1. Managing Compassion Fatigue, Vicarious Trauma and Burnout in the CIT Responder
Michelle S. Albert, LPC, CSOTP Andrea Shea, LPC
Jail Diversion Supervisor Emergency Services Supervisor
Alexandria CSB Prince William CSB
Both
Virginia CIT Conference October 16, 2018

2. Exercise: Life / Work Balance
Were the areas in which you score high what you predicted they would be?
Are there things in your life draining you that you didn’t suspect or realize?
When is the last time you gave careful thought to specific things that drain you?
Do you engage in healthy self-care practices?
Do you practice self-validated caregiving? Is your self-care guilt-free?
Michelle

3. Kitchen Table Wisdom (1996)
“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”
Kitchen Table Wisdom (1996)
Rachel Naomi Remen
Andrea

4. Objectives
Develop a framework for understanding and differentiating between:
Moral Distress
Vicarious Trauma
Burnout
Compassion Fatigue
Normalize the “helper experience”
Self-Assessment / Awareness
Self-Care and Resilience Strategies
Have Fun!
Andrea

5. First World Problems https://www.youtube.com/watch?v=vN2WzQzxuoA
Andrea

6. The Reality of Helping Professions
Compromised or inflexible systems (i.e. schedules, lack of staff, lack of training, poor work space/environment)
Systemic challenges and budget cuts
Difficult stories and situations of those you help
Losses
Disclaimer – own experiences
Michelle

7. Moral Distress An issue that affects all helping professions
Involves a threat to one’s moral integrity – that sense of wholeness and self-worth that comes from having clearly defined values that are congruent with one’s perceptions and actions
A Helper may experience Moral Distress or Moral Injury multiple times per day or shift
“When policies or routines conflict…with beliefs…about patient care” (Mitchell 2000)
Michelle – Opioids and shooting domestic callers

8. Which of these three is most damaging?
Trauma
“Primary” trauma – A trauma experienced in the first-person. Professional or personal - Many people in the helping profession have experienced multiple personal traumas. It’s part of what makes us good at our jobs!
Secondary or “Vicarious” Trauma – A trauma that is experienced second-hand, in the re-telling of events, investigations, observations
Tertiary Trauma – Long-range effects of a traumatic incident or pervasive environmental conditions
Which of these three is most damaging?
Michelle

9. Vicarious Trauma (VT)
Occurs when the stories we hear from people transfer onto us in a way where we are secondarily traumatized and have difficulty ridding ourselves of the images and experiences they have shared
The profound shift Helpers experience in their world view when they work with people who have experienced trauma
Fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material
Michelle slide
Andrea Example of Jamaica

10. COACH
Andrea

11. Burnout Does not mean our world view has been changed
Gradual onset of dissatisfaction and resentment with the work environment
The exhaustion and disconnect employees can experience when job satisfaction is low and they feel powerless and overwhelmed
Directly related to the work environment – hours, supervisors, training, etc.
Depleted ability to cope with work demands
Feel powerless to achieve goals
Specific to the work environment, Burnout is the easiest to fix
Andrea

12. Compassion Fatigue (CF)
Characterized by an emotional and physical exhaustion, a Helper can develop CF over the course of their career when they are unable to refuel and regenerate
A deep erosion of our compassion and our ability to tolerate the strong emotions and difficult stories of those with whom we work
Stems from absorbing the suffering of others (Figley, 2009)
Andrea

13. The Compassionate Connection
Michelle

14. Risk Factors Intensity Frequency Severity Proximity Personal Factors
Previous trauma
Anxiety
Depression
Impulsive/High-risk behaviors
Substance use
Michelle
High Risk bx: gambling to excess, indiscriminate sexual behavior, motorcycles

15. Where are your Skittles?
Have you noticed a change in your world view or have you found that you give the best of yourself at work and have nothing left when you get home?
Andrea: Skittles
You may find that you experience signs and symptoms that are physical, professional, personal and spiritual

16. Physical Symptoms Shock / Disbelief Sweating Rapid heartbeat
Unexplained aches and pains
Dizziness
Impaired immune system
Restlessness
Sleep disturbance
Appetite disturbance
Andrea

