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A compassion fatigue informed approach: the wellness trail for refugee workers

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A compassion fatigue informed approach: the wellness trail for refugee workers

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Content Running Head: A COMPASSION FATIGUE INFORMED APPROACH
A Compassion Fatigue Informed Approach:
The Wellness Trail for Refugee Workers
Maria Hu, LCSW
Capstone Project
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work, University of Southern California
December 2019
A COMPASSION FATIGUE INFORMED APPROACH 1

Acknowledgement

My deepest gratitude goes to my committee members, Dr. Michael Rank, Dr.
George Orras, and Dr. Jennifer Lewis. To Dr. Rank, who believed in my work from day
one and conveyed an enormous amount of guidance and unconditional regard. To Dr.
George Orras, who never wavered and challenged me to think outside the box. To Dr.
Jennifer Lewis who pushed me to think more globally. I am extremely thankful for all of
your suggestions and for pushing me farther than I fathomed I could potentially go.
The sacrifices that my mother: Maria Castillo-Hu endured, as an immigrant is a
reason why I chose to pursue a Doctorate in Social Work with a focus on the refugee
population. Although I was born in the United States, I was raised to think as an immigrant
because of the values and morals that were instilled in me by my loving mother. My
mother migrated to the United States in the early 1960s. Not a day goes by that she does
not share her migration journey to the states. She sought asylum and eventually was
granted permission to live in the United States legally as a resident. With perseverance, my
mother became a U.S. citizen.
To the love of my life, my husband: Stephen Hydon. The man who always been a
consistent source of encouragement and inspiration. I am deeply grateful for having you in
my life. I sincerely could not have done this without your support. Thank you, for caring
for our children, cooking my favorite meatballs, and buying me snacks while I attended my
classes. You are truly a remarkable human being. I will forever be grateful for the
sacrifices you have made for our family. To my dearest colleague, sister from another
mother, Dr. Umeka Franklin: GURL! Where would I be without our friendship! You are
such an amazing woman whom I admire so greatly. Words cannot express how much I
appreciate your unconditional love and support through these years. You are truly an angel
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in disguise! To my three children, Vincent, Tea-Mea, and Cameron. You three are the air I
breathe in. I love you so dearly and will always love and cherish you unconditionally.
Cameron, thank you for being so patient and for taking care of your sister while I was
attending to my doctoral studies. I hope someday you will be just as proud of mommy as I
am of you. To Vincent, there are no words to describe the love I have for you. Thank you
for always caring for your sisters. I am deeply proud of you. You have inspired me to do
great things. To Colin, C-Piece: I love you so much, papito. I look forward to having more
time to make your favorite pasta dish at home. Thank you, papa for always trying to sneak
in a look into my classes- LOL! Last but not least, thank you to my dear colleague, Rafael
Angulo for your continuous support with the development of my project. Mil gracias!

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Executive Summary
The proposed project will help to close the health gap by implementing a program
to mitigate the impact of compassion fatigue among refugee workers at the Association of
Latin America. Specifically, the proposed project aims at teaching refugee workers the
signs and symptoms associated with compassion fatigue as well as other measures that can
reduce levels of stress. The link between the project and the Grand Challenge is that it
seeks to address the wicked problem by raising awareness of the symptoms of compassion
fatigue and teaching workers strategies to prevent and reduce its impact. This project is to
protect refugee workers from the psychological and physical injuries caused by working
with traumatized migrant survivors.
The program will utilize a web-based and in-person psychoeducational format that
teaches specific strategies aimed at reducing the impact of compassion fatigue among the
refugee workers of the Association of Latin America. The program focuses on engaging
workers in mindfulness practices and implementing self-care plans by using the four
domains: physical, emotional, spiritual and workplace/professional. The overall purpose of
purpose of the project within the larger framework is that it assist refugee workers engage
in preventative care to promote overall health by learning the impact of compassion fatigue
and the strategies that can be implemented to either prevent or mitigate the effects.
Many refugees from Latin America fled their country of origin due to persecution,
violence, or war. Refugee workers are part of the service delivery team that serves the
needs of this population. In the midst of their work, refugee workers are at the frontline
witnessing refugees recount their journey of migration, often filled with horrific traumatic
events. Witnessing traumatized migrant survivors recount their stories of trauma
automatically places the refugee workers at risk for developing compassion fatigue: the
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“bearing suffering of clients who have suffered traumatic event” (Figley, 1995, p. 7). The
overall problem that this project is addressing is the unaddressed compassion fatigue that is
connected to the shared practices among the organizations that host the refugee worker
population.
The methodology of this project consists of a program that mitigates the impact of
compassion fatigue among refugee workers from the Association of Latin America. The
program is comprised of a 90-minute web-based program and five 90 minute in-person
support groups. The program will administer a self-report survey called the Professional
Quality of Life Scale (ProQol; Stamm, 2005) to 20 refugee workers from the Los Angeles
satellite office of the Association of Latin America to assess levels of compassion fatigue.
The ProQol survey will be administered online at the beginning of the program and every
three months for one year from the start of the program.
The Association of Latin America has three satellite offices in the state of
California: Los Angeles, San Diego, and San Francisco. Recruiters will be included in the
design of the program in efforts to expand to other sites. Their role will be to engage
stakeholders to ensure the necessary buy-in is reached for implementation and sustainment
of the program. The project will first be implemented Los Angeles site, which is
considered one of the largest offices that services the most immigrants. In year two, the
project aims at being implemented at the San Diego site. The San Diego site is considered
the second-largest due to its proximity of being close to the Mexico and United States
Border. During its third year, the project is intended to be implemented at the San
Francisco site. Given that the United States has the most refugees, this innovation will
assist refugee workers to render service without compromising the well-being of the
migrant population. The project addresses potential implications that is considered beyond
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the local context. A working environment plays a central role in the success of the staff and
the population they serve. Overall, this project will help cultivate a culture of resilience and
a healthier working environment for all.
The step the project takes beyond the local context is that it applies to the larger
refugee population. Currently, programs addressing compassion fatigue have primarily
been created for mental health and medical professionals. This program fills the gap by
addressing the needs of refugee workers. The overall intent of this project is to expand it
nationwide to other organizations that support the refugee population.

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Table of Contents
Executive Summary 3
Conceptual Framework 7
Description of Social Problem: Prevalence & Incidence 8
Important and Relevant Concepts Defined 10
Description of What is Known About Research, Practice, and Innovation 12
Resulting Gaps in Knowledge and Impact 13
Description of Conceptual Framework and Theory of Change 14
General Description of Proposed Project 18

Problems of Practice and Solutions/Innovations 18
Explanation of design (e.g., program development, intervention design, policy
change strategy) 18
Justification of Innovation 26
Description of Proposed Impact: Goals, What Are You Trying to Resolve 28
Detailed Logic Model: Visual Image, Inputs, Outputs, Resources, List
Timeframes/Benchmarks 28
Explanation of How the Proposed Solution Will Improve Grand Challenge Area 29
Feedback From Multiple Stakeholders on Proposed Solution and Feasibility 31
Analysis of How Innovative Solution Is Positioned Within History, Policy and
Public Knowledge 31
Evidence or Data to Show Impact 32
Description of Political, Organizational and Community Allies 33
Description of Political, Organizational and Community Obstacles 33
Analysis of Alternative Pathways 34

Project Structure, Methodology and Action Components 34
Implementation Plan and Timeline: Realistic Financial Plans 35
Description of Measurement of Outcomes Using Data or Community Input 38
Plan for Stakeholder Involvement That Includes Relevant Constituencies 38
Communication Plan and Strategies That Will Engage Audiences 39
Dissemination Plan for Broader Impact 39
Ethical Concerns and Possible Negative Consequences 40
Summary of Project Plans and Conclusions 41

Conclusion, Actions & Implications
Implications of Project in Terms of How it Will Improve Practice or Policy 41
Acknowledgement of Limitations and Risks: Recommendations for Future Work 42
Capstone Project Advancement Plan 43

References 45
Appendix A: English ProQOL 57
Appendix B: Spanish ProQOL 59

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Conceptual Framework
Migrant Refugee Population from Latin America

