The Concise ProQOL Manual: The concise manual for the Professional Quality of Life Scale , 2 nd Edition

Abstract

This is the official manual for the ProQOL (the Professional Quality of Life Scale) which is a 30 item self-report measure of the positive and negative effects of working with people who have experienced suffering and trauma. The ProQol contains three subscales measuring Compassion Fatigue (Burnout and Secondary Traumatic Stress scales) and Compassion Satisfaction (Compassion Satisfaction scale). The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma. The measure has been in use since 1995 and is cited in over 1,000 peer-reviewed papers. The manual explains the background, theory, practical and research uses for the measure.

Full text

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TheConciseProQOLManual
BethHudnallStamm,PhD
Proqol.org
BethHudnallStamm.comand
CompassionSatisfactionAndCompassionFatigue.com
2010

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THECONCISEMANUALFORTHE
PROFESSIONALQUALITYOFLIFESCALE
THEProQOL

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TheConciseProQOLManual,2ndEdition
Reference
Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID:
ProQOL.org.
Copyright  Beth Hudnall Stamm. All rights reserved.
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Published The ProQOL.org, P.O. Box 4362. Pocatello, ID 83205-4362
Cover design by Beth Hudnall Stamm
Images copyright 2008 Henry E. Stamm, IV
Printed in Trebuchert MS font for the headers and 11 point Calibrifontforthebody.
ISSN to be applied for
Reference
Stamm, B.H. (2010). The Concise ProQOL Manual. Pocatello, ID: ProQOL.org.
Acknowledgements
IhereprovideacknowledgementsfortheirfaithfulcontributionstothedevelopmentoftheProQOL
gotoJosephM.Rudolph,EdwardM.Varra,KellyDavis,DebraLarsen,CraigHigson‐Smith,AmyC.
Hudnall,HenryE.Stamm,andtoallthosefromaroundtheworldwhocontributedtheirrawdatato
thedatabank.IamforeverindebtedtoCharlesF.Figleywhooriginatedthescale,andin1996,

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handedthescaleofftomesaying“Iputasemicolonthere;youtakeitandputaperiodattheendof
thesentence.”Noonecouldhavewishedforabettermentor,colleague,andfriend.
This material may be freely copied as long as (a) author is credited, (b) no changes are made, & (c)
it is not sold except for in agreement specifically with the author.
TABLEOFCONTENTS
TheProQOL..........................................................................................................................................................3
Section1:CompassionSatisfactionandCompassionFatigue.............................................................................8
Figure1:DiagramofProfessionalQualityofLife........................................................8
Background..............................................................................................................................................8
Figure2:Theoreticalpathanalysis............................................................................10
Section2:ScaleDefinitions...............................................................................................................................12
CompassionSatisfaction............................................................................................12
CompassionFatigue...................................................................................................12
Section3:ScaleProperties................................................................................................................................13
ScaleDistribution...................................................................................................................................13
Table1:ProQOLMoments........................................................................................13
Reliability................................................................................................................................................13
Validity13
Section4:AdministrationoftheProQOL..........................................................................................................14
IndividualAdministration.......................................................................................................................14
GroupAdministration............................................................................................................................15
ResearchAdministration........................................................................................................................15
Section5:Proqolscoring...................................................................................................................................15
CalculatingtheScoresonTheproqol....................................................................................................15
ScaleDefinitionsandScores..................................................................................................................17
CutScores..............................................................................................................................................18
Table2:CutScoresfortheProQOL...........................................................................18
Section6:InterpretingtheProQOL...................................................................................................................18
TheProQOLIsNotDiagnostic................................................................................................................18

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TheImportanceofKnowingMorethanJusttheProQOLScores...........................................................19
ScoresAcrossDemographicCategories.................................................................................................19
Table3:Gender........................................................................................................19
Table4:AgeGroup...................................................................................................20
Table4:Race.............................................................................................................20
Table5:IncomeGroup.............................................................................................20
Table6:YearsatCurrentEmployer..........................................................................20
Table7:YearsinField...............................................................................................21
InterpretingIndividualScales.................................................................................................................21
CompassionSatisfaction...........................................................................................21
CompassionFatigue..................................................................................................21
InterpretingScaleScoresinCombination..............................................................................................22
HighCompassionSatisfaction,ModeratetoLowBurnoutand
SecondaryTraumaticStress......................................................................................22
HighBurnout,ModeratetoLowCompassionSatisfactionand
SecondaryTraumaticStress......................................................................................22
HighSecondaryTraumaticStresswithLowBurnoutandLow
CompassionSatisfaction...........................................................................................22
HighSecondaryTraumaticStressandHighCompassion
SatisfactionwithLowBurnout..................................................................................23
HighSecondaryTraumaticStressandHighBurnoutwithLow
CompassionSatisfaction...........................................................................................23
InterpretingtheProQOLataGroupLevel................................................................23
Section7:UsingtheProQOLforDecisionMaking............................................................................................24
ChangingthePerson‐EventInteraction.................................................................................................24
MonitoringChangeAcrossTime............................................................................................................25
Section8:TheProQOLTestandHandout........................................................................................................26
ProfessionalQualityofLifeScale(ProQOL)..................................................Error!Bookmarknotdefined.
ProQOLSelfScoringWorksheet................................................................Error!Bookmarknotdefined.
Scoring..................................................................................................................Error!Bookmarknotdefined.

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YourScoresonTheProQOL:ProfessionalQualityOfLifeScale...............Error!Bookmarknotdefined.
SECTION9:ConvertingfromtheProQOLIVtotheProQOL5...........................................................................31
TableforDeterminingProQOLt‐ScorefromRawScores..........................................31
SECTION10:Bibliography..................................................................................................................................35
SECTION11:FrequentlyAskedQuestions.........................................................................................................73
AbouttheAuthor...............................................................................................................................................77
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SECTION1:COMPASSIONSATISFACTIONANDCOMPASSIONFATIGUE
Professionalqualityoflifeisthequalityonefeelsnrelationtotheirworkasahelper.Boththepositiveand
negativeaspectsofdoingone’sjobinfluenceonesprofessionalqualityoflife.Peoplewhoworkinhelping
professionsmayrespondtoindividual,community,national,andeveninternationalcrises.Helperscanbe
foundinthehealthcareprofessionals,socialserviceworkers,teachers,attorneys,policeofficers,firefighters,
clergy,airlineandothertransportationstaff,disastersiteclean‐upcrews,andotherswhoofferassistanceat
thetimeoftheeventorlater.
Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchlike
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandwork‐relatedtrauma.Sometraumaatworkcanbedirect(primary)trauma.Inother
cases,work‐relatedtraumabeacombinationofbothprimaryandsecondarytrauma.
FIGURE1:DIAGRAMOFPROFESSIONALQUALITYOFLIFE
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BACKGROUND
Professionalqualityoflifeforthoseprovidingcarehasbeenatopicofgrowinginterestoverthepasttwenty
years.Researchhasthatshownthosewhohelppeoplethathavebeenexposedtotraumaticstressorsareat
riskfordevelopingnegativesymptomsassociatedwithburnout,depression,andposttraumaticstress
disorder.Inthisbodyofliterature,typicallyknownassecondarytraumatizationorvicarioustraumatization,
thepositivefeelingsaboutpeople’sabilitytohelpareknownasCompassionSatisfaction(CS).Thenegative,
secondaryoutcomeshavevariouslybeenidentifiedasburnout,countertransference,CompassionFatigue(CF)
andSecondaryTraumaticStress(STS),andVicariousTraumatization(VT).
Whiletheincidenceofdevelopingproblemsassociatedwiththenegativeaspectsofprovidingcareseemsto
below,theyareseriousandcanaffectanindividual,theirfamilyandcloseothers,thecaretheyprovide,and
theirorganizations.Thepositiveaspectsofhelpingcanbeviewedasaltruism;feelinggoodthatyoucando
somethingtohelp.Thenegativeeffectsofprovidingcareareaggravatedbytheseverityofthetraumatic
materialtowhichthehelperisexposed,suchasdirectcontactwithvictims,particularlywhentheexposureis
ofagrotesqueandgraphicnature.Theoutcomesmayincludeburnout,depression,increaseduseof
substances,andsymptomsofposttraumaticstressdisorder.
ProfessionalQualityofLife
Compassion
Satisfaction
Compassion
Fatigue
Burnout Secondary
Trauma

