Residential Resilience: Caring for Those Who Care for Those Leads to Improved Care May 20, 2014 Tiffany Idziak, LMSW, CTS Bob VandePol, LMSW

The Calling to Compassion There is no greater honor….there is no greater responsibility...than to be there for someone on the worst day of their life

Presentation Outline The personal and business case for “doing the right thing” The occupational hazards of residential services Assaults: the unique impact of violence Clinical underpinnings and considerations The Residential Resilience program at Pine Rest

You Can Do Well at Doing Good “Be nice to people.” Johanna Vegter (1962) “Ach, Junge! Do ta rrright ting and isss gut for bissniss.” Nanning Vegter (1962)

Fight. Flight. Freeze. Focus

WHY? Impact of the Existential Amygdala

Financial/Program Costs of Assaults Individual and Team trauma (and drama) Employee Attrition – recruitment, hiring, training…..Again. Reduced productivity. Yet another task for managers Loss of a safe treatment milieu Lowered morale Reputational damage Workers Comp and Disability costs

Is It All About the Clients? Trauma Trained Therapists Trauma Informed Environment Debriefing sessions for clients “I signed up for this!?” Professional Quality of Life Scale

The Life Expectancy of Direct Care Staff Industry standards Our agency’s goal Our current data

Violence is Personal

Did Grandma Lie?! Part of what makes traumatic events so distressing is that they violate many of the basic assumptions people have about themselves and the world.

Finding Meaning “…the degree to which people can ultimately come to an understanding of such events in the early aftermath may help restore a sense of security and hasten the process of adaptation.” – Updegraff, Silver, and Holman (2008)

Anticipate Resilience A belief in a cause bigger than one’s self. A reason to press on Positive social support The presence of pre- incident healthy coping skills and activities

Self-View Predicts Resilience Attribution of personal weakness in selection as victim or in experience of stress reactions predicts a negative trajectory. Normal reaction to an abnormal event vs. I’m a pathetically weak wimp.

Darn! Wrong place. Wrong Time vs. They picked me because I’m weak. Whew! Grateful to be alive vs. This kind of stuff always happens to me. Normal reaction to an abnormal event vs. I’m a weak wimp. Attributional Decision-trees

Perception Becomes Reality “It is important to note that it is not the coping skills that individuals have or do not have that are important. What counts are the coping skills that individuals believe they have or do not.” Oakley Ray, 2004

Shattered World View Many trauma survivors struggle with challenges to sense of meaning and justice in the face of shattered assumptions about prevailing justice in in the world due to the way in which they were either exposed to traumatic events or treated during the post- traumatic aftermath. – Hobfoll, Watson, et.al., 2007

My View of My Organization Predicts Resilience We are the Hokies vs. We are the Victims This organization cares about me vs. I’m just a number. My leader knows his/her stuff vs. My leader is clueless.

I Am Resilient Because We Are Resilient

TeleCare Clinical Underpinnings Psychological Body Armor Position Leadership favorably You find what you look for Organizational/Leadership Attribution Personal Attribution Normalization of reactions Contain the crisis intentionally Non-invasive Strengths-based Resilience Plans

Attribution-related objectives Focus initially upon What; not Why Pursue safety (and the perception of) safety Reduce exaggeration of personal responsibility Confront catastrophizing and the belief that the incident and its sequelae are the result of personal weakness Identify and reinforce personal/community strengths Normalize reactions; including attribution distortions Set in place an expectation of recovery with psycho-education Emphasize resiliency Support access to faith-based and other community resources

Houston, We Have a Problem Blaming Chronic lateness Anger Sleep disturbances Workaholism Physical complaints Abuse of alcohol and food

Decision to Launch Residential Resilience Realizing we needed to do more Wanting staff to always feel they work at a “great place” that cares Knowing we have tried “other things” in the past and didn’t feel success

Buy In Name—harder than you might think, but very important. Who to talk with first and why Making it safe to let someone new into “the family”

Rainbows and Unicorns Things we had to work through – Keeping people informed – Gender barriers – I’m strong. You’re weak. – “Why didn’t I get a call from Bob?????” – Timely referrals

Facts Versus Feel Good Workers Comp claims last year versus this year--- 33% decrease Return to work data after referral % Feedback from participants The feeling “Bob is on our team”.

Residential Resilience Training Referral Resilience Leadership development Challenges TeleCare Process description On-Site Response Elements and objectives

Contact Information Tiffany Idziak Bob VandePol Tiffany Idziak Bob VandePol