1. 1 AMEDD Center & School Soldier & Family Support Branch www.behavioralhealth.army.mil https://www.cs.amedd.army.mil/sfsb/spss_prt.asp prt@amedd.army.mil Provider Resiliency Training PRT

2. 2 That which is to give light must endure burning Vicktor Frankl, Man’s Search for Meaning, 1963

3. 3 Military Care Providers: Who Are We? ALL who provide services to those that have experienced some level of trauma or suffering

4. 4 Terms Compassion (Provider) Fatigue: –Impacts the individual who is exposed to those who have been directly traumatized –Also known as Secondary Trauma –The military terminology for Compassion Fatigue is Provider Fatigue

5. 5 Terms Burnout: –Emotional exhaustion due to job strain –It may not be trauma related –Erosion of idealism

6. 6 BURNOUT!!

7. 7 Terms Detachment allows us to remain connected but not overwhelmed by the trauma

8. 8 Terms Compassion Satisfaction: –The sense of satisfaction a Provider has when working

9. 9 Term Resiliency is the ability to: Sustain good health and well-being in stressful conditions Bounce-back easily from setbacks Cope well with non-stop change Overcome adversity Convert misfortune into good luck Become stronger and better year after year

10. 10 Resiliency Resiliency grows through healthy responses to stressors Resiliency, for many, is a learned inner strength

11. 11 Questions??

12. 12 Provider Fatigue Markers

13. 13 Provider Fatigue Cognitive Markers –Intrusive thoughts –Decreased attention span –Thoughts of harm to self or others –Reduced sense of safety

14. 14 Provider Fatigue Emotional Markers –Powerlessness –Anxiety/Fear –Anger/Irritability –Numbness –Shame

15. 15 Provider Fatigue Behavioral Markers –Poor sleep –Appetite changes –Jumpy, on edge –Increased distrustfulness –Self-medicating

16. 16 Provider Fatigue Spiritual Markers –Decreased sense of hope/purpose –Anger at God –Questioning of prior beliefs –Loss of compassion

17. 17 Provider Fatigue Somatic Markers –Rapid heartbeat –Breathing difficulties –Aches and pains –Dizziness –Exhaustion

18. 18 Provider Fatigue Relationship Markers –Decreased interest in intimacy –Mistrust/Isolation –Overprotection as a parent –Interpersonal conflicts

19. 19 Provider Fatigue Work Performance Effects –Low Morale –Absenteeism –Interpersonal conflict

20. 20 Provider Fatigue Even in the darkest of circumstances, Provider Fatigue can be: –Natural –Predictable –Manageable

21. 21 Questions??

22. 22 Resiliency Strengths

23. 23 Resiliency Strengths Manage your health Be proactive in problem-solving Increase self-strengths: self-esteem, self- confidence, and self-concept Develop response choices Learn good lessons from difficult situations Siebert, A (2005)

24. 24 Resiliency Encouragement Family of Origin Sayings/Slogans that encourage resiliency: –“You can do anything you put your mind to” –“Just do it” –“Be all that you can be”

25. 25 Resilient Role Model

26. 26 Building Resiliency Through Self-care

27. 27 Resiliency Building Self-care –Physical Through nutrition Through exercise Through good sleep routine –Mental Relaxation techniques (meditation, yoga, music, deep breathing) Hobbies/ leisure activities Through setting goals and making plans of actions

28. 28 Resiliency Building Self-care cont.: –Emotional Personal journal writing Alone time Acceptance of difficult situations Finding time for humor

29. 29 Resiliency Building Self-care cont. –Social Increase activities with family and friends Join a new group activity (through church, intramural sports, etc.) Find a way to become involved in community programs

30. 30 Resiliency Building Self-care cont. –Spiritual Through Prayer Through Reading Inspirational/ Devotional Material Through Forgiveness

31. 31 Do’s & Don’ts of Provider Fatigue Do’s –Talk with someone –Understand that the pain you feel is normal –Start exercising and eating properly –Get enough sleep –Take time apart –Develop interest outside your field Dont’s –Blame others –Look for a new job, buy a new car, get a divorce, have an affair –Get into the habit of complaining with your colleagues –Hire a lawyer –Work harder and longer –Self medicate –Neglect yourself and your own interests John-Henry Pfifferling, PhD and Kay Gilley, MS Family Management Practice

32. 32 Questions??

