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Compassion fatigue, burnout, and secondary trauma in resident assistants

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Compassion fatigue, burnout, and secondary trauma in resident assistants

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Content Compassion Fatigue, Burnout, and Secondary Trauma in Resident Assistants by Jason Jeremiah Thibodeaux Rossier School of Education University of Southern California A dissertation submitted to the faculty in partial fulfillment of the requirements for the degree of Doctor of Education August 2021 © Copyright by Jason Jeremiah Thibodeaux 2021 All Rights Reserved The Committee for Jason Jeremiah Thibodeaux certifies the approval of this Dissertation Shafiqa Ahmadi Smita Ruzicka Patricia Tobey, Committee Chair Rossier School of Education University of Southern California 2021 iv Abstract The number of students with mental health issues in institutions of higher education has been rising over the past few years, and the COVID-19 pandemic has accelerated this issue. Depression, anxiety, and suicide ideation are the most serious concerns. While the impact of working with others in distress is well documented in the health professions, this impact is less studied in educational institutions. This study measures compassion fatigue (burnout and secondary trauma) and compassion satisfaction via the Professional Quality of Life Scale in Resident Assistants at a public research university. Additional data regarding the impact of working with others in distress, the mental health consequences of the pandemic, and self- efficacy around helping skill is examined. Demographic relationships with the scales for burnout, secondary trauma, and compassion satisfaction are explored, along with the level of support provided by the organization. Recommendations for decreasing the burnout and mental health issues reported by Resident Assistants are examined. Keywords: Student Affairs, Compassion Fatigue, Burnout, Resident Assistants v Acknowledgements If you told 18 year old me that one day, I would go on to earn a doctorate, I would have never believed you. Yet here we are, all these years later, wrapping up an incredible journey that I could have never accomplished by myself. First, I want to thank my amazing chair, Dr. Pat Tobey. Without your encouragement, care, and compassion, I would have never made it this far. You taught me so much about the true power of feedback in empowering others to accomplish things they never thought possible. I would also like to thank the other members of my committee, Drs. Shafiqa Ahmadi and Smita Ruzicka, who always helped me see my research through new eyes and kept pushing me to do my best work. I also would like to thank the other unofficial members of my committee (and Golden Girls crew), Dr. LaToya Smith and Martha Compton. Your love, support, laughter, and tears carried me the whole way through. To my many colleagues and work friends, thank you for all your support in this journey. Without you, this never would have happened. A big thank you to my parents for teaching me to persevere, even when things get hard. And a huge thank you to all the RAs that so willingly told me their stories and trusted me with their data. Finally, a big thank you to my heart, soul, and trusted writing companion, Ripley, the best German Shepherd I could ever have. You have been my pandemic buddy, and your never ending source of love and companionship keeps me going even in the darkest of times. Thanks for always being there for me. And to all the awkward kids out there feeling like you don’t belong and doubting yourself, this is for you. vi Table of Contents Abstract .......................................................................................................................................... iv Acknowledgements ......................................................................................................................... v List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................. x List of Abbreviations ..................................................................................................................... xi Chapter One: Overview of the Study .............................................................................................. 1 Introduction to the Problem of Practice .............................................................................. 1 Organizational Context and Mission .................................................................................. 2 Organizational Goal ............................................................................................................ 6 Related Literature ................................................................................................................ 6 Importance of the Study ...................................................................................................... 8 Description of Stakeholder Groups ................................................................................... 10 Stakeholder’s Performance Goals & Group for the Study ................................................ 11 Purpose of the Project and Questions ............................................................................... 12 Theoretical Framework ..................................................................................................... 13 Definitions ......................................................................................................................... 15 Organization of the Study ................................................................................................. 17 Chapter Two: Review of the Literature ........................................................................................ 18 Mental Health of the College Student Population ............................................................ 18 Social Cognitive Theory ................................................................................................... 22 Compassion Fatigue .......................................................................................................... 24 Student Development Theory ........................................................................................... 29 vii CAS Professional Standards for Higher Education .......................................................... 33 Impact on Student Success ................................................................................................ 35 Impact of COVID-19 on Students .................................................................................... 37 Strategies for Addressing the Problem ............................................................................. 39 Summary ........................................................................................................................... 41 Chapter Three: Methodology ........................................................................................................ 43 Sampling and Recruitment ................................................................................................ 44 Stakeholders ...................................................................................................................... 46 Data Collection and Instrumentation ................................................................................ 46 Validity and Reliability ..................................................................................................... 49 Role of the Investigator ..................................................................................................... 50 Ethical Considerations ...................................................................................................... 51 Chapter Four: Results ................................................................................................................... 54 Preliminary Analysis ......................................................................................................... 54 Research Question 1 ......................................................................................................... 57 Research Question 2 ......................................................................................................... 85 Research Question 3 ......................................................................................................... 88 Chapter Summary ............................................................................................................. 92 Chapter Five: Discussion .............................................................................................................. 94 Findings ............................................................................................................................ 95 Implications for Practice ................................................................................................. 101 Future Research .............................................................................................................. 110 Conclusions ..................................................................................................................... 114 viii References ................................................................................................................................... 116 Appendix A: Theoretical Framework Alignment Matrix ........................................................... 126 Appendix B: Consent Form ........................................................................................................ 127 Appendix C: Permission to Use ProQOL ................................................................................... 131 Appendix D: Survey Instrument ................................................................................................. 134 ix List of Tables Table 1: Demographic Variables for All Participants .................................................................... 55 Table 2: Cronbach’s a for ProQOL Assessment ........................................................................... 56 Table 3: Descriptive Statistics of ProQOL Results ....................................................................... 57 Table 4: Relationships Between Ethnicity and ProQOL Scores – Cohen’s d ............................... 64 Table 5: Relationships Between Variables Measures – Cohen’s f ................................................ 65 Table 6: Relationships Between ProQOL Scales – Pearson’s r .................................................... 66 Table 7: Descriptive Statistics of Support Variable ...................................................................... 67 Table 8: Relationships Between Ethnicity and Support – Cohen’s d ............................................ 69 Table 9: Relationships Between Variables Measures – Cohen’s f ................................................ 70 Table 10: Relationships Between ProQOL Scales and Support Variable – Pearson’s r ................ 71 Table 11: In what ways, if any, has being a Resident Assistant affected your own mental health? ....................................................................................................................................................... 76 Table 12: In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing? .................................................................................. 79 Table 13: Compared to previous quarters, how has COVID-19 and/or racial injustice impacted your own wellbeing? ..................................................................................................................... 81 Table 14: Safety Concerns Described by Asian Resident Assistants ............................................ 84 Table 15: In your role as a Resident Assistant, how confident do you feel in your ability to support fellow students with mental health issues? ...................................................................... 87 Table 16: In your role as a Resident Assistant, how do you care for your own wellbeing? ......... 91 Table 17: Implementation and Assessment Plan ......................................................................... 108 x List of Figures Figure 1: Overview of the Professional Quality of Life Theory ................................................... 14 Figure 2: Detailed Theoretical Model of Compassion Satisfaction and Compassion Fatigue ..... 15 Figure 3: Compassion Satisfaction Score Distribution ................................................................. 59 Figure 4: Burnout Score Distribution ........................................................................................... 60 Figure 5: Secondary Trauma Score Distribution .......................................................................... 62 Figure 6: Distribution of Support Variable Responses ................................................................. 68 Figure 7: In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing? .................................................................................. 80 xi List of Abbreviations ACHA American College Health Association LGBTQIA Lesbian, Gay, Bisexual, Trans, Queer, Intersex, and Asexual NCHA National College Health Assessment ProQOL Professional Quality of Life Scale PTSD Post-traumatic Stress Disorder 1 Chapter One: Overview of the Study Introduction to the Problem of Practice As student mental health is a growing issue within higher education, it is important that Resident Assistants be equipped with the proper tools to engage in addressing the mental health of their fellow classmates. Specifically, data collected by the Center for Collegiate Mental Health (2017) from the past five years have shown a 10% increase each year in students presenting concerns that involve self-injurious and suicidal behaviors (Xiao et al., 2017). Additional research has shown that almost half of individuals in the traditionally college-age population had a mental health condition within the year prior to the study (Blanco et al., 2008; Wynaden et al., 2014). The evidence highlights that depression and self-injurious behaviors are the most common issues, with each impacting approximately 10% of the student population (Zivin et al., 2009). Additionally, there is also a rapid rise in the utilization of campus counseling services, as researchers found a 28.9% increase in the number of students seeking services from a university counseling center between 2009 and 2014 (Xiao et al., 2017). While the rapid growth in the need for mental health services is a well-documented issue, the impact of this situation on Resident Assistants is not well understood. Specifically, only one recent study has examined the impact of working with students in mental distress on Resident Assistants (McCarthy, 2019). Furthermore, the only other recent research on this topic appears in three dissertation studies of student affairs professionals (Bernstein Chernoff, 2016; Carter, 2019; Lank, 2019; Miller, 2018). This is concerning, as multiple studies on healthcare professionals show that individuals can become mentally distressed themselves as a result of exposure to the trauma of others (McCormack et al., 2018; Morse et al., 2011; Ray et al., 2013; Sim et al., 2016; Tehrani, 2007). 2 This is an important issue, as Residents Assistants are central in creating an environment of care for students and in supporting the mental health needs of their students (Blimling, 2003). Specifically, as paraprofessional staff members that have oversight for a community of fellow students that live on-campus, they are also first line responders that are responsible for student safety and for responding to emergencies on an on-call basis. This often means that a Resident Assistant is the first person to know that one of their students is experiencing mental distress. In fact, Manata et al. (2017) identified that counseling depressed students and providing advice to students experiencing problems are critical parts of the Resident Assistant role. As universities rely heavily on Resident Assistants to support student mental health and identify students in distress, there is a critical gap in the literature in both understanding the impact that the rise in mental health issues has on Resident Assistants and in ensuring that Resident Assistants have the necessary tools to meet their responsibilities. Organizational Context and Mission Gray University (pseudonym) is a highly ranked public research university that serves a diverse population of students from across the globe. The university is considered a high- research activity university and attracts a competitive application pool for undergraduate and graduate admissions. The average GPA for students admitted as freshmen was slightly above a 4.0, and for transfer students, the average GPA was above 3.5. Additionally, the average SAT score is in the high 1200s. The university is large with tens of thousands of students (both undergraduates and graduates), and almost 40% of Gray University students identify as first- generation college students. Furthermore, almost 80% of the student body are underrepresented minorities. Specifically, Asian students comprise exceed 1/3 of the student population, and 1/5 of 3 the student body is Chicanx/Latinx. Given this, the university is considered an emerging Hispanic-serving institution. Gray University also has a broad mission to transform the state and society through education, public service, research, and knowledge creation. Science, technology, engineering, math, social sciences, and the arts are all highly valued and popular at this university. Though the university has a reputation for being more focused on the hard sciences, important social science research occurs at this school, and students of various social science disciplines constitute approximately 33% of the university. Mental health needs are a serious concern at Gray University. According to a survey conducted by the American College Health Association (2019) Over 33% of Gray University students reported feeling stressed. It should be noted that approximately 45% reported more than an average amount of stress, and 15% reported tremendous stress levels. This stress translates into mental health issues, as over 60% of the participants also reported feeling frequently or occasionally depressed, and 14% seriously considered suicide. Furthermore, 64% reported overwhelming anxiety, and a large majority of students reported that they felt frequently or occasionally overwhelmed by their workloads. It should be noted that these numbers are higher than the comparison group of other similar universities from across the United States (“Gray University Executive Summary ACHA-NCHA II,” 2019). Therefore, it can be concluded that mental health is a more serious issue at Gray University as compared to its peer institutions. It should be further noted that there are inadequate resources to address these high levels of stress, depression, and anxiety, as the current ratio of students to professional mental health staff does not meet the standards set by the professional organization that provides accreditation to counseling centers. Specifically, the recommended ratio of professional mental health staff 4 members to students is 1 staff member for every 1000-1500 students (Spivack et al., 2010). However, the current staffing model at Gray University has 1 mental health staff member for every 1527 students. Furthermore, students have been seriously impacted by the recent events in our society. Specifically, the COVID-19 pandemic required all classes to be delivered remotely, and students were encouraged to move off campus if possible. This major disruption to the studies of thousands of students was not well received, and as a result, many reported a negative academic experience. Additionally, Gray University made a decision to continue to provide an on-campus residential experience to as many students as possible. The resulted in Gray University housing approximately 6000 undergraduate students on campus during the 2020 Fall Quarter. While all students lived in single-occupancy rooms, this is among the largest on campus population in the United States during the COVID-19 pandemic. Students living on campus are required to be screened for symptoms of COVID-19 on a daily basis and tested for the virus on a weekly basis. If a student tests positive or has been exposed, they are placed in a separate housing facility until cleared by the medical professionals. Furthermore, mask wearing and physical distancing are required at all times, expect when students are in their private bedrooms. It should be noted that Resident Assistants are responsible for enforcing these requirements. While these safety protocols have resulted in low numbers of COVID-19 cases on campus and a relatively successful and safe on campus experience, this has made the role of the Resident Assistant even more critical and stressful, especially given the importance of health and safety being a paramount component of the position. Also, the related economic fallout has impacted thousands of students who reported financial difficulties as a result of a family member or a personal loss of employment. 5 Furthermore, the national conversation around police brutality, the impact on communities of color, and the related protests have impacted Gray University’s students. Specifically, protests occurred locally in the city in which the school is located, and many students reported disturbances to their ability to concentrate or perform academically as a result of these events. Additionally, the Black Student Union has been in communication with the school’s administration to demand changes in the policies, practices, and climate of Gray University. However, the university administration’s response has not been well-received. Furthermore, the upcoming presidential election is a major source of stress for many students, as there is a concern that the climate on campus and in the country may be hostile towards minorities; this is significant given that most students at Gray University are from underrepresented groups. Also, these are important issues specifically for Resident Assistants, as equity, diversity, and inclusion are critical parts of the Resident Assistant role. Furthermore, given that the compensation for Resident Assistants is in the form of free on campus housing and a stipend for meals and other expenses, the role often attracts students from low income and minority backgrounds. These are groups that are already disproportionally stressed economically and racially, and the current environment is exacerbating many of these issues. The mental health and wellbeing of students from low income and minority communities is particularly of importance, as they are being disproportionally affected by the pandemic and economic fallout. Resident Assistants play a critical role in student care and concern, oftentimes being the first to respond to a variety of stressful and crisis situations in the residence halls. Currently, there are no published demographic or other descriptive statistics on the Resident Assistant population at Gray University. However, that will be addressed in this study. Additionally, given the critical role that Resident Assistants play at Gray University in supporting the mental health 6 of the student population, it is vital that the impact of the issues outlined above be fully understood. Organizational Goal Gray University has several organizational goals related to developing students that are prepared to live in a global society, cultivating inclusivity, elevating research, economic development, cultural enrichment, and sustainability. As part of these various goals, increasing retention and graduation rates are important elements of accomplishing these objectives. Currently, Gray University retains 95% of first-time freshmen, and 87% of these students graduate within 6 years. On average, it takes freshmen 4.2 years to complete their degrees. For transfer students, the 6-year graduation rate is 86%, and students take 2.5 years to complete their degrees. However, Gray University would like to both increase the graduation rate and decrease the time it takes a student to earn a degree. Additionally, the Division of Student Affairs at Gray University has set a goal for improving the culture of wellbeing and noted that this is essential to student success. A major objective in service of this goal is to create a culture of wellbeing that incorporates healthy and sustainable behaviors (Gray University, 2020). Therefore, Gray University has made it clear that in order to fully develop students into citizens of a globalized world, it is vital that students’ own health and welfare be attended to and improved. Related Literature The literature consistently shows that large and growing portions of the college student population meet the criteria for a mental health diagnosis. Specifically, in an analysis of data collected by the Center for Collegiate Mental Health at Pennsylvania State University, Xiao et al. (2017) determined that suicidal and self-injurious behaviors are increasing. According to this same analysis, between 2010-2015, there was a 30% increase in the number of students seeking 7 mental health services. Out of this group, 25% of students seeking services had engaged in self- harm behavior, 33% considered suicide, and 10% attempted suicide. The research also found a consistent year-over-year increase. According to a different study, almost half of college-aged individuals met the criteria for a psychiatric disorder in the preceding year of the study (Blanco et al., 2008). College counseling centers are experiencing a growing demand for their services due to the rise in both the number of students seeking their services and the complexity of the issues they are presenting. One study found that the demand for counseling services is increasing at a rate faster than growth in the student body (Xiao et al., 2017). Specifically, the researchers found that between 2010 and 2015, there was a 30% increase in the number of students seeking mental health services across this time period. However, university enrollments only increased 6% in the same period. Additionally, Watkins, Hunt, and Eisenberg (2012) found that the volume and complexity of the issues being presented at college counseling centers exceeds their capacity to address these issues. Specifically, in interviews with 10 college counseling center administration staff members, it was reported that the need for crisis services increased two to three times relative to previous years, but there were no new staff added to meet this demand. Given this increasing demand, tools for staff that work to address student wellbeing outside of the counseling center are needed, and preventative efforts are an important component of proactively addressing mental health. In a meta-analysis of various mental health prevention programs that address depression, anxiety, stress, and relationship issues, it was determined that preventative programs are effective and help alleviate mental health symptoms outside of an individual therapy context (Conley et al., 2017). Additionally, in a review of peer support programs (one at a hospital and another at a university), it was found that these programs help 8 reduce the stigma associated with seeking mental health support, assist non-clinicians recognize possible signs someone is experiencing suicide ideation, and model problem solving behavior for individuals to proactively address mental health issues (Kirsch et al., 2014). Such efforts could be utilized by Resident Assistants and other student staff members in addressing the growing issue of student mental health. By engaging peers and the university community in psychoeducation around mental health, these efforts can prevent mental health issues from escalating. Importance of the Study Gray University is committed to increasing its graduation rate, and part of doing so is improving student wellbeing by increasing access to psychological services and addressing student housing needs. Approximately 40% of students live on campus at Gray University, and the university has a goal of eventually being able to guarantee on campus housing for any student for the entire length of their educational endeavors. Based on the currently projected construction, by 2030, there will eventually be housing for close to 50% of the student population. This massive housing infrastructure also requires support services and staffing. Currently, Gray University employs 224 students as Resident Assistants in university housing. The addition of new residential spaces will require a significant increase in the number of Resident Assistants supporting the on-campus population. Given the rise in students with mental health issues and the role that Resident Assistants play in supporting these students, it is important to consider the impact that the growth in the on-campus student population has on a large population of student employees in the Resident Assistant role. Specifically, Resident Assistants are often the first point of contact for a student expressing signs of mental distress. As Resident Assistants have an 9 important role in both the prevention of mental health issues and in responding to students in distress, additional research is needed to ensure that Resident Assistants are effective in their ability to care for their own wellbeing. However, as most of the research on this problem is on addressing student mental health or on the impact of mental health issues on individuals that work in healthcare, there is a gap in the literature in understanding how Resident Assistants are impacted by mental health issues and what resources are necessary to support the welfare of staff engaged in this work. For example, Raimondi (2019) noted that while much research has been conducted regarding the impact on staff responsible for caring for others, most of the research is on professions outside of higher education. Especially given that this issue is increasing in magnitude and volume, it is critical that the impact of this issue on Resident Assistants be understood so that resources can also be developed to care for the caregivers. If Resident Assistants providing support to their fellow students are themselves too burnt out to do their jobs, this will impact their effectiveness and academic success. Therefore, this study will help better understand how the rise in mental health issues on college campuses impacts the Resident Assistants that support these students, and this in turn will lead to better professional development and services for Resident Assistants to ensure they are at their best when providing critical care for students in need. Furthermore, it is important to address the significant increase in the severity of mental health issues that are being presented by college students to ensure student success. Student mental health has an impact on academic success, as previous research has found that up to 11% of college dropouts are due to mental health reasons (Mojtabai et al., 2015). It has been found that students with depression were at a higher risk for dropping out of college (Eisenberg et al., 2009), and that college students who obtained the recommended support from counseling 10 services had higher GPAs and were more likely to graduate, as compared to peers who did not follow through with obtaining the recommended mental health treatment (Schwitzer et al., 2018). The research has shown that mental health can be a barrier to successfully completing a college education. Given the growing necessity of obtaining a college education, unaddressed mental health issues in college students can have a significant impact on a person’s future. However, it is important to note that Gray University does not currently track if students leave due to mental health reasons. Reasons for withdrawing from the university are only captured in broad categories, such as personal, medical, and other, and that will be an important issue to address as part of this study. Description of Stakeholder Groups Given the large-scale impact of this problem, a number of stakeholders are interested in addressing this problem. First, students with mental health issues are an important group, as they rely on the support they receive from other staff to address their own needs and wellbeing. Second, Resident Assistants and other paraprofessional student employees are an important stakeholder group, as they are key staff members on the front lines of addressing the student mental health crisis. Additionally, as this problem likely had an impact on them as well, it is important to address their own needs both as fellow students and as employees. Third, other students are important stakeholders, given that mental health issues can have an impact on the entire university community. Safe and healthy students thrive academically, and addressing the needs of students in crisis benefits the entire student population. Furthermore, professional staff members who are responsible for addressing the mental health needs of students, including staff who supervise Resident Assistants, are also an important stakeholder in this study. Given that they cannot do this work alone, it is important that they have the resources and support to ensure 11 they can contribute to the wellbeing of students. For the supervisors of Resident Assistants, their work supporting their student employees and by extension their residential communities, is improved by creating professional development experiences for their student staff members. Additionally, the university administration is an important stakeholder, given their responsibility for student wellbeing and academic success. As there is a connection between wellbeing and academic achievement, addressing this issue is important to ensuring that students are both safe and successful in their academic pursuits. Finally, the state and federal governments are important stakeholders, given their roles in funding a public university. As both entities make financial investments in institutions of higher education, they also have expectations that students graduate in a timely manner from universities. Services that increase students’ academic achievements are ultimately in the best interests of the government that wants to increase the educational attainment of their constituents. Stakeholder’s Performance Goals & Group for the Study Ultimately, all stakeholders share a common goal of increasing the academic success of students in higher education, and graduation from an institution is an important metric demonstrating this achievement. However, in the context of this study, the impact of the rise in student mental health issues on Resident Assistants is being examined. For this stakeholder group, one of the major goals is to understand if the increase in mental health issues is indeed impacting Resident Assistants, their experiences and day-to-day responsibilities, and if so, to have the necessary tools to address their own wellbeing. This ultimately impacts both their own academic achievement and the achievement of the fellow students they serve. Although an analysis of all stakeholder groups and their related goals would be useful in responding to this issue, this study will centrally focus its examination on the impact on Resident 12 Assistants. By focusing on this specific stakeholder group, a gap in the research around student mental health issues and Resident Assistants can be addressed. Furthermore, this will ensure that the needs of Resident Assistants are addressed in responding to fellow students in crisis. By examining the impact of student mental health issues on Resident Assistants, we can determine how to best support both these student employees and the students they serve. This will, in turn, inform best practices that address student success around mental health. Purpose of the Project and Questions The purpose of this study is to understand the impact that this rise in mental health issues in higher education has on Resident Assistants and examine self-care strategies for this population. This is critical given that Resident Assistants are on the front lines working to identify, support, and respond to students in mental distress. The knowledge from this study will then be used to identify professional competencies for Resident Assistants to ensure they are equipped to both support the students they work with and care for their own wellbeing. The questions guiding this study are the following: 1. How are Resident Assistants at Gray University impacted by the increasing volume and complexity of mental health issues occurring in higher education? 