Currently, the largest refugee pandemic since the modern era is taking place. While
the world is focused on the refugee influx in Europe, there is another population that
deserves immediate attention: the migrant population from Latin America. In 2017, the
United States granted legal status to approximately 146,000 illegal immigrants (Blizzard &
Batalova, 2019). In this paper, refugees will not be designated as such by their legal status
under United States law; rather, the term “refugees” is herein defined as individuals who
fled their country of origin due to fear of harm or persecution. According to the United
Nations High Commissioner for Refugees (UNHCR), in 2017, there are about 70 million
individuals globally who were displaced due to war, persecution, or violation of human
rights. The United States has been recognized as among the countries that admit the most
refugees (Blizzard & Batalova, 2019).
Researchers have investigated the reasons so many flee their countries of origin.
Experts have demonstrated that the primary motives are escaping high rates of violence
and searching opportunities for employment and education (Eguizábal et al., 2015; Lusk &
Terrazas, 2015). Specifically, these migrants have reported being victims of torture, sexual
assault, kidnapping, extortion, and slave labor (Lusk & Terrazas, 2015). A study conducted
by the UNHCR reported that thousands of Central Americans had fled their home countries
to escape violence (Eguizábal et al., 2015). Eguizábal and colleagues interviewed 160
women from El Salvador, Guatemala, Honduras, and Mexico who were detained by
Immigration and Customs Enforcement. These women explained that, during their
migration, they paid large amounts of money to human smugglers (Eguizábal et al., 2015).
They further indicated in their interviews that they took contraceptives before their
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departure to prevent the risk of becoming pregnant in the event they were raped (Eguizábal
et al., 2015). Each of these women underwent asylum proceedings.
Description of Social Problem: Prevalence & Incidence
The health disparities in the United States have been linked to specific determinants
found in communities of marginalized and oppressed people, such as undocumented
immigrants. The Social Work Grand Challenge that this project address is Close the Health
Gap. For instance, those who arrive in the United States illegally or with no citizenship
status cannot access most medical and mental health services. The problem is that there are
not effective strategies that promote a healthy work-life balance for those suffering from
discrimination and who live and work in toxic environments.
The Role of the Refugee Worker
The Association Offices of Latin America are a safe haven for many immigrants as
their goal is to defend and protect the rights of their citizens. They manage diplomatic
transactions on behalf of the immigrants' country of origin. The refugee workers are part of
the service delivery for organizations as they play a central role in assisting immigrants in
navigating American culture (Nezer, 2013; Akinsulure-Smith, Espinosa, & Hallock, 2018).
Their role is to provide assistance related to passport and visa issuance, temporary work
permits, legal representation pertaining to deportation proceedings, and safety advocacy
concerning family and community violence. However, organizations serving the immigrant
population tend to have minimal resources (Nawyn, 2010) due to lack of funding and
training. Despite these limited resources, organizations and government agencies have
taken extra measures to provide support services related to physical and mental health,
education, and employment (Nawyn, 2010). Workers are literally at the frontline providing
supportive services to the immigrant population. In the midst of their work, refugee
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workers often listen to painful stories that are filled with traumatic events. Refugee workers
provide support for those facing deportation proceedings as well for people who are
victims of domestic violence, sex trafficking, and kidnapping.
Understanding compassion fatigue. Listening to someone recount stories of
trauma can place the listener at risk for developing compassion fatigue. Figley (1995)
coined the term "compassion fatigue" as the emotional residue from working with those
who have been impacted by trauma. Specifically, compassion fatigue is "bearing the
suffering of clients and the natural consequent behaviors and emotions resulting from
knowing about a traumatizing event experienced or suffered by a person" (Figley, 1995,
p.7). Exposure to those experiencing distress can adversely impact a professional's mental
and physical health, safety, well-being (Cocker & Joss, 2016). These conditions are known
to increase sickness, which leads to absence, psychological injury claims, job turnover, and
loss of productivity (Cocker & Joss, 2016).
Researchers cautioned that if this occupational hazard is not adequately addressed
within an organization, clients may be inadvertently harmed (Lusk & Terrazas, 2015).
Lusk and Terrazas (2015) found that paraprofessionals who provide supportive services to
traumatized migrants are at high risk of developing secondary exposure to trauma.
Therefore, compassion fatigue is an occupational hazard for those working directly with
clients who have a history of trauma. Addressing compassion fatigue within the workforce
can help promote a healthy work-life balance for those who work in demanding and toxic
work environments.

