Operationalizing Self-Care Strategies Supportive Housing Network of New York Annual Conference 2017 Mary Adams, LCSW, University Settlement/The Door

Using Crisis Debriefing to Integrate Trauma Informed Practices & Self-Care What is debriefing? Debriefing refers to a formal strategy used by trained facilitators to respond when a crisis or traumatic event occurs. A team (two or more people) will “debrief“ with a department or a group of staff or team when members have experienced a traumatic event. Traumatic events can include: The serious injury or death of a client/participant or participants family member Serious violence that has impacted the community, a staff member, a participant Responding after a physical/natural disaster such as fire, earthquake, terrorism, car/plane crash

But first, a word about crisis & trauma and the helping professional To understand debriefing after a crisis, helping professionals first need to talk about our work, the impact of trauma in our work and understand secondary traumatic stress. Once we have thought about crisis in the context of our work we will be better able to respond to crisis, for ourselves, for our teams and for our clients and communities.

Secondary Traumatic Stress Secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another. Its symptoms mimic those of post-traumatic stress disorder (PTSD).  Secondary trauma is commonly referred to as "the stress resulting from helping or wanting to help a traumatized or suffering person

Helping Professionals are at Higher Risk for Secondary Traumatic Stress We are drawn to work because it brings meaning to our life. Often we are passionate and deeply committed to what we do “I want to give back”; “I like being role model or mentor”; “I want to make a difference” We may come from the community; be committed to positive change, committed to advocacy, breaking cycles, etc. We are often empathic by nature – something that can make us “good” at our work. But there is a cost to our caring; evidence shows helping professionals are at high risk for Secondary traumatic stress. Suffering from STS impacts & hurts our clients We can feel depleted and unable to do our jobs well (and may leave)

Common symptoms & conditions of STS Fatigue/chronic exhaustion Hopelessness Irritability Sleeplessness/impacting sleep Intrusive thoughts/reoccurring thoughts about the trauma Inadequate/ineffective Avoidance/Social Withdrawal Inability to listen or avoidance of clients Anger & cynicism Helpless Disorganized/poor memory Lateness/reduced productivity Physical ailments Guilt Fear Hypervigilance Disconnection/Poor boundaries

Debriefing – Restoring Resiliency Crisis Response Our response to Crisis at program sites – Introduction & describe the purpose and process; Structured group facilitated by group leaders. Questions are asked of each member – around the circle. Incident: Brief review of the incident will be used to begin talking about the incident Thoughts: from a cognitive discussion (what happened) to the affective domain (emotional or first thought, or most prominent thought). Reactions: focuses on the impact on the participants. The heart of the critical incident debriefing. Anger, sadness, loss, confusion, frustration, etc. may emerge. (helping staff connect the crisis to themselves & their feelings) Symptoms: How has this shown up in you life? Cognitive, physical, emotional, behavioral symptoms, etc. (this is a teaching phase) Teaching: Normalize reactions/feelings – using Common Reactions to Stress; stages of grief & loss can be reviewed; Stress management techniques are introduced. Psychoed

Debriefing – (Cont.) Close-Out: Facilitators summarize – our bodies & minds responding to trauma physically & emotionally. Ways to de-stress and calm ourselves Follow-Up: Refreshments, individual conversations, room to ask for individualized help/support or for facilitators to offer more support. Follow up conversations with supervisors, phone calls to members may be warranted.

Borrowing from Debriefing to Respond to Other Program and Organizational Incidents Integrating “shorter” version of debriefing for mid-level incidents. Using the debriefing model to process important issues that may not be an incident, or a crisis but need the attention of leaderships: an important staff member is leaving, the change in the federal administration, significant change in a policy or practice that will seriously impact your program, etc. Using components to process incidents or challenging situations with individual staff member. Providing brief “information session” ensures all staff have essential information they need to respond to an urgent situation – with the policy of a formal debriefing in the coming days helps calm and support staff during the immediate crisis or serious situation.

How do we our work, provide support for clients and keep ourselves healthy? Psychoeducation about the impact of trauma and secondary traumatic stress Acknowledging that helping professionals are at higher risk for STS Acknowledging our exposure & increased exposure to crisis, trauma and STS in our work Recognizing and understanding our own responses to trauma Knowing how trauma & crisis impacts us & “shows up” in us Professional Self-Care – Oxygen Mask Analogy – you must take care of yourself before you can care for others Creating a Self-Care Plan Building in support through individual and peer support and supervision Investing in supervision & building in time to talk about stressors related to work Speak to your supervisor when you are feeling the impact of stress or trauma Organizational supports and structures that respond to crisis and support Take time when stress is impacting your well-being Create a Debriefing team

Balancing Empathy & Self-Care Set emotional boundaries: Empathy and compassion are generally at the forefront of a human services career. The challenge is to remain compassionate, empathetic, and supportive of others without becoming overly involved and taking on another’s pain. Setting emotional boundaries helps maintain a connection while still remembering and honoring the fact that you are a separate person with your own needs. Post-traumatic growth refers to positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. Resilience is empowering Stress is not all bad There is a path out of trauma Perfection, ease of existence and a guarantee of safety is an illusion