2. What are Resident Assistants’ perceptions regarding their ability to successfully support student mental health issues? 3. What self-care and support strategies do Resident Assistants use to maintain their own wellbeing? 13 Theoretical Framework This study will involve a survey of Resident Assistants that work in student affairs units at Gray University. Specifically, the Professional Quality of Life Scale (Stamm, 2010), also referred to as the “ProQOL,” will be used to identify if compassion fatigue and burnout are present in Resident Assistants. Additional questions will be asked about how Resident Assistants care for their own wellbeing and their self-efficacy in doing so. The theoretical framework for examining this issue is the Theory of Compassion Satisfaction and Compassion Fatigue. Specifically, this theory examines the impact of individuals and professionals working in helping professions. This includes occupations such as health care professionals, educators, police officers, firefighters, and others who respond to disasters (Stamm, 2010). Under this theory, the Professional Quality of Life measures how someone feels about their work in relation to their environment. This is important given that individuals that work in helping professions are exposed to difficult and challenging environmental factors, experiences, and events. The Professional Quality of Life can be divided into the positive feeling about work, described as Compassion Satisfaction, and the negative feelings, described as Compassion Fatigue. With Compassion Satisfaction, a person feels that they are able to make a difference and assist others in need. On the other hand, Compassion Fatigue describes the negative impact one experiences which can be further broken down into burnout and secondary trauma. Burnout is defined as feelings of “exhaustion, frustration, anger, and depression” (Stamm, 2010, p. 8). Secondary trauma is feelings of fear or other negative emotions that are directly the result of being exposed to the trauma of other individuals. It should be noted that fear is a central component of secondary trauma that distinguishes it from burnout (Stamm, 2010). Figure 1 from Stamm (2010) illustrates this theory: 14 Figure 1 Overview of the Professional Quality of Life Theory From Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org. Stamm (2010) further elaborates on this theory by describing how the work environment, the environment of the person being assisted, and the helper’s environment all have roles in Compassion Fatigue and Compassion Satisfaction. For example, a helper may feel Compassion Satisfaction as a result of their work environment, but a specific client’s environment may lead to feelings of Compassion Fatigue. Stamm (2010) illustrates this theoretical framework in Figure 2 below: 15 Figure 2 Detailed Theoretical Model of Compassion Satisfaction and Compassion Fatigue From Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org. This theory is important in understanding how the environment on a college campus, especially given the documented increase in mental health issues in higher education, and the role of a Resident Assistant impact an individual’s experiences in their roles in working to support student wellbeing. Definitions The following terms and concepts are key elements of this study. Therefore, the following definitions will create a greater understanding of their importance and applicability in addressing the issue of student mental health on college campuses. Anxiety: An umbrella terms for a variety of disorders that involve both a “real or perceived threat” as well as “anticipation of a future threat” (American Psychiatric Association, 2013, p. 189). 16 Burnout: An element of compassion fatigue that involves feelings of exhaustion, negative feelings or mental distance from a job, and a loss of effectiveness in a job that result from chronic workplace stress (Stamm, 2010; World Health Organization, 2018). Compassion fatigue: When an individual who works in a caring profession experiences a loss of empathy due to constantly being exposed to traumatizing events experienced by another person. This can involve feelings of exhaustion, anger, depression, or fear. Compassion fatigue includes two elements: burnout and secondary trauma (Figley, 1995; Stamm, 2010). Compassion satisfaction: The positive feelings that individuals derive from their work. Compassion satisfaction could come from a work environment, colleagues, or feelings about your work’s contribution to society. This is on the opposite end of the continuum as compared to compassion fatigue (Stamm, 2010). Depression: An umbrella term for a number of mood dysregulation issues which commonly feature “sad, empty, or irritable mood” (p. 155) along with physical and cognitive changes that impact a person’s functioning (American Psychiatric Association, 2013). Posttraumatic stress disorder: Feelings of both psychological and physical distress occurring as the direct result of being exposed to a traumatic event (American Psychiatric Association, 2013). Resident Assistant: A paraprofessional student staff member at an institution of higher education that has oversight for a community of fellow students that live on-campus. Resident Assistants typically live in their on-campus community in a residential facility among their residents and are responsible for creating a welcoming community, student safety, and responding to emergencies on an on-call basis (Blimling, 2003). 17 Secondary trauma: A second element of compassion fatigue in which a person experiences negative feelings, fear, or other symptoms typically experienced by someone directly exposed to trauma, due to being exposed to the traumatic events of others. (Stamm, 2010). Organization of the Study To fully examine the impact of student mental health issues on Resident Assistants, this study will be organized into five chapters. The first chapter provided an overview of the problem of practice and how this issue will be examined. The second chapter reviews the literature around student mental health, compassion fatigue, burnout, and secondary trauma, and examines both strategies and gaps in the literature in addressing these issues. The third chapter outlines the methodology employed to examine the impact of working with students in crisis on Resident Assistants through a survey. The details about the participants and data collection will be discussed. The fourth chapter analyzes this data and discusses the results. Finally, the fifth chapter provides recommendations based on the data collected for addressing the needs of Resident Assistants as well as areas of future research. 18 Chapter Two: Review of the Literature This chapter reviews the literature related to college student mental health, compassion fatigue, and secondary trauma. First, this review will discuss research on the increase in mental health issues appearing in student populations at institutions of higher education. Next, this review will discuss the concepts of compassion fatigue, compassion satisfaction, secondary trauma, and burnout. Furthermore, this review will examine the literature related to measuring compassion fatigue, research on psychological wellbeing, and strategies for addressing compassion fatigue. Finally, literature on social cognitive theory will be examined as a theoretical lens through which this research is examined. Mental Health of the College Student Population Mental health and the needs of students has rapidly become an area of focus for institutions of higher education, as the literature consistently shows that large and growing portions of the college student population meet the criteria for a mental health diagnosis. Specifically, the Center for Collegiate Mental Health at Pennsylvania State University collects data from university counseling centers across the country, and researchers have analyzed the data from this center. In one analysis of the data, Xiao et al. (2017) determined that suicidal and self-injurious behaviors are increasing. According to this same analysis, between 2010-2015, there was a 30% increase in the number of students seeking mental health services. Out of this group, 25% of students seeking services had engaged in self-harm behavior, 33% considered suicide, and 10% attempted suicide. The research also found a consistent year-over-year increase. Furthermore, there is also a rapid rise in the utilization of campus counseling services, as researchers found a 28.9% increase in the number of students seeking services from a university counseling center between 2009 and 2014 (Xiao et al., 2017). 19 Additional research has demonstrated that almost half of individuals in the traditionally college-age population had a mental health condition within the year prior to the study (Blanco et al., 2008). According Blanco et al. (2008), almost half of college-aged individuals met the criteria for a psychiatric disorder in the preceding year of the study (Blanco et al., 2008). This research used the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) that included psychometrically sound measures of a broad range of psychiatric disorders. The most prevalent disorders in the college students were alcohol use disorders (20%), followed by personality disorders (18%). Additionally, mood and anxiety disorders were found to be prevalent. Researchers have also found that significant portions of the student population could be diagnosed with a mental health disorder (Zivin et al., 2009). In this study, a survey was distributed to students at a university in the midwestern portion of the United States. The researchers found that over half of the students who completed the survey had at least one mental health issue. Depression and eating disorders were the most common diagnoses for students, with each impacting approximately 10% of the student population. As demonstrated by the research, the population of college students that is dealing with the symptoms of a mental health disorder is increasing. However, this growth is having a significant impact on college counseling centers’ ability to meet the demand for their services. Impact of Growth on College Counseling Centers College counseling centers are experiencing a growing demand for their services due to the rise in both the number of students seeking their services and the complexity of the issues they are presenting. One study found that the demand for counseling services is increasing at a rate faster than growth in the student body (Xiao et al., 2017). Specifically, the researchers found 20 that between 2010 and 2015, there was a 30% increase in the number of students seeking mental health services across this time period. However, university enrollments only increased 6% in the same period. Additionally, Watkins, Hunt, and Eisenberg (2012) found that the volume and complexity of the issues being presented at college counseling centers exceeds their capacity to address these issues. Specifically, in interviews with 10 college counseling center administration staff members, it was reported that the need for crisis services increased two to three times relative to previous years, but there were no new staff added to meet this demand. Furthermore, Locke, Wallace, and Brunner (2016) found that the demand for college mental health services is growing in a manner that is not explained by a growth in the demand for education in general. Specifically, this study examined data from Center for Collegiate Mental Health from 2016 and found that over the preceding five years, the use of college counseling centers has been increasing at five to seven times the rate of institutional growth. The increased need for the services offered by mental health professionals is important in addressing the growing population of students with mental health disorders. However, mental health also overlaps with the well-established college issue of substance abuse. Mental Health and Substance Abuse Researchers have found that there is an intersection between mental health and substance abuse in college students. According to Blanco et al. (2008), college students that have a mental health diagnosis may also have an issue with substance abuse. Specifically, by examining data from the National Epidemiologic Survey on Alcohol and Related Conditions, the researchers found that college students are more likely to have diagnoses of alcohol use disorder, mood disorders, and anxiety disorders. Additionally, polysubstance abuse and dependence are more common in college. 21 A different study conducted by Cranford, Eisenberg, and Serras (2008) found that students may cope with anxiety by engaging in the misuse of alcohol. This research involved a survey at large public university in the midwestern part of the United States, and data revealed that students with anxiety were more likely to engage in binge drinking. Finally, a third study found that college students who engage in alcohol abuse are more likely to also be dealing with depression or anxiety (Mason et al., 2014). This particular study involved a survey given to undergraduates enrolled in a psychology course at university in the southeastern United States. The data demonstrated that 1 in 5 students met the criteria for an alcohol abuse or alcohol dependence diagnosis. Additionally, the researchers found that young adults have the highest rates of dual diagnosis with depression. The most common coexisting issues were anxiety, substance use, and suicide ideation. Given this research, it is clear that substance use is a component of the mental health issue that exists on college campuses. Stigma Associated with Mental Health Furthermore, there is significant stigma associated with mental health issues. In research conducted at two Australian universities, Wynaden et al. (2014) found that stigma for mental health issues was strongly tied to experiencing discrimination as a result of having a mental health issue. These findings were replicated on a larger scale by Gaddis, Ramirez, and Hernandez (2018) where they analyzed data from over 62,000 students across 75 different colleges and universities provided via the Healthy Minds Study. Specifically, the Healthy Minds Study is a tool that surveys college students on a variety of mental health topics, and the researchers for this study compared those responses to data on the profiles of the various institutions. Based on the researcher’s analysis of this data, higher levels of stigma around mental health issues was associated with students underreporting mental health symptoms. Furthermore, 22 stigma also led to less engagement with mental health professionals for treatment, whether in the form of medication or therapy. Clearly, the stigma associated with mental health issues exists in higher education environments and creates barriers to seeking support for addressing a mental health concern. Social Cognitive Theory Bandura’s Social Cognitive Theory is a useful theoretical framework for examining this problem, as this examines the interaction and influence between a person, the environment, and behavior (Bandura, 2005). Specifically, various personal or individual, behavioral, and environmental factors that may influence the mental health of college students. By approaching this problem from the viewpoint of the Social Cognitive Theory, both large-scale and individualized approaches to understanding and addressing the growing problem of mental health among higher education students can be explored. Individual and Environmental Influences In examining why there has been a rapid increase in the number of students at colleges and universities that are experiencing mental health issues, researchers have examined various factors that influence a student’s wellbeing. Specifically, Byrd and McKinney (2012) examined data from the 2006 Student Development Survey to look at the social and emotional support students receive on campus. Using Bronfenbrenner’s ecological systems theory to examine the various levels of influence on a student, they found that at the individual level, there was a connection between the stress a student was experiencing and overall self-esteem. Students with higher levels of stress had move negative views of themselves and their abilities. Additionally, higher self-esteem may be a protective factor against the stressors experienced in the collegiate environment. At the interpersonal, they examined how social support factored into a student’s 23 mental health. Students with less social support experienced more mental health issues. And finally, they also examined the influence of the institutional factors, such as the campus climate and academic requirements. Again, students that viewed the climate of the campus as being hostile towards them (i.e., due to their status in a minority population) experienced higher levels of mental health issues. According to the researchers, the influences at the institutional and individual levels account for 49% of the causes of student mental health issues (Byrd & McKinney, 2012). Given this, it is clear that the environment has a huge impact on a student’s overall mental health. Other studies have also found similar results that demonstrate the impact of the person and the environment on student wellbeing. At the personal level, one researcher found that students experiencing high levels of stress are more likely to experience “spillover” effects of excessive stress, such as inadequate sleep and poor mental health (Pedersen, 2012). Furthermore, in an environmental study of living-learning programs on university campuses, Fink (2014) found that a sense of belonging and a supportive environment was an important component influencing a student’s overall mental health. Specifically, the climate of the institution, the student’s engagement with college activities, and the student’s interactions with the faculty and staff at the institution were all important environmental factors that influenced the prevalence of mental health issues. Individual factors such as a student’s demographics and their preparation for the collegiate environment also influenced their ability to be successful at the university level. This research is especially important in helping universities address the sense of belonging sought by students from underrepresented backgrounds, as this demonstrated the protective element provided by living-learning programs that create supportive environments for students from various identities (Fink, 2014). 24 Compassion Fatigue Compassion Fatigue is defined in the literature as a loss of empathy due to constantly being exposed to the trauma experienced by another person. This can involve feelings of exhaustion, anger, depression, or fear. Furthermore, compassion fatigue includes two elements: burnout and secondary trauma (Figley, 1995; Stamm, 2010). These two components of compassion fatigue will be examined further, including how they appear in the current literature. Burnout Burnout is a collection of symptoms that describe emotional exhaustion as a result of repeated exposure to demanding working situations and chronic work-related stress (Figley, 1995; Stamm, 2010; World Health Organization, 2018). Figley (1995) specifically noted that burnout is defined as “a state of physical, emotional and metal exhaustion caused by long term involvement in emotionally demanding situations” (Pines & Aronson, 1988, p. 9, as cited in Figley, 1995). It is noted that burnout develops gradually as a result of prolonged exposure to stress at work and a loss of achievement or sense of accomplishment. The symptoms of burnout are physical, emotional, behavioral, work-related, and interpersonal. These can include physical exhaustion, anxiety, depression, aggression, substance abuse, poor work performance, absenteeism, and withdrawing from clients and colleagues (Kahill, 1988, as cited in Figley, 1995). More recently, Figley and his colleagues have noted that burnout is likely when an individual does not have job satisfaction or social support, but their job involves a high level of emotional involvement (Boscarino et al., 2010). Burnout is a serious concern for providers of mental health services, as this has been shown to be an issue in many studies. First, in a qualitative study of psychologists that work a university counseling centers, burnout was reported due to increased demand for services from 25 students without a related increase in resources to meet those demands (Sim et al., 2016). Also, Maslach and Leiter (2016) described that there is a relationship between burnout and a lack of control over a work environment, especially as related to overwork. This is important to note given the rapid rise in mental health issues experienced by students documented earlier. Furthermore, in a metanalysis of 29 studies on burnout in psychologists, emotional exhaustion was reported as the most common symptom of burnout in addition to concerns about high workloads (McCormack et al., 2018). Finally, Morse et al. (2011) confirmed the concern about burnout for mental health providers, as between 21% to 67% of mental health providers may be experiencing burnout. Given these high levels of burnout for mental health professionals, there is a concern that this issue may extend to other individuals supporting students with mental health issues. However, the literature does not appear to address this issue. Note that there is some disagreement in the literature about using the ProQOL to measure burnout. First, several recent research projects in healthcare settings found Cronbach alphas below 0.70 for the burnout scale when administering the ProQOL. Specifically, in a study on the work conditions of nurses in a psychiatric unit, the burnout scale of the ProQOL was found to have a Cronbach’s alpha of 0.59 (Maila et al., 2020). Another study on palliative care professionals that sought to compare the ProQOL’s psychometric properties between different countries found that on the burnout scale, the Spanish version of the instrument had a Cronbach’s alpha of 0.537, and the Portuguese version had a Cronbach’s alpha of 0.654 (Galiana et al., 2016). Furthermore, a different study on palliative care volunteers found the burnout scale of the ProQOL had a Cronbach’s alpha of 0.12 (Pöyhiä et al., 2019). Second, researchers examining the validity of the ProQOL have been critical of the burnout scale and suggested that it should be reevaluated and improved or entirely revised (Hemsworth et al., 2018; Sprang & Craig, 2015). 26 Secondary Trauma Secondary trauma is defined as the emotions and behaviors that a person experiences as a result of being exposed to the trauma of a person they are helping. In other words, dealing with the pain and suffering of others can be contagious to the systems designed to support those who are suffering (Figley, 1995). According to Figley (1995), the trauma experienced by the victim is “an event outside the range of usual human experiences that would be markedly distressing to almost anyone” (p. 8). For the person that is helping the victim of the trauma, their exposure to this person’s trauma can result in experiences such as reexperiencing the traumatic event, avoiding things that remind them of the traumatic event, and a sense of being persistently stimulated (Figley, 1995). Figley (1995) also noted that this persistent stimulation can be in the form of sleep difficulties, irritability, issues with concentration, or hypervigilance (p. 8). Stamm (2010) also noted that fear as a result of a work-related trauma is a central component of compassion fatigue that distinguishes it from burnout. Furthermore, secondary trauma can occur rapidly, and the symptoms can quickly emerge after exposure to a traumatic event (Figley, 1995). More recent research has documented that secondary trauma is often associated with disaster recovery, poor psychological health, and other negative life events (Boscarino et al., 2010). Secondary trauma has been well documented in individuals that work in helping professions. For example, in a quantitative study of 430 psychologists, psychiatrists, counselors, nurses, doctors, police offices, and others human service professionals, these individuals were invited to complete a survey that measured the impact of trauma on their wellbeing and asked for comments about how they find support. According to the researcher, over 60% of the 27 respondents reported negative feelings and beliefs as a direct result of their exposure to traumatized clients (Tehrani, 2007). More limited research has documented secondary trauma in educators. In a mixed methods study of principals that work in schools along the U.S.-Mexico border, the ProQOL was administered to measure the levels of compassion satisfaction, burnout, and secondary trauma among this group of educators. Additionally, interviews were conducted to identify burnout and secondary trauma in principals and to gain insight into their self-care strategies. The researchers found that 22.23% of the respondents were dealing with secondary trauma, based on the responses from the ProQOL. In the qualitative interviews, the principals described the impact of working with students who had been sexually assaulted or that had experienced the murder of a family member. These educators described emotional difficulties related to their exposure to these situations (DeMatthews et al., 2019). While this study is in the context of K-12 education, this impact of students’ experiences on the individuals helping them in their education is important, as secondary trauma continues to be an issue for educators working in colleges and universities. Compassion Satisfaction Compassion satisfaction is the positive feelings that individuals derive from their work (Stamm, 2010). The relationship between compassion satisfaction and compassion fatigue has been studied extensively in healthcare professionals. In a study conducted by Ray et al. (2013), the ProQOL was used to measure and understand the prevalence of compassion fatigue and compassion satisfaction among 169 mental health care professionals. Based on the results, experience, work satisfaction, relationships with colleagues, and opportunities for promotion were all important factors in mitigating the effects of compassion fatigue and increasing 28 compassion satisfaction. This is similar to other studies of a similar nature, thus demonstrating the importance of these factors in increasing compassion satisfaction for individuals that work in helping professions (Ray et al., 2013). However, there is a lack of literature on compassion satisfaction in education professionals. In the research that is available, compassion satisfaction is prevalent and an important counterbalance to the impact of working with students experiencing significant distress. For example, in the same study of principals of schools along the U.S.