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In1995,threebooksintroducedtheconceptsofthenegativeeffectsoncaregiverswhoprovidecaretothose
whohavebeentraumatized.123Theterminologywasatthattime,andcontinuestobe,ataxonomical
conundrum.However,sincethattime,Figley,Stamm,andPearlmantogetherhaveproducedover50
additionalscientificwritingsonthetopic.Castingabroadnetacrossthetopic,over500papers,booksand
articleshavebeenwritten,includingnearly200peer‐reviewedpapers,130dissertationsalongwithvarious
unpublishedstudies.Amongwhichthereareandahundredresearchpapersusingatypeofmeasurementof
thenegativeeffectsofsecondaryexposuretotraumaticstress.Researchhasbeenconductedacrossmultiple
culturesworldwide,andacrossmultipletypesoftraumaticeventexposures.
Asnotedabove,thereareissuesassociatedwiththevarioustermsusedtodescribenegativeeffects.There
arethreeacceptedterms:compassionfatigue,secondarytraumaticstress,andvicarioustrauma.Theredo
seemtobenuancesbetweenthetermsbutthereisnodelineationbetweenthemsufficienttosaythatthey
aretrulydifferent.Therehavebeensomepapersthathavetriedtoferretoutthespecificdifferencesbetween
thenamesandtheconstructs.4Thesepapershavebeenlargelyunsuccessfulinidentifyingrealdifferences
betweentheconceptsaspresentedundereachname.Thethreetermsareusedoften,eveninwritingthat
combinesFigley(compassionfatigue),Stamm(secondarytraumaticstress)andPearlman(vicarious
traumatization).Thevariousnamesrepresentthreeconverginglinesofevidencethatproducedthree
differentconstructnames.Asthetopichasmatured,reconfigurationofthetermsseemstimely.
Ingeneral,lookingbeyondissuesoftaxonomy,therehasbeenlittlenegativecritiqueofthetopicasawhole.
Nonetheless,therearearticlesthatquestioninitsentiretytheconceptofsecondarynegativeeffectsdueto
workwithpeoplewhohavebeentraumatized.56Botharticlespointtoalackofresearch,perhapsallowablein
somepartgiventhenascentnatureoftheconstruct,particularlyintheArvaypaper,whichwaspublishedin
2001.Fouryearslater,atthecoreofKadambi&Ennis’(2005)suggestiontore‐examinethecredibilityofthe
topicaremeasurementissues,thatis,refineddefinitionsofthecharacteristicsandreliableandvalidmeasures
oftheconstructs.Thesecritiquesseemwellearnedatthepointthattheywerewritten.Whetherinresponse
tothecritiques,orasnaturalevolution,overhalfoftheresearcharticlesthatexistwerewrittenafterthese
critiquesreviewswereconducted.Inaddition,astheauthorspointedout,therewerevariedmeansof
assessingthenegativeeffects.
Basedonexperienceandsomeresearch,organizationalpreventionprogramsarebelievedtohelpmaximize
helpers’well‐being(CS)andreducetherisksfordevelopingcompassionfatigueandsecondarytrauma.Ata
minimum,organizationalprogramsshowtheworkerthattheyhaveformallyaddressedthepotentialforthe
worktoaffecttheworker.Goodprogramsdonotidentifytootherworkersorsupervisors,specificinformation
abouttheworker'sprofessionalqualityoflifeunlesstheinformationissharedbytheworker.Insomecases,


1Figley,C.R.(Ed.)(1995).Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
2Pearlman,L.A.,&Saakvitne,K.W.(1995).Traumaandthetherapist:Countertransferenceandvicarioustraumatizationinpsychotherapy
withincestsurvivorsNewYork:Norton.
3Stamm,B.H.(.Ed).(1995).Secondarytraumaticstress:Self‐careissuesforclinicians,researchers,andeducators.Maryland:SidranPress:
Lutherville.
4cfBaird,K.,&Kracen,A.C.(2006).Vicarioustraumatizationandsecondarytraumaticstress:Aresearchsynthesis.Counselling
PsychologyQuarterly,19(2),181‐188.
5Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),1‐21.
6Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283‐293.

10

supervisorsaddressperformanceissuesthattheybelievemaybenegativeaspectsofhelpingbutinthose
cases,theprincipalsoforganizationalhumanresourcessuggestthattheseperformanceissuesshouldbe
handledassuch,notasaflawinthecharacteroftheemployee,butaperformanceissue.
Theoverallconceptofprofessionalqualityoflifeiscomplexbecauseitisassociatedwithcharacteristicsofthe
workenvironment(organizationalandtask‐wise),theindividual'spersonalcharacteristicsandtheindividual's
exposuretoprimaryandsecondarytraumaintheworksetting.Thiscomplexityappliestopaidworkers(e.g.
medicalpersonnel)andvolunteers(e.g.RedCrossdisasterresponders).
ThediagrambelowhelpsillustratetheelementsofProfessionalQualityofLife.Inthecenterofthediagram
arecompassionsatisfactionandcompassionfatigue.CompassionSatisfactionisthepositiveaspectsofhelping
othersandCompassionSatisfactionarethenegativeone.Ascanbeseen,oneworkenvironment,client(or
thepersonhelped)environmentandtheperson’senvironmentallhavearolltoplay.Forexample,apoor
workenvironmentmaycontributetoCompassionFatigue.Atthesametime,apersoncouldfeelcompassion
satisfactionthattheycouldhelpothersdespitethatpoorworkenvironment.CompassionFatiguecontains
twoverydifferentaspects.Bothhavethecharacteristicofbeingnegative.However,work‐relatedtraumahas
adistinctiveaspectoffearassociatedwithit.Whileitismorerarethanoverallfeelingsofwhatwecancall
burnout,itisverypowerfulinitseffectonaperson.Whenbothburnoutandtraumaarepresentinaperson’s
lifetheirlifecanbeverydifficultindeed.Thediagrambelowshowsatheoreticalpathanalysisofpositiveand
negativeoutcomesofhelpingthosewhohaveexperiencedtraumaticstress.
FIGURE2:THEORETICALPATHANALYSIS


11



12

Fourscalesemergedintheearlyresearch.Twoofthem(theImpactofEventScaleandtheTraumaticStress
InstituteBeliefScale)werenotspecifictosecondaryexposure.Theywereusedequallyforpeoplewhowere
thedirectvictimsoftraumaaswellasforthosewhoweresecondarilyexposedintheirroleashelpers.78Two
measuresemergedasspecificmeasuresforsecondaryexposure.TheCompassionFatigueTestinitsvarious
versions9101112andtheSecondaryTraumaticStressScale.13
TheProfessionalQualityofLifeScale,knownastheProQOL,isthemostcommonlyusedmeasureofthe
positiveandnegativeeffectsofworkingwithpeoplewhohaveexperiencedextremelystressfulevents.Ofthe
100papersinthePILOTSdatabase(thePublishedLiteratureinPosttraumaticStressDisorder),46useda
versionoftheProQOL.ThemeasurewasoriginallycalledtheCompassionFatigueSelfTestanddevelopedby
CharlesFigleyinthelate1980sStammandFigleybegancollaboratingin1988.In1993,Stammaddedthe
conceptofcompassionsatisfactionandthenameofthemeasurechangedtotheCompassionSatisfactionand
FatigueTest,ofwhichtherewereseveralversions.Theseversionsintheearly1990swereFigleyandStamm,
thenStammandFigley.ThroughapositivejointagreementbetweenFigleyandStammthemeasureshifted
entirelytoStamminthelate1990sandwasrenamedtheProfessionalQualityofLifeScale.TheProQOL,
originallydevelopedinEnglish,istranslatedintoFinnish,French,German,Hebrew,Italian,Japanese,Spanish,
Croat.EuropeanPortugueseandRussiantranslationsareinprocess.
SECTION2:SCALEDEFINITIONS
COMPASSIONSATISFACTION
Compassionsatisfactionisaboutthepleasureyouderivefrombeingabletodoyourworkwell.Forexample,
youmayfeellikeitisapleasuretohelpothersthroughyourwork.Youmayfeelpositivelyaboutyour
colleaguesoryourabilitytocontributetotheworksettingoreventhegreatergoodofsociety.
COMPASSIONFATIGUE
Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchassuchas
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandwork‐relatedtrauma.Itisimportanttorememberthatsometraumaatworkcanbe
direct(primary)trauma.Work‐relatedtraumabeacombinationofbothprimaryandsecondarytrauma.


7Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),1‐21.
8Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283‐293.
9Figley,C.R(Ed.).(1995)Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
10Figley,C.R.,&Stamm,B.H.(1996).PsychometricReviewofCompassionFatigueSelfTest.InB.H.Stamm(Ed),MeasurementofStress,
TraumaandAdaptation.Lutherville,MD:SidranPress.
11Stamm,B.H.(2002).MeasuringCompassionSatisfactionasWellasFatigue:DevelopmentalHistoryoftheCompassionFatigueand
SatisfactionTest.InC.R.Figley(Ed.),107‐119.
12Stamm,B.H.(2008).TheProQOLTestManual,2ndEd.Towson,MD:SidranPressandtheProQOL.org.
13Bride,B.E.,Robinson,M.M.,Yegidis,B.L.,&Figley,C.R.(2004).Developmentandvalidationofthesecondarytraumaticstressscale.
ResearchonSocialWorkPractice,14(1),27‐35.

13

BURNOUT
BurnoutisoneelementofthenegativeeffectsofcaringthatisknownasCompassionFatigue.Mostpeople
haveanintuitiveideaofwhatburnoutis.Fromtheresearchperspective,burnoutisassociatedwithfeelingsof
hopelessnessanddifficultiesindealingwithworkorindoingyourjobeffectively.Thesenegativefeelings
usuallyhaveagradualonset.Theycanreflectthefeelingthatyoureffortsmakenodifference,ortheycanbe
associatedwithaveryhighworkloadoranon‐supportiveworkenvironment.
SECONDARYTRAUMATICSTRESS
SecondaryTraumaticStress(STS)isanelementofCompassionfatigue(CF).STSisaboutwork‐related,
secondaryexposuretopeoplewhohaveexperiencedextremelyortraumaticallystressfulevents.Thenegative
effectsofSTSmayincludefearsleepdifficulties,intrusiveimages,oravoidingremindersoftheperson’s
traumaticexperiences.STSisrelatedtoVicariousTraumaasitsharesmanysimilarcharacteristics.
SECTION3:SCALEPROPERTIES
SCALEDISTRIBUTION
TABLE1:PROQOLMOMENTS
CStscoreBOtscore STStscore
N11871187 1187
Mean5050 50
Std.ErrorofMean0.290.29 0.29
Median5149 49
Mode5351 49
Std.Deviation1010 10
Skewness‐0.920.25 0.82
Kurtosis1.51‐0.31 0.87
RELIABILITY
VALIDITY
Thereisgoodconstructvaliditywithover200publishedpapers.Therearealsomorethan100,000articleson
theinternet.Ofthe100publishedresearchpapersoncompassionfatigue,secondarytraumaticstressand
vicarioustraumatization,nearlyhalfhaveutilizedtheProQOLoroneofitsearlierversions.Thethreescales
measureseparateconstructs.TheCompassionFatiguescaleisdistinct.Theinter‐scalecorrelationsshow2%
sharedvariance(r=‐.23;co‐σ=5%;n=1187)withSecondaryTraumaticStressand5%sharedvariance(r=.‐.14;
co‐σ=2%;n=1187)withBurnout.WhilethereissharedvariancebetweenBurnoutandSecondaryTraumatic
Stressthetwoscalesmeasuredifferentconstructswiththesharedvariancelikelyreflectingthedistressthatis
commontobothconditions.Thesharedvariancebetweenthesetwoscalesis34%(r=.58;;co‐σ=34%;

14

n=1187).Thescalesbothmeasurenegativeaffectbutareclearlydifferent;theBOscaledoesnotaddressfear
whiletheSTSscaledoes.
SECTION4:ADMINISTRATIONOFTHEPROQOL
PerhapsthemostimportantpartofadministrationoftheProQOL,orforthatmatteranypsychologicaltest,is
forpeopletounderstandwhattheyarebeingaskedtodo.Iftheyfeelliketheyarebeing“observed”and
measuredfortheir(bad)behavior,theyareunlikelytowanttoparticipateor,iftheydo,toprovidereliable
answers.Itisimportanttoexplainthelogicofthemeasureandtoengagetheperson’sdesiretotakethetest.
Itisalsoimportanttoestablishifthepersonhasarighttorefusetotakethetestorifitisrequiredasa
conditionofsomesituationsuchasemployment.
INDIVIDUALADMINISTRATION
Inthistypeofadministration,apersontypicallytakesthetestandeitherself‐scoresorreceivesscores
computedbyacomputer.Inthissituation,thedataarenotrecordedelsewhereandthepersondoesnot
discusshisorherresultsunlesstheychoosetodoso.Individualadministrationmayalsobeinitiatedbyan
outsidesource.Thedatamayormaynotbearchived.Forexample,apersonmaytaketheProQOLaspartof
jobcounselingoranemployeeassistanceprogram.TheymaytaketheProQOLaspartoftheirongoingself‐
careplan.Itisimportanttoestablishwiththeindividualexactlywhatwillhappenwithhisorherdatabecause
datasecurityandprivacyareveryimportantissues.Inmanycases,therequiredstandardsexceedthoseof
generalmedicalrecords.


15

GROUPADMINISTRATION
Inthistypeofadministration,agroupofpeoplecompletetheProQOLsimultaneously.Thismaybeina
classroomsettingorsomethinglikeindividualcomputerworkstationsinacomputerlab.Thekeyaspectofthe
groupadministrationisthatthereareotherspresentwhoaredoingthesameactivity.Inagroup
administrationitisimportanttoconsiderthegroupeffectonscores.Ifafewpeoplearequitevocalabout
theirunwillingnesstoparticipate,thereisaneffectonalloftheparticipants.Ifpeoplefeeltheyarebeing
watchedbyothers,orareembarrassedtobeinthegroup,thescoresareunlikelytobevalidandprivacyrights
mayhavebeenviolated.Peopleshouldnotbesingledoutsoastocauseembarrassment.Forexample,you
shouldnotsetupagroupadministrationforallpeoplewhomademedicalerrorsiftheadministrationisbased
ontheassumptionthattheirmistakesoccurredbecauseofburnout.
Inthecaseofaself‐test,peoplemaybegivengeneralinformationsuchas“otherswhoscoresimilarlyto
you…”Bycontrast,inthecaseofindividualadministration,feedbackmaybemuchmorespecific.Feedbackin
groupsettingsshouldnotbeaboutasingleindividualbutaboutthingsthatapplytomorethanoneperson.
Themostimportantthingaboutgivingfeedbackistobeprepared.Bepreparedtogivespecificandclear
informationappropriatetothesettingandbepreparedtoanswerquestions.Youwillalwaysgetthatone
questionyoumostdon’twanttoanswer!
Whenworkingingroupsettings,itisnotuncommonforoneortwoindividualstoproviderevealingpersonal
informationthatarenotappropriatetothegroupsetting.Inthesecasesitisincumbentonthetest
administratortocontainandrefocustheattentionoftheclass.Goodethicalbehaviorsuggeststhetest
administratorfollowupwiththepersoninamoreappropriatesetting.Insituationssuchasthese,itisusually
appropriatetoprovideareferralforemployeeassistanceorotherhelpsuchasmentalorphysicalhealthcare.
Inthecasethattheadministratorbelievesthatthereisanimminentdanger,theyshouldtakeemergency
actionssuchascalling911andprotectingtheperson,themselves,andothersfromharminthebestwaythat
theycan.
RESEARCHADMINISTRATION
TheProQOLisfrequentlyusedinresearch.Thetestmaybecollectedaspartofasurveypacketinwhichthe
participantreceivesnoinformationregardingtheiranswers,oritmaybegivenasacombinedresearchand
trainingactivity.Ineithercase,thedataaregenerallyrecordedandscoredbycomputer.Groupresultsmaybe
published.Insomecases,acopyoftherawdataaredonatedtotheProQOLdatabankwheretheyare
combinedwithotherresearchdatatosupportdevelopmentalworkontheProQOL.
SECTION5:PROQOLSCORING
CALCULATINGTHESCORESONTHEPROQOL
TherearethreestepstoscoringtheProQOL.Thefirststepistoreversesomeitems.Thesecondstepistosum
theitemsbysubscaleandthethirdstepistoconverttherawscoretoat‐score.Thefirstsetbelowshowsthe
scoringactionsindetail.Twomethodsforscoringarepresented.ThefirstistofollowSteps1‐2andthenuse
thetableattheendofthissectiontoconvertrawscorestot‐scores.Thesecondmethodusescomputer

