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Mental Health of Speech-Language Pathologists:

Let’s Talk About It Voice of the Mountains

Region 19

Phuong Lien Palafox, M.S., CCC-SLP phuong.palafox@bilinguistics.com

http://bilinguistics.com/speech-therapy-blog/

Today’s Goals:

Define and identify mental health considerations for speech-language pathologists.

Describe self-care as an ethnical mandate per principles of ethics for speech-language pathologists.

Identify outcomes for stressors for speech-language pathologists.

Identify effective and efficacious strategies to support the emotional, psychological, and social well-being of speech-language pathologists. State of Current Affairs ASHA 2015 Work/Life Survey: https://www.asha.org/uploadedFiles/2015-Work-Life-Survey-SLP-Summary-Report.pdf Job Satisfaction Very dissatisfied 2.4 Dissatisfied 1.6 Neutral 6.8 Satisfied 36.7 Very satisfied 52.5

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Most Important Factors for Accepting or Staying in Job Administration’s support of my work 20.7 Benefits 33.1 Challenging work 6.7 Compensation/pay 43.1 Flexibility to balance life and work 49.3 Job security 11.4 Meaningfulness of job 37.5 Relationship with coworkers 17.3

93% of educators report a high-stress level (Herman, Hickmon-Rosa, Reinke, 2018)

46% of teachers feel high levels of daily stress (Gallup, 2014)

58% of teachers stated mental health as “not good” for at least seven of the previous 30 days (American Federation of Teachers, 2017)

One-third of school-based SLPs (35%) reported experiencing serious work problems. SLPs were more challenged by employment-related factors than by student-related issues (Ferney Harris, S., Prater, M. A., Dyches, T. T., & Allen Heath, M., 2009)

SLP Student Stress due to Bureaucratic Restrictions, Time and Workload Management, Lack of Professional Supports, and Instructional Limitations (Fimian, M. J., Lieberman, R. J., & Fastenau, P. S.,1991)

School-Based Challenges Large amount of paperwork 79.2 Large workload/caseload 71.2 Lack of time for Collaboration 53.5 Budget constraints 46.9 Incorporating optimal service delivery 34.5

Mental Health Considerations for SLPs

Compassion fatigue: results from stresses generated between the clinician and the patient, aka “secondary traumatic stress disorder” or “vicarious traumatic stress disorder.” It essentially means that by being close to our patients in an empathic way, are at risk of being traumatized by the patient’s suffering.

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Burnout: Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related. It occurs gradually over time. It results from:

1. stressors related to one’s work environment – work-related stressors or institutional-related stressors, something akin to the administrative hassles or the daily grind

2. the clash of one’s personal values with the values of the institution 3. or not feeling as if one has control over their work environment

Primary Characteristics of Burnout are:

Emotional and physical exhaustion. You may feel drained, exhausted, overloaded, tired, low and lacking adequate energy. Physical problems can include stomach pains, digestion problems, frequent colds and illnesses, headaches and body pain, rashes, breakouts, grinding your teeth in your sleep, problems sleeping.

Feelings of cynicism and detachment from one’s job. You feel increasingly negative and frustrated about your job and your colleagues. You may distance yourself emotionally from your work. You may lose the sense of why you do what you do.

Reduced performance or sense of lack of personal accomplishment, aka “a sense of not really getting the job done”. People with burnout tend to be negative about their activities, find it hard to concentrate, are listless, and lack creativity.

Other warning signs: anger/irritability, excessive tearfulness, increased use of alcohol and drugs, excessive “screen time”, withdrawal and isolation, not returning phone calls, avoiding colleagues and social gatherings, changes in appetite and/or weight, problems in your personal relationships, excessive guilt, feelings of hopelessness.

Burnout can lead to Depression and Anxiety Disorders. Feelings of sadness and anxiety are normal parts of the human experience. Their purpose is to alert us to problems in our lives. Although it doesn’t feel good, it is ok (and actually very important) to feel these emotions. If your symptoms persist for a long time, impair your functioning in any way, reduce your quality of life, or include self-harming or suicidal thoughts, it’s time to get help. Research shows that the most effective treatment is talk therapy, sometimes combined with medication. Find an experienced mental health provider to help you work through this. If you’re interested in medication, start by talking to your PCP (most of them are comfortable and experienced in prescribing psychotropic medication).

Self-Care as an Ethical Mandate Per ASHA Code of Ethics: Principles of Ethics I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner. Line G: Individuals whose professional practice is adversely affected by substance abuse, addiction, or other health-related conditions are impaired practitioners and shall seek professional assistance and, where appropriate, withdraw from the affected areas of practice.

