The Development and Validation of an Index to Measure Vicarious Trauma Exposure Among Substance Use Providers

项目摘要 美国阿片类药物流行的一个经常被忽视的后果是其对物质的健康影响 使用提供者（SUPs），如成瘾治疗师，同伴康复专家和案例管理员。阿片类药物 这一流行病使成瘾治疗服务紧张，美国可能会减少250，000个SUPs， 到2025年解决阿片类药物流行所需的数量。劳动力流动率对此有很大贡献 短缺，部分原因是过度暴露于替代性创伤。替代性创伤指的是“二手” 创伤传播时，与人谁经历了创伤“第一手”互动。在社会服务中， 专业人士认为，替代性创伤与抑郁、焦虑和创伤后的发展有关。 应力由于超过50%的劳动力正在恢复， 自己上瘾。目前还没有工具来衡量替代性创伤的暴露， 现有的量表仅测量暴露的副产品，例如症状。因此很难评估 SUPs和其他“帮助专业人员”中替代性创伤暴露的患病率以及 这种暴露。因此，很难确定在哪里进行干预以保护这支劳动力。 本研究的目的是开发替代性职业创伤暴露（VOTE）指数， 评估其有效性和可靠性在一个有代表性的国家样本的SUPs。先前收集的焦点小组 访谈数据和社会服务工作条件的实证文献将进行分析，以确定 替代性创伤暴露源这将通知VOTE索引开发，将使用 SUPs的认知访谈（N=10）。完善后的指数将在全国抽样的初级保健单位中传播， 定额抽样参与者（N=600）将通过与国家协会的合作伙伴关系招募。 酗酒和药物滥用咨询师和成瘾技术转让中心。子样本将是 随机重新抽样以建立重测信度。受访者将分为培训和测试 数据集。自举非线性主成分分析将用于分析项目的结构 和观测值，并将项减少为不相关的主成分。将进行显著性因素分析， 用于评估模型拟合度和可靠性。将拟合线性模型以评估收敛和判别效度。 这项拟议研究的贡献是开发和验证了第一种仪器， 测量替代性创伤暴露，并将其与“下游”效应区分开来，如症状和 健康成果。VOTE指数将促进职业流行病学对这种关系的理解 替代性创伤暴露与工人健康状况不佳、劳动力流动率和客户服务之间的关系。该指数将 还帮助研究人员，从业人员和政策制定者确定在哪里进行干预，以保护劳动力， 从而提高提供关键成瘾治疗服务以解决美国阿片类药物流行病的能力。

PROJECT ABSTRACT An often-overlooked consequence of the opioid epidemic in the United States is its health impact on substance use providers (SUPs), such as addiction therapists, peer recovery specialists, and case managers. The opioid epidemic has strained addiction treatment services, and the US will likely fall 250,000 SUPs short of the number needed to address the opioid epidemic by 2025. Workforce turnover contributes substantially to this shortage, driven in part by SUP exposure to vicarious trauma. Vicarious trauma refers to the “second hand” trauma transmitted when interacting with people who experienced trauma “firsthand.” Among social service professionals, vicarious trauma is associated with the development of depression, anxiety, and post-traumatic stress. The SUP workforce is likely particularly vulnerable to vicarious trauma since over 50% are recovering from addiction themselves. No instrument currently exists to measure exposure to vicarious trauma, and existing scales only measure biproducts of the exposure, such as symptoms. It is therefore difficult to assess prevalence of vicarious trauma exposure among SUPs and other “helping professionals” and the sources of this exposure. As a result, it is challenging to identify where to intervene to protect this workforce. The goal of this study is to develop the Vicarious Occupational Trauma Exposure (VOTE) Index and assess its validity and reliability in a representative national sample of SUPs. Previously-collected focus group and interview data and empirical literature on social service working conditions will be analyzed to identify vicarious trauma exposure sources. This will inform VOTE Index development, which will be modified using cognitive interview of SUPs (N=10). The refined index will be disseminated in a national sample of SUPs using quota sampling. Participants (N=600) will be recruited through partnerships with the National Association of Alcoholism and Drug Abuse Counselors and Addiction Technology Transfer Centers. A subsample will be randomly resampled to establish test-retest reliability. Respondents will be divided into training and testing datasets. Bootstrapped nonlinear principal component analysis will be used to analyze the structure of items and observations and reduce items to uncorrelated principal components. Confirmatory factor analysis will be used to assess model fit and reliability. A linear model will be fit to assess convergent and discriminant validity. The contribution of this proposed research is the development and validation of the first instrument to measure vicarious trauma exposure and differentiate it from “downstream” effects, such as symptoms and health outcomes. The VOTE Index will advance occupational epidemiologic understanding of the relationship between vicarious trauma exposure and poor worker health, workforce turnover, and client care. This index will also help researchers, practitioners, and policy-makers identify where to intervene to protect the workforce, thereby improving capacity to provide critical addiction treatment services to address the US opioid epidemic.