16
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scoring.ThecomputercodepresentedbelowiswrittenforSPSSthatcanbeconvertedbytheusertoother
statisticalprogramsifneeded.
Step1:Reverseitems1,4,15,17,and29into1r,4r,15r,17rand29r(1=5)(2=4)(3=3)(4=2)(5=1)
Step2:Sumtheitemsforeachsubscale.
CS=SUM(pq3,pq6,pq12,pq16,pq18,p20,pq22,pq24,pq27,pq30).
BO=SUM(pq1r,pq4r,pq8,pq10,pq15r,pq17r,pq19,pq21,pq26,pq29r).
STS=SUM(pq2,pq5,pq7,pq9,pq11,pq13,pq14,pq23,pq25,pq28).
Step3:ConverttheZscorestot‐scoreswithrawscoremean=50andtherawscorestandarddeviation=10.
BelowistheSPSSCodeforScoringtheProQOL,includingroutinestocomputetherawandt‐scores.
COMMENT:Step1:ScoreProQOLIV.or5Variablenamesinsyntaxassumepq#foreachitem.Thisroutine
reversesitems1,14,15,17and29thenscoresthethreescalesoftheProQOLIV;SecondaryTraumaticStress
thenewscalenamefortheoldCompassionFatiguescale.
RECODEpq1pq4pq15pq17pq29
 (1=5)(2=4)(3=3)(4=2)(5=1)
INTOpq1Rpq4Rpq15Rpq17Rpq29r.
COMPUTECS=SUM(pq3,pq6,pq12,pq16,pq18,pq20,pq22,pq24,pq27,pq30).
COMPUTEBO=SUM(pq1r,pq4r,pq8,pq10,pq15r,pq17r,pq19,pq21,pq26,pq29r).
COMPUTESTS=SUM(pq2,pq5,pq7,pq9,pq11,pq13,pq14,pq23,pq25,pq28).
EXECUTE.
COMMENT:Step2:ConvertrawscoretoZscore.Notethatthisroutineproducesanextraneousoutputfile
withnandmeansthatcanbedeleted.
DESCRIPTIVES
VARIABLES=CSBOSTS/SAVE.
COMMENT:Step3ConvertZscoretotscore.
COMPUTEtCS=(ZCS*10)+50.
VARIABLELABELStCS'CStscore'.
EXECUTE.
COMPUTEtBO=(ZBO*10)+50.
VARIABLELABELStBO'BOtscore'.
EXECUTE.
COMPUTEtSTS=(ZSTS*10)+50.
VARIABLELABELStSTS'STStscore'.
EXECUTE.
COMMENT:Interpretationofscores:Themeanscoreforanyscaleis50withastandarddeviationof10.
COMMENT:ThecutscoresfortheCSscaleare44atthe25thpercentileand57atthe75thpercentile.
COMMENT:ThecutscoresfortheBOscaleare43atthe25thpercentileand56atthe75thpercentile.
COMMENT:ThecutscoresfortheSTSscaleareat42forthe25thpercentileand56forthe75th percentile.

17

SCALEDEFINITIONSANDSCORES
Belowarethescaledefinitionsandtheaveragescores.Thissectionisthesameasthescoringhandout.
Compassionsatisfactionisaboutthepleasureyouderivefrombeingabletodoyourworkwell.Forexample,
youmayfeellikeitisapleasuretohelpothersthroughyourwork.Youmayfeelpositivelyaboutyour
colleaguesoryourabilitytocontributetotheworksettingoreventhegreatergoodofsociety.Higherscores
onthisscalerepresentagreatersatisfactionrelatedtoyourabilitytobeaneffectivecaregiverinyourjob.
Theaveragescoreis50(SD10;alphascalereliability.88).About25%ofpeoplescorehigherthan57and
about25%ofpeoplescorebelow43.Ifyouareinthehigherrange,youprobablyderiveagooddealof
professionalsatisfactionfromyourposition.Ifyourscoresarebelow40,youmayeitherfindproblemswith
yourjob,ortheremaybesomeotherreason—forexample,youmightderiveyoursatisfactionfromactivities
otherthanyourjob.
BurnoutMostpeoplehaveanintuitiveideaofwhatburnoutis.Fromtheresearchperspective,burnoutisone
oftheelementsofcompassionfatigue.Itisassociatedwithfeelingsofhopelessnessanddifficultiesindealing
withworkorindoingyourjobeffectively.Thesenegativefeelingsusuallyhaveagradualonset.Theycan
reflectthefeelingthatyoureffortsmakenodifference,ortheycanbeassociatedwithaveryhighworkloador
anon‐supportiveworkenvironment.Higherscoresonthisscalemeanthatyouareathigherriskforburnout.
Theaveragescoreontheburnoutscaleis50(SD10;alphascalereliability.75).About25%ofpeoplescore
above57andabout25%ofpeoplescorebelow43.Ifyourscoreisbelow18,thisprobablyreflectspositive
feelingsaboutyourabilitytobeeffectiveinyourwork.Ifyouscoreabove57youmaywishtothinkabout
whatatworkmakesyoufeellikeyouarenoteffectiveinyourposition.Yourscoremayreflectyourmood;
perhapsyouwerehavinga“badday”orareinneedofsometimeoff.Ifthehighscorepersistsorifitis
reflectiveofotherworries,itmaybeacauseforconcern.
SecondaryTraumaticStressThesecondcomponentofCompassionFatigue(CF)issecondarytraumaticstress
(STS).Itisaboutyourwork‐related,secondaryexposuretoextremelyortraumaticallystressfulevents.
Developingproblemsduetoexposuretoother’straumaissomewhatrarebutdoeshappentomanypeople
whocareforthosewhohaveexperiencedextremelyortraumaticallystressfulevents.Forexample,youmay
repeatedlyhearstoriesaboutthetraumaticthingsthathappentootherpeople,commonlycalledVicarious
Traumatization.Youmayseeorprovidetreatmenttopeoplewhohaveexperiencedhorrificevents.Ifyour
workputsyoudirectlyinthepathofdanger,forexampleduetoyourworkasaemergencymedicalpersonnel,
adisasterresponderorasamedicinepersonnel,thisisnotsecondaryexposure;yourexposureisprimary.
However,ifyouareexposedtoothers’traumaticeventsasaresultofyourwork,suchasprovidingcareto
peoplewhohavesustainedemotionalorphysicalinjuries,thisissecondaryexposure.ThesymptomsofSTS
areusuallyrapidinonsetandassociatedwithaparticularevent.Theymayincludebeingafraid,having
difficultysleeping,havingimagesoftheupsettingeventpopintoyourmind,oravoidingthingsthatremind
youoftheevent.
Theaveragescoreonthisscaleis50(SD10;alphascalereliability.81).About25%ofpeoplescorebelow43
andabout25%ofpeoplescoreabove57.Ifyourscoreisabove57,youmaywanttotakesometimetothink
aboutwhatatworkmaybefrighteningtoyouorifthereissomeotherreasonfortheelevatedscore.While
higherscoresdonotmeanthatyoudohaveaproblem,theyareanindicationthatyoumaywanttoexamine