-Mexico border described earlier, DeMatthews et al. (2019) found that 41.73% of the participants were experiencing compassion satisfaction. Similar to studies of healthcare professionals, years of experience and a sense of purpose were mitigating factors in helping buffer principals from the impact of working with students in distress (DeMatthews et al., 2019). Additional research is needed to understand if finding from the studies on healthcare professionals are applicable to education professionals. Impact on Student Employees While several recent dissertations have documented the impact of compassion fatigue on student affairs professionals (Bernstein Chernoff, 2016; Carter, 2019; Lank, 2019; Miller, 2018), almost no peer-reviewed research exists on the impact of the higher education mental health crisis on student employees. In one quantitative study of Resident Assistants, McCarthy (2019) utilized the ProQOL and found that Resident Assistants who worked specifically with students engaging in self-injury were more likely to be dealing with burnout and secondary trauma. Given the important role that students play in supporting their peers on campus and the growing mental needs of students in higher education, as outlined earlier, it is important that additional research be conducted in this area. A greater understanding of how compassion fatigue and compassion 29 satisfaction impact student employees on the front lines is critical to both the wellbeing of these employees as well as to the students that they support on a daily basis. Student Development Theory Student Affairs professional practice is grounded in student development theory. Specifically, student development in higher education is described through a variety of theories and models that describe the psychological and social development that students go through as part of their postsecondary educational experience (Patton et al., 2016). Given this, the work of Resident Assistants is guided by various student development theories. This is important to note, especially given that Resident Assistants are also students. Therefore, Resident Assistants have the unique role of both providing opportunities for their students to grow through developmental experiences while also personally experiencing student development as a scholar at an institution of higher education. A variety of student development theories that are relevant to the Resident Assistant role are described in this section. Schlossberg’s Theory of Mattering and Marginality First, Nancy Schlossberg’s theory of mattering and marginality is important in describing how a sense of belonging is important when people take on new roles, such as being a student at a university. Marginality results when an individual feels like they do not belong in this new setting, whereas mattering is a feeling of being important to other individuals. There are five dimensions to mattering: attention, importance, ego-extension, dependence, and appreciation. Specifically, mattering occurs through feeling noticed, cared for, and needed. This is especially important in higher education, especially given that a lack of feelings of mattering can lead to depression (Patton et al., 2016). Therefore, much of the work of Resident Assistant is centered around helping students feel seen, noticed, and that they matter. Schlossberg also noted that for 30 students from minoritized backgrounds, feelings of marginality may be permanent, whereas students from dominate identity groups may find marginality to be temporary and part of a transition process. Schlossberg’s Theory of Transition A second theory by Nancy Schlossberg is the theory of transition. According to this theory, there are four factors that are important in the success or failure of a transition process: situation, self, support, and strategies (Patton et al., 2016). This is important given that higher education is a critical transition for young adults as they go from being children dependent on their caregivers to fully independent adults. A critical part of this process for Resident Assistants is the support factor, as they provide social and psychological support for students going through the transition process. Of note, Resident Assistants are also going through their own personal transition and need this support (as well as the other factors) as well. Bourdieu’s Theory of Social Reproduction Third, Pierre Bourdieu’s theory of social reproduction is important in understanding how socioeconomic status intersects with educational opportunities and experiences. Specifically, Bourdieu’s theory describes how a dominant group creates unwritten rules to maintain power over the subordinate group. Bourdieu also describes how economic, social, and cultural capital are key components of social class. Cultural capital is especially relevant in institutions of higher education, as this describes knowledge as a source of power in dominant groups. In other words, these are the unwritten rules of success in an educational environment (Patton et al., 2016). This is of particular importance in higher education, as this may be the first time that a student is exposed to individuals from different social classes. Additionally, access to financial resources may be crucial to a student’s ability to engage in the unwritten rules of education, such as the 31 long-term academic and career success that comes with being involved in extracurricular activities. For example, a student that may need to work to support themselves through college has less time and money available to spend on student organizations or unpaid internships. Resident Assistants play a crucial role in helping students navigate these new relationships with individuals different from them and in access resources that support their financial wellbeing. Erikson’s Identity Development Theory The next theory was developed by psychologist Erik Erikson in an effort to describe the various developmental stages that individuals go through during the course of their lifespan as related to their identity. Overall, there are eight stages across an individual’s life, and stage five is the most relevant to undergraduate students of traditional age. Specifically, this stage, labeled identity versus identity diffusion, is where a person comes to understand who they are, their purpose in life, and their true sense of self. This stage is a critical part of emerging into adulthood and is a central part of the college experience (Patton et al., 2016). Resident Assistants are involved in facilitating this critical stage of development on a daily basis, whether that is through counseling conversations with students about class and major choices, through deeper philosophical programming about social and political issues. In fact, this stage is often a centerpiece of the college experience, as higher education is often seen as the place where people “find themselves.” Phinney’s Model of Ethnic Identity Development Jean Phinney’s model of ethnic identity development is based on Erikson’s identify development theory and is important for the wellbeing of students from minoritized backgrounds (Patton et al., 2016). Specifically, this model describes three stages that individuals go through as part of understanding their ethnicity. In the first stage, individuals have given little consideration 32 to their ethnicity. In the second stage, individuals become more aware of their ethnic identity as a result of experiences that require them to consider this part of their identity. This can be through negative experiences, such as harassment, discrimination, and white privilege. Phinney notes that intense feelings are a defining characteristic of this stage, as individuals experience anger towards the privileged group and guilt about previously being unaware of such dynamics. The third stage is one of integration in which an individual accepts their own ethnic identity and gains an awareness of the ethnic identities of others (Patton et al., 2016). These stages are especially important for supporting students from minoritized backgrounds, as higher education is often the place in which this model plays out. Chickering’s Developmental Vectors Finally, Arthur Chickering further developed Erikson’s work on identity to create seven vectors that are crucial to identity development. These vectors are developing competence, managing emotions, moving through autonomy toward independence, developing mature interpersonal relationships, establishing identity, developing purpose, and developing integrity (Patton et al., 2016). In many ways, these vectors integrate and apply the theories and models covered earlier into one holistic model. This includes the work that Resident Assistants do to help students find community and therefore develop relationships, to support students in understanding and regulating their emotional wellbeing, and to guide students in understanding both their own identities and the identities of other students who are different from them. Overall, these theories are important for students in understanding who they are as people, how they experience the world, and how they navigate an increasingly complex and challenging social environment. Additionally, Resident Assistants are a critical component of facilitating this development for students through the programming, support, and experiences 33 that they provide to their students. Given the importance of this work in student affairs and postsecondary education, professional standards for this work will be explored in the following section. CAS Professional Standards for Higher Education The Council for the Advancement of Standards in Higher Education (CAS) is a professional associated dedicated to ensuring quality in education programs and services. In service of this effort, they have developed professional standards for institutions of higher learning. Specifically, the CAS Professional Standards for Higher Education outline professional competencies, staffing requirements, and other benchmarks for the various areas that comprise higher education institutions. These standards are used by institutions in evaluating their own programs and services to ensure that they are of a high quality, providing excellent services, and in line with professional standards and best practices (Wells, 2015). Counseling services are critical to the educational mission of higher education, as they attend to the wellbeing of the student population. For Counseling Services, CAS standards state that a core responsibility of a counseling center is to “help foster an environment supportive of the intellectual, emotional, spiritual, and physical development of students” (Wells, 2015, p. 204). In doing so, professional counselors are an integral part of the educational experience of students by working with them to identify barriers to their academic success and advocating for their needs (Wells, 2015). By addressing the mental health of the student population, they help teach students how to cope with mental distress and address issues that may be preventing students from performing at their best of their abilities. The residential experience is also a critical component of many institutions of higher education, as providing a supportive living and learning environment is necessary for the 34 academic success of students. Resident Assistants are a central component of residential life programs, and the CAS standards address the required trainings and competencies that student employees should possess. Specifically, one of the functions listed in the standards for residence life staff, including resident assistants, is crisis intervention (Wells, 2015). Additionally, it is noted that residence life staff “must receive adequate training to make appropriate and timely referrals regarding any escalating behavior problems” (Wells, 2015, p. 296). Residence life staff are central to addressing emergencies on campus, and residence life is also an important part of the threat assessment group at institutions of higher education (Wells, 2015). Given that residence life creates a home for students, they are also important in the educational journey provided at colleges and universities. However, as demonstrated by the CAS standards, they are responsible for attending to the mental wellbeing of students, especially when students are exhibiting behaviors that indicate that they are experiencing mental distress. Resident Assistant Role In an effort to identify critical elements of the Resident Assistant role to better inform training and performance evaluation, Manata et al. (2017) conducted a quantitative study of 175 Resident Assistants at a large midwestern university. Specifically, the researchers reviewed the literature on student leadership, student development, and resident assistants to identify critical components of the Resident Assistant role. A survey was then designed for the participants to identity on a Likert scale the importance of the various components of the Resident Assistant role. Based on the research, important parts of the Resident Assistant role identified by the participants were managing conflict, maintaining physical safety, connecting with residents, forming relationships, connecting students to resources, encouraging involvement, counseling, academic support, role modeling, time management, and fostering physical safety. The 35 researchers noted that identifying these areas could be used to further examine Resident Assistants’ knowledge of these competences, and this in turn may inform their job performance (Manata et al., 2017). It should be noted that Resident Assistants are a central part of the support network for identifying students at risk of serious mental health issues on college campuses. Specifically, following the high-profile suicide of a student at the Massachusetts Institute of Technology (MIT), a task force examined the mental health issues on the MIT campus and the role that the university played in responding to students in mental distress. Resident Assistants and the residential life program were identified as key components of the support network for identifying and assisting students who may be experiencing mental illness. Additionally, training for residential life staff (including Resident Assistants) in crisis intervention and stress management was recommended by this task force, given the critical role that residence life plays in supporting students’ needs (Massachusetts Institute of Technology, 2001). As this specific case impacted how universities across the United States address student mental health, the recommendations of this task force are important in understanding the importance of having Resident Assistants who are properly trained to recognize and address the mental health needs of students. Impact on Student Success Student mental health has an impact on academic success, as previous research has found that up to 11% of college dropouts are due to mental health reasons (Mojtabai et al., 2015). Specifically, Mojtabai et al. (2015) examined data from the National Comorbidity Survey to correlate the prevalence of mental health disorders with educational achievement. The researchers found that between 37%-47% of the respondents experienced a mental health disorder while pursuing a higher education credential. Given the impact that mental health issues 36 have on college completion, the researchers extrapolated that approximately 850,000 college students do not finish their degrees due to a mental health diagnosis. Additionally, it has been found that students with depression were at a higher risk for dropping out of college (Eisenberg et al., 2009). In this study, the researchers conducted a survey study of graduate and undergraduate students enrolled at a large public university. This survey examined the mental health of students by measuring symptoms of depression, anxiety, and eating disorders and compared this with data from academic records, such as GPA, graduation, average credit hours, and admissions test scores. Eisenberg, Golberstein, and Hunt (2009) found that symptoms of major depression were associated with a lower GPA, and overall academic performance was negatively impacted by students that reported symptoms of mental illness. Furthermore, it has been found that college students who obtained the recommended support from counseling services had higher GPAs and were more likely to graduate, as compared to peers who did not follow through with obtaining the recommended mental health treatment (Schwitzer et al., 2018). Specifically, Schwitzer et al. (2018) examined data from a large metropolitan university during an eight year period to compare counseling center utilization with the academic datapoints of those students. The researchers found that the more counseling sessions a student had, the higher their GPA was likely to be and the more likely it was that they graduated within a six year timeframe. Additionally, students that completed their counseling treatment also had higher GPAs, and students that did not complete their counseling treatment were 64.1% less likely to earn their degree. Clearly, the research has shown that mental health can be a barrier to successfully completing a college education. Given the growing necessity of obtaining a college education, 37 unaddressed mental health issues in college students can have a significant impact on a person’s future. Impact of COVID-19 on Students Recently, the SARS-CoV-2 virus and the related COVID-19 pandemic have caused major disruptions for colleges and university. To combat the spread of SARS-CoV-2, many schools moved instruction online and closed or reduced capacity in on campus housing facilities. Given that this situation is new and ongoing, there is a lack of published research on the impact of the pandemic on students in higher education. Sahu (2020) noted that among the many challenges that universities must address in light of the pandemic, one major issue is supporting the mental health of the university population. Specifically, the increased anxiety and uncertainty about how the pandemic will unfold has created a great deal of stress, and this stress impacts both the ability of students to learn and their overall health. Furthermore, international students that are unable to return home due to travel restrictions may be concerned for their families, and students may be worried about the impact of this situation on their academic performance and degree completion. Furthermore, the related economic fallout of the pandemic may be another concern for students who are worried about their ability to find employment after graduation (Sahu, 2020). In a recently published study on the impact of COVID-19 on students in higher education, it was found that depression and anxiety were increasing at significant rates (Chirikov et al., 2020). Specifically, the Student Experience in the Research University (SERU) Consortium conducted a survey across students at nine public research universities that included 30,725 undergraduate students and 15,346 graduate and professional students. The survey utilized currently available screening tools for major depression and general anxiety. Based on 38 the results, 35% of undergraduate students and 32% of graduate and professional students had depression. Furthermore, 39% of all students (undergraduate, graduate, and professional students) had anxiety disorder. The prevalence rates among graduate and professional students is of note, as incidents of major depression doubled from 2019 to 2020. Additionally, the rate of anxiety is 1.5 times higher from 2019 to 2020. Of further concern, these issues were even higher in marginalized populations, such as students of color, LGBTQIA (lesbian, gay, bisexual, trans, queer, intersex, and asexual) students, and low income students (Chirikov et al., 2020). These findings were replicated in another study conducted to assess the mental health of adults in the United States during June of 2020. Specifically, a web based survey was distributed to a sample of adults that represented the greater population of the United States, and questions on the survey assessed for symptoms of anxiety and depression. The results demonstrated that 41% of the participants had a mental health condition, and 31% specifically reported symptoms of depression or anxiety. Also, 26% of the participants reported symptoms of posttraumatic stress disorder, acute stress disorder, and adjustment disorders associated with the COVID-19 pandemic. Additionally, 26% of the respondents that were 18-24 years of age reported that they had experienced suicide ideation in the previous thirty days. This is especially of note given that this is significantly higher than the overall rate of serious thoughts of suicide that 11% of the entire population reported (Czeisler et al., 2020). Noticeably, young adults are experiencing more significant mental health consequences related to COVID-19. Furthermore, Li et al. (2020) documented the impact of COVID-19 on students in the health professions in China. Specifically, this quantitative study utilized instruments that measure psychological distress and acute stress reaction. Based on the data collected, the researchers found that 27% of health professions students were experiencing significant distress. 39 Furthermore, the researchers were concerned that 11% of health professions students in China were displaying symptoms that could later develop into post-traumatic stress disorder. It should be further noted that the researchers documented that mental health issues may be exacerbated once the students graduate and enter into professional practice, as additional research has shown that 70% of healthcare workers in China were experiencing mental distress as a result of the pandemic (Lai et al., 2020). Clearly, the pandemic is impacts students who are studying and working in healthcare. In the professional publication Student Affairs Today, Dr. Salvador Mena (2020), Vice Chancellor for Student Affairs at Rutgers University-New Brunswick, noted that the COVID-19 pandemic is exacerbating existing inequalities in the student population. Specifically, Dr. Mena noted that students with economic difficulty before the pandemic faced additional challenges with stable access to food, housing, and technology. In fact, given that a computer and reliable internet access are now necessary to continue remote learning at an institution of higher education, technology has become a basic necessity for students (McCarthy, 2020). While it should be noted that this is not a research study, this anecdotal information from a practitioner in the field is important for documenting how COVID-19 is impacting higher education students. Strategies for Addressing the Problem Given that there are a number of influences on mental health from the perspective of the Social Cognitive Theory, there are also a number of research-based solutions to address the various inputs that impact a student’s mental wellbeing. Downs, Alderman, Schneiber, and Swerdlow (2016) reviewed a number of different strategies for addressing the mental health needs of college students. This includes individual-level interventions that involve talk-therapy with trained mental health clinicians and medication prescribed by medical professionals. These 40 researchers discuss that a team-based approach is the best method for addressing the mental health needs of students given the various factors and impacts on a student’s overall functioning. Furthermore, psychoeducation to teach students how to manage life stressors is an important preventative measure to help proactively address mental health issues experienced by students. Other research has examined the importance of creating a campus climate that is supportive of seeing mental health treatment. According to one study at a large university in the southeastern United States, a campus climate that is supportive of seeking mental health services impacts the value and reduces the stigma associated with mental health issues (Chen et al., 2016). Additionally, a survey of students at various public institutions of higher education across the state of California found that a campus climate that is supportive of help-seeking for mental health issues is an important factor in addressing student mental health (Sontag-Padilla et al., 2016). Finally, in research examining the impact of a student wellness program at the University of California Davis School of Medicine, creating a culture that is supportive of student mental and physical wellbeing had a significant impact on self-referrals for campus services. Specifically, this research noted that the percentage of students that actively sought mental health services increased approximately 30% since the creation of the program (Seritan et al., 2015). Researchers have also found other important influences that can proactively address the growing need for student mental health services. Specifically, it was found that students with good coping skills were more inclined to seek mental health assistance (Sontag-Padilla et al., 2016). Given this, the researchers recommend that teaching effective coping skills to students may be an effective way to increase help-seeking behaviors and prevent mental health issues. Furthermore, this same research also found that a least half of the students who needed mental health assistance obtained care from a provide outside of the college or university (Sontag- 41 Padilla et al., 2016). This is an important environmental factor to consider, as the availability of and relationships with off-campus providers may be a critical component of effectively responding to the mental health needs of students. Finally, preventative efforts are an important component of proactively addressing mental health. In a meta-analysis of various mental health prevention programs that address depression, anxiety, stress, and relationship issues, it was determined that these programs are effective and help alleviate mental health symptoms outside of an individual therapy context (Conley et al., 2017). Additionally, in a review of peer support programs (one at a hospital and another at a university), it was found that these programs help reduce the stigma associated with seeking mental health support, assist non-clinicians recognize possible signs someone is experiencing suicide ideation, and model problem solving behavior for individuals to proactively address mental health issues (Kirsch et al., 2014). By engaging peers and the university community in psychoeducation around mental health, these efforts can impact the person, the behavior, and the environment in a way that prevents mental health issues from escalating. Summary As outlined in this literature, there is a significant growth in the number of students in higher education experiencing mental distress. Furthermore, the volume and complexity of the issues students are presenting exceeds the capabilities of college counseling centers. This has the potential to impact student wellbeing, safety, and academic success. While there are many reasons for the growth in mental health issues, the impact that this growth is having on university staff is not well researched. This is important to understand given the significant impact that similar issues have on healthcare professionals. Specifically, compassion fatigue and compassion satisfaction are well documented among individuals that work in healthcare, and this is important 42 to ensuring that patients receive high quality care. However, parallel helping profession roles in higher education environments are not well researched, thus leaving open questions about how to best support student affairs staff that work with students in distress. Additionally, given the important role that Resident Assistants have in supporting their peers and the professional staff that work to support student wellbeing, it is important to understand the impact that the student mental health crisis has on Resident Assistants. 43 Chapter Three: Methodology The purpose of this study was to determine if Resident Assistants were impacted by rise in mental health issues at institutions of higher education and explore self-care strategies utilized by Resident Assistants. Specifically, a quantitative instrument was developed utilizing the ProQOL to determine if Resident Assistants are experiencing compassion fatigue as a result of their work. Furthermore, open-ended items were added to the survey to ask Resident Assistants to describe their self-care strategies and describe their feelings of self-efficacy in addressing student mental health concerns. In turn, this was used to determine training and professional development resources that should be provided to Resident Assistants to support them as they work with students experiencing mental distress. The questions guiding this study were as follows: 1. How are Resident Assistants at Gray University impacted by the increasing volume and complexity of mental health issues occurring in higher education? 2. What are Resident Assistants’ perceptions regarding their ability to successfully support student mental health issues? 