A Well-being Promotion Program Increases Self-Compassion, Resilience and Active Coping among Providers Who Work with Children and Families

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Lengua, Rebecca Calhoun, Ignatius Balinbin, Robyn Long, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3912071/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study examined the effects of the REsilient Attitudes and Living for Professionals (REAL Pro) prevention intervention on the well-being of professionals who work with children and families. The program combines mindfulness and self-compassion practices with cognitive-behavioral tools that aim to promote improved stress management, emotion regulation and well-being, and was evaluated with early childhood (n = 87) and K-12 educators (n = 40), staff serving youth in out-of-school or after-school settings (n = 31), and medical providers (n = 35). Participants completed pre- and post-test assessments, reporting on measures of stress management (perceived stress, self-compassion), emotion regulation (dysregulation, active coping, denial), and well-being (flourishing, resilience, burnout, secondary trauma symptoms). Dependent sample t-tests were conducted, showing significant improvement from pre- to post-test in self-compassion, emotion regulation, active coping, and a trend toward increased resilience. Three-month follow-up in a small subset of the sample (n = 11) suggested potential delayed reduction in burnout and secondary trauma symptoms. The preventive intervention shows promise for providing professionals with tools for stress management and emotion regulation and reducing burnout in providers working with children and families who tend to experience substantial work-related stress. Child and Family Providers Mindfulness Self-compassion Coping Emotion Regulation Intervention Introduction The well-being of professionals engaged in child and family services impacts the quality and efficacy of their work (Salamehe et al., 2021). Among these service providers, including early childhood educators, K-12 educators, community-based organization staff, and medical personnel, there are substantial levels of secondary trauma symptoms and burnout (Faulkner et al.,2016; Grist & Caudle, 2021 ; Lamson et al., 2014 ; Ormiston et al., 2022 ). Research examining the well-being of service providers often focuses exclusively on the well-being of one professional group at a time. Focusing on a single professional population restricts the sample, consequently limiting our understanding of the intersectional impacts of secondary trauma symptoms and burnout across a variety of professions (Ormiston et al., 2022 ). In turn, this hinders the development of interventions that can be effectively implemented in various contexts. In order to provide high-quality care for a broad spectrum of individuals in caring professions, it is necessary to identify interventions that reduce secondary trauma symptoms and burnout and promote well-being in providers across professions. This study examined the effectiveness of a well-being and resilience promotion program with early childhood and K-12 educators, community-based organization staff, and medical personnel who work with children and families. Across caregiving professions, levels of stress are high. The 2013 Gallup-Health-Well-Being Index found that 46% of teachers in K-12, 46% of nurses and 45% of physicians report high levels of daily stress, which is the highest among the 14 professional categories included in the study (Gallup, 2014). Additionally, secondary traumatic stress (STS) and burnout are often seen in the context of professions that demand high levels of emotional labor and caregiving, such as healthcare, education, and social services (Lamson et al., 2014 ; Mulyani et al., 2021 ; Sinclair et al., 2017 ). Emotional distress resulting from indirect exposure to a traumatic experience, typically in care professions, can lead to STS (Sinclair et al., 2017 ; Ormiston et al., 2022 ). The clinical manifestations of STS are comparable and almost identical to those seen in Post-Traumatic Stress Disorder (PTSD). Affected individuals may experience symptoms such as avoidance, arousal, and feeling that they are re-living the traumatic event (Lamson et al., 2014 ; Thomas & Wilson, 2004 ). Professionals who work in caregiving roles are at risk for developing STS due to empathically engaging with individuals who have experienced trauma (Ormiston et al., 2022 ). In addition, individuals in these professional roles can also experience burnout, which describes a state of chronic physical and emotional exhaustion that may include feelings such as reduced accomplishment and depersonalization, a sense of detachment from oneself, or a loss of personal identity (Andrew, 2015 ; Cumming & Wong, 2018 ). STS and burnout can induce heightened irritability, negative self-perceptions, and erosion of emotional reserves. Further, experiencing STS or burnout can decrease one’s capacity for attention to detail and can hinder the formation of meaningful, trusting relationships, thus compromising the overall quality of care, and evidencing the need for prompt and evidence-based intervention (Lamson et al., 2010; Ormiston et al., 2022 ). The spectrum of child and family service providers includes early childhood and K-12 educators, community-based organization staff, and medical personnel. STS and burnout have been shown to reduce these professionals’ capacity to provide quality care. One study found that the incidence of depressive symptoms in early childhood educators predicted poorer education quality, which, in turn, was related to worse cognitive outcomes for the learning children (Miller & Flint-Stipp, 2019 ). This suggests that educator depression negatively impacted children’s cognitive outcomes, with the quality of education acting as a mediator in this relationship. Additionally, systematic review found evidence that teacher burnout is associated with worse academic achievement and lower quality student motivation (Madigan & Kim, 2021 ). Another systematic review found that nurse burnout is associated with worsening safety and quality of care, as well as decreased patient satisfaction (Jun et al., 2021 ). Currently, there are several existing programs that seek to ameliorate the high levels of stress and burnout for caring professionals. While these programs have yielded some positive results, the studies all have important limitations to consider. The Facilitating Attuned Interactions (FAN) approach represents one example of a program that, despite employing an intricate 15-month mentorship process, did not conclusively reduce burnout among child welfare professionals (Hazen et al., 2020 ). Similarly, Orsi et al.’s ( 2023 ) Resilience Alliance (RA) intervention failed to significantly influence job satisfaction and turnover rates, despite showing some impact on turnover ideation. While Luthar & Mendes ( 2020 ) were able to illuminate some of the unique challenges faced by educators working through traumatic environments, their study’s limited sample size raised concerns about its generalizability. The REAL Pro (REsilient Attitudes and Living for Professionals) intervention, a multi-profession program designed to enhance well-being and mitigate stress and burnout among service providers, offers an innovative solution by integrating universal principles that are applicable across various professional groups. Rather than an emphasis on the unique stressors faced by each profession, evidence-based cognitive-behavioral and mindfulness practices form the foundation of the intervention; the versatility of these techniques provides a broad but effective means for fostering emotional regulation and resilience (Neff, 2009 ; Castillo-Gualda, 2019). REAL Pro is a relatively brief, 9-to-12-hour intervention, typically delivered across 6 sessions that each focus on developing practical emotion regulation and coping skills that professionals can integrate into their day-to-day life and work. In this study, we expected that, across diverse professions, those who participated in the intervention would cultivate improved capacities for self-compassion, emotional regulation and effective coping strategies. In this way, stress and burnout should be reduced in these individuals, thus supporting the intervention’s wide-reaching applicability. By implementing and evaluating the REAL Pro intervention, this study aimed to establish a novel mechanism for reducing STS and burnout and improving well-being in providers across various care settings. We conducted a preliminary evaluation of the REAL Pro intervention to explore its potential effectiveness in promoting provider well-being. By performing pre- and post-test analyses of participants’ perceived stress, emotional regulation, and overall well-being, this study aimed to provide preliminary evidence of the REAL Pro intervention's impact on these professional groups and evaluate the best practices for its successful implementation. Method Participants Over a 2-year period, 193 professionals who work with children, youth and families participated in REAL Pro training as part of professional development in their respective work settings. Work settings included organizations offering early childhood and after-school programs to families in low-income contexts; K-12 public school educators of an urban public school with 32% of families qualifying for free and reduced lunch, 54% BIPOC, and 21% non-English speaking background; and medical professionals working at a university hospital that provides 60% of hospital charity care and 50% of hospital care for Medicaid recipients in the county in which it is located. All participants were invited to enroll in the evaluation study and complete pretest and posttest assessments, and of those, 136 (70%) enrolled. Professionals enrolled in the evaluation included early childhood educators (n = 87), K-12 educators (n = 40), medical providers (n = 35), and staff who work with K-12 age youth in out-of-school or after-school services (n = 31). Three of the agencies had a strong dual language program for English language learners. Of those enrolled in the study, 98 (72%) completed posttest assessments. As a result of additional funding available at one early childhood site, a small number of participants (n = 11) were asked to complete a 3- month follow-up assessment. In addition, nine participants from that site volunteered to participate in a focus group for the qualitative component of this research. Procedures There were 3 staff facilitators, all of whom had multiple years of related training and experience. Two programs were delivered in-person at the workplace setting, and the remaining eight were delivered online due to the COVID19 pandemic related closures. For this study, the program was implemented 10 times and was adapted in length and format to meet the needs of the organizations participating. As such, 7 cohorts met weekly for 90 minutes for 6 weeks, 1 cohort met weekly for 60 minutes for 8 weeks, 1 cohort met for three 2-hour workshops and 1 cohort met for two 6-hour workshops. All study procedures were approved by the University of Washington’s Human Subjects Division, and participant informed consent was obtained from all participants prior to their participation in the research. Two weeks prior to the start of each program, group participants were sent an email asking them to participate in the research study and complete an online survey. Immediately following the program, participants were again prompted to complete the research survey. Participants at one site were also invited to complete a 3-month follow up assessment. Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at the University of Washington (Harris et al. 2009). REDCap is a secure, web-based software platform designed to support data capture for research studies. Participants were compensated $ 20 and $ 25 for completing the pre- and post-test surveys, respectively. All program attendees were additionally asked to complete a feedback survey at the end of the program. In order to gain a deeper understanding of participants' experiences with REAL Pro, we conducted a focus group at one of the research sites. The focus group was held online via Zoom with nine participants, who were all staff members from the same site. All staff members who had attended REAL Pro training were sent an invitation via email to participate in a focus group. They signed up to participate via an online form, were allowed work time to attend, and were provided a $ 20 gift card as compensation. To limit bias, the focus group was led by two of the co-authors who were not part of the intervention or quantitative data collection and analyses. The group lasted one hour and was led using a semi-structured format with questions prepared in advance with spontaneous follow-up questions and prompts. Intervention REAL Pro (Resilient Attitudes & Living for Professionals) is a mindfulness and self-compassion based coping enhancement program grounded in psychology, neuroscience, and contemplative practice research. Each session includes a mix of mindfulness practices (e.g., breath awareness, Hatha yoga, guided meditation practices) and cognitive behavioral emotion regulation skills (e.g., cognitive reframing, balanced decision making, radical acceptance, stress tolerance). The content focuses on promoting personal well-being while also supporting the socio-emotional development of children, improving relationships with colleagues and families, and building a culture of compassion and resilience at work. (see Table 1 ). Table 1 REAL Pro Intervention Content Content Related Practices Stress & Resilience overview Physiological stress response and how stress affects us mentally, emotionally and physically. How mindfulness and self-compassion support resilience and well-being. ● Body Scan ● Yoga ● Tuning into the Breath Noticing Our Thoughts Learning to notice the mind’s patterns and to identify and label thoughts. ● Labeling Thoughts ● Sounds & Thoughts Meditation ● Mindfulness of the Senses Wise Mind Awareness of the benefits of balancing emotion and reason to make decisions and be effective. ● Wise Mind Breathing ● Be in the Pause Emotion Regulation Purpose of emotions and goals of emotion regulation. Normalizing emotional experiences. Understanding how culture and family affect emotional acceptance and expression. ● + 2 Breathing ● Yoga ● 3 − 2–1 ● Willing Hands Window of Tolerance What expands or shrinks our ability to cope. Discussion of in the moment coping tools. ● The 3 Ps: pause, be present, proceed ● Progressive Muscle Relaxation Radical Acceptance Navigating situations we cannot change. Identifying our locus of control when faced with challenging situations. Identifying ways to support oneself in these situations. ● Radical Acceptance worksheet Common Humanity Recognizing interconnectedness. Developing the ability to intentionally