1. (Compassion Fatigue Presentation) JCMVAMC & Community Service Council Muskogee, OK January 7, 2014 “SO YOU ARE THINKING OF QUITTING?” (Compassion Fatigue Presentation) JCMVAMC & Community Service Council Muskogee, OK January 7, 2014 Jim Lyall, MPA, CIRS Lanny Endicott, D.Min., LCSW, LMFT Erv Janssen, MD

2. Objectives for Our Time Together 1.Share our growing collaboration: JCMVAMC & CSC 2. Discuss dimensions of Compassion Satisfaction – Compassion Fatigue – Burnout 3. Explore complexities of Compassion Fatigue

4. Community Collaboration The Veterans' Initiative of the CSC (2009) The Initiative's relationship with VA administration & various departments CSC sponsorship of "Silent Wounds of War" Assistance with VA Resource Fair

5. Coffee Bunker: veteran drop-in center (Tulsa – 41st & Sheridan) Wounded Warrior Project Cognitive Processing Therapy Training in Military Culture Question Persuade Refer Suicide prevention Moral Injury/Soul Injury Training

6. Continuing Collaboration Veteran's Treatment Court Preventing/Ending Homelessness Moral/Soul Injury Annual Veteran's Stand Down

7. Future Considerations Community Based One-Stop-Shop Center Continuing Communication between VA & Community-based Organizations

8. Dimensions of “Compassion” SatisfactionFatigue (Secondary Trauma) Burnout

9. Compassion Satisfaction Encouragers Experiences pleasure from helping Perceives agency as supportive Personally enjoys the work Able to do the work Sees work as fulfilling (“work may be viewed as a calling”) Adapted from Beth StammEncouragers Experiences pleasure from helping Perceives agency as supportive Personally enjoys the work Able to do the work Sees work as fulfilling (“work may be viewed as a calling”) Adapted from Beth Stamm

10. Compassion Fatigue Discouragers Missing pleasure from helping Agency not perceived as supportive Doesn't enjoy the work Questions the ability to do the work Unfulfilled, disillusioned in the work Discouragers Missing pleasure from helping Agency not perceived as supportive Doesn't enjoy the work Questions the ability to do the work Unfulfilled, disillusioned in the work

11. Fatigue Frequent illness Sleep problems Disillusionment with work Helplessness Sense of Hopelessness Being harsh with other staff Cynicism Powerless to change events Anger toward the organization and/or “clientele” Depression and isolation Staying away from co- workers Reduced commitment to work Being absent Use of Chemicals For more see: http://www.compassionfatigue.org

12. Burnout Worn out Helpless Exhausted Loss in Productivity Loss of Self (Soul) Takes time to develop Person is often not aware Key sign is looking to quit and/or change jobs

13. Additional Fatigue Factors Working with the traumatized Working with the traumatized Absorbing trauma of others Absorbing trauma of others Personal exposure to trauma Personal exposure to trauma Accompanying sense of: Accompanying sense of: powerlessness, hopelessness, powerlessness, hopelessness, "wearing out" "wearing out"

14. http://www.proqol.org

15. Model for Burnout Primary Trauma(s) Compassion Fatigue (ST) Stress of Life Burnout

16. Personal Strategies for Prevention Recovery Personal Strategies for Prevention Recovery ExerciseReading Diet Music Diet Music Journaling“Breathing” Meditation Gardening Meditation Gardening Spiritual Photography Sports Sleep Sports Sleep Family Hobbies

17. Some Strategies at Work In the Unit, Team, Group Creating opportunities to share Nurturing an encouraging atmosphere Keeping information confidential Spending social time together Maintaining an atmosphere of safety

18. Self-Care is Balance Care for MeMy Responsibilities Self-Care is Balance Care for Me My Responsibilities

19. Professional "Impairment"

20. Complexities of Compassion Fatigue

21. Patient/Family Me/Team Hospital/System Complexity of Compassion Fatigue (from the perspective of a clinician)

22. The role of compassion: The VA motto March 4, 1865: President Abraham Lincoln “To care for him who shall have borne the battle and for his widow, and his orphan.” Thus the framework is set……… COMPASSION is foundational for our work in a system with the mission of caring Compassion engages The quality of compassion puts us at risk AND, not only for those who have direct contact with patients, clients or families……but for all who are a part of the VA!! U. S. Department of Veterans Affairs; Celebrating America’s Freedoms; The Origin of the VA Motto: Lincoln’s Second Inaugural Address

23. Compassion Fatigue Related to relationships: Clinician-patient/client Within groups: In families of those suffering from PTSD: “like a virus, the stress spreads” In “systems” such as teams, or a hospital ➢ NOT JUST LIMITED TO “CLINICAL STAFF” Figley, Charles R.: What is Compassion Fatigue-Prevention & Treatment; Gift From Within- PTSD, Resources for Survivors and Caregivers (web page) © Green Cross Foundation http://www.giftfromwithin.org/html/What-is-Compassion-Fatigue-Dr-Charles-Figley.html

24. A Concern for the VA In VA publication: Organizational Health (Vol. 18; Spring 2013) “Healing the healers”, Linda Belton, p. 4 “Burnout in the VA: How are we doing?”, Katerin Osatuke, p. 5 “All Things Connected….”, Linda Belton, p. 10. And from a “sister” VA: Puget Sound VA pushing to hire, grow, retain staff: “Low job satisfaction and morale may be one factor driving turnover” “Demands of job take a big toll” “I loved every job I ever had, but I just burned out at the VA” (supervising physician) The Seattle Times, December 20, 2014[http://seattletimes.com/html/localnews/2025279563_vastaffingsxml.html]

25. PERSONAL REFLECTIONS: TAKING STOCK 1. Introspective (honest, in-depth) effort 2. Review with others: ENCOURAGING CONTINUING CONVERSATION Family Friends Work colleagues Supervisor? Professional consultation 3. Structured assessment: PROFESSIONAL QUALITY OF LIFE SCALE 30 question “self test” for self scoring Beth Stamm

26. What Can Be Done? 1.Creative possibilities by continuing the conversation Not just complaining Together generating ideas, exploring possibilities Minimize “It will never work” 2.The Mayo experience: “Peer Support Trumps Time Off in Preventing MD Burnout” 90 minutes every 2nd week (9 month trial period) 6-8 physicians with trained facilitators/colleagues vs. unsupervised time off 3. CREW “Being locally creative”! A randomized controlled trial evaluating the effect of facilitated small group sessions on physician well‐being and job satisfaction (C. West, L. Dyrbye, J. Sloan, T. Shanafelt); Research Presentation 26 Oct 2012 Peer Support Trumps Time Off in Preventing MD Burnout. Medscape. Nov 06, 2012

27