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This study examines levels of secondary traumatic stress (STS), compassion fatigue, burnout, and compassion satisfaction in social workers in the State of Montana. It also seeks to explain how specific organizational factors or peer support can potentially reduce the impact of these phenomena. A mixed methodology was utilized. Respondents (N = 256, response rate = 56%) completed 4 short measures: (a) the Social Work Demographics/Workplace Questionnaire, (b) the Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, & Figley, 2004), (c) the Professional Quality of Life Scale (ProQOL) (Stamm, 2010), and (d) an original peer support survey. A smaller sample (N = 15) of follow-up interviews were conducted to collect qualitative data. A theory-based approach guided the qualitative data analysis, for which ATLAS-Ti software was used. Findings indicate that social workers in the sample experience significant levels of STS (M = 33.63, SD = 11.30), with 40.9% (n = 105) meeting the criteria for posttraumatic stress disorder, using the STSS (α = .92) as a proxy measure. ProQOL (α = .76) results confirm the presence of high levels of burnout and compassion fatigue on subscale scores, with t tests indicating that individuals performing case management reported lower levels than other groups. Age and time in current job were not found to be significant factors, whereas lower levels of job satisfaction and intent to look for other work were predictive of higher burnout and compassion fatigue scores. Qualitative data analysis revealed themes related to worker perceptions of factors that contributed to their levels of STS. Implications for policy and practice changes are offered.