feel connected to others. ● Just Like Me ● Peace & Kindness (metta practice) Self-Compassion How self-compassion supports resilience. Noticing the inner voice/critic. Modeling self-compassion with families. ● How would I treat a friend? ● Self-Compassion Break ● Breathing with Anchor Phrases Measures For the quantitative assessment, participants completed self-report measures assessing self-compassion, perceived stress, emotion regulation, coping, indicators of well-being including resilience and flourishing, and indicators of professional burnout and secondary traumatic stress. Measures were selected to assess the targets of the program including reducing stress, improving emotion regulation, enhancing active coping, and promoting well-being. Perceived Stress was assessed using the 10-item Perceived Stress Scale (PSS; Cohen et al., 1983 ) which assesses current levels of perceived stress (6 items) and appraisal of ability to cope with stress (4 items). Internal consistency was 𝛼 = .68 in this study. Self-Compassion was measured using the 12-item Self-Compassion Scale-Short Form (Raes et al., 2011 ) which assesses dimensions of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification on 5-point scale (1 = almost never – 5 = almost always). Response options include “I’m intolerant and impatient towards those aspects of my personality I don’t like,” and “I try to see my failings as a part of the human condition”. Internal consistency of .80 − .92 has been reported and was 𝛼 = .89 in this study. Emotion Dysregulation was measured using the brief 18-item Difficulties in Emotion Regulation Scale (Victor & Klonsky, 2016 ), scored so that it represented deficits in awareness, understanding, and acceptance of emotions, impulse control, and access to emotion regulation strategies. Participants rate statements such as “I pay attention to how I feel,” and “When I am upset, I become out of control,” on a 5-point scale (1 = almost never – 5 = almost always). Internal consistency reliability of .97 has been reported and was .91 in this study. Coping was assessed using the 24-item short form of the Brief COPE inventory (Carver et al., 1989 ), which asks participants what they do or feel during a stressful event. In this study, we assessed engagement strategies, which combined active (i.e. “I concentrate my efforts on doing something about it”), planning (i.e. “I make a plan of action”), positive reappraisal (i.e. “I try to see it in a different light, to make it seem more positive”), and acceptance (i.e. “I get used to the idea that it happened”) coping strategies, with 𝛼 = .83. We also assessed denial (i.e. “I refuse to believe that it has happened”) as a disengagement strategy, with 𝛼 = .82. Well-being was indicated with measures of resilience and flourishing. On the 6-item Brief Resilience Scale (Smith et al., 2008 ) respondents indicated on a 5-point scale their ability to cope with and recover from stressful situations (1 = strongly disagree – 5 = strongly agree). Examples include “I tend to bounce back quickly after hard times,” and “I have a hard time making it through stressful events”. Internal consistency ranging from .80 − .91 has been reported, and was .87 in this study. Well-being was also assessed using the 8-item Flourishing Scale (Diener et al., 2010 ). Respondents indicate on a 7-point scale (1 = strongly disagree – 7 = strongly agree) their agreement with items such as “I am engaged and interested in my daily activities,” and “I lead a purposeful and meaningful life”. Alpha was .87. Burnout and secondary traumatic stress were assessed using 2 subscales (10 items each) from the Professional Quality of Life Measure (ProQOL; Stamm, 2010 ). Participants rated items assessing feeling overwhelmed, worn out, ineffective and unsupported in their work. Internal consistency reliabilities were 𝛼 = .64 for burnout and 𝛼 = .87 for secondary traumatic stress in this study. Analytic Plan The aim of the study was to evaluate the benefit of REAL Pro to providers and staff who work with children and families. Dependent measures t-tests were conducted to examine changes in outcomes from pretest to posttest. Intent to treat analyses were used such that everyone enrolled in the study was included in analyses regardless of their degree of participation. Missing posttest values were substituted with the sample posttest mean value. Consequently, analyses were conducted on the 136 providers who enrolled in the study and completed pretest surveys. Mean-value substitution addresses bias potentially introduced by attrition while preserving power for analyses and preserving the estimate of the magnitude of the effect. Additional dependent measures t-test were conducted to assess the degree of change from pretest to follow-up assessments in the small number (n = 11) of participants who were asked to complete a 3-month follow-up assessment (all participants at one early childhood site). These analyses provide preliminary evidence about whether program benefits continued or were maintained over time. Qualitative analyses were conducted for a focus group held with a sub-sample at one early childhood education site serving families living in low-income contexts. Participants were informed that the purpose of the group was to provide insight into what worked well, what was useful to them and what didn’t work as well in the REAL Pro sessions in order to improve the program for others. Participants were first asked a series of questions regarding what was good about the program including: 1) What moments or lessons stand out in your mind as the most valuable or important? 2) What aspects of REAL Pro have you carried forward into your life? 3) Do you have any reflections on how this program has affected your work community? The participants were then asked to share what they would change or improve: 1) Suppose that you were in charge and could make one change that would make the program better. What would you do? 2) What else could be improved? Any other suggestions for improvement? The participants were also asked how they would describe the program to someone else, a friend or family member. The focus group was recorded and transcribed with participants’ names redacted for analysis with both facilitators reviewing the transcript for accuracy. Transcripts were coded and thematic analysis was conducted by the author and one research coordinator. Codes were developed through an iterative process by the two coders to ensure consistency in coding and themes were developed independently and finalized by consensus. Results Preliminary Analyses Missing data. Cases with complete data (n = 98), that is both pre- and posttest assessments, were compared with those missing data (n = 38) to assess the potential for bias introduced by attrition. There were no differences on pretest variables related to missingness. The magnitude of the effects of missingness were small for all variables (r = .01 to .11), indicating that little bias was introduced by missing posttest responses. To determine whether rates of missing data differed by provider group, χ 2 tests were conducted, and all tests were nonsignificant indicating that the provider groups completed surveys at similar rates. Provider group related to pretest levels. We examined whether the provider groups differed in their pretest levels on study variables. Early childhood educators reported higher levels of self-compassion (r = .18, p = 0.034), whereas K-12 teachers reported lower levels (r = − .18, p = 0.038). Youth providers reported greater difficulties with emotion regulation (r = .19, p = 0.026) and higher perceived stress (r = .21, p = 0.018). Early childhood educators reported more use of denial coping (r = .22, p = 0.010) while providers in medical settings reported less denial coping (r = − .21, p = 0.017). To assess whether intervention effects depended on the provider groups, multiple regressions were conducted regressing posttest values on pretest levels and all the provider group status indicators. None of the effects of provider group status was significant indicating that rank order changes from pretest to posttest were not different across the provider groups. Intervention Effects The correlations among all study variables are provided in Table 2 . Table 3 includes pretest (n = 136), posttest (n = 98) and follow-up (n = 11) means and standard deviations. Intent to treat analyses were conducted with sample mean replacement for missing posttest data. Dependent-sample paired t-test analyses tested differences from pretest to posttest, and Cohen’s repeated measures d provided an estimate of intervention effect sizes. Results showed significant improvements in self-compassion, active coping and emotion dysregulation, with moderate effect sizes. There was a trend towards improved resilience as well. There were no significant mean differences from pretest to posttest for perceived stress, denial coping, flourishing, burnout or secondary traumatic stress. Table 2 Correlations among study variables at pretest. SC PS ED AC DE FL RE BO Reducing Stress Self-compassion (SC) -- Perceived Stress (PS) -0.555** -- Emotion Regulation Emo Dysregulation (ED) -0.620** 0.498** -- Active Coping (AC) 0.549** -0.305** -0.274** -- Denial (DE) 0.133 0.046 0.386** -0.132 -- Well-being Flourishing (FL) 0.635** -0.355** -0.427** 0.503** -0.130 -- Resilience (RE) 0.661** -0.503** -0.572** 0.449** -0.135 0.537** -- Burnout (BO) -0.035 0.291** 0.231** 0.187* 0.033 0.131 -0.096 -- Secondary Trauma (ST) -0.418** 0.433** 0.515** -0.150 0.289** -0.395** -0.377** 0.289** *p < .05; **p < .01 Table 3 Observed means, standard deviations, dependent sample t-tests for complete cases for pretest to posttest change, pretest to follow-up change, and intervention effect sizes. Pretest M(SD) n = 136 Posttest M(SD) n = 98 Follow-up M(SD) n = 11 Pre/posttest Difference t-test, p-value (df = 135) Cohen’s d Repeated Measures Pre/Follow-up Difference t-test, p-value (df = 10) Reducing Stress Self-compassion 3.03(0.77) 3.20(0.56) 3.70(0.59) 3.30, 0.001 0.34 3.07, 0.012 Perceived Stress 2.15(0.57) 2.08(0.42) 1.86(0.33) 1.52, 0.131 0.12 1.09, 0.301 Emotion Regulation Emo Dysregulation 2.53(0.73) 2.41(0.47) 2.02(0.36) 2.12, 0.036 0.27 1.08, 0.307 Active Coping 1.95(0.50) 2.03(0.42) 2.17(0.52) 2.17, 0.032 0.32 0.53, 0.607 Denial 0.38(0.63) 0.43(0.54) 0.45(0.65) 0.78, 0.437 0.10 1.30, 0.223 Well-being Flourishing 5.72(0.79) 5.81(0.73) 6.15(0.60) 1.50, 0.136 0.22 1.27, 0.233 Resilience 3.16(0.79) 3.27(0.60) 3.83(0.78) 1.85, 0.067 0.29 1.00, 0.341 Burnout 3.36(0.39) 3.34(0.32) 3.14(0.18) 0.64, 0.523 0.06 2.72, 0.022 Secondary Trauma 2.48(0.66) 2.42(0.56) 1.91(0.40) 1.19. 0.236 0.16 3.01, 0.013 Dependent-sample paired t-tests were also conducted to examine change from pretest to follow-up in the small sample from which follow-up assessments were obtained. A significant difference on self-compassion from pretest suggests significant improvements at posttest were maintained. Significant differences from pretest to follow-up on burnout and secondary traumatic stress emerged when there were not significant differences from pretest to posttest. This might be an artifact of the small subsample of participants who were asked to complete a follow-up assessment, or it could suggest a delayed effect of the program on burnout and secondary trauma. To explore this, differences from posttest to follow-up were examined. There was a significant decrease in secondary traumatic stress from posttest to follow-up ( t [10] = 4.908, p = 0.001) and a trend toward a decrease in burnout ( t [10] = 1.785, p = 0.104). Acceptability The REAL Pro program also showed high acceptability, with participants reporting high levels of satisfaction and positive feedback. All participants in the program (193), not only those participating in the evaluation study, were invited to complete program feedback surveys, and 183 (95%) program participants completed the feedback survey. Responses showed that 98% (179/183) of respondents indicated the program content was useful and interesting; 97% (177/183) would recommend the program to colleagues; and 96% (175/183) reported the skills help with managing emotions and coping with challenging situations. Themes in feedback surveys indicated that staff have integrated coping skills into their workdays, enhanced their ability to model self-regulation skills with children, and that teams found a common language to discuss stress and well-being. Qualitative Themes emerged in three categories from the focus group: Benefits of the program : Individual benefits to the participants themselves; practical tools or skills used with children and families; and strengthening a sense of community among staff at the center. Aspects of the program that allowed for the above benefits to be realized included the space created by the facilitators felt safe; the program and facilitators were flexible, and adaptations were made to meet the needs of the group; and practices and concepts were introduced that provided valuable ongoing support. Program Improvement suggestions included lengthening the program or having additional ongoing support. In presenting the results, we are intentionally relying on quotes from the participants to honor the perspective and framing that they, personally, gave to their experiences in REAL Pro. Quotations are indented and led by the study identification number assigned to the participant being quoted. 1. Benefits of the program : Participants described the benefits of the program for them personally as a “release” from stress, anxiety and pressures with all participants agreeing with the ones who shared this. The sessions themselves provided time for release and the content provided support for participants to care for themselves. 103: ...it's helped me calm myself, help my anxiety, help my stress level, give me a release. 106: I think it was a good time for us to kind of just release and unravel from everything that's been going on. 109: Yes, I agree [with release] somehow teaching us how to let go of situations that are uncertain and remain focused on the here and now. Participants also discussed practical ways they applied skills learned in REAL Pro when working with children, interacting with parents, or to support themselves in difficult moments. 101: …with REAL Pro we've been able to apply it to our daily life, like, whether it be our home life or work life, like it's something that's practical that you can change. You can use it not only with yourself but with your students as well. 103: ...when I am in the classroom with students, it is magical to see these 3–5 year olds close their eyes, and sit calmly and use this practice as a group. 