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Important and Relevant Concepts Defined
Research suggests that compassion fatigue is also termed vicarious trauma and
secondary trauma. This is largely because the preconditions of risk for compassion fatigue
like working with traumatized others, unresolved personal trauma, or countertransference
are similar to the precipitating factors that could onset the symptoms of vicarious or
secondary trauma. Therefore, due to these similarities, the literature is ambiguous in terms
of the characteristics of each phenomenon. Nonetheless, experts have defined compassion
fatigue as a combination of burnout and secondary trauma (Cocker & Joss, 2016; Stamm,
2010).
Impact of compassion fatigue. Experts who examined compassion fatigue among
professionals working in centers or units for trauma treatment and results indicated that the
longer they were on the job, the higher their compassion fatigue (Kjellenberg, Nilsson,
Daukantaité, & Cardeña, 2014). Exposure to patients or clients experiencing trauma or
distress can negatively impact a professional’s mental and physical health, safety, and
wellbeing, as well as that of their families, the people they care for[, and their employing
organizations. These conditions are known to increase sickness, which can potentially lead
to absences, psychological injury claims, job turnover, and can negatively impact
productivity (Cocker & Joss, 2016). One study of professionals who worked primarily with
recently arrived immigrants described many workers felt emotionally drained and had
feelings of inadequacy in their work (Tatar, 2012). The impact of compassion fatigue can
range from subtle mood swings to palpable changes in behavior. These may include low
self-esteem, increased irritability, perfectionism, and self-injurious behavior (Harr, 2013).
Other impacts are not visible but can impede a person’s outlook on life and emotional state.
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With the former, an individual may develop a pessimistic view of their belief system, and,
with the latter, might experience feelings of guilt and fear (Harr, 2013). Individuals
experiencing compassion fatigue may show less empathy towards those they help or may
believe they lack the ability to perform their daily job tasks. These feelings can negatively
affect the work environment, leading to low morale and projection of blame onto
coworkers (Harr, 2013).
Burnout. Harr (2013) reported that burnout is similar to compassion fatigue but has
distinct characteristics. The emotional symptoms of burnout consist of cynicism,
irritability, frustration, and hypervigilance (Harr, 2013). The physical symptoms are
exhaustion, fatigue, sleep disturbances, and frequent headaches (Heinmann & Heinmann,
2017). The Global Development Professional Network, in 2015, examined the well-being
of approximately 800 humanitarian workers supporting the immigrant population. One
participant reported that compassion fatigue and burnout are a hidden secret and critical
issue that must be brought to light to prevent further harm. The study further revealed that
approximately 50% of the participants were diagnosed with anxiety and depression
(Young, 2015). Although some professions have taken steps to close the health gap, some
health needs continue to be neglected.
Self-care. Workers who work in the helping profession have found self-care
difficult (Harr, 2013). Self-care is acknowledging the “need for personal replenishment and
renewal” (Harr, 2013, p. 83). To infuse a self-care model within an organization, it is
essential first to examine how its culture supports its staff (Maltzman, 2011). Maltzman
(2011) identified organizational self-care as centered around the beliefs that staff members
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are skilled in their job, that self-care is encouraged and supported, that compassion fatigue
is an occupational hazard, and that compassion fatigue is not the sufferer’s fault.
Immigrant. A non-citizen who is permitted to live in the United States as a legal
resident. Retrieved from https://www.dhs.gov/immigration-statistics/data-standards-and-
definitions/definition-terms#permanent_resident_alien
Refugee. A refugee is an individual who is born in a foreign country and is unable
to return to that country due to fear or persecution (United States Department of Homeland
Security, 2018). Retrieved from https://www.dhs.gov/immigration-statistics/data-
standards-and-definitions/definition-terms#18
Trauma. Trauma is considered to occur when an individual has been exposed to an
event that has been emotionally damaging, physically harming, or life-threatening
(Substance Abuse and Mental Services Administration, 2014).
Description of What is Known About Research, Practice, and Innovation
The phenomenon of compassion fatigue among refugee workers has been tucked
away for years. For the first time in history, compassion fatigue is going to be addressed
among the refugee workers with this innovation. Currently, there is a lack of research
examining the effects of compassion fatigue among refugee workers. There is one study
that investigated the mental health conditions of social work staff who worked directly
with the refugee population (Wirth, Mette, Prill, Harth, and Nienhaus, 2018). They found
that professionals who work with this population are in desperate need of ongoing
consultation and supervision when dealing with refugees.
To this date, very few employing organizations have developed initiatives within
the workplace to address the needs of the workers who support the refugee population. For
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instance, some of the programs provide one-hour webinars that encourage refugee workers
to use a trauma-informed approach when supporting this population (Schriver, 2018).
Other organizations, such as the Queensland Program of Assistance Survivors of Torture
and Trauma (QPASTT), developed a guidebook that explains the signs and symptoms of
compassion fatigue and burnout (QPASTT, 2016). Further, some programs train
professionals to become certified in compassion fatigue. The International Association of
Trauma Professionals launched a program that offers six hours of pre-recorded videos by
Dr. Eric Gentry. This course trains professionals on how to mitigate the impact of
compassion fatigue. This course is provided in English and is only available to mental
health providers, physicians, educators, clergy, and other types of helping professionals
(International Association of Trauma Professionals, n.d.).
This project connects with today’s environment as it addresses the refugee crisis in
the United States. For example, in 2014, the United States saw an increase in the number of
Central Americans arriving at the United States/Mexico border (Eguizábal et al., 2015).
The State Department of Worldwide Refugee Admissions Processing System reported that,
in 2018, 54,000 refugees resettled in the United States (Zong, Batalova, & Hallock, 2018).
In 2016, about 110,000 immigrants sought refugee status. The United States is admitting
large numbers of refugees, and they are fast becoming part of the fabric of our society. As
a result, professionals working directly with these immigrants witnessed the recounting of
traumatic stories (Lusk & Terrazas, 2015), which puts these professionals at risk for
developing compassion fatigue (Tello, Castellon, Aguilar, & Sawyer, 2017).
Resulting Gaps in Knowledge and Impact
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Researchers and practitioners have sought to mitigate the impact of compassion
fatigue with interventions ranging from individual to organizational strategies. However,
most of the literature and innovations have been related to mental health practitioners and
medical professionals (Bercier, 2013) and do not address the risks for refugee workers.
Research has demonstrated that this area of study has been primarily focused on social
workers, nurses, oncology staff, medical center staff, hospice workers, and military
personnel (Cocker & Joss, 2016) and police officers (Andersen, & Papazoglou, 2015).
When examining the effectiveness of strategies of compassion, the results demonstrate
mixed results. One of the programs that resulted in reduced levels of compassion fatigue is
the Accelerated Recovery Program for Compassion Fatigue developed by Gentry,
Baranowsky, and Dunning (2002). This program is comprised of five sessions focused on
enhancing resiliency and self-efficacy.
Description of Conceptual Framework and Theory of Change
The conceptual framework for this innovation is Danieli’s (1998) trauma and the
continuity of the self (TCMI) framework applied through a historical trauma-informed
lens. Danieli coined the TCMI theoretical framework, which provides an understanding of
how trauma relates to an individual’s experience. This framework helps to explain the
various ways one adapts after a crisis and the complex layers of surviving a traumatic
event. This framework helps provide insight into how to recover from trauma across all
systems and cultures (Danieli, 2007). Utilizing this model will encourage refugee workers
in this project to become more culturally competent when working with the refugee
population. Specifically, this theoretical framework uses a multidimensionality lens that
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encompasses the identity of an individual, the aftermath of trauma exposure, and the
adaptation process.
It is important to note that historical trauma is a central element of the TCMI
framework. Although most studies have focused on individual experiences, recent studies
have investigated the implications of massive group trauma, which is historical trauma.
Historical trauma has been addressed in terms of populations who have endured trauma
such as American Indians, the refugee population, and Holocaust survivors (Xiong, 2015).
This framework will provide insight into the historical trauma experienced by refugee
workers and promote their healing. This project will bring to light the secrecy that has been
maintained among refugee workers.
Danieli (1998) indicated that an individual’s identity interacts with multiple
systems or spheres, so the TCMI framework is used in various disciplines. This model will
help determine how much a system has been ruptured and can assist with the selection of
interventions (Danieli, 2007). Specifically, this project utilizes the TCMI framework to
explore specific strategies to reduce the impact of compassion fatigue among refugee
workers. The TCMI framework theorizes that an individual has identity constructs such as
race, sexual orientation, and religious affiliations that interact with various spheres. These
spheres are educational, interpersonal-familial, social, religious and spiritual,
environmental, legal, and political (Danieli, 1998). According to Danieli (1998), when an
individual’s exposure to a traumatic event or situation can cause a rupture and adversely
influence the spheres, causing that individual to become stuck. Since these spheres are
interconnected, this framework theorizes that exposure to trauma can cause a rupture in an
entire system. Danieli (1998) reported that the magnitude of the trauma and how an
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individual copes with the trauma could assist with determining the severity of the rupture.
Without the opportunity to heal from trauma exposure, the rupture can affect future
generations.
Danieli (1998) provided specific recommendations that help heal and interrupt the
transference of trauma to future generations. One of the suggestions was the notion of
awareness as a whole. Danieli stated that recovery from trauma requires examination and
acknowledgment of the traumatic experiences. To enter the stage of recovery, “the
integration of traumatic experiences must be examined from the perspective of the totality
of the trauma survivors’ family and community members” (Danieli, 2007, p. 69).
Therefore, this project will examine both the experiences of refugee workers and the
traumatic experiences of their family and community members.
The other conceptual framework taken into consideration is the notion of cultural
bereavement. According to Bughra and Becker (2005), the natural consequence of the loss
of one's cultural values, social structures, and social identity is cultural bereavement.
Studies have shown that cultural bereavement is the feeling of guilt concerning the
relinquishment of one's culture and country of origin (Bughra & Becker, 2005). Although
cultural bereavement is considered a natural consequence when migrating from another
country, if the symptoms interfere with one's daily function, it then warrants an assessment
for mental health services (Bhugra & Becker, 2005). Eisneburch (1990) analyzed how
cultural bereavement may affect mental well-being. He noted that immigrants not given the
opportunity to process the loss of culture might experience mental health issues.
Eisneburch (1990) emphasized the understanding of cultural bereavement because it can
prevent misdiagnoses.
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General Description of Proposed Project
The proposed project will contribute to the improvements of the Grand Challenge:
Close the Health Gap by educating, treating, and managing the impact of compassion
fatigue among refugee workers at the Association Offices of Latin America. The project
aims at cultivating a culture of resilience and a healthier working environment for all
refugee workers. It seeks to solve the problem by raising awareness of the symptoms of
compassion fatigue and teaching workers strategies to prevent and reduce its impact. This
project is to protect refugee workers from the psychological and physical injuries caused
by working with traumatized migrant survivors. Overall, it will shift the paradigm from an
individual approach to a systemic one for healthier working environments.

Problems of Practice and Solutions/Innovations
Explanation of design (e.g., program development, intervention design, policy change
strategy)
Wellness Trail Refugee Worker Program. The Wellness Trail Refugee Worker
Program provides an understanding of the elements of compassion fatigue while
addressing important concepts of self-care and mindfulness practices. The program teaches
the signs of compassion fatigue and stress reduction strategies through the use of
mindfulness practices to promote their overall health. The project will contribute to
improvements of the Grand Challenge: Close the Health Gap. It will protect refugee
workers from the psychological and physical injuries of working with traumatized migrant
survivors. The program takes a two-prong approach: a web-based program and in-person
support groups.
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The web-based program. The web-based program is facilitated in a dynamic and
engaging format that provides an opportunity for self-discovery. The program unpacks
concepts that can further assist in expanding knowledge of conditions that can affect the
refugee workers’ role. The program is aimed at protecting refugee workers from
compassion fatigue by supporting their resiliency through mindfulness practices and self-
care plans. It will explain how compassion fatigue is a natural consequence and teach
specific strategies to mitigate or prevent its impact.
Before beginning the web-based program. The program will engage viewers in a
self-report activity of the Professional Quality of Life Survey (ProQol) which was created
by Stamm (2005). The purpose of this survey is to discover and examine the level of
compassion fatigue. This survey contains a 30-item self-report that examines the risk of
compassion fatigue. After the survey is completed, participants will move on to the content
of the web-based program.
Module One: Role of empathy and understanding compassion fatigue. The role
of empathy is explained within this module because being empathic places the worker at
risk of developing compassion fatigue.
Empathy is a central element of a refugee worker’s role. Empathy consists of
emotionally comprehending what another is experiencing. Without empathy, individuals
would not be able to relate to others. Empathy assists refugee workers in helping those who
have been impacted by trauma to rebuild their lives during their resettlement phase. While
empathy may not be enough to address complex conditions, it does help foster the
relationship between refugee worker and the refugee.
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Definitions. This section also provides an overview of compassion fatigue,
secondary trauma, and burnout. Relaxation skills are infused at the end of the module.
The five phases of compassion fatigue. This module reviews the four phases of
compassion fatigue: zealot phase, irritability phase, withdrawal phase, and the zombie
phase. These phases were developed by Douglas Fakkema (Animal Advocacy, n.d.).
The adverse effects of compassion fatigue. This module explains the six adverse
effects of compassion fatigue: social, psychological, emotional, professional, behavioral,
and physical.
Social adverse effects. To begin, social adverse effects of compassion fatigue
consider the aspects of how an individual socializes in the environment and the adverse
impacts of this socialization. For example, an individual might avoid situations that remind
her/him of a traumatic event like a neighborhood, street corner, or convenience store. An
individual might isolate him/herself from co-workers or significant others or friends,
withdrawing from them altogether (Showalter, 2010).
Psychological adverse effects. Psychological effects are those that affect an
individual’s mental or emotional. Since emotional impact will be covered in the following
section, a simple description of the impact of compassion fatigue on the mental state is
presented here. This is important because frontline workers may be unable to respond to
immigrants with concern or empathy (Beaumont, Durkin, Hollins-Martin, & Carson, 2017)
and may experience distress, anxiety, and negative thoughts (Duarte & Pinto-Gouveia,
2017) or lack internal peace (Snelgar, Renard, & Shelton, 2017). The emotional toll on a
person experiencing compassion fatigue may include worrying and lack of joy (Showalter,
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2010; Newsom, 2010), apathy (Newsome, 2010), hopelessness, and countertransference
(Harr, 2013).
Professional adverse effects. Similar to some of the symptoms listed above, the
professional impact of compassion fatigue suggests that individuals take on too much,
avoid working with colleagues in teams, or isolate themselves. Other studies suggest a
person might withdraw from specific spaces or become highly irritable towards others
(U.S. Department of Education, 2012). Some literature mentions individuals may wonder if
they can still help the clients or consumers they serve (Harr, 2013) or have difficulty
concentrating on job tasks and assignments (Harr, 2013). Lastly, individuals may come to
work with low energy or negative attitudes.
Behavioral adverse effects. Behavioral effects of compassion fatigue also merit
discussion. Coping strategies are ways we deal with stress or difficult circumstances and
can lead to certain behaviors. Individuals experiencing compassion fatigue may change the
way they cope or behave and may engage in excessive alcohol consumption, substance
abuse (Slatten, Carson, & Carson, 2011), increased gambling, or overspending on shopping
(U.S. Department of Education, 2012). Other behavior patterns are subtle: irritability or
impatience (Harr, Brice, Riley, & Moore, 2014).
Physical adverse effects. The last adverse effect discussed will be the physical
impact. Often most debilitating if not addressed, physical conditions range in severity from
indistinct sickness or nausea to headaches (Newsom, 2010) or dizziness and rapid heart
rate (U.S. Department of Education, 2012). Individuals may also experience sleeplessness
(Reim Ifrach & Miller, 2016) due to restlessness caused by thinking about clients or
patients.
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22