3. What self-care and support strategies do Resident Assistants use to maintain their own wellbeing? This chapter will review the sampling and recruitment strategy for this study, describe the survey instrument that will be utilized by the researcher, and discuss issues of reliability and validity as related to this project. Additionally, the confidentiality and anonymity of the data will be discussed, as sensitive information about Resident Assistants is being collected. This is an important consideration to ensure the participants are honest in their responses. Furthermore, ethical considerations, including the role of the researcher in this project, will be discussed to 44 ensure this study is conducted in a principled manner that protects the wellbeing of the participants. Sampling and Recruitment To conduct this research, the researcher focused specifically on Resident Assistants, as this is a population of student employees that regularly interact with students experiencing mental health issues. In fact, responding to student crises is a critical component of the position. Therefore, conducting research on this group was helpful in ensuring that the researcher was working with student employees that have experience with the problem under investigation. Additionally, the sampling design was multistage clustering. Specifically, the researcher’s organization is broken into eight separate undergraduate residential life units that do not share common management. Given this, it was important that Residents Assistants from all eight clusters be represented in the sample, as this ensured that the sample was representative of the entire population of the researcher’s organization (Creswell & Creswell, 2018; Pazzaglia et al., 2016). The requirements to participate in the study were that the participant must be currently employed as a Resident Assistant in the researcher’s organization at the time of completing the survey. Furthermore, the participants must be 18 years of age or older. Additionally, the researcher asked about their tenure in the position, as comparing the experiences of new Resident Assistants to experienced staff members lead to useful data that answers the first research question. Specifically, this comparison was useful in demonstrating how Resident Assistants are impacted by exposure to mental health issues as part of their duties. Furthermore, the experiences of seasoned staff members may inform professional development competencies to assist Resident 45 Assistants in dealing with compassion fatigue. This in turn addresses the other research questions of this study. To recruit Resident Assistants to participate in the survey, the researcher worked with a proxy that was not within the reporting structure of the Resident Assistants. This proxy met with the supervisors of Resident Assistants to explain the purpose of the survey, communicated the importance of this research, described how the results will be used, and addressed concerns about confidentiality. By using a proxy, this eliminates any perception that the researcher was requiring Resident Assistants to participate in the survey. Also, the proxy provided survey invitations that were distributed through the Resident Assistant email distribution listservs. By using the listserv, Resident Assistants were not emailed individually to participate in the study, and therefore, there was no concern about collecting private student contact information to recruit participants. The proxy explained how this research will be helpful in improving both the work environment for Resident Assistants and potentially the work environments of students across the country. Explaining the importance of this work in addressing student mental health was a compelling incentive for current Resident Assistants to participate, as this is an issue that is important to students in higher education. Additionally, it was important to explain that the survey was completely anonymous and that the data did not impact students’ employment, as this may have been a concern that exists for students to report potentially negative things about their current work environment (Robinson & Firth Leonard, 2019). Furthermore, incentives were provided in the form of a drawing for one of three Amazon gift cards (in the amount of $100, $50, and $25) for participants that choose to participate in the drawing. Contact information for the drawing was collected in a database separate from the research survey, and therefore, the identities of the participants were not associated with their responses. Given that the population 46 is 224 Resident Assistants, the researcher needed to have at least 123 responses to ensure a 90% confidence level with a 5% margin of error. Stakeholders Resident Assistants (paraprofessional student staff) were the primary stakeholders of this study, as they are the focus of the survey. Specifically, the survey instrument was designed to examine their experiences, thoughts, and feelings, and this was used to understand how they are impacted by the rise of mental health issues in higher education. This will inform improvements in their workplace by informing professional development and support opportunities that address the needs of Resident Assistants. Given this, professional student affairs staff members who supervise Resident Assistants are also an important stakeholder in this study, as their work supporting Resident Assistants, and by extension their residential communities, is improved by examining and developing professional development experiences for their student staff members. As Resident Assistants have a central role in creating a supportive community for the institution, this issue has the potential to impact the entire campus community, as staff that are well are better able to perform the complex and demanding requirements of their positions. Data Collection and Instrumentation The survey that was administered is the Professional Quality of Life Scale, also referred to as the “ProQOL.” Specifically, the ProQOL assessment asks the respondent to rate how often they have experienced thirty different statements that describe various feelings about work and work-related stressors. Overall, the questions were used to measure compassion satisfaction and compassion fatigue (comprised of burnout and secondary trauma). Note that as described earlier, burnout and secondary trauma are elements of compassion fatigue. The tool asks a variety of questions about a person’s thoughts and feelings related to their work and the impact that their 47 work has on their own feelings and behaviors. Based on the scoring of individual questions, the results are given in specific scales related to participants’ levels of compassion satisfaction, burnout, and secondary trauma. The various combinations of these different scales (i.e., high burnout, low secondary trauma, and low compassion satisfaction) can provide insight into the wellbeing of the participants and the overall work environment. Additionally, while this tool is not meant to be a diagnostic measure of mental health issues, it can provide insight into the impact a work environment is having on an individual (Stamm, 2010). Measuring the thoughts and behaviors of Resident Assistants was important to gaining insight into the research questions (Robinson & Firth Leonard, 2019). Specifically, the ProQOL allows for a greater understanding of the experiences of the respondents, as this tool was used to directly ask about the thoughts and behaviors of the individuals taking this instrument. This was important to understanding how working as a Resident Assistant has impacted an individual’s thoughts and feelings, and by extension, their mental health. As the ProQOL gives specific scales related to participants’ levels of compassion satisfaction, burnout, and secondary trauma (Stamm, 2010), this helped to address the research questions in understanding how the rise in mental health issues in higher education may be impacting Resident Assistants own wellbeing. To ensure the reliability and validity of the instrument, no substantial changes were made to the ProQOL, and it was given in its entirety. Specifically, the ProQOL provides a space for the individual administering the survey to replace the word “helper” with the appropriate name of the group being surveyed (The ProQol Measure In English and Non-English Translations, 2012). In this case, the word “helper” was replaced with “Resident Assistant.” Additionally, several open-ended questions were added to the survey to allow respondents to provide detailed explanations of how their job has impacted their mental health and to describe self-care practices 48 that Resident Assistants engage in to manage their own wellbeing. Allowing for the opportunity to provide additional and detailed information in response to the survey allowed for further insight into the experiences of the participants (Robinson & Firth Leonard, 2019). While this was primarily a quantitative study, intramethod mixing was utilized by including open-ended questions that provided important qualitative data in response to the research questions. Applying multiple methods of data collection within the same instrument creates a stronger study that addresses the flaws a singular research method (Johnson & Christensen, 2015). Data was collected via an online Qualtrics survey during the early part of the Winter 2021 Quarter. One element that research shows is important to encourage participation is that the survey was evaluated to ensure that it is not too lengthy or complex. By doing so, this helps reduce the amount of time that participants must spend to finish the survey, thus making it seem like less of a burden to complete (Robinson & Firth Leonard, 2019). Additionally, the survey was divided into sections that display five questions at a time along with a progress bar that shows how much of the survey remains for the respondent to complete. Breaking the survey into smaller parts makes the instrument appears to be visually more manageable to the respondents, thus making it seem less long and burdensome to complete (Robinson & Firth Leonard, 2019). To encourage participation in the survey, several research-based methods were utilized, such as compelling invitations, engaging reminders, incentives, and informed consent (Robinson & Firth Leonard, 2019). Specifically, compelling invitations were developed that explain the research topic and the purpose of this study. This helped the Resident Assistants understand the importance of the project, how their confidentiality was protected in the research process, and how the data were used to enhance their work environment. This provided an incentive for them to participate, as their participation had the potential to improve both their own experience and 49 the experience of future Resident Assistants. Furthermore, a drawing for participants that elected to provide their contact information was held, as described earlier, to further incentivize participation. Following the distribution of the initial invitation, engaging reminders about the survey were sent before the opportunity to participate concluded. Finally, informed consent was a critical part of the data collection to ensure that participants understand that their participation was anonymous, how the data was stored, who had access to the data, and how participation does not impact their employment. This was important to ensure that Resident Assistants felt comfortable being open and honest in their participation. Note that as Gray University is a separate research site from the University of Southern California, the researcher has consulted with the Institutional Review Board at Gray University regarding this research project. As the researcher is not conducting this research as part of their job duties at Gray University and access to private student information protected by law is not required for this project, the Institutional Review Board at Gray University stated that they do not need to be engaged in this research project. Therefore, approval for this research was only required from the University of Southern California. Validity and Reliability To ensure the reliability of this study, a preexisting tool, the ProQOL, was utilized. This assessment has already been vetted and validated as being psychometrically sound (Stamm, 2010). By using an existing assessment, this ensures that data being collected was consistent throughout this project and therefore internally reliable (Creswell & Creswell, 2018). For the ProQOL, the scale for compassion satisfaction has an alpha scale reliability of 0.88, the burnout scale has an alpha scale reliability of 0.75, and the scale for secondary traumatic stress has an alpha scale reliability of 0.81. Furthermore, the full scale has no statistically significant 50 differences based on the gender, age, income, years of employment, or years of experience of the respondents. However, whites report a statistically significant less amount of burnout as compared to non-whites (Stamm, 2010). Also note that there is some disagreement about the validity of the burnout scale, as discussed earlier (Hemsworth et al., 2018; Sprang & Craig, 2015). Validity was also maximized by using a predeveloped instrument and through the process by which participants were selected for involvement in this research project (Creswell & Creswell, 2018). As described earlier, cluster sampling was used in determining the sample to be surveyed. Given that the researcher’s organization is divided into eight autonomous Residential Life units that do not share common training or organizational hierarchies, it was important that all eight clusters be represented in this sample. This ensured that the participant pool was representative of the various clusters of the entire organization (Pazzaglia et al., 2016). Additionally, utilizing a predevelopment instrument establishes content validity, as the ProQOL has been developed and vetted by mental health experts that study compassion fatigue, burnout, and secondary trauma (Salkind, 2014). Finally, the selection criteria for participation that limited the respondents to current Resident Assistants also addressed the validity of the survey by ensuring that participation in this research was limited to individuals with experience relevant to the research questions. Role of the Investigator The role of the investigator was an important consideration in this research, as the researcher has a supervisory relationship with some of the potential participants in this study. Specifically, the research site is divided into a number of distinct and independent Residential Life units. The researcher supervises the Director of Residential Life for one of these units, and 51 the Resident Assistants for one unit report to this Director. While there is a layer of management between the researcher and Resident Assistants, it was important to keep this concern in mind so that there was no conflict of interest for the researcher. In an effort to address this concern, a proxy was used to communicate with the Directors of Residence Life about this research, as outlined earlier. Specifically, the proxy communicated with the Directors of Residence Life about this research project as well as provided the survey invitations for Resident Assistants to participate. By using a proxy, the researcher did not interact directly with either the Directors of Resident Life or the Resident Assistants. Therefore, the participants should not have felt coerced to participate based on the supervisory relationship of the researcher with the Resident Assistants. Furthermore, it is important to note that due to the organizational structure of the university, this supervisory relationship only exists for approximately 14% of the Resident Assistants. The remaining population of Resident Assistants were not under the purview of the researcher. Finally, as outlined below, efforts were made to ensure the data is anonymous and that the participants were fully informed of their anonymity, the protection of their employment, and their right to decline participation in the study. Given that this research was collecting potentially sensitive information about the experiences of Resident Assistants, these were important considerations in both protecting the integrity of the information provided by the participants and in ensuring that the participants felt free to provide open and honest information about their experiences which therefore ensures the integrity of this research. Ethical Considerations This research was done from a pragmatic worldview, as this was seeking to find a solution to the problem of how mental health issues in higher education impact Resident 52 Assistants working to address these situations (Creswell & Creswell, 2018). However, it is important that ethical issues, specifically around power dynamics, were addressed to ensure that participants were protected in the research process. Given that this research was conducted on students employees by their organization and by a researcher that oversees a portion of their functional area, it was important that they not be compelled into participating, that their participation was anonymous, and that the data was protected. Additionally, Resident Assistants needed to be informed that their employment was not impacted as a result of participating (or declining to participate) in the study. In fact, Resident Assistants may report that there were practices the researcher engaged in that were barriers to their own well-being. To obtain this information, it was important that Resident Assistants felt secure in being honest. To effectively manage these issues, the researcher needed to work with the staff that manage Resident Assistants via a proxy to ensure they understand the protocols the researcher established to protect their anonymity and the integrity of the data. Specifically, the main survey instrument did not collect identifying information, and the researcher did not know which students completed any particular survey. (As noted earlier, participants elected to provide identifying information for the purpose of participating in a drawing. However, this identifying information was collected separately from the survey data and was not connected with the participants’ responses.) Furthermore, responses to the survey were secured on a password-protected website that was only accessible to the researcher, and the data only contained aggregate responses to the survey instrument. Taking these steps to remove direct access to the responses provided by students as well as the use of a proxy addressed the issue of the imbalance in the power dynamic, as students may have perceived the researcher as having authority over the position (Creswell & Creswell, 2018; Robinson & Firth Leonard, 2019). 53 Furthermore, given the power dynamics and the fact that this survey was addressing a sensitive topic, social desirability bias may have been an issue. To address this, the survey was composed of mostly closed-ended questions with standardized and wide-ranging response options to help normalize their experiences (Robinson & Firth Leonard, 2019). Taking these steps helped to ensure that the participants were not just providing responses that make them appear in the best light, especially given that this study asked Resident Assistants to discuss negative ways in which their employment was impacting them. Overall, addressing these ethical concerns protects both the integrity of this research project and the wellbeing of the participants. 54 Chapter Four: Results This chapter presents the quantitative and qualitative results to address the research questions: 1. How are Resident Assistants at Gray University impacted by the increasing volume and complexity of mental health issues occurring in higher education? 2. What are Resident Assistants’ perceptions regarding their ability to successfully support student mental health issues? 3. What self-care and support strategies do Resident Assistants use to maintain their own wellbeing? Preliminary Analysis This section presents the results of descriptive analyses and demographic information on the participants of the study. Overall, 125 participants completed the survey through the end of the section that contained the full ProQOL scale, thus allowing for scales of compassion satisfaction, burnout, and secondary trauma to be calculated. As there were 224 eligible Resident Assistants that received invitations to complete the survey, this resulted in a 55.8% response rate. Additionally, 125 participants produce a confidence level of 90% with a 5% margin of error. Overall, the participants were mainly first year Resident Assistants, as 61.6% reported that this was the first year in the position. Resident Assistants with one year of experience represented 11.2% of the respondents, while 23.2% had two years of experience, and 4% had three years of experience. The participants heavily identified as female (66.4%), while 26.4% identified as male, 6.4% identified as non-binary, and 0.8% declined to identify their gender. Additionally, participants reported their ethnicity as Asian (33.6%), Hispanic/Latinx (31.2%), Caucasian (30.4%), Black/African (8.8%), Native American (1.6%), and Pacific Islander (1.6%). 55 Other ethnicities were reported by 4.8% of the participants, and 3.2% declined to provide their ethnicity. (Participants that selected “other” for their ethnicity could enter an ethnicity of their own description, and the responses provided were Southeast Asian, White, Mexican-Egyptian, and Middle Eastern.) Note that participants could report multiple ethnicities. Table 1 outlines the overall demographics reported by the study participants, as described above. Table 1 Demographic Variables for All Participants Variable n % Gender Female Male Non-binary Declined to state 83 33 8 1 66.4 26.4 6.4 0.8 Ethnicity Asian Hispanic/Latinx Caucasian Black/African Other Declined to state Native American Pacific Islander 42 39 38 11 6 4 2 2 33.6 31.2 30.4 8.8 4.8 3.2 1.6 1.6 Years of Experience Less than one year 1 year 2 years 3 years 77 14 29 5 61.6 11.2 23.2 4.0 56 In order to examine the reliability of the research instrument, Cronbach’s alpha was calculated for the overall survey as well as for the items that comprise each of the three scales. The overall survey resulted in a Cronbach’s alpha of 0.79, which indicates a high level of internal reliability on the entire survey instrument. Additionally, the compassion satisfaction scale also had a high degree of internal consistency with a Cronbach’s alpha of 0.90. This is in line with the Cronbach’s alpha for the instrument given as 0.88 (Stamm, 2010). Furthermore, the secondary trauma scale also had a high level of internal consistency with a Cronbach’s alpha of 0.75. This is also similar to the Cronbach’s alpha for the instrument given as 0.81 (Stamm, 2010). Of note, the burnout scale had a lower Cronbach’s alpha of 0.47. This is lower than the expected alpha of the instrument, given as 0.75. Overall, the survey instrument appears to have a high degree of internal reliability, with the exception of the burnout scale. Table 2 summarizes the Cronbach’s alpha computed for each component of the survey. Table 2 Cronbach’ s a for ProQOL Assessment Item Cronbach’s a Overall Assessment 0.79 Compassion Satisfaction 0.90 Burnout 0.47 Secondary Trauma 0.75 57 Research Question 1 Research question 1 asked, How are Resident Assistants at Gray University impacted by the increasing volume and complexity of mental health issues occurring in higher education? Multiple elements of the survey addressed this question, including scores on the ProQOL as well as open ended questions regarding the mental health and wellbeing of the participants. Each of these various parts of the survey will be analyzed in this section. First, the results of the ProQOL section of the survey produced three scales for each of the elements under evaluation: compassion satisfaction, burnout, and secondary trauma. Overall, Resident Assistants reported moderate levels of compassion satisfaction and burnout, and low levels of secondary trauma. A summary of the descriptive statistics for each of these scales is outlined in Table 3, and further details of the results of each scale will be described in this section. Table 3 Descriptive Statistics of ProQOL Results Scale M Mdn SD Level Minimum Maximum n Compassion Satisfaction 37.4 38 5.2 Moderate 20 46 125 Burnout 26.2 26 4.6 Moderate 16 38 125 Secondary Trauma 21.6 21 5.0 Low 12 40 125 58 For the compassion satisfaction scale, the overall results indicate that Resident Assistants are experiencing moderate levels of compassion satisfaction (M=37.4; Mdn=38; SD=5.2; n=125). Specifically, compassion satisfaction scores range from 10-50, and the ProQOL defines low compassion satisfaction as a score of 22 or less, moderate compassion satisfaction as a score between 23 and 41, and high compassion satisfaction as a score of 42 or higher (Stamm, 2010). Given the close values of the mean and median compassion satisfaction score (37.4 and 38 respectively), there does not appear to be strong outliers in the spread of scores. Figure 3 contains a distribution of all of the individual scores for compassion satisfaction, and this demonstrates that the results are negatively skewed towards the higher end of the scale. Specifically, the majority of the scores are on the higher end of the entire compassion satisfaction scale, with the majority appearing on the upper end of the moderate range. Additionally, there is a subset of Resident Assistants (n=25) that are experiencing high levels of compassion satisfaction (score of 42-50). Based on these results, it appears that overall, most Resident Assistants are positively experiencing moderate levels of compassion satisfaction. 59 Figure 3 Compassion Satisfaction Score Distribution Note. This chart shows the number of individuals that had certain scores on the compassion satisfaction scale. Compassion satisfaction scores range from 10-50, based on the answers provided by the participant. Low: 10-22; Moderate: 23-41; High: 42-50. n=125. Next, the burnout scale indicates that overall, Resident Assistants are experiencing moderate levels of burnout (M=26.2; Mdn=26; SD=4.6; n=125). Specifically, burnout scores range from 10-50, and the ProQOL defines low burnout as a score of 22 or less, moderate burnout as a score between 23 and 41, and high compassion satisfaction as a score of 42 or higher (Stamm, 2010). The close values in the mean score of 26.2 and the median score of 26 also indicate that there are no strong outliers in the results of this scale. Figure 4 illustrates the spread of individual burnout scale results for individual participants. These results show the burnout scores occurring mostly in the middle of the range of the scale. However, the bimodal distribution of these scores indicate that there is a subset of individuals (n=33) reporting lower 0 2 4 6 8 10 12 14 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 Frequency of Scores Score 60 levels of burnout, while the majority of participants reported more moderate levels of burnout (n=92). No individuals reported high levels of burnout. Overall, while these results indicate that Resident Assistants are experiencing moderate levels of burnout within their positions, the distribution of the individual scores is important in further examining why a subset of Resident Assistants are experiencing lower levels of burnout as compared to the majority of their peers. The qualitative data provided by the participants in later questions on the survey may further illuminate the reasons behind this and will be described later in this chapter. Figure 4 Burnout Score Distribution Note. This chart shows the number of individuals that had certain scores on the burnout scale. Burnout scores range from 10-50, based on the answers provided by the participant. Low: 10-22; Moderate: 23-41; High: 42-50. n=125. 0 2 4 6 8 10 12 14 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 Frequency of Scores Score 61 Finally, the secondary trauma scale results show that Resident Assistants are experiencing low levels of secondary trauma (M=21.6; Mdn=21; SD=5.0; n=125). Specifically, secondary trauma scores range from 10-50, and the ProQOL defines low secondary trauma as a score of 22 or less, moderate secondary trauma as a score between 23 and 41, and high secondary trauma as a score of 42 or higher (Stamm, 2010). The close values in the mean score of 21.6 and median score of 21 demonstrate that there are no strong outliers in the secondary trauma scale results. The individual results for the secondary trauma scale appear in Figure 5. Overall, these results appear on the lower to middle range of the scale. There are 74 Resident Assistant experiencing low levels of secondary trauma, 51 Resident Assistants experiencing moderate levels of secondary trauma, and zero resident assistants at the high level. Generally, these results indicate that Resident Assistants are experiencing low levels of secondary trauma. However, it is important to note that the overall results are 2 points below the moderate range, and a significant subset of participants (n=51) are in the moderate range. 62 Figure 5 Secondary Trauma Score Distribution Note. This chart shows the number of individuals that had certain scores on the secondary trauma scale. Secondary trauma scores range from 10-50, based on the answers provided by the participant. Low: 10-22; Moderate: 23-41; High: 42-50. n=125. Next, relationships between the ProQOL scales and the demographic characteristics reported by the study participants were examined in an effort to better understand what role these factors may play in understanding how Resident Assistants are impacted by the increasing volume and complexity of mental health issues. First, a ranked t test for independent samples was conducted to compare the ethnicities reported by the participants with the scores for compassion satisfaction, burnout, and secondary trauma. The results of this analysis are described in Table 4 using Cohen’s d to determine the effect size of the relationship between the variables. 0 2 4 6 8 10 12 14 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 Frequency of Scores Score 63 Based on this analysis, participants that did not select Hispanic/Latinx (M=22.3; n=86) tended to have higher secondary trauma scores as compared to individuals that did select Hispanic/Latinx (M=20.0; n=39) (p=0.01). The effect size of this relationship is medium, with a Cohen’s d of 0.56. Additionally, participants that did not select Hispanic/Latinx (M=26.7; n=86) tended to have higher burnout scores as compared to individuals that did select Hispanic/Latinx (M=24.9; n=39) (p=0.04). The effect size of the relationship on burnout scores is also medium, with a Cohen’s d of 0.40. Overall, the results of this t test indicate that participants that identified part of their ethnicity as Hispanic/Latinx were experiencing lower levels of burnout and secondary trauma as compared to their peers from other ethnicities. Otherwise, there were no statistically significant differences between the scores reported for compassion satisfaction, burnout, secondary trauma and the various ethnicities reported by the participants. It should be noted that participants that did not select other for their ethnicity (M=37.6; n=119) tended to have higher compassion satisfaction scores as compared to individuals that did select other (M=34.0; n=6) (p=0.04). However, given the small number of individuals (n=6) that selected other for their ethnicity and the variety of responses entered for other ethnicities, it is difficult to draw a conclusion from this result. Overall, the results of this analysis indicate that Hispanic/Latinx individuals may be the only group experiencing significant differences in their experiences as it relates to burnout and secondary trauma. 64 Table 4 Relationships Between Ethnicity and ProQOL Scores – Cohen’ s d Compassion Satisfaction Burnout Secondary Trauma n Asian 0.03 0.08 0.29 42 Black/African 0.23 0.16 0.30 11 Caucasian 0.08 0.08 0.09 38 Hispanic/Latinx 0.08 0.40* 0.56** 39 Native American *** *** *** 2 Pacific Islander *** *** *** 2 Other 0.79* 0.79 0.76 6 Declined to state 0.01 0.22 0.36 4 Note. All values are expressed as Cohen’s d. *p < .05. **p < .01. ***No statistical test could be run due to insufficient data. Additionally, an analysis of variance (ANOVA) was conducted to compare the gender and years of experience reported by the participants with the scores for compassion satisfaction, burnout, and secondary trauma. The results of this analysis are described in Table 5 using Cohen’s f to determine the effect size of the relationship between the variables. Based on these results, the only statistically significant relationship identified was between compassion satisfaction scores and years of experience (p=0.049). Specifically, individuals with three years of experience as a Resident Assistant had the highest compassion satisfaction scores (M=40.2; n=5), as compared to Resident Assistants with two years of experience (M=35.0; n=29), one year of experience (M=39.6; n=14), and less than one year of experience (M=37.7; n=77). The effect size of this relationship was medium, with a Cohen’s f of 0.30. There were no statistically significant relationships between the other variables under consideration. Overall, these results indicate that there may be a relationship between the amount of experience a Resident Assistant has and their experience of compassion satisfaction. However, it is important to note that the 65 differences between the average compassion satisfaction scores of each group indicate that this relationship does not have a substantial impact in increasing compassion satisfaction. Table 5 Relationships Between Variables Measures – Cohen’ s f Measure Gender Years of Experience Compassion Satisfaction 0.09 0.30* Burnout 0.05 0.14 Secondary Trauma 0.18 0.13 Note. All values are expressed as Cohen’s f. n=125. *p < .05. 66 Furthermore, Pearson’s correlation coefficients were calculated between the different scales on the ProQOL in order to examine the relationships between the various components of the ProQOL. Table 6 summarizes the results of the analysis of these relationships. Specifically, burnout was found to be negatively correlated with compassion satisfaction with a moderate to strong relationship (r=-0.40; n=125; p<0.01). Additionally, secondary trauma was found to be positively correlated with burnout with a moderate to strong relationship (r=0.42; n=125; p<0.01). Both of these relationships were found to be statistically significant. Note that there was no statistically significant relationship identified between secondary trauma and compassion satisfaction. Therefore, it can be concluded that Resident Assistants experiencing higher levels of burnout also experienced higher levels of secondary trauma and lower levels of compassion satisfaction. Likewise, Resident Assistants with lower levels of burnout also experienced lower levels of secondary trauma and higher levels of compassion satisfaction. Table 6 Relationships Between ProQOL Scales – Pearson’ s r Scale 1 2 3 1. Compassion Satisfaction - 2. Burnout -0.40** - 3. Secondary Trauma 0.02 0.42** - Note. All values are expressed as Pearson’s r. n=125. **p < .01. 67 The next variable under consideration was constructed using responses to the question on the survey that asked the participants to indicate their experiences with the statement, “I am supported by my organization in my role as a Resident Assistant.” In response to this statement, the participants indicated their level of support using a Likert scale response, ranging from “never” (value of 1) on the low end of the scale to “very often” (value of 5) on the high end of the scale. This data has been labeled as the “support” variable. A summary of the descriptive statistics of the responses to this question appear in Table 7. Based on the results, the participants indicated a high level of support from the organization (M=4.1; Mdn=4; SD=0.9; n=125). Additionally, while the participants indicated experiencing support at all levels of this scale, the majority of the participants reported experiencing support from the organization often (n=53) or very often (n=46). Very few participants reported never (n=1) or rarely (n=5) experiencing support. The spread of responses to this question is displayed in Figure 6. Overall, it can be concluded that Resident Assistants are experiencing high levels of support from their organization. Table 7 Descriptive Statistics of Support Variable M Mdn SD Minimum Maximum n Support 4.1 4 0.9 1 5 125 68 Figure 6 Distribution of Support Variable Responses n=125. Next, relationships between the support variable and the demographic characteristics reported by the study participants were examined in an effort to better understand what role these factors may play in understanding how Resident Assistants are experiencing various levels of support from the organization. First, a t test for independent samples was conducted to compare the ethnicities reported by the participants with support variable. The results of this analysis are described in Table 8 using Cohen’s d to determine the effect size of the relationship between the variables. Based on this analysis, participants that selected Black/African tend of have statistically significant higher levels of support (M=4.6; Mdn=5; n=11) as compared to individuals that did not select this ethnicity (M=4.1; Mdn=4; n=114) (p=0.01). The effect size of this relationship is medium, with a Cohen’s d of 0.72. Otherwise, there were no statistically significant differences between the support variable and the various ethnicities reported by the participants. It should be noted that participants that did not select other for their ethnicity tended 1 5 20 53 46 Never Rarely Sometimes Often Very Often "I am supported by my organization in my role as a Resident Assistant." 