Self-Care

215 Journal of Gerontological Social Work, 52:215–229, 2009 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 online DOI: 10.1080/01634370802609296 WGER 0163-4372 1540-4048 Journal of Gerontological Social Work, Vol. 52, No. 3, 2009: pp. 0–0 Journal of Gerontological Social Work Compassion Fatigue and the Adult Protective Services Social Worker Compassion Fatigue and Social Workers D. B. Bourassa DARA BERGEL BOURASSA Department of Social Work and Gerontology, Shippensburg University, Shippensburg, Pennsylvania, USA Compassion fatigue is a relatively new term that describes the symptoms that are experienced by social workers and other help- ing professionals who work with clients experiencing trauma. This article defines the concept of compassion fatigue and relates compassion fatigue to Adult Protective Services (APS) social work- ers. It is proposed that APS social workers may be susceptible to the deleterious effects of compassion fatigue due to the nature of their work and environment. Suggestions for avoidance of compassion fatigue are also discussed, including self-care strategies and the need for continuing education regarding this phenomenon.

KEYWORDS Compassion fatigue, self-care, continuing education, social work, social workers, adult protective services INTRODUCTION Compassion fatigue refers to the potentially harmful symptoms and effects that are experienced by helping professionals who participate in trauma work.

Compassion fatigue is most likely to affect the professions that work with vic- tims of traumatic events, such as physical and sexual abuse, rape, natural and man-made disasters, and any other disturbing life-events that have the ability to harm a person. The act of listening to the traumatic recounts can initiate the symptoms and effects of compassion fatigue, which have the ability to become psychologically and physically harmful to the professional (Figley, 2002a). Received 17 July 2007; accepted 18 September 2008.

Address correspondence to Dara Bergel Bourassa, Department of Social Work and Gerontology, Shippensburg University, 1871 Old Main Dr., Shippensburg, PA 17257.

E-mail: [email protected] 216D. B. Bourassa Studies have been conducted in many professions that interact with traumatized clients, such as physicians, nurses, emergency personnel, private mental health therapists, family violence counselors, and child protective ser- vices workers. However, it is interesting to note that Leon, Altholz, and Dziegielewski (1999) wrote the only article that addresses the gerontological social workers’ susceptibility to compassion fatigue, which indicates a defi- cient amount of knowledge and information that pertains to social workers who work with the elderly. At this time, no empirical evidence has been conducted with social workers who work in Adult Protective Services (APS). DEFINING APS WORK Those who work in APS conduct in-depth investigations for suspected abuse, abandonment, and neglect referrals, offer client protection, and pro- vide ongoing case management for older adults (Bergeron, 2002; Daly, Jogerst, Haigh, Leeney, & Dawson, 2005; Teaster, Roberto, Duke, & Kim, 2000). APS investigators make decisive judgments regarding social, legal, and medical interventions. The function of an APS social worker is exten- sive and complex.

The APS worker deals primarily with crisis intervention due to the nature of the life-threatening conditions that are involved with abuse, aban- donment, and neglect (Bergeron, 2002; Daly et al., 2005). APS social work- ers provide referrals and arrange for formal services, such as visiting nurses, home health aides, and Meals-On-Wheels delivery services to service older adults. Additional formal services provided within the APS context include removal of an elderly person from the home environment and placement into a health care facility, or securing a financial power of attorney or guard- ian for the court-determined incompetent older adult. The APS worker can also suggest family supportive services to assist the elderly person and those that help care for the elderly person.

Challenges Specific to APS Social Workers APS social workers work comprehensively with the elderly client and the family, which places the APS social worker in a dual role of interviewing, intervening, and assisting both parties involved in the suspected abuse, abandonment, or neglect (Bergeron, 2002). This could prove to be danger- ous to the APS social worker and the elderly client, because the investiga- tion process may increase the propensity for violence against the older adult and/or the social worker when the abuser is confronted by the social worker (Bergeron, 2002).

APS social workers characteristically have excessive caseloads, which restricts the amount of time that the social worker has to establish rapport Compassion Fatigue and Social Workers217 and trust with the client (Daly, Jogerst, Brinig, & Dawson, 2003). Both Balaswamy (2002) and Daly et al. (2003) have reported that the stress of a large caseload weighs heavily on the conscience of an APS social worker due to the limited amount of time that is given to investigating reports of abuse. Additionally, earlier research by Cushway, Tyler, and Nolan (1996) determined that working with clients who have experienced verbal and physical abuse is extremely stressful to the social worker.