While compassion fatigue should not be considered as a sign of weakness or failure
but, rather, a strength in that someone recognizes they are experiencing something different
or unusual, the adverse effects can be life-altering (Flarity, Gentry, & Mesnikoff, 2013).
The ways in which resilience and self-care ameliorate the impact of compassion fatigue
will be discussed next.
Module Two: Promoting resilience through mindfulness practices. Resilience is
an innate trait that humans nurture throughout life (Srivastava, 2011). According to
Davydov, Stewart, Ritchie, and Chaudieu (2010), resilience helps us deal with adversity.
This is an important concept to consider for refugee workers who listen to stories of
tragedy or abuse and must use their resistance to remain mentally balanced in these
interactions. This module will assist workers to enhance their resilience skills through
mindfulness-based practices geared to reduce stress. Experts consider mindfulness as
"paying attention in a particular way; on purpose, in the present moment, and non-
judgmentally" (Kabat-Zinn, 1990, p.14). Research has shown that mindfulness strategies
can protect against compassion fatigue (Decker, Brown, Ong, & Stiney-Ziskind, 2015). In
particular, workers who actively engage in mindfulness practices often are better equipped
to handle stressors (Decker et al., 2015). This project will teach participants mindfulness-
based strategies derived from the mindfulness-based stress reduction (MBSR) program
(Kabat-Zinn, 1990). Recent studies have examined the advantages of practicing
mindfulness within the workplace. In recent years, Hyland, Lee, and Mills (2015)
investigated mindfulness strategies in various professional settings. They indicated that
mindfulness provides an array of emotional and physical advantages. These researchers
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23

stated that, given the benefits that mindfulness practices provide, many employers now
embed these practices in the culture of their organization.
The self-care plan. Within this module, participants will create and implement self-
care plans in four domains: physical, emotional, spiritual, and workplace/professional.
Self-care is considered a vital step to sustaining a healthy life balance, and Newell,
Macneil, and Newell (2010) postulated that the practice of self-care is useful for workers
experiencing compassion fatigue. One study found that self-care routines helped workers
control symptoms of compassion fatigue by engaging in physical exercise, eating better,
and practicing mindful relaxation (Meadors & Lamson, 2008). Workers have a high
susceptibility to compassion fatigue (Harr et al., 2014), which is why their self-care must
be addressed.
Physical domain. The first aspect of self-care to review is physical self-care. In
terms of refugee workers, physical self-care refers to improving how they eat, sleep, and
engage in physical exercise. Pearce (2013) reported that healthy eating habits were a way
to combat isolation. In their study of 129 mental health professionals, Puig et al. (2012)
found that participants who did not eat properly or exercise regularly experienced fatigue
and stress. Physical self-care may help alleviate symptoms of compassion fatigue and their
impact on consulate staff.
Emotional domain. The next area of self-care to explore is emotional self-care.
Emotional self-care can be described as our ability to regulate our emotions and enhance
our coping mechanisms and skills. Emotional self-care may involve talking with a therapist
or finding support systems wherein an individual can find productive and healthy ways to
discuss how they are feeling (U.S. Department of Education, 2012). Essentially, emotional
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24

self-care is the process by which individuals actively engage in their well-being and
emotional stability (Crane & Ward, 2016).
Workplace domain. Workplace self-care is an equally necessary condition to
incorporate in this module because, without it, the quality of services can suffer, and
consulate workers may be limited in their ability to fully engage with clients (Lee & Miller,
2013). Thus, intentionally practicing self-care may reduce negative consequences on their
work and may help them actualize the favorable outcomes of their work (Lee & Miller,
2013). However, self-care is not solely the responsibility of the worker. An agency may
also be responsible for creating environments in which self-care is embraced.
Organizations that understand compassion fatigue as impacting service workers can
contribute to individuals’ coping mechanisms (Newell & Nelson-Gardell, 2014). One such
contribution might be rewarding staff for staying home and taking care of themselves
rather than reporting to work (Crane & Ward, 2016). Acknowledging one’s strengths,
engaging in stress-reduction activities, proactive involvement in solving problems, and
setting clear boundaries of self and others are examples of emotional self-care (Lee &
Miller, 2013 ).
Spiritual domain. The next area is spiritual self-care. Experts define spirituality as
practices that promote self-discovery and overall well-being (White, Peters, & Schim,
2011). Examples include meditating, grounding exercises, self-reflection, and praying (Lee
& Miller, 2013). Experts define spirituality as practices that promote self-discovery and
overall well-being (White et al., 2011). Often, spirituality is confused with religion (White
et al., 2011), which is why some experts believe there is not a clear definition of
spirituality (White et al., 2011). One researcher considered spirituality as a concept that
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25

involves a combination of religious and nonreligious practices (Dessio et al., 2004).
Regardless of the lack of a consistent definition, this domain is an element of self-care as
immigrants are known to actively engage in spiritual practices such as prayers and faith in
a higher power (Campesino, Belyea, & Schwartz, 2009).
In conclusion, self-care is an important concept that should permeate within all
professions (Lee & Miller, 2013) and organizations of which refugee workers are a part of.
Without proper attention to a healthy self-care regimen across multiple life domains,
refugee workers risk deepening the negative impact of compassion fatigue.
Innovation, Part 2: Promoting resilience through mindfulness practices. The in-
person support groups will be a platform where refugee workers will process their self-care
plans and promote their resilience skills through mindfulness-based strategies derived from
MBSR (Kabat-Zinn, 1982). Kabat-Zinn introduced mindfulness into Western psychology
in 1979 at the University of Massachusetts Medical Center. The MBSR program is
centered around meditation, yoga, and body scan strategies (Kabat-Zinn, 1982).
Mindfulness is characterized as "the awareness that emerges through paying attention on
purpose, in the present moment, and nonjudgmentally to the unfolding of experience
moment to moment" (Kabat-Zinn, 2003 p. 144).
The support groups will consist of five 90-minute sessions. Each session will
involve engaging participants in learning and practicing one mindfulness strategy. Since
the concept of mindfulness will be foreign to some, participants will be invited to learn
what mindfulness entails. Given that mindfulness strategies can create feelings of
awkwardness, the first session will involve normalizing the potential uncomfortable
feelings and the effectiveness of learning these strategies.
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The first mindfulness practice that will be infused is mediation. Given that
mediation is one of the cornerstones of mindfulness practices, participants will be invited
to practice mediating in the group. Mediation consists of focusing on breathing, physical
sensations, thoughts, and feelings. The following strategy that participants will be
introduced to is body scanning. This strategy promotes stress reduction. As participants
engage in the body scan exercise, they will be asked to concentrate on a specific part of the
body, one at a time, to identify areas where they hold tension. After every session,
participants will be asked to practice the skills learned from the sessions daily.
The facilitators of the groups will be the supervisor of the refugee workers and an
MSW Intern from the USC Dworak-Peck School of Social Work. Prior to meeting with
the groups, the intern and supervisor will participate in three 8-hour training sessions
consisting of mindfulness practices and the facilitation of self-care plans. The program
manager will be the lead trainer who will facilitate the training for each trainee.
Justification of Innovation
This innovation was developed in this manner because researchers found that the
combination of improved self-care (Kalumbula, 2018) and the practice of mindfulness
(Setti & Argentero, 2014) protects against compassion fatigue. Also, the literature
demonstrates that to heal and recover from trauma, one must first acknowledge the impact
of traumatic experiences (Danieli, 1998), which is why the psychoeducational component
was added to this innovation. The web-based program will allow refugee workers to
become aware of the implications of working with the traumatized migrant population.
The justification as to why the support groups were designed in this manner is
because recent data shows that support groups who utilize a reflective approach provide
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27

better care for consumers (Gabrielsson, Engström, & Gustafsson, 2019). Additionally,
mindfulness has been infused into this innovation because experts have found that those
who practice mindfulness strategies tend to be equipped with emotional regulation (Teper,
Segal, & Inzlicht, 2013) to shield against the impact of compassion fatigue (Zhang, 2017).
Other experts stated that one of the most effective ways to reduce the impact of
compassion fatigue is to increase awareness of its signs and symptoms (Harr, 2013; Vu &
Bodenmann, 2017).

