What Our Work Does to Us (© The Legal Aid Society 2019)

What Our Work Does to Us (© The Legal Aid Society 2019)
THE LEGAL AID SOCIETY JUVENILE RIGHTS PRACTICE Training Materials © The Legal Aid Society 2019 All rights reserved. No part of this work may be reproduced or transmitted without the prior written permission of The Legal Aid Society. What Our Work Does to Us (© The Legal Aid Society 2019)

The Legal Aid Society of New York City
Oldest (est. 1876) and largest private, not-for-profit organization providing free legal assistance in the US Represents clients in over 300,000 cases each year Provides comprehensive range of legal services in three practice areas: civil, criminal and juvenile Services provided in a network of 25 neighborhood and court-house offices by a staff of 1100 attorneys and 700 social workers, investigators, paralegals, and support staff What Our Work Does to Us (© The Legal Aid Society 2019)

Juvenile Rights Practice
Established concurrently with the NYS Family Court in 1962 Provides representation to 90% of the children appearing in the five NYC Family Courts on dependency, termination of parental rights, status offense, and delinquency petitions Represents more than 32,000 children, ages birth to 21 years, each year Provides representation in appellate cases and initiates class action lawsuits and other litigation aimed at system reform Pioneered the use of professional social workers to assist in representing children What Our Work Does to Us (© The Legal Aid Society 2019)

Secondary Trauma Stress Interdisciplinary Committee
The committee started in 2009 It consists of members from all JRP disciplines, attorneys, social workers and support staff It was formed in response to individuals beginning to identify symptoms of Secondary Trauma Stress They felt the need to define their own STS experiences and learn more about STS They wanted to develop ways to address their STS and to assist colleagues also experiencing STS What Our Work Does to Us (© The Legal Aid Society 2019)

Legal Work, including for Juvenile Rights is...
Meaningful Fulfilling Endlessly fascinating Invigorating All with great colleagues What Our Work Does to Us (© The Legal Aid Society 2019)

But, You Might… Get over involved in work
Skip lunch to work Stay late at the office Fail to use vacation days Sacrifice your health and private time to work What Our Work Does to Us (© The Legal Aid Society 2019)

Someday Might Find Yourself…
What Our Work Does to Us (© The Legal Aid Society 2019)

If that’s you, you may be suffering from Secondary Trauma Stress, or
Vicarious Trauma, or Burnout; and, it’s time to find out what’s happening to you and what to do about it. What Our Work Does to Us (© The Legal Aid Society 2019)

What are Secondary Trauma Stress (STS), Vicarious Trauma (VT) and Burnout? Do we at JRP have Secondary Trauma Stress (STS), Vicarious Trauma (VT) or Burnout? Why do we at JRP have Secondary Trauma Stress (STS), Vicarious Trauma (VT) and Burnout? What are we going to do about it? What Our Work Does to Us (© The Legal Aid Society 2019)

1. What Are: Secondary Trauma Stress? Vicarious Trauma? Burnout?

Stress Defined A mentally or emotionally disruptive or disquieting influence, it can be positive or negative. It emerges over time. Each new stress builds on unresolved past stress, compounding the effect of additional stress. What Our Work Does to Us (© The Legal Aid Society 2019)

Trauma Defined Trauma: Any shock that creates substantial damage to the psychological health of the individual. Traumatic stress: The strain on the human mind and body from a specific major event that shocks, stuns and horrifies. What Our Work Does to Us (© The Legal Aid Society 2019)

Vicarious Trauma (VT) Defined
Witnessing traumatic events experienced by our clients Absorbing the sight, sound, touch, and feel of the stories told by the victim Causing an instant physical reaction Questioning beliefs about kindness of others and safety What Our Work Does to Us (© The Legal Aid Society 2019)

Symptoms of Vicarious Trauma (VT)
The trauma experienced by the client creates distress in the helper which may cause symptoms such as: Minor sleep problems Hyper-arousal Intrusive thoughts Recurring dreams Avoidance or emotional numbing What Our Work Does to Us (© The Legal Aid Society 2019)

Secondary Trauma Stress (STS) Defined
AKA Compassion Fatigue Combination of exposure to trauma and empathy Behavior and emotions resulting from knowing about a traumatizing event experienced by someone close Emotional weight experienced when helping or wanting to help a traumatized person What Our Work Does to Us (© The Legal Aid Society 2019)