69 to have higher support scores (M=4.1; Mdn=4; n=119) as compared to individuals that did select other (M=3.5; Mdn=4; n=6) (p=0.04). However, given the small number of individuals (n=6) that selected other for their ethnicity and the variety of responses entered for other ethnicities, it is difficult to draw a conclusion from this result. Overall, the results of this analysis indicate that Resident Assistants that identify as Black/African may be the only group experiencing significant differences in their experiences as it relates to feeling supported by the organization in the Resident Assistant role. Table 8 Relationships Between Ethnicity and Support – Cohen’ s d Support n Asian 0.18 42 Black/African 0.72* 11 Caucasian 0.26 38 Hispanic/Latinx 0.30 39 Native American *** 2 Pacific Islander *** 2 Other 0.77* 6 Declined to state 0.21 4 Note. All values are expressed as Cohen’s d. *p < .05. ***No statistical test could be run due to insufficient data. 70 Table 9 Relationships Between Variables Measures – Cohen’ s f Gender Years of Experience Support 0.14 0.33 Note. All values are expressed as Cohen’s f. p > .05. n=125. Furthermore, an analysis of variance (ANOVA) was conducted to compare the gender and years of experience reported by the participants with the support variable, and the results of this analysis are described in Table 9 using Cohen’s f to determine the effect size of the relationship between the variables. Based on the results of this analysis, there were no statistically significant relationships between the variables under consideration. Therefore, gender and years of experience do not appear to have a relationship with the levels of support experienced by Resident Assistants. Also, Pearson’s correlation coefficients were calculated between the different scales on the ProQOL and the support variable in order to examine the relationships between these two factors. The results of this analysis appear in Table 10. Based on these results, statistically significant relationships were found between the support variable and burnout and compassion satisfaction. Specifically, compassion satisfaction was found to be positively correlated with the support variable with a moderate to strong relationship (r=0.45; n=125; p<0.01). Additionally, burnout was found to be negatively correlated with the support variable with a weak to moderate relationship (r=-0.26; n=125; p<0.01). Note that there was no statistically significant relationship identified between secondary trauma and the support variable. Therefore, it can be concluded that Resident Assistants that experienced higher levels of compassion satisfaction also felt more 71 supported by the organization, and Resident Assistants that experienced high levels of burnout may have felt less supported by the organization. Table 10 Relationships Between ProQOL Scales and Support Variable – Pearson’ s r Measure Support Compassion Satisfaction 0.45** Burnout -0.26** Secondary Trauma -0.16 Note. All values are expressed as Pearson’s r. n=125. **p < .01. 72 Qualitative Analysis of Resident Assistant Mental Health Additional qualitative data was gathered via the survey in an effort to further understand the mental health of Resident Assistants. Specifically, an open-ended question on the survey asked, “In what ways, if any, has being a Resident Assistant affected your own mental health?” The majority of the responses provided information that described symptoms of mental health concerns and expressed distress about trying to find a healthy balance between work and non- work activities. Other responses disclosed feelings of isolation and negative impacts to personal energy. In contrast to these themes, a large number of responses also described how the job positively supported mental wellbeing. A sample of quotes provided by different participants in these various themes appears in Table 11. Mental Health Symptoms More specifically, responses about stress, anxiety, isolation, and depression were common descriptions used by the participants to describe the impact of the Resident Assistant role on their wellbeing. In particular, the word “stress” appeared 31 times in the responses given by the participants, and 41 participants described symptoms of mental health issues in their narrative. For instance, one participant described how stress intersects with both their Resident Assistant duties and academic responsibilities by stating, “Stress can definitely be a factor, especially while focusing on personal academics while supporting others. I find myself pulled in many directions, mentally.” Another participant disclosed a similar experience about how “the workload sometimes can feel overwhelming with school and my other job which leads to burnout and anxiety.” In this description, it appears that the time required by the position leads to symptoms of mental distress. Several responses also described how COVID protocols caused feelings of isolation which then also led to mental health concerns. For example, one response 73 mentioned that “living in a single unit is extremely isolating… Being in meeting is the highlight of my week but as soon as they end I am alone again and it gets bad, the frequency of intrusive thoughts are increasing for me.” Additionally, another Resident Assistant described being overly self-critical about the impact they were having on their residents and mentioned that this “gave me anxiety and put me in a depressive episode for weeks.” Similar concerns about the demands of the Resident Assistant role and the impact this had on their mental wellness were described by other participants. Therefore, it appears that stress related to the responsibilities of the position is a common source of mental health concerns for the Resident Assistants. Work-Life Balance Another theme that emerged was the difficulty in finding balance between the time required by the Resident Assistant role and the desire to spend time doing things outside of the job, as described by 41 participants. For example, one participant mentioned that they “have an ‘always on’ mentality, so I feel like there is always something I could be doing or planning...” and that they “have guilt about taking breaks sometimes.” In this response, the participants appear to feel obligated to be entirely dedicated to the position at all times. Another Resident Assistant described feeling the need to continuously be available by stating, “It is sometimes incredibly difficult to take time for myself when I know that I have to be on call for my residents 24/7. Having a job that is always on means that sometimes I don’t feel like I have time to do basic self care and that can become overwhelming.” Clearly, this Resident Assistant felt compelled to be devoted to the position at the expense of their own wellbeing. This intersection between the time demands of the position and mental wellness was a common theme, as described in one response that mentioned how the role “has worn me out a bit and caused some anxiety because I feel as though I am constantly balancing the RA position with everything else, 74 especially during COVID.” As described earlier, this difficulty in finding a balance between work and non-work activities appears to be a source of stress and anxiety for Resident Assistants and may be a contributing factor in the mental destress described by the participants. Positive Impact of the Resident Assistant Role An encouraging theme also emerged from 41 responses that described the positive impact of the Resident Assistant role on a number of participants. For example, one participant identified that the Resident Assistant role has “brought to my attention, my mental health and how I can improve, be better, and improve myself.” This theme of describing how the position taught the participant how to improve their own wellbeing appeared in several responses. For instance, one Resident Assistant described this by stating the role “made me more aware of my mental health and I feel more comfortable reaching out to friends and family for help or to just open up to them about situations or tough times I go through.” Another participant described this theme of self-improvement by sharing, “I think being a Resident Assistant has benefitted more than harmed my mental health. This position has given me the opportunity to make valuable connections and have meaningful conversations.” Finally, another response disclosed how the position improved a negative mental state, sharing that “My mental health had already been unstable. The RA position is a job and comes with benefits and I am very grateful for it. I actually think the RA position helped with my mental health to be more stable.” These comments indicate that the Resident Assistant role has been transformative for a number of participants in understanding, caring for, and stabilizing their own wellbeing. Overall, the narratives provided in response to this question suggest that the Resident Assistant role has both positive and negative elements. Stress and time demands appear to lead to feelings of anxiety and depression for some Resident Assistants, while others found the role to be 75 critical in terms of learning how to care for their own mental wellbeing. In fact, some participants felt that the Resident Assistant role was a central element in stabilizing their own mental wellbeing. While these elements may contrast each other, both are important in understanding how the Resident Assistant role impacts the mental health of the individuals performing the duties of the position. 76 Table 11 In what ways, if any, has being a Resident Assistant affected your own mental health? Mental Health Symptoms Work/Life Balance Isolation Positive Outcomes I have not been able to sleep as much and having to deal with second-hand trauma and reliving some of trauma through my residents stories. It's hard to try going to CAPS [Counseling and Psychological Services] with my experiences in the past, and I have not been able to let that go. I have an “always on” mentality, so I feel like there is always something I could be doing or planning- therefore, I have guilt about taking breaks sometimes. Living in a single unit is extremely isolating, I find myself not verbally talking to anyone and occasionally not leaving my room for upwards of 50 hours…Being in meeting is the highlight of my week but as soon as they end I am alone again and it gets bad, the frequency of intrusive thoughts are increasing for me. It has had a positive affect on my mental health in the sense that I feel like I’m contributing to my community. However, there are definitely negative affects on mental health from being on- call 24/7. I sometimes feel like I can never be off of work and that gets tiring. It can quickly pile up my schedule causing me to feel overwhelmed. When catching up on my work, I find that I am always sleep deprived. Has worn me out a bit and caused some anxiety because I feel as though I am constantly balancing the RA position with everything else, especially during COVID. Being on campus with COVID-19 restrictions is lonely, and being at home before I came to campus for the RA job was much more enjoyable. Overall though, I think this job is very rewarding and positively affects my mental health because I can see an impact that I have on residents (e.g. helping them with personal or academic issues). It is mentally exhausting to be a full time student and be working as an RA. It's added a constant sense of being on- call. At any time, one of my residents might text or call or email me, needing me to respond ASAP. The isolation has been particularly rough, and remaining connected to the community is difficult, let alone creating that community. My mental health had already been unstable... I actually think the RA position helped with my mental health to be more stable. 77 Qualitative Analysis of Resident Assistant Warning Signs Further qualitative data was gathered via an open-ended question that asked, “In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing?” Major themes that emerged from the responses involved comments about difficulty sleeping, a lack of energy, and descriptions of mental health symptoms. These themes also appeared to intersect with academic difficulty and feeling disconnected from others. A sample of quotes provided by different participants in these various areas and the intersection of those themes appears in Table 12. Mental Health Symptoms Specifically, 65 Resident Assistants described mental health issues when discussing indicators of needing to address their own wellbeing. These were often combined with concerns about sleep disturbances, as mentioned by 27 participants. For example, one Resident Assistant described warning signs as “when I start losing sleep, going through depression, can’t eat.” Another participant described indicators such as “anxiety, a sense of feeling overwhelmed, lack of sleep, feeling tired,” and a third participant mentioned “not sleeping, crying randomly, feeling a sense of anxiety before an interaction with a resident.” Clearly, many Resident Assistants noted that feelings of depression and anxiety were combined with being unable to get adequate sleep. Lack of Energy Furthermore, feeling a lack of energy was mentioned by 31 participants. For instance, one Resident Assistant described “feeling really tired and lack of motivation” when discussing warning signs of needing to address their own wellbeing. Another Resident Assistant mentioned “feeling burnout, restless or tired” as indicators that their mental health was in decline. One participant mentioned a combination of the themes being discussed when they stated, “I think 78 warning signs are excessive tiredness/inability to do work, reluctance to socialize/wanting to self-isolate, and having anxiety attacks or panic attacks regularly.” Overall, it appears that based on the information provided by the participants, low energy and problems with sleep were often interrelated with mental health issues. Personal Difficulties and Routine Disruption Additional themes that emerged as warning signs included feeling disconnected from others, academic difficulties, disruptions in routine, and poor eating habits. For instance, a participant described how they “start to seclude myself from my friends and family and fall into a repetitive cycle of having little to no contact with others and being overall unproductive” when mentioning how they become detached from others. Another Resident Assistant described this similarly by stating, “Feeling the need to flee campus or escape my apartment is typically an indicator that I have gone too far or am too anxious. I then know to reconnect with others and seek help.” Other Resident Assistants detailed academic difficulties by mentioning warnings such as when they “get behind on school work,” and that “failing two classes was the warning sign for me.” Finally, inadequate nutrition was mentioned by Resident Assistants that described warning signs such as “forgetting to eat or losing sleep over work,” and “not sleeping enough, eating enough, drinking enough water, not taking care of personal hygiene, and isolating myself.” Generally, changes to typical routines, academic performance, and personal hygiene also intersected with poor mental health and appeared to be indicators that Resident Assistants’ wellbeing was in decline. 79 Table 12 In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing? Mental Health Symptoms Academic Difficulty Disconnect from Others Sleep When I can’t sleep immediately at night and spend time tossing and turning, when I find myself being irrationally sad and when the words of a resident affect me enough to be on my mind the entire day. If I am not sleeping well or I am sleeping too much. Also if I am not doing well academically or shut myself out. If I were not sleeping enough, eating enough, drinking enough water, not taking care of personal hygiene, and isolating myself. Energy I think warning signs are excessive tiredness/inability to do work, reluctance to socialize/wanting to self-isolate, and having anxiety attacks or panic attacks regularly. If I’m always tired and my grades reflect my performance dropping Isolation, trouble getting out of bed, not eating, etc. Overall, sleep, energy, and mental distress were common issues mentioned by the participants in response to this question. To illustrate the frequency of these themes, Figure 7 uses the most common words that appeared in the participants’ responses and displays words that were used most often in larger text. In summary, Resident Assistants appear to have awareness of what mental distress looks like and how this can serve as a warning that their personal wellbeing needs to be addressed. Additionally, Resident Assistants identified the intersections between wellbeing, sleep, and energy and also identified how problems in these areas impact other things, such as academic performance and personal relationships. 80 Figure 7 In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing? Qualitative Analysis of the Impact of COVID-19 and Racial Injustice Finally, additional qualitative data was collected in an attempt to address the research question by asking, “Compared to previous quarters, how has COVID-19 and/or racial injustice impacted your own wellbeing?” Similar responses to other questions reviewed above, major themes that emerged from the responses involved negative impacts to mental health and feelings of isolation. Other themes emerged around concerns for personal safety, experiences with academic difficulty, low energy, changes in routine, and self-reflection on how to address systemic racism. Examples of quotes provided by the Resident Assistants in these thematic areas appear in Table 13. Additionally, several responses discussed how concerns about a Resident Assistant’s ethnicity might impact their own personal safety. Although only a small number of 81 participants mentioned this concern, the information provided by these participants will be reviewed due to the impact that this could potentially have on the entire university community. Table 13 Compared to previous quarters, how has COVID-19 and/or racial injustice impacted your own wellbeing? Safety Academic Difficulty Energy Mental Health Symptoms Prior to COVID, because there were so many students on campus, you didn't really hear about criminal activity. This quarter a girl was assaulted on campus. This really affected me and made me anxious to leave my dorm after dark. I have taken precautions but I try to get everything done before dark. My dorm was broken into in the beginning of the school year, and this has also made me incredibly anxious about leaving my dorm and my belongings. COVID-19 has upended the world & it has definitely left me fatigued and struggling to find motivation to do anything whether that be academics, student life, or work. Each week feels like a never-ending cycle & I know that I don't feel happy or as happy as I could if we weren't in a pandemic. I haven't exercised since September. In previous quarters I would go to RIMAC at least once a week. I sometimes eat bad because I don't feel it is necessary to present as healthy since I don't see others in person. I have no motivation so I don't shower everyday and don't do laundry as often either. Isolation Both of these issues, remind me of my loneliness, isolation, and depression. Living alone without any other roommates can be hard to handle at times. These issues constantly put me on edge to stay safe and alert. Everything around me has been affected in some way. COVID -19 restrictions have technically made me isolate myself from some of my closest people. Some classes have been more difficult… which led to other academic issues and my very first breakdown. Being inside all the time has been very tough, and especially not being able to meet friends every day has been mentally draining at some points. I also feel kind of sad that… I was not able to get THAT close to other RAs outside my building or area team. 82 Mental Health Impact In response to this question about the impact of racial injustice and COVID-19 on Resident Assistants’ wellbeing, 45 participants described how their mental health had been negatively impacted due to the pandemic and racial injustice. Additionally, 43 participants described being isolated. These responses were often interwoven with narratives about concerns for personal safety, a lack of energy, and academic difficulties. For example, one Resident Assistant described the feelings of isolation and how this impacted their overall functioning, stating: COVID-19 has severely impacted my wellbeing. ... I've spent almost a year in near isolation, with some outings with friends or spending time with my significant other. Because of working and learning online, my physical health has had a dramatic plummet, and I'm really not able to balance work, school and taking physical care of myself. I've felt more depressed as the year went on (2020-2021). ... I feel extremely trapped in my circumstances, as living on campus has been very strict and even more isolating than living at home or at an apartment. Another Resident Assistant explained feeling a lack of energy and motivation due to the pandemic and conflicted about their ability to participate in the social movement around racial injustice due to other demands on their time: COVID-19 has upended the world & it has definitely left me fatigued and struggling to find motivation to do anything whether that be academics, student life, or work. Each week feels like a never-ending cycle & I know that I don't feel happy or as happy as I could if we weren't in a pandemic. Racial injustice really affected me last spring with the death of Breonna Taylor & so many others when streets erupted with protests. I felt torn 83 because I wanted to participate in something I believed in but at the same time, I was forced to also work at my job & focus on academics & I felt like school wasn't supportive of the situation students were facing when compounded with both racial injustice & COVID-19. As with previous qualitative questions, Resident Assistants shared narratives about experiencing anxiety, depression, and stress connected with the isolation of the COVID pandemic. Additionally, a lack of social connections, stress, and the other demands of the position appear to be a major source of mental health issues for Resident Assistants. This appears to be a major theme throughout the various open-ended questions, as the stress and demands of the position appear to have been exacerbated by the protocols required to control the spread of COVID-19, including limits on interactions with other individuals. Safety Concerns Furthermore, the interaction between the pandemic and racial injustice appeared in several responses, as Resident Assistants described feeling unsafe due to their racial identity. A summary of these responses appears in Table 14. For example, one participant stated: Covid-19 has caused my family stress beyond measurable means. Having parents who are physicians, I worry about their safety as they battle virus in the front line. Having an Asian mother, I worry about her safety as anti-Asian crime rises. Another Resident Assistant described similar concerns about discrimination against the Asian American community related to the pandemic, stating, “As for racial injustice. I am an Asian American and the recent attacks against my community has left be scared and feeling unsafe.” Furthermore, one participant described the relationship between their safety and feelings of isolation by expressing, “I feel very isolated. The few social interactions I have in person feel 84 awkward because I haven't talked to people on a regular basis. With COVID still around and me being Asian-American I feel like I get stared at.” Clearly, several Resident Assistants are experiencing concerns about their safety related to both the pandemic and their racial identity, and this in turn impacts their overall metal health and wellbeing. The connection between these elements is particularly of note given that the majority of the participants in this survey are from minority ethnicities. It should also be noted that the participants that provided this data also identify as female, indicating an intersection between race and gender that contributes to concerns for personal safety. Table 14 Safety Concerns Described by Asian Resident Assistants Safety Family Covid-19 has caused my family stress beyond measurable means. Having parents who are physicians, I worry about their safety as they battle virus in the front line. Having an Asian mother, I worry about her safety as anti-Asian crime rises. Isolation I feel very isolated. The few social interactions I have in person feel awkward because I haven't talked to people on a regular basis. With COVID still around and me being Asian-American I feel like I get stared at. Violence As for racial injustice. I am an Asian American and the recent attacks against my community has left be scared and feeling unsafe. 85 Research Question 2 Research question 2 asked, What are Resident Assistants’ perceptions regarding their ability to successfully support student mental health issues? To address this question, an open-ended query appeared on the survey, and this qualitative data was analyzed to understand Resident Assistants’ self-efficacy in their role supporting resident mental wellbeing. Specifically, a free-response question on the survey asked, “In your role as a Resident Assistant, how confident do you feel in your ability to support fellow students with mental health issues?” Overall, the responses to this question where positive, as 93 participants described how they felt prepared to address the mental health needs of their residents. Additionally, Resident Assistants described particular skills that they use in this effort, including showing empathy, listening, and personally relating to the experiences of the residents. A sample of quotes provided by different participants that describe the use of these various skills appears in Table 15. Self-Efficacy in Supporting Resident Wellbeing In support of the finding that Resident Assistant feel confident in supporting the mental health of their residents, many participants described specifically why they believe they are effective in this area. For example, one participant stated “I feel pretty confident in supporting fellow students with mental health issues. Although I don't suffer from any, I do know how to make someone comfortable and advise them to support.” Another participant described their efficacy in this area by providing: I feel very confident. I have had multiple situations where I have had to deal with fellow students with mental health issues. I feel in tune enough with my emotions that I feel like I can handle high stress situations. 86 A third Resident Assistant described their confidence in working to support the mental health of their residents as a result of the information they received during training and through practice within the role: After being an RA for more than one year, I feel that my ability to support others with mental health issues has drastically improved through the training and experience I've gone through. While my abilities to help others improves, so does my ability to address my own troubles and obstacles. Overall, the theme of feeling confident in supporting resident mental wellbeing due to proper training and experience appeared in many of the responses to this question. Based on this, it appears that the current training is effectively preparing Resident Assistants to feel efficacious in their ability to successfully support mental wellbeing. Helping Skills Given that the majority of Resident Assistants feel confident in their abilities to support the mental health needs of their residents, the description of the skills they use in this effort is important in understanding specifically how Resident Assistants are able to be effective. For example, one Resident Assistant described how they are “an empathetic person as well as a good listener,” and another mentioned that they are “always open to listen to residents’ concerns and check in on them.” Clearly, these participants understand that listening skills and providing empathy are important elements of supporting their residents. Additionally, another participant described how they can relate to the experiences of their residents, as they mentioned that they “feel fairly confident [in supporting students with mental health issues] having recently gone through processes with the university myself.” Other participants similarly described their own experiences working with mental health resources and how that gave them insight into what their 87 residents would experience when they were connected with mental health professionals. The shared experience of working with mental health providers was an important element in helping Resident Assistant feel effective in their work supporting the mental wellbeing of residents. Table 15 In your role as a Resident Assistant, how confident do you feel in your ability to support fellow students with mental health issues? Listen Empathy Personally Relate I feel somewhat confident that I can be a person of support for my residents. I am always open to listen to residents' concerns and check in on them. Helping others brings me a lot of joy, especially when I feel down myself. I feel very confident in supporting students with mental health issues… I feel like I am empathetic enough to understand the situation but when it comes down to something as serious as mental health concerns, I can also compartmentalise [sic] well enough to help out the student in the best possible way Very confident! I'm generally able to bounce back after moments of sadness or frustration. And being able to personally work through my moments allows me to better relate to resident concerns with mental health. I can also confidently refer them to resources or activities that may facilitate a better mental space. I feel confident in listening to them, providing resources, letting them know they are heard. I can only help them as much as they reach out and I am concerned that they will not reach out. I feel relatively confident. Thus far I have not had many major situations of this type, but I am comfortable in my ability and training to empathize and point residents to helpful resources. I feel very confident I could help because of my experiences; I will want to help others from the struggles I faced to prevent them from going through the same trauma. I think the best way to support students is to listen and point them to resources if they would like them/need them. I try my best to relate to my residents or make them feel like they're being heard/that I care about their wellbeing. I feel confident in this. I feel confident, I am an empathetic person as well as a good listener, and training has also informed me of resources that can help students that I can refer them too. I feel pretty confident as I understand the struggles they could be facing as I have plenty of mental health issues/concerns myself. 