Furthermore, not all APS workers are degreed social workers, nor do they have sufficient training in issues that affect the elderly (Bergeron, 2002; Daly et al., 2005; Teitelman & O’Neill, 2001). Therefore, some of the APS employees may have difficulty understanding family dynamics and provide limited interventions (Bergeron, 2002; Daly et al.; Teitelman & O’Neill). Last, working with a large amount of abuse and neglect cases, and having limited support from coworkers and supervisors may contribute to emotional exhaustion, depersonalization, and the eventual burnout of the APS social worker (Figley, 1995a, 1999; Leon et al., 1999).

APS social workers work intensely with victims of abuse and neglect.

The APS social worker, therefore, has the possibility of being constantly exposed to the traumatic experiences and stressors of their clients. The duties of APS work can be construed as a potential risk factor for the devel- opment of compassion fatigue, which may ultimately impair the social worker from providing effective services (Bride, Robinson, Yegidis, & Figley, 2004). COMPASSION FATIGUE/SECONDARY TRAUMA Compassion fatigue is associated with the cost of caring for a traumatized individual (Figley, 1995a; 1995b). It can be defined as “the natural conse- quent behaviors and emotions resulting from knowing about a traumatizing event experienced by a [client] and the stress from helping or wanting to help a traumatized person” (Figley, 1995a, p. 7). Compassion fatigue is caused by the constant stress of working with a traumatized client, the emotional demands placed upon the workers listening to the horrific details of the event, and the negative reactions that are evoked from working with traumatic material (Bell, 2003; Figley, 1995a). Compassion fatigue proposes that simply learning about a traumatic event can traumatize social workers and other professionals that treat clients experiencing crises. These profes- sionals do not have to be physically harmed or threatened by harm to expe- rience compassion fatigue (Meyers & Cornille, 2002). Compassion fatigue used to be referred to as secondary traumatic stress disorder; however, the health care professionals dealing with aspects of secondary trauma did not want the negative connotation related to suffering from a “disor- der” (Baranowsky, 2002). Presently, secondary traumatic stress disorder is 218D. B. Bourassa synonymous with compassion fatigue (Baranowsky, 2002; Salston & Figley, 2003).

The negative responses that people with compassion fatigue exhibit mimic the reactions that a person living with posttraumatic stress disorder (PTSD) would display (Figley, 2002a; Jenkins & Baird, 2002). Compassion fatigue is comprised of symptoms that include intrusive imagery that is related to the client’s traumatic material, avoidant responses, sadness, irritability, grief, difficulty concentrating, depression, anxiety, exaggerated startle response, hypervigilance for the traumatized person, rage, nightmares, diminished inter- est in activities, detachment from others, diminished affect, interpersonal and work problems, physiological responses, addictive behaviors, and relentless reexperiencing, recollections, or reminders of the client’s distressing event (American Psychiatric Association [APA], 2000; Gentry, Baranowsky, & Dunning, 2002). These symptoms must persist for over a month before being classified as compassion fatigue (O’Halloran & Linton, 2000). However, the dif- ference between PTSD and compassion fatigue are the stressors that initiates the symptoms. For PTSD, the stressors can be any event that directly threatens the self or an abrupt devastation of one’s environment. The stressors that elicit compassion fatigue symptoms are contributed to being exposed to information about a traumatizing event experienced by a client (APA, 2000; Figley, 1995a).

Interestingly, the Diagnostic and Statistical Manual of Mental Disor- ders, fourth edition, text revision (DSM-IV-TR) recognizes that professionals can be traumatized by learning about a traumatic event that the client expe- rienced (Ortlepp & Friedman, 2002). However, the DSM-IV-TR does not make any mention of compassion fatigue being in the same class as PTSD, nor does it acknowledge that compassion fatigue is a condition that trauma workers often suffer (APA, 2000; Figley, 2002a).

Compassion fatigue is considered a risk factor that results from working with people who have experienced traumatic events (Collins & Long, 2003b). It is a reaction to listening and witnessing the effects of the trau- matic event of the client (Figley, 2002a). This maladaptive stress response is considered inevitable, can occur regardless of age, gender, ethnicity, and level of education, and is sudden and acute in nature (Berger, 2001; Collins & Long, 2003a). Additionally, compassion fatigue can result from observing a single traumatic episode (Figley, 1995a).