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Impaired Practitioner: An individual whose professional practice is adversely affected by addiction, substance abuse, or health-related and/or mental health–related conditions. Principle of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. Line H: Individuals shall ensure that all technology and instrumentation used to provide services or to conduct research and scholarly activities are in proper working order and are properly calibrated. Let's view the SLP herself/himself as the most important piece of equipment used in the provision of services. Treating and Preventing Burnout and Mental Health Needs is NOT selfish. It is required in order for you to provide ethical and competent services to your clients. What is Self-Care? Brianna Wiest, Author and Journalist

“True self-care is not salt baths and chocolate cake, it is making the choice to build a life you don’t need to regularly escape from.”

And it isn’t just a choice, it is an ongoing discipline.

https://thoughtcatalog.com/brianna-wiest/2017/11/this-is-what-self-care-really-means-because-its-not-all-salt-baths-and-chocolate-cake/

Tami Forman, Forbes Women Contributor

Self-care is not an indulgence. Self-care is a discipline. It requires tough-mindedness, a deep and personal understanding of your priorities, and a respect for both yourself and the people you choose to spend your life with.

For example, self-care is “turning off the TV instead of watching another episode of “The Crown” because the alarm is going off at 5am so you can get to the gym.” Self-care is also a discipline because it’s not something you do once in awhile when the world gets crazy. It’s what you do every day, every week, month in and month out. It’s taking care of yourself in a way that doesn’t require you to “indulge” in order to restore balance. It’s making the commitment to stay healthy and balanced as a regular practice.

How to Help Prevent & Treat Burnout Organizational Factors: Who you work for is the biggest factor in employee wellbeing. Access to supportive flexible manager, Leadership with constant training and quality supervision, control over schedule, talking about compassionate fatigue and burnout, peer supervision and supportive

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debriefing, professional development for staff about mental health, use non-judgmental language, talking about mental health in supervision, leaders get their own support, tangible action plan, Talk and De-stigmatize (If you feel safe with leadership, find your emotional support [venting, productive and constructive ways] Model the importance of self-care and prevention of burnout. Individual Factors:

1. Simply name it. Saying it out loud, or writing it down is powerful. “My mental health is at risk. I need to prioritize my health.”

2. Start with a self-assessment

a. Am I experiencing any of the signs of Burnout listed above? b. What are my specific work-related stressors? (“compliance” rules, case load, lack of

professional support, isolation from other SLPs, battling insurance, time constraints, difficult clients, etc.)

c. What are my personal vulnerabilities? (problems in my personal life, mental health issues, physical health issues, certain personality characteristics, difficulty with assertiveness and advocating for myself, neglecting my needs, poor self-care)

3. Develop a plan to minimize/address the above. Talk to your support system for ideas if you get

stuck.

4. Develop and maintain a strong support system, BOTH PROFESSIONALLY AND AT HOME.

5. Increase your self-awareness through mindfulness meditation and narrative work such as journaling. Working through self-help books and participating in therapy can be very helpful with this process if you’re not sure where to start.

a. Check yourself before you wreck yourself: Examine your thoughts. What are you telling yourself about your current feelings? Are you blaming yourself unfairly? Do you feel guilty about feeling burned out? Feelings (and thoughts) are not facts. Don’t let them bring you down and cause you more suffering. Being an SLP is hard.

6. Practice self-care DAILY. Specific steps include:

a. Physical: i. Protect your sleep! The average adult needs 7-9 hours of sleep EVERY night. Give

yourself a bedtime and stick to it. Use good sleep hygiene. ii. Eating (eat regularly, mindfully, and eat well)

iii. Exercise (one of only 2 ways of stopping the “stress response” in our body) iv. Address physical illness (e.g., allergies) and make time for preventative

healthcare. Get your annual checkups, dental cleanings, vision checks, etc.

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b. Behavioral Strategies: Work smarter, not harder. i. Time management skills (e.g., write reports immediately following assessment,

put up signs of office hours) ii. Allotment of Activities (e.g., check emails at certain day)

iii. Set aside breaks (ideally for 15 minutes at least 2x day) “We cannot sustain higher level thinking for lengthy times. Basically, those parts of the brains fatigue.” Be more efficient.

iv. Put structure on taking work home. Set yourself a turn-off time. “Myth of Multi-Tasking”

c. Learn Mindfulness and Meditation

i. In addition to exercise, the only other way of turning off the stress response. ii. Incorporate it throughout your day. Here are some simple ways to do so:

1. When you are doing something, pay attention only to it. Each time your mind wanders, catch it and bring it back to the task at hand. Repeat. Repeat. Repeat.

