Background: Vicarious trauma (VT) is “second-hand” trauma transmitted to workers interacting with individuals who experienced trauma directly. Among healthcare and social service workers, more severe VT symptoms are associated with burnout, depression, and turnover. Current instruments measure VT symptoms, but none identify how workers are exposed. This gap prevents researchers and organizations from identifying ways to protect essential workers.

Objective: To develop and test an instrument to measure VT exposure experiences, frequency; and severity.

Methods: To develop the Vicarious Occupational Trauma Exposure (VOTE) Index’s domains and items with content validity, two researchers double-coded qualitative data of substance use disorder (SUD) providers (N=49) and VT literature (N=109) (mean kappa=0.98). Twenty items were generated and modified with cognitive interviews of SUD providers (N=19) and expert consultation (N=9). Psychometric properties of the instrument were tested in a survey of SUD providers, quota sampled to reflect the workforce (N=1,415). Participants were resampled 2 weeks later for test-retest reliability. Using Principal component analysis (PCA), we assessed dimensionality. Using linear regression, we tested convergent and discriminant validity across occupational settings and geography. Reliability was evaluated using Cronbach alpha and intraclass correlation coefficient (ICCs) scores.

Results: The 16-item VOTE Index includes 4 exposure domains: clients sharing about trauma; reviewing evidence of trauma; documenting trauma; and coworkers sharing about trauma. PCA indicated a unidimensional structure. Summary scores were highly correlated with psychological distress and job satisfaction measures (p<0.001) (convergent validity). Correlation with celebrity entertainment was not significant (discriminant validity). The index demonstrated excellent internal consistency (α=0.92) and test-retest reliability (ICC=0.86).

Conclusion: The VOTE Index is the first instrument to measure occupational VT exposure. We established strong content, convergent, and discriminant validity and excellent reliability through formative research and statistical testing with SUD providers. The VOTE Index may help develop equitable organizational interventions to protect workers from VT.