Michele M. Many, MSW, LCSW, BACS Department of Psychiatry The Critical Importance of Self-care for Child Welfare Professionals and Volunteers Michele M. Many, MSW, LCSW, BACS November 8, 2017 LSU Health, New Orleans Department of Psychiatry

Stress and its impact

Different Kinds of Stress Demands exceed abilities Chronic or Excessive Stress Low demands (Boredom) Challenge (Optimal performance)

One way to think about stress

Physical Effects of Stress Chronic/Excessive Stressors

Seeing is believing

Fight, Flight, and Freeze Threat !!! Adrenaline Cortisol Increased heart rate Increased glucose Rapid, shallow breathing Hyper-focus on threat/escape No complex thought is possible Cannot weigh options, make moral judgments, think about consequences.

Basic brain development 3 primary sections of the brain - evolutionarily ordered Brainstem/Cerebellum – body brain – “Freeze” Limbic system – emotional brain – “Fight/flight” Neocortex – thinking brain Brain stem & Cerebellum Limbic system Neocortex

It works when facing a bear But nowadays the “bear” is an angry parent or a driver who cuts you off… Our brains/bodies don’t know the difference Chronic activation of “alarm system” “Free floating anxiety”, depression, cynicism, irritability Cuts off/reduces access to our “thinking brain” or neocortex Interferes with comprehension and problem solving “Tunnel vision” and “blind with anger”

What Is Vicarious Trauma and Secondary Traumatic stress?

Stressors faced by Helpers Vicarious Traumatization “. . .the cumulative effect of working with survivors of traumatic life events. Anyone who engages empathically with victims or survivors is vulnerable.” (Pearlman & Saakvitne, 1995, p.31.) Related to Secondary Traumatic Stress STS is an acute response to traumatic material and mimics PTSD Anyone exposed to others’ traumatic narrative is vulnerable

Risk Factors Engaging empathically Measuring self-worth by how much you help others Unrealistic expectations Fear of showing “weakness” Fear of being judged unable to do job Discomfort with offers of emotional support

Risk Factors Repeated exposure to traumatic material Inability to say “no.” Letting work bleed over into your personal time Exposure to the survivor’s anger Perfectionism

Signs of Vicarious Trauma

“Red flags” for VT Problems with Emotion regulation Self worth Making decisions Managing boundaries Relationships Physical health (aches & pains, illnesses, accidents) Emotional detachment

What Helps?

“Interpersonal neurobiology” Specific to mammals – prolonged caregiving period Brain/NS development related to our social supports/caregiving experiences Ghosts and Angels in the Nursery Allows us to expand our survival response to our community Helps us to feel and be safer

Good news! Caring for others is a protective factor! Oxytocin protects the heart Triggers use of social supports to deal with stress. Belief that stress is harmful increases harmful effects Belief that it is not neutralizes that effect and allows coping skills applied to be more effective

Prevention strategies

Prevention (personal) Prioritize your social supports Improve eating, sleep and exercise habits Maintain adequate self-care Identify nourishing activities and prioritize them Reduce depleting relationships and activities. Know & honor your own limitations Self-compassion Say “no” when you can

Prevention at work Venting can make you feel worse Assume the best Maintain appropriate boundaries with clients Ask yourself: “Whose needs am I meeting?” Leave work at work! - Unwind on the way home Take breaks Humor (to reduce tension, not increase it)

Changing how you feel

Meditate/Mindfulness 10 minutes a day

Most important: agency level strategies

Administrators should Ensure a culture of support and respect Model appropriate self-care practices accepting emotional support from others appropriate use of vacation/sick leave Monitor conflicts and promote positive staff relations Buddy systems “2 is 1 and 1 is none” Regularly debrief after stressful incidents Manage workloads

Agency-level interventions Provide professional supervision “Reflective Supervision” is a powerful tool Supervision for those who are exposed to others’ traumas as part of their work Originally developed for home-visiting early childhood workers Training and resources at Zero to Three: (Shamoon-Shanok & Gilkerson) www.zerotothree.org

Resources Secondary Traumatic Stress: A fact sheet for child-serving professionals http://nctsn.org/sites/default/files/assets/pdfs/secondary_traumatic_tress.pdf Professional Quality of Life screener – self score http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf Essential Elements of a Trauma Informed Juvenile Justice System http://www.nctsn.org/sites/default/files/assets/pdfs/jj_ee_final.pdf Desk Stretches – Mayo Clinic video collection http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-stretches/art-20046041?pg=2 Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking, NY NY.

Contact info mmany@lsuhsc.edu