Potential Risk Factors Leading to Compassion Fatigue If a social worker who specifically works with traumatized clients is exposed to one of the following risk factors or has a history of a risk factor, then the social worker will be more likely to experience compassion fatigue. The possibility also exists that risk factors can be expected to inten- sify to more severe impairments, such as burnout (Berger, 2001; Everall & Paulson, 2004; Figley, 2002a; Inbar & Ganor, 2003). Compassion Fatigue and Social Workers219 Personal history of trauma. Compassion fatigue is a unique condition in which there may be no preexisting characteristics or unresolved psycho- logical conflicts to help describe a social worker’s responses (Hesse, 2002).

However, studies have shown a correlation between a social worker’s past personal history of trauma and the development of compassion fatigue (Baird & Jenkins, 2003; Nelson-Gardell & Harris, 2003).

Countertransference. Jenkins and Baird (2002) study found that 55% of their sample had a history of either sexual assault, sexual abuse, or domestic violence. Salston and Figley (2003), Cunningham (2003), Baird and Jenkins (2003), Nelson-Gardell and Harris (2003), and Kinzel and Nanson (2000) suggested that trauma workers who have some sort of trauma history are more susceptible to experiencing symptoms of compas- sion fatigue as a result of their working with clients’ traumatic material, especially if a social worker who was sexually abused in the past investi- gates or works with a client that has been sexually abused, as well. This signifies that countertransference has the ability to increase the risk of developing compassion fatigue due to the unconscious perceptions, dis- tortions, and reactions of a therapist’s own life experiences when treating a client (Hesse, 2002).

Degree of exposure to traumatic material. This construct can be defined as being directly subjected to the client’s traumatic event and the constant sense of responsibility for the care of clients over an extended period of time (Figley, 2002a). Figley suggests that one of the reasons why social workers leave direct practice and seek employment as directors and super- visors, or eventually leave the field, is due to this emotionally exhaus- tive work.

The length of time that a worker has been exposed to traumatic mate- rial and caring for traumatized clients was significantly correlated with com- passion fatigue (Bride et al., 2004; Hyman, 2004). Brady, Guy, Polestra, and Brokaw (1999) conducted a cross-sectional study evaluating vicarious trauma in female therapists. The researchers found that female therapists who see more traumatized clients throughout their careers or have a heavier caseload of trauma survivors are more likely to experience symptoms than therapists who do not have a large caseload of traumatized clients. Similar results have been found by Collins and Long (2003a) and Cunningham (2003).

Front-line Child Protective Services social workers are more likely to experience compassion fatigue than their supervisors (Nelson-Gardell & Harris, 2003). This can be attributed to front-line social workers being exposed to more client trauma material versus their supervisors, who were not exposed to traumatic material as often, due to the nature of the supervisory role. Boscarino, Figley, and Adams (2004) studied the rela- tionship between exposure to client traumatic material and compassion fatigue. The researchers found that social workers who worked with 220D. B. Bourassa more survivors of the September 11th terrorist attacks were more at risk for developing compassion fatigue. Social workers who did not work with the traumatized survivors did not experience compassion fatigue symptoms.

Empathy. Empathy is defined as the social workers’ ability to under- stand and partake in other people’s experiences, as well as sympathize with the events that may happen to their clients (Nelson-Gardell & Harris, 2003).

Empathy is essential in fostering a therapeutic relationship (Baranowsky, 2002; Nelson-Gardell & Harris, 2003). Empathy is also an extremely impor- tant resource that social workers need to utilize to be able to completely understand the client’s situation (Dane & Chachkes, 2001).

Nevertheless, this intense process intensifies the risk of the social worker being subjected to compassion fatigue (Trippany, Kress, & Wilcoxon, 2004). It is empathy, “that sponsors caring work to excise the wounds of the past but also empathy that leaves the care providers vulnera- ble to the residual wounding inflicted during work that uncovers traumatic material” (Baranowsky, 2002, p. 157). Dane and Chachkes (2001) examined the effects of hospital work on social workers in a qualitative study and found that the workers articulated the strain and resulting stress from being empathic.

