Introducing a Novel Intervention, CoHealing, to Address Teacher Burnout and Indirect Trauma
Center on Trauma and Adversity, Mandel School of Applied Social Science, Case Western Reserve University, 11235 Bellflower Road, Cleveland, OH 44106-7164, USA
Breen School of Nursing and Health Professions, Ursuline College, 2550 Lander Road, Pepper Pike, USA
Harborview Injury Prevention & Research Center, University of Washington, USA
Levin College of Public Affairs and Education, Cleveland State University, USA
Academic Editor: Brandis Ansley
Received: February 28, 2023 | Accepted: September 03, 2023 | Published: September 07, 2023
OBM Integrative and Complementary Medicine 2023, Volume 8, Issue 3, doi:10.21926/obm.icm.2303036
Recommended citation: King JA, Holmes MR, Evans K, Bender AE, King-White D. Introducing a Novel Intervention, CoHealing, to Address Teacher Burnout and Indirect Trauma. OBM Integrative and Complementary Medicine 2023; 8(3): 036; doi:10.21926/obm.icm.2303036.
© 2023 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
Decades of research have established the long-standing problems of stress and burnout in American educators and the associated detrimental effects on individuals, schools, districts, and the education sector overall [1,2,3]. The COVID-19 pandemic exacerbated these issues in the education sector, with teachers and education staff facing unprecedented challenges. The pandemic led to the closure of K-12 schools across the country, impacting 56.4 million students . The sudden shift to online learning required significant adjustments to teaching methods and technology, and many teachers had to quickly adapt to new platforms and technologies to ensure that students could continue to learn remotely. Along with technological challenges related to the abrupt transition to remote learning, teachers struggled to balance the mental health and academic needs of their students in an, at times, chaotic online environment . The increased workload and lack of adequate structural support, coupled with concerns for personal and family health and safety, presented high-pressure circumstances that have been associated with increased psychological distress for teachers and education staff . Research on teachers during the pandemic has demonstrated the prevalence of anxiety symptoms . The resulting challenges have contributed to heightened levels of job-related stress and associated syndromes such as burnout and secondary traumatic stress among teachers and education staff. Secondary traumatic stress is an occupational hazard for helping professionals such as educators and can result from exposure to student’s or colleague’s traumatic experiences and the stress inherent to wanting to help . Teachers and education staff have been increasingly vulnerable to secondary traumatic stress as they have had to navigate the complex needs of their students while also managing their own mental health and well-being.
The impact of the pandemic on teachers and education staff has highlighted the need for greater mental health support and resources to help them cope with these challenges. Coping refers to an individual's utilization of behavioral and cognitive strategies aimed at modifying unfavorable aspects of their environment and reducing or alleviating internal threats arising from stress or trauma [9,10]. As the education sector continues to understand and adapt to the lasting impact of the pandemic on students and educators, it is critical that teachers and education staff are provided with the support and resources they need to address their stress and burnout to then support their ability to continue to provide high-quality education to their students. One such promising intervention, CoHealing, is aimed at promoting a more resilient, interdisciplinary network of trauma-informed helping professionals (e.g., teachers, medical providers, social workers) by reducing secondary traumatic stress, burnout, and isolation.
1.1 Impact of the COVID-19 Pandemic on Teachers and Education Staff
The pandemic has exposed and exacerbated existing inequalities in the education system, with marginalized communities disproportionately impacted by the crisis . Teachers and staff in K-12 settings have been on the frontlines of addressing the social and emotional needs of students who have experienced trauma (e.g., loss of a loved one) and disruptions to their education due to the pandemic . Given the complex needs and demanding work conditions during the COVID-19 pandemic, teachers have experienced elevated levels of exhaustion from the cumulative, repeated, pervasive, long-term stress, which can increase the risk for indirect trauma and job stress syndromes such as secondary traumatic stress and burnout [12,13,14]. Secondary traumatic stress closely resembles post-traumatic stress disorder (PTSD), manifesting through similar symptom clusters of re-experiencing, avoidance, and hyperarousal in response to the traumatic experiences of others [8,15,16]. Burnout is unique in that the stress symptoms (i.e., exhaustion, depersonalization, cynicism, and reduced efficacy) result from any type of constraint in the work environment (e.g, too high caseload) [15,17]. Understood through these symptom domains, indirect traumatic stress results in adverse mental, physical, and behavioral health symptoms including, but not limited to: trauma-related symptoms (e.g., hyperarousal, re-experiencing and avoidance) distorted identity, beliefs and cognitions; strain in ability to empathize; social withdrawal and mistrust; emotional, physical, and mental exhaustion; sleeplessness; headaches; cardiovascular diseases; flu and colds; and gastrointestinal issues.[8,12,13,18,19,20,21] Despite the risk of indirect trauma and job stress syndromes, many helping professionals, such as teachers, are drawn to the challenge of addressing community health, trauma, and violence because the work often generates a sense of compassion satisfaction––personal and professional purpose, autonomy, and accomplishment, particularly when successes occur in therapeutic relationships, crisis situations and demanding conditions [8,22,23].