104:...you know we're in a meeting and I'm thinking to myself okay you've got to, you've got to breathe yourself, you've got to remember, Just Like Me [a compassion-based practice]. And if my Window of Tolerance [a stress tolerance model] is closing, what am I going to do to change that? Participants discussed the importance of the sense of community and authenticity that REAL Pro supported among the organization’s staff with all participants in agreement that REAL Pro built trust among staff. Participants shared: 106: …[REAL Pro] was a great opportunity for us to be real and be authentic with each other in terms of, like, how we were feeling with our emotions and our struggles and I think that that in itself, like, it helped generate a lot of, like, trust and respect within each other. 105: I think [REAL Pro] has given us techniques that help with communication among ourselves. 104: I think [REAL Pro] helped foster a sense of community that wasn't there when some people were at home, some people were in the building, there were a lot of external forces that were putting pressure on people… When asked what aspects of REAL Pro they had carried forward into their lives, participants identified four in-the-moment coping skills (ranging from breathing to sensory practices), two compassion-based practices, and a mindfulness-based body scan. 2. Aspects of the program that allowed for the above benefits to be realized: The positive regard for the program shared by participants was attributed largely to the facilitators’ ability to create an environment that felt safe and supportive to the participants. One participant described the program as “genuine and real” and said the facilitators “are like one of us” (participant 103). Other participants noted: 108: I truly believed that they accepted me right where I was. There was no prerequisites… I didn't have to show up any kind of way, I didn't have to filter myself in any kind of way… I always felt [I was] an equal participant…they were just so inclusive - so inclusive. 104: Like you were really heard and listened and valued and that carried over each week. One participant specifically identified the importance of having a facilitator of color leading the program contributing to the sense of safety. 106: I think that it was really helpful that we had a person of color kind of lead us into this, because I think you know as a [ethnicity removed to protect identity] woman, like, I'm not really raised on the idea of emotion. I'm not really raised to, you know, talking about, like, my anxiety and stuff and having, like, just that representation there … And every time that I shared I felt seen in that sense…we have a lot of POC and BIPOC… People were just more comfortable in that sense, and it made everyone feel heard and seen…it's super important that we're talking about certain things and that we’re being represented in that way. Another aspect of building a sense of safety that participants described was the facilitators’ ability to be responsive to the participants and situations unfolding at their center and in society. For example, a participant noted that the facilitators were mindful of when to have Zoom breakout groups by teams or have managers in a different group due to power dynamics. 101: I remember one day when stuff happened there was like a whole bunch of us that just, we were drained and did not want to talk and so they said, private message me if you don't want to talk. And they put us in separate groups, of groups that wanted to talk with each other and groups that just sat there and were silent for a little bit. 3. Program Improvement : When asked for ways they would change the program to make it better, participants were quick to indicate how much they appreciated the program, including expressing deep appreciation for the facilitators. There was agreement that they want more of this programming in an ongoing way and one also speculated that it may have been even better in-person if that had been a possibility given the pandemic. 107: I wish we meet them on weekly basis 101: …if it was available it'd be awesome if we could have that resource at our Center, like, have someone there in the moment or maybe even have them available through zoom I guess… in the moment (when you are) needing help, or that day needing help. One participant also indicated they would like more direct support for implementing mindfulness with the families they work with. 104: We want to bring a parent group together … I am pretty new at this whole mindfulness thing so like it would have been helpful if it was kind of pre-packaged like, this is how you would present it or, this is what you would present instead of having to think to myself, like, how would I change it an adapt it if I was talking to parents… Discussion This study aimed to establish preliminary evidence for an intervention that can reduce STS and burnout and improve well-being in providers across various care settings. This study evaluated the effectiveness of the REAL Pro intervention in reducing STS and burnout and improving well-being through increased capacities for self-compassion, emotional regulation and effective coping in professionals who work with children and families. Reduced stress and burnout ultimately would be expected to improve services received by children and families (e.g., Salamehe et al., 2021). The findings for intervention effectiveness were mixed. Participants demonstrated significant increases in self-compassion, active coping and emotion regulation and a trend towards improved resilience. However, significant improvements in perceived stress, STS or burnout were not observed at posttest. Exploratory follow-up analyses with a small subset of the sample suggests there might be delayed effects of the intervention on reduced STS and burnout, suggesting the possibility that, as participants’ capacities for self-compassion, coping and emotion regulation improve, they may experience reductions in STS and burnout over time. Levels of stress, STS and burnout are high among professionals who provide services to children and families (Gallup, 2014; Lamson et al., 2014 ; Mulyani et al., 2021 ; Sinclair et al., 2017 ). While it is critical to address structural and organizational factors that contribute to this, there are also individual level factors that can be promoted to potentially reduce STS and burnout (e.g., Brigham et al., 2018 ). A strength of the REAL Pro intervention is the combination of mindful self-compassion practices with cognitive-behavioral coping and emotion regulation skills that have been shown to reduce perceived stress, symptoms of anxiety and depression, and improve well-being on other populations (e.g., Ferrari et al., 2019 , Long et al., 2023 ). Although the quantitative results of this study were mixed, class feedback surveys and qualitative findings suggest that participants made use of and experienced the intended benefits from the mindfulness and coping skills, indicating that participating in the intervention provided stress relief. In addition, in qualitative feedback participants reported that they will be able to utilize the practices and skills in their work with children and families. Professionals need tools both for their own well-being and for supporting the social, emotional and behavioral well-being of the children and families they serve, and the skills taught in REAL Pro may accomplish both. Having practical tools for managing stress and difficult work-related situations can improve provider-client relationships and services. For example, one study showed that being trained in an effective social-emotional learning program mitigated the negative association of teacher burnout with the quality of teacher-child interactions and instructional support in Head Start classrooms (Sandilos et al., 2020). Given high rates of stress, STS and burnout in child- and family-serving professions and the impact those have on the quality of services (e.g., Salamehe et al., 2021), interventions that can address both are needed. Another strength of this study lies in its effort to address STS, burnout and well-being among a variety of professionals in child and family services, whereas most studies focus on one profession only (e.g., Ormiston et al., 2022 ). Our results indicated that the program effects were equivalent across professions, suggesting that it can be applicable to a variety of professionals working with children and families. By recognizing the interrelated nature and common experiences of various professions that serve children and families, the REAL Pro intervention has the potential to reach many groups of crucial service providers to boost their resilience and effectiveness. REAL Pro attempts to alleviate symptoms of stress and burnout across a range of care providers through streamlined and universally applicable methods, including learning more appropriate ways to understand and respond to stress, strengthening tools for tuning into oneself and the clients with whom one works, and cultivating a culture of compassion for self and others at work. These methods can reduce reactionary responses in providers and help them respond to difficult situations in a balanced way. In addition, these methods support providers’ capacities to respond to their own emotional needs and learn key skills that support them in their day-to-day lives. This study evaluating the REAL Pro intervention shares some of the same limitations as other similar intervention studies mentioned earlier (Hazen et al., 2020 ; Luthar & Mendes, 2020 ; Orsi et al., 2023 ). In this preliminary evaluation, the sample size was limited impacting the ability to detect small intervention effects. In addition, we were unable to include a control group for comparison, and participants self-selected into the study introducing potential bias relative to all the individuals who participated in the intervention. However, the REAL Pro intervention is scalable such that it may be universally applied to address staff well-being across a diverse spectrum of caring professionals. By improving well-being and emotional regulation, the REAL Pro intervention addresses both distinct and common challenges related to STS and burnout that are experienced in a variety of caregiving professions. As such, despite the limitations of this pilot study, the REAL Pro intervention shows promise for succeeding in its intended purpose and reaching a broad population. This study lays a foundation for further investigations of the REAL Pro intervention that aims to foster a thriving and resilient workforce that can deliver high-quality services to children and families. Future evaluations of REAL Pro would benefit from use of a more rigorous research design that includes a comparison group, randomized assignment to groups, and follow-up assessments. In addition, future evaluations could examine the impact of the intervention on organizational factors, such as contributing to a supportive, collegial environment that values staff well-being. Nonetheless, the results of this study suggest promising directions for REAL Pro to support the well-being of child and family serving professionals and quality of care they provide. Declarations Author Contribution L.L. and R.L. developed the intervention and designed the study. R.L., R.C., and M.A. implemented the intervention and oversaw data collection. L.L and K.S. conducted data analyses. L.L., R.C., I.B., and R.L. wrote the manuscript. All authors contributed to the interpretation of the results and to the final manuscript. Conflict of Interest The authors have no conflicts of interest to disclose. Data availability The dataset included in this study is not publicly available due to not having participant consent or IRB approval to make it publicly available. Data are available from the corresponding author upon reasonable request. References Andrew, Y. (2015). What we feel and what we do: Emotional capital in early childhood work. Early Years , 35(4), 351-365. DOI: 10.1080/09575146.2015.1077206 Braun, V., & Clarke, V. (2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology. https://doi.org/10.1080/14780887.2020.1769238 Brigham, T., Barden, C., Dopp, A. L., Hengerer, A., Kaplan, J., Malone, B., ... & Nora, L. M. (2018). A journey to construct an all-encompassing conceptual model of factors affecting clinician well-being and resilience. NAM perspectives , 8 (1), 201801b. Carver, C. S., M. F. Schneier, and J. K. Weintraub. 1989. “Assessing Coping Strategies: A Theoretically Based Approach.” Journal of Personality and Social Psychology 56 (2): 267–83. https://doi.org/10.1037/0022-3514.56.2.267. Castillo-Gualda, R., Herrero, M., Rodríguez-Carvajal, R., Brackett, M. A., & Fernández-Berrocal, P. (2019). The role of emotional regulation ability, personality, and burnout among Spanish teachers. International Journal of Stress Management , 26(2), 146-158 https://doi.org/10.1037/str0000098 Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. Psychological services , 11 (1), 75–86. https://doi.org/10.1037/a0033798 Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior , 385-396. https://www.jstor.org/stable/2136404 Cumming, T., & Wong, S. (2018). Towards a holistic conceptualisation of early childhood educators’ work-related well-being. Contemporary Issues in Early Childhood , doi:10.1177/146394911877257 Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research , 97 (2), 143–156. https://doi.org/10.1007/s11205-009-9493-y Figley, C. R. (2013). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Routledge. Ferrari, M., Hunt, C., Harrysunker, A. (2019) Self-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs. Mindfulness 10, 1455–1473. https://doi.org/10.1007/s12671-019-01134-6 Faulkner, M., Gerstenblatt, P., Lee, A., Vallejo, V., & Travis, D. (2016). Childcare providers: Work stress and personal well-being. Journal of Early Childhood Research , 14(3), 280-293. http://doi:10.1177/1476718x14552871 Gallup Organization (2014). State of America’s Schools: The Path to Winning Again in Education. https://www.gallup.com/education/269648/state-america-schools-report.aspx Grist, C. L., & Caudle, L. A. (2021). An examination of the relationships between adverse childhood experiences, personality traits, and job-related burnout in early childhood educators. Teaching and Teacher Education , 105, 103426. https://doi.org/10.1016/j.tate.2021.103426 Hazen, K. P., Carlson, M. L., Hatton-Bowers, H., Fessinger, M. B., Cole-Mossman, J., Bahm, J., Hauptman, K., Brank, E. M., & Gilkerson, L. (2020). Evaluating the Facilitating Attuned Interactions (FAN) approach: Vicarious Trauma, professional Burnout, and reflective practice. Children and Youth Services Review , 112 , 104925. https://doi.org/10.1016/j.childyouth.2020.104925 Hupe, T. M., & Stevenson, M. C. (2019). Teachers’ intentions to report suspected child abuse: The influence of compassion fatigue. Journal of Child Custody , 16(4), 364-386. https://doi.org/10.1080/15379418.2019.1663334 Jun, J., Oiemeni, M.M., Kalamani, R., Tong, J. Crecelius, M.L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review, International Journal of Nursing Studies, 119, https://doi.org/10.1016/j.ijnurstu.2021.103933. Kerig, P. K. (2018). Enhancing Resilience Among Providers of Trauma-Informed Care: A Curriculum for Protection Against Secondary Traumatic Stress Among Non-Mental Health Professionals. Journal of Aggression, Maltreatment & Trauma , 28(5), 613–630. https://doi.org/10.1080/10926771.2018.1468373 Lamson, A., Meadors, P., Mendenhall, T. (2014). Working with Providers and Healthcare Systems Experiencing Compassion Fatigue and Burnout. In: Hodgson, J., Lamson, A., Mendenhall, T., Crane, D. (eds) Medical Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-03482-9_7 Long, R., B., Kennedy, M., Spink, K. M., Lengua, L. J. (2023). Promoting college student and staff well-being through a mindfulness-based coping program. OBM Integrative and Complementary Medicine, 8(3), 1-41. Luthar, S. S., & Mendes, S. H. (2020). Trauma-informed schools: Supporting educators as they support the children. International Journal of School & Educational Psychology, 8 (2), 147–157. https://doi.org/10.1080/21683603.2020.1721385 Madigan, D.J., & Kim, L.E. (2021). Does teacher burnout affect students? A systematic review of its association with academic achievement and student-reported outcomes, International Journal of Educational Research , 105, https://doi.org/10.1016/j.ijer.2020.101714. Meadors, P., Lamson, A., Swanson, M., White, M., & Sira, N. (2010). Secondary Traumatization in Pediatric Healthcare Providers: Compassion Fatigue, Burnout, and Secondary Traumatic Stress. OMEGA - Journal of Death and Dying , 60(2), 103–128. doi:10.2190/om.60.2.a Miller, K. & Flint-Stipp, K, (2019). Preservice Teacher Burnout: Secondary Trauma and Self-Care. Issues in Teacher Education, 28(2) , 28-45. https://eric.ed.gov/?id=EJ1239631 Mulyani, S., Salameh, A. A., Komariah, A., Timoshin, A., Hashim, N. M. Z., Fauziah, R. S. P., Mulyaningsih, M., Ahmad, I., & Din, S. M. U. (2021). Emotional Regulation as a Remedy for Teacher Burnout in Special Schools: Evaluating School Climate, Teacher’s Work-Life Balance and Children Behavior. Frontiers in Psychology , 12. https://doi.org/10.3389/fpsyg.2021.655850 Neff, K. D. (2009). The Role of Self-Compassion in Development: A Healthier Way to Relate to Oneself. Human development , 52(4), 211–214. https://doi.org/10.1159/000215071 Ormiston, H. E., Nygaard, M. A., & Apgar, S. (2022). A Systematic Review of Secondary Traumatic Stress and Compassion Fatigue in Teachers. School Mental Health , 14(4), 802–817. https://doi.org/10.1007/s12310-022-09525-2 Orsi, R., Harrison, C. L., Rockwell, K. E., & Barbee, A. P. (2023). Addressing Secondary Traumatic Stress, Burnout, Resilience and Turnover in the Child Welfare Workforce: Results from a 6-Month, Cluster-Randomized Control Trial of Resilience Alliance. Children and Youth Services Review , 151 , 107044. https://doi.org/10.1016/j.childyouth.2023.107044 Park, E. Y., & Shin, M. (2020). A meta-analysis of special education teachers’ burnout. Sage Ope n, 10(2), https://doi.org/10.1177/215824402091829 Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self‐Compassion Scale. Clinical Psychology & Psychotherapy , 18 (3), 250–255. https://doi.org/10.1002/cpp.702 Ramdan, I. M., Yasinta, E., & Suhatmady, B. (2020, April). Burnout and related factors amongst special school teachers in samarinda. Atlantis Press , 67-71. https://doi/10.2991/assehr.k.200417.015 Sandilos, L. E., Goble, P., & Schwartz, S. L. (2020a). Burnout and Teacher–Child Interactions: The Moderating Influence of SEL Interventions in Head Start Classrooms. Early Education and Development, 31(7), 1169–1185. https://doi.org/10.1080/10409289.2020.1788331 Sinclair, S., Raffin-Bouchal, S., Venturato, L., Mijovic-Kondejewski, J., & Smith-MacDonald, L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature. International journal of nursing studies , 69, 9-24. https://doi.org/10.1016/j.ijnurstu.2017.01.003 Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The Brief Resilience Scale: Assessing the Ability to Bounce Back. International Journal of Behavioral Medicine 15(3), 194–200. https://doi.org/10.1080/10705500802222972 Stamm, B. H. (2010). The Concise ProQOL Manual, 2nd Ed. (p. 74). www.ProQOL.org Thomas, R., & Wilson, J. (2004). Issues and controversies in the understanding and diagnosis of compassion fatigue, vicarious traumatization and secondary traumatic stress disorder. International Journal of Emergency Mental Health , 6, 81-92. Victor, S. E., & Klonsky, E. D. (2016). Validation of a brief version of the Difficulties in Emotion Regulation Scale (DERS-18) in five samples. Journal of Psychopathology and Behavioral Assessment , 38 (4), 582–589. https://doi.org/10.1007/s10862-016-9547-9 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3912071","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273854292,"identity":"dd1f02e3-81c3-4de9-b4bf-cd4a54e5e742","order_by":0,"name":"Liliana J. Lengua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoklEQVRIiWNgGAWjYBACPmbmhgNAWg7M4yFGCxszI1iLMQlaGBgbQHRiA/Fa2BkbD/zcYZe+4UYC44O3bUQ67GDvmeRcoBZmw7nEajnA28acu+F2Aps0L9G2/G2rTze4ncD+m2gth3nbDicAtbAxE69Ftu244cz7D5sl55wjQgs//+HDH9+2VcvznTl88MObMiK0IAFIBI2CUTAKRsEooAYAADBxNNRHTttwAAAAAElFTkSuQmCC","orcid":"","institution":"University of Washington","correspondingAuthor":true,"prefix":"","firstName":"Liliana","middleName":"J.","lastName":"Lengua","suffix":""},{"id":273854293,"identity":"33599740-2006-4df1-b13f-bf7dd14846cb","order_by":1,"name":"Rebecca Calhoun","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Calhoun","suffix":""},{"id":273854294,"identity":"f69a7fad-293b-43f2-84f8-b9bc57bbecbc","order_by":2,"name":"Ignatius Balinbin","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Ignatius","middleName":"","lastName":"Balinbin","suffix":""},{"id":273854295,"identity":"c912e46d-257b-431c-a67b-894012b9c636","order_by":3,"name":"Robyn Long","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Robyn","middleName":"","lastName":"Long","suffix":""},{"id":273854296,"identity":"74e62d56-3709-4ac2-9317-84bbe5ccaf1f","order_by":4,"name":"Katie Malloy Spink","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"Malloy","lastName":"Spink","suffix":""},{"id":273854297,"identity":"a2bd3fa9-3ad4-41ee-959f-a0f1920ce2ca","order_by":5,"name":"Marie Angeles","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Angeles","suffix":""}],"badges":[],"createdAt":"2024-01-31 00:44:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3912071/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3912071/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62756403,"identity":"2e978968-691a-4193-9e62-3fd4eb91c514","added_by":"auto","created_at":"2024-08-19 06:42:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":738920,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3912071/v1/eb321c2a-a410-41eb-9b10-2dffe643213c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Well-being Promotion Program Increases Self-Compassion, Resilience and Active Coping among Providers Who Work with Children and Families","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe well-being of professionals engaged in child and family services impacts the quality and efficacy of their work (Salamehe et al., 2021). Among these service providers, including early childhood educators, K-12 educators, community-based organization staff, and medical personnel, there are substantial levels of secondary trauma symptoms and burnout (Faulkner et al.,2016; Grist \u0026amp; Caudle, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lamson et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ormiston et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Research examining the well-being of service providers often focuses exclusively on the well-being of one professional group at a time. Focusing on a single professional population restricts the sample, consequently limiting our understanding of the intersectional impacts of secondary trauma symptoms and burnout across a variety of professions (Ormiston et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). In turn, this hinders the development of interventions that can be effectively implemented in various contexts. In order to provide high-quality care for a broad spectrum of individuals in caring professions, it is necessary to identify interventions that reduce secondary trauma symptoms and burnout and promote well-being in providers across professions. This study examined the effectiveness of a well-being and resilience promotion program with early childhood and K-12 educators, community-based organization staff, and medical personnel who work with children and families.\u003c/p\u003e\n\u003cp\u003eAcross caregiving professions, levels of stress are high. The 2013 \u003cem\u003eGallup-Health-Well-Being Index\u003c/em\u003e found that 46% of teachers in K-12, 46% of nurses and 45% of physicians report high levels of daily stress, which is the highest among the 14 professional categories included in the study (Gallup, 2014). Additionally, secondary traumatic stress (STS) and burnout are often seen in the context of professions that demand high levels of emotional labor and caregiving, such as healthcare, education, and social services (Lamson et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e; Mulyani et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sinclair et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Emotional distress resulting from indirect exposure to a traumatic experience, typically in care professions, can lead to STS (Sinclair et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ormiston et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). The clinical manifestations of STS are comparable and almost identical to those seen in Post-Traumatic Stress Disorder (PTSD). Affected individuals may experience symptoms such as avoidance, arousal, and feeling that they are re-living the traumatic event (Lamson et al., \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e; Thomas \u0026amp; Wilson, \u003cspan class=\"CitationRef\"\u003e2004\u003c/span\u003e). Professionals who work in caregiving roles are at risk for developing STS due to empathically engaging with individuals who have experienced trauma (Ormiston et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). In addition, individuals in these professional roles can also experience burnout, which describes a state of chronic physical and emotional exhaustion that may include feelings such as reduced accomplishment and depersonalization, a sense of detachment from oneself, or a loss of personal identity (Andrew, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Cumming \u0026amp; Wong, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). STS and burnout can induce heightened irritability, negative self-perceptions, and erosion of emotional reserves. Further, experiencing STS or burnout can decrease one\u0026rsquo;s capacity for attention to detail and can hinder the formation of meaningful, trusting relationships, thus compromising the overall quality of care, and evidencing the need for prompt and evidence-based intervention (Lamson et al., 2010; Ormiston et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe spectrum of child and family service providers includes early childhood and K-12 educators, community-based organization staff, and medical personnel. STS and burnout have been shown to reduce these professionals\u0026rsquo; capacity to provide quality care. One study found that the incidence of depressive symptoms in early childhood educators predicted poorer education quality, which, in turn, was related to worse cognitive outcomes for the learning children (Miller \u0026amp; Flint-Stipp, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). This suggests that educator depression negatively impacted children\u0026rsquo;s cognitive outcomes, with the quality of education acting as a mediator in this relationship. Additionally, systematic review found evidence that teacher burnout is associated with worse academic achievement and lower quality student motivation (Madigan \u0026amp; Kim, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Another systematic review found that nurse burnout is associated with worsening safety and quality of care, as well as decreased patient satisfaction (Jun et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eCurrently, there are several existing programs that seek to ameliorate the high levels of stress and burnout for caring professionals. While these programs have yielded some positive results, the studies all have important limitations to consider. The Facilitating Attuned Interactions (FAN) approach represents one example of a program that, despite employing an intricate 15-month mentorship process, did not conclusively reduce burnout among child welfare professionals (Hazen et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Similarly, Orsi et al.\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) Resilience Alliance (RA) intervention failed to significantly influence job satisfaction and turnover rates, despite showing some impact on turnover ideation. While Luthar \u0026amp; Mendes (\u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e) were able to illuminate some of the unique challenges faced by educators working through traumatic environments, their study\u0026rsquo;s limited sample size raised concerns about its generalizability.\u003c/p\u003e\n\u003cp\u003eThe REAL Pro (REsilient Attitudes and Living for Professionals) intervention, a multi-profession program designed to enhance well-being and mitigate stress and burnout among service providers, offers an innovative solution by integrating universal principles that are applicable across various professional groups. Rather than an emphasis on the unique stressors faced by each profession, evidence-based cognitive-behavioral and mindfulness practices form the foundation of the intervention; the versatility of these techniques provides a broad but effective means for fostering emotional regulation and resilience (Neff, \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e; Castillo-Gualda, 2019). REAL Pro is a relatively brief, 9-to-12-hour intervention, typically delivered across 6 sessions that each focus on developing practical emotion regulation and coping skills that professionals can integrate into their day-to-day life and work.\u003c/p\u003e\n\u003cp\u003eIn this study, we expected that, across diverse professions, those who participated in the intervention would cultivate improved capacities for self-compassion, emotional regulation and effective coping strategies. In this way, stress and burnout should be reduced in these individuals, thus supporting the intervention\u0026rsquo;s wide-reaching applicability. By implementing and evaluating the REAL Pro intervention, this study aimed to establish a novel mechanism for reducing STS and burnout and improving well-being in providers across various care settings. We conducted a preliminary evaluation of the REAL Pro intervention to explore its potential effectiveness in promoting provider well-being. By performing pre- and post-test analyses of participants\u0026rsquo; perceived stress, emotional regulation, and overall well-being, this study aimed to provide preliminary evidence of the REAL Pro intervention's impact on these professional groups and evaluate the best practices for its successful implementation.