Inexperience working with trauma. Pearlman and Mac Ian’s seminal study (1995) reported that the younger and less-experienced the therapist was, the more likely the therapist was to experience disruptions in their personal and professional lives, as well as having the most negative reac- tions when providing therapy. Adams, Matto, and Harrington (2001) stud- ied clinical social workers regarding their burnout and vicarious trauma experiences and found that lack of experience working with trauma vic- tims and survivors played a part in the social worker developing compas- sion fatigue. Cunningham (2003) also found that clinicians with fewer years of experience working with trauma were more likely to suffer from disturbances in their cognitive schemas. Similarly, Baird and Jenkins (2003) found that therapists that have not had the experience of working with traumatized victims tend to associate more with the victim than with the function of a therapist. The inexperienced social worker perhaps has not learned how to effectively set up boundaries between themselves and their clients.

The Impact of Compassion Fatigue on Social Workers If the risk factors have not been identified and effectively treated, this can place professionals at a greater risk for ethical concerns, problems with the social worker’s coping skills, a decrease in the social worker’s sense of accomplishment, damaged spirituality, and interpersonal problems (Everall & Paulson, 2004; Hyman, 2004; Salston & Figley, 2003). Compassion Fatigue and Social Workers221 Ethical issues. The National Association of Social Workers Code of Ethics (1999) has stated:

Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judg- ment. . . . Social workers should not take unfair advantage of any pro- fessional relationship or exploit others to further their personal, religious, political, and business interests. . . . Social workers should not allow their personal problems, psychological distress . . . or mental health difficulties to interfere with their professional judgment and per- formance or to jeopardize the best interests of people for whom they have a professional responsibility. [pp. 9 & 23] One of the foremost reasons why compassion fatigue is harmful is due to the ethical issues that can arise when a worker experiences it. Social workers who do not sufficiently manage their compassion fatigue are more likely to encounter disturbances in their degree of empathy, resulting in deficient therapy sessions (Salston & Figley, 2003). This is in direct violation of the NASW Code of Ethics (1999), specifically the ethical standards located in section 4, entitled “Social Workers’ Ethical Responsibilities as Profession- als.” The specific standards that may be violated are Section 4.01, “Compe- tence;” Section 4.03, “Private Conduct;” and Section 4.05, “Impairment.” Social workers who are suffering from the effects of compassion fatigue tend to engage in more boundary violations and more substance abuse, and find it difficult to maintain a therapeutic relationship (Everall & Paulson, 2004; Hesse, 2002; Kinzel & Nanson, 2000; Salston & Figley, 2003). It is believed that social workers who are experiencing compassion fatigue have a tendency to misdiagnose more often, abuse clients, and leave the profes- sional field (Bride et al., 2004; Valent, 2002). Social workers enduring com- passion fatigue potentially may miss scheduled appointments, abandon clients, lose interest in work, become extremely abrasive and judgmental towards their clients, and may feel anger towards their clients when they have not fulfilled the goals addressed in therapy (Baird & Jenkins, 2003; Iliffe & Steed, 2000; Trippany et al., 2004). Other ethical issues arise when the social worker begins to avoid their client for fear of listening to the cli- ent’s traumatic recount. Or, the social worker may appear visibly disturbed by the event, which will prevent the client from discussing the traumatic event.

Problems with coping skills. Social workers experience issues with coping when they are subjected to compassion fatigue. These workers are more likely to engage in avoidance of the client, evasion of their problems, and alienation from their professional colleagues (Hyman, 2004; Kinzel & Nanson, 2000). Dane and Chachkes’ study (2001) found that social workers brought work home with them, worried about their clients, and had difficulty 222D. B. Bourassa separating themselves from their client’s problems. Furthermore, social workers find it increasingly difficult dealing with their emotions from listen- ing to traumatic material. This may encourage a worker to turn to abusing substances or leave the profession early (Cunningham, 2003).

In addition, social workers may develop “survivor guilt” if their coping skills are affected (Dane & Chachkes, 2001). The authors found that social worker’s “feelings of guilt for not having suffered as the client is common in trauma work. [The subjects] felt guilty that they were not able to do more for the client” (p. 41).

Social workers who work with the elderly may experience death or aging anxiety from constantly facing their own mortality when working with this specific population (Anderson & Wiscott, 2003). Gerontological social workers could find themselves desensitized to the various aspects of abuse and issues that the elderly face. Adequate coping skills could help deter these negative associations.