Indirect trauma and burnout are common among teachers and education staff in general, with research demonstrating higher rates of indirect trauma in this population during the COVID-19 pandemic [24,25,26]. Researchers note the significance of creative anxiety during the pandemic: “the unease, worry, and dread that arises from having to think in an open-ended and creative way, focus on novelty, or come up with a unique way of doing something” . Further, Anderson et al.  demonstrated creative anxiety to be predictive of secondary traumatic stress in their sample of teachers. During the pandemic, teachers have reported experiencing depersonalization and emotional exhaustion, an increase in compassion fatigue over time, stress from the rapid transition to online education, experiencing reduced levels of concentration, feeling more tired but getting less sleep, having higher than typical workloads, and having added worries about student’s well-being . Educators may be particularly vulnerable to burnout and secondary traumatic stress, stemming from concerns for students, unsupportive or constantly shifting school policies, and poor work-life balance; this may be especially true for educators working in under-resourced schools with majority racial/ethnic minorities . The cumulative effects of being exposed to students’ trauma compounded with their own stress, can facilitate burnout and indirect trauma [24,25]. Both burnout and indirect trauma pose great risk to teachers and educational staff, but they are highly preventable with proper intervention.
1.2 Co-Healing, a Group Intervention to Address Indirect Trauma
According to trauma theory , adverse social conditions can have a detrimental impact on mental and physical well-being by serving as stressors that activate neural and somatic stress responses . While acute stress responses may have potentially beneficial and adaptive effects, prolonged or recurrent episodes of stress system arousal can lead to adverse health outcomes. In the context of chronic stress, physiological changes such as immune function suppression, elevated blood pressure, and increased heart rate may contribute to an elevated risk of long-term physical conditions such as premature heart disease, as well as mental health issues including depression and anxiety. Modulation theory  proposes the existence of a "window of tolerance" within individuals, representing the range of psychological arousal that can be comfortably experienced at any given moment. This window encompasses a central zone, within which individuals operate in a balanced state. The boundaries of this window define the thresholds where individuals can transition into states of hyperarousal (fight/flight) or hypoarousal (freeze/faint). Modulation theory also indicates that trauma narrows this ‘window’ resulting in lower tolerance of arousal, which moves the person out of their tolerance zone, but developing a greater ability to self-regulate autonomic arousal using mind and body practices can lead to expanding the ‘window of tolerance.’
Grounded in trauma theory and modulation theory (see Figure 1), CoHealing is the first model of its kind to address symptoms of indirect trauma. A group intervention, CoHealing aims at expanding individuals’ ‘window of tolerance’ by providing self-regulation tools such as mind and body practices, relational connection as a coping resource, and psychoeducation about the symptoms of indirect trauma. Reducing the damaging effects of indirect trauma is critical to maintaining a healthy and resilient educational workforce that will, in turn, continue to provide high-quality educational experiences to children and youth.
Figure 1 Modulation theory depiction of the ‘Window of Tolerance’ as applied to the intervention CoHealing.
As shown in Figure 1, there are three core tenets of CoHealing that are grounded in empirical evidence: (1) self-regulation of autonomic arousal, (2) relational connection as a coping resource, and (3) psychoeducation about symptoms of indirect trauma.
1.2.1 Self-Regulation of Autonomic Arousal
Each session of CoHealing begins and ends with skill building to support emotional and autonomic self-regulation. Self-regulation strategies (e.g., mind and body practices, also called self-care) are aimed at reducing symptoms of indirect trauma  in order to expand one's ‘window of tolerance’ [23,32]. A multitude of self-regulation skills are introduced throughout the CoHealing intervention and participants are guided through planning for ongoing implementation in their daily lives. Skills training in specific mind and body practices such as mindfulness and meditation, breathing techniques, grounding activities, and relaxation exercises can promote physical and emotional regulation. When regularly practiced, mindfulness has been shown to decrease physiological arousal, increase present-centered awareness , and increase nonjudgmental acceptance of potentially distressing emotional/cognitive states as well as internal/external triggers that are trauma related . Physical care, such as exercise, nutrition, and rest have been found to be beneficial in alleviating stress and in reducing symptoms related to indirect trauma and PTSD [35,36,37]. Reflection (e.g., journaling) and creative expression (e.g., art) have also been found to reduce indirect trauma symptoms , and can create separation from stressful work . Building awareness around the needs for, and benefits of, self-regulation are core threads that run throughout the CoHealing intervention.
1.2.2 Relational Connection as a Coping Resource
Physical distancing practices challenge the most reliable methods of mitigating trauma-related stress––healthy relational connectedness to people . The communal coping theory provides a useful framework for exploring the relationship between social connections and effective adaptation in the face of adversity, such as the collective trauma of the COVID-19 pandemic. Communal coping is a process that takes place when groups come together to deal with shared stress or trauma, engaging in collaborative problem-solving, emotional support, and strategies to cope as a group through difficult times . At the core of communal coping theory is that coping with stress is fundamentally a social process, characterized by shared experiences among those involved . Consequently, the belief that "We are all in this together" helps alleviate individual burdens, blame, and guilt. The multidisciplinary nature of the CoHealing intervention allows for the opportunity to engage in communal coping both within and between helping professions. In addition to the individual benefits such as stress buffering and expanded access to resources derived from emotional connections during times of collective trauma, this framework highlights the critical role of communal coping in fostering enduring relational commitments that extend beyond the challenging circumstances.