18
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howyoufeelaboutyourworkandyourworkenvironment.Youmaywishtodiscussthiswithyoursupervisor,
acolleague,orahealthcareprofessional.
CUTSCORES
TheProQOLmeasureisbestusedinitscontinuousform.However,manypeopleprefertohavecutscoresto
indicaterelativerisksorprotectivefactors.Toaddresstheseneeds,cutscoresareprovided.Thecutsareset
atthe25thand75thpercentiles.Theyarepotentiallyoverlyinclusive—thatistheytendtoType1error.This
meansthatthethereisagreaterpossibilityofhavingafalsepositivethanmissingsomeonewhoactually
belongsinaparticulargroup.Becausethisisascreeningandplanningtool,itisprobablylessproblematiccto
includesomeonewhoshouldnotbeincludedthantoexcludesomeonewhatshouldbeincludedsothat
supportiveorcorrectiveactionisconsideredevenifitisnotneeded.Scoresneartheboarderscanbe
particularlytroublesomeinthatthecutpointisanartificiallyappliedcriteria.Pleasenotethatwhilewe
providecutscoresbasedonthe75thpercentile,wedonotrecommendthatthemeasurebeusedforanything
otherthanscreening,andwepreferfromastatisticalperspective,tousethecontinuousnumbers.
TABLE2:CUTSCORESFORTHEPROQOL
Compassion
SatisfactionBurnoutSecondaryTraumatic
Stress
BottomQuartile(25th
Percentile)444342
Mean(50thPercentile)505050
TopQuartile(75thPercentile)575656
SECTION6:INTERPRETINGTHEProQOL
THEPROQOLISNOTDIAGNOSTIC
ThemostimportantaspectaboutinterpretingtheProQOListhatitisnotadiagnostictest.Thereareno
officialdiagnosesintheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems10th
Revision(ICD‐10)orintheDiagnosticandStatisticalManualofMentalDisorders(DSM‐IV‐TR,2000).
Thebodyofresearchonburnoutandposttraumaticstressdisorderindicatesaclosekinshipwitheachto
depression.Whilethisisusefulinformation,depressionisageneraltermthatalsoisaspecificdiagnosisofa
mentaldisorderandiswidelyandofficiallyrecognizedbyboththemedicalandthementalhealth
communities.Therefore,itisimpossible,andgrievouslyinappropriate,todiagnosedepressionoranyother
disorderfromtheresultoftheProQOL.
WhattheProQOLcando,fromadiagnosticperspective,istoraiseissuestoaddresswithuseofappropriate
diagnosticprocedures.Forexample,asnotedabove,bothburnoutandPTSDarefrequent“co‐travelers”with

19

depression.Ahighscoreoneitherburnoutorsecondarytraumaticstress,orahighscoreonbothwithalow
scoreoncompassionsatisfaction,canbeanauguryofclinicaldepressionthatdeservestreatment.Clearlythe
disordermostcommonlyassociatedwithsecondarytraumaisPTSD.Infact,theDSM‐IV‐TRPTSDA1criteria
specifythattheeventmayhappentoselfortoothers.Additionally,itspecifiesthataperson’sreactionmust
involvefear,helplessness,orhorror.However,whatitdoesnotspecifyiswhenonehas“experienced,
witnessed,orwasconfronted”withthethreattoanother.Despitethisparallelofcompassionfatigueand/or
secondarytraumatoPTSD,itcannotbeoveremphasizedthattheseissuesareanaturalconsequenceof
traumaworkandnotnecessarilypathologicalinnature(Figley,1995;Larsen&Stamm,2008;Stamm,1999).
Giventheseconcerns,theProQOLcanbeaguideinregardtoanindividual’sororganization’sbalanceof
positiveandnegativeexperiencerelatedtodoingeitherpaidorvolunteerwork.Foranindividualoran
organization,highscoresoncompassionsatisfactionareareflectionofengagementwiththeworkbeingdone.
THEIMPORTANCEOFKNOWINGMORETHANJUSTTHEPROQOLSCORES
Itisimportanttokeepinmindthatknowingmoreinformationaboutthetest‐takeroragroup’sscoreisbetter
thanhavinglessinformation.Theinterpretationsectionbelowisgeneralandnotbasedoncovariatesor
demographicsthatmustbeconsideredwheninterpretingscoresforspecificpeopleorspecificgroups.For
example,scoresforapersonwhoisadeployedservicemanorwomanmightbenormalforthatsituationbut
elevatedforsomeoneworkinginanon‐deploymentsetting.Similarly,itmaybeimportanttoknowbasic
demographicinformation—isthetesttakermaleorfemale.
SCORESACROSSDEMOGRAPHICCATEGORIES
Somedataareavailableacrossvariousdemographiccategories.Thesemeansareproducedfromadatabank
of1,289casescreatedfrommultiplestudies.Whilethisisalargenumberandshouldreducethe
measurementerror,testingconditionsandparticipantnumbersacrossthevariablesfluctuatewidely.Caution
shouldbeexercisedinusingthesedata.Additionally,thesedataarereportedacrosssingledemographics.
Otheranalysesofthesedataindicatethattheremaybeverycomplexinteractionsthatcouldnotbereported
hereduetoconstraintswithinthedatabank.
Twoveryimportantcovariatesthatcannotbeaddressedatthistimethroughdatainthedatabankarework
settingandtypesofpeopleassisted.Anystudymustincludethisvariable.
TABLE3:GENDER
CStscore  BOtscore STStscore
sexmalefemale male female malefemale
Mean49.0150.14 48.99 50.37 49.0550.18
Std.Deviation10.819.77 9.75 10.26 9.9510.15
N315760 315 760 315760
Nostatisticaldifferenceswereobservedacrossgender.


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TABLE4:AGEGROUP
CStscore  BOtscore STStscore
18‐35yrs36andup 18‐35 yrs 36andup 18‐35yrs36andup
Mean50.1251.0050.11 47.74 53.61 50.75
Std.Deviation8.769.508.50 8.25 9.74 9.27
N10693106 93 106 93
Nostatisticaldifferenceswereobservedacrossagegroup.
TABLE4:RACE
CStscore  BOtscore STStscore
Non‐WhiteWhiteNon‐White White Non‐WhiteWhite
Mean50.1649.8752.82 47.65 51.4648.78
Std.Deviation9.8610.1210.23 9.17 9.74 10.06
N540647540 647 540 647
Nosignificantdifferenceswereobservedacrosswhiteandnon‐whites.Significantdifferencewereobserved
onBurnoutandonSecondaryTraumaticStress.Whitesreportedlessburnout(F1,1183=84,14;p<.001;Power=
1)andlessSTS(F1,1183=21.38;p<.001;Power=.97).
TABLE5:INCOMEGROUP
CStscore   BOtscore STStscore 
Income
Group
Upto
45KUSD
46Kto
75KUSD
More
than75K
Upto
45KUSD
46Kto
75KUSD
More
than75K
Upto
45KUSD
46Kto
75KUSD
More
than75K
Mean49.9648.9451.4647.22 48.11 46.67 49.56 48.0748.33
Std.Dev11.499.25 9.919.56 8.16 9.72 11.10 8.769.66
N270256167270 256 167 270 256167
Nostatisticaldifferenceswereobservedacrossincomegroups.
TABLE6:YEARSATCURRENTEMPLOYER
CStscore   BOtscore STStscore 
<5years5to15
years
>15
years
<5years5to15
years
>15
years
<5years5to15
years
>15
years
Mean49.8549.4950.3147.55 47.32 49.43 48.93 47.9549.10
Std.Dev10.2110.858.998.86 9.85 9.35 9.65 10.109.38
N42010158420 101 58 420 10158
Nostatisticaldifferenceswereobservedacrossyearswithcurrentemployergroups.