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eOver a 2-year period, 193 professionals who work with children, youth and families participated in REAL Pro training as part of professional development in their respective work settings. Work settings included organizations offering early childhood and after-school programs to families in low-income contexts; K-12 public school educators of an urban public school with 32% of families qualifying for free and reduced lunch, 54% BIPOC, and 21% non-English speaking background; and medical professionals working at a university hospital that provides 60% of hospital charity care and 50% of hospital care for Medicaid recipients in the county in which it is located. All participants were invited to enroll in the evaluation study and complete pretest and posttest assessments, and of those, 136 (70%) enrolled. Professionals enrolled in the evaluation included early childhood educators (n\u0026thinsp;=\u0026thinsp;87), K-12 educators (n\u0026thinsp;=\u0026thinsp;40), medical providers (n\u0026thinsp;=\u0026thinsp;35), and staff who work with K-12 age youth in out-of-school or after-school services (n\u0026thinsp;=\u0026thinsp;31). Three of the agencies had a strong dual language program for English language learners. Of those enrolled in the study, 98 (72%) completed posttest assessments. As a result of additional funding available at one early childhood site, a small number of participants (n\u0026thinsp;=\u0026thinsp;11) were asked to complete a 3- month follow-up assessment. In addition, nine participants from that site volunteered to participate in a focus group for the qualitative component of this research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cp\u003eThere were 3 staff facilitators, all of whom had multiple years of related training and experience. Two programs were delivered in-person at the workplace setting, and the remaining eight were delivered online due to the COVID19 pandemic related closures. For this study, the program was implemented 10 times and was adapted in length and format to meet the needs of the organizations participating. As such, 7 cohorts met weekly for 90 minutes for 6 weeks, 1 cohort met weekly for 60 minutes for 8 weeks, 1 cohort met for three 2-hour workshops and 1 cohort met for two 6-hour workshops. All study procedures were approved by the University of Washington\u0026rsquo;s Human Subjects Division, and participant informed consent was obtained from all participants prior to their participation in the research. Two weeks prior to the start of each program, group participants were sent an email asking them to participate in the research study and complete an online survey. Immediately following the program, participants were again prompted to complete the research survey. Participants at one site were also invited to complete a 3-month follow up assessment. Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at the University of Washington (Harris et al. 2009). REDCap is a secure, web-based software platform designed to support data capture for research studies. Participants were compensated \u003cspan\u003e$\u003c/span\u003e20 and \u003cspan\u003e$\u003c/span\u003e25 for completing the pre- and post-test surveys, respectively. All program attendees were additionally asked to complete a feedback survey at the end of the program.\u003c/p\u003e \u003cp\u003e In order to gain a deeper understanding of participants' experiences with REAL Pro, we conducted a focus group at one of the research sites. The focus group was held online via Zoom with nine participants, who were all staff members from the same site. All staff members who had attended REAL Pro training were sent an invitation via email to participate in a focus group. They signed up to participate via an online form, were allowed work time to attend, and were provided a \u003cspan\u003e$\u003c/span\u003e20 gift card as compensation. To limit bias, the focus group was led by two of the co-authors who were not part of the intervention or quantitative data collection and analyses. The group lasted one hour and was led using a semi-structured format with questions prepared in advance with spontaneous follow-up questions and prompts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eREAL Pro (Resilient Attitudes \u0026amp; Living for Professionals) is a mindfulness and self-compassion based coping enhancement program grounded in psychology, neuroscience, and contemplative practice research. Each session includes a mix of mindfulness practices (e.g., breath awareness, Hatha yoga, guided meditation practices) and cognitive behavioral emotion regulation skills (e.g., cognitive reframing, balanced decision making, radical acceptance, stress tolerance). The content focuses on promoting personal well-being while also supporting the socio-emotional development of children, improving relationships with colleagues and families, and building a culture of compassion and resilience at work. (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eREAL Pro Intervention Content\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelated Practices\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStress \u0026amp; Resilience overview\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePhysiological stress response and how stress affects us mentally, emotionally and physically.\u003c/p\u003e \u003cp\u003eHow mindfulness and self-compassion support resilience and well-being.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Body Scan\u003c/p\u003e \u003cp\u003e● Yoga\u003c/p\u003e \u003cp\u003e● Tuning into the Breath\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNoticing Our Thoughts\u003c/b\u003e\u003c/p\u003e \u003cp\u003eLearning to notice the mind\u0026rsquo;s patterns and to identify and label thoughts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Labeling Thoughts\u003c/p\u003e \u003cp\u003e● Sounds \u0026amp; Thoughts Meditation\u003c/p\u003e \u003cp\u003e● Mindfulness of the Senses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWise Mind\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAwareness of the benefits of balancing emotion and reason to make decisions and be effective.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Wise Mind Breathing\u003c/p\u003e \u003cp\u003e● Be in the Pause\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotion Regulation\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePurpose of emotions and goals of emotion regulation.\u003c/p\u003e \u003cp\u003eNormalizing emotional experiences.\u003c/p\u003e \u003cp\u003eUnderstanding how culture and family affect emotional acceptance and expression.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● +\u0026thinsp;2 Breathing\u003c/p\u003e \u003cp\u003e● Yoga\u003c/p\u003e \u003cp\u003e● 3\u0026thinsp;\u0026minus;\u0026thinsp;2\u0026ndash;1\u003c/p\u003e \u003cp\u003e● Willing Hands\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWindow of Tolerance\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWhat expands or shrinks our ability to cope.\u003c/p\u003e \u003cp\u003eDiscussion of in the moment coping tools.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● The 3 Ps: pause, be present, proceed\u003c/p\u003e \u003cp\u003e● Progressive Muscle Relaxation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadical Acceptance\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNavigating situations we cannot change.\u003c/p\u003e \u003cp\u003eIdentifying our locus of control when faced with challenging situations.\u003c/p\u003e \u003cp\u003eIdentifying ways to support oneself in these situations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Radical Acceptance worksheet\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommon Humanity\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRecognizing interconnectedness.\u003c/p\u003e \u003cp\u003eDeveloping the ability to intentionally feel connected to others.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● Just Like Me\u003c/p\u003e \u003cp\u003e● Peace \u0026amp; Kindness (metta practice)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-Compassion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHow self-compassion supports resilience.\u003c/p\u003e \u003cp\u003eNoticing the inner voice/critic.\u003c/p\u003e \u003cp\u003eModeling self-compassion with families.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e● How would I treat a friend?\u003c/p\u003e \u003cp\u003e● Self-Compassion Break\u003c/p\u003e \u003cp\u003e● Breathing with Anchor Phrases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eFor the quantitative assessment, participants completed self-report measures assessing self-compassion, perceived stress, emotion regulation, coping, indicators of well-being including resilience and flourishing, and indicators of professional burnout and secondary traumatic stress. Measures were selected to assess the targets of the program including reducing stress, improving emotion regulation, enhancing active coping, and promoting well-being.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePerceived Stress\u003c/b\u003e was assessed using the 10-item Perceived Stress Scale (PSS; Cohen et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1983\u003c/span\u003e) which assesses current levels of perceived stress (6 items) and appraisal of ability to cope with stress (4 items). Internal consistency was \u0026#120572; = .68 in this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf-Compassion\u003c/b\u003e was measured using the 12-item Self-Compassion Scale-Short Form (Raes et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) which assesses dimensions of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification on 5-point scale (1\u0026thinsp;=\u0026thinsp;almost never \u0026ndash; 5\u0026thinsp;=\u0026thinsp;almost always). Response options include \u0026ldquo;I\u0026rsquo;m intolerant and impatient towards those aspects of my personality I don\u0026rsquo;t like,\u0026rdquo; and \u0026ldquo;I try to see my failings as a part of the human condition\u0026rdquo;. Internal consistency of .80 \u0026minus;\u0026thinsp;.92 has been reported and was \u0026#120572; = .89 in this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEmotion Dysregulation\u003c/b\u003e was measured using the brief 18-item Difficulties in Emotion Regulation Scale (Victor \u0026amp; Klonsky, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), scored so that it represented deficits in awareness, understanding, and acceptance of emotions, impulse control, and access to emotion regulation strategies. Participants rate statements such as \u0026ldquo;I pay attention to how I feel,\u0026rdquo; and \u0026ldquo;When I am upset, I become out of control,\u0026rdquo; on a 5-point scale (1\u0026thinsp;=\u0026thinsp;almost never \u0026ndash; 5\u0026thinsp;=\u0026thinsp;almost always). Internal consistency reliability of .97 has been reported and was .91 in this study.\u003c/p\u003e \u003cp\u003e\u003cb\u003eCoping\u003c/b\u003e was assessed using the 24-item short form of the Brief COPE inventory (Carver et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1989\u003c/span\u003e), which asks participants what they do or feel during a stressful event. In this study, we assessed engagement strategies, which combined active (i.e. \u0026ldquo;I concentrate my efforts on doing something about it\u0026rdquo;), planning (i.e. \u0026ldquo;I make a plan of action\u0026rdquo;), positive reappraisal (i.e. \u0026ldquo;I try to see it in a different light, to make it seem more positive\u0026rdquo;), and acceptance (i.e. \u0026ldquo;I get used to the idea that it happened\u0026rdquo;) coping strategies, with \u0026#120572; = .83. We also assessed denial (i.e. \u0026ldquo;I refuse to believe that it has happened\u0026rdquo;) as a disengagement strategy, with \u0026#120572; = .82.\u003c/p\u003e \u003cp\u003e \u003cb\u003eWell-being\u003c/b\u003e was indicated with measures of resilience and flourishing. On the 6-item Brief Resilience Scale (Smith et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) respondents indicated on a 5-point scale their ability to cope with and recover from stressful situations (1\u0026thinsp;=\u0026thinsp;strongly disagree \u0026ndash; 5\u0026thinsp;=\u0026thinsp;strongly agree). Examples include \u0026ldquo;I tend to bounce back quickly after hard times,\u0026rdquo; and \u0026ldquo;I have a hard time making it through stressful events\u0026rdquo;. Internal consistency ranging from .80 \u0026minus;\u0026thinsp;.91 has been reported, and was .87 in this study. Well-being was also assessed using the 8-item Flourishing Scale (Diener et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Respondents indicate on a 7-point scale (1\u0026thinsp;=\u0026thinsp;strongly disagree \u0026ndash; 7\u0026thinsp;=\u0026thinsp;strongly agree) their agreement with items such as \u0026ldquo;I am engaged and interested in my daily activities,\u0026rdquo; and \u0026ldquo;I lead a purposeful and meaningful life\u0026rdquo;. Alpha was .87.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBurnout and secondary traumatic stress\u003c/b\u003e were assessed using 2 subscales (10 items each) from the Professional Quality of Life Measure (ProQOL; Stamm, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Participants rated items assessing feeling overwhelmed, worn out, ineffective and unsupported in their work. Internal consistency reliabilities were \u0026#120572; = .64 for burnout and \u0026#120572; = .87 for secondary traumatic stress in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalytic Plan\u003c/h2\u003e \u003cp\u003eThe aim of the study was to evaluate the benefit of REAL Pro to providers and staff who work with children and families. Dependent measures t-tests were conducted to examine changes in outcomes from pretest to posttest. Intent to treat analyses were used such that everyone enrolled in the study was included in analyses regardless of their degree of participation. Missing posttest values were substituted with the sample posttest mean value. Consequently, analyses were conducted on the 136 providers who enrolled in the study and completed pretest surveys. Mean-value substitution addresses bias potentially introduced by attrition while preserving power for analyses and preserving the estimate of the magnitude of the effect. Additional dependent measures t-test were conducted to assess the degree of change from pretest to follow-up assessments in the small number (n\u0026thinsp;=\u0026thinsp;11) of participants who were asked to complete a 3-month follow-up assessment (all participants at one early childhood site). These analyses provide preliminary evidence about whether program benefits continued or were maintained over time.