The CoHealing intervention places significant emphasis on enhancing social connections as a coping resource. Research consistently demonstrates that resilience and well-being among educators are closely tied to social support and connection with others [42,43]. However, the COVID-19 quarantine and physical distancing measures have disrupted common ways people experience connection. Research on how other helping professionals define emotional connectedness and how they have adapted to maintaining connections with loved ones during the pandemic reveal intricate dynamics characterized by various elements, including expressions of empathy, valuing others, providing assistance and support, demonstrating physical and emotional presence, and embracing vulnerability . Furthermore, feeling isolated and disconnected, particularly during collective trauma, can negatively impact one’s mental health . Maintaining relational connection with a network of professionals doing similar work is an essential strategy in preventing and coping with indirect trauma . In a group setting, sharing similar experiences decreases a sense of isolation and enhances social support . Individual and group narrative exercises can be an effective technique in seeking factual information about experiences, cognitions, and questions to help identify sources of distress, analyzing how trauma or indirect trauma symptoms function, and developing possible solutions .
1.2.3 Psychoeducation about Symptoms of Indirect Trauma
The didactic portion of the CoHealing intervention focuses on education about indirect trauma, relational health, and vicarious posttraumatic growth, and resilience. Psychoeducation is an evidence based technique which uses a strengths based approach in integrating therapeutic and educational interventions . Psychoeducation about the identification, prevention, symptoms and treatment of secondary traumatic stress has been recognized as important for helping professionals . Self-assessment is also a useful strategy in recognizing indirect trauma as helping professionals may not recognize the symptoms .
2. Materials and Methods
2.1 Components of the CoHealing Intervention
CoHealing is a monthly group-intervention delivered over six months aimed at promoting a more resilient, interdisciplinary network of trauma-informed helping professionals by reducing secondary traumatic stress, burnout, and isolation. CoHealing provides self-regulation tools, relational connection as a coping resource, and psychoeducation on the causes and symptoms of indirect trauma. CoHealing was born out of the need to enhance the relational health of trauma-informed helping professionals and to address indirect trauma and job-related vicarious trauma, secondary traumatic stress, and compassion fatigue across disciplines. In order to ensure a culturally sensitive, anti-oppressive trauma-informed program, CoHealing was developed in collaboration with members of the broader Cleveland community, representing diverse cultures, racial and ethnic backgrounds, gender identities, sexual orientations, and socioeconomic positions. Each session was developed and co-facilitated by one doctoral level, licensed social worker holding expertise in indirect trauma and trauma-informed practice and one community member holding expertise in their lived experience. Goals of CoHealing include: 1) Fostering social relationships that enhance interprofessional collaboration and community; 2) Reducing secondary traumatic stress and burnout; 3) Reducing turnover rates in the helping professions; and 4) Improving the quality and continuity of care for individuals, families, and communities experiencing trauma and adversity. Reducing the damaging effects of indirect trauma is critical to maintaining a healthy and resilient workforce that will, in turn, continue to provide high-quality health and human services to individuals and communities experiencing trauma and adversity. CoHealing was piloted in 2019 using an in-person format and was adapted in 2020 to allow for virtual facilitation during the COVID-19 pandemic. The model can be flexibly modified for either format, depending on the needs and resources of the host group.
Prior to conducting the preliminary evaluation on the effectiveness of CoHealing on secondary trauma, approval was obtained from the Case Western Reserve University Institutional Review Board.
2.1.1 CoHealing Intervention Structure
The CoHealing intervention consists of six distinct sessions. Sessions are designed to stand alone, yet complement one another, and are anchored by consistency in structure and integration of core concepts. Sessions begin with an overview of SAMHSA’s  principles of trauma-informed care and a discussion of the way the session will align with principles of safety, trustworthiness and transparency, peer support, empowerment, voice and choice, collaboration and mutuality, and sensitivity to cultural, historical, and gender issues. Each session moves through a consistent agenda: ‘Mingle’ small group discussion and reflection, didactic instruction, facilitator-led discussion and exploration of a monthly theme, and an experiential self-regulation activity to close. Each session lasted approximately two hours. The general outline for CoHealing sessions is presented in Table 1. While monthly themes vary, the three connecting threads that tie each CoHealing session together are attention to relational connection, self-regulation, and psychoeducation. These core concepts, described below, are illustrated across each of the six monthly themes.
Relational Connection. To build trust, rapport, and connection between participants, each CoHealing session includes multiple opportunities to participate in small group and large group discussion. The ‘Mingle’ portion of the session places participants in groups of two or three to explore how they are being impacted by their work, why they have chosen to enter a helping profession, and what about the work keeps them going. Monthly topic activities and self-regulation activities end with an opportunity to debrief and reflect on what it was like to engage, to listen, and to share with others. The final 10-15 minutes of the session is left open and unstructured as participants are encouraged to network, connect, and engage with anyone they had not yet connected with during the session.
