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

> **NIH NIH R36** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2022 · $52,537

## Abstract

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

## Key facts

- **NIH application ID:** 10353869
- **Project number:** 1R36DA055242-01
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** Elisabeth Anne Stelson
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $52,537
- **Award type:** 1
- **Project period:** 2022-05-15 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10353869

## Citation

> US National Institutes of Health, RePORTER application 10353869, The Development and Validation of an Index to Measure Vicarious Trauma Exposure Among Substance Use Providers (1R36DA055242-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10353869. Licensed CC0.

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