\u003c/p\u003e \u003cp\u003eQualitative analyses were conducted for a focus group held with a sub-sample at one early childhood education site serving families living in low-income contexts. Participants were informed that the purpose of the group was to provide insight into what worked well, what was useful to them and what didn\u0026rsquo;t work as well in the REAL Pro sessions in order to improve the program for others. Participants were first asked a series of questions regarding what was good about the program including: 1) What moments or lessons stand out in your mind as the most valuable or important? 2) What aspects of REAL Pro have you carried forward into your life? 3) Do you have any reflections on how this program has affected your work community? The participants were then asked to share what they would change or improve: 1) Suppose that you were in charge and could make one change that would make the program better. What would you do? 2) What else could be improved? Any other suggestions for improvement? The participants were also asked how they would describe the program to someone else, a friend or family member.\u003c/p\u003e \u003cp\u003e The focus group was recorded and transcribed with participants\u0026rsquo; names redacted for analysis with both facilitators reviewing the transcript for accuracy. Transcripts were coded and thematic analysis was conducted by the author and one research coordinator. Codes were developed through an iterative process by the two coders to ensure consistency in coding and themes were developed independently and finalized by consensus.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003ePreliminary Analyses\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eMissing data.\u003c/strong\u003e Cases with complete data (n\u0026thinsp;=\u0026thinsp;98), that is both pre- and posttest assessments, were compared with those missing data (n\u0026thinsp;=\u0026thinsp;38) to assess the potential for bias introduced by attrition. There were no differences on pretest variables related to missingness. The magnitude of the effects of missingness were small for all variables (r\u0026thinsp;=\u0026thinsp;.01 to .11), indicating that little bias was introduced by missing posttest responses. To determine whether rates of missing data differed by provider group, \u0026chi;\u003csup\u003e2\u003c/sup\u003e tests were conducted, and all tests were nonsignificant indicating that the provider groups completed surveys at similar rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProvider group related to pretest levels.\u003c/strong\u003e We examined whether the provider groups differed in their pretest levels on study variables. Early childhood educators reported higher levels of self-compassion (r\u0026thinsp;=\u0026thinsp;.18, p\u0026thinsp;=\u0026thinsp;0.034), whereas K-12 teachers reported lower levels (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.18, p\u0026thinsp;=\u0026thinsp;0.038). Youth providers reported greater difficulties with emotion regulation (r\u0026thinsp;=\u0026thinsp;.19, p\u0026thinsp;=\u0026thinsp;0.026) and higher perceived stress (r\u0026thinsp;=\u0026thinsp;.21, p\u0026thinsp;=\u0026thinsp;0.018). Early childhood educators reported more use of denial coping (r\u0026thinsp;=\u0026thinsp;.22, p\u0026thinsp;=\u0026thinsp;0.010) while providers in medical settings reported less denial coping (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.21, p\u0026thinsp;=\u0026thinsp;0.017). To assess whether intervention effects depended on the provider groups, multiple regressions were conducted regressing posttest values on pretest levels and all the provider group status indicators. None of the effects of provider group status was significant indicating that rank order changes from pretest to posttest were not different across the provider groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eIntervention Effects\u003c/h2\u003e\n\u003cp\u003eThe correlations among all study variables are provided in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e includes pretest (n\u0026thinsp;=\u0026thinsp;136), posttest (n\u0026thinsp;=\u0026thinsp;98) and follow-up (n\u0026thinsp;=\u0026thinsp;11) means and standard deviations. Intent to treat analyses were conducted with sample mean replacement for missing posttest data. Dependent-sample paired t-test analyses tested differences from pretest to posttest, and Cohen\u0026rsquo;s repeated measures \u003cem\u003ed\u003c/em\u003e provided an estimate of intervention effect sizes. Results showed significant improvements in self-compassion, active coping and emotion dysregulation, with moderate effect sizes. There was a trend towards improved resilience as well. There were no significant mean differences from pretest to posttest for perceived stress, denial coping, flourishing, burnout or secondary traumatic stress.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCorrelations among study variables at pretest.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eED\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFL\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBO\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eReducing Stress\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-compassion (SC)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePerceived Stress (PS)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.555**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmotion Regulation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmo Dysregulation (ED)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.620**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.498**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive Coping (AC)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.549**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.305**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.274**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDenial (DE)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.386**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWell-being\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFlourishing (FL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.635**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.355**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.427**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.503**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResilience (RE)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.661**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.503**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.572**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.449**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.537**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBurnout (BO)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.291**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.231**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.187*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e--\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary Trauma (ST)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.418**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.433**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.515**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.289**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.395**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.377**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.289**\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;.01\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eObserved means, standard deviations, dependent sample t-tests for complete cases for pretest to posttest change, pretest to follow-up change, and intervention effect sizes.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePretest\u003c/p\u003e\n\u003cp\u003eM(SD)\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;136\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePosttest M(SD)\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;98\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFollow-up\u003c/p\u003e\n\u003cp\u003eM(SD)\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePre/posttest\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDifference\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003et-test, p-value\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(df\u0026thinsp;=\u0026thinsp;135)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCohen\u0026rsquo;s d\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRepeated\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePre/Follow-up Difference\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003et-test, p-value\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(df\u0026thinsp;=\u0026thinsp;10)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReducing Stress\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-compassion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.03(0.77)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.20(0.56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.70(0.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.30, 0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.07, 0.012\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePerceived Stress\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.15(0.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.08(0.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.86(0.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.52, 0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.09, 0.301\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmotion Regulation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmo Dysregulation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.53(0.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.41(0.47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.02(0.36)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.12, 0.036\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.08, 0.307\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActive Coping\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.95(0.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.03(0.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.17(0.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.17, 0.032\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.53, 0.607\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDenial\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.38(0.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.43(0.54)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.45(0.65)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.78, 0.437\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.30, 0.223\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWell-being\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFlourishing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.72(0.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.81(0.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.15(0.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.50, 0.136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.27, 0.233\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResilience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.16(0.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.27(0.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.83(0.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.85, 0.067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.00, 0.341\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBurnout\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.36(0.39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.34(0.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.14(0.18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.64, 0.523\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.72, 0.022\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary Trauma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.48(0.66)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.42(0.56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.91(0.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.19. 0.236\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.01, 0.013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eDependent-sample paired t-tests were also conducted to examine change from pretest to follow-up in the small sample from which follow-up assessments were obtained. A significant difference on self-compassion from pretest suggests significant improvements at posttest were maintained. Significant differences from pretest to follow-up on burnout and secondary traumatic stress emerged when there were not significant differences from pretest to posttest. This might be an artifact of the small subsample of participants who were asked to complete a follow-up assessment, or it could suggest a delayed effect of the program on burnout and secondary trauma. To explore this, differences from posttest to follow-up were examined. There was a significant decrease in secondary traumatic stress from posttest to follow-up (\u003cem\u003et\u003c/em\u003e[10]\u0026thinsp;=\u0026thinsp;4.908, p\u0026thinsp;=\u0026thinsp;0.001) and a trend toward a decrease in burnout (\u003cem\u003et\u003c/em\u003e[10]\u0026thinsp;=\u0026thinsp;1.785, p\u0026thinsp;=\u0026thinsp;0.104).\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eAcceptability\u003c/h2\u003e\n\u003cp\u003eThe REAL Pro program also showed high acceptability, with participants reporting high levels of satisfaction and positive feedback. All participants in the program (193), not only those participating in the evaluation study, were invited to complete program feedback surveys, and 183 (95%) program participants completed the feedback survey. Responses showed that 98% (179/183) of respondents indicated the program content was useful and interesting; 97% (177/183) would recommend the program to colleagues; and 96% (175/183) reported the skills help with managing emotions and coping with challenging situations. Themes in feedback surveys indicated that staff have integrated coping skills into their workdays, enhanced their ability to model self-regulation skills with children, and that teams found a common language to discuss stress and well-being.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eQualitative\u003c/h2\u003e\n\u003cp\u003eThemes emerged in three categories from the focus group:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eBenefits of the program\u003c/strong\u003e: Individual benefits to the participants themselves; practical tools or skills used with children and families; and strengthening a sense of community among staff at the center.