Self-Regulation. In keeping with trauma-informed approaches , each session begins and ends with opportunities to both explore and engage in self-regulation. At the start of each session, participants are invited to check-in with themselves about what their bodies may need and are encouraged to eat, drink, move, breathe, or otherwise self-soothe in whatever ways feel best in order to prioritize self-regulation. Each session ends with an experiential exercise aiming to soothe the nervous system and expand the ‘window of tolerance.’ Exercises include guided imagery, breathwork, acupressure, and polyvagal-informed somatic grounding, among others. Participants are encouraged to consider how they may implement regular self-regulation practices between sessions of CoHealing in the form of a self-care plan.
Psychoeducation. The didactic portion of the session focuses on psychoeducation about indirect trauma, relational health, and vicarious posttraumatic growth and resilience. Shared language is created by offering definitions and clear distinction between often misused terms such as vicarious trauma, compassion fatigue, and burnout. Participants receive resources on these concepts and are encouraged to check-in with themselves regarding their symptoms of indirect trauma and/or vicarious posttraumatic growth and resilience. Each monthly topic also includes an educational component, as facilitators discuss the evidence informing the topic, relevant definitions, and offer personal examples to illustrate.
2.1.2 CoHealing Session Content
The six monthly CoHealing themes tap into a range of topics designed to deepen participants’ understanding of self-care, promote well-being, and encourage peer support and connection. A detailed overview of each monthly theme is described below.
Session 1 Theme: Tapping into our Role as Helpers: Why We’re Here, How We Cope. Participants are introduced to the concepts of vicarious trauma and vicarious posttraumatic growth; prevalence rates among different groups of helping professionals are provided. Self-regulation skills and other methods of coping are offered as ways of mitigating the impact of indirect trauma. Participants are asked to consider their challenges and triumphs of their work, as well as the ways they currently cope with stress or indirect trauma exposure and share their reflections in breakout groups of 4-5; large group debrief follows. A critical examination of the term ‘self-care’ is offered. Participants are encouraged to begin thinking about potential components of a plan for self-regulation and stress management. Closing self-regulation exercise: Mindful breathing.
Session 2 Theme: Creating a Story of Self as a Carer. Participants explore the function of narrative sharing and storytelling within the context of indirect trauma and resilience. The importance of ongoing reflection is explored. Participants are given a template for creating a story of self, including prompts to reflect on how they ended up in the role of a carer, how aspects of their personality show up in their work, and how challenges, choices, outcomes, and their morals/values have molded who they are as helping professionals. Participants are given 10 minutes to craft their narratives, and then placed into small groups of 2-3 where they are invited to share them aloud. A final full group debrief occurs where participants are asked how they were impacted by listening and by sharing. Closing self-regulation exercise: Mindful movement paired with breathwork.
Session 3 Theme: Safety and Emotional Armoring. Participants are asked to explore what ‘safety’ means in their work and how they may enhance their own safety and the safety of those they serve. Dr. Brene Brown’s work on emotional armoring is introduced and defined; psychological body armor as a tool for resilience is defined. Participants are put into small groups (e.g., three or four participants) and asked to discuss prompts around both honoring and shedding their emotional armor, and how both may impact the people they serve. A large group debrief follows, where participants can reflect on what they shared and what they heard. Closing self-regulation exercise: guided visualization.
Session 4 Theme: The Work of Grief and Loss. Participants are encouraged to consider how personal or professional loss has impacted their work and discuss the significance of validation in the grieving process. Anticipatory grief, complicated grief, and disenfranchised grief are defined, and examples of each are shared. Participants meet in small groups to explore their own experiences with each type of grief and the ways they have given and received support in their personal and professional grieving. A large group debrief follows, where participants are asked to reflect on what they learned by sharing and by listening. Closing self-regulation exercise: acupressure for stress relief.
Session 5 Theme: Polyvagal Theory and the Social Nervous System. Participants are given an overview of the neurobiology of trauma, the fight/flight/freeze/flock/fawn stress response, and the role of the nervous system. Participants are introduced to the social nervous system and polyvagal theory and encouraged to consider the role of the social nervous system in their work. Participants are put into small groups and asked to consider and discuss their somatic experience of social engagement throughout the session. In the large group debrief, participants are asked to reflect on what they learned by sharing and by listening. Closing self-regulation exercise: polyvagal-informed somatic settling.
Session 6 Theme: Trauma, Identity, and Sense of Self. In the final session, participants are provided with the evidence base for the impact of trauma (both direct and indirect) on identity and sense of self and guidance around living in line with values. Two opportunities for creative expression occur as participants are asked to draw a version of their ‘best self’ and an image that represents a time they adjusted to changing life circumstances, then share these images with the large group and discuss how to move toward a life that reflects each of them. Participants are invited to engage in a reflection activity where they offer affirmation to one another and reflect on how they’ve been impacted by one another throughout the CoHealing program. Participants are offered support in solidifying and implementing their self-care plans. Closing self-regulation exercise: guided gratitude meditation.
