1. AN OVERVIEW OF SECONDARY TRAUMATIC STRESS DISORDER PRESENTED BY: SANDRA GORMON-BROWN, MSW, LICSW & LORI EASTEP, MSW, LICSW OF GRASSROOTS THERAPY GROUP WWW.GRASSROOTSTHERAPY.COM COMPASSION FATIGUE

2.  Activity: easel paper  Trainer Introductions  Introductions:  Name  Role  Office  One thing you hope to walk away with today WELCOME

3.  Welcome  Overview  Definitions – Secondary Traumatic Stress aka Caregiver Fatigue vs Burnout  Neurobiology  Vulnerability Factors  Signs and Symptoms  Assessment tool  Self-awareness and self-care  Practical Tools  Wrap Up  Evaluation AGENDA

4.  Gain a theoretical understanding of secondary traumatic stress (STS) disorder aka compassion fatigue and burnout.  Identify signs and symptoms of STS and burnout  Discuss causes and consequences of STS and burnout with consideration of social, psychological, spiritual, biological/neurological, systemic, organizational, and societal correlates  Practice some self-administered stress reduction/relaxation techniques  Practical Tools OVERVIEW

5.  Growing literature documenting the impact on front line workers. High staff turnover.  Child Welfare Staff are not recognized as first responders  Despite that, they must react to crisis situations with incomplete information about what may lie ahead  Risks are real–physical and psychological  Unlike other first responders, they receive very little public recognition.  Public focus is often negative WHY IS THIS TRAINING IMPORTANT?

6.  Staff feel helpless  Reduced perspective and critical thinking skills  Negative world view  Difficulty recognizing and managing emotions  May under or over react – impaired judgment – risk to kids  Factionalism and lack of collaboration  If several people in a unit are short tempered, argumentative and pessimistic, people around them are impacted.  Ultimately, an entire unit or organization can behave like a traumatized person. PERSONAL AND ORGANIZATIONAL IMPACT

7. “We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.” C. Figley, 1995

8.  Secondary Traumatic Stress / Caregiver fatigue: Also called “vicarious traumatization” (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co- exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.  Burnout: Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related. DEFINITIONS

9. Large Group Brainstorm  Identify Causes  Who is at risk? WHAT CAUSES STS/BURNOUT?

10. Commonalities of Burnout and Compassion Fatigue:  Emotional exhaustion  Reduced sense of personal accomplishment or meaning in work  Mental exhaustion  Decreased interactions with others (isolation)  Depersonalization (symptoms disconnected from real causes)  Physical exhaustion BURNOUT VS COMPASSION FATIGUE

11.  Burn out emerges over time. Stages include enthusiasm, stagnation, frustration and apathy.  Compassion fatigue has a more rapid onset.  Compassion Fatigue has a faster recovery (less severe, if recognized and managed early). CLEAR DIFFERENCE

12.  HANDOUT  Take a few moments to complete  Discussion: results and responses COMPASSION FATIGUE TEST

13.  Understanding Basic Neurobiology of Trauma  Handouts – Brain Basics, Triune Brain, Hand Model  Freeze, Flight or Fright  Flipping Your Lid NEUROBIOLOGY

15. CAN ANYONE RELATE?

16. BRAIN BASICS

17. TRIUNE BRAIN MODEL

18. THE HAND MODEL OF THE HUMAN BRAIN (DR. DAN SIEGEL)

19.  https://www.youtube.com/watch ?v=8xQ0rKdiRV0 https://www.youtube.com/watch ?v=8xQ0rKdiRV0  Notice what comes up……….  Somatic Symptoms PRECIOUS VIDEO

20. Brainstorm: What Behaviors Would You See in a Colleague / Staff Member or Yourself Experiencing Compassion Fatigue?  Biological/Physical  Social  Psychological  Handout – Examples of Compassion Fatigue/Burnout Symptoms SIGNS AND SYMPTOMS OF COMPASSION FATIGUE

21. Brainstorm:  What stops you from speaking up?  What stops your colleagues / staff? BARRIERS TO ACKNOWLEDGMENT

22.  Handout PROQOL  Take test  Discuss results  Any surprises? PROFESSIONAL QUALITY OF LIFE SCALE (PROQOL)

23.  Learn as much as possible – articulate emotions and reactions  Know your “triggers”. Learn to defuse or avoid them.  Resolve your own personal issues! Do your work!  Be human. Allow yourself to grieve when bad things happen.  Develop realistic expectations about the rewards and limitations of being a child welfare worker.  Set boundaries for yourself.  Develop awareness of irrational beliefs about helping. Make alterations as needed.  Assess your work / life balance SELF AWARENESS

24.  Breathing / Grounding and Raising Energy Exercises  Physical Self Care  Emotional Self Care  Psychological Self Care  Spiritual Self Care  Workplace or Professional Self Care Handout – How to decrease your vulnerability to compassion fatigue TOOLS FOR SELF CARE “ I HAVEN’T BREATHED SINCE LAST WEEK”

25.  Practice compassion and gratitude toward staff.  Random acts of kindness.  Ask staff for input regarding clients who trigger them. Try to take this into consideration when making case assignments.  Actively nurture a sense of community within your unit.  Remind staff of the meaning in their work. If they’ve lost it, help them to find it.  Share information.  Listen  Encourage use of personal time.  Treat staff as adult professionals but don’t be too hands off.  Support staff to attend medical appointments.  Support staff to “do their own work”. TOOLS FOR STAFF CARE

26. Handouts…..  Stop in Your Tracks….Why am I doing what I’m Doing?  Think of a Challenging Work Situation….What 3 things makes it challenging…What 3 things make you appreciate it? Where are you more likely to focus and why?  At the beginning and end of each work day, take a distinct moment to think about what you’re grateful for and why.  Advocate for your workplace to develop a forum to express gratitude for one another.  When your day begins, take several deep breaths….What is my intention for the day?  At the end of the day, what can I put down. What do I not need to carry with me.  Designate a weekly day of non-obligation for myself. If this is too much…..what about 10 minutes per day of non-obligation? TRY THIS……

27.  This won’t work….I don’t have time…..You don’t understand…. OVERCOMING CYNICISM

28. Research shows that people who can do the work successfully over time demonstrate the following characteristics:  Sense of personal control – realistic expectations and personal responsibility.  Pursuit of personally meaningful tasks- Present and engaged in life. Ability to be active rather than passive in challenging times.  Healthy lifestyle choices – Diet, exercise, relaxation  Social support – Relationships with others who can serve as a buffer when dealing with difficult situations.  Capable of negative affect when faced with adversity but a belief that actions can resolve problems results in a general mood of wellbeing.  Bessel Vander Kolk DEBILITATION VS ADAPTION DO YOU HAVE THE SKILLS?

29.  Questions / Answers  Evaluation WRAP UP

30. THANK YOU

31. Marich, J. (2014). Trauma, PTSD & Traumatic Grief: Effective Assessments and Immediate Interventions. Child Welfare Resource Center for Adoption (2010). Compassion Fatigue: Secondary Traumatic Stress Disorder, Burnout, Vicarious Trauma. Van Dernoot Lipsky, L & Burk, C (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Additional references cited on handouts REFERENCES