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eAspects of the program that allowed for the above benefits to be realized included\u003c/strong\u003e the space created by the facilitators felt safe; the program and facilitators were flexible, and adaptations were made to meet the needs of the group; and practices and concepts were introduced that provided valuable ongoing support.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eProgram Improvement\u003c/strong\u003e suggestions included lengthening the program or having additional ongoing support.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eIn presenting the results, we are intentionally relying on quotes from the participants to honor the perspective and framing that they, personally, gave to their experiences in REAL Pro. Quotations are indented and led by the study identification number assigned to the participant being quoted.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1. Benefits of the program\u003c/em\u003e: Participants described the benefits of the program for them personally as a \u0026ldquo;release\u0026rdquo; from stress, anxiety and pressures with all participants agreeing with the ones who shared this. The sessions themselves provided time for release and the content provided support for participants to care for themselves.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e103: ...it's helped me calm myself, help my anxiety, help my stress level, give me a release.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e106: I think it was a good time for us to kind of just release and unravel from everything that's been going on.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e109: Yes, I agree [with release] somehow teaching us how to let go of situations that are uncertain and remain focused on the here and now.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants also discussed practical ways they applied skills learned in REAL Pro when working with children, interacting with parents, or to support themselves in difficult moments.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e101: \u0026hellip;with REAL Pro we've been able to apply it to our daily life, like, whether it be our home life or work life, like it's something that's practical that you can change. You can use it not only with yourself but with your students as well.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e103: ...when I am in the classroom with students, it is magical to see these 3\u0026ndash;5 year olds close their eyes, and sit calmly and use this practice as a group.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e104:...you know we're in a meeting and I'm thinking to myself okay you've got to, you've got to breathe yourself, you've got to remember, Just Like Me [a compassion-based practice]. And if my Window of Tolerance [a stress tolerance model] is closing, what am I going to do to change that?\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants discussed the importance of the sense of community and authenticity that REAL Pro supported among the organization\u0026rsquo;s staff with all participants in agreement that REAL Pro built trust among staff. Participants shared:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e106: \u0026hellip;[REAL Pro] was a great opportunity for us to be real and be authentic with each other in terms of, like, how we were feeling with our emotions and our struggles and I think that that in itself, like, it helped generate a lot of, like, trust and respect within each other.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e105: I think [REAL Pro] has given us techniques that help with communication among ourselves.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e104: I think [REAL Pro] helped foster a sense of community that wasn't there when some people were at home, some people were in the building, there were a lot of external forces that were putting pressure on people\u0026hellip;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen asked what aspects of REAL Pro they had carried forward into their lives, participants identified four in-the-moment coping skills (ranging from breathing to sensory practices), two compassion-based practices, and a mindfulness-based body scan.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e2. Aspects of the program that allowed for the above benefits to be realized:\u003c/h2\u003e\n\u003cp\u003eThe positive regard for the program shared by participants was attributed largely to the facilitators\u0026rsquo; ability to create an environment that felt safe and supportive to the participants. One participant described the program as \u0026ldquo;genuine and real\u0026rdquo; and said the facilitators \u0026ldquo;are like one of us\u0026rdquo; (participant 103). Other participants noted:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e108: I truly believed that they accepted me right where I was. There was no prerequisites\u0026hellip; I didn't have to show up any kind of way, I didn't have to filter myself in any kind of way\u0026hellip;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI always felt [I was] an equal participant\u0026hellip;they were just so inclusive - so inclusive.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e104: Like you were really heard and listened and valued and that carried over each week.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOne participant specifically identified the importance of having a facilitator of color leading the program contributing to the sense of safety.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e106: I think that it was really helpful that we had a person of color kind of lead us into this, because I think you know as a [ethnicity removed to protect identity] woman, like, I'm not really raised on the idea of emotion. I'm not really raised to, you know, talking about, like, my anxiety and stuff and having, like, just that representation there \u0026hellip; And every time that I shared I felt seen in that sense\u0026hellip;we have a lot of POC and BIPOC\u0026hellip; People were just more comfortable in that sense, and it made everyone feel heard and seen\u0026hellip;it's super important that we're talking about certain things and that we\u0026rsquo;re being represented in that way.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAnother aspect of building a sense of safety that participants described was the facilitators\u0026rsquo; ability to be responsive to the participants and situations unfolding at their center and in society. For example, a participant noted that the facilitators were mindful of when to have Zoom breakout groups by teams or have managers in a different group due to power dynamics.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e101: I remember one day when stuff happened there was like a whole bunch of us that just, we were drained and did not want to talk and so they said, private message me if you don't want to talk. And they put us in separate groups, of groups that wanted to talk with each other and groups that just sat there and were silent for a little bit.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e3. Program Improvement\u003c/em\u003e: When asked for ways they would change the program to make it better, participants were quick to indicate how much they appreciated the program, including expressing deep appreciation for the facilitators. There was agreement that they want more of this programming in an ongoing way and one also speculated that it may have been even better in-person if that had been a possibility given the pandemic.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cem\u003e107: I wish we meet them on weekly basis\u003c/em\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e101: \u0026hellip;if it was available it'd be awesome if we could have that resource at our Center, like, have someone there in the moment or maybe even have them available through zoom I guess\u0026hellip; in the moment (when you are) needing help, or that day needing help.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOne participant also indicated they would like more direct support for implementing mindfulness with the families they work with.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e104: We want to bring a parent group together \u0026hellip; I am pretty new at this whole mindfulness thing so like it would have been helpful if it was kind of pre-packaged like, this is how you would present it or, this is what you would present instead of having to think to myself, like, how would I change it an adapt it if I was talking to parents\u0026hellip;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to establish preliminary evidence for an intervention that can reduce STS and burnout and improve well-being in providers across various care settings. This study evaluated the effectiveness of the REAL Pro intervention in reducing STS and burnout and improving well-being through increased capacities for self-compassion, emotional regulation and effective coping in professionals who work with children and families. Reduced stress and burnout ultimately would be expected to improve services received by children and families (e.g., Salamehe et al., 2021). The findings for intervention effectiveness were mixed. Participants demonstrated significant increases in self-compassion, active coping and emotion regulation and a trend towards improved resilience. However, significant improvements in perceived stress, STS or burnout were not observed at posttest. Exploratory follow-up analyses with a small subset of the sample suggests there might be delayed effects of the intervention on reduced STS and burnout, suggesting the possibility that, as participants\u0026rsquo; capacities for self-compassion, coping and emotion regulation improve, they may experience reductions in STS and burnout over time.\u003c/p\u003e \u003cp\u003eLevels of stress, STS and burnout are high among professionals who provide services to children and families (Gallup, 2014; Lamson et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Mulyani et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sinclair et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). While it is critical to address structural and organizational factors that contribute to this, there are also individual level factors that can be promoted to potentially reduce STS and burnout (e.g., Brigham et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A strength of the REAL Pro intervention is the combination of mindful self-compassion practices with cognitive-behavioral coping and emotion regulation skills that have been shown to reduce perceived stress, symptoms of anxiety and depression, and improve well-being on other populations (e.g., Ferrari et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Long et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Although the quantitative results of this study were mixed, class feedback surveys and qualitative findings suggest that participants made use of and experienced the intended benefits from the mindfulness and coping skills, indicating that participating in the intervention provided stress relief.\u003c/p\u003e \u003cp\u003eIn addition, in qualitative feedback participants reported that they will be able to utilize the practices and skills in their work with children and families. Professionals need tools both for their own well-being and for supporting the social, emotional and behavioral well-being of the children and families they serve, and the skills taught in REAL Pro may accomplish both. Having practical tools for managing stress and difficult work-related situations can improve provider-client relationships and services. For example, one study showed that being trained in an effective social-emotional learning program mitigated the negative association of teacher burnout with the quality of teacher-child interactions and instructional support in Head Start classrooms (Sandilos et al., 2020). Given high rates of stress, STS and burnout in child- and family-serving professions and the impact those have on the quality of services (e.g., Salamehe et al., 2021), interventions that can address both are needed.\u003c/p\u003e \u003cp\u003eAnother strength of this study lies in its effort to address STS, burnout and well-being among a variety of professionals in child and family services, whereas most studies focus on one profession only (e.g., Ormiston et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Our results indicated that the program effects were equivalent across professions, suggesting that it can be applicable to a variety of professionals working with children and families. By recognizing the interrelated nature and common experiences of various professions that serve children and families, the REAL Pro intervention has the potential to reach many groups of crucial service providers to boost their resilience and effectiveness. REAL Pro attempts to alleviate symptoms of stress and burnout across a range of care providers through streamlined and universally applicable methods, including learning more appropriate ways to understand and respond to stress, strengthening tools for tuning into oneself and the clients with whom one works, and cultivating a culture of compassion for self and others at work. These methods can reduce reactionary responses in providers and help them respond to difficult situations in a balanced way. In addition, these methods support providers\u0026rsquo; capacities to respond to their own emotional needs and learn key skills that support them in their day-to-day lives.\u003c/p\u003e \u003cp\u003eThis study evaluating the REAL Pro intervention shares some of the same limitations as other similar intervention studies mentioned earlier (Hazen et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Luthar \u0026amp; Mendes, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Orsi et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In this preliminary evaluation, the sample size was limited impacting the ability to detect small intervention effects. In addition, we were unable to include a control group for comparison, and participants self-selected into the study introducing potential bias relative to all the individuals who participated in the intervention. However, the REAL Pro intervention is scalable such that it may be universally applied to address staff well-being across a diverse spectrum of caring professionals. By improving well-being and emotional regulation, the REAL Pro intervention addresses both distinct and common challenges related to STS and burnout that are experienced in a variety of caregiving professions. As such, despite the limitations of this pilot study, the REAL Pro intervention shows promise for succeeding in its intended purpose and reaching a broad population.