17. Impact on Professional Functioning
Performance
Decrease in quality and quantity Low motivation
Avoidance of job tasks Increased mistakes
Setting perfectionist standards Obsessing about details
Morale
Decrease in confidence Loss of interest
Dissatisfaction Negative attitude
Apathy Lack of appreciation
Detachment Feelings of incompleteness
Andrea
Interpersonal
Withdrawal from colleagues Impatience
Decrease in quality of relationships Poor communication
Staff conflicts

18. Impact on Personal Functioning
Withdrawal from others
Decreased interest in intimacy
Mistrust
Intolerance
Loneliness
Projection of anger or blame
Irritability
Michelle

19. Spiritual Symptoms of Poor Self Care
Questioning the meaning of life
Loss of purpose
Lack of self-satisfaction
Pervasive hopelessness
Angry at higher power
Questioning prior beliefs
Michelle

20. Do these symptoms leave you feeling like…
… THIS??

21. Protective Factors Support system Part-time work or other tasks
Adequate training
Work-Life balance
Belief system
Current coping strategies
Implementation of self-care techniques
Ability to recognize warning signs
Michelle

22. My Colleagues are Awful!
Many Helpers find the negativity of their colleagues to be a big challenge
Reframe this negativity and think of it as an organizational form of compassion fatigue, caused by the CF and VT that some of our most depleted colleagues are experiencing
Andrea

23. What Does Your Dragon Look Like?
Health
Caution
Warning
Danger
Andrea

24. Meet the Dragons
Michelle

25. Key Elements in Review
CF/VT can affect an individual or can contaminate an entire workplace as a whole
Not all workplaces are created equal! You could be experiencing burnout due to an unsupportive workplace in addition to CF/VT from the challenging work you do
Andrea

26. Well, That’s Lovely. Now What?
Awareness is the first step
What is affecting you… CF? VT? Burnout? Moral Distress? A combination of two or more?
Understand your warning signs
What are your “Big Three”?
Andrea

27. ABC’s of Prevention and Maintenance
Awareness – Recognizing signs and symptoms
Balance – Taking personal responsibility
Connection – Seeking consultation and debriefing
Michelle

28. Have you been slimed? Debriefing vs. Venting aka “sliming”
Self-Awareness – Pay attention to how your sharing impacts others;
avoid “sliming”
Andrea
Permission to come aboard
Fair warning

29. Get Control of Yourself
BREATHE!!!
Identify the desired outcome
Steps for a desired outcome:
Ask yourself what you want
Identify areas in your life where you DO have control
Make a plan:
What’s in your Self Care First Aid Kit? (Your “person”, snacks, stress ball, comedy, music, exercise, etc.)
Andrea – weight example and what you can live with

30. 4 Domains of Control to Make a Change
Physical
Cognitive / Attitude
Existential / Meaning & Purpose
Relationships – “No” is not a four-letter word
Andrea

31. When to Seek Outside Help
An increase in self-destructive or high-risk behaviors (alcohol, food, drugs/medications, spending, etc.)
Missing work
Increased irritability
Lack of empathy towards everyone
Anxiety
Symptoms of depression
Sleep and/or appetite disturbance
Withdrawing
Anhedonia/Apathy
Michelle

32. Healthy Detachment
What are you in this for? Are you making it about you? Are you wanting helping someone else to provide you with a sense of satisfaction? (e.g. “You’re OK… then I’m OK”)
“It doesn’t mean we don’t care. It means we learn to love, care and be involved without going crazy.” (M. Beattie, 1992)
“When we allow people to be who they are, then we stop trying to change things we can’t.” (M. Beattie, 1992)
Michelle

33. Stress Reduction Activity
BANG HEAD HERE
Andrea
Directions
Place on firm, flat surface
Follow directions on circle
Repeat step 2 as necessary or until unconscious
If unconscious, cease stress reduction activity

34. Guided Meditation

35. “I did the best I could with the light I had to see by”
“I did the best I could with the light I had to see by” Author Unknown