2.2 Preliminary Evaluation
While the purpose of the paper was to describe the CoHealing intervention, we have conducted a limited preliminary evaluation. The purpose of a preliminary evaluation is to conduct an initial broad assessment of intervention concept and rudimentary exploration of effectiveness. The primary goal of a preliminary evaluation was to assess the potential value and feasibility of pursuing the research further. We conducted two forms of preliminary evaluation: (1) a post-session evaluation after each CoHealing and (2) preliminary testing of effectiveness of CoHealing using an online survey-based, longitudinal design.
2.2.1 Preliminary Evaluation Using Post-Session Data
In 2019, over 200 helping professionals from a number of disciplines (37% social work, 23% other mental health professionals, 8% education, 4% medical, 7% community work/social entrepreneurship, 21% other disciplines) attended CoHealing, with session attendance ranging from 15-35 attendees. Post-session data from each session was collected asking attendees to voluntarily respond using a Likert scale indicating the strength of agreement to each statement (1 = strongly disagree, 5 = strongly agree): (1) You gained a new knowledge or skill. (2) You connected with other participants. (3) You felt safe and supported in the space. (4) The content and activities were relevant and can be applied to your work. (5) The people you serve will benefit from your having attended CoHealing. Post-session surveys were anonymous, and no demographic was collected from attendees. A total of 121 post-session surveys were completed.
2.2.2 Preliminary Evaluation on the Effectiveness of Cohealing on Secondary Trauma
All attendees of a CoHealing event were invited to participate in the study over a six-month period from January to June 2019. Once participants consented to be in the study, participants were sent eight electronic surveys over a one-year period (monthly for months 1-6, month 9, and month 12) regardless of their attendance of CoHealing events. Participants self-reported on the professional quality of life (ProQOL, ). The ProQOL is a 30-item measure assessing compassion satisfaction (i.e., pleasure from doing work; 10 items), burnout (i.e., feeling hopeless about doing work; 10 items), and secondary traumatic stress (i.e., secondary exposure to extremely or traumatically stressful events through doing work; 10 items) at each time point. The secondary traumatic stress subscale was used for the preliminary evaluation and was summed according to the scoring protocol provided by the measure authors . Data on gender and race were collected.
A total of 41 participants enrolled in the preliminary evaluation study and 26 participants completed surveys at two or more time points. Because this is a preliminary evaluation, there was no control group. Participants in the preliminary evaluation study were 70.37% female (11.11% male; 18.52% chose to not answer) and 59.26% White (14.81% Black or African American; 7.41% Asian; 18.52% other race). Participants were entered into a monthly drawing for a $20 gift card.
3.1 Results from the Preliminary Evaluation Using Post-Session Data
Post-session data indicated that attendees (n = 121) found the sessions to be beneficial; the averages of responses indicating the strength of agreement to each statement (1 = strongly disagree, 5 = strongly agree): ‘You gained a new knowledge or skill’ (M = 4.3), ‘You connected with other participants’ (M = 4.6), ‘You felt safe and supported in the space’ (M = 4.88), ‘The content and activities were relevant and can be applied to your work’ (M = 4.77), and ‘The people you serve will benefit from your attending CoHealing’ (M = 4.6).
3.2 Results from the Preliminary Evaluation on the Effectiveness of Cohealing on Secondary Trauma
During the participants' first session, the mean secondary trauma score (STS) was 22.29 (σ = 8.22). About 41% (n = 11) demonstrated a moderate or high STS. There were 26 participants who completed more than one CoHealing session and completed at least one follow-up questionnaire. From the first session to the last session, participants reported on average a decrease of 1.64 points on the STS (σ = 8.43, d = -0.20, p = 0.47).
Teaching is consistently ranked as one of the most stressful careers in the United States [52,53]. The COVID-19 pandemic has exacerbated job-related stress for teachers and administrators alike, leaving the entire profession vulnerable to burnout and indirect trauma. Since COVID-19, educators have been found to more likely to suffer from burnout than the general population of working adults and twice as likely to report job-related stress . Reducing the damaging effects of indirect trauma is critical to maintaining a healthy and resilient education workforce that can continue to provide high-quality education services to students as they navigate through the long-term educational impacts of the COVID-19 pandemic [55,56].
This article presented, CoHealing, a promising intervention to mitigate the impact of indirect trauma and burnout in educators. CoHealing is not only timely for the COVID-19 pandemic but has broader implications for maintaining a resilient workforce of educators across a variety of public health emergencies. CoHealing is grounded in a strong theoretical base and utilizes evidence-based self-regulation skills in combination with relational connection as a coping resource and psychoeducation, all shown to be effective in reducing stress and indirect trauma symptoms. The purpose of this paper was to provide an intervention description. While preliminary findings demonstrated reduced secondary trauma symptoms, this was not a statistically significant decrease. More research is needed to robustly evaluate CoHealing including larger sample size, retention of participants across time, and the use of control group comparison. All of these elements were limitations in the preliminary evaluation. With further evaluation, this novel intervention may have the potential to help foster healthy adaptation and bolster indirect trauma recovery for helping professionals including teachers and educational staff.