Factors Contributing to STS
Chronic nature of our work and its stresses Our own experiences with trauma triggered by hearing about clients’ trauma Lack of control over work life Experiencing: The pain of our clients The difference between expectations and realities The difference between how we perceive our job and how our clients and their families perceive it A sense that showing emotions, especially for attorneys, is seen as weakness What Our Work Does to Us (© The Legal Aid Society 2019)

Burnout Defined Three dimensions: Emotional exhaustion Depersonalization Low feeling of accomplishment Often stems from the distance between a person’s values and goals and the resources available to achieve them Can be the end result of Secondary Trauma Stress and Vicarious Trauma What Our Work Does to Us (© The Legal Aid Society 2019)

Signs of Burnout Fatigue Poor Sleep Headaches Anxiety and irritability Depression Cynicism Gradual erosion of idealism What Our Work Does to Us (© The Legal Aid Society 2019)

Post Traumatic Stress Disorder
The recent revision of the DSM-5 broadened the diagnostic criteria for PTSD to include secondary, work-related exposure. Triggering event = exposure to actual or threatened death, serious injury or sexual violence Method of exposure: Directly experiencing the event Witnessing the event occur to others Learning that the event occurred to a close family member or friend Being repeatedly exposed to extreme and aversive details of the event through one’s work What Our Work Does to Us (© The Legal Aid Society 2019)

2. Do We Have: Secondary Trauma Stress? Vicarious Trauma? Burnout?

Our 2010 and 2014 Surveys We asked 30 questions were asked to develop JRP-specific data: Characteristics of the responders Work styles Environment Effects of our work We used the ProQOL in our Legal Aid survey What Our Work Does to Us (© The Legal Aid Society 2019)

The Professional Quality of Life Scale (ProQOL)
A 30 item self report scale Measures Compassion Satisfaction, Burnout and Secondary Trauma Stress Statistically valid measure developed with data from over 3,000 people Most widely used measure of the positive and negative aspects of helping Can be found at What Our Work Does to Us (© The Legal Aid Society 2019)

Professional Quality of Life Scale (ProQOL) Compassion Satisfaction and Compassion Fatigue (ProQOL) Version 5 (2009) When you [help] people you have direct contact with their lives. As you may have found, your compassion for those you [help] can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a [helper]. Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days. 1=Never 2=Rarely 3=Sometimes 4=Often 5=Very Often I am happy. I am preoccupied with more than one person I [help]. I get satisfaction from being able to [help] people. I feel connected to others. I jump or am startled by unexpected sounds. I feel invigorated after working with those I [help]. I find it difficult to separate my personal life from my life as a [helper]. I am not as productive at work because I am losing sleep over traumatic experiences of a person I [help]. I think that I might have been affected by the traumatic stress of those I [help]. I feel trapped by my job as a [helper]. Because of my [helping], I have felt "on edge" about various things. I like my work as a [helper]. I feel depressed because of the traumatic experiences of the people I [help]. I feel as though I am experiencing the trauma of someone I have [helped]. I have beliefs that sustain me. I am pleased with how I am able to keep up with [helping] techniques and protocols. I am the person I always wanted to be. My work makes me feel satisfied. I feel worn out because of my work as a [helper]. I have happy thoughts and feelings about those I [help] and how I could help them. I feel overwhelmed because my case [work] load seems endless. I believe I can make a difference through my work. I avoid certain activities or situations because they remind me of frightening experiences of the people I [help]. I am proud of what I can do to [help]. As a result of my [helping], I have intrusive, frightening thoughts. I feel "bogged down" by the system. I have thoughts that I am a "success" as a [helper]. I can't recall important parts of my work with trauma victims. I am a very caring person. I am happy that I chose to do this work. What Our Work Does to Us (© The Legal Aid Society 2019)

2010 Findings All JRP disciplines except support Staff were experiencing levels of Secondary Trauma Stress above normal limits. Staff attorneys were experiencing the most STS. Staff attorneys made up the only discipline that was experiencing burnout above normal limits. All disciplines were experiencing compassion satisfaction within normal limits. SW and support staff were above the median. Paras, managers and attorneys were below the median. Why just normal for dedicated workers doing such a great job? What Our Work Does to Us (© The Legal Aid Society 2019)

ProQOL Scores: & 2014 What Our Work Does to Us (© The Legal Aid Society 2019)

Why Do We Have: Secondary Trauma Stress? Vicarious Trauma? Burnout?

