A Cross-Disciplinary Comparison of Perceptions of Compassion Fatigue and Satisfaction Among Service Providers of Highly Traumatized Children and Adolescents Sophie de Figueiredo and Alexis Yetwin Children’s Hospital Los Angeles, Los Angeles, California Sara Sherer, Mari Radzik, and Ellen Iverson Children’s Hospital Los Angeles, Los Angeles, California and University of Southern California This article is reporting data from the qualitative arm of a mixed-methods study in which the researchers explored perceptions of compassion fatigue (CF), compassion satisfaction (CS), and burnout (BO) among a subset of clinical providers from various disciplines providing services to highly traumatized youth. Thirty-six providers (case managers, psychology fellows, psychologists, and clinical social workers) completed an anonymous online survey collecting demographic, professional, and personal data. Twenty- five providers participated in discipline-specific focus groups that solicited reflections on providing services to traumatized youth. Qualitative analyses provided rich illustrations of the impact of working with highly traumatized youth. Results also highlighted the unique nuances of how each provider type perceived and experienced CF, CS, and BO and presented how personal, professional, and organizational factors interacted to influence the manifestation of these constructs. Keywords: compassion fatigue, compassion satisfaction, burnout, adolescent mental health, posttraumatic growth Clinical providers working with traumatized populations are re- peatedly exposed to their clients’ high levels of trauma-related stress. Often, providers working with such populations are drawn to the field because of a desire to help others and relieve suffering; however, “the very act of being compassionate and empathic extracts a cost . . . In [an] effort to view the world from the perspective of the suffering [providers] suffer” (Figley, 2002, p. 1434). Thus, providers primarily treating highly traumatized clients are likely to be especially vulner- able to taking on their clients’ suffering at the expense of their own well-being. Compassion fatigue (CF) refers to the exhaustion and negative emotional, physiological, biological, and cognitive effects resulting from the cumulative effects of empathic engagement with, and sec- ondary exposure to, trauma (Bride, Radey, & Figley, 2007; Figley, 1995, 2002; Ray, Wong, White, & Heaslip, 2013). CF can include symptoms of secondary traumatic stress (STS), which mirror those of posttraumatic stress disorder (PTSD), such as re-experiencing the client’s traumatic event, avoidance of reminders, and hyperarousal (e.g., hypervigilance) (American Psychiatric Association, 2000; El- wood, Mott, Lohr, & Galovski, 2011; Figley, 2002). CF and STS are often used interchangeably; however, when differentiated, CF refers specifically to those in helping professions whereas STS is used more broadly (Bride et al., 2007; Elwood et al., 2011; Figley, 2002). Given this study’s focus on clinical providers, we use the term compassion fatigue to refer to this concept. By definition, CF is distinct from burnout (BO), which refers to a cumulative sense of exhaustion, being overwhelmed, frustration, and reduced self-efficacy in response to stressful occupational factors, rather than secondary trauma exposure (Bell, Kulkarni, & Dalton, 2003; Craig & Sprang, 2010; Meldrum, King, & Spooner, 2002; Rossi et al., 2012). Although CF and BO can manifest similarly and often coexist, BO alone has not been shown to fully encapsulate the stress experienced by trauma providers serving trauma-exposed clients (Bell et al., 2003). However, research has indicated that risk and protective factors of BO and CF can overlap and subsequently influence the unique development of either outcome (Adams, Boscarino, & Figley, 2006; Rossi et al., 2012). This article was published Online First May 19, 2014. Sophie de Figueiredo, Division of Adolescent Medicine, USC Univer- sity Center for Excellence in Developmental Disabilities (UCEDD), Chil- dren’s Hospital Los Angeles, Los Angeles, California; Alexis Yetwin, USC University Center for Excellence in Developmental Disabilities (UCEDD), Children’s Hospital Los Angeles; Sara Sherer, Mari Radzik, and Ellen Iverson, Division of Adolescent Medicine, Children’s Hospital Los Ange- les, and Department of Pediatrics, University of Southern California. This project was completed in partial fulfillment of the requirements of Dr. Sophie de Figueiredo’s participation in the Clinical Child Psychology Postdoctoral Fellowship at the USC University Center for Excellence in Developmental Disabilities (UCEDD), and in the California Leadership Education in Neurodevelopmental Disabilities (LEND) Interdisciplinary Training Program. This research was partially funded by the USC UCEDD CA-LEND program and the authors would like to express our gratitude. The authors would like to acknowledge Meghan Treese, BA, and Deborah Akinsilo, BA, for their tremendous assistance in facilitating, transcribing, and coding our focus groups. The authors would also like to acknowledge Marian Williams, PhD, Irina Zamora, PsyD, Jennifer Bloom, MPH, and Jennifer Schwartz, PsyD, for their support and consultation on the current research. Finally, we thank our study participants for offering their time and thoughtful contributions. Correspondence concerning this article should be addressed to Sophie de Figueiredo, Division of Adolescent Medicine, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS#2, Los Angeles, CA 90027. E-mail: sdefigueiredo@chla.usc.edu This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Traumatology © 2014 American Psychological Association 2014, Vol. 20, No. 4, 286 –295 1085-9373/14/$12.00 http://dx.doi.org/10.1037/h0099833 286