88 Research Question 3 Research question 3 asked, What self-care and support strategies do Resident Assistants use to maintain their own wellbeing? An open-ended question appeared on the survey in order to gather qualitative data that would address this research question. Specifically, a free-response question on the survey asked, “In your role as a Resident Assistant, how do you care for your own wellbeing?” Based on the qualitative analysis of the responses provided by the participants, major themes in the narratives included setting boundaries, getting rest, and engaging in personal connections with other individuals. Other subjects mentioned by several participants included engaging in hobbies, exercise, and being proactive about caring for an individual’s mental health. A sample of quotes provided by different participants in these various themes appears in Table 16. Boundary Setting In particular, setting boundaries and making time for self-care were the most common responses to this question, as 55 participants mentioned these particular strategies. For example, one Resident Assistant described their boundary-setting strategy by stating, “I take time away from my job by driving off campus and disconnecting from school and work.” Of note, several participants described physically leaving campus as a tactic for separating from the demands of the Resident Assistant role. For example, one Resident Assistant mentioned, “I get away from campus at least once a week to get away from that ‘work’ monotony.” Another described the benefits of removing themselves from the physical environment, stating that their self-care strategy is, “Physically removing myself from campus, and not just when I'm overwhelmed. I love it here but leaving is so beneficial sometimes.” Finally, another Resident Assistant 89 explained how setting boundaries, leaving the university campus, and connecting with other individuals are the core components of their self-care strategy: I take time for myself. This means taking time to work out, go off-campus, and spend time with people that I love. The best thing that I can do to care for my well-being is surrounding myself with people that I know care about me and want to see me thrive in my role. Clearly for many Resident Assistants, setting boundaries on work, both mentally and physically, were important parts of caring for their own wellbeing. Connecting with Others and Self Care Many other Resident Assistant interwove setting limits on work with other strategies such as engaging in personal connections with other individuals. In fact, connecting with other individuals was the second most common response, as 32 Resident Assistants mentioned this specific strategy. Furthermore, getting rest was the third most common theme, as it was mentioned in 28 responses. In particular, one participant stated, “I try to make time for breaks, spend my weekend evenings/nights either relaxing or having fun with my roommates/friends. Overall, I try to take my mind off of the job and do something that isn't school related.” Another participant spoke of how connecting with friends and engaging in exercise is part of their boundary-setting, by mentioning, “I try to separate my work from my home as much as possible. I workout, talk to friends, and have different hobbies to self care.” One Resident Assistant described how exercise and other entertainment allowed for rest from the position, describing, “I try to continue to exercise in the morning and watch tv shows that let me turn off my brain.” Finally, another Resident Assistant described particular boundary and self-care strategies as “separating the work done as an RA from other functions” and gave examples of caring for their 90 mental health such as “walks/runs, good sleep schedule, yoga/meditation, listening to music.” Given that many Resident Assistants listed particular activities such as exercise, hobbies, and non-work related activities, it is clear that Resident Assistants understand that engaging in physical and mental tasks that are unrelated to the demands of their position are a critical part of separating from the Resident Assistant role and caring for their own wellbeing. Unhealthy Coping It should be noted that a small subset of individuals (n=7) did describe unhealth coping mechanisms, such as alcohol consumption, or a lack of awareness of how to care for their own wellbeing. For example, one participant’s response to this question described their self-care strategies as, “playing video games, watching TV, casually drinking.” Another participant stated, “I dont have the time to practice self care since I am constantly doing it for others.” Several responses to this question described how the participant did not engage in self-care or did not know how to. This is important in understanding that there is not universal agreement that all Resident Assistants feel effective in their ability to care for their own wellbeing. Overall, many Resident Assistants understanding that setting limits on work, engaging in other activities, and personal relationships are important elements of self-care. Connecting with other individuals is of particular importance, especially in light of the answers to previous questions that discussed concerns about loneliness and isolation. Additionally, physically and mentally removing oneself from the work environment is central to wellbeing. However, as noted earlier, not all Resident Assistants have an awareness of how to care for their wellbeing in a healthy manner. 91 Table 16 In your role as a Resident Assistant, how do you care for your own wellbeing? Boundaries Connect with Others Rest Exercise I try to detach myself from my residents and remind myself that I too am a student and no one can expect me to be perfect, regardless of the standard I set for myself I make sure to plan my time and activities, I also heavily rely on the support of my friends and family I dedicate time to do RA work, then I dedicate time for personal rest. I make sure to get enough sleep, talk to friends and family, exercise, journal, read, and meditate. I try to take breaks on the weekend, such as going to the beach. Daily, I try to use working out as a break from my RA work and School work. I talk to the other RAs to see if they're experiencing the same things. I get away from campus at least once a week to get away from that “work” monotony. I try to make time for breaks, spend my weekend evenings/nights either relaxing or having fun with my roommates/friends. Overall, I try to take my mind off of the job and do something that isn't school related. I often take time for myself by going on walks or going to watch the sunset. This helps me clear my mind of issues or things that happened during my shift or during classes. I try to continue to exercise in the morning and watch tv shows that let me turn off my brain. I try to separate my RA self and my student self. I try to relax on the weekends if I'm not busy or on duty In my previous year of experience, I would take a Friday off to relax and do my hobbies (painting and playing video games), and I would often go off campus to hang out with my friends and explore the city my campus is located in. This year, I've taken some weekends off, and I occasionally stay with friends/family off campus to take a break from my role. I make sure to take time for myself. I make sure I am well rested and fed; I ensure that my own body is a priority in my life. I try to separate my work from my home as much as possible. I workout, talk to friends, and have different hobbies to self care. 92 Chapter Summary The results of the ProQOL survey indicate that Resident Assistants are experiencing moderate levels of compassion satisfaction, moderate levels of burnout, and low levels of secondary trauma. Of note, the compassion satisfaction results are negatively skewed towards the higher end of the scale, and the burnout results are split in a bimodal distribution with a subset of individuals at the lower end of the scale. Additionally, participants that identified part of their ethnicity as Hispanic/Latinx were experiencing lower levels of burnout and secondary trauma as compared to their peers from other ethnicities. Furthermore, there may be a positive relationship between the amount of experience a Resident Assistant has in the role and their level of compassion satisfaction. There were also relationships between the various scales on the ProQOL. Specifically, Resident Assistants that experienced higher levels of burnout also experienced higher levels of secondary trauma and lower levels of compassion satisfaction. In contrast to this, Resident Assistants with lower levels of burnout also experienced lower levels of secondary trauma and higher levels of compassion satisfaction. Also, Resident Assistants overall indicated a high level of support from the organization. Resident Assistants that identify as Black/African tend of have statistically significant higher levels of support than other Resident Assistants. Furthermore, Resident Assistants that experienced higher levels of compassion satisfaction also felt more supported by the organization, and Resident Assistants that experienced high levels of burnout may have felt less supported by the organization. In asking the participants about their own mental health, most participants described experiences that indicate the role was inducing mental health symptoms. Additionally, work-life 93 balance was identified as a significant issue. Feelings of isolation, difficulty sleeping, declining academic performance, changes in routine, and negative impacts to personal energy were also recognized as problems. In contrast to these themes, Resident Assistants also described how the job positively supported mental wellbeing. Given the COVID-19 pandemic and national conversation around systemic racism, Resident Assistants were also asked to describe how these issues impacted their wellbeing. Major themes that emerged from the responses involved negative impacts to mental health and feelings of isolation. Other themes emerged around concerns for personal safety, experiences with academic difficulty, low energy, changes in routine, and self-reflection on how to address systemic racism. Of note, several participants discussed how concerns about their ethnicity might impact their own personal safety. Resident Assistants were also asked to describe their self-efficacy in their role supporting the mental wellbeing of their residents. Overall, the majority of the responses indicated that Resident Assistants felt prepared to address the mental health needs of their constituents. Particular skills that Resident Assistants use in this effort including showing empathy, listening, and personally relating to the experiences of the residents. Finally, in asking Resident Assistants to describe self-care and support strategies to maintain their own wellbeing, participants described setting boundaries, physically leaving campus, getting rest, engaging in personal connections, engaging in hobbies, exercise, and being proactive about caring for their own mental health. Given the previous responses about experiences of loneliness, connecting with other individuals is of particular importance. However, not all Resident Assistants have an awareness of how to care for their wellbeing in a healthy manner. 94 Chapter Five: Discussion This study examined the impact of the student mental health crisis on Resident Assistants at Gray University. Specifically, self-injurious and suicidal behaviors have been increasing at institutions of higher education in the United States each year (Xiao et al., 2017), and research has demonstrated that almost half of individuals in the traditionally college-age population had a mental health condition (Blanco et al., 2008; Wynaden et al., 2014). Depression and self- injurious behaviors were the most common issues, with each impacting approximately 10% of the student population (Zivin et al., 2009). This problem has also been occurring locally at Gray University, as over 60% of students reported feeling frequently or occasionally depressed, 14% seriously considered suicide, and 64% reported overwhelming anxiety (“Gray University Executive Summary ACHA-NCHA II,” 2019). These problems have been exacerbated by the COVID-19 pandemic, as recent research on higher education students found incidents of major depression doubled from 2019 to 2020. Additionally, the rate of anxiety was 1.5 times higher from 2019 to 2020. Of further concern, these issues were even higher in marginalized populations, such as students of color, LGBTQIA students, and low income students (Chirikov et al., 2020). Given this environment, this study attempted to understand how Resident Assistants at Gray University are impacted by the increasing volume and complexity of mental health issues. Additional data was collected regarding Resident Assistants’ self-care strategies in support of their own wellbeing, and information about their self-efficacy in supporting student mental health was also obtained. This data was collected using an online survey that contained several elements. First, the survey contained the full Professional Quality of Life Scale, as this was used to measure compassion satisfaction, burnout, and secondary trauma in the Resident Assistant 95 population. Second, additional quantitative and qualitative items were added to collect data about Resident Assistants’ experiences with experiencing mental health issues, the support they received from the organization, self-care strategies, and the impact of the pandemic on their wellbeing. Demographic data on the participants was also collected. The data was then analyzed using quantitative methods to understand the overall ProQOL scores of the Resident Assistant population as well as the relationships between the ProQOL scores and various demographic variables. Qualitative methods were also used to analyze the open-ended questions about Resident Assistants’ mental wellbeing, self-efficacy, and other experiences. Findings The data provided by this survey revealed many important findings regarding Resident Assistants’ experiences. First, the ProQOL provided insight into the mental wellbeing of Resident Assistants, especially in light of the impact of their work environment. Additionally, several demographic variables had relationships with the ProQOL results. Furthermore, qualitative data provided by the Resident Assistants provided insight into their experiences with wellbeing during the pandemic, their experiences with racial injustice, and their understanding of caring for the wellbeing of their residents. Moderate Compassion Fatigue A review of the overall ProQOL results show that Resident Assistants are experiencing moderate levels of compassion fatigue. Specifically, an analysis of the aggregate ProQOL scores indicate moderate levels of compassion satisfaction, moderate levels of burnout, and low levels of secondary trauma. This suggests that while Resident Assistants feel desirable levels of satisfaction with their jobs, they are experiencing undesirable levels of burnout due to overwhelming work demands. The qualitative data provided by the participants supported this 96 concern about burnout, given the large number of comments that described the difficult balance between their Resident Assistant duties and other responsibilities as a significant issue that impacted their mental wellbeing. This finding is contrary to previous research that connected high levels of burnout with low job satisfaction (Boscarino et al., 2010), as in this situation, the Resident Assistants appear to be both satisfied with their helping role at the university and simultaneously overburdened by their work responsibilities. It is possible that this discrepancy may be due to the impact of the COVID-19 pandemic, as many responses also discussed the significant impact that the pandemic was having on their work demands and overall wellbeing. This idea is supported by other research that connected burnout to increased demands for services from students without a related increase in resources to meet those demands (Sim et al., 2016). The unknown and uncontrollable nature of the pandemic may also be a contributing factor in this, as other research found that there is a relationship between burnout and a lack of control over a work environment (Maslach & Leiter, 2016). Also, the low Cronbach’s alpha (a = 0.47) of the burnout scale may be another contributing element of this discrepancy. Positive Compassion Satisfaction With regards to the compassion satisfaction, the results overwhelming skewed negatively towards the higher end of the scale. In fact, 25 Resident Assistants had scores that rated them as having high compassion satisfaction. These results are congruent with both the responses to the question about support received from the organization and the qualitative data about how the Resident Assistant role impacts wellbeing. First, Resident Assistants overall indicated that they received high levels of support from the organization. Of note, a statistically significant positive correlation was found between levels of support and compassion satisfaction. Second, a number of open-ended responses described how the Resident Assistant role was a supportive and 97 protective factor that positively influenced and maintained their mental health. In fact, many participants described how the position was rewarding and helpful to the community, and this in turn was supportive of their own wellbeing. This is similar to other research on mental health care professionals that identified work satisfaction, among other variables, as important in increasing compassion satisfaction (Ray et al., 2013). This finding may also explain the bimodal distribution of burnout scores, as a significant subset of Resident Assistants (n=33) had burnout scores on the low end of the range. Taken together, these results indicate that Resident Assistants that experience high levels of support from the organization are able to use this support as a mitigating factor against burnout. Demographics and Compassion Fatigue There were several demographic variables that appeared to have a relationship with ProQOL scores and the level of support from the organization. First, a t test indicated that participants that identified part of their ethnicity as Hispanic/Latinx were experiencing lower levels of burnout and secondary trauma as compared to their peers from other ethnicities. Given that 31.2% of the participants identified part of their ethnicity as Hispanic/Latinx, this may also be a contributing factor in explaining why the burnout scores for Resident Assistants appeared in a bimodal distribution. Second, an analysis of variance found a statistically significant relationship between compassion satisfaction scores and years of experience. Specifically, Resident Assistants with three years of experience had the highest compassion satisfaction scores. This is in line with prior research that found years of experience and a sense of purpose were mitigating factors in helping buffer principals from the impact of working with students in distress (DeMatthews et al., 2019). However, this relationship should be taken with caution, as Resident Assistants with 98 two years of experience had the lowest compassion satisfaction scores out of the participant groups. Third, a t test found that Resident Assistants that identified as Black/African reported statistically significant higher levels of support than other Resident Assistants. Given that a sense of belonging and a supportive environment has been found as an important component influencing a student’s overall mental health (Fink, 2014) this is an encouraging finding, especially as many participants described the negative impact that the national attention on the reality of racial injustices in society had on Resident Assistant wellbeing. However, the specific reasons for this particular finding are unclear based on the open-ended responses provided by Black/African participants and is an area in needs of further research. Resident Assistant Mental Distress Additional qualitative data provided by the participants revealed that Resident Assistants are experiencing signs of mental distress, both as a result of their jobs and related to the pandemic. First, stress, anxiety, depression, and isolation are significant concerns reported within the Resident Assistant population. The reasons for this identified by the participants are a combination of the workload and the stressors related to the COVID-19 pandemic. In particular, safety protocols that eliminate roommates, guests, and activities were specific causes of feelings of isolation. Second, sleep disturbances and low energy were also common issues for Resident Assistants, as it was mentioned that feeling tired and being unable to sleep was often connected with feeling depression or anxiety. This is similar to research that found that students experiencing high levels of stress were more likely to experience inadequate sleep and poor mental health (Pedersen, 2012). Finally, feeling disconnected from other individuals, poor academic performance, and unhealthy eating habits were also reported by Resident Assistants. 99 These findings are congruent with the moderate levels of burnout reported in the ProQOL data. Furthermore, these themes align with other research that has shown that rates of anxiety and depression within higher education environments have significantly increased during the COVID-19 pandemic (Chirikov et al., 2020; Czeisler et al., 2020). Asian Resident Assistant Safety Concerns The qualitative data also revealed that several Resident Assistants felt unsafe due to their racial identity. Specifically, the narratives provided in several responses disclosed that the participants were concerned for their personal safety and the safety of their families due to the rise in anti-Asian attitudes occurring in society. Given that COVID-19 was being blamed on Asian countries, Resident Assistants that identified as Asian were alarmed by violence being perpetrated against members of their community. It should be noted that this data was gathered prior to the mass shooting that occurred in Atlanta in March 2021, and therefore, it is possible that this concern has grown since the data was gathered. Confidence in Helping Skills Next, qualitative data demonstrated that Resident Assistants overwhelmingly felt efficacious in their ability to successfully support mental health issues. Specifically, 93 participants described how they felt prepared to support their residents. As part of their responses, Resident Assistants described particular skills that they use, including showing empathy, listening, and personally relating to the experiences of the residents. Many participants described how they personally had utilized mental health services, and this in turn was helpful in connecting with their residents around this topic. This would indicate that the overall climate is supportive of student mental health. The research supports the importance of this particular outcome, as multiple studies have demonstrated that a campus climate that is supportive of 100 seeking mental health services is an important factor in successfully addressing student mental wellbeing (Chen et al., 2015; Sontag-Padilla et al., 2016). Resident Assistant Self-Care Finally, qualitative data was analyzed in an effort to understand what self-care and support strategies Resident Assistants use to maintain their own wellbeing. Setting boundaries and making time for self-care were the strategies mentioned most often by the participants. In particular, physically leaving the university campus as a way to separate from the demands of the Resident Assistant role was mentioned by a number of participants. Additionally, connecting with friends and family was also discussed by a number of participants. This is especially important in light of the previous findings that isolation is a serious concern among Resident Assistants. Given the social distancing rules required by the pandemic, being able to connect with other individuals was of particular importance to maintaining wellbeing. In fact, it is plausible that the lack of social connections induced by the pandemic may have been a factor that contributed to the depression and anxiety being reported by Resident Assistants. Lastly, getting rest was another common strategy mentioned by Resident Assistants. This is also of importance given the previous finding that sleep disturbances and a lack of energy were common problems for Resident Assistants. Despite these positive self-care strategies, it is important to note that a small number of participants described unhealth coping mechanisms, such as alcohol consumption. Other participants also mentioned a lack of awareness of how to care for their own wellbeing or simply responded that they do not care for their own welfare. This is important in understanding that there is additional work that needs to be done to ensure that all Resident Assistants have the knowledge, skills, and support to care for their own wellbeing. 101 Implications for Practice Several implications arise from this study. While there is support for particular demographics, improvements in support for other populations can be improved. In particular, safety is a concern mentioned for Resident Assistants that identify as Asian. Additional efforts are needed to increase work-life balance for Resident Assistants, to encourage help seeking behavior and to encourage self-care strategies that Resident Assistants often promote for their residents. Negative coping mechanisms are of particular concern, and additional support for LGBTQIA and other minority groups should be further explored, especially in light of the effects of the pandemic. Support for Black and Latinx Resident Assistants First, the organization appears to be partially supportive of the needs of Black and Latinx Resident Assistants, while the needs of Asian students in particular may need to be addressed. As outlined earlier, participants that identified part of their ethnicity as Hispanic/Latinx were experiencing lower levels of burnout and secondary trauma as compared to their peers from other ethnicities, and participants that identified part of their ethnicity as Black/African tend of have higher levels of support. These findings are encouraging, especially given the concerns about the climate of racial injustice. Support for Asian Resident Assistants However, it is also concerning that Asian Resident Assistants did not also have similar outcomes, especially in light of the qualitative data that showed specific concern for the safety and wellbeing of Asian Resident Assistants. Given the national attention on violence directed at the Asian community and the racist rhetoric blaming the Asian community for the pandemic, additional support is needed to address the wellbeing of Asian Resident Assistants. Ensuring that 102 Asian Resident Assistant feel safe in their roles and in the community could potentially address their own experiences with compassion fatigue. From a student development theory perspective, Phinney’s model of ethnic identity development illuminates how the national climate that is hostile towards Asians can highlight a hyperawareness of a Resident Assistant’s ethnic identity (Patton et al., 2016). This includes an awareness gained through negative experiences, such as harassment and discrimination. Ensuring that Asian Resident Assistants feel as if they matter is of great importance, as Schlossberg’s theory of mattering and marginality discusses how not feeling as though you matter can lead to depression (Patton et al., 2016). Given that Asian Resident Assistants may feel particularly vulnerable and aware of their own ethnic identity, providing an environment that is supportive and affirming of their identity is of great importance. Creating a culture that is supportive of Asian Resident Assistants be accomplished by engaging in several best-practices identified in the research. First, the university administration can engage in programming and other messaging campaigns that promote information that counters stereotypes about Asians and elevates Asians to ensure they are seen and included as a welcome part of the university community. For example, stories that counter the model minority myth of Asian Americans and illustrate the disproportionate impact that the pandemic has had on Asian American communities can help counter the negative narratives about Asian Americans. Second, the administration should elevate Asian students into leadership and other roles to help demonstrate that Asians are also Americans. Placing Asian students into prominent roles creates visibility for Asian Americans and assists in combating negative stereotypes. Finally, promoting contact between Asian students and other identities has been shown to reduce prejudice and can be accomplished through events that celebrate Asian culture. Acknowledging and commemorating significant parts of the Asian American experience has the dual impact of 103 ensuring that Asian students feel included while also creating opportunities for other students to learn more about, take the perspective of, and ultimately humanize their Asian classmates (Jilani, 2021). Furthermore, ensuring that the issue of violence against Asians and other issues around racial injustice are included in Resident Assistant training is critical in ensuring that both the needs of Resident Assistants are addressed and that Resident Assistants are equipped to address these issues within the student population they serve. As Resident Assistants spoke about the impact of the overlapping elements of the impact of the pandemic on minority communities and the national attention towards racial injustice, enhancing their cultural humility is critical. While Resident Assistant training may currently include a module that discusses issues around identity and racial injustice, these fundamental issued should be elevated. The qualitative data provided by Resident Assistants supports the need and desire for more information and discussion about these topics. Furthermore, issues of racial injustice and violence should be addressed on a more ongoing basis, such as through Resident Assistant staff meetings and professional development. This ensures that the needs of Resident Assistants and the communities they serve are addressed on a more ongoing basis. Support for Resident Assistant Wellbeing: Boundary Setting While the overall organizational climate is rated by Resident Assistants as being supportive, there is room for further growth in this support. This could be accomplished through policies and actions that encourage boundary setting between work and non-work activities, and a great balance between school and personal obligations. Given that Resident Assistants live where they work, this is especially challenging, as there are no physical barriers between their work, school, and personal environments. The pandemic also complicates this, as their living 104 environment has now also become their classroom due to remote course instruction. The qualitative data supports the need for further growth in supporting work-life balance, as many Resident Assistants described how the lack of boundaries in the position was a negative influence on their own mental health. Furthermore, setting boundaries with the Resident Assistant role and physically leaving campus in an effort to remove oneself from the work environment were described as self-care strategies. This could be accomplished by creating a schedule for when Resident Assistants are allowed to entirely disengage from the responsibilities of their roles and building in set times for Resident Assistants to leave campus. Resident Assistants should also be encouraged to organize regular trips off campus to truly disengage from the role. Given the fact that Resident Assistants have both described the need for boundaries and the effectiveness of setting those boundaries in the Resident Assistant role, it is critical that the actions of the professional staff model and support the importance of setting limits on work hours and responsibilities. This also means that the professional staff should be mindful about when they are communicating with Resident Assistants about non-urgent items, especially after regular work hours. Support for Resident Assistant Wellbeing: Self-Care Additional enhancements could be made to the environment by encouraging Resident Assistants to apply the care and compassions strategies that they use to attend to their residents’ wellbeing to their own self-care. Specifically, the qualitative data demonstrated that Resident Assistants overwhelmingly felt confident in their ability to support other students with mental health issues. The majority of the open-ended responses to this section of the survey described positive feelings of self-efficacy in this area, and many Resident Assistants described particular skills that they use in this effort, including showing empathy, listening, and personally relating to 105 the experiences of the residents. However, it appears that Resident Assistants are better at using these skills in supporting others than they are in supporting their own wellbeing. This idea is supported by the burnout scores, as these show that Resident Assistants are experiencing moderate levels of burnout. Furthermore, it is clear that many Resident Assistants know how to care for their own wellbeing, as described by their responses to the question about this topic. For example, Resident Assistants described how setting boundaries, getting rest, and engaging in personal connections with other individuals were effective strategies for self-care. Therefore, while it appears that Resident Assistants have the knowledge and skills to address mental wellbeing, they are not always applying these skills in an effort to address their own mental health. Additional support, training, and role modeling may be necessary to encourage Resident Assistants to apply the strategies they use to care for others to also care for themselves. Specifically, encouraging help seeking behaviors among the Resident Assistant population may be a critical element of reducing their overall burnout and ensuring that they are caring for their own mental health and wellbeing. This could be accomplished by engaging the assistance of the mental health and recreational services on campus and including these resources in meetings on a more regular basis. Relaxation skills, exercise, and other mental self-care can be taught and modeled by the professional staff and including these elements into staff meetings on a regular basis can communicate the importance of self-care activities. Impacts of the Pandemic on Wellbeing The COVID-19 pandemic has elevated the need for efforts that enhance Resident Assistant wellbeing, as the extended isolation protocols have exacerbated many of the mental health issues that are being experienced by students. Specifically, recent research has 106 demonstrated that depression and anxiety have increased dramatically among college students over the past year. Additionally, these mental health concerns were even higher in marginalized populations, such as students of color, LGBTQIA students, and low income students (Chirikov et al., 2020). Additional research has shown that 26% of traditionally-aged college students were experiencing suicide ideation during the pandemic (Czeisler et al., 2020). The findings of Chirikov et al. (2020) and Czeisler et al. (2020) illustrate the significant weight that the pandemic has had on college students, and specifically, students from marginalized populations. The qualitative data provided by the Resident Assistants as part of this study echo these finding and further illuminate the negative impact that the pandemic has had on their overall wellbeing and mental health. Given all of this and the fact that COVID-19 and the resulting economic difficulties have disproportionally impacted marginalized communities, it is clear that a large portion of the Resident Assistant population is in need of support for their mental health and a work climate that encourages and models the importance of help seeking behaviors as a normal and important part of the Resident Assistant role. Examining this issue through the lenses of Social Cognitive Theory and Bronfenbrenner’s ecological systems, efforts to impact the Resident Assistant work environment have the potential to positively influence their mental wellbeing. Prior research in this area on the wellbeing of minority students in educational settings found that influences at the institutional and individual levels account for 49% of the causes of student mental health issues (Byrd & McKinney, 2012). Therefore, efforts to address the institutional climate that acknowledges the impact of the pandemic, the safety concerns of Asian Resident Assistants in particular, and the need to promote and support self- care strategies are crucial in addressing this issue. 