In addition to individual-level interventions aimed at reducing secondary trauma and burnout, it is also important for schools to consider organizational-level opportunities that promote connection, empowerment, and culture that enhance resilience among staff . Indirect trauma symptoms can be exacerbated or influenced by the culture, environment, and systems processes of the organization [58,59]. The World Health Organization  and the National Institute for Occupational Safety and Health  have included stress-related disorders as risks to occupational hazards. School is a complex environment with complex job demands, including both individual and school-level challenges like high workload, role conflict, school climate, and conflicts with colleagues [52,62]. At the organizational level, class size, school size, the availability of support, and teachers’ job-specific tasks are among the significant variables related to burnout . There are also economic risks that organizations face when the prevention of indirect traumatic stress among staff is perceived as a self-directed rather than systems-wide, collaborative effort . The National Commission on Teaching and America’s Future estimated the national cost of public school teacher turnover to be more than \$7.4 billion; an average of \$20,000 per teacher who is not retained . Such financial costs are associated with high absenteeism, early retirement, and lower-quality job performance . It is clear from the research that a concerted focus on addressing the impact of indirect trauma is key to promoting teacher well-being and retention, effectiveness, and quality delivery of education.
The prevalence and effects of stress and burnout among educators have been studied for decades . While stress and burnout are not necessarily new experiences for teachers, the COVID-19 pandemic exacerbated them as teachers, staff, and administrators struggled to adapt to online learning while balancing the mental health and academic needs of their students. The resulting challenges have led to heightened levels of stress, burnout, and anxiety among teachers and education staff, highlighting the need for greater mental health support and resources. Coping strategies that address these challenges are critical to ensuring that teachers can continue to provide high-quality education to their students. The CoHealing intervention is a promising approach that seeks to reduce secondary traumatic stress, burnout, and isolation by promoting a more resilient, trauma-informed network of helping professionals. By addressing the mental health needs of teachers and education staff, we can support their ability to navigate the complex needs of their students.
Thank you to the community members who co-developed and co-facilitated CoHealing: Damian Calvert, Danielle Graham, Erica Johnson, Jessica Julian, Kelly DiTurno, Lauren Welch, Lindsay Kirkham-Olsen, Melissa Libertini, Natay Bates, and Robin Rentrope.
Jennifer King is the creator of the CoHealing intervention. Introduction: all authors. Methods: King, Holmes, Evans. Results: Holmes, Bender. Discussion: all authors. Conclusion: King, Holmes.
This project was funded by St. Luke's Foundation. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the St. Luke's Foundation.
The authors have declared that no competing interests exist.
- Agyapong B, Obuobi-Donkor G, Burback L, Wei Y. Stress, burnout, anxiety and depression among teachers: A scoping review. International journal of environmental research and public health. 2022; 19: 10706. [CrossRef]
- Farber BA. Crisis in education: Stress and burnout in the American teacher. San Francisco, CA: Jossey-Bass; 1991. pp. xxi, 351.
- Kalker P. Teacher stress and burnout: Causes and coping strategies [Internet]. 1984 [cited date 2023 August 25]. Available from: https://www.proquest.com/openview/dad83cbb63e52727743f4f9b23d7d318/1?pq-origsite=gscholar&cbl=1816594.
- Schwalbach J. Outsized and opaque: K–12 pandemic education spending [Internet]. Washington, D.C.: The Heritage Foundation; 2021. Available from: https://www.heritage.org/education/report/outsized-and-opaque-k-12-pandemic-education-spending.
- Minkos ML, Gelbar NW. Considerations for educators in supporting student learning in the midst of COVID‐19. Psychol Sch. 2021; 58: 416-426. [CrossRef]
- Brunier A, Drysdale C. COVID-19 disrupting mental health services in most countries, WHO survey [Internet]. Geneva: World Health Organization; 2020. Available from: https://friends-project.eu/media/who_int_news_item_05_10_2020_covid_19_disrupting_mental_health_services_in_most_countries_who_survey.pdf.
- Pressley T, Ha C, Learn E. Teacher stress and anxiety during COVID-19: An empirical study. Sch Psychol. 2021; 36: 367-376. [CrossRef]
- Figley CR. Compassion fatigue: Toward a new understanding of the costs of caring. In: Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. Baltimore, MD, US: The Sidran Press; 1995. pp. 3-28.