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TABLE7:YEARSINFIELD
CStscore  BOtscore STStscore 
<5years5to15
years
>15
years
<5years5to15
years
>15
years
<5years5to15
years
>15
years
Mean49.5249.8050.3647.4448.5947.3648.3547.4247.85
Std.Dev10.419.389.479.168.149.598.838.809.89
N183136165183136165183136165
Nostatisticaldifferenceswereobservedacrossyearsinfieldgroups.
INTERPRETINGINDIVIDUALSCALES
COMPASSIONSATISFACTION
Compassionsatisfactionischaracterizedbyfeelingsatisfiedbyone’sjobandfromthehelpingitself.Itis
characterizedbypeoplefeelinginvigoratedbyworkthattheyliketodo.Theyfeeltheycankeepupwithnew
technologyandprotocols.Theyexperiencehappythoughts,feelsuccessful,arehappywiththeworktheydo,
wanttocontinuetodoit,andbelievetheycanmakeadifference.
COMPASSIONFATIGUE
Compassionfatigueischaracterizedbythenegativeaspectsofprovidingcaretothosewhohaveexperienced
extremeortraumaticstressors.Thesenegativeresponsesincludefeelingsofbeingoverwhelmedbythework
thataredistinguishedfromfeelingsoffearassociatedwiththework.Thus,therearetwoscalesfor
CompassionFatigue.
BURNOUT
BurnoutisthepartofCompassionFatiguethatischaracterizedbyfeelingsofunhappiness,disconnectedness,
andinsensitivitytotheworkenvironment.Itcanincludeexhaustion,feelingsofbeingoverwhelmed,bogged
down,being“out‐of‐touch”withthepersonheorshewantstobe,whilehavingnosustainingbeliefs.
SECONDARYTRAUMATICSTRESS
SecondaryTraumaticStressisanelementofcompassionfatiguethatischaracterizedbybeingpreoccupied
withthoughtsofpeopleonehashelped.Caregiversreportfeelingtrapped,onedge,exhausted,overwhelmed,
andinfectedbyothers’trauma.Characteristicsincludeaninabilitytosleep,sometimesforgettingimportant
things,andaninabilitytoseparateone’sprivatelifeandhisorherlifeasahelper—andexperiencingthe
traumaofsomeoneonehelped,eventotheextentofavoidingactivitiestoavoidremindersofthetrauma.It
isimportanttonotethatdevelopingproblemswithsecondarytraumaticstressisrarebutitdoeshappento
manypeople.


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
INTERPRETINGSCALESCORESINCOMBINATION
HIGHCOMPASSIONSATISFACTION,MODERATETOLOWBURNOUTANDSECONDARY
TRAUMATICSTRESS
Thisisthemostpositiveresult.Thisresultrepresentsapersonwhoreceivespositivereinforcementfromtheir
work.Theycarrynosignificantconcernsaboutbeing“boggeddown”orinabilitytobeefficaciousintheir
work—eitherasanindividualorwithintheirorganization.Theydonotsufferanynoteworthyfearsresulting
fromtheirwork.Thesepersonsmaybenefitfromengagement,opportunitiesforcontinuingeducation,and
otheropportunitiestogrowintheirposition.Theyarelikelygoodinfluencesontheircolleaguesandtheir
organization.Theyareprobablylikedbytheirpatients,whoseekouttheirassistance.
HIGHBURNOUT,MODERATETOLOWCOMPASSIONSATISFACTIONANDSECONDARY
TRAUMATICSTRESS
Peoplewhoscorehighonburnout,inanycombinationwiththeotherscales,areatriskasindividualsandmay
alsoputtheirorganizationsinhigh‐risksituations.Burnoutisafeelingofinefficacy.Intheworksetting,this
maybearesultofpersonalororganizationalfactors.Theprototypeburnoutisassociatedwithhighworkloads
andpoorsystemfunction.Apersonmayfeelasifthereis“nothingtheycando”tomakethingsbetter.Itis
likelytheyaredisengagedfromtheirpatients,eventhoughthisisnotassociatedwithanyfearasaresultof
engagementwiththeirpatients.Peoplesufferingfromburnoutoftenbenefitfromtakingtimeoff.Theymay
alsobenefitfromchangingtheirroutinewithintheorganization.Organizationsthathavemanypeoplewith
burnoutshouldseriouslyconsidertheirorganizationalsystemandtheuseoftheirhumancapitaltoidentify
pitfallsinthesystemandwaystosupportpeopleinaccomplishingbusinessgoalsandwork.
HIGHSECONDARYTRAUMATICSTRESSWITHLOWBURNOUTANDLOWCOMPASSION
SATISFACTION
Peoplewhomakethesescoresaretypicallyoverwhelmedbyanegativeexperienceatworkascharacterized
byfear.Ifthisfearisrelatedtoaneventthathappenedtothepersondirectly,suchashavingtheirlife
endangeredasaresultofparticipatinginadangerousrescue,oriftheyexperiencedatraumaticeventsuchas
sexualviolencebyacolleague,thesearenotsecondaryexperiences.Thesearedirectexposurestodangerous
events.However,iftheperson’sfearisrelatedtotakingcareofotherswhoweredirectlyinharm’sway,thisis
secondarytraumaticstress.Thesepeoplearelikelytobenefitfromimmediatetreatmentfortraumaticstress
and,whenpresent,depression.Becausetheyareneutralinregardtotheirfeelingsofinefficacyatwork,or
feelingsofpleasureassociatedwiththeirwork,considerfocusingonthefear‐relatedworkexperiences.
Counteringthefearmightincludechangingthecase‐loadmix,theworkenvironment(likeassigningworkwith
colleagueswhomtheytrust),orintroducingothersafetymeasures.