107 Education on Positive Coping Mechanisms Finally, negative coping mechanisms and a lack of coping skills were mentioned by several Resident Assistants. While the number of participants that mentioned this is low, this is still concerning in light of current efforts to address student wellbeing. Specifically, consuming alcohol was mentioned as a self-care strategy, despite the fact that this would likely exacerbate mental health issues. Additionally, a lack of information about how to engage in self-care is also alarming, especially given the importance of this topic for all students. If Resident Assistants are unsure of how to manage their own wellbeing, or if they are engaged in activities that negatively impact their wellbeing, it is likely that they will have difficulties in performing their work responsibilities, engaging in their academics, and caring for the wellbeing of their residents. Given how systemic this issue could potentially become, it is imperative that all Resident Assistants have the knowledge, skills, and awareness of how to both manage their own wellbeing, as well as how to identify concerning behaviors in both their residents and fellow Resident Assistant colleagues. As many Resident Assistants spoke of how the role was supportive of their own mental health, there is potential to address this issue and ensure that all Resident Assistants are able to care for both themselves and each other. Including self-care and wellbeing in professional development activities for Resident Assistants may be necessary to ensure that both the culture is supportive of mental wellbeing as well as ensure that Resident Assistants have the tools and skillset to care for their wellbeing. Given the responsibility that they have for the wellbeing of their residents, it is critical that Resident Assistants are able to mirror the skills they strive to instill upon their residents. 108 Training and Assessment Training Resident Assistants is a crucial element of addressing the issues outlined earlier, as well as assessing these efforts to ensure the effectiveness of the training and other efforts. Specifically, learning outcomes such as understanding racial injustice issues, increasing support for Asian Resident Assistants, increasing boundaries between Resident Assistant role and other activities, developing better self-care skills for Resident Assistants, and understanding Resident Assistant Wellbeing are vital elements in addressing the needs identified by this study. Various methods and activities as well as the timeline for implementing these activities appear in Table 17. Also, these efforts will be assessed via triangulation through mixed methods, as this allows for a combination of quantitative and qualitative data in an effort to identify common patterns (Patton, 2017). This includes conducting interviews and focus groups, as well as quantitative measures, such as additional administrations of the ProQOL. In many ways, this is a continuation of the research conducted in this study. Doing so allows for both more in-depth data that addresses the research questions as well as information about the effectiveness of the training efforts designed to address the problems outlined in this study. Table 17 Implementation and Assessment Plan Outcome Methods Timeline Understanding and dialogue of racial injustice issues Include an element into Resident Assistant training that addresses racial injustice, especially in light of the pandemic Incorporate regular discussions of racial injustice into Resident Assistant staff meetings Starting Summer 2021 Starting Fall 2021 109 Outcome Methods Timeline Increase support for Asian Resident Assistants Programming and campaign that dispels model minority myth Story telling about the impact of the pandemic on Asian American communities Ensure representation from Asian Resident Assistants in leadership positions Cultural Celebrations Starting Fall 2021 Increase boundaries between Resident Assistant role and other activities Develop policy that allows Resident Assistants to be officially off duty at certain times Allow Resident Assistants to schedule off duty time Create opportunities for Resident Assistants to engage in off campus activities Summer 2021 Starting Fall 2021 Starting Fall 2021 Develop better self-care skills for Resident Assistants Develop partnership with Counseling Services and Student Health to teach self-care and mental health awareness to Resident Assistants Incorporate self-care strategies into Resident Assistant Training Include an element of self-care learning into Resident Assistant staff meetings Address Resident Assistant community mental health needs in coordination with Counseling Services Summer 2021 Summer 2021 Starting Fall 2021 Starting Fall 2021 Understanding of Resident Assistant Wellbeing Additional ProQOL administrations Spring 2022 and yearly thereafter 110 Future Research This study and gaps in the literature illuminate the need for further research in a number of areas. Specifically, more in-depth data regarding the impact of the pandemic could be gathered as well as additional information about how Resident Assistants support the wellbeing of other students. Additional ProQOL data is also needed in the future to assess how the scores on the assessment may be changing over time, especially as the pandemic lessens in its impact on educational environments. Also, more research on burnout and compassion fatigue as it relates to individuals that work in educational environments is needed. Finally, additional data is necessary to understand the mental health of LGBTQIA Resident Assistants, given the unique needs of this population. Need for Additional Data First, this study provided a new understanding of the current mental wellbeing of Resident Assistants, both through the quantitative data of the ProQOL and the qualitative data of the open-ended questions. However, more detailed information about Resident Assistant wellbeing could be obtained through focus groups and individual interviews, as this would allow for more rich descriptions of the experiences of Resident Assistants. While the data provided in this study is helping in gaining an initial understanding of how Resident Assistants are impacted by the rise in student mental health issues, the pandemic, and racial injustice, there is still much to be learned. Additional information is needed about how Resident Assistants learn how to care for themselves and their residents and why they rated their organization as supportive. This is especially important in further exploring the split in the burnout scores, as the data available through this study do not fully explain why a subset of Resident Assistants is experiencing more burnout than another. Direct conversations with Resident Assistants would provide more detailed 111 information why individuals may or may not be experiencing higher levels of burnout as well as illuminate gaps in training and knowledge that could be used to address this concern. Understanding Organizational Support Furthermore, an in-depth understanding of how Resident Assistants are impacted by the national conversation around racial injustice is also needed to better support Resident Assistant wellbeing. The qualitative data illustrated that this is a topic on the minds of many Resident Assistants, and many spoke about the serious impact this had on their own wellbeing. Given that they are simultaneously rating the organization as supportive, information is needed about specific strategies that the organization is engaging in that the Resident Assistants find supportive. This could be helpful in highlighting best practices the organization participates in and ensuring those activities are enhanced. As the safety of Asian Resident Assistants was a serious concern that was illuminated through this study, this is also critically important in ensuring that the safety needs of this community are addressed. Additional data is needed to support students and Resident Assistants that identify as Asian to safeguard their own wellbeing as part of the campus community. Given the importance of belonging and the environment on mental wellbeing, as outlined earlier, this is an important and timely need for Resident Assistants. Post-Pandemic Assessment Second, as this study was conducted during the pandemic, it is possible that the unique circumstances and learning environment necessitated by COVID-19 impacted the results. Also, it is important to understand if Resident Assistant is stable or changing overtime. Given both of these factors, additionally assessments should be conducted in the future to provide comparison data on Resident Assistant wellbeing. This is important in understanding if the pandemic had a 112 unique impact on Resident Assistants and in understanding if additional efforts made on the part of the professional staff to address the mental health of Resident Assistants are effective in reducing burnout scores and improving compassion satisfaction. Furthermore, as there are multiple environmental factors that influence wellbeing, such as the campus climate toward minority populations, gathering this data at future points is a useful barometer in understanding the mental health of the Resident Assistant population. As Resident Assistants have a critical role in supporting the mental wellbeing of the entire student population, understanding and attending to the mental health of the Resident Assistant population is required, and these efforts should be continuous and ongoing. Additional Research in Educational Contexts Third, as much of the prior research on compassion fatigue and burnout is on healthcare professionals, further research is needed on individuals that work in educational environments. While this study is helpful in term of understanding how working in human service roles at an institution of higher education impacts mental wellbeing, it is one of a handful of dissertations and other research studies on this topic. At the same time, the mental health needs of higher education students have only grown over time, and this growth has been compounded by the pandemic. Therefore, more reach on the topic of burnout and compassion fatigue in educational environments will continue to inform best practices for organizations that work to support student wellbeing. As there is a link between academic success and wellbeing, this is a necessary component of the educational environment that needs to be addressed to ensure the health, safety, and success of students in higher education. Furthermore, addressing student wellbeing could pay dividends in terms of addressing the mental health of an entire population of 113 individuals, as these students will carry the skills they use to attend to their own wellbeing throughout their adult lives. Resident Assistant Self-Efficacy Fourth, additional data needs to be gathered about the self-efficacy of Resident Assistants in supporting student mental health issues. With this study, the overwhelming majority of Resident Assistants responded to this open-ended question with affirmative and confident responses. While this data is encouraging, these responses were unexpected, and in hindsight this question could have been asked via a Likert scale item. This could also allow for comparisons across various demographic variables to ensure that there are no gaps in self-efficacy for any particular population. Given the impact to wellbeing on minority populations, this is especially important in ensuring that the entire group of Resident Assistants shares this positive view of their abilities in supporting student wellbeing. Furthermore, focus groups and interviews on this topic could provide more in-depth information about the knowledge and training that Resident Assistants have in this area, allowing for best practices to be identified and gaps in understanding to be addressed. As part of the data collected in response to the open-ended item on this topic was useful in understanding the helping skills that Resident Assistants use in their efforts to support student wellbeing, a more thorough understanding of how Resident Assistants learn to support wellbeing is important to better address the needs of the students they serve. This could also help to further clarify why Resident Assistants may have a good understanding of how to care for others while simultaneously failing to apply those same skills to themselves. LGBTQIA Resident Assistants Finally, additional research is needed on Resident Assistants that identify as LGBTQIA to gain insight into both the impact of the climate on their own wellbeing as well as how they 114 may be experiencing compassion fatigue, burnout, and secondary trauma. Specifically, this study did not include any questions that would identify a participant as LGBTQIA. However, as noted earlier, LGBTQIA students are among the population of minority individuals that experienced more significant increases in depression and anxiety during the pandemic (Chirikov et al., 2020). This means that there is a subset of the Resident Assistant population that may be experiencing disproportional impacts to their wellbeing, but the data about the level and severity of this impact is unknown. Given that there are special programs dedicated to the residential living and learning environments of LGBTQIA students, this is a serious gap in understanding the wellbeing of this population. As LGBTQIA Resident Assistants may be providing support to fellow students that also belong to the LGBTQIA population, it is important that the mental health of these students be better known and understood. As the pandemic has been particularly difficult on minority communities, it is vital that the wellbeing of LGBTQIA Resident Assistants be further explored to ensure that their needs are addressed. Conclusions Overall, Resident Assistants appear to be experiencing moderate levels of compassion fatigue. This is encouraging, especially given the difficulty and challenging circumstances of the pandemic on educational environments. However, the spilt in burnout scores is of concern, and overall, there is room for reducing the median burnout score of the Resident Assistant population. As discussed, this could be accomplished through efforts that encourage more balance between work and other responsibilities and supporting Resident Assistants in physically removing themselves from the work environment. Additionally, while Resident Assistants appear to have a good understanding in how to support the mental wellbeing of their residents and feel confident in their ability to do so, they are less effective in applying those skills to their 115 own mental wellbeing. Additional training in this area may be needed, as well as support from the organization in modeling and encouraging a focus on self-care and the importance of mental. health. As Resident Assistants overall rated the organization as supportive, there appears to be a level of trust between Resident Assistants and the professional staff. Given this, further support from the staff in attending to self-care may be well-received by Resident Assistants. Additional concerns regarding the safety of Asian Resident Assistants should also be addressed, especially in light of recent violence directed towards the Asian community. Furthermore, given the impact of the pandemic on minority communities, additional discussion and efforts in supporting the mental wellbeing of students from minority backgrounds is critical to addressing the mental wellbeing of these populations. Finally, this study contributes to small body of literature on compassion fatigue, burnout, secondary trauma, and compassion satisfaction in educational environments. Given that there is a large body of literature that demonstrates the growing need to address the mental health of higher education students, the link between caring for the health of others and impact this has on the providers of this care is critical in addressing this problem. Further research is needed in this area to better understand how individuals responsible for caring for the mental welling of students is needed to ensure that the mental health of all students is improved. As demonstrated through this study, Resident Assistants can also experience their own mental health concerns as a direct result of the demands of their position and the lack of boundaries between their role as a Resident Assistant and their responsibilities as a student. Addressing the mental wellbeing of Resident Assistants is necessary in both improving their own environment and in addressing the mental health of the students they serve. 116 References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bandura, A. (2005). The evolution of social cognitive theory. In K. G. Smith & M.A. Hitt (Eds.), Great Minds in Management (pp. 9–35). Oxford: Oxford University. Bernstein Chernoff, C. (2016). 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Theory of Compassion Satisfaction and Compassion Fatigue (Figley, 1995; Stamm, 2010) Survey Questions: 4-33 (taken directly from the ProQOL) 34 (Support Variable) 35, 37, and 39 (Open ended) 2. What are Resident Assistants’ perceptions regarding their ability to successfully support student mental health issues? Theory of Compassion Satisfaction and Compassion Fatigue (Figley, 1995; Stamm, 2010) Survey Question 38 (Open ended) 3. What self-care and support strategies do Resident Assistants use to maintain their own wellbeing? Theory of Compassion Satisfaction and Compassion Fatigue (Figley, 1995; Stamm, 2010) Survey Question 36 (Open ended) Demographic Questions Survey Questions: 1-3 127 Appendix B: Consent Form 128 129 130 131 Appendix C: Permission to Use ProQOL 8/29/20, 10)05 PM University of Southern California Mail - Permission to Use ProQOL Page 1 of 1 https://mail.google.com/mail/u/0?ik=a64a030686&view=pt&search=…read-f%3A1674742020809681142&simpl=msg-f%3A1674742020809681142 Jason Thibodeaux <jthibode@usc.edu> Permission to Use ProQOL 1 message ProQOL Office <noreply@surveygizmo.com> Tue, Aug 11, 2020 at 8:03 AM Reply-To: ProQOL Office <proqol@cvt.org> To: jthibode@usc.edu Thank you for your interest in the ProQOL. The ProQOL measure may be freely copied and used, without individualized permission from the ProQOL office, as long as: (a) You credit The Center for Victims of Torture and provide a link to www.ProQOL.org; (b) It is not sold; and (c) No changes are made, other than creating or using a translation, and/or replacing "[helper]" with a more specific term such as "nurse." Because you have agreed that your use of the ProQOL follows the above criteria, the ProQOL Office at the Center for Victims of Torture grants you permission to use the ProQOL. Your recorded request is attached here as a PDF. If you have any questions or comments, you can contact us at proqol@cvt.org. Note that unfortunately our capacity is quite limited, as this is a volunteer-run effort, but we will do what we can to respond within a couple of weeks. Thank you! The ProQOL Office at The Center for Victims of Torture proqol@cvt.org PermissionToUseProQOL.pdf 19K 132 Permission to Use the ProQOL Thank you for your interest in using the Professional Quality of Life Measure (ProQOL). Please share the following information with us to obtain permission to use the measure: Please provide your contact information: Email Address jthibode@usc.edu Name Jason Thibodeaux Organization Name, if applicable University of Southern California Country USA Please tell us briefly about your project: I am conducting a study for my dissertation on compassion fatigue and burnout in Resident Assistants and seeing how their work related to the student mental health crisis in higher education. The goal is to understand if Resident Assistant are experiencing compassion fatigue and burnout and what skills they have or need to manage these issues. Below are my research questions: 1. Are student employees at Western University impacted by the increasing volume and complexity of mental health issues occurring in higher education? 2. How effective do student employees at Western University feel in their ability to successfully support student mental health issues? 3. What self-care strategies do student employees use to maintain their own wellbeing? What is the population you will be using the ProQOL with? Undergraduate students employed as Resident Assistants In what language/s do you plan to use the ProQOL? Listed here are the languages in which the ProQOL is currently available (see https://proqol.org/ProQol_Test.html). If you wish to use a language not listed here, please select "Other" and specify which language/s. English The ProQOL measure may be freely copied and used, without individualized permission from the ProQOL office, as long as: You credit The Center for Victims of Torture and provide a link to www.ProQOL.org; It is not sold; and No changes are made, other than creating or using a translation, and/or replacing "[helper]" with a more specific term such as "nurse." Note that the following situations are acceptable: You can reformat the ProQOL, including putting it in a virtual format You can use the ProQOL as part of work you are paid to do, such as at a training: you just cannot sell the measure itself 133 Does your use of the ProQOL abide by the three criteria listed above? (If yes, you are free to use the ProQOL immediately upon submitting this form. If not, the ProQOL office will be in contact in order to establish your permission to use the measure.) Y e s Thank you for your interest in the ProQOL! We hope that you find it useful. You will receive an email from the ProQOL office that records your answers to these questions and provides your permission to use the ProQOL. We invite any comments from you about the ProQOL and the experience of using it at proqol@cvt.org. Please also contact us if you have any questions about using the ProQOL, even if you noted them on this form. Note that unfortunately, our capacity is quite limited so we may not be able to respond to your note: however, we greatly appreciate your engagement. 134 Appendix D: Survey Instrument Start of Block: Consent Q0 Resident Assistant Wellbeing Survey Q43 Statement of Consent By completing this survey, I acknowledge that I have read (or someone has read to me) the information provided in the consent form for this study. I have been given a chance to ask questions. All my questions have been answered. By completing this survey, I am agreeing to take part in this study and acknowledge that I am at least 18 years of age or older. o Yes, I am agreeing to take part in this study and acknowledge that I am at least 18 years of age or older. (1) o No, I am not agreeing to take part in this study and/or I am under the age of 18. (2) End of Block: Consent Start of Block: Demographic info 1 135 Q1 How many years of experience do you have as a Resident Assistant? o Less than one year (this is my first year as an RA) (0) o 1 year (1) o 2 years (2) o 3 years (3) o 4+ years (4) End of Block: Demographic info 1 Start of Block: Demographic info 2 Q2 I identify my gender as: o Female (1) o Male (2) o Non-binary (3) o Prefer not to answer (4) o Other: (6) ________________________________________________ 136 Q3 I identify my ethnicity as (select all that apply): ▢ Asian (1) ▢ Black/African (2) ▢ Caucasian (3) ▢ Hispanic/Latinx (4) ▢ Native American (5) ▢ Pacific Islander (6) ▢ Prefer not to answer (7) ▢ Other: (8) ________________________________________________ End of Block: Demographic info 2 Start of Block: Professional Quality of Life Scale 1 When you help people, you have direct contact with their lives. As you may have found, your compassion for those you help can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative. Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. 137 Q4 Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I am happy. (1) o o o o o I am preoccupied with more than one person I help. (2) o o o o o I get satisfaction from being able to help people. (3) o o o o o I feel connected to others. (4) o o o o o I jump or am startled by unexpected sounds. (5) o o o o o End of Block: Professional Quality of Life Scale 1 Start of Block: Professional Quality of Life Scale 2 138 Q5 Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I feel invigorated after working with those I help. (1) o o o o o I find it difficult to separate my personal life from my life as a Resident Assistant. (2) o o o o o I am not as productive at work because I am losing sleep over traumatic experiences of a person I helped. (3) o o o o o I think that I might have been affected by the traumatic stress of those I help. (4) o o o o o I feel trapped by my job as a Resident Assistant. (5) o o o o o End of Block: Professional Quality of Life Scale 2 Start of Block: Professional Quality of Life Scale 3 139 Q6 Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) Because of my job as a Resident Assistant, I have felt "on edge" about various things. (1) o o o o o I like my work as a Resident Assistant. (2) o o o o o I feel depressed because of the traumatic experiences of the people I help. (3) o o o o o I feel as though I am experiencing the trauma of someone I have helped. (4) o o o o o I have beliefs that sustain me. (5) o o o o o End of Block: Professional Quality of Life Scale 3 Start of Block: Professional Quality of Life Scale 4 140 Q7 Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I am pleased with how I am able to keep up with Resident Assistant techniques and protocols. (1) o o o o o I am the person I always wanted to be. (2) o o o o o My work makes me feel satisfied. (3) o o o o o I feel worn out because of my work as a Resident Assistant. (4) o o o o o I have happy thoughts and feelings about those I help and how I could help them. (5) o o o o o End of Block: Professional Quality of Life Scale 4 Start of Block: Professional Quality of Life Scale 5 141 Q8 Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I feel overwhelmed because my work load seem endless. (1) o o o o o I believe I can make a difference through my work. (2) o o o o o I avoid certain activities or situations because they remind me of frightening experiences of the people I help. (3) o o o o o I am proud of what I can do to help. (4) o o o o o As a result of my job as a Resident Assistant, I have intrusive, frightening thoughts. (5) o o o o o End of Block: Professional Quality of Life Scale 5 Start of Block: Professional Quality of Life Scale 6 142 Q9 Consider each of the following questions about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced these things in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I feel "bogged down" by the system. (1) o o o o o I have thoughts that I am a "success" as a Resident Assistant. (2) o o o o o I can't recall important parts of my work with trauma victims. (3) o o o o o I am a very caring person. (4) o o o o o I am happy that I chose to do this work. (5) o o o o o End of Block: Professional Quality of Life Scale 6 Start of Block: Block 13 Q34 Consider following question about you and your current work situation as a Resident Assistant. Select the response that honestly reflects how frequently you experienced this in the last 30 days. Never (1) Rarely (2) Sometimes (3) Often (4) Very Often (5) I am supported by my organization in my role as a Resident Assistant. (1) o o o o o 143 End of Block: Block 13 Start of Block: Open 1 Q35 In what ways, if any, has being a Resident Assistant affected your own mental health? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Q36 In your role as a Resident Assistant, how do you care for your own wellbeing? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: Open 1 Start of Block: Open 2 Q37 In your role as a Resident Assistant, what are warning signs that you may need to do something to address your own wellbeing? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 144 Q38 In your role as a Resident Assistant, how confident do you feel in your ability to support fellow students with mental health issues? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: Open 2 Start of Block: Block 12 Q39 Compared to previous quarters, how has COVID-19 and/or racial injustice impacted your own wellbeing? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ End of Block: Block 12 Start of Block: Block 11 Q40 Would you like to enter a raffle for a chance to win a prize for participating? o Yes (1) o No (2) End of Block: Block 11