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Description of Proposed Impact: Goals, What Are You Trying to Resolve
The overall goals are to raise awareness of the signs of compassion fatigue and to
increase self-care and mindfulness practices. The impact of this program is that it will
allow refugee workers the opportunity to provide service without compromising the well-
being of their clients. Providing refugee workers with strategies and access to resources on
managing compassion fatigue will increase compassion for themselves and others.
Teaching and encouraging self-care and mindfulness practices will provide refugee
workers with the tools necessary to work effectively in an emotionally challenging work
environment.
Detailed Logic Model: Visual Image, Inputs, Outputs, Resources, List
Title: Wellness Trail for refugee workers
Problem: The problem is that refugee workers are living with unaddressed compassion
fatigue. Compassion fatigue is considered an occupational hazard that can lead to the onset
of mental illness symptoms such as depression and anxiety, increase employee turnover
and absenteeism, and lower job satisfaction.
Solution: The proposed capstone project seeks to close the health gap by implementing a
program that assists refugee workers in manage the impact of compassion fatigue.

Inputs Activities Outputs Outcomes Impact
$10,000
equipment- laptop,
supplies, branding
of materials

$3,000
maintenance of
the web program

$15,000
Supervision of
Master of Social
Work
Interns/Students
(Field Instructor)

One Focus Group
before the
program

Administering the
survey to all
workers in the
consulate office
every 90 days for
one year

Development of
the Web-Based
Program

Training the MSW
#20 refugee workers
trained

Five – 90-minute
Reflective Learning
Groups to refugee
workers

Thirty-six hours of the
Program Manager
training the MSW
interns, Field
Instructor, and the
Supervisor of refugee
workers.

Increased
knowledge of
compassion
fatigue:
Awareness of
the signs and
symptoms of
compassion
fatigue

Learn how to
develop and
initiate their
self-care
plans using
Self-care
strategies that will
promote a healthy
work-life balance

Increase ability to
manage stressful
situations:
emotional
regulation

Reduce levels of
compassion
fatigue

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29

$15,000 Program
Manager

$10,000 bonus
payment for
Recruiter/Refugee
Worker

$5000 hiring of a
statistician to
collect and
interpret the data

$5000
Development of
Web Program and
Support Group

The staff of the
Consulate offices-
non-refugee
workers

Refugee Workers

Supervisors of the
Refugee Worker

interns, Supervisor
Refugee Worker
and Field
Instructor on the
content and the
delivery of the
program

Collect data and
interpret the data

Present the data to
government
officials.

Have a dialogue
with Consul
officials regarding
the training
program

Interview MSW
interns and Field
Instructor- hire the
Field Instructor as
an independent
consultant.

Forty hours total of
collecting the data and
interpreting the data.

90 min Web-Based
Program

Each participant will
be required to engage:
Professional Quality of
Life Scale which takes
the 30 min to
complete; the survey
must be administered
every 90 days, which
comes out to 2 hours
total per participant.

the three
domains

Intermediate
Outcome
measure:
Increase the
buy-in of the
program to
improve
emotional
well-being
and maintain
a work-life
balance for
refugee
workers.

Long term
outcome:
become a
permanent
program
within 18
consulate
offices in the
United
States.

Explanation of How the Proposed Solution Will Improve Grand Challenge Area
The Wellness Trail Program helps refugee workers understand the core elements of
compassion fatigue while addressing concepts of self-care and mindfulness practices. This
proposal attempts to close the health gap by specifically addressing three of the efforts
identified in this grand challenge: improving conditions of daily life, fostering the
development of a healthy interpersonal workforce, and cultivating health innovation in
community-based centers.
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30

Improving the conditions of daily life. Work-life balance consists of navigating
the stressors related to the workplace and the pressures of friends and family. This specific
project provides refugee workers with a greater sense of ownership and control of their
lives. The project invites participants to developing personalized self-care plans and learns
various mindfulness practices. These specific practices will allow participants the
opportunity to stay focus on the present moment, which results in prioritizing. Being able
to prioritize is an important step in obtaining a healthy work-life for the refugee worker.
The overall premise of this project is to improve the conditions of our daily lives.
Fostering the development of a healthy interpersonal workforce. This project
promotes a healthy interpersonal work environment for refugee workers at the Association
of Latin America. It fosters effective communication among the refugee workers and their
supervisors. The project provides the workers the opportunity to process their experiences,
thoughts and ideas of their work. The development of this project demonstrates the interest
in the wellbeing of the workers and the migrants they service. The project emphasizes the
importance of taking care of ourselves to prevent illnesses or burnout. The elimination of a
toxic work environment is also significant factor of this project as it teaches refugee
workers various strategies that manages the impact of compassion fatigue. The project
encourages interposal skills that fosters connection among co-workers. It also helps
workers understand the need to be mindful of the impact of working with the traumatized
migrant population.
Cultivate health innovation in community-based centers. Another unique
feature of the Wellness Trail Project is the in-person support groups after completion of the
web-based program. The support groups foster a community-based approach that serves
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31

the underserved population who are the refugee workers. In the support group, the workers
have the space to process their experiences and learn various mindfulness strategies to
maintain a work-life balance. The program helps build and foster partnerships among the
refugee workers. Lastly, the support groups promote access to health care for refugee
workers.
Feedback From Multiple Stakeholders on Proposed Solution and Feasibility
Stakeholders have reported that the identified innovation aligns with the needs and
the capacity of the identified organization. Various stakeholders indicated that the
innovation addresses their needs explicitly and adequately fits within their budget.
Concerning feasibility, the appropriate buy-in has been established by critical stakeholders.
The implementation materials, such as the web-based program, are currently in production.
To ensure the identified solution can reach and sustain its proposed outcomes, stakeholders
have actively assisted with implementation. Before implementing the innovation, specific
training will be provided for staff who will be assisting with the facilitation. Also, a
questionnaire will be utilized to help with the fidelity of the program. As far as measuring
the outcomes of the innovation, and evaluation tool will be administered to assess the
outcomes. Furthermore, the innovation is administratively feasible within the policies of
the organization. The innovation has been embedded within the organizational structure.
Fortunately, the innovation is not only applicable to the audience of this organization but
also has access to the recommended targeted audience: the refugee workers of the
Association of Latin America.
Analysis of How Innovative Solution Is Positioned Within History, Policy and Public
Knowledge
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Given the current refugee crisis, this innovation represents an important action in
helping refugee workers improve their overall well-being. This innovation disrupts the
norms that have been ingrained for decades. By addressing the impact of compassion
fatigue among refugee workers, this innovation solution is expanding to other settings.
Assisting refugee workers within the realm of compassion fatigue is currently being
understood. This innovation brings to light a phenomenon not discussed away for decades.
With regard to this occupational hazard, several anonymous government officials have
reported having no knowledge of this condition. Although they have witnessed the
symptoms among workers, they did not know compassion fatigue existed. This innovation
is positioned wherein workers have only been instructed to help those in need. History has
demonstrated that workers fear the stigma of seeking emotional support, as experts
reported that, when workers ask for assistance, they consider it as “undermining their self-
image” (Guskovict & Potocky, 2018, p. 977).
Evidence or Data to Show Impact
During the 1990s, compassion fatigue began to be investigated and analyzed among
practitioners and researchers. In recent years, Vu and Bodenmann (2017) conducted a
systematic analysis of the research on mitigating the impact of compassion fatigue. Results
demonstrated that there are specific individual, professional, and organizational strategies
that help prevent and fight the effects of compassion fatigue. This particular innovation
contains research-based strategies known to be effective in preventing or managing the
impact of compassion fatigue. Evidence has shown that practicing self-care regularly and
supporting resilience can better manage the personal adverse effects of compassion fatigue
(Vu & Bodenmann, 2017). Another impactful strategy to reduce compassion fatigue is to
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33