The Bottom Line STS is an occupational hazard of our work. What Our Work Does to Us (© The Legal Aid Society 2019)

Our Working Theory Exposure to trauma is part of the job. We work in a crisis-oriented, dysfunctional system. We develop a different sense of “normal”. Our work is client directed, or child client directed. What Our Work Does to Us (© The Legal Aid Society 2019)

Exposure to Trauma Our clients and their families have all experienced trauma. They come to us seeking help with a current trauma. Their past traumas become a part of our work with them. During the case, our clients will often experience new, additional trauma. The clients may experience additional trauma in their lives, such as immigration, housing and health insurance problems What Our Work Does to Us (© The Legal Aid Society 2019)

The System We Work In Problem focused Power and control are important Players in the system do not collaborate, cooperate and/or communicate Lack of resources Sustainability problems Poor training, supervision and support for many players in the system A sense of having to compensate for the failures of others What Our Work Does to Us (© The Legal Aid Society 2019)

Our Work Is Client Directed
There is no definition of winning in our cases. We have an important but limited role in our clients lives. We are not here to “save” our clients. We have to trust that our clients’ decisions are right for them even if we feel differently. What Our Work Does to Us (© The Legal Aid Society 2019)

People Bring Themselves
People bring their experiences and personal perspectives to anything they do: Their attitudes, beliefs and assumptions Their relationships with family, friends and others Their history of trauma Their cultural background Their socio-economic situation ADAPTED FROM: ©Beth Hudnall, What Our Work Does to Us (© The Legal Aid Society 2019)

What Is Our Motivation? Why did we choose a profession focused on helping others? What core beliefs led us to it? What do we get out of it? What don’t we get out of it (money, status, power)? Something in your life and experience propelled you to do this work, what is it? Revisit it, often, to refresh your motivation. What Our Work Does to Us (© The Legal Aid Society 2019)

We Have Empathy Empathy is: Appreciation of the feelings of others, even if they are distant others Emotional responsiveness Willingness to be/work with others who have problems You can’t do this job without empathy, but that empathy makes you susceptible to STS. What Our Work Does to Us (© The Legal Aid Society 2019)

Caring Has a Price STS is a natural result of knowledge about a trauma. It is also the result of wanting to help a trauma victim, and possibly not being able to do so. We pay the price every day. What Our Work Does to Us (© The Legal Aid Society 2019)

Caring Has a Price Empathy Caring STS What Our Work Does to Us (© The Legal Aid Society 2019)

4. What Are We Going to Do About It?

Preventing and Managing STS
Knowledge Recognition Response Personal Institutional Professional What Our Work Does to Us (© The Legal Aid Society 2019)

The Ethics of Self Care Do no harm to yourself when helping others. Pay yourself first. Attend to your physical, social, emotional, and spiritual needs so you can provide the highest quality services to your clients. Neglecting sufficient self care can cause harm to those you serve. What Our Work Does to Us (© The Legal Aid Society 2019)

Personal Responses Be an Advocate for Yourself
Remember the basics: sleep, eat, exercise, laugh Balance home & work - leave work, refuel and refill Cultivate healthy intimate and family relationships Develop a healthy attitude towards the use of drugs and alcohol Get regular medical & dental checkups Consider including spirituality or meditation in your day If needed, seek counseling and professional help What Our Work Does to Us (© The Legal Aid Society 2019)

I Give My Clients My Personal Contact Information What Our Work Does to Us (© The Legal Aid Society 2019)

I Feel that I Need to Be Available to My Clients Outside of Work Hours

I Check My E-mail on My Personal Time

Save Time for Things that Give Your Life Meaning
Contact with nature Spirituality Exercise Creative expression Volunteer work Hobbies Whatever else works for you What Our Work Does to Us (© The Legal Aid Society 2019)

Stress Management Awareness of Physical Manifestations
Skills to calm and soothe yourself Progressive relaxation Practice Mindfulness Biofeedback Centering and using guided imagery Breathing exercises Awareness of Physical Manifestations Empathic resonance (tendency to experience the same feelings as the client, e.g. anger, sadness, etc.) Hyper-arousal, hyper-sensitivity (tendency to over-react to stimuli) What Our Work Does to Us (© The Legal Aid Society 2019)