Abstract (if available)

Abstract The number of students with mental health issues in institutions of higher education has been rising over the past few years, and the COVID-19 pandemic has accelerated this issue. Depression, anxiety, and suicide ideation are the most serious concerns. While the impact of working with others in distress is well documented in the health professions, this impact is less studied in educational institutions. This study measures compassion fatigue (burnout and secondary trauma) and compassion satisfaction via the Professional Quality of Life Scale in Resident Assistants at a public research university. Additional data regarding the impact of working with others in distress, the mental health consequences of the pandemic, and self-efficacy around helping skill is examined. Demographic relationships with the scales for burnout, secondary trauma, and compassion satisfaction are explored, along with the level of support provided by the organization. Recommendations for decreasing the burnout and mental health issues reported by Resident Assistants are examined.

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Thibodeaux, Jason Jeremiah (author)

Core Title Compassion fatigue, burnout, and secondary trauma in resident assistants

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2021-08

Publication Date 06/10/2021

Defense Date 05/06/2021

Publisher University of Southern California. Libraries (digital)

Tag burnout,compassion fatigue,OAI-PMH Harvest,resident assistants,student affairs

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Tobey, Patricia (committee chair), Ahmadi, Shafiqa (committee member), Ruzicka, Smita (committee member)

Creator Email jasonjt@gmail.com,jthibode@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-468748

Unique identifier UC13012645

Identifier etd-Thibodeaux-9651.pdf (filename),usctheses-c89-468748 (legacy record id)

Legacy Identifier etd-Thibodeaux-9651

Dmrecord 468748

Document Type Dissertation

Rights Thibodeaux, Jason Jeremiah

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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