Tool measures workers’ exposure to others’ trauma

Victim advocates, child-welfare workers, forensic nurses, refugee service providers, substance-use counselors, prosecutors — these and other “helping professionals” often encounter disturbing stories of violence and abuse in the course of their work. Secondhand exposure to traumatizing events can take a toll on the helpers, leading to anxiety and depression, and causing some to leave their fields entirely, exacerbating chronic workforce shortages in many such professions.  

Researchers at Washington University School of Public Health in St. Louis, Harvard University and Boston College have created a tool to measure workplace exposure to secondhand, or vicarious, trauma, as a first step toward finding organizational-level ways to protect workers in the helping professions from one of the biggest dangers of their jobs. A paper describing the development of the tool, called the Vicarious Occupational Trauma Exposure (VOTE) Index, is published in the journal Traumatology. The VOTE Index is available online. 

“People who work in these environments often think vicarious trauma and secondary traumatic stress are inherent byproducts of working in a trauma-saturated environment,” said lead author Beth Stelson, MPH, MSW, PhD, an assistant professor at WashU School of Public Health. A social worker, Stelson has worked in organizations providing services to survivors of intimate-partner violence. “We often think, because it’s endemic in these work environments, there’s nothing we can do about it. But that’s not true. Vicarious trauma is a workplace safety and health issue. We figured out how to reduce workers’ exposure to, say, loud noises or toxic chemicals to protect their health. We can figure out how to reduce exposure to vicarious trauma, too.”

Current efforts to address vicarious trauma tend to focus on reducing its impact by encouraging individuals to practice self-care. While such interventions can be effective at managing symptoms, they don’t do anything to reduce the exposure. For that, occupational health researchers and employers need some way to assess when, where and how frequently workers are exposed to secondhand trauma and how severely the exposure affects them. 

Stelson and colleagues designed the VOTE Index to be broadly applicable to a variety of helping professions, and validated it in the substance use-disorder workforce, which has one of the highest rates of vicarious-trauma symptoms. The research team started with a literature review of behavioral-health, victim-advocate, and housing-insecurity workforces, as well as interviews and focus groups with 49 substance use-disorder workers, to identify major sources of occupational vicarious trauma. Based on this input, the researchers wrote a set of questions to assess workers’ experiences with those sources, iteratively refining the questions with the aid of another 28 helping professionals. They tested the questions with 1,415 workers in the substance-use disorder workforce, carefully sampled to be nationally representative. 

The final tool contained 16 questions across four domains: clients sharing about trauma, reviewing evidence of trauma, documenting trauma, and coworkers sharing about trauma. For each question, respondents were given the opportunity to report how often they experienced the exposure, and how distressing it typically was for them. The answers were combined to create two scores: an unweighted one that reflected the sum of all of the exposures, and a weighted score that multiplied the summed exposures by their impact. The researchers validated the index by demonstrating that both weighted and unweighted scores correlate with established measures of traumatic stress and that the scores remained stable after re-testing, a sign that the tool is reliable over time. 

The index is not designed to diagnose individuals who may be struggling with symptoms of vicarious trauma, Stelson said. It’s meant to help researchers and employers understand where this trauma is coming from so they can design workplaces that keep everyone healthy. 

“The weighted score may be more appropriate for researchers because it incorporates the magnitude of the effect and generates a much wider distribution of scores, which can improve precision in statistical analyses,” Stelson said. “The unweighted score is easier to use, so that may be more useful for organizations. It can show you which jobs are hot spots for vicarious trauma, where you might want to start thinking about changing workflows or providing additional support to workers in particular jobs.”

Stelson and colleagues are now evaluating the VOTE Index in other workforces, such as forensic nurses. The index is also being used as part of a National Institutes of Health (NIH)-funded, worker-led pilot program to improve worker health in residential addiction treatment centers in Massachusetts. Stelson is leading that study with colleagues at Harvard, Boston College and the Massachusetts Department of Public Health.

“In occupational health, we’ve been really good at identifying problems, but we’re less good at fixing them,” Stelson said. “In this next study, workers are looking at their own work environments and figuring out how to improve them, and one factor to consider is vicarious trauma. I’m really excited to see if this makes a difference.”

Tamara Schneider, MPH, PhD, is the assistant director of communications and senior science writer at WashU Public Health. She holds a double bachelor’s degree in molecular biophysics & biochemistry and in sociology from Yale University, a master’s in public health from the University of California, Berkeley, and a PhD in biomedical science from the University of California, San Diego. She joined WashU as a science writer in 2016.

Stelson EA, Sabbath EL, Chen L, Sorensen G, Berkman L, Moallef S, Kubzansky LD. The Vicarious Occupational Trauma Exposure (VOTE) Index: Development and Validation With a Substance Use Disorder Workforce. Traumatology. February 12, 2026. DOI: 10.1037/trm0000647

This study was funded by the National Institute on Drug Abuse, grant number R36DA055242-01; the National Heart, Lung, and Blood Institute, grant number 5T32HL098048-15; and the National Cancer Institute, grant number 2T32CA057711-26, all of the National Institutes of Health (NIH). This study also was funded by the National Institute for Occupational Safety and Health, grant number T42OH008416; and the Harvard T.H. Chan School of Public Health Lee Kum Sheung Center for Health and Happiness. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.