Traumatic Incidents to Taking Care Responding to Traumatic Incidents to Prevent Mental Health Deterioration David Vittoria, LCSW, MCAP, ICADC, NCAC II The Behavioral Health Conference May 15th, 2018

Welcome “From caring comes courage.” Lao Tzu

David Vittoria Children & Adolescents SMI Adults SUD Treatment Hospital Administration Concordia Behavioral Health Trauma Resolution Services NYC Fire Department University of Miami Florida International University

Why We’re Here That which makes us so good at, and committed to this work, is also what makes it so difficult.

Why We’re Here We do this work because we care and because we are naturally empathic.

n./’em-pə-thē/ or /ɛmpəᴓi Meaningful Connection em  pa  thy n./’em-pə-thē/ or /ɛmpəᴓi The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another, of either the past or the present, without having fully communicated in an objectively explicit manner.

Negative Consequences & Positive Outcomes Meaningful Connection Negative Consequences & Positive Outcomes

Objectives Understand Prevalence & Impact Define Burnout, Vicarious Trauma & Resilience Discover How to Enhance Our Quality of Life Embrace Trauma Stewardship

Objectives Understand Prevalence & Impact Define Burnout, Vicarious Trauma & Resilience Discover How to Enhance Our Quality of Life Embrace Trauma Stewardship

Objectives Understand Prevalence & Impact Define Burnout, Vicarious Trauma & Resilience Discover How to Enhance Our Quality of Life Embrace Trauma Stewardship

Objectives Understand Prevalence & Impact Define Burnout, Vicarious Trauma & Resilience Discover How to Enhance Our Quality of Life Embrace Trauma Stewardship

Prevalence & Impact

The Emotional Price of Caring Prevalence & Impact The Emotional Price of Caring Stress scores of trauma counselors are almost twice as high as those of newly widowed women and higher than patients newly diagnosed with breast cancer. Killian & Hernandez-Wolfe, 2013

The Emotional Price of Caring Social Workers / Trauma Victims Prevalence & Impact The Emotional Price of Caring Social Workers / Trauma Victims 39% Reported current symptoms of burnout. Muller, 2014

The Emotional Price of Caring Social Workers / Trauma Victims Prevalence & Impact The Emotional Price of Caring Social Workers / Trauma Victims 75% Have experienced burnout during career. Brown, 2017

The Emotional Price of Caring Social Workers / Trauma Victims Prevalence & Impact The Emotional Price of Caring Social Workers / Trauma Victims 83% Have considered leaving their job. Maslach, 2014

92% Prevalence & Impact The Emotional Price of Caring Child Protective Services / Trauma Victims 92% Scored “high” on a measure of emotional exhaustion. Anderson, 2011

The Emotional Price of Caring Prevalence & Impact The Emotional Price of Caring Empathic Strain Objective Cognitive and/ or affective reactions that are expectable and develop in response to the client’s trauma story, behavior and personality. Subjective Reactions that develop from the clinician’s own conflicts and unresolved or idiosyncratic issues from their development over lifespan. Wilson, 1994

The Emotional Price of Caring The Emotional Price of Caring Prevalence & Impact The Emotional Price of Caring Empathic Strain The Emotional Price of Caring “Whether objective or subjective in nature, empathic strain is a type of countertransference reaction that can compromise clinicians’ ability to be empathic with the trauma survivors they work with. The therapeutic relationship and clinician’s response to the survivor is injured, weakened, or stretched beyond its appropriate boundaries.” Wilson, 1994

Burnout, Vicarious Trauma & Resilience

Burnout & Vicarious Trauma A depletion or exhaustion of a person’s mental & physical resources attributed to his or her prolonged yet unsuccessful striving toward unrealistic expectations, internally or externally derived. Freudenberger, 1984 Vicarious Trauma A state of tension & preoccupation of the stories & trauma experiences described by clients, developed over time, generally across clinical relationships & involving multiple clients. Saakvitne, 1996

Burnout We have strong empathic skills. We are compassionate people. We want to channel #’s 1 & 2 to help people. # 3 especially true when working with survivors. We are often stretched beyond our capacity. Our work is extremely intense. We have our own, personal vulnerabilities. We work in extreme situations. We often have inadequate training, support & resources.

Burnout – Top 10 Systemic Risk Factors Excessive workload High-stress settings (“in the trenches”) Sense of powerlessness / minimal or no control Frustration with bureaucracy Insufficient resources Stagnation – few opportunities for reward, growth Inadequate supervision Lack of fairness / perception of injustice Value / ethical conflicts Feelings of isolation / disconnection Figley, 1995

Vicarious Trauma A transformation in the trauma worker’s inner experience resulting from empathic engagement with a client’s trauma material. Pearlman, 1995

Vicarious Trauma It is considered to be a natural and inevitable outcome of engaging in work with trauma survivors. It is not evidence of psychopathology and it is considered normal under the circumstances. Pearlman, 1995

Vicarious Trauma - Signs Preoccupation about those we’ve tried to help Feeling overwhelmed Feeling trapped or “on edge” Forgetfulness about important matters Sleep disturbance Trouble maintaining boundaries – work and personal Avoidance symptoms, not unlike PTSD Pearlman, 1995

Vicarious Trauma - Signs Secondary Traumatic Stress Scale (STSS) - Intrusion - Avoidance - Arousal

Vicarious Resilience Clinicians working with trauma survivors can be positively affected by witnessing how the survivors cope effectively and overcome significant trauma to lead healthy and meaningful lives. Levine, 2009

Vicarious Resilience A qualitative study of Jewish interviewers of Holocaust survivors found that they reported positive transformative effects, which could be considered signs of resilience, from their experiences as interviewers that they perceived to outweigh any negative impacts they encountered. Levine, 2009

Vicarious Resilience The positive effects included an increased appreciation for their own life and good fortune; deepened appreciation for the resilience and strength of Holocaust survivors; enhanced empathy, compassion, and sensitivity toward survivors and other people in general; a greater sense of justice; a stronger identification as a Jew; and a greater sensitivity to prejudice. Levine, 2009

Enhancing Our Quality of Life (5 Things You Can Do Right Now!)

Enhancing Our Quality of Life 1. Self-Assessment. Professional Quality of Life Scale (PROQOL) measures compassion satisfaction and compassion fatigue. Available at: www.proqol.org

Enhancing Our Quality of Life 2. Continuing education. International Society of Traumatic Stress Studies (ISTSS) provides updated information about trauma workshops & CEU’s. Information at: www.istss.org

Enhancing Our Quality of Life 3. Personal therapy. Association for Traumatic Stress Specialists (ATSS) provides information on therapists who work with clinicians. More at: www.atss.info

Enhancing Our Quality of Life 4. Supervision. Five key components should be covered in the supervision of trauma therapists: Theory Education Relationship Safety Vicarious Trauma

Enhancing Our Quality of Life 5. Mindfulness. Compassion meditation for caregivers helps us maintain a state of balance and live in the moment. Consider trying apps and podcasts such as: Calm Headspace 10% Happier

Trauma Stewardship

Trauma Stewardship

Trauma Stewardship TraumaStewardship.com

Resources

David Vittoria, LCSW, MCAP, ICADC, NCAC II Thank You! David Vittoria, LCSW, MCAP, ICADC, NCAC II Office: (305) 514-5220 Cell: (305) 202-2198 David.Vittoria@ConcordiaBH.com