2. Take diaphragmatic breaths – aka “belly breaths”.

3. Start each session with a mindfulness practice so both you and the client

benefit.

iii. Set aside 20 minutes each day for dedicated meditation or deep relaxation practice.

d. Heart Factors:

i. Remember your “why.” Post visual reminders of this. ii. Practice Gratitude (The rule of 3’s. Name 3 things daily for 3 weeks)

e. Work/Life Balance

i. Protect your time off work. ii. Spend time doing things that are meaningful to you and fill you back up.

iii. Time with loved ones, make and/or enjoy art, spend time in nature and with animals, community involvement, religious/spiritual pursuits.

f. Beware Informational Overload and Emotional Vampires: Even under the best

circumstances, information overload is too much for our minds to handle. This leads to decreased productivity, poorer decision making, feeling overwhelmed, anxiety, and depression.

i. Social media and news: Social media and media intentionally exploit our brain’s reward system and patterns of reinforcement. The result on us is negative

ii. People in your life who take more than they give you.

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g. Set Boundaries with Yourself & with Others

i. Tell people no. Rehearse first. ii. Protect your personal life hours FIRST.

Let’s Talk Advocacy

Advocacy Circle – Advocacy is Student-Centered (Trici Schraeder, 2019) Student Mandates & Adequate Resources SLP Get the J.O.B.

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Consider your daily rate of pay Interview Ingenuity

“Do you use a workload or caseload model?” “Tell me about what my day-to-day will look like.” “Tell me about what support as a new district team member will ‘look like’. ”Tell me about opportunities for professional development.” “Tell me about the SLP turnover rate and SLP job satisfaction.” “Tell me about the process for campus/caseload/workload changes during end-of-year and beginning-of-year processes.”

School-Based Strategies SLP-Centered Strategies “My SLP worth is not based on my productivity. It’s based on my humanity.” New SLP Cohort SLP Mentor Face-to-Face Meet-ups (Meetings, Virtual Meeting, Q&A) Service Delivery Continuum Blog Post on Staffing Considerations: https://bilinguistics.com/staffing-considerations-slps/ Campus-Centered Strategies Build the Relationship Share Your Superpowers Educational Sessions

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District-Centered Strategies Workload versus Caseload (ASHA, 2000)

Every student has individualized needs.

The workload solution is driven by needs identified in IEPs.

Each SLP’s workload is different because all students are different.

It is possible to use one workload analysis approach.

It is not possible to apply one workload solution to all situations. Prime Duties (Tammy Qualls) Time Studies Workload Support: Extra $ for Testing, hourly paid SLPs to help, 3 to 1 Model ((Wegner, Meeham & Berkowitz, 2018; Schraeder, 2019)

Consult with other professionals (12%)

Conduct evaluations (12%)

Observe students in other environments (12%)

Meet with families (7%)

Participate in continuing education activities (5%)

Make up sessions (12%)

Plan for students (11%)

Develop materials (11%)

IEP meetings (11%)

Program AAC devices (7%)

Steps o Pilot Program with 3 campuses o Transparency: Letter to Parents, Meetings with Campus Leaders, Schedules on Doors o Follow-Up and Feedback

SLPs Unite

Talk to Special Education Leadership

Talk to School Board

Austin ISD Transcript: “My name is Jane Aldridge. I am an AISD speech-language pathologist, taxpayer and parent. I’m here with my colleagues to request time at a future meeting to discuss our compensation and workload. Our pay is far below national, state, and local levels for SLPs. This impedes both hiring and retaining AISD speech therapists. We lost 20% of our SLPs from last year. This year, we have not been able to fill all our open positions. We currently serve nearly 4,000 AISD students and their families. Our services are mandated through IDEA law, and we love providing quality services to families.

Our annual salary in AISD is as much as $13,000 below the neighboring school districts. We recognize that AISD participates in social security and that contract length may vary, but the salary discrepancy is not explained by those differences. Our mid-career pay is nationally in the bottom

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10th percentile compared with other school-based SLPs, despite Austin’s high cost of living. In addition, over the last several years, the number of students we case manage, evaluate and treat for speech and language disorders has exploded.