increase awareness of the specific signs of this condition (Harr, 2013; Vu & Bodenmann,
2017) and teaching effective self-care strategies (Harr, 2013). Recently, the phenomenon of
mindfulness has rapidly become a popular choice for stress reduction. Research has shown
that employing organizations have begun providing programs centered on mindfulness to
assist their staff due to their physical and emotional positive outcomes (Hyland, Lee, &
Mills, 2015.
Description of Political, Organizational and Community Allies
An anonymous agency located within the community fully supporting this
innovative solution. Initially, officials at this agency were hesitant due to a lack of
knowledge and fear attached to needing assistance. After several years of fostering
relationships with this specific agency, officials have become a significant ally for this
program. The innovative solution was examined by various stakeholders in the community.
A mental health agency that supports the immigrant population examined the solution and
reported how essential it is to support the well-being of our providers. Some of these
stakeholders noted that it is our ethical responsibility to support our consumers and the
frontline workers who are assisting them. This agency is interested in embedding this type
of training in their annual professional development seminars.
Description of Political, Organizational and Community Obstacles
One potential obstacle that can affect this innovation is the change of administration
that is set to occur in four years. This change affects the organizational structure of this
agency, which can adversely impact the sustainability of this innovation. Officials within
this organization have reported that the only way this program can be sustained is if it is
voted into the bylaws of the organization. For policies to be accepted, they must be
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34

approved and voted in by the members of the organization. Policies would need to be
analyzed by administrators, which can take approximately 12 months.
Analysis of Alternative Pathways
In the event a participant’s compassion is not reduced, an alternative pathway has
been identified to address the obstacle. The case manager, who serves as a mental health
navigator for the department of mental health, will conduct an individual session with the
participant to assess the situation. In that session, the navigator will facilitate an assessment
and determine if a referral for mental health services is warranted. This specific agency has
two navigators who assist with linkage to community resources. They are trained in
psychoeducation on mental health. Their role as navigators is to provide workshops on
reducing the stigma attached to mental health.
Project Structure, Methodology and Action Components
Analysis of the market for the innovative solution. In analyzing the current market
relative to this innovative solution, this specific program has never been implemented at
any Association Office of Latin America within the United States. The analysis of the
market for this innovative solution consists of webinars, recorded videos, and written
brochures and guidebooks for medical and mental health professionals. In further
examining the market for this innovation, it appears that few organizations have infused
mindfulness practices into the work-place environment. The one significant factor that
these organizations have failed to include is the implementation of self-care plans or the
psychoeducational component associated with compassion fatigue. The market further
shows that training on compassion fatigue has been primarily offered to mental health and
medical workers. As far as research, there is a limited amount of research examining the
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35

effects of compassion fatigue among refugee workers. The research that exists has
primarily focused on secondary traumatic stress and burnout.
Implementation Plan and Timeline: Realistic Financial Plans
Details of financial plans and staging. This program is intended to operate through
an anonymous foreign entity. The program costs $63,000 for the first year of
implementation. These funds need to be utilized to support the implementation and
sustainment of the program. The program is intended to be initiated at the Los Angeles
satellite office of the Association of Latin America. The internal stakeholders consist of the
refugee workers, master’s in social work interns, the field instructor who is a licensed
social worker, and the government officials of the association. Refugee workers play a role
in financial planning. The program requires that there is a sufficient number of refugee
workers participating. Obtaining the buy-in of the refugee workers is a crucial element of
this program, for, without their support, this program would be non-existent. The field
instructor plays a significant role in the budget planning of this program. Depending on the
level of expertise of the social worker, their contracting fees can be up to $300 an hour.
Therefore, it is essential that this program contract a competent and seasoned social worker
whose contracting cost does not exceed what is allocated for contracting fees. As far as the
government officials of the association office, they also play a significant role. The office
has a team of individuals who allocate funding for their professional development training.
Those stakeholders must fully understand the purpose and the benefits of this program for
their staff. Having their support will also ensure this program functions properly and is
viable.
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36

In order to begin the program, a cost of $10,000 will need to occur for equipment
such as two laptops, projectors, art supplies, and the branding of the mindfulness and self-
care plans. The maintenance cost of the web program is $3,000 and $5,000 for the
development of the program, which is to paid to the Program Manager. Given that the
Association will host two Master of Social Work interns, they require weekly individual
supervision from a licensed clinical social worker. This cost of the total cost for
supervision is $20,000 for one full year. Also, the hiring of a statistician is $5,000, which
will involve gathering and interpreting the data that will be collected from the self-report
surveys. The program design requires the hiring of two recruiters, which is the cost $5,000.
The recruiters will be staff from the satellite office, which will be provided as a bonus to
their annual salary. The hiring of the Program will entail a total of $15,000 per year. The
role of the Program Manager will ensure the program is implemented and sustained for a
period of one contracted year.
Budget cycle. The first phase of the budget cycle is the preparation phase. During
this phase, the committee of the program will convene as a team and carefully consider the
parameters of the budget, how the revenue will be funded, and how resources will be
distributed for the program. Specifically, during this phase, the team will convene to
determine the activities and expenses needed for the program. For now, the team has
considered a set of required activities, which are the cost to train the two interns, field
instructor, and two supervisors who serve as refugee workers, the fees for the training
facilitators, the equipment and software costs, and the cost for operations.
The next phase of the cycle is budget approval. Given that the Association of Latin
America functions under the auspice of the Embassy of Latin America to the United States,
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37

the budget plan must be submitted to the finance committee of the Ambassador of Latin
America to the United States for approval. The committee meets every month in
Washington, DC, and a vote will be taking place before the approval is executed. The
program will also undergo an evaluation phase. During this phase, the tenets of the
program will be analyzed to determine the effectiveness of the program.
The next phase in financial planning is the auditing phase. This phase will consist
of internal auditing. The auditor will be an employee of the Association of Latin America
who will offer insight, evaluate the risks, find ways to improve the operations, and examine
the program's efficiency and effectiveness. The financial reports and statements will be
furnished by the auditor to monitor the compliance and budgetary limitations of the
program.

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38

Description of Measurement of Outcomes Using Data or Community Input
The measurement of outcome that will be utilized to assess the levels of
compassion fatigue of this project is the Professional Quality of Life Scale (ProQol),
which was created by Stamm (2005). This measure contains a 30-item self-report that
examines the risk of compassion fatigue. The Alpha score of the ProQol survey ranges
between .80 for compassion fatigue to .87 for compassion satisfaction, which demonstrates
that it has adequate internal consistency. The Cronbach’s coefficients are 0.864. This scale
will measure the risk factors associated with compassion fatigue. A score of 23 or lower
within the compassion satisfaction subscale indicates that the participant might be
experiencing symptoms of compassion fatigue. Specifically, the ProQol survey will be
administered online at the beginning of the program and every three months for one year
from the start of the program.
Plan for Stakeholder Involvement That Includes Relevant Constituencies
The project encompasses a comprehensive plan that includes relevant
constituencies. The plan for stakeholder involvement consists of facilitating a focus group
with various constituents. The purpose of the focus group is to obtain quality information
to implement and sustain the program. The focus group will also ensure that stakeholders
feel involved and included in the process. To ensure a wide range of stakeholders are
involved, questions will be posted via survey to obtain feedback from various
constituencies: Can you please describe the individuals who can potentially be affected
during and after this specific program that addresses compassion fatigue? Who are the
individuals who could potentially have an interest in the outcome of this program of
compassion fatigue? Can you list and describe the groups that could be potentially positive
A COMPASSION FATIGUE INFORMED APPROACH
39

or negative impacted by being part of this program? The focus group members will have
common characteristics such as occupation and their length of service with the refugee
population. Although the focus group is considered to be homogenous in terms of similar
characteristics, the group will also include some elements of diversity.
Communication Plan and Strategies That Will Engage Audiences
The project’s communication plan consists of various strategies that is likely to
have a significant impact on relevant constituencies. The first strategy is ensuring that the
information regarding the Wellness Trail Program is presented clearly, concisely, and
transparently. This strategy aims at providing information about the project in a genuine,
factual, and easy-to-understand manner. This strategy will give stakeholders the
opportunity to understand the intention of the project, their role within the program, and
how it can potentially impact them. The second strategy of this plan is communicating with
stakeholders through their preferred methods of communication. It is essential to
acknowledge that every person and community communicates in various styles.
Constituencies will have a variety of options to communicate and provide feedback or
input. For example, online platforms such as Facebook and Twitter will be used to engage
audiences. Other audiences prefer not to utilize online platforms to communicate and
prefer in-person meetings. With these audiences, the program manager plans to contact the
administrator of this organization to schedule an in-person meeting. Also, other
organizations prefer online meetings. For them, meetings and webinars will be coordinated
to disseminate and exchange information.
Dissemination Plan for Broader Impact
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40