23

HIGHSECONDARYTRAUMATICSTRESSANDHIGHCOMPASSIONSATISFACTIONWITH
LOWBURNOUT
Thiscombinationistypicallyuniquetohigh‐risksituationssuchasworkinginareasofwarandcivilviolence.
Peoplewhoscoreinthisrangeareoftenhighlyeffectiveattheirworkbecausetheyfeeltheirworkmatters.
However,theyhaveaprivateselfthatisextremelyfearfulbecauseoftheirengagementwithothers.Some
fearisaccurateandappropriateinhigh‐risksituation.However,highsecondarytraumaticstressismarkedby
thoughts,feelings,andmemoriesofothers’traumaticexperiencesmixedwiththeirownexperiences.Thiscan
beparticularlydifficulttounderstandwhentheexperiencesofthosetowhomthepersonprovideshelpare
similartohisorherown.Knowingthatothershavebeentraumatizedbythesametypeofsituationsinwhich
thepersonfindshimorherselfhasthepotentialtochangetheperson’sinterpretationoftheevent.
Peoplewithscoreslikethistypicallybenefitfromencouragementtobuildontheirfeelingsofaltruismand
thoughtsthattheyarecontributingtothegreatergood.Simultaneously,theirfearsandfear‐related
symptomsshouldbeaddressed.Depressionistheoreticallyunlikelygiventheirhighfeelingsofsatisfaction.At
times,changesintheworkenvironmentcoupledwithadditionalsupportivesupervisionmayalleviatethe
PTSD‐likesymptoms.Atothertimes,therapyormedicationorbothmaybeagoodalternative.
HIGHSECONDARYTRAUMATICSTRESSANDHIGHBURNOUTWITHLOWCOMPASSION
SATISFACTION
Thiscombinationisseeminglythemostdistressing.Notonlydoesthepersonfeeloverwhelmedanduselessin
theworksetting,theyareliterallyfrightenedbyit.Peoplewiththiscombinationofscoresareprobablyhelped
mostbybeingremovedfromtheircurrentworksetting.AssessmentforPTSDanddepressionisimportant.
Treatmentforeitherorbothmayhavepositiveoutcomes,butareturntoanunmodifiedworksituationis
unlikelytobefruitful.However,ifthepersoniswilling,itmaybethatheorshecanchangetheefficacyby
addressingtheirownskillsandsystems(suchasadditionaltraining)orbyworkingwiththeorganizationto
identifyareorganizedworkassignment.
INTERPRETINGTHEPROQOLATAGROUPLEVEL
Yearsofdatacollectionandpractice‐basedevidencehaveprovidedusefulinformationonsystemand
individuallevels.Forexample,thereappeartobenoscalescoredifferencesbygender.Nonehavebeen
observedbycountry,althoughthismaybereflectiveofthetypeofworkersandsettingsthatareusing
westernizedmeasures.Whilenotshownintheoveralldatabank,someunpublishedstudiesaswellassome
individualstudiesthatcontributedtothebankshoweddifferencesbasedonthenumberofyearsinthefield—
moreyearsinthefieldtypicallyisassociatedwithlowerscores.Whileitistemptingtopresumethosewith
moreexperiencedobetter,itislikelythatthosewithgreaterexposureandlowresiliencyleftthefield,while
thosethatremainedweredifferentiallyresilient.Whenlookingacrossprofessions,suchasmentalhealth,
physicalhealth,andchildprotectionworkers,dataindicatesthatphysicalhealthworkers(e.g.,nurses,primary
caredoctors)experiencetheleasttrauma,whileteachersremainthemostsatisfied.Ascouldbeexpected,
thoseworkersdealingwithchildrenandfamiliesintraumatendtoexperiencehigherlevelsofBOthanany
othergroup.

24

SECTION7:USINGTHEPROQOLFORDECISIONMAKING
Obviously,the“ideal”workenvironmentintermsofmanagingstressandtraumaisonethatcombineshighCS
withlowBOandSTS.Practice‐basedevidenceandpreliminaryquantitativeevidencesuggestinteresting
resultsinlessthanidealworkenvironments.ThosewhohavehighlevelsofSTSaccompaniedbyhighCSand,
typically,astrongsenseofaltruism,maycontinuetobeeffectiveattheirjobsandoftenrespondwelltoa
shortSTSintervention.Whileitisimportantforaworker’ssupervisortomakethistypeofdecision
individually,sometimesitispossibletoaccomplishinterventioninvivo,withoutchangingaworkassignment.
Incontrast,thosewithhighlevelsofbothBOandSTSmaybethemostatrisk,bothtothemselvesandina
worksetting.Inthissituation,thecaregiversareafraidandseenohopeforchange,whichpotentiallyruins
theireffectiveness.Theoretically,thisnegativeprofileisassociatedwithmedicalerror,butbecausethedata
arenotinonthatconcern,itistoosoontosaywithcertainty.Regardlessofthesystemeffectsofpeoplewho
areexperiencinghighlevelsofbothBOandSTS,itisimportantthatinterventionsbepursuedforthemas
individuals.Supervisorsshouldconsiderjobreassignmentduringtheinterventiontime.
CHANGINGTHEPERSON‐EVENTINTERACTION
OneoftherewardingaspectsoftheProQOListhatitprovidesaplatformforchange.Itcanleadto
introspectionandtobrainstormingaboutwhatisrightandwhatcanbemadebetterandwhatiswrongand
cannotbemadebetter.Itisimportanttoidentifythingsthataregoingwellandthosethingsthatarenot.Itis
alsoimportanttorealizethatsomethingsshouldbehorrible.Dealingwithburnvictims,forexample,cannot
reallybenormalized.Theburnsthemselvesareseriouswoundsandnooneshouldtrytopretendotherwise.
However,thatsameburnvictimmayprovideagoodsourceofcompassionsatisfactionwhenthehelperfeels
thatadifferenceisbeingmade.Indangeroussettings,itiscriticallyimportantnottotrytotakeawaypeople’s
necessaryfears.Beingafraidmaybetheverythingthatkeepsthemfrombeingkilled.
Attheindividuallevel,apersonmayreviewpersonalandworkenvironments.Thismaybedoneindividually,
withfamily,withafriendorcolleague,orwithaprofessional.Regardlessofthemethod,thisisaplanabout
thatpersonandforthatperson;itishisorhersandnottheiremployer’sortheirdoctor’s.Aplandictated
fromoutsideislikelytoleadtodissatisfactionandamarkerforburnout—anorganizationthatdictates
personalbeliefsisprobablyanorganizationthatdoesnotvaluetheirpersonnel’sthoughtsandfeelings.
Changingworkgroupscanbeeasyoritcanbeverydifficult.Thedifferenceistheinterestofthegroupin
investigatingandrespondingtoissuesofprofessionalqualityoflife.Someworkgroupsjustdonotwantto
dealwiththeissue.Theremaybeanattitudeof“ifyoucannottaketheheat,getoutofthekitchen.”Other
groupsmaygenuinelywanttochangebutmaynotknowhowbesttochange.Somegroupsbecomedistressed
thatchangeisnotpossiblewithoutanoutsidesource.Somegroupsmayalreadybefunctioningwellandno
changeisadvisable.Theroleofthehelperinthissituationistotrytohelpthegroupmembersidentifytheir
“style”andworkfromthere.Theprinciplesofanygoodgrouptheorycanassistinmanagingagroup’sneeds.
Itisimportanttorememberthattherewillbetimeswhenagroup’sneedsareveryclearandquite
reasonable,butunattainable.Thisiscommonincivilviolenceorwarsettings.Aworkgroup’smembersmay
decidethattheywishtochangeshiftsmoreoften.However,theremaybeinsufficientnumbersofpeopleto
makethatpossible.Insituationssuchasthis,yourroleistotrytoidentifyalternativestothereallyneeded,
butimpossible,intervention.Thegroupmembersthemselvesmaybethebestsourceofalternatives.

25

MONITORINGCHANGEACROSSTIME
TheProQOLitselfisstableacrosstime,whichmeansthatthescoresacrosstimereflectchangesintheperson,
notinthemeasureitself.Somepeopleself‐administertheProQOLataregularself‐determinedintervaltosee
howtheyaredoing.Othersmaychoosetotakethetestonce.Someorganizationswillrequiremultiple
administrationswhileothersmayignoreprofessionalqualityoflifealtogether.
IftheProQOLisusedacrosstime,thereshouldbeawaytoconsiderwhatthosechangesmean.Thiscanbe
somethingassimpleasagraphshowingaperson’supsanddownsacrosstimeoritmaybeaformalreviewof
one’sself‐careplanortheplanforaworkgroup.Itisimportantthattheinformationbeuseful.Onepotentially
importantuseoftheinformationistoreevaluateandadjustone’sself‐careplanorevenagroup’sor
organization’splan.


