4/25/2017 11:01 AM Compassion Fatigue, Impairment, and Social Worker Self-care NASW ANNUAL FALL CONFERENCE, 2015 Asheville, NC Dottie Saxon Greene, PhD, LCSW, LCAS, CCS East Tennessee State University Assistant Professor, Department of Social Work 423-439-6569 greeneds@mail.etsu.edu © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

OVERVIEW RATIONALE FOR THE TOPIC COMPASSION FATIGUE, STS, VT, BO, AND IMPAIRMENT WHAT DOES THE RESEARCH SAY? PROFESSIONAL AND ETHICAL RESPONSIBILITES SELF-CARE SELF-ASSESSMENTS

SELF-CARE, SELF-CARE, SELF-CARE, Blah, Blah, Blah… SELF-CARE, SELF-CARE, SELF-CARE, Blah, Blah, Blah….. WHAT’S ALL THE HOOPLAH ABOUT? YOU ARE THE TOOL! OUR CLIENTS DESERVE THE BEST WE CAN BRING FORTH! YOU DESERVE THE BEST YOU! YOU CANNOT TAKE A CLIENT BEYOND THAT WHICH YOU ARE! SOCIAL WORKERS DON’T STOP BEING HUMAN OCCUPATIONAL HAZARDS NASW CODE OF ETHICS CSWE COMPETENICES AND PRACTICE BEHAVIORS

TERMS/CONSTRUCTS COMPASSION FATIGUE BURNOUT SECONDARY TRAUMATIZATION VICARIOUS TRAUMA IMPAIRMENT Seminal works’ authors Christine Maslach Charles Figley Beth Stamm Pearlman & Saakvitne

Courtesy of Beth Stamm, PhD www.proqol.org PROFESSIONAL QUALITY OF LIFE: Compassion Satisfaction & Compassion Fatigue Courtesy of Beth Stamm, PhD www.proqol.org

Professional Quality of Life (PROQL) the quality one feels in relation to their work as a helper Compassion Satisfaction Positive aspects of working as a helper Compassion Fatigue Negative aspects of working as a helper Burnout Inefficacy and feeling overwhelmed, unhappiness, exhaustion, disconnectedness, insensitivity to work environment Work-related traumatic stress Primary traumatic stress direct target of event Secondary traumatic exposure to event due to a relationship with the primary person

Compassion Satisfaction The positive aspects of helping Pleasure and satisfaction derived from working in helping, care giving systems Work is invigorating May be related to Providing care The system Work with colleagues Beliefs about self Altruism

SECONDARY TRAUMATIC STRESS Preoccupied with thoughts of people helped Feeling trapped, on edge, exhausted, overwhelmed, and “infected” by others’ trauma Inability to sleep Forgetfulness Inability to separate private life from helper life Experiencing the trauma of someone helped Can be identical to PTSD Avoidance, arousal & numbing Re-experiencing, intrusive recollection Distress & impairment

VICARIOUS TRAUMA VT: A process of cognitive [change] resulting from [chronic] empathic engagement with trauma survivors” (Pearlman, 1992, p. 52). Shift in worldview related to beliefs to core beliefs about Sense of self Safety Trust Intimacy Control Spirituality (Pearlmann, 1998; Pearlmann & McIan, 1995; Pearlman & Saakvitne, 1995)

Differentiating between ST & VT According to Figley (1995), STS more related to behavioral sxs rather than intrinsic cognitive changes STS mimics PTSD VT cognitive change process

BURNOUT “A state of physical, emotional, psychological, and spiritual exhaustion resulting from chronic exposure to (or practice with) populations that are vulnerable or suffering (Pines & Aronson, 1998). A process that occurs over time (indv & organization) Meta-construct Exhaustion Depersonalization Reduction in one’s sense of personal accomplishment

Professional Quality of Life Compassion Fatigue Compassion Satisfaction The positive aspects of helping “The good stuff” The negative aspects of helping “The bad stuff’

Relationships Are Complex Multiple spheres Work environment “People helped” environment Personal environment Positive (CS) & negative (CF) Altruism CS can override CF Compassion Fatigue two parts Worn out (BO) common Frightened, traumatized (STS) rarer but powerful

Complex Relationships Professional Quality of Life Compassion Fatigue Compassion Satisfaction (ProQOL CS) Work Environment Client Environment Personal Environment Traumatized by work Secondary Exposure (ProQOL STS) Primary Exposure Frustration Anger Exhaustion Depressed by Work Environment (ProQOL Burnout)

Impairment Defined According to Barker (2003), an impaired social worker is one who is unable to function adequately as a professional social worker and provide competent care to clients as a result of a physical or mental disorder or personal problems, or the ability or desire to adhere to the code of ethics of the profession. The problems most commonly include alcoholism, substance abuse, mental illness, burnout, stress, and relationship problem.” (p. 210)

Manifestations of Impairment AOD use issues Depression (3 xs the rate of general pop (Seibert, 2004)) Vicarious trauma Secondary traumatization (PTSD-like sxs) Burnout (70% lifetime rate (Seibert, 2005)) Compassion fatigue Unethical conduct Professional mistakes Failure to provide competent care

Manifestations of Impairment, cont. Absenteeism Cancelled appointments Late for work Pessimistic Hoping for cancellations Impatience

Consequences of Impairment Compromises performance Jeopardizes client safety Damages reputation of agency/organization Damaging to the reputation of social work profession Raises questions about the competency of the profession as a whole Harms experienced by the distressed social worker

WHAT DOES THE RESEARCH SAY???

