Partnering With Pastoral Care to Address Secondary Trauma via a Bereavement Ritual

Objective: A multitude of factors contribute to the burnout of staff and providers within health care, including secondary traumatic stress (STS), which has a unique negative impact on patient care. Unfortunately, STS is often unrecognized within pediatric primary care (PPC), even in clinics providing care to a patient population that experiences a disproportionate rate of negative events (e.g., sleep-related infant deaths, gun violence, abuse/neglect). We developed and implemented one strategy to address STS through an interdisciplinary partnership with pastoral care. Method: This work arose from identified needs (e.g., group-level assessment) in two PPC clinics at a large academic medical center that are the medical homes for families experiencing social complexity, trauma, adversity secondary to poverty, oppression, and discrimination. Specifically, we developed a bereavement ritual informed by the literature on meaning making. Results: A pediatric psychologist in one of the PPC clinics assembled a multidisciplinary team comprising medical providers, nurses, clinical managers, social workers, chaplains, and bereavement counselors to collaboratively develop a trauma-informed workplace model. The team used the reach, effectiveness, adoption, implementation, maintenance/sustainment (RE-AIM) implementation science framework to guide the conceptualization, implementation, and spread of this model to the second clinic. Results from a group-level assessment indicated the need to incorporate meaning making into trauma-informed interventions. Conclusions: This bereavement ritual creates opportunities for inclusive spiritual practices and meaning making while also promoting a relationship between the primary care team and chaplaincy, which increases the likelihood that team members would utilize other hospital-wide services offered by pastoral care. Implications for Impact Statement Working in a busy pediatric primary care setting with patients experiencing high levels of social complexity can result in secondary traumatic stress among staff and providers. Multidisciplinary teams that include pastoral care are uniquely positioned to mitigate this stress by developing and implementing interventions for the medical team that incorporate individual spiritual practices and promote meaning making.