Decrease in sense of accomplishment. Social workers also felt a lack of a sense of accomplishment when they were feeling some aspects of com- passion fatigue. Iliffe and Steed (2000) conducted a qualitative study with domestic violence counselors. They found that almost all of the participants encountered a loss of confidence when working with domestic violence clients, reporting that they felt “ineffectual, inadequate, powerless, and at times stress and anxious” from working with this type of clientele (p. 399).

Counselor’s felt that they were constantly questioning their skills and com- petency with their clients. The Adams et al. (2001) study quantitatively agreed with Iliffe and Steed’s results. It was found that social workers with a decreased sense of accomplishment were more likely to experience symp- toms of compassion fatigue.

Damaged spirituality. Limited research has been conducted regarding the impact of compassion fatigue on a social worker’s spirituality. Dated articles suggest that compassion fatigue can weaken a social worker’s sense of spirituality, by destroying a person’s sense of worth and faith. Spirituality was found to help trauma therapists listen to the traumatic material and to remain resilient during this process (Trippany et al., 2004).

Personal problems. Last, social workers experience problems within their personal and professional life. Social workers who are suffering from compassion fatigue are more emotionally withdrawn from their friends, family, and colleagues, due to a decrease in access to their emotions (Inbar & Ganor, 2003; Salston & Figley, 2003; Trippany et al., 2004). Intimacy may become difficult because of the intrusive thoughts and vivid memories of the client’s traumatic event resurfacing while engaging in intimate acts.

Adams et al. (2001) found that if the social worker’s social supports were not sympathetic, the social worker was more likely to experience disruptive symptoms. Dane and Chachkes (2001) stated that social support from friends, family, peers, and supervisors was extremely important, however, Compassion Fatigue and Social Workers223 “family and friends did not appear to understand the realities of the work environment and therefore could not empathasize adequately” (p. 43).

Burnout If the risk factors of compassion fatigue are not recognized and successfully treated, burnout may result. Social workers experience burnout due to an exorbitant amount of work-related pressures and a degree of emotional and mental exhaustion that emerges gradually over a long period of time (Brady et al., 1999). Moreover, burnout is a key factor in turnover in the helping professions (Maslach, 1982), and social work in particular (Anderson, 2000).

Burnout and Gerontological Social Workers Past research reveals that working with the elderly has been cited as the leading reason why gerontological social workers tend to burnout quickly (Leon et al., 1999; Poulin & Walter, 1993a; 1993b). In agencies that assist the elderly, there are high caseloads, a lack of social support of colleagues, and difficult clients. Social workers also have to work with older adults encom- passing a wide range of all cognitive levels, which makes it difficult, at times, to work with this specific population (Carp; 2000; Cocco, Gatti, de Mendonca Lima, & Camus, 2003).

Poulin and Walter (1993a) conducted the first study evaluating burnout among gerontological social workers. A random sample of 3,000 NASW members and 1,200 members of the Gerontological Society of America were asked to complete Maslach and Jackson’s Burnout Inventory. Findings showed that gerontological social workers who were less satisfied with their clientele, were more likely to feel the effects of burnout (Poulin & Walter, 1993a). Cocco et al. (2003) found similar results when examining burnout in nurses. The study evaluated stress and burnout in nursing home and geriat- ric wards, and the findings stated that the work environment was a major cause of burnout.

Furthermore, terminal illness and death are omnipresent factors when working with this clientele. If a social worker has not fully dealt with his or her own mortality, then it is difficult for the social worker to handle the death of a client, which could potentially lead to burnout (Anderson & Wiscott, 2003).

Effects of Burnout Burnout has similar effects to those of compassion fatigue. One of the most apparent effects of burnout is physical exhaustion (Maslach, 1982). The social worker may experience a disturbance in normal sleep patterns, feeling 224D. B. Bourassa constantly tired, and may be more susceptible to various illnesses. The social worker may also emotionally detach from the workplace and clients, as well as in his or her personal life.

To cope with these issues, the social worker may utilize drugs and/or alcohol to try to relieve this suffering. The social worker also will have trouble coping with the smaller problems in life and at work, due to the psychological exhaustion component of burnout. The social worker may also experience a reduced level of accomplishment and self-esteem, akin to the effects of compassion fatigue.

Burnout may lead to a social worker quitting his or her job, or possibly leaving the social work profession. Kottler (2003) believed that there is no cure once a social worker has reached the level of burnout, and that the social worker must change to another job or assume different roles and responsibilities within the workplace.

