Secondary Traumatic Stress Scale (STSS)

What is Secondary Traumatic Stress?

Secondary Traumatic Stress (STS), also known as Vicarious Trauma or Compassion Fatigue, occurs when professionals who work with trauma survivors experience trauma symptoms themselves. Unlike direct trauma exposure, STS develops through repeated exposure to others' traumatic experiences and stories.

Who Should Take This Assessment?

• Trauma professionals: Therapists, counselors, social workers
• Healthcare workers: Nurses, physicians, emergency responders
• First responders: Police officers, firefighters, EMTs
• Human service workers: Child welfare workers, victim advocates
• Legal professionals: Prosecutors, victim advocates, court personnel
• Anyone working with trauma survivors: Teachers, clergy, volunteers

Key Features of STSS

• 17-item assessment measuring frequency of STS symptoms
• Three main domains: Intrusion, Avoidance, and Arousal
• 5-point Likert scale (0 = Never, 4 = Very Often)
• Time frame: Past 7 days
• Administration time: 5-10 minutes

Scoring and Interpretation

The STSS provides both subscale scores and a total score:

• Total Score Range: 0-85
• Minimal: 0-7
• Mild: 8-17
• Moderate: 18-27
• Moderate-High: 28-37
• Severe: 38+

Three Symptom Domains

Intrusion (Items 1-5)

Unwanted thoughts, images, dreams, or physical reactions related to clients' trauma experiences

Avoidance (Items 6-10)

Emotional numbing, detachment, loss of interest, and avoidance of trauma-related stimuli

Arousal (Items 11-17)

Hypervigilance, irritability, sleep disturbances, concentration difficulties, and exaggerated startle responses

Frequently Asked Questions

Q: How is STSS different from burnout?

A: While burnout involves emotional exhaustion and cynicism about work, STSS specifically involves trauma symptoms that mirror PTSD. STSS is trauma-specific, while burnout is more general work-related stress.

Q: Can STSS affect anyone who works with trauma survivors?

A: Yes, STSS can affect anyone who regularly hears about or witnesses others' traumatic experiences, regardless of their profession. However, the risk is higher for those with direct, intense, or prolonged exposure.

Q: What are the warning signs of STSS?

A: Warning signs include intrusive thoughts about clients' trauma, emotional numbness, hypervigilance, sleep disturbances, irritability, and difficulty concentrating. Physical symptoms like rapid heartbeat or sweating when reminded of trauma may also occur.

Q: How can I prevent STSS?

A: Prevention strategies include regular supervision, self-care practices, maintaining work-life boundaries, peer support, and ongoing professional development in trauma-informed care.

Q: What should I do if my STSS score is high?

A: If you score in the moderate-high or severe range, consult with a mental health professional experienced in trauma. Consider workload adjustments, additional supervision, and trauma-focused therapy.

Q: How often should I take the STSS?

A: Many organizations recommend quarterly or annual STSS screening for trauma workers. More frequent monitoring may be needed during high-stress periods or after particularly challenging cases.

Q: Is STSS the same as Vicarious Trauma?

A: STSS and Vicarious Trauma are closely related terms that are often used interchangeably. Both refer to the impact of working with trauma survivors, though Vicarious Trauma may also include changes in beliefs about the world and self.

Clinical Applications

• Screening: Early identification of STS symptoms
• Monitoring: Track symptom changes over time
• Intervention planning: Guide treatment and support strategies
• Workplace wellness: Inform organizational prevention programs
• Research: Study the impact of trauma work on professionals

Prevention and Self-Care Strategies

• Regular clinical supervision and consultation
• Peer support groups and debriefing sessions
• Maintaining work-life boundaries
• Practicing mindfulness and stress management
• Engaging in regular physical activity
• Seeking personal therapy when needed
• Taking regular breaks and vacations
• Building a strong support network

Professional Development Recommendations

• Training in trauma-informed care
• Vicarious trauma education
• Self-care and burnout prevention workshops
• Trauma-focused therapy techniques
• Organizational wellness programs

Research Evidence

The STSS has been validated in multiple studies and demonstrates good psychometric properties:

• Reliability: Internal consistency (α = .93)
• Validity: Correlates with other trauma measures
• Sensitivity: Detects symptom changes over time
• Clinical utility: Guides intervention planning

Important Considerations

• The STSS is a screening tool, not a diagnostic instrument
• Results should be interpreted by qualified mental health professionals
• Cultural factors may influence symptom expression and reporting
• Individual differences in resilience and coping affect vulnerability
• Organizational factors (caseload, support) influence STS development