Mindfulness in the Workplace
Mindfulness is defined as having “moment-to-moment awareness without judgment.” It can also be characterized with these three words: intention, attention and attitude. Mindfulness in the workplace means being present and attentive to the task at hand. It also means having the skills to effectively cope with both short and long term stress. Research has linked mindfulness meditation to the following: Boost in productivity level Decrease in stress levels related to work Promotes self-care What Our Work Does to Us (© The Legal Aid Society 2019)

Smartphone apps for meditation and calming
Calm Headspace 10% Happier Buddhify Meditation Studio Meditation Made Simple What Our Work Does to Us (© The Legal Aid Society 2018)

Suggested Institutional Responses
Create a safe and supportive environment Ensure regular supervision and peer and individual support, especially during times of crisis Balance case load size/work load Encourage attendance at continuing professional education Address effects of STS and other job issues Undertake coalition building with other system players Guarantee a healthy work setting Make sure staff understands policies and procedures Provide access to leaders and supervisors Create adequate human resource policies Provide a method for seeking counseling and professional help Create awareness of these issues during staff recruiting What Our Work Does to Us (© The Legal Aid Society 2019)

Supervisory Responses
Create and maintain an open and nonjudgmental professional space Supervisors must address STS issues Identify pertinent cases, discuss issues, validate reactions, encourage self care Good supervision includes: Dedicated time A collaborative relationship Constructive feedback Reflection Self exploration Mentorship APPRECIATION AND RECOGNITION!!!! What Our Work Does to Us (© The Legal Aid Society 2019)

Crisis Debriefing (The Critical Incident Protocol)
Acknowledge difficulties of case Share current reactions Validation and normalization Monitor STS reactions Self care sharing of ideas Practice one stress management technique Encourage self care What Our Work Does to Us (© The Legal Aid Society 2019)

Professional Responses Within Your Office
Acknowledge toll of work Arrange job into manageable, well paced parts Boundary and limit setting - You can only accomplish so much with limited hours and personal resources Engage in daily goal setting and/or self evaluation at the end of the day Develop and implement plans for coping with STS Reduce and resist isolation in yourself and others Make worker care a team activity Help each other keep good work boundaries What Our Work Does to Us (© The Legal Aid Society 2019)

Professional Responses Outside Your Office
Reach out for peer support - formally and informally Cultivate relationships with professional peers Attend professional trainings Participate in professional societies Cultivate relationships with other professionals who have a positive attitude Find professional mentors Engage in social activism to help clients and the community develop a sense of shared mission What Our Work Does to Us (© The Legal Aid Society 2019)

Staff Recruiting Considerations
Begin during the hiring process Inform candidates of the inherent stresses of the job Describe the caseload and clients Explain support and supervision in place Explore the candidates’ attitude to handling stress What Our Work Does to Us (© The Legal Aid Society 2019)

What We Have Done at JRP JRP staff training Critical Incident Protocol De-stress and Digest meeting Intern training Surveys Information dissemination Ongoing STS Committee Published The Hidden Cost of Empathy: How to Address Secondary Trauma Stress in a Child Law Office. ABA Children’s Rights Litigation Section Newsletter January 9, 2017 Tranquility Boxes What Our Work Does to Us (© The Legal Aid Society 2018)

Building Resilience Resilience is how a person recovers (bounces back) from stress and trauma. Resilience is related to the delicate balance between the factors and defenses that protect against cumulative stress (prevention and management). It is based on having/employing coping skills that allow for continued stress resolution. It can be inherited or innate, but resilience can also be learned and developed. What Our Work Does to Us (© The Legal Aid Society 2019)

Compassion Satisfaction
Perceived stress is associated with lower compassion and job satisfaction. Workers in the same setting who report higher job satisfaction report less stress. Job satisfaction is associated with higher levels of social support, autonomy and effectiveness. What Our Work Does to Us (© The Legal Aid Society 2019)

The three most important things to remember are:
ABC The three most important things to remember are: 1. Awareness 2. Balance 3. Communication What Our Work Does to Us (© The Legal Aid Society 2019)

Thank you Please feel free to contact us
Vicki E. Light Bronx Brad Martin Manhattan Lina Del Plato Brooklyn Eileen Lopez Queens Karen Levit Queens Alexis Koerner Staten Island Daniela LaValva Pine Street What Our Work Does to Us (© The Legal Aid Society 2019)

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