26

SECTION8:THEPROQOLTESTANDHANDOUT
PROFESSIONAL QUALITY OF LIFE SCALE (PROQOL)
COMPASSION SATISFACTION AND COMPASSION FATIGUE
(PROQOL) VERSION 5 (2009)
When you [help] people you have direct contact with their lives. As you may have found, your
compassion for those you [help] can affect you in positive and negative ways. Below are some
questions about your experiences, both positive and negative, as a [helper]. Consider each of the
following questions about you and your current work situation. Select the number that honestly
reflects how frequently you experienced these things in the last 30 days.
1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often
1.
I am happy.
2.
I am preoccupied with more than one person I [help].
3.
I get satisfaction from being able to [help]
people.
4.
I feel connected to others.
5.
I jump or am startled by unexpected sounds.
6.
I feel invigorated after working with those I [help].
7.
I find it difficult to separate my personal life from my life as a [helper].
8.
I am not as productive at work because I am losing sleep over traumatic experiences of
a person I [help].
9.
I think that I might have been affected by the traumatic stress of those I [help].
10.
I feel trapped by my job as a [helper].
11.
Because of my [helping], I have felt "on edge" about various things.
12.
I like my work as a [helper].
13.
I feel depressed because of the traumatic experiences of the people I [help].
14.
I feel as though I am experiencing the trauma of someone I have [helped].
15.
I have beliefs that sustain me.

27

16.
I am pleased with how I am able to keep up with [helping]
t
echniques and protocols.
17.
I am the person I always wanted to be.
18.
My work makes me feel satisfied.
19.
I feel worn out because of my work as a [helper].
20.
I have happy thoughts and feelings about those I [help]
and how I could help them.
21.
I feel overwhelmed because my case [work] load seems endless.
22.
I believe I can make a difference through my work.
23.
I avoid certain activities or situations because they remind me of frightening experiences
of the people I [help].
24.
I am proud of what I can do to [help].
25.
As a result of my [helping], I have intrusive, frightening thoughts.
26.
I feel "bo
g
ged down" by the system.
27.
I have thoughts that I am a "success" as a [helper].
28.
I can't recall important parts of my work with trauma victims.
29.
I am a very caring person.
30.
I am happy that I chose to do this work.

28

YOUR SCORES ON THE PROQOL: PROFESSIONAL QUALITY OF LIFE
SCREENING
Based on your responses, place your personal scores below. If you have any concerns, you should discuss
them with a physical or mental health care professional.
Compassion Satisfaction _____________
Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example,
you may feel like it is a pleasure to help others through your work. You may feel positively about your
colleagues or your ability to contribute to the work setting or even the greater good of society. Higher scores
on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job.
The average score is 50 (SD 10; alpha scale reliability .88). About 25% of people score higher than 57 and
about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of
professional satisfaction from your position. If your scores are below 40, you may either find problems with
your job, or there may be some other reason—for example, you might derive your satisfaction from activities
other than your job.
Burnout_____________
Most people have an intuitive idea of what burnout is. From the research perspective, burnout is one of the
elements of Compassion Fatigue (CF). It is associated with feelings of hopelessness and difficulties in dealing
with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can
reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or
a non-supportive work environment. Higher scores on this scale mean that you are at higher risk for burnout.
The average score on the burnout scale is 50 (SD 10; alpha scale reliability .75). About 25% of people score
above 57 and about 25% of people score below 43. If your score is below 18, this probably reflects positive
feelings about your ability to be effective in your work. If you score above 57 you may wish to think about
what at work makes you feel like you are not effective in your position. Your score may reflect your mood;
perhaps you were having a “bad day” or are in need of some time off. If the high score persists or if it is
reflective of other worries, it may be a cause for concern.
Secondary Traumatic Stress_____________
The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work
related, secondary exposure to extremely or traumatically stressful events. Developing problems due to
exposure to other’s trauma is somewhat rare but does happen to many people who care for those who have
experienced extremely or traumatically stressful events. For example, you may repeatedly hear stories about
the traumatic things that happen to other people, commonly called Vicarious Traumatization. If your work
puts you directly in the path of danger, for example, field work in a war or area of civil violence, this is not
secondary exposure; your exposure is primary. However, if you are exposed to others’ traumatic events as a
result of your work, for example, as a therapist or an emergency worker, this is secondary exposure. The
symptoms of STS are usually rapid in onset and associated with a particular event. They may include being
afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things
that remind you of the event.
The average score on this scale is 50 (SD 10; alpha scale reliability .81). About 25% of people score below 43
and about 25% of people score above 57. If your score is above 57, you may want to take some time to think
about what at work may be frightening to you or if there is some other reason for the elevated score. While
higher scores do not mean that you do have a problem, they are an indication that you may want to examine
how you feel about your work and your work environment. You may wish to discuss this with your
supervisor, a colleague, or a health care professional.

29

WHAT IS MY SCORE AND WHAT DOES IT MEAN?
In this section, you will score your test and then you can compare your score to the interpretation below.
To find your score on each section, total the questions listed on the left in each section and then find your
score in the table on the right of the section.
Compassion Satisfaction Scale:
3. ____
6. ____
12. ____
16. ____
18. ____
20. ____
22. ____
24. ____
27. ____
30. ____
T o t a l: _____
The sum of my
Compassion
Satisfaction questions
So My Score
Equals
My Level of
Compassion
22 or less
43 or less Low
Between
23 and 41
A
round 50 Average
42 or more
57 or more High
Burnout Scale:
*1. ____ = ____
*4. ____ = ____
8. ____
10. ____
*15. ____ = ____
*17. ____ = ____
19. ____
21. ____
26. ____
*29. ____ = ____
The sum of my
Burnout Questions
So My Score
Equals
My Level of
Burnout
22 or less
43 or less Low
Between 23 and 41
A
round 50 Average
42 or more
57 or more High
Reverse the scores for those that are starred.
0=0, 1=5, 2=4, 3=3, 4=2, 5=1
T o t a l: _____

30

Secondary Trauma Scale:
2. ____
5. ____
7. ____
9. ____
11. ____
13. ____
14. ____
23. ____
25. ____
28. ____
T o t a l: _____
The sum of my
Secondary Traumatic
Stress questions
So My Score
Equals
My Level of
Secondary
Traumatic
Stress
22 or less
43 or less
Low
Between 23 and 41
A
round 50
Average
42 or more
57 or more
High



31

SECTION9:CONVERTINGFROMTHEPROQOLIVTOTHEPROQOL5
ThissectionprovidesdirectionsifyouhaveusedpreviousversionsoftheProQOLandwouldliketobridge
fromolderversionstothenewversion.ThecurrentProQOL(version5)issimplerthanitspreviousversions.
Thegrammarhasbeenrefinedandthescaleforscoringismorefamiliartomostpeople.
Thecurrentversionisnearlyidenticaltotheolderversion.Thereareafewgrammarchangesinthequestions.
Theprimarychangeisreportingscoresinat‐scoreformatratherthanarawscoreformat.Thet‐scorehas
multipleadvantages,includingtheequilibrationofthemeanscoreacrossversionsoftheProQOLandacross
thescales.Thet‐scoreuseameanof50andastandarddeviationof10.Thus,ifyouscore50onthe
CompassionSatisfactionScaleitiscomparabletoa50ontheSecondaryTraumaorBurnoutscale.Ascoreof
50isthemeanscoreonanyscale.
Byusingthestandardizedt‐scoremakesitpossibletoeasilycompareacrossversionsoftheProQOL.Theolder
versionsoftheProQOLdonotincludetheadditionalstepstoconverttherawscorestoatscore.Becausethe
t‐scoreisastandardizedscore,onceanypreviousversionoftheProQOL,includingtheProQOLIV,scoresare
convertedtot‐scores,theyaredirectlycomparabletot‐scoresontheProQOL5.
Pleasemakesurethatyouareusingthe30‐itemProOQLwiththesubscalesCompassionSatisfaction,Burnout
andSecondaryTraumaticStress(alsoformerlycalledtheCompassionFatigueScale).Ifyouareusingtheolder
66‐itemCompassionSatisfactionandFatigueScaleortheCompassionFatiguescale,thesecannotbedirectly
compared.
WerecognizethatthesechangescanbeworrisomeifapreviousversionoftheProQOLhasbeenused.When
possible,tscoresshouldbereportedratherthanrawscores.InsomecasesProQOLscoresfromanearlier
versionhavebeendistributedtothepersonwhotookthetest.IfthetestisrepeatedusingtheProQOL5,the
reportinghandoutcansay
“WhenyoutooktheProQOLlast,