistance Program will be provided. Also, it is important to note that although this program will be part of their work as a Refugee Service Worker, they will be asked to provide informed consent to render the service. IRB approval is not applicable at this time.

Measures – What instruments or measures will you use to evaluate outcomes? (Please provide formal citations of existing instruments).

The instrument that will be used to evaluate the outcome is the Professional Quality of Life Scale (ProQol) which was created by Stamm (2005). This specific measure contains a 30-item self-report that examines the risk of compassion fatigue. The Alpha score of the ProQol survey ranges between .80 for compassion fatigue to 0.87 for compassion satisfaction which demonstrates that it has an adequate internal consistency. The Cronbach’s coefficients are 0.864. This specific scale will measure the risk factors associated with compassion fatigue.

Data collection – How will you collect the data? What is data collection methods? Time(s) of measurement?

The data will be collected via online and can be completed within 36 hours from receiving the link. Specifically, the ProQol survey will be administered at the very beginning of the program and six weeks after the program. A staff member of the consulate office will send out reminders daily for the survey. The data collection will be placed in a secure web site. The data will not have any identifying information, however, will have codes to link each response to a Refugee Service Worker.

Data Analysis 

The responses gathered from Refugee Service Workers of the ProQol scale will be number coded. To analyze the data, the information that is collected will be uploaded onto statistical software called Statistical Package for Social Science (SSPS). Levels of compassion fatigue will be analyzed using in SPSS. 

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