She woke up at 5:30 a.m. and checked her email for emergencies. By 8, she was at work preparing a plan for a child and, at 10:30, she met with her manager and a client who yelled at her, accusing her of lying.

Before noon, she already felt belittled and demeaned.

After that, it was off to a home visit until 1:30 p.m., then another, with a teenager and foster parent until 3:30 p.m. She arrived, late, at 4:45 p.m., to the next visit. This family was upset with her, too.

She worked until 7:30. She got home just in time to put her kids to bed. And check email and get a few things done and go to bed. And regardless of how tired she felt, she did not sleep well that night.

At 5:30 the next morning, Warren County Child Protective caseworker Becky Campana woke to another day full of appointments, trauma, hope, defeat and exhaustion.

A recent study shows that 53 percent of Ohio's children's services caseworkers have symptoms of post-traumatic stress disorder. That compares with national incidences that range from 35 percent to 75 percent of child-welfare staff.

Campana is not among them. But the burden she carries is indicative of the job that is taking considerable toll on those who work to keep children safe.

Campana runs a blurry race every day (sometimes until after 11 at night) tied to children who can't stay at their own homes because their parents hurt or neglect them.

Still, some days are worse than others.

The teen was a handful. She'd had to move him from place to place for years because of his behavior. Forget a permanent home. And in this snowstorm on this night, here she was, driving him to some new place again. Trying to keep the wheels on the road.

"He said, 'Mom,' " she recalled. "He called me mom. And he said, 'Could you just take me to your house?' Like, 'why do I have to go to another place?' "

Her heart did not stop of course, but it felt like it.

"You understand that you're the only constant person for the last three years in that child's life, and they really do look at you as a mom figure. You see trauma happening to kids. You feel that," said Campana. "You take that home, as much as you don't want to."

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It is thoughts like these and days like most, for child-welfare workers, that make the recent findings about PTSD symptoms among them both frustrating and heart wrenching.

“We were shocked,” said Angela Sausser, executive director of the Public Children Services Association of Ohio.

So what's to be done?

A national research study is underway to help with the recruitment and retention of child-welfare staff nationwide. That's where the PTSD finding came from. The project is headed by the Quality Improvement Center for Workforce Development, which is partnering with the U.S. Health and Human Services' Children's Bureau in a five-year, federally funded project.

Participating states are Ohio, Michigan, Virginia, Oklahoma, Louisiana, Nebraska and Washington. Milwaukee and the Eastern Band of Cherokee Indians are jurisdictions that are also taking part. In Ohio, eight counties are taking part: Hamilton, Champaign, Crawford, Knox, Montgomery, Summit, Trumbull and Wayne.

Ohio is planning an intervention strategy to prevent and lessen the effects of burnout, secondary trauma and disengagement among caseworkers, said Angela Terez, a spokeswoman for Ohio Job and Family Services.

"This is a critical time in the study. Our results could have implications for all 88 Ohio counties," Terez said, "as well as for the nation."

Once the intervention is done, she said, its impact on the caseworkers and outcomes among children will be assessed.

Kody Krebs, a Hamilton County Children’s Services manager, encourages his staff to talk to each other and to him about their stresses.

He is not surprised about the PTSD findings. Children's services workers are focused on their clients and can forget to take care of themselves, Krebs said. "We tuck it away and continue to do the job."

Working through the trauma

Hamilton County children's services worker Morgan Springsteen was assigned to a little girl whose mother was struggling, with some success, with addiction last year. One day in April, Springsteen got a call. The child and her caregiver had found the girl's mother dead from an overdose.

"I was one of the first calls they made," Springsteen said. "It was very unexpected. It was a mom who had been doing well."

She hurried to the scene, worried about how the child was coping. "She was sitting in the car. She opened the car door immediately and gave me a hug. She was very upset."

Springsteen stayed with the girl for hours, shielded her from some police questions and whisked her off to a nearby restaurant for a break from it all.

"I kept thinking," Springsteen said, " 'How is this kid going to go to sleep tonight, and how are we going to go forward?' "

She said she tries to keep healthy boundaries with her families, works on "self-care" and, when she gets back to her office after a troubling case, finds a colleague and talks it out.

That's common with child-protective workers, said Susan Walther, director of Warren County Children Services. "Our caseworkers are close-knit and many are friends outside of work."

They also get training in secondary trauma – that indirect exposure they have to their work kids' difficult lives – to help them understand how their job can affect their lives and to give them skills to cope. And supervisors meet routinely with the caseworkers, watching out for their well-being.

The work is not without its rewards. Caseworkers describe getting "excited" about watching a child and parent interact well. About seeing a parent who's progressing in addiction treatment. There's the joy of seeing a foster family hug their new child. Or a child smile at you.

"I love my job," said Michaela Parker, a child-protective services caseworker in Warren County.

"The kids are amazing. They're resilient," she said.

Even so, she said, "It gets to you, because it's a 5-year-old, a 6-year-old child telling you that they got whooped with a belt or they were getting smacked with a paddle."

"I always try to imagine and understand their pain," she said. "This isn't always a good thing. Trying to personally imagine and understand the pain and emotion of a rape a child suffered at age 12 is torture."

Parker is assigned to an Ohio intervention program that gives kids whose parents have addiction specialized services and helps their parents with treatment. The idea is to keep families together, but sometimes a child must be removed.

That happened in February. A parent tested positive for drugs, and Parker had to break the news and take the child from their home.

The parents were in tears and angry. Another caseworker called police for help, and Parker had to get the child ready to go with his family watching. She knew that one parent had suicidal ideation, and that weighed on her.

"I was upset," she said. "I wished I did not have to remove the child."

Hours later she was relieved to drop off the child with a foster caregiver who was thrilled to welcome a child.

But Parker slept fitfully that night, dreaming that the parent died by suicide while she was at their home.

Parker never had to worry about being harmed, or hungry, or having any need unmet as a child. Now she's working in the same county where she grew up.

"I have witnessed overdoses, been exposed to illegal substances, lost several clients to overdose deaths and witnessed children sob because they just want to go back to their parents," she said.

She is only 24.

Her colleague Campana, at 32, is, pretty much a senior caseworker, a highly experienced social worker with six years behind her.

She said she's glad to handle cases with teenagers now rather than small children who might remind her of her own kids.

But her case kids are, in a way, her kids, too. Kids like the teenager in the snowstorm.

Eventually the boy aged out of the system at 18. He was, as Campana called it, "emancipated."

She has no idea where he is now.