- Gil S. Coping style in predicting posttraumatic stress disorder among Israeli students. Anxiety Stress Coping. 2005; 18: 351-359. [CrossRef]
- Weinberg M, Gil S, Gilbar O. Forgiveness, coping, and terrorism: Do tendency to forgive and coping strategies associate with the level of posttraumatic symptoms of injured victims of terror attacks? J Clin Psychol. 2014; 70: 693-703. [CrossRef]
- Bozkurt A, Karakaya K, Turk M, Karakaya Ö, Castellanos-Reyes D. The impact of COVID-19 on education: A meta-narrative review. TechTrends. 2022; 66: 883-896. [CrossRef]
- Tabor PD. Vicarious traumatization: Concept analysis. J Forensic Nurs. 2011; 7: 203-208. [CrossRef]
- Shoji K, Lesnierowska M, Smoktunowicz E, Bock J, Luszczynska A, Benight CC, et al. What comes first, job burnout or secondary traumatic stress? Findings from two longitudinal studies from the US and Poland. PLoS One. 2015; 10: e0136730. [CrossRef]
- Killian KD. Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors. Traumatology. 2008; 14: 32-44. [CrossRef]
- Adams RE, Boscarino JA, Galea S. Social and psychological resources and health outcomes after the World Trade Center disaster. Soc Sci Med. 2006; 62: 176-188. [CrossRef]
- Canfield J. Secondary traumatization, burnout, and vicarious traumatization: A review of the literature as it relates to therapists who treat trauma. Smith Coll Stud Soc Work. 2005; 75: 81-101. [CrossRef]
- Maltzman S. An organizational self-care model: Practical suggestions for development and implementation. Couns Psychol. 2011; 39: 303-319. [CrossRef]
- Hernandez-Wolfe P, Killian K, Engstrom D, Gangsei D. Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. J Humanist Psychol. 2015; 55: 153-172. [CrossRef]
- Iqbal A. The ethical considerations of counselling psychologists working with trauma: Is there a risk of vicarious traumatisation. Couns Psychol Rev. 2015; 30: 44-51. [CrossRef]
- Kim H, Ji J, Kao D. Burnout and physical health among social workers: A three-year longitudinal study. Soc Work. 2011; 56: 258-268. [CrossRef]
- Holmes MR, Rentrope CR, Korsch-Williams A, King JA. Impact of COVID-19 pandemic on posttraumatic stress, grief, burnout, and secondary trauma of social workers in the United States. Clin Soc Work J. 2021; 49: 495-504. [CrossRef]
- Walker E, Morin C, Labrie N. Supporting staff at risk for compassion fatigue. Hong Kong: Peel Public Health; 2013.
- Cohen K, Collens P. The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychol Trauma. 2013; 5: 570-580. [CrossRef]
- Yu X, Sun C, Sun B, Yuan X, Ding F, Zhang M. The cost of caring: Compassion fatigue is a special form of teacher burnout. Sustainability. 2022; 14: 6071. [CrossRef]
- Nadeem E, Shernoff ES, Coccaro C, Stokes-Tyler D. Supporting teachers during the COVID-19 pandemic: A community-partnered rapid needs assessment. Sch Psychol. 2022; 37: 309-318. [CrossRef]
- Gómez-Domínguez V, Navarro-Mateu D, Prado-Gascó VJ, Gómez-Domínguez T. How much do we care about teacher burnout during the pandemic: A bibliometric review. Int J Environ Res Public Health. 2022; 19: 7134. [CrossRef]
- Anderson RC, Bousselot T, Katz-Buoincontro J, Todd J. Generating buoyancy in a sea of uncertainty: Teachers creativity and well-being during the COVID-19 pandemic. Front Psychol. 2021; 11: 614774. [CrossRef]
- Herman JL. Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. London: Hachette UK; 2015.
- Zaleski KL, Johnson DK, Klein JT. Grounding Judith Herman’s trauma theory within interpersonal neuroscience and evidence-based practice modalities for trauma treatment. Smith Coll Stud Soc Work. 2016; 86: 377-393. [CrossRef]
- Ogden P, Minton K, Pain C. Trauma and the body: A sensorimotor approach to psychotherapy (Norton series on interpersonal neurobiology). New York: W. W. Norton & Company; 2006.
- Regehr C, Bober T. In the line of fire: Trauma in the emergency services. New York: Oxford University Press; 2005. [CrossRef]
- Iliffe G, Steed LG. Exploring the counselor's experience of working with perpetrators and survivors of domestic violence. J Interpers Violence. 2000; 15: 393-412. [CrossRef]
- Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol. 2003; 10: 125-143. [CrossRef]
- Follette VM, Vijay A. Mindfulness for trauma and posttraumatic stress disorder. In: Clinical handbook of mindfulness. New York: Springer; 2009. pp. 299-317. [CrossRef]
- Hunter SV, Schofield MJ. How counsellors cope with traumatized clients: Personal, professional and organizational strategies. Int J Adv Couns. 2006; 28: 121-138. [CrossRef]
- Pistorius KD, Feinauer LL, Harper JM, Stahmann RF, Miller RB. Working with sexually abused children. Am J Fam Ther. 2008; 36: 181-195. [CrossRef]
- Steed LG, Downing R. A phenomenological study of vicarious traumatisation amongst psychologists and professional counsellors working in the field of sexual abuse/assault. Australas J Disaster Trauma Stud. 1998; 2.
- Conrad DJ, Perry BD. The cost of caring. Child Trauma Academy’s Interdisciplinary Education Series. 2000. [CrossRef]
- McCann IL, Pearlman LA. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. J Trauma Stress. 1990; 3: 131-149. [CrossRef]
- Ludy-Dobson CR, Perry BD. The role of healthy relational interactions in buffering the impact of childhood trauma. In: Working with children to heal interpersonal trauma: The power of play. New York: The Guilford Press; 2010.