The dissemination plan consists of shifting the paradigm from an individual
approach to more of a systemic approach for a healthier working environment within a
consular setting. The goal is to reorganize the operational plan to provide this training
annually to every consulate in the United States.
Initially, the program will be implemented at a local satellite office in the Los
Angeles area for one full year. Specifically, the refugee workers at the Los Angeles site
will undergo training in the Wellness Trail from January 2020 to February 2021. Given
that there are 18 satellite offices across the nation, the organizational plan is to have the
program launch at all of them within three years after its first implementation. The long-
term vision is to create a program where other refugee workers can be trained with this
model so they can provide support to other consulate offices. The program envisions
having a train-the-trainer model to empower refugee workers.
Another effort to have a strong impact on relevant audiences is joining the annual
conference, No Mas, This conference is held at the USC Suzanne Dworak-Peck School of
Social Work by the Latinx Social Work Caucus. The purpose of this conference is to
inform and educate the community who support the immigrant population. Being part of
this conference will provide the opportunity to network with other organizations and share
insights on ways to expand to other communities, such as schools and non-profit
organizations. Connecting directly with other embassies and consulates can further broaden
the impact of this innovative solution. Explaining to others the work that is being done to
protect our workers can demonstrate the need for this unaddressed issue.
Ethical Concerns and Possible Negative Consequences
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41

The ethical consideration is that, if participants exhibit symptoms of a mental health
condition, community resources must be readily available. Another possible negative
circumstance is that this capstone will rely on self-reporting of the ProQol survey, which
has positive and negative implications. According to Sinkowitz-Cochran (2013), self-
reporting surveys assist researchers and practitioners gain information that can either create
or improve programs. However, self-reporting surveys contain measurement error. For
instance, participants, either under-report or over-report (Sinkowitz-Cochran, 2013).
Therefore, it is highly recommended that, after the self-survey is administered, a brief
interview is conducted to ensure the accuracy of the data.
Summary of Project Plans and Conclusions
In summary, the project will provide refugee workers with an opportunity to engage
in preventive care that promotes a work-life balance and a healthy work environment. This
specific project will affect immigrants in our nation and the workers who support them.
This innovation will disrupt the norms at every satellite office in California because there is
currently no evidence of a similar program. In conclusion, this program will help prevent
re-traumatization and assist workers in maintaining a healthy work-life balance to promote
a positive organizational climate.
Implications of Project in Terms of How it Will Improve Practice or Policy
A possible implication of this project is that it will give refugee workers the
opportunity to render services with excellence without compromising the well-being of the
clients they support. Another essential implication is that it will permit refugee workers to
engage in preventive care to promote healthy work environments. Given that this project
will bring forth a self-evaluation survey of the ProQOL (Stamm, 2005), it will help the
A COMPASSION FATIGUE INFORMED APPROACH
42

refugee workers analyze their levels of compassion satisfaction, compassion fatigue, and
burnout. Allowing the workers to self-evaluate their levels of compassion and burnout will
provide them insight into professional and personal aspects of their lives. Also, this can
assist stakeholders in comprehending the refugee service workers’ areas of growth as well
as needs.

Acknowledgement of Limitations and Risks: Recommendations for Future Work
It is essential to acknowledge the possible limitations and risks involved with this
program. The fact that the program involves a small number of refugee workers at one
satellite office is a limitation. The sample is intended to be 20 refugee workers from
various cities in Southern California. The results of this program may be limited in terms of
generalizability to refugee workers in other areas in the United States. Another possible
limitation of this program is that the surveys will be self-administered. Participants may
respond to the survey questions in a manner that they believe would be either favorable or
unfavorable, thus creating bias in the results. Therefore, the facilitators of this program
must meet with each refugee worker to ensure the accuracy of the survey. In addition, the
program facilitators can be unfamiliar with cultural idioms. Therefore, interviews will
ensure the professionals who engage with the Latino community are fluent in Spanish,
culturally competent, and sensitive to the population they would be serving. Also, another
significant limitation to this study is underreporting ratings of compassion fatigue among
refugee workers due to fear or stigma. One of the strategies that aim at targeting this
limitation is by having the mental health navigator from the Los Angeles County
A COMPASSION FATIGUE INFORMED APPROACH
43

Department of Mental Health meet with the individual to normalize and break down any
possible resistance. The navigators are present daily, providing support to the workers and
the consumers of the Association of Latin America.
Assessing the prevalence of compassion fatigue among refugee workers is a step
towards addressing the problem on a personal and systemic level. Program administrators,
directors, and supervisors should consider the consequences of working with traumatized
migrants and provide support to the worker. It is important to shed light on the often-
overlooked effects of trauma on the helper by examining the personal and professional
impact of fatigue through training. Organizations should promote self-care strategies to
lessen the risk of compassion fatigue among frontline workers.
A Concrete Plan Has Been Provided for Advancing Next Steps of the DSW Capstone
Project
A detailed plan has been developed to ensure this capstone project expands to other
communities. Currently, there are three foreign satellite offices in the state of California
Los Angeles, San Diego, and San Francisco that support the role of the refugee workers.
Given that the Los Angeles satellite office is the largest site and serves the most
immigrants, this capstone is intended to begin at this site.
The expansion of this project is comprised of three phases. The first phase is the
identification of recruiters. Within six months from the beginning, the program at the Los
Angeles site, the program manager, and supervisor of the refugee workers will send out a
survey to identify four recruiters. This survey will explain the role of the recruiter, which
may involve traveling to San Francisco and San Diego. The recruiter will provide
informational meetings via the Zoom platform and in person. The second phase of the
A COMPASSION FATIGUE INFORMED APPROACH
44

expansion is the development of program content. The MSW intern, along with the
supervisor of the refugee workers and the program manager, will develop a PowerPoint to
provide in-depth information on the program. The purpose of the development of the
program content is to receive the necessary buy-in from other stakeholders. Once the
content is developed, each recruiter will undergo four-hour mock training with the program
manager, the supervisor of the refugee workers, and the intern. Once the recruiters
complete the train-the-trainer phase, they will receive permission to begin outreach efforts
at their assigned satellite office. Each recruiter will be assigned one satellite office.
Recruitment efforts consist of, first, reaching out to each lead administrator for a 15-minute
overview of the program via Zoom. During this meeting, recruiters will explain their role
and the goals of the program. After the informational meeting, the recruiter will follow up
with the administrator to determine the best date and time to meet with their administrators
for their buy-in into the program. The recruiters will then be asked to visit each of their
assigned satellite offices to attend.

A COMPASSION FATIGUE INFORMED APPROACH
45

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Appendix A: English ProQOL
Professional Quality of Life Scale
(ProQOL)

Compassion Satisfaction and Compassion Fatigue
(ProQOL) Version 5 (2009)
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, as a [helper]. Consider
each of the following questions about you and your current work situation. Select the
number that honestly reflects how frequently you experienced these things in the last 30
days.

1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often

1. I am happy.
2. I am preoccupied with more than one person I [help].
3. I get satisfaction from being able to [help] people.
4. I feel connected to others.
5. I jump or am startled by unexpected sounds.
6. I feel invigorated after working with those I [help].
7. I find it difficult to separate my personal life from my life as a [helper].
8. I am not as productive at work because I am losing sleep over traumatic
experiences of a person I [help].
9. I think that I might have been affected by the traumatic stress of those I [help].
10. I feel trapped by my job as a [helper].
11. Because of my [helping], I have felt "on edge" about various things.
12. I like my work as a [helper].
13. I feel depressed because of the traumatic experiences of the people I [help].
14. I feel as though I am experiencing the trauma of someone I have [helped].
15. I have beliefs that sustain me.
16. I am pleased with how I am able to keep up with [helping] techniques and
protocols.
17. I am the person I always wanted to be.
18. My work makes me feel satisfied.
19. I feel worn out because of my work as a [helper].
20. I have happy thoughts and feelings about those I [help] and how I could help
them.
21. I feel overwhelmed because my case [work] load seems endless.
22. I believe I can make a difference through my work.
23. I avoid certain activities or situations because they remind me of frightening
experiences of the people I [help].
24. I am proud of what I can do to [help].
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25. As a result of my [helping], I have intrusive, frightening thoughts.
26. I feel "bogged down" by the system.
27. I have thoughts that I am a "success" as a [helper].
28. I can't recall important parts of my work with trauma victims.
29. I am a very caring person.
30. I am happy that I chose to do this work.

© B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL).
/www.isu.edu/~bhstamm or www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no
changes are made, and (c) it is not sold.
59
© B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV
59
(ProQOL).
http://www.isu.edu/~bhstamm. This test may be freely copied as long as (a) author is credited, (b) no
changes are made, and (c) it is not sold. Translated by Maria Eugenia Morante Benadero, Bernardo Moreno Jimenez, Alfredo Rodriguez
Muñoz, Universidad Autónoma de Madrid, Spain.

Appendix B: Spanish ProQOL
ProQOL -vIV
PROFESSIONAL QUALITY OF LIFE
Compassion Satisfaction and Fatigue Subscales – Version IV

Cuestionario de Fatiga de Compasión y Satisfacción
Tercera Revisión

Ayudar a otros le pone en contacto directo con la vida de otras personas. Como usted
seguramente lo ha comprobado, su compasión o empatía por aquellos que
ayuda tiene aspectos tanto positivos como negativos. Quisiéramos hacerle
preguntas acerca de sus experiencias, positivas y negativas, como profesional de
la urgencia médica. Considere cada uno de las siguientes preguntas de acuerdo
con su situación actual. Marque en cada frase, siendo lo más sincero posible, el
valor que refleje su experiencia profesional más frecuente para usted en los
últimos 30 días.