\u003c/p\u003e \u003cp\u003eThis study lays a foundation for further investigations of the REAL Pro intervention that aims to foster a thriving and resilient workforce that can deliver high-quality services to children and families. Future evaluations of REAL Pro would benefit from use of a more rigorous research design that includes a comparison group, randomized assignment to groups, and follow-up assessments. In addition, future evaluations could examine the impact of the intervention on organizational factors, such as contributing to a supportive, collegial environment that values staff well-being. Nonetheless, the results of this study suggest promising directions for REAL Pro to support the well-being of child and family serving professionals and quality of care they provide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eL.L. and R.L. developed the intervention and designed the study. R.L., R.C., and M.A. implemented the intervention and oversaw data collection. L.L and K.S. conducted data analyses. L.L., R.C., I.B., and R.L. wrote the manuscript. All authors contributed to the interpretation of the results and to the final manuscript.\u003c/p\u003e\n\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eThe dataset included in this study is not publicly available due to not having participant consent or IRB approval to make it publicly available. Data are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAndrew, Y. (2015). What we feel and what we do: Emotional capital in early childhood work. \u003cem\u003eEarly Years\u003c/em\u003e, 35(4), 351-365. DOI: 10.1080/09575146.2015.1077206\u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology. https://doi.org/10.1080/14780887.2020.1769238 \u003c/li\u003e\n\u003cli\u003eBrigham, T., Barden, C., Dopp, A. L., Hengerer, A., Kaplan, J., Malone, B., ... \u0026amp; Nora, L. M. (2018). A journey to construct an all-encompassing conceptual model of factors affecting clinician well-being and resilience. \u003cem\u003eNAM perspectives\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(1), 201801b.\u003c/li\u003e\n\u003cli\u003eCarver, C. S., M. F. Schneier, and J. K. Weintraub. 1989. \u0026ldquo;Assessing Coping Strategies: A Theoretically Based Approach.\u0026rdquo; \u003cem\u003eJournal of Personality and Social Psychology\u003c/em\u003e 56 (2): 267\u0026ndash;83. https://doi.org/10.1037/0022-3514.56.2.267. \u003c/li\u003e\n\u003cli\u003eCastillo-Gualda, R., Herrero, M., Rodr\u0026iacute;guez-Carvajal, R., Brackett, M. A., \u0026amp; Fern\u0026aacute;ndez-Berrocal, P. (2019). The role of emotional regulation ability, personality, and burnout among Spanish teachers. \u003cem\u003eInternational Journal of Stress Management\u003c/em\u003e, 26(2), 146-158 https://doi.org/10.1037/str0000098\u003c/li\u003e\n\u003cli\u003eCieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., \u0026amp; Benight, C. C. (2014). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. \u003cem\u003ePsychological services\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 75\u0026ndash;86. https://doi.org/10.1037/a0033798 \u003c/li\u003e\n\u003cli\u003eCohen, S., Kamarck, T., \u0026amp; Mermelstein, R. (1983). A global measure of perceived stress. \u003cem\u003eJournal of health and social behavior\u003c/em\u003e, 385-396. https://www.jstor.org/stable/2136404\u003c/li\u003e\n\u003cli\u003eCumming, T., \u0026amp; Wong, S. (2018). Towards a holistic conceptualisation of early childhood educators\u0026rsquo; work-related well-being. \u003cem\u003eContemporary Issues in Early Childhood\u003c/em\u003e, doi:10.1177/146394911877257\u003c/li\u003e\n\u003cli\u003eDiener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., \u0026amp; Biswas-Diener, R. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. \u003cem\u003eSocial Indicators Research\u003c/em\u003e, \u003cem\u003e97\u003c/em\u003e(2), 143\u0026ndash;156. https://doi.org/10.1007/s11205-009-9493-y \u003c/li\u003e\n\u003cli\u003eFigley, C. R. (2013). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Routledge. \u003c/li\u003e\n\u003cli\u003eFerrari, M., Hunt, C., Harrysunker, A. (2019) \u003cem\u003eSelf-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs.\u003c/em\u003e Mindfulness 10, 1455\u0026ndash;1473. https://doi.org/10.1007/s12671-019-01134-6\u003c/li\u003e\n\u003cli\u003eFaulkner, M., Gerstenblatt, P., Lee, A., Vallejo, V., \u0026amp; Travis, D. (2016). Childcare providers: Work stress and personal well-being. \u003cem\u003eJournal of Early Childhood Research\u003c/em\u003e, 14(3), 280-293. http://doi:10.1177/1476718x14552871 \u003c/li\u003e\n\u003cli\u003eGallup Organization (2014). \u003cem\u003eState of America\u0026rsquo;s Schools: The Path to Winning Again in Education. \u003c/em\u003e\u003cem\u003ehttps://www.gallup.com/education/269648/state-america-schools-report.aspx\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eGrist, C. L., \u0026amp; Caudle, L. A. (2021). An examination of the relationships between adverse childhood experiences, personality traits, and job-related burnout in early childhood educators. \u003cem\u003eTeaching and Teacher Education\u003c/em\u003e, 105, 103426. https://doi.org/10.1016/j.tate.2021.103426\u003c/li\u003e\n\u003cli\u003eHazen, K. P., Carlson, M. L., Hatton-Bowers, H., Fessinger, M. B., Cole-Mossman, J., Bahm, J., Hauptman, K., Brank, E. M., \u0026amp; Gilkerson, L. (2020). Evaluating the Facilitating Attuned Interactions (FAN) approach: Vicarious Trauma, professional Burnout, and reflective practice. \u003cem\u003eChildren and Youth Services Review\u003c/em\u003e, \u003cem\u003e112\u003c/em\u003e, 104925. https://doi.org/10.1016/j.childyouth.2020.104925\u003c/li\u003e\n\u003cli\u003eHupe, T. M., \u0026amp; Stevenson, M. C. (2019). Teachers\u0026rsquo; intentions to report suspected child abuse: The influence of compassion fatigue. \u003cem\u003eJournal of Child Custody\u003c/em\u003e, 16(4), 364-386. https://doi.org/10.1080/15379418.2019.1663334\u003c/li\u003e\n\u003cli\u003eJun, J., Oiemeni, M.M., Kalamani, R., Tong, J. Crecelius, M.L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review, \u003cem\u003eInternational Journal of Nursing Studies,\u003c/em\u003e 119, https://doi.org/10.1016/j.ijnurstu.2021.103933.\u003c/li\u003e\n\u003cli\u003eKerig, P. K. (2018). Enhancing Resilience Among Providers of Trauma-Informed Care: A Curriculum for Protection Against Secondary Traumatic Stress Among Non-Mental Health Professionals. \u003cem\u003eJournal of Aggression, Maltreatment \u0026amp; Trauma\u003c/em\u003e, 28(5), 613\u0026ndash;630. https://doi.org/10.1080/10926771.2018.1468373\u003c/li\u003e\n\u003cli\u003eLamson, A., Meadors, P., Mendenhall, T. (2014). Working with Providers and Healthcare Systems Experiencing Compassion Fatigue and Burnout. In: Hodgson, J., Lamson, A., Mendenhall, T., Crane, D. (eds) Medical Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-03482-9_7\u003c/li\u003e\n\u003cli\u003eLong, R., B., Kennedy, M., Spink, K. M., Lengua, L. J. (2023). Promoting college student and staff well-being through a mindfulness-based coping program. \u003cem\u003eOBM Integrative and Complementary Medicine, 8(3),\u003c/em\u003e 1-41.\u003c/li\u003e\n\u003cli\u003eLuthar, S. S., \u0026amp; Mendes, S. H. (2020). Trauma-informed schools: Supporting educators as they support the children. \u003cem\u003eInternational Journal of School \u0026amp; Educational Psychology, 8\u003c/em\u003e(2), 147\u0026ndash;157. https://doi.org/10.1080/21683603.2020.1721385\u003c/li\u003e\n\u003cli\u003eMadigan, D.J., \u0026amp; Kim, L.E. (2021). Does teacher burnout affect students? A systematic review of its association with academic achievement and student-reported outcomes, \u003cem\u003eInternational Journal of Educational Research\u003c/em\u003e, 105, https://doi.org/10.1016/j.ijer.2020.101714.\u003c/li\u003e\n\u003cli\u003eMeadors, P., Lamson, A., Swanson, M., White, M., \u0026amp; Sira, N. (2010). Secondary Traumatization in Pediatric Healthcare Providers: Compassion Fatigue, Burnout, and Secondary Traumatic Stress. \u003cem\u003eOMEGA - Journal of Death and Dying\u003c/em\u003e, 60(2), 103\u0026ndash;128. doi:10.2190/om.60.2.a \u003c/li\u003e\n\u003cli\u003eMiller, K. \u0026amp; Flint-Stipp, K, (2019). Preservice Teacher Burnout: Secondary Trauma and Self-Care. \u003cem\u003eIssues in Teacher Education, 28(2)\u003c/em\u003e, 28-45. https://eric.ed.gov/?id=EJ1239631\u003c/li\u003e\n\u003cli\u003eMulyani, S., Salameh, A. A., Komariah, A., Timoshin, A., Hashim, N. M. Z., Fauziah, R. S. P., Mulyaningsih, M., Ahmad, I., \u0026amp; Din, S. M. U. (2021). Emotional Regulation as a Remedy for Teacher Burnout in Special Schools: Evaluating School Climate, Teacher\u0026rsquo;s Work-Life Balance and Children Behavior. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, 12. https://doi.org/10.3389/fpsyg.2021.655850\u003c/li\u003e\n\u003cli\u003eNeff, K. D. (2009). The Role of Self-Compassion in Development: A Healthier Way to Relate to Oneself. \u003cem\u003eHuman development\u003c/em\u003e, 52(4), 211\u0026ndash;214. https://doi.org/10.1159/000215071\u003c/li\u003e\n\u003cli\u003eOrmiston, H. E., Nygaard, M. A., \u0026amp; Apgar, S. (2022). A Systematic Review of Secondary Traumatic Stress and Compassion Fatigue in Teachers. \u003cem\u003eSchool Mental Health\u003c/em\u003e, 14(4), 802\u0026ndash;817. https://doi.org/10.1007/s12310-022-09525-2\u003c/li\u003e\n\u003cli\u003eOrsi, R., Harrison, C. L., Rockwell, K. E., \u0026amp; Barbee, A. P. (2023). Addressing Secondary Traumatic Stress, Burnout, Resilience and Turnover in the Child Welfare Workforce: Results from a 6-Month, Cluster-Randomized Control Trial of Resilience Alliance. \u003cem\u003eChildren and Youth Services Review\u003c/em\u003e, \u003cem\u003e151\u003c/em\u003e, 107044. https://doi.org/10.1016/j.childyouth.2023.107044\u003c/li\u003e\n\u003cli\u003ePark, E. Y., \u0026amp; Shin, M. (2020). A meta-analysis of special education teachers\u0026rsquo; burnout. \u003cem\u003eSage Ope\u003c/em\u003en, 10(2), https://doi.org/10.1177/215824402091829\u003c/li\u003e\n\u003cli\u003eRaes, F., Pommier, E., Neff, K. D., \u0026amp; Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self‐Compassion Scale. \u003cem\u003eClinical Psychology \u0026amp; Psychotherapy\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(3), 250\u0026ndash;255. https://doi.org/10.1002/cpp.702\u003c/li\u003e\n\u003cli\u003eRamdan, I. M., Yasinta, E., \u0026amp; Suhatmady, B. (2020, April). Burnout and related factors amongst special school teachers in samarinda. \u003cem\u003eAtlantis Press\u003c/em\u003e, 67-71. https://doi/10.2991/assehr.k.200417.015\u003c/li\u003e\n\u003cli\u003eSandilos, L. E., Goble, P., \u0026amp; Schwartz, S. L. (2020a). Burnout and Teacher\u0026ndash;Child Interactions: The Moderating Influence of SEL Interventions in Head Start Classrooms. Early Education and Development, 31(7), 1169\u0026ndash;1185. https://doi.org/10.1080/10409289.2020.1788331\u003c/li\u003e\n\u003cli\u003eSinclair, S., Raffin-Bouchal, S., Venturato, L., Mijovic-Kondejewski, J., \u0026amp; Smith-MacDonald, L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature. \u003cem\u003eInternational journal of nursing studies\u003c/em\u003e, 69, 9-24. https://doi.org/10.1016/j.ijnurstu.2017.01.003\u003c/li\u003e\n\u003cli\u003eSmith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., \u0026amp; Bernard, J. (2008). The Brief Resilience Scale: Assessing the Ability to Bounce Back. \u003cem\u003eInternational Journal of Behavioral Medicine\u003c/em\u003e 15(3), 194\u0026ndash;200. https://doi.org/10.1080/10705500802222972\u003c/li\u003e\n\u003cli\u003eStamm, B. H. (2010). \u003cem\u003eThe Concise ProQOL Manual, 2nd Ed.\u003c/em\u003e (p. 74). www.ProQOL.org\u003c/li\u003e\n\u003cli\u003eThomas, R., \u0026amp; Wilson, J. (2004). Issues and controversies in the understanding and diagnosis of compassion fatigue, vicarious traumatization and secondary traumatic stress disorder. \u003cem\u003eInternational Journal of Emergency Mental Health\u003c/em\u003e, 6, 81-92.\u003c/li\u003e\n\u003cli\u003eVictor, S. E., \u0026amp; Klonsky, E. D. (2016). Validation of a brief version of the Difficulties in Emotion Regulation Scale (DERS-18) in five samples. \u003cem\u003eJournal of Psychopathology and Behavioral Assessment\u003c/em\u003e, \u003cem\u003e38\u003c/em\u003e(4), 582\u0026ndash;589. https://doi.org/10.1007/s10862-016-9547-9\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Child and Family Providers, Mindfulness, Self-compassion, Coping, Emotion Regulation, Intervention","lastPublishedDoi":"10.21203/rs.3.rs-3912071/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3912071/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study examined the effects of the \u003cem\u003eREsilient Attitudes and Living for Professionals\u003c/em\u003e (REAL Pro) prevention intervention on the well-being of professionals who work with children and families. The program combines mindfulness and self-compassion practices with cognitive-behavioral tools that aim to promote improved stress management, emotion regulation and well-being, and was evaluated with early childhood (n\u0026thinsp;=\u0026thinsp;87) and K-12 educators (n\u0026thinsp;=\u0026thinsp;40), staff serving youth in out-of-school or after-school settings (n\u0026thinsp;=\u0026thinsp;31), and medical providers (n\u0026thinsp;=\u0026thinsp;35). Participants completed pre- and post-test assessments, reporting on measures of stress management (perceived stress, self-compassion), emotion regulation (dysregulation, active coping, denial), and well-being (flourishing, resilience, burnout, secondary trauma symptoms). Dependent sample t-tests were conducted, showing significant improvement from pre- to post-test in self-compassion, emotion regulation, active coping, and a trend toward increased resilience. Three-month follow-up in a small subset of the sample (n\u0026thinsp;=\u0026thinsp;11) suggested potential delayed reduction in burnout and secondary trauma symptoms. The preventive intervention shows promise for providing professionals with tools for stress management and emotion regulation and reducing burnout in providers working with children and families who tend to experience substantial work-related stress.\u003c/p\u003e","manuscriptTitle":"A Well-being Promotion Program Increases Self-Compassion, Resilience and Active Coping among Providers Who Work with Children and Families","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-22 15:49:22","doi":"10.21203/rs.3.rs-3912071/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8a4a7800-9f79-4b7b-87c6-f8297df1fb5f","owner":[],"postedDate":"February 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-19T06:42:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-22 15:49:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3912071","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3912071","identity":"rs-3912071","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}