- Lyons RF, Mickelson KD, Sullivan MJ, Coyne JC. Coping as a communal process. J Soc Pers Relat. 1998; 15: 579-605. [CrossRef]
- Vorell MS, Carmack HJ. Healing the healer: Stress and coping strategies in the field of temporary medical work. Health Commun. 2015; 30: 398-408. [CrossRef]
- Ziegelstein RC. Creating structured opportunities for social engagement to promote well-being and avoid burnout in medical students and residents. Acad Med. 2018; 93: 537-539. [CrossRef]
- Bender AE, Berg KA, Miller EK, Evans KE, Holmes MR. “Making sure we are all okay”: Healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic. Clin Soc Work J. 2021; 49: 445-455. [CrossRef]
- Gable SL, Bedrov A. Social isolation and social support in good times and bad times. Curr Opin Psychol. 2022; 44: 89-93. [CrossRef]
- Hesse AR. Secondary trauma: How working with trauma survivors affects therapists. Clin Soc Work J. 2002; 30: 293-309. [CrossRef]
- Naturale A. Secondary traumatic stress in social workers responding to disasters: Reports from the field. Clin Soc Work J. 2007; 35: 173-181. [CrossRef]
- White M, Epston D. Narrative means to therapeutic ends. New York: W. W. Norton & Company; 1990.
- Lukens EP, McFarlane WR. Psychoeducation as evidence-based practice: Considerations for practice, research, and policy. Brief Treat Crisis Interv. 2004; 4: 205-225. [CrossRef]
- Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma-informed approach [Internet]. Huntsville: National Children's Advocacy Center; 2014 [cited date 2020 November 07]. Available from: https://calio.dspacedirect.org/handle/11212/1971.
- Hudnall Stamm B. Professional quality of life [Internet]. Sao Paulo: Center for Victims of Torture; 2009 [cited date 2020 November 17]. Available from: https://proqol.org/.
- Saloviita T, Pakarinen E. Teacher burnout explained: Teacher-, student-, and organisation-level variables. Teach Teach Educ. 2021; 97: 103221. [CrossRef]
- Gallup Inc. State of America’s schools report [Internet]. Gallup Inc.; 2023 [cited date 2023 February 28]. Available from: https://www.gallup.com/education/269648/state-america-schools-report.aspx.
- Steiner ED, Doan S, Woo A, Gittens AD, Lawrence RA, Berdie L, et al. Restoring teacher and principal well-being is an essential step for rebuilding schools: Findings from the State of the American teacher and State of the American principal surveys [Internet]. Santa Monica, CA: RAND Corporation; 2022 [cited date 2023 February 28]. Available from: https://www.rand.org/pubs/research_reports/RRA1108-4.html.
- Madigan DJ, Kim LE. Does teacher burnout affect students? A systematic review of its association with academic achievement and student-reported outcomes. Int J Educ Res. 2021; 105: 101714. [CrossRef]
- Carver-Thomas D, Darling-Hammond L. The trouble with teacher turnover: How teacher attrition affects students and schools. Educ Policy Anal Arch. 2019; 27. doi: 10.14507/epaa.27.3699. [CrossRef]
- Winblad NE, Changaris M, Stein PK. Effect of somatic experiencing resiliency-based trauma treatment training on quality of life and psychological health as potential markers of resilience in treating professionals. Front Neurosci. 2018; 12: 70. [CrossRef]
- Iyamuremye JD, Brysiewicz P. The development of a model for dealing with secondary traumatic stress in mental health workers in Rwanda. Health SA Gesondheid. 2015; 20: 59-65. [CrossRef]
- Northeastern University's Institute on Urban Health Research and Practice, in collaboration with William James College. Guidelines for a vicarious trauma-informed organization: Human resources [Internet]. Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice; 2016. Available from: https://vtt.ovc.ojp.gov/ojpasset/Documents/OS_HR_Guidelines-508.pdf.
- World Health Organization. Occupational health: Stress at the workplace [Internet]. Geneva: World Health Organization; 2018. Available from: http://www.who.int/occupational_health/topics/stressatwp/en/.
- National Institute for Occupational Safety and Health. Stress at work [Internet]. Atlanta: Centers for Disease Control and Prevention; 2018. Available from: https://www.cdc.gov/niosh/topics/stress/.
- Skaalvik EM, Skaalvik S. Teacher self-efficacy and teacher burnout: A study of relations. Teach Teach Educ. 2010; 26: 1059-1069. [CrossRef]
- Bell H, Kulkarni S, Dalton L. Organizational prevention of vicarious trauma. Fam Soc. 2003; 84: 463-470. [CrossRef]
- Carroll TG. The high cost of teacher turnover. Policy brief [Internet]. Washington, DC: National Commission on Teaching and America’s Future; 2007 [cited date 2023 February 28]. Available from: https://eric.ed.gov/?id=ED498001.