33. 33 Take Action Continue to assess your level of Provider Fatigue Decide which area of your life needs improved resiliency activities Create a Self-Care Plan Chose an accountability buddy for your self - care plan Buddies are good, but if you need professional help, find an appropriate counselor

34. 34 Management Role What Does the Staff Need? Options for Support Work environments that acknowledge the reality of secondary or vicarious trauma and offer support for self-care and connection Forums for discussions about the work and its stresses A group with a focus on discussing and addressing vicarious traumatization A buddy system (Identify a colleague with whom you will discuss the work and its challenges.) Regular clinical consultation Personal psychotherapy Continuing education opportunities that address these topics Emotional release (opportunities to express strong feelings of grief, fear, anger, gratitude) Realistic expectations for selves Information Karen W. Saakvitne, PhD; B. Hudnall Stamm, PhD www.APAHelpCenter.org

35. 35 Counseling Sources Seek help: –If you feel overwhelmed –If you have thoughts about harming yourself or others –If family or friends are expressing concerns about your well being Military OneSource: –1-800-342-9647 –www.militaryonesource.com Contact local services: –Dept of Behavioral Health –Community Mental/Behavioral Health clinics –Chaplains –Family Life Centers

36. 36 Questions Email questions to: www.behavioralhealth.army.mil

37. 37 References Adams, RE; Boscarino, J; & Figley, CR (in press). Compassion fatigue among a sample of New York Social Workers: Instrument psychometrics. Journal of Orthopsychiatry.Compassion fatigue among a sample of New York Social Workers: Instrument psychometrics Bride, B. E., Robinson, M. M., Yegidis, B. & Figley, C. R. (2004). Development and Validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14:1, 27-36. Development and Validation of the Secondary Traumatic Stress Scale Dealing with Critical Incident Stress and Compassion Fatigue. American Association of Critical Care Nurses. Retrieved January 6, 2005, from Figley, C. R. (2002). Treating Compassion Fatigue. New York: Brunner- Rutledge.Treating Compassion Fatigue Figley, C.R. (Ed.) (1995). Compassion Fatigue: Secondary Traumatic Stress Disorders from Treating the Traumatized. New York: Brunner/Mazel. (Review)Compassion Fatigue: Secondary Traumatic Stress Disorders from Treating the TraumatizedReview Figley, C. R. (2002). Compassion fatigue and the psychotherapist's chronic lack of self care. Journal of Clinical Psychology, 58:11, 1433- 1441.Journal of Clinical Psychology

38. 38 References Figley, C.R. (2003). Compassion Fatigue: An Introduction. Gift From Within. Retrieved January 3, 2005, from http://www.greencross.org/_Research/CompassionFatigue.asp http://www.greencross.org/_Research/CompassionFatigue.asp Figley, C.R., Nash, W.P. (Ed.) (2007). Combat Stress Injury Theory, Research, and Management. New York: Taylor & Frances Group. FunkRev. Jeffrey R.,M.Div., P.C.C., “Balancing the Burdens of Caregiving: Avoiding Compassion Fatigue”, Healthcare Chaplains Ministry Association Gentry J. E. (2002) Burning Up: The Negative Effects of Caregiving. AKH Consultant and St. Petersburg College. AKH Inc. O’Grady, K (2003). Symptoms and prevention outlined. Vet Center Voice, Vol. 25, No. 3, 44-45. Regehr, C; Goldberg, G; & Hughes J (2002). Exposure to Human Tragedy, Empathy, and Trauma in Ambulance Paramedics. American Journal of Orthopsychiatry 2002, Vol. 72, No. 4, 505-513.

39. 39 References Siebert, A. (2005). The Resiliency Advantage. New York: Brunner- Rutledge. Stamm, B.(1997-2005). Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm Thompson, R.T. USA (2003). Compassion Fatigue: The Professional Liability for Caring Too Much. The Human Side of School Crisis – A Public Entity Institute Symposium. Retrieved January 6, 2005, from http://www.riskinstitute.org/symposiumdocs/CompassionFatigue- PERISymposiumPaper.pdf http://www.isu.edu/~bhstamm “When Helping Hurts: Preventing & Treating Compassion Fatigue”, Video, Gift From Within, www.giftfromwithin.org,17 Minute Preview, 2006www.giftfromwithin.org