When we are not fully staffed, the district and taxpayers must pay costly contractors to provide mandatory services. Last year, AISD paid speech therapy contract providers nearly $600,000. Given the number of this year’s unfilled positions, the district is on track to spend even more in contract fees. We did not receive the pay raise that SEES staff and physical therapists received last year. This year, we are not included in the 7% raise for instructional staff with 5+ years of experience]. We also do not receive teacher pay perks like PPfT, extra pay for national certification or a stipend for licensure or supervising student interns.

We ask you to allot us time in the next meeting so that we can explain our role in AISD and why a salary increase for SLPs is needed to insure that all eligible students receive economical, efficacious and IEP compliant services.”

This is a process problem. This is not a people problem. Nation and State-Based Strategies ASHA Advocacy: https://www.asha.org/advocacy/ Bill Tracker per ASHA: https://takeaction.asha.org/?0 TSHA Capitol Watch: https://www.txsha.org/p/bl/bl/blogid=4 Know your representatives: https://house.texas.gov/members/find-your-representative/ Letter Template Dear Representative, I am a speech-language pathologist working in the schools and a clinic. I strongly support proposed legislation to increase pay for school personnel and increase funding for students. Speech-language pathologists across the state feel that services have been compromised by limited resources and ever-increasing caseloads. I hope that you will support [name of bill] to improve [your state] schools. Additionally, in our clinic, we have been faced with increasing denials by managed care organizations. Our families’ access to care has been negatively impacted by excessive denials and the time-consuming process of appealing the denials. We hope you will support [name of bill], which increase transparency in this process and allow children to maintain their needed therapy services during the appeal process. Sincerely, (Your Name)

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Resources Beck, A. R., Verticchio, H., Seeman, S., Milliken, E., & Schaab, H. (2017). A mindfulness practice for communication sciences and disorders undergraduate and speech-language pathology graduate students: effects on stress, self-compassion, and perfectionism. American journal of speech-language pathology, 26(3), 893-907. Ferney Harris, S., Prater, M. A., Dyches, T. T., & Allen Heath, M. (2009). Job stress of school-based speech-language pathologists. Communication Disorders Quarterly, 30(2), 103-111. Fimian, M. J., Lieberman, R. J., & Fastenau, P. S. (1991). Development and validation of an instrument to measure occupational stress in speech-language pathologists. Journal of Speech, Language, and Hearing Research, 34(2), 439-446. Herman, K. C., Hickmon-Rosa, J. E., & Reinke, W. M. (2018). Empirically derived profiles of teacher stress, burnout, self-efficacy, and coping and associated student outcomes. Journal of Positive Behavior Interventions, 20(2), 90-100. 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. Schraeder, T. (2019). The 3: 1 Model—One of Many Workload Solutions to Improve Students’ Success. History, 24(5). Wegner, J., Meehan, S. Berkowitz, A. (2018). The 3:1 services delivery model: A National Survey. Presented at the 2018 ASHA National Convention: Boston, MA https://www.asha.org/uploadedFiles/2015-Work-Life-Survey-SLP-Summary-Report.pdf https://www.asha.org/uploadedFiles/2017-SLP-Health-Care-Survey-Annual-Salary-Report.pdf https://www.asha.org/uploadedFiles/2018-Schools-Survey-Salaries-and-Wages.pdf ASHA Resources SLP Internship Year with an Anxiety Disorder : https://bilinguistics.com/speech-language-pathologist-with-anxiety/ Are You Experience Too Much Stress? : https://www.asha.org/associates/Are-You-Stressed/ 3 Steps to Reduce Stress Over the Things You Can’t Change : https://blog.asha.org/2018/11/23/3-steps-to-reduce-stress-over-the-things-you-cant-change/ 3 Easy Time-Saving Tips to De-Stress Your Day : https://blog.asha.org/2017/08/10/3-easy-time-saving-tips-to-de-stress-your-day/

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Three Out-of-the-Box Mindfulness Hacks : https://blog.asha.org/2019/08/05/three-out-of-the-box-mindfulness-hacks/ 5 Tips for a Smoother Post-Vacation Transition to Work and School : https://blog.asha.org/2019/09/03/5-tips-for-a-smoother-post-vacation-transition-to-work-and-school/ Breaking Out of Burnout : When a speech-language pathologist saw signs of burnout among her faculty-clinician colleagues, she set out to make over her division. Stress and the Surfboard : Learning to surf gives an SLP insight into managing stress and overcoming challenges. Strong Callings : Flailing at work? Determine how your job can better draw on your strengths. If that’s not possible, it may be time to look elsewhere. Holding On… and Letting Go : When an SLP cared for her father at the end of his life, she came to see palliative rehabilitation as a paradox. The experience transformed her approach from treatment-oriented to well-being-oriented.