0=Nunca 1=Raramente 2=Algunas veces 3=Con alguna frecuencia 4=Casi siempre 5=Siempre

1. Soy feliz.
2. Estoy preocupado por una o más personas a las que he ayudado o ayudo.
3. Estoy satisfecho de poder ayudar a la gente.
4. Me siento vinculado a otras personas, con ocasión de mi trabajo.
5. Me sobresaltan los sonidos inesperados.
6. Me siento fortalecido después de trabajar con las personas a las que he ayudado.
7. Encuentro difícil separar mi vida personal de mi vida profesional.
8. Pierdo el sueño por las experiencias traumáticas de las personas a las que he ayudado.
9. Creo que he sido afectado negativamente por las experiencias traumáticas de
aquellos a quienes he ayudado.
10. Me siento “a tr ap a do ” por mi trabajo.
11. Debido a mi profesión tengo la sensación de estar al límite en varias cosas.
12. Me gusta trabajar ayudando a la gente.
13. Me siento deprimido como resultado de mi trabajo.
14. Me siento como si fuera yo el que experimenta el trauma de alguien al que he
ayudado.
15. Tengo creencias (religiosas, espirituales u otras) que me apoyan en mi trabajo
profesional.
16. Estoy satisfecho por cómo soy capaz de mantenerme al día en las técnicas y
procedimientos de asistencia médica.
60
© B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV
60
(ProQOL).
http://www.isu.edu/~bhstamm. This test may be freely copied as long as (a) author is credited, (b) no
changes are made, and (c) it is not sold. Translated by Maria Eugenia Morante Benadero, Bernardo Moreno Jimenez, Alfredo Rodriguez
Muñoz, Universidad Autónoma de Madrid, Spain.
17. Soy la persona que siempre he querido ser.
18. Mi trabajo me hace sentirme satisfecho.
19. Por causa de mi trabajo me siento agotado.
20. Tengo pensamientos de satisfacción acerca de las personas a las que he
ayudado y sobre cómo he podido ayudarles.
21. Me siento abrumado por la cantidad y tipo de trabajo que tengo que afrontar.
22. Creo que puedo hacer cambiar las cosas a través de mi trabajo.
23. Evito ciertas actividades o situaciones porque me recuerdan a las experiencias
espantosas de la gente a la que he ayudado.
24. Planeo continuar con mi trabajo por muchos años.
0=Nunca 1=Raramente 2=Algunas veces 3=Con alguna frecuencia 4=Casi siempre 5=Siempre
25. Como resultado de mi trabajo profesional, tengo pensamientos molestos,
repentinos, indeseados.
26. Me siento “e s ta nca d o” (sin saber qué hacer) por como funciona el sistema sanitario.
27. Considero que soy un buen profesional.
28. No puedo recordar determinados acontecimientos relacionadas con víctimas
muy traumáticas.
29. Soy una persona demasiado sensible.
30. Estoy feliz por haber elegido hacer este trabajo.

© B. Hudnall Stamm, Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales-III, 1995 -
2002, http://www.isu.edu/~bhstamm. This form may be freely copied as long as (a) author is credited, (b)
no changes are made, & (c) it is not sold.

Self-scoring directions Research Information on the
ProQOL – CSF-vIV: Professional Quality of Life: Compassion Satisfaction and
Fatigue Subscales

Por favor anote lo que ha encontrado en este cuestionario y considere que las
siguientes puntuaciones deberían ser usadas como una guía, no como información
confirmatoria. Las subescalas y los puntos de corte se han derivado teóricamente.
Cuando sea posible, los datos deberían de ser usados de una manera continuo, así como
la puntuación de corte. Estos puntos de corte deben de utilizarse como
orientación y ejemplos comparativos, no como información diagnóstica o
confirmatoria.

61
© B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV
61
(ProQOL).
http://www.isu.edu/~bhstamm. This test may be freely copied as long as (a) author is credited, (b) no
changes are made, and (c) it is not sold. Translated by Maria Eugenia Morante Benadero, Bernardo Moreno Jimenez, Alfredo Rodriguez
Muñoz, Universidad Autónoma de Madrid, Spain.
Self-scoring directions

1. Estar seguro de su respuesta en todos los items.
2. Algunos ítems son inversos, y la puntuación obtenida sería la contraria.
3. La puntuación inversa sería (i.e. 0=0, 1=5, 2=4, 3=3). Los ítems cuya puntuación hay que
invertir son cinco: 1, 4, 15, 17 y 29.
Nota: la puntuación 0 no es reversible porque a pesar de todo es una evaluación nula
en la dirección del ítem.
4. Marca los ítems según:
a. Poner una x en los siguientes diez ítems: 3, 6, 12, 16, 18, 20, 22, 24, 27, 30
b. Poner un “ vi st o” en los siguientes diez ítems: 1, 4, 8, 10, 15, 17, 19, 21, 26, 29
c. Poner una círculo en los siguientes 10 ítems: 2, 5, 7, 9, 11, 13, 14, 23, 25, 28

5. Sume los números que anotó por cada uno de los ítems y compárelos con las puntuaciones
teóricas.
6. Escriba sus respuestas debajo. La puntación está basada en puntos de corte teóricos derivados de
continuas investigaciones y aproximaciones. Si usted tiene alguna cuestión o duda, debería discutirlas
con el mismo profesional de la ayuda.

La puntuación media en esta escala es de 13 (SD 6; alpha .80). Aproximadamente el 25%
de gente puntúa por debajo de 8 y un 25% de la gente por encima de 17. Si su
puntuación está por encima de 17, usted puede tomarse algún tiempo para pensar
sobre lo espantoso que es para usted su trabajo o si hay alguna otra razón para
esta elevada puntuación. Mientras que puntuaciones altas no significan que usted
tenga un problema, sí es un indicador de que usted puede querer interrogarse
sobre cómo se siente ante su trabajo y lo que a éste le rodea. Usted puede desear
discutir esto con su supervisor, un compañero de trabajo, o con un profesional.

Abstract (if available)

Abstract The proposed project will help to close the health gap by implementing a program to mitigate the impact of compassion fatigue among refugee workers at the Association of Latin America. Specifically, the proposed project aims at teaching refugee workers the signs and symptoms associated with compassion fatigue as well as other measures that can reduce levels of stress. The link between the project and the Grand Challenge is that it seeks to address the wicked problem by raising awareness of the symptoms of compassion fatigue and teaching workers strategies to prevent and reduce its impact. This project is to protect refugee workers from the psychological and physical injuries caused by working with traumatized migrant survivors.The program will utilize a web-based and in-person psycho-educational format that teaches specific strategies aimed at reducing the impact of compassion fatigue among the refugee workers of the Association of Latin America. The program focuses on engaging workers in mindfulness practices and implementing self-care plans by using the four domains: physical, emotional, spiritual and workplace/professional. The overall purpose of purpose of the project within the larger framework is that it assist refugee workers engage in preventative care to promote overall health by learning the impact of compassion fatigue and the strategies that can be implemented to either prevent or mitigate the effects. Many refugees from Latin America fled their country of origin due to persecution, violence, or war. Refugee workers are part of the service delivery team that serves the needs of this population. In the midst of their work, refugee workers are at the front-line witnessing refugees recount their journey of migration, often filled with horrific traumatic events. Witnessing traumatized migrant survivors recount their stories of trauma automatically places the refugee workers at risk for developing compassion fatigue: the “bearing suffering of clients who have suffered traumatic event” (Figley, 1995, p. 7). The overall problem that this project is addressing is the unaddressed compassion fatigue that is connected to the shared practices among the organizations that host the refugee worker population. The methodology of this project consists of a program that mitigates the impact of compassion fatigue among refugee workers from the Association of Latin America. The program is comprised of a 90-minute web-based program and five 90 minute in-person support groups. The program will administer a self-report survey called the Professional Quality of Life Scale (ProQol

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Asset Metadata

Creator Hu, Maria (author), Hydon, Maria C. (author)

Core Title A compassion fatigue informed approach: the wellness trail for refugee workers

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 02/08/2021

Defense Date 11/21/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag compassion fatigue,OAI-PMH Harvest,refugee workers

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee chair), Orras, George (committee member), Rank, Michael (committee member)

Creator Email mariahu@usc.edu,mhchacha13@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-418982

Unique identifier UC11668760

Identifier Maria_Hydon_A_COMPASSION_FATIGUE_INFORMED_APPROACH.pdf (filename),usctheses-c89-418982 (legacy record id)

Legacy Identifier Maria_Hydon_A_COMPASSION_FATIGUE_INFORMED_APPROACH.pdf

Dmrecord 418982

Document Type Capstone project

Rights Hu, Maria; Hydon, Maria C.

Type texts

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

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA