AOT Webinar: Project Director Learning Community Compassion Fatigue

– [Melissa] Okay everyone, it is 3:00 pm so we’re gonna go ahead with this webinar. Welcome, I am Melissa Neal, and I am the lead with
the community center, the lead on helping provide
the technical assistance going out to all 17 of the AOT grantees. So welcome this afternoon,
we’ve got a full schedule. I’m gonna dive right in. The first thing I wanna say is the views, opinions, and
content expressed in this presentation do not necessarily
reflect the views, opinions, and policies of the Center
for Mental Health Services, SAMHSA, or the US Department
of Health and Human Services. And then a few housekeeping items. First of all, please
keep your phones on mute. And that includes all of the panelists. If you could keep your phone on mute while you’re not presenting, then that will help us a
lot with the noise control. Also just a quick reminder, please do not put your phones on hold as often that does lead to us having some lovely background music,
so we’d appreciate that you not put your phones on hold. We are recording this webinar, we want to provide it for
others to watch at a later time. And finally, we’re gonna
do an informal roll call. As everyone looks at their screen, you’ll see a chat box at the
bottom right hand of the screen and so if you could, in that chat box, provide your name, your
roll, and anyone else that is listening in on the presentation with you and that is the way that we
are gonna take roll call today so that we can go ahead and
dive into our presentation. Here’s a quick overview of our agenda. Sorry, I had a little feedback. We’ve got three great presenters. Lisa Callahan, many of
you are familiar with her. She used to have my roll as leading the TA for the AOT grant program. She’s still a site lead for
many of you, and is taking, she is over the TA we’re delivering through the communities and practice, and the, I’m sorry, by
the advisory consult through the AOT program. She has an extensive
background in this work. She is a senior research associate here as Policy Research
Associates, so you can see her many qualifications
there on the bio slide. We also have Dave Wilhelm with us, who’s been a clinical
counselor for 41 years, has had extensive experience supervising. And has had a lot of background
in a lot of the innovative and new things that we’ve
tried throughout the years to provide more services to
people with mental illness. And again you can see much of his extensive qualifications on the bio slide. And then finally we have Cathy Cave who has 30 years of experience
as an administrator, facilitator, and consultant. She is also a founding
partner of Inspired Vision. And has functioned as a
collection-director of SAMHSA’s program to achieve wellness, and has been a senior training
consultant with the National Center on Domestic Violence,
Trauma, and Mental Health. So without further ado,
I’m gonna turn it over to Lisa Callahan. – [Lisa] Good afternoon everybody. I wanna thank you for
those of you who have requested that we do a
webinar on compassion, fatigue, and secondary
and vicarious trauma because it really is
a very important topic for work force wellness and
for making sure that the services that you’re
delivering to the people in your programs are done
with the kind of care and compassion that you intend them to be. It’s a really important issue. I’m gonna just offer some
definitions here so we know which words we can use interchangeably
and not because a lot of times there’s some
confusion in terms of the, in terms of the, why am I not advancing? – [Melissa] You’re
clicking the wrong button. – [Lisa] Okay, there we go, there we go. So the terms that I’m gonna spell out here just in a couple of minutes
are compassion fatigue, burnout, secondary traumatic
stress, and vicarious trauma. Because sometimes we
use them interchangeably and incorrectly, so I’m gonna make sure we’re talking about the same thing when we describe certain symptoms
and problems that we are, our colleagues might be having. Compassion fatigue is
really beyond empathy for the people you are working with. It’s something that is inevitable perhaps in working with people
who have complex trauma, complex problems, and it is at the same time it is often,
the compassion is really is why you’re doing the
work that you’re doing. Another side to compassion fatigue that I wanna just mention is also compassion resilience which can evolve from working with people
with complex problems. When you see someone achieve a milestone and make another step
forward in their recovery, it does feed back to you
some positive feelings. And that’s really an important
part of the work as well. There’s a counterbalance if you will between compassion fatigue
and compassion resilience, which is keeping that in mind. Controlled empathy is the
practice of individuals who work with people in
the mental health system, criminal justice system,
and it’s a constant monitoring of your own emotions
when you’re working with or talking with people to not react with what might perhaps be a more normal emotional response when
someone reveals something very troubling to you,
something very disturbing, but instead to keep that
professional demeanor. It does tax your central
nervous system to do that. That’s something which also
can feed into the development of compassion fatigue is
the constant monitoring of the way that you’re
reacting to individuals. Compassion fatigue, unlike the next terms that we’re going to define, the onset of it can be
relatively quick, unlike the vicarious trauma or secondary
trauma or even burnout. The negative effects really are a form of exhaustion, frustration,
anger, being ineffective, but it’s something that
can happy quite quickly. Also the good news is
that compassion fatigue responds very well to a number of evidence based practices
and work place wellness interventions which Cathy and Dave are both going to talk
about after I’m finished. Burnout is really a long term reaction to the stress of working with
people who bring to the work a lot of issues, a lot of
problems, a lot of trauma. But it also can be caused by conflict in the workplace itself,
so this is something as a supervisor or as someone who is working with other colleagues, you can bring this to your
supervisor’s attention because it does cause an overall, it really degrades the workplace
environment when there’s a lot of conflict and a lot
of street in the workplace. But that’s what burnout is,
it’s pretty much that feeling of being emotionally exhausted
and taxed and overextended. But it does take awhile
for burnout to develop. Vicarious trauma and secondary trauma are used interchangeably. People have preferences
for one term or the other, but they’re referring to the same thing. Perhaps the best way to think about vicarious or secondary trauma is the way Figley defined
it is the cost of caring. The work that you do, the
emotion and the energy that you put into the work that you do
has an inevitable cost to it, especially if well ness
and self care are not part of your workplace. Vicarious trauma and secondary
trauma really parallel, in terms of the symptoms,
parallel primary trauma, the re-experiencing, the numbness, the avoidance, the persistent
arousal, being jumpy. It really is a new part of the DSM-V which I’m sure all of you are aware of in that there’s a new cluster
of diagnoses that are called trauma and stress related disorders. And for the first time the DSM includes vicarious trauma and secondary trauma as part of that diagnostic cluster. If you think about the,
it may seem as though the distinctions among
these terms is relatively small, but if you think
about vicarious trauma, secondary trauma, and
burnout as really being longer term effects from
the work that you do and compassion fatigue being more, it can be a more immediate
or short term effect. I think that’s a good way to
think about them in terms of the work and the way that
you can respond to those events in your workplace and in your work. So I’m gonna turn it over to Dave now. And then Cathy will follow him. – [Dave] Okay, I may need
somebody to advance the slides for me because I seem
to have lost that ability. – [Melissa] You should be
able to advance them now. – [Dave] I don’t have the
buttons to push on that. – [Melissa] Okay, well I can do that then. – [Dave] Okay, so let me
just start with following up with what Lisa just said,
and welcome to everyone. We’re wanting to try to provide
some brief description of interventions that the
supervisors can take with helping to minimize
the negative effects of the stress that we’re
talking about here, vicarious trauma on staff. One of the first stages
that you can assist with is what’s called the defusing stage. This is when you’re
pulling together the staff that are directly involved
with the incident, and immediately after the event, usually within one to four
hours after the event. And you’re of course establishing an atmosphere of confidentiality. Usually this session lasts
no more than an hour. The purpose of it is to provide some basic education around
the common predictable stress symptoms that
they may be experiencing. You’re then providing an
opportunity also for them to share their reactions
and to vent their emotions. The goal here is to try
to minimize the impact of this stressful event
so that they can return to their normal routine, both
at work and also at home. Could you advance please? Debriefing is a more formal
type of intervention. It is conducted usually
within three to five days after the event, and it takes longer, depending on the number of
staff that are involved. You need to give at
least two to three hours. It could take longer. Obviously you wanna
provide a safe setting, that the staff perceive as
safe without any interruptions. And the purpose is to
provide both psychological and educational benefits. It’s a very structured
process where you try and move the participants through
a process of cognitive, emotional, and back to a cognitive theme. And it encourages staff to
talk about their emotions and the stress that they
might be experiencing. You’re trying to create
a shared experience among the affected staff
so that no staff person feels like they’re having to
deal with this on their own. Again, this debriefing follows, at least the one I’m introducing, follows a seven stage intervention model, as promoted by the American
Counseling Association. The next slide is talking
about the first phase, which is called the introduction phase. Again, we’re emphasizing confidentiality, there is no recording of any
kind that would be allowed. People are required to
stay for the entire group no matter what level of
participation they may engage in. This first phase is mandatory,
the others are optional. Again, this is not to be critical, either of staff or of the
operational procedures. It purely is to provide
a supportive environment for the staff that were
directly involved in this, whatever the trauma was,
traumatic event, next please. The fact phase is we’re
getting into the cognitive elements here, and you’re
first asking participants to introduce themselves and to
explain what their specific job or responsibilities
were during the incident. And then ask them to explain
the facts of the incident as they know it from their
perspective, next slide please. Remaining in the cognitive theme here, we’re then asking them to first talk about what was their original thoughts
right after the incident. This allows participants to
personalize their experience, so it’s not just the global facts, but their specific
experience and the specific thoughts that were running
that were running through their head at the time
and immediately afterward. Next slide please. The reaction phase, and this is the most emotionally charged part
of the debriefing process. This is, you’re asking what is
the worst part of this event. This segment can last
30 to 45 minutes easily. Again it’s the most emotionally charged. The idea is to really facilitate participants focusing on
their emotional experience, and try to get them to tap
into what those emotions are and to be able to verbalize
that, next slide please. The symptom phase is where
you’re then asking them what symptoms are they
continuing to experience as a result of this vicarious trauma. And you’re also providing them
some educational information about the four stages that they likely will have been going through. The immediate stage during
and after the event, which then can morph into
maybe different symptoms during the next few days. And then maybe the
residual symptoms that are continuing three to five
days after the event. Then even further, as they
are replaying the event in their mind as they’re talking about it during this debriefing session, there might be other emotions
that surface that maybe they didn’t allow themselves
to experience previously. Next slide please. The teaching phase is
where you’re providing them both verbal and written
material that describe in detail how the body is affected by stress, both physically and psychologically. And also some of the
strategies that have been found to be helpful in helping
staff, or helping people in vicarious trauma situations
to deal with that stress. Possibly even giving them a
list of appropriate websites that they can follow up on
their own, next slide please. Finally the re-entry phase is where we’re encouraging participants
to ask questions and provide that opportunity
for the staff to talk about parts of the incident that
they’re still struggling with. You’re inviting them to
raise any other issues that have not yet been discussed. The group leaders
themselves, their roll is to not only help create a safe environment, but also to be role
models for other staff to show how to be supportive of each other. You may also find yourself
wanting to ask the question, is there anything positive
that came out of this incident to help balance the negativity
of the event itself? Ultimately you wanna be
sure that you’re providing each participant with
a list of phone numbers and addresses that they
may choose to access later as resources to help them
if they feel like they need further formal and possibly
professional attention. Next slide please, I
do wanna emphasize that for those staff that are
involved in conducting this protocol, that it’s
important that they have received formal training
themselves in how to conduct these debriefing sessions,
next slide please, hello? Workplace stressors,
this is what we’re gonna move into next, we’re
gonna be talking about what are the common workplace stressors that staff can be going through? Based on my experience working
the community behavioral health center, and working
primarily, again one of my roles was supervising all the
case management staff that had to serve the
persons with the most severe persistent mental
illness in the community. These are some of the
common things that I know they were facing, so
I developed a listing. I’m sure it’s not an all inclusive list, but I think these are
some of the common things that your staff may be experiencing. Caseload size, we know
that a lot of agencies are understaffed because
of financial constraints. That can tend to be a strain on staff. Documentation requirements,
particularly if you are involved at all with Medicaid billings, very precise documentation requirements and medical necessity
documentation has to be completed. Our productivity, billing requirements. We know that oftentimes
staff have to be able to bill at a certain level in
order to support their position. Their feet are held to the fire on that. Staff turnover, these
positions are often times very high stress positions,
and burnout is not uncommon. Staff turnover means that
other staff then have to absorb their case loads, and so that
provides additional stress. Staff oftentimes will
express that they don’t feel like they’ve had adequate
training, and they don’t have all the skill sets they would
like to have in order to be able to help some of these
more challenging clients. Inadequate resources to help clients. Staff are able to easily
identify what the needs are, but have difficulty
accessing the resources to help their client, they
find that very frustrating. Documenting eligibility for services. We live in a climate right now nationally where we’re having to
ensure that we don’t have illegal immigrants that
we’re providing services to, and so people have to
show that they have proper identification, social security
cards, birth certificates, whatever, this is a
population that doesn’t always do a good job of maintaining those. Trying to reestablish that can
be a very challenging effort. Obtaining and maintaining client benefits, so we’re talking about
accessing, whether it be food stamps or helping
them apply for disability, or helping them get into
shelters, things of that sort. Next slide please. Staff, especially those coming
out of an academic setting, maybe moving into a
position for the first time may have unrealistic expectations
about what their client can achieve, or at least how
fast they can achieve it. Sometimes they feel like they’re working much harder than clients, and
don’t get much satisfaction internally about their
clients’ accomplishments because they don’t feel like
they’re accomplishing enough. Unfortunately some of these
clients have a tendency toward threatening behavior, or
even violent behavior. These clients oftentimes
don’t live in the safest neighborhoods, and staff
are expected to enter into these neighborhoods and
likely even into maybe these clients’ homes,
and are not sure what they’re gonna be facing
when they enter that. Or what they might be taking
out with them, unwanted critters whether it be cockroaches
or the dreaded bed bugs. Requiring persons to use their
own personal transportation. Staff are concerned
about clients coming into their personal cars, mandatory on call, that’s something else that
staff are sometimes required, and find that, especially single parents can oftentimes find this a
very difficult challenge. Inadequate intra-agency
communication means that oftentimes these staff feel like they have a lot of valuable information to share with other professional staff, yet those professional staff
don’t seem to value their input they feel discarded or discredited. And oftentimes they work at a location outside of the main
office that may not have the same amenities as those
working within the main office, so they feel a bit like the
step children of the agency. Next please, supervision strategies. How do we deal with, how do
we help staff manage all these various workplace stressors
that they’re facing here? Next slide please, weekly
team meetings are critical. Again you’re emphasizing
the team over me thinking. You don’t want staff
out there feeling like they have to be lone rangers dealing with all the challenges on their own. Different staff have
to be somewhat familiar with each others clients
so that if they have to fill in for some reason that
they have at least a thumbnail sketch on the client that they’re
gonna be intervening with. Monthly individual supervision,
especially at least in the first year, it’s critical
to make sure that you’re as a supervisor able to review
any administrative issues having to do with productivity, having to do with
documentation requirements, allowing the staff to
discuss any challenges they’re having with difficult clients and brainstorming interventions,
and allowing staff maybe to talk about some
of the personal stressors they’re having in their own lives. Sometimes unfortunately
there may have to be staff corrective action
plans that are developed, that are highlighting in
detail specific deficiencies that have to be addressed and
providing timelines in which that has to be completed,
unfortunately not every person entering into this
field is a good match. It is a very stressful position to be in, and sometimes difficult
decisions have to be made regarding whether it’s a good fit or not. And then one thing I really
wanna emphasize is that from a supervisory standpoint,
supervisors need to be consistent, predictable, and approachable. Staff don’t need to have to worry about what mood you’re gonna be in
when they come in each day. If you want clients, excuse
me, staff to be able to bring difficult, challenging
issues to your attention, or maybe even personal
issues to your attention, then they need to view you
as a safe person to approach. I think that’s very
important, next slide please. Caseload management,
and here we’re talking more about just numbers,
we’re talking about different clients require different levels of energy and
effort to help manage them. You need to look at clients caseloads from high utilizers of service,
or high need clients, and making sure you’re
balancing caseloads, keeping that in mind as well. Staff client conflict, again
you don’t wanna have a scenario where there’s antagonism
developing between the client and the staff that doesn’t
allow for therapeutic rapport. Staff can start developing
antagonistic attitudes towards clients, and clients
start avoiding staff, and that’s not productive,
so try and have a good match between clients and
staff is really critical. Identifying incentives, this is another critical element also. This population is not
the kind of individuals who want outsiders into their lives. Unless they can identify an advantage for allowing you into their
life, they’re not gonna want you to be part of
their life, so to be able to provide some incentives,
whether it’s simply transportation to get them
to different appointments or taking them grocery
shopping, or helping them to access say food through
the local food pantry, or clothing through say
Salvation Army or Goodwill or things that is a direct positive
impact on them, bus passes, taxi vouchers, things that
are truly valuable to them, assisting them in getting
into a homeless shelter. By doing those kinds of things, then they can see that you
may be of value to them, and they allow you to be
entering into their life. Those engagement resources are critical. Using multiple staff to
address complex needs, even though staff may have
a primary responsibility for a client, clients
sometimes have so many things that they have to have
addressed simultaneously, whether it be significant
medical issues, homelessness, they’re involved in the
criminal justice system, you may have to divide that
between different staff to focus on those definitions,
rather than having one staff trying to deal with it
all, next slide please. Staff training, staff
trying to include input from staff in terms of what they perceive is their training needs,
where they feel like they might be somewhat deficient
in what they’d like to have more skills in to help manage
the staff more effectively. Making sure that beyond
the normal orientation that there’s adequate
shadowing time for new staff to shadow staff that are
basically conducting the responsibilities of the job
as they will have to do it themselves, and to have a mentor
assigned to them beyond the normal shadowing so that they
have somebody they can connect with in their day to day
routine to answer for clarification or
instruction or direction or just reinforce that what
they’re doing is okay. The next bullet I’m talking
about stages of readiness for change, I think this
is very important also. We talked about unrealistic expectations that staff may have
regarding their clients motivation and ability to make
progress in their recovery. You want the staff to be
able to meet the client where they are, not where
they want them to be. If the client is at a place where they’re in a pre-contemplative
state, they’re not even acknowledging they have a
problem, let alone working on it, and yet the staff are
already in the action phase where they’re trying to
get them to move forward very assertively toward
implementing their treatment plan, there’s gonna be a
disconnect and the clients are going to avoid the
staff whenever they can. Trying to match the staff’s
approach to the client based on where the client
is at is an important part of this intervention strategy. Helping them to develop, I’m sorry, could you back up one more
time please I’m sorry. Backwards please, backwards please, we kinda missed something
there, can you go back? Thank you. No, next slide, number 30. Thank you, also want you to, motivational interviewing
strategies, that’s the other thing I wanted to just quickly mention here. It is important to help
staff learn those strategies, to help develop internal
motivation within their clients to move forward with their treatment plan. To give them hopefully the ability to hope for a better life for themselves. And maintaining an awareness
of some of the current research based best practice
models that you might wanna do some training around,
next slide please. The emphasizing safety
is a critical piece here. Hopefully you have protocol
developed here to minimize staff risk and provide training
around that at least annually. One of the things that
I wanna emphasize is you really should have a list of clients that seem to have by history
of propensity for violence and to review that
periodically so that staff can keep up on that,
on changes in people’s mental status and behavior
patterns that could pose a risk. Really should emphasize
strongly that staff should pay attention to their gut
and whenever the situation that they’re experiencing
some uneasiness that make sure they feel
they have the permission to back out of those, and
maybe even encourage them to pair up with another staff
person before entering into potentially dangerous
situations, next slide please. Managing stress, again
the open door policy I’ve already alluded to
that, being predictable, consistent, and approachable,
you wanna have an open door policy so staff feel
that they can come to you. You wanna look for signs of burnout as Lisa had outlined here very detailed. Informally bring somebody into your office and make observational statements about what you’re observing that
is causing some concern, your part in giving them
the opportunity to share what might be struggles
that they’re having. Encourage the staff to
build a working relationship with what we call
secondary consumers such as family members if they’re
healthy family members that they can use to assist
them in managing their clients. And also developing relationships
with key individuals in the community partnerships,
social service agencies that they may interface with whether it be Department of Human
Services, whether it be homeless shelters, the
probation department, law enforcement, whatever that may be, to have key individuals that
they can have contact with that can facilitate them accessing
resources for their clients. And of course encourage
staff to take lunch breaks. You may not be able to mandate that, but I strongly encourage
you to really and strongly encourage that for their own
self care, next slide please. Staff morale, again, recognize
staff accomplishments. We used to do this at the
end of each team meeting by saying is there any staff that wanna talk about clients that have made some significant accomplishments
that highlights the efforts that the staff person has
made to assist that client. Value staff input and really support what the other professional staff, the value of the information
that these line staff have. That the provisional staff
should not dismiss that. Advocate for the legitimate needs means you might have to move up the
administrative ladder here and help the powers to be to understand the importance of developing
those incentive resources that I talked about earlier
to try to engage clients. If you have the availability
as a supervisor to in some way shape or
form to shadow your staff and observe first hand
the kind of challenges they’re experiencing, that
would be of some value and I think it builds credibility
between you and your staff and ultimately you don’t
wanna expect staff to do what you wouldn’t do, next slide please. And finally staff
satisfaction, helping to set realistic goals, again we
kinda talked about that. Again sometimes you have to
help staff look backwards in terms of where the client had been and where they are now,
for staff to recognize that they have made progress,
and to help staff understand that progress sometimes
is very incremental. And then also help them
understand that they’re not responsible for the outcomes
of their clients’ decisions. Of course you don’t want clients to, clients must suffer the
natural consequences. You don’t want them to suffer
consequences that could be very dangerous to them,
but clients oftentimes have to accept the natural
consequences of their decisions for them to recognize the changes they have to make in
their lives and maybe to allow staff to be more
apart of their lives. And ultimately provide
professional growth opportunities, whether it be through furthering
their formal education or by providing them more
opportunities on the team, to have more responsibilities
that will acknowledge your respect for their maturity on
the team and their expertise. And I think I will need now
to pass this onto Cathy. – [Cathy] Thank you. Hi everyone, this is Cathy Cave, I’m happy to spend some time with you. Thank you so much, for
both previous presenters, because I think you laid
a good foundation for the big picture about where we need to go. And I’d also like to bring
some conversation about self-awareness, some
strategies for self reflection, and ways for us to think about shared responsibility
for staff’s wellness. In the thick of this work,
we often forget about our own needs until they’re so big we can no longer meet them in simple ways. In my work over the last 30 years, this has been true in
all of the various areas of mental health and substitute services. Whether it’s been administrative
work or direct service work it’s really thinking about
that throughout our systems, throughout our programs, how
do we cultivate self-awareness? It’s one thing to say, oh yeah, y’all need to take care of yourselves. But we really need to
cultivate self-awareness to make self care even possible. Those are some of the things
that I’m hoping to cover in the time that we have left today. At the core of our work,
we have all this intention. We want to be kind and respectful and hold up people’s dignity,
and wanna treat people in ways that we ourselves
would wanna be treated, and that they would wanna be treated. We would hope that we honor culture, we hope that we’re aware of when we are in our own personal space where the ways we’re behaving we recognize, oh wait, that’s not how I mean to be or
want to be and I’m gonna take care of myself so that I can
be better at this tomorrow. The reality is, is that
we consistently have factors in our organizations
and in our individual relationships, in our
individual histories, and in our day to day
that really do impact how we feel, how we respond to others. I wanna take a minute to
acknowledge some of those things. Some of this we’ve talked
about already today, so I don’t want to spend too much time. But I’m a trauma survivor,
and I talk about that on a national level probably
at some point every day. What’s clear to me is that
secondary trauma influences all of us who are doing
human service work. Wherever we’re doing
that work, it’s part of what’s in the mix, so secondary
trauma is because we care, it’s because someone else’s
experience activates our own fear responses and
our own trauma responses. To think about that in a
more self reflective way, self aware way is to recognize that many of us who are
working in human services have our own personal
experiences with trauma. There could be anything in
our day to day interactions with other people, other
human beings, walking down the street that could bring
about a trauma response. It’s being self-aware to the point where I can recognize and say you
know what that’s my stuff. That’s not that person’s
stuff, that person who’s in our services is doing the best
they can with what they’ve got. At this point in time
this is where they are. What’s happening for me now,
this is mine, and I need to own it, I need to recognize
it, and I need to navigate it. We’ve already talked quite a
bit about stress and burnout. Part of our deal is
how do we consider ways as individuals and as organizations that we can have strategies and resources to lessen the stress
and to navigate burnout. What I will say about burnout is often people don’t come back from
that space of being burned out, so there’s an organizational
frustration quality with it. Often people don’t come back from that without a job change or
serious intervention. On their own parts or the
part of others, so it’s really thinking about the role of
supervision in all of this. When I think about the
impact of role expectations, and I was listening, there’s
all of those things about case loads and how we are trying
to document what we do and how on many levels, the work
that’s expected of us on the day to day is not what we
thought we were signing up for. So our passion around
supporting other people, really being considerate
of what people experience in their own day to day with
mental health challenges, with substance use disorders,
but all of the things that keep people from being their best selves, and being as independent
as they possibly can, that we’re passionate about those things. I never heard anyone say
I love the paperwork, bring me more documentation. Often the things that we’re
spending our time doing are things that in our hearts
we can get resentful about. And then related to that is
our own personal growth needs. Many of us may have come
in the door with an idea of I’ll do this job now, and then
along the way realize that I wanna do something that has more impact or more decision making authority or I wanna do more of what I’m doing. Whatever supports staff to
be their best selves can be growth needs, and it’s keeping
those issues on the table. One of the things that I would offer, a little bit of a
different sort of view is I’m a firm believer in weekly supervision. Open door is great,
but the people who come when the door is open are
people who know that they’re struggling and often can
identify what that struggle is. When we have regular supervision,
and it doesn’t have to be an hour, it doesn’t have to be, it should never be
several hours because then it’s something else, it’s not supervision. It’s how do we prevent opportunities in addition to team meetings
where there’s regular contact so supervisors can be
consistent and can be reliable and can become trustworthy, become safe, and can use processes that
we’ve been talking about in a way that strengthens the relationship between supervisors and
staff, and supports staff in knowing that it’s okay to
say I’m struggling with this. And yes open door’s important, but that regularly scheduled check in, even if it’s 15 minutes
can be really useful in the day to day work that we do, particularly when teams
are out and working, very independently out,
mostly in the field, coming back and checking in,
in addition to team meetings that are more consistent and regular supervision can
be a really useful tool. Secondary trauma, this
is something that was put out in the world and I just love it. It’s that when our hearts
and our minds are open, we are so open and present,
that of course we would be impacted by other people’s experiences. Just acknowledging that,
and acknowledging that when people share their
experiences we’re affected, and that that’s part of the
norm, it’s part of what happens. There’s also some offering
about what to do with that. Transforming secondary
trauma requires some balance. It’s not just work life
balance, it’s balance in how we are aware, so
it again comes back to how do we cultivate self-awareness? Being attune to our needs and our limits, in some places where we
work the word boundaries is frowned upon and I think
boundaries are healthy. It’s how we use them, it’s
making sure that we’re using the boundaries we have
as a resource to say these are my limitations and I
also respect your limitations but being transparent about
that and talking about it. It’s knowing ourselves and then finding our best way to balance our
work and our rest and our play with the work that we do and
that we’re passionate about. It also requires being very connected, so again coming back to
self-awareness and being open to some feedback about,
am I really connecting to people in my family that
I want to connect to, to family that I want to connect to, to friends that I wanna connect with, to other things that are in
my community that I want to be apart of in connection to
things that are meaningful. Because those are the things, the resources for our resilience. Self care is not always easy, and we really can’t just say
yes go take care of yourself, make sure you do a good job around that. It’s really providing the resources for staff to do that on a regular basis, and having support systems
in place where staff then can say I’m not feeling this today, I’m not sure what’s happening for me, I’m feeling disconnected and distant. It’s often those feelings
that will come up and when folks are self-aware
you recognize it and say I need to deal with this now. When we’re struggling
around self-awareness we can get buried under these feelings that can just feel like
there’s bricks on your chest, where I feel like I’m
not being my best self, I’m not doing what I want
to do, and recognizing that as symptoms of compassion
fatigue rather than I’m defective in some way, it’s a natural part of
the work that we’re doing. At the core of trauma stress is this, there’s a breakdown in the
ability to regulate ourselves. It’s our feelings of connection,
our feelings of being supported, our feelings of
being able to support others really can be impacted
by trauma and whether again it doesn’t matter
the source of that trauma. It could be someone else’s
experience and we were present, or it could be trauma
reminders of our own. But that when we’re feeling
like we can’t navigate it, can’t sort it out, that’s dysregulation. And dysregulation can happen
in terms of our thoughts, our emotions, our awareness
of even where we are in a space, that physical
sense of have energy, feeling safe, feeling connected, and being present in the here and now. In our work we can experience
dysregulation in this way. In the wellness project,
we’ve talked a lot about finding mind-body practices
that can support healing and staying self-aware and centered. And we also have talked
about this in other areas of trauma work that I do. Part of this is really being able to say dysregulation looks like
something, and it’s our bodies being impacted by trauma stress. One of the ways to combat
that is to actually do work on the body that
will directly address where we’re holding our distress. When we can’t talk, which we
often may be struggling to do, we can always access
practices that are reliable, that can be helpful,
they’re empowering because we can use them and share them. We’re talking about how
we can sustain ourselves in times of distress that will support our overall wellness
and sense of wellbeing, and also can be useful for prevention. Some of those practices
are listed here in terms of breath work, so if we had
longer time today we could actually practice some
breathing techniques together. But something that’s
really really simple is pattern breathing where
you, we teach it to, I do a lot of work in foster
care and in child welfare. We’ve taught this to foster parents, and we’ve taught this to youth, and I’ve taught this in
peer support circles. Really it’s a pattern breathing where you inhale to the count of
four, you hold your breath to the count of seven, and you
exhale to the count of eight. And you do that, three, four, five times. And just that in the moment
can really be helpful in helping you to take a moment, be more self-aware, notice
your breathing, notice the stress, and where we’re
holding it, and then let it go. As an example of a practice that can help, again in the moment you can
do it absolutely anywhere and anyone can do some version of that. It’s paying attention to I’m
stressed, I’m holding it, I need to take a breath and let it go. Body movement practices,
mindfulness practices that can be used to focus on something. Again you can offer this to
people that you’re supporting. We can do this ourselves, we
can do it with colleagues, we can do it with the people
that we’re working with as we’re out in the field. Mindfulness practice really
means again noticing. It’s bringing people to the present when our stress responses
may have us either really distant and disconnected, or it may have our anxiety going. Really thinking about in this moment, how do I become grounded and centered and connected to the here and now? In the supplemental resources there’s some more information about the
activities that we talk about, there’s some examples, I will
mention the resource that people who are involved
in treatment courses have shared with me, and that
is there’s a website called Oasis in the Overwhelm, Millie
Grenough is the clinician who put some of this work out in the world and really speaks to here
are some wellness strategies that you can use while you’re
working, so at your desk or in your vehicle or out in the field. Things that you can just stop
in the moment and practice. Visualizing or using guided
imagery, taking breaths, attending to the sensory
environment that’s around you. Really thinking about
do I have things easy? One of the things I often carry with me when I’m in the field is
a small star shaped pillow and the word breath is embroidered on it. Something that has some
texture that I can hold that in the moment is a quick
reminder, let me focus on something, take a deep
breath, and then go to work. And do it in a preventive way
where in between appointments I’m taking time to breath,
taking time to meditate, taking time to move my body
in a way where I can just, maybe I’m gonna flex my
shoulders and let them down, and bring them up and let them down. Things that we can actually
do to support ourselves in the midst of the work that we’re doing. What’s important for us in
cultivating self-awareness, it’s being aware of the
impact of trauma and otherwise experience upon your own life. There’s what happens in our
experiences with others, but what’s my own stuff? Knowing the sights and
sounds, it might be smells. As a trauma survivor, I am very aware of the smells that might
activate my own fear response, so then I can prepare myself
and have preventive strategies for when I smell those things
rather than often running, I can say wait a minute,
I know what that is. And that being uncomfortable right now is not the same as being unsafe right now. And that too is part of
cultivating self-awareness. And know that some of our own stuff, the things that happened in
our own histories can influence how we see others and
how we experience others. So really taking time
to think that through and using supervision
to help navigate that. I wanna talk a little bit
about our reflective process that can be used in supervision, can be used with
colleagues, and can be used as a preventive strategy so that when, if you only have a few
minutes for supervision that you can really touch base around what’s happening for you and
what’s happening for staff, and to really have a
system, a way of going about the practice of having a conversation so that it becomes predictable
and becomes reliable. And this again is a way to increase self-awareness and self care. We can often without reflection be unaware of what’s happening, unaware of the impact of our experiences, unaware of how we’re impacting others. And the goal of reflective
practice is in this collaborative way to provide some perspective
and clarity so we can move forward with awareness about
the impact of our work on us. This is a diagram that was
developed by a colleague of mine. Really thinking through
what reflection looks like. For folks who are interested
in some additional information about reflective practice,
a lot of this work started in the Zero to Three movement, which if you Google Zero
to Three will come up. And they actually have
lots of newsletters, lots of information about
using reflection as part of supervision, and Zero to
Three is a preschool practice. We’ve used this approach
in all kinds of work, with adults, in advocacy,
in mental health work, and substance use work,
so really thinking through in a few minutes that we start
with whatever the event is. And again if you use this as
part of a regular practice, what you can do when there’s an event is actually use some of
the debriefing strategies that we talked about earlier. You wanna start with what’s
the event or experience and then explore separate from that what you thought about
it or felt about it. Not everyone of us is
a touchy feely person that loves to talk about feelings. If you can think about it in terms of here’s an event, what happened. Separate from the what, what are you thoughts
and/or feelings about it. Checking perspective is
where as a supervisor you might offer feedback
and say let me give you another thought, here’s another
way to look at it, let me give you some feedback about
what I noticed and what I saw. And then the last step is actually collaborative problem solving,
and a plan to move forward. What reflective practice offers
when you use it on a regular basis is a quick check in
system of having conversations. What I realized is that today we have very little time to talk more about this, but what I would offer is that when we can separate out the
event from our feelings about it and then be open to how
other people experienced it, and feedback, and how people are seeing us in how we’re responding. And then we can step to
next time this comes up, or if this continues to
bother me or impact me, here’s some strategies
that I can put into place. What that means is that in
our workplace we have to really think about what
are the kinds of strategies that we already do, and
what are we open to try? And part of that means really looking at some organizational
strategies, and I love this that came out of some
workplace wellness approaches conversations, is you
can only make the canary so healthy to survive the mine. At some point you just need a better mine. The wellness mindset means
that there’s this partnership between the organization and the people who work in the organization
to really think through how people are impacted by
the work that they’re doing. And that we look at a
whole health approach. There’s what does our physical
environment look like? Do we have time for practice? I love the idea of yes,
you have lunch every day. Take breaks when you need them. And take a minute in between
conversations with different people that you’re serving
so that we can press pause. It’s really looking at how do
we incorporate these values into all of our organizations
so that we can create community and values around wellness. That’s what builds a positive outlook. For leaders, those of us who
are managers, supervisors, if we’re working all day
without taking a break, we’re not eating our lunch,
we’re not making it clear for folks that whatever practices
that help you for wellness let’s try to make space
for that in the day. Then what we’re modeling for people is we want you to take care of yourself, but we’re not doing it ourself. How do we model wellness
and that we encourage people to use internal and external supports, and we provide supervision
strategies that actually are effective, and we do
that on a regular basis. What happens in many organizations is that supervision is reactive
and in response to crisis. It’s very hard for
staff to see supervisors as predictable and
trustworthy when we only see each other when in crisis. Thinking about wellness,
thinking about the dimensions of wellness, folks can get
more information about that if you like, is how do we support
each other in the work that we do, and bring a mindset to our work? Caring for myself is not self-indulgent, it’s self-preservation,
and it’s a quote by Audre Lorde that I love
to share with folks. I’m gonna turn the program
in our last few minutes over to Melissa. – [Melissa] Thank you very much Cathy. We are a few minutes from
the end of the webinar. However we will keep this
line open if questions are flowing, we don’t want
to stop the conversation. After the Q and A we
do have some resources we want to make available for you, a live download as well as
some other links and resources. But for now, we welcome,
the lines are open, so we welcome if you
would like to hop on and give us a question by
phone or type a question in the chat box, we would love to have our panelists available to
answer any questions. So just to get the juices rolling, I wanna start with one question for Dave. And you covered two different things, that diffusing and debriefing. Could you describe and give a few examples of what kind of incidents
would you recommend diffusing for versus a full debriefing? – [Dave] It’s not
necessarily one or the other. Diffusing can be just simply a precursor to the debriefing
itself, so in other words it’s a more immediate response to staff. Within immediately after
the event to provide them some opportunity again to
get some initial support and an opportunity to express
what they’re experiencing internally in that snapshot of time, so it’s not a matter of one or the other. It can be simply just
a precursor to do that initial intervention, and
then to be able to set up a more formal scheduled debriefing. I mean again, the debriefing
would be more for a true what they call MUI, major unusual incident where something that, a severe
outcome for say a client. Maybe a death of a
client, that would clearly warrant a more formal debriefing. But the choosing may be even something maybe with a staff person
who had been experiencing something they observed in a client. Maybe they had been recently
assaulted or something and it was alarming them
or maybe stimulating as Cathy was talking about,
some of their own internal past trauma symptoms themselves, it reactivated some of that stuff. Diffusing I guess could be used alone. And if it’s not as intense of a trauma. But again my presentation
wasn’t to say that it was one or the other, again the
model I was trying to present was that diffusing should always happen, and that potentially then
that being a precursor to the debriefing if that makes any sense. – [Melissa] Okay, are there any questions? – [Cathy] This is Cathy, I have a thought, just to follow up on what Dave just said. When you incorporate a reflection cycle into regular supervision, what it does, it allows folks to get comfortable with diffusing and debriefing,
if that becomes apart of the regular let’s talk about what’s happening. Often people work in teams,
work out in the community, do a lot of independent work,
we’re often not used to then being in a space where we
disclose what we’re experiencing. Reflection offers a
regular opportunity for practicing that, and also
doing that together in a group after a bigger event, or
a more significant event. I was really appreciating
what you were sharing David, thank you for that. – [Dave] And I think along
with what you’re saying Cathy, what I identify with is that
helping staff understand that their thoughts
precede their emotions, and to draw that clear correlation that your thoughts will generate
the emotions that you have. What is self taught, what
are you telling yourself at that moment in time
about had just transpired, or what you thought your role was, or what you thought you didn’t do, and all the emotions that may trigger. Getting staff, just as
we work with clients, to help them understand
that same internal process. Our thoughts precede our
emotions, and so I think that fits in exactly with what
you’re talking about also. – [Melissa] Okay, thank you to you both. Just quick reminders,
if you joined the call in the middle of the presentation or late, I do want to ask you to
please in the chat box identify yourself and
your role to your location so we will have an accurate role call. If you’re looking at
your computer screens, you may have noticed that
a little box popped up with three files, and
if you click on those, you’ll see an option to
download those files. We have provided the
webinar slides along with two additional handouts. And then in the next couple of slides, we have some additional
tools that may be of interest or use to your location, and to your site. These slides are included in this download that I just mentioned, so
you can get those links and you don’t have to write
all of this down right now. Any other questions while we have Cathy, Dave, and Lisa with
us, any other questions? – [Cambria] This is Cambria
Thompson Jackson AOT team leader and I don’t have a question,
but I’m not sitting in front of my computer
so I’m not able to log in with my name and location. – [Melissa] Thank you. Well I have it now, thank you. – [Cambria] You’re welcome, thank you. – [Melissa] We also
have a couple of slides of additional resources, so
if you download those slides you’ll also see two slides
at the end with several of the resources and links
that might be of interest. I just wanna put one last
call out for questions. I know we are at the end
of the day on a Friday, but since we have Cathy,
Dave, and Lisa with us I wanna make sure we have plenty of time to use them as resources,
so last call for questions. Alright, well that brings us to the end of this project collective call. The next project collective
call will be held in a couple of months. Thank you very much for joining us today. Feel free to reach out to me or Cassandra if you have any questions
or need to follow up to this webinar, we’d be happy to link you with our presenters if you
do wanna have some follow up. Thank you so much and hope
everyone has a great weekend. Bye bye. – [Cathy] Bye. – [Dave] Bye.

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