Pooler, Seibert, Fual, and Huber (2008) Social workers who identified the following personal history issues were more likely to experience professional impairment. Alcohol and drug misuse by a parent, partner, family member, or close friend; Having a troubled parent Physical, sexual, or emotional abuse. Parentification as a child

Fledgling social workers are at higher risk for compassion fatigue (CF) and burnout (BO) compared to those who have longevity in the field and are older in age. (Newell & MacneNeil, 2010; Salloum, Kondrat, Johnson & Olson, 2014) Social workers are more likely to consider leaving the field during their first four years in practice (Whitaker, Weismiller, & Clark, 2006).

Bride, Jones, and Macmaster (2007) found with child welfare workers that 92% of respondents reported at least one symptom of STS at least occasionally. Salloum and associates (2014) reported 30% - 60 % burnout rate Seibert (2005) found 39% practicing SWers currently experiencing BO with a nearly 75% lifetime rate of BO

A study conducted for NASW found additional work-related stressors which contribute to burnout: having more responsibilities than they can handle; needing to complete routine task that have little intrinsic value; having few opportunities for advancement/promotion; being expected work long hours; receiving few resources to adequately accomplish work tasks; having conflicting or unclear job expectations; getting minimal support form co-workers and supervisors; and, being unable to balance professional and personal life. (Arrington, 2008, p. 3)

PROFESSIONAL & ETHICAL RESPONSIBILITIES: NASW CODE OF ETHICS & COUNCIL ON SOCIAL WORK EDUCATION

Codes of Ethics on Therapists Impairment, Burnout, and Self-Care Ethical principles of psychologists 2.06 Personal problems and conflicts Code of ethics of the NASW 2.09 Impairment of colleagues 2.10 Incompetence of colleagues ACA code of ethics C.2g Impairment C2.h Counselor incapacitation… F5b Student & supervisor responsibilities Impairment AAMFT code of ethics Principles of medical ethics (psychiatrists) AMHCA code of ethics (Zur Institute, n.d.)

NASW’s standard 2.09 mandates that: (a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse , or mental health difficulties, and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action. (b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

NASW’s standard 4.05 mandates that: (a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility. (b) Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others.

NASW POLICY STATEMENT RE: IMPAIRMENT Since the ability to perceive situations clearly and objectively is pivotal in social work, impairment may compromise performance and, thus, jeopardize the rights of clients and treatment effectiveness (NASW, 2008).

NASW POLICY STATEMENT RE: IMPAIRMENT NASW recognizes that the prevention, identification, and treatment of professional impairment is vital to protect the welfare of clients, practicing social workers, the work environment, and the integrity of the profession. A multi-systemic approach, focusing on prevention, identification, and treatment, must be used to address professional impairment among social workers (NASW, 2008).

COUNCIL ON SOCIAL WORK EDUCATION: Educational Policy and Accreditation Standards Educational Policy 2.1.1—Identify as a professional social worker and conduct oneself accordingly. Social workers serve as representatives of the profession, its mission, and its core values. They know the profession’s history. Social workers commit themselves to the profession’s enhancement and to their own professional conduct and growth. Social workers advocate for client access to the services of social work; practice personal reflection and self-correction to assure continual professional development; attend to professional roles and boundaries; demonstrate professional demeanor in behavior, appearance, and communication; engage in career-long learning; and use supervision and consultation.

WHAT’S THE SOLUTION???

NASW POLICY STATEMENT ON SELF-CARE NASW recognizes and acknowledges the unique and valuable contributions of the professional social worker. NASW supports the practice of professional self-care for social workers as a means of maintaining their competence, strengthening the profession, and preserving the integrity of their work with clients. Education, self-awareness, and commitment are considered key to promoting the practice of professional self-care. (NASW, 2008, p.270)

WHAT IS SELF-CARE??? “Process of purposeful engagement in practices that promote holistic health and well-being of the self” (Lee and Miller, 2013,p. 98). “Professional self-care can be defined as the utilization of skills and strategies by social workers to maintain their own personal, familial, emotional, and spiritual needs while attending to the needs and demands of their clients” (Figley, Stamm, and NASW as cited by Newell &Nelson-Gardell (2014) p. 431).

Macro barriers to self-care Large caseloads Caseloads with high acuity, chronicity, and trauma Lack of client resources Inadequate supervision Restraints and limitations of bureaucratic systems Inadequate compensation Lack of professional support and professional development opportunities Safety concerns Lack of recognition and autonomy Organizational culture (Cox & Steiner, 2013; Lee & Miller, 2013; Napoli & Bonifas, 2011; NASW, 2008; Newell & MacNeil, 2010; Newell & Nelson-Gardell, 2014; Salloum et al., 2015; Seibert, 2005).

PREVENTION & INTERVENTION: Self-Care Mental health hygiene Eat well Sleep well Exercise regularly Humor Spirituality Mindfulness Hobbies Social support Personal therapy Vacation Work-related self-care Do NOT work overtime Learn to say “No” Regular supervision Peer supervision Advocate for manageable caseloads Professional development activities Do NOT bring work home Organizational culture of wellness

Disappointed with people_______ Hopeless______ Trapped______ The Burnout Measure, Short Version (Maslach-Pines, 2005) Use the following scale 1 2 3 4 5 6 7 never almost never rarely sometimes often very often always Tired ______ Disappointed with people_______ Hopeless______ Trapped______ Helpless_______ Depressed_____ Physically weak/Sickly_____ Worthless/Feel like a failure____ Difficulties sleeping_______ “I’ve had it” _______ Up to 2.4 indicates low burnout; between 2.5-3.4 indicates danger signs; 3.5 4.4 indicates burnout; 4.5-5.4 serious problem of burnout; Score of 5.5 requires immediate professional intervention.

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