Compassion Fatigue and Gerontological Social Workers It has been documented that compassion fatigue has the ability to affect all professions that work with traumatized victims, and if not identified and treated, could possibly lead to burnout (Berger, 2001). However, there is a dearth of literature that explores compassion fatigue affecting social workers who work with the elderly (Leon et al., 1999). In particular, there have been no published studies concerning the impact of compassion fatigue and social workers who investigate allegations of abuse and neglect through the Adult Protective system.

How Compassion Fatigue May Affect APS Social Workers APS social workers could be especially vulnerable to compassion fatigue because they usually have a high caseload of abused or neglected victims, thus, having the tendency to be repeatedly subjected to traumatic material due to listening to and working with clients that are in or have experienced abusive situations (Boscarino et al., 2004; Dane & Chachkes, 2001). Even if the APS social worker is not exposed to traumatic material on a constant basis, it is believed that a single traumatic episode can incur aspects of compassion fatigue (Collins & Long, 2003a).

APS social workers who work with the traumatized elderly are also vulnerable to experiencing compassion fatigue during their careers, due to providing in-depth services to clients experiencing a crisis (Adams et al., 2001; Boscarino et al., 2004; Figley, 2002a). The same set of skills and assessment techniques required in professions dealing solely with trauma are utilized in the APS realm, as well. Furthermore, the APS social worker has an added difficulty when the elderly client is cognitively impaired. APS social workers are often engrossed in the intensity of their elderly clients Compassion Fatigue and Social Workers225 and their family members, making them vulnerable to compassion fatigue.

In addition, there may be some unresolved trauma within the APS social workers’ life that may make them more susceptible to compassion fatigue. SUGGESTIONS TO AMELIORATE OR PREVENT COMPASSION FATIGUE AMONG APS SOCIAL WORKERS It is extremely important for APS social workers to identify the risk factors and effects of compassion fatigue, to prevent this phenomenon from infil- trating their practice and personal lives.

Education About Compassion Fatigue To prevent compassion fatigue from affecting the APS social worker, it is important for the social worker to implement self-care strategies. First and foremost, education about compassion fatigue and recognizing the symp- toms and effects of compassion fatigue are crucial to the identification and treatment of this syndrome. Education about compassion fatigue can be in the form of attending formal presentations about compassion fatigue or informal “brown-bag” discussions. During staff meetings, trainings, or in peer consultations, the effects of compassion fatigue can be discussed to further educate oneself about compassion fatigue. Figley (2002b) believed that it is the agency’s responsibility to provide education about compassion fatigue in addition to “informed procedures for handling stress and its cumulative effects” (p. 215).

Peer Support For the new APS social worker, as well as the seasoned APS social worker, developing peer support may prove to be helpful in the prevention of com- passion fatigue. APS social workers could agree to watch out for each other to make sure that they are not becoming too stressed out with the work and to encourage the other worker to take a break from work, if needed. Breaks from work could include a lunch break or a simple walk around the block to try to reduce the amount of stress that the social worker may be experienc- ing (Myers & Wee, 2002). Another suggestion in the prevention of compas- sion fatigue would be to engage in encouragement and supportive actions towards co-workers. Myers and Wee recommended listening to coworkers, especially after a difficult APS case. Positive reinforcement, in the form of compliments, has also been advised to help prevent compassion fatigue, as well as simply bringing the coworker a snack or something to drink while the coworker may be dealing with a stressful situation (Myers & Wee, 2002). 226D. B. Bourassa Diffusion from APS Work In addition, it is essential to allow some time to defuse at the end of the work day to prevent compassion fatigue. The APS social worker could discuss the day’s events with another coworker or supervisor. Engaging in exercise or simply taking some time to listen to enjoyable music during the commute to home can be helpful in neutralizing the stressful nature of APS work (Myers & Wee, 2002). CONCLUSION Through this literature review, it appears that APS social workers who are listening to the traumatic experiences of their clients may be in jeopardy of developing compassion fatigue and if unidentified and untreated, this could possibly lead to burnout. It has been identified that the risk factors and the effects of compassion fatigue have been explored with social workers who work in Child Protective Services, employee assistance pro- grams, crisis intervention agencies, domestic violence agencies, and private practices. However, these symptoms, risk factors, and effects have not been explored in the realm of gerontological social work, specifically with APS agencies.

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