THE COST OF CARING - Iowa Department of Public HealthCare for Yourself) The... · •Distinguish between burnout, compassion fatigue, secondary traumatic stress, vicarious trauma,

THE COST OF CARING: TRANSFORM FATIGUE INTO SATISFACTION

Tiffany Conroy, MSW, LISWInjury Prevention Program Manager

Iowa Department of Public Health

BEFORE WE GET STARTED… • Violence and trauma are prevalent, so assume that there

are survivors among us (because there are!)

• Please take care of yourself. Step out or check out as you need to (please come back if you can).

• Respect confidentiality

• Anything else?

LEARNING OBJECTIVES • Demonstrate understanding of the physical and emotional impact of working as a helping professional

• Distinguish between burnout, compassion fatigue, secondary traumatic stress, vicarious trauma, and compassion satisfaction

• Identify strategies for recognizing warning signs, ameliorating the effects, and preventing the various types of fatigue

• Create a personalized action plan for addressing the cost of caring, and offer resources for sustainable and effective self-care

WHY PUBLIC HEALTH? • Health Promotion vs. Carer of Ill Health • Focusing on individual and population health

needs

• Recognition of individuals as active participants in their health journey vs. passive recipients or providers of care

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet...We burn out not because we don’t care but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care.” -Ramen, MD., R. N. Kitchen Table Wisdom (2006)

BRENÉ BROWN ON EMPATHY

http://www.youtube.com/watch?v=1Evwgu369Jw

DEFINITIONS & DISTINCTIONS

▪ What is trauma & how does it affect health?

▪ The terms Burnout, Compassion Fatigue, Vicarious Trauma, Secondary Traumatic Stress are often used interchangeably-but they’re not the same

▪ Having clear definitions will help with improved data and research on the topics

Trauma is… “an event, series of events, or a set of circumstances experienced by an individual as physically or emotionally harmful, or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” –SAMHSA

“Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way… Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.” -Dr. Paul Farmer

● "It refers to the avoidable limitations society places on groups of people that constrain them from achieving the quality of life that would have otherwise been possible. These limitations could be political, economic, religious, cultural, or legal in nature and usually originate in institutions that have authority over particular subjects." -Bandy X Lee

● “isms” & “phobias” (i.e. ageism, racism, sexism, homophobia, transphobia)

TRAUMA TYPES Primary Trauma•Caused by traumatic event that happens to you

• Primary trauma from your personal life

• Primary trauma caused by work-related exposure • Is primary trauma because it happens to

you (e.g. being a first responder on a crime scene)

Secondary Trauma • You are not in actual danger, you are not at the scene of the traumatic event firsthand

• You are absorbing the trauma input from exposure to a client’s retelling of their trauma, reading traumatic details, watching traumatic news coverage

Both primary & secondary trauma exposure can lead to PTSD

-Mathieu, F. The Compassion Fatigue Workbook (2012)

BRIEF DEFINITIONS Burnout has to do with stress and frustration caused by the workplace

(Saakvine & Pearlman,1996).

Compassion fatigue refers to the deep emotional and physical wearing down that takes place when helping professionals are unable to refuel and renew (Figley, 1995).

Vicarious trauma describes profound negative changes in our worldview due to the exposure to traumatic content of clients (Saakvine & Pearlman,1996).

Secondary traumatic stress is the result of being a witness to a traumatic event or series of traumatic events, which can lead to PTSD-like symptoms (Figley, 1995).

Retrieved from: http://www.olgaphoenix.com/blog/painful-truths-about-vicarious-trauma-statistics-from-

the-field/

http://www.olgaphoenix.com/blog/painful-truths-about-vicarious-trauma-statistics-from-the-field/

VULNERABILITY FACTORS • Personal & current life factors

• History of childhood trauma, coping style, difficult life circumstances

• Relationship to, or close identification with, those being assisted

• Working conditions • Risk of personal injury • Insufficient training•Working in isolation


Why am I doing what I am doing?

“Before starting your workday, take a moment to literally stop in your tracks and ask yourself, “Why am I doing what I am doing?” After you hear your answer, remind yourself, gently, that you are making a choice to do this work. Take a deep breath; breathe in both the responsibility & the freedom in this acknowledgement.”

– van Dernoot Lipsky, L. Trauma Stewardship (2009)

COMPASSION SATISFACTION

• Compassion Satisfaction is a positive benefit that one receives from direct interaction with individual who are suffering or traumatized.

• This can include feelings of pleasure as a result of being able to help others as part of your work, or a strong belief in the significance and value of your role.

• Higher levels of compassion satisfaction are associated with reduced risk of CF/VT/Burnout Salloum, A., Kondrat, D., Johnco, C. & Olson, K., (2015)

• Pearlman & Mac Ian’s 1995 study suggests that those with a history of violence, who continue to commit to the work long term, are healthier with fewer effects (because they may find meaning in their own trauma by dedicating their work to survivors)

Pearlman, L. & Mac Ian, P. Vicarious Traumatization: An Empirical Study of the Effects of Trauma Work on Trauma Therapists. (1995)

TRAUMA STEWARDSHIP BEARING WITNESS TO TRAUMA WITHOUT SURRENDERING THE ABILITY TO LIVE FULLY

•Trauma Stewardship is the entire conversation about… • How we come to do this work • How we are affected by it • How we make sense of and learn from our experiences

• As stewards, we…• create a space for & honor others’ hardship and suffering, and yet we do not assume their pain as

our own• develop & maintain a long-term strategy that enables us to remain whole & helpful to others & our

surroundings even amid great challenges

• Trauma Stewardship calls us to engage oppression & trauma-whether through our careers or in our personal lives-by caring for, tending to, and responsibly guiding other beings who are struggling.

-van Dernoot Lipsky, L. Trauma Stewardship (2009)

PROCESS OF THE COST OF CARING

Intervention OR Attrition Trauma InputsPrevention OR Threshold

Reached

WARNING SIGNS OF CF & VT

A TRANSFORMATION TAKES PLACE...

“A transformation takes place within us as a result of exposure to the suffering of other living beings or the planet. This transformation can result from deliberate or inadvertent exposure, formal or informal contact, paid or volunteer work...We are talking about ways in which the world looks and feels like a different place to you as a result of your doing your work.”


Beyond the Cliff

https://youtu.be/uOzDGrcvmus?t=406

THREE LEVELS • Physical • Behavioral • Psychological

“When we keep ourselves numbed out on adrenaline or overworking or cynicism, we don’t have an accurate gauge of

ourselves or our needs.”-van Dernoot Lipsky, L. Trauma Stewardship (2009)

PHYSICAL SIGNS

• Physical Exhaustion

• Insomnia or Hypersomnia

• Headaches or Migraines

•Somatization or Hypochondria


BEHAVIORAL SIGNS • Increased Use of Alcohol & Drugs

• Other Addictions

• Anger & Irritability

• Avoidance of Clients

• Impaired Ability to Make Decisions

• Forgetfulness

• Problems in Personal Relationships

• Attrition

• Compromised Care for Clients

• The Silencing Response -Mathieu, F. The Compassion Fatigue Workbook (2012)

• Exaggerated Sense of Responsibility

PSYCHOLOGICAL SIGNS

• Emotional Exhaustion

• Distancing

• Negative Self-Image

• Depression

• Reduced Ability to Feel Sympathy & Empathy

• Cynicism & Embitterment

• Resentment

• Dread of Working with Certain Clients

• Feeling Professional Helplessness

• Failure to Nurture & Develop Non-Work Aspects of Life

• Depersonalization (Dissociation or “auto-pilot)

• Diminished Sense of Enjoyment/Career

• Disruption of World View/Heightened Anxiety or Irrational Fears

• Increased Sense of Personal Vulnerability

• Inability to Tolerate Strong Feelings

• Problems with Intimacy

• Hypervigilance

• Intrusive Imagery

• Hypersensitivity to Emotionally Charged Stimuli

• Insensitivity to Emotional Material

• Loss of Hope

• Difficulty Separating Personal & Professional Lives


STRATEGIES TO ADDRESS CF & VT

“As trainers, educators, and supervisors, we want to protect therapists from compassion fatigue, enhance their resilience, and help professions deliver quality mental health interventions, but to achieve these goals, we may need to shift paradigms, moving our focus away from individualistic efforts at education and training and toward a more systematic approach of advocacy for healthier working conditions.” – (Killian, K.D., 2008)

THREE LEVELS

You

Professional

Debriefing Training

Organizational

Peer Supervision

Acknowledging CF

Personal

Transitional Time

Hobbies


DEVELOPING AN EARLY WARNING SYSTEM

My Warning Signs Written Exercise 1. What sign & symptoms stand out the

most for me? 2. What signs & symptoms do I bring

home with me most often? 3. What signs & symptoms do I experience

at work? 4. What do I have to lose if I don’t deal with

the effects of this occupational hazard? 5. What do I stand to gain if I move toward

improved self-care? 6. Who will be the biggest supporters of

my self-care?


ORGANIZATIONAL STRATEGIES WHAT CAN ORGANIZATIONS DO?

1. Basic considerations to lessen risk of CF/VT• Adequate salary & time off (including R&R) for all staff;• Sufficient orientation, professional training, and management supervision for staff

to feel competent & supported in their jobs • Plan for staff safety (including security trainings & briefing on security protocols)• Access to medical & mental health support services including: health care,

information/training about the psychological hazards of the work and effective self-care, access to good confidential counseling support as needed

• Support for families around issues such as child care, separation, and relocation

2. Organization Culture & Work Roles • Encouraging connections, morale, and relationships• Encouraging communication and staff contributions


ORGANIZATIONAL STRATEGIESWHAT MANAGERS CAN DO?

1. Understand the psychological impact of helping work 2. Set a good example by the way that you care about yourself3. Especially during times of increased pressure or crises, look for ways to help keep

staff challenges in perspective 4. Express concern about the general well-being of your staff and not just the quality

of work they’re doing 5. Make sure that staff suggestions & feedback about their jobs & organization are

heard and valued (even if they won’t result in tangible change in near future) 6. Do not say or do things what would stigmatize staff who are struggling with CF/VT

or other stress or trauma-related issues 7. Strive to stay positive whenever possible, and to praise and acknowledge effort &

results whenever possible


ORGANIZATIONAL STRATEGIESREFLECTIVE SUPERVISION

The primary objectives of reflective supervision/consultation include:

• Form a trusting relationship between supervisor & supervisee

• Establish consistent & predictable meetings & times

• Listen

• Remain emotionally present

• Teach/guide

• Nurture/support

• Apply the integration of emotion & reason

• Foster the reflective process to be internalized by the supervisee

• Explore the parallel progress & to allow time for personal reflection

• Attend to how reactions to the content affect the process

-Michigan Assn. for Infant Mental Health (2010)

PROFESSIONAL STRATEGIESLOW IMPACT DISCLOSURE

Four Key Steps:

1.Self-Awareness

2. Fair Warning

3. Consent

4. Low-Impact Debriefing


1-SELF-AWARENESS • Take note of a typical week & reflect on the way you formally & informally debrief with your colleagues • How much detail did you provide? • How much detail did they share with you? • What was most helpful?


2-FAIR WARNING

• Before you start, give your colleague fair warning that you’re going to debrief• Key difference between ad hoc “water cooler” and more formal consultation

• Remember…you use “fair warning” in everyday life

• Think about what you need from the listener • Do you just want them to listen? Do you want advice?

• Be clear to better ensure your needs are met & they know what you’re asking of them

• This allows the listener to prepare…and to also give (or not give) consent


3-CONSENT • After giving FAIR WARNING, you need to ask for consent

• The listener has the right to decline, or qualify what they’re able and ready to hear

•You should be prepared to be okay with the listener saying “no” or “not right now”


4-LIMITED DISCLOSURE 1. How much do you really need to share to

convey the issues and have your needs met?

2. Questions to ask yourself before sharing graphic details:

• What is the setting of the conversation? (Debriefing session? Case consult? Work lunch? Parking lot catch up?)

• Is the listener…o Aware of what you’re about to share? o Able to control the flow of what you’re about to share with them?

• If it’s a case consult or debriefing…has the listener been given fair warning & given consent?


PERSONAL STRATEGIES FOUR STEPS TO WELLNESS

Step 4Make a commitment

to change

Step 3 Develop resiliency

skills Step 2

Enhance self care/work-life balance

Step 1Take Stock


STEP 1: TAKE STOCK

• Track Your Physical Well-Being

• Track & Limit Your Trauma Inputs

•Getting the “Wake-Up Call”


Is your container full?

STEP 2: ENHANCE SELF-CARE & WORK-LIFE BALANCE • Deal with the work part of work-life balance

• Deal with the life part of work-life balance

• Enhance your self-care • The basics of self-care: Sleep, Rest, Proper Diet, Exercise, Vacations • Strategies beyond the “basics”

• Be aware of the “must be nice” phenomenon

• Find time for yourself everyday-Rebalance your workload

• Learn to say no (or yes) more often

• Let the compassionate voice speak


Somewhere between internalizing an ethic of martyrdom & ignoring ongoing crises lies the balance that we must find in order to sustain our work. -van Dernoot Lipsky, L. Trauma Stewardship (2009)

STEP 3: DEVELOPING CF RESILIENCY THROUGH RELAXATION TRAINING & STRESS REDUCTION

1. Developing self-awareness skills

2. Daily meditation, relaxation training, controlled breathing, and visualization

3. Trauma Stewardship: Managing Trauma Exposure

4. Body Awareness

“By developing the deep sense of awareness needed to care for ourselves by caring for others and the world around us, we can greatly enhance our potential to work for change, ethically and with integrity, for generations to come.”



STEP 4: MAKING A COMMITMENT TO CHANGE “Make a formal, tangible commitment: Written, public, specific, and measurable promises of self-care.” –Green Cross “Standards of Care”

Idea Factory

Change I could make in the next week?

What do I need to get in place to make this happen?

Change I could make in the next month?


Change I could make in the next year?



CONTACT ME

Tiffany Conroy, MSW, LISW

[email protected]

515-242-6514

mailto:[email protected]

Documents

THE COST OF CARING - Iowa Department of Public HealthCare for Yourself) The... · •Distinguish between burnout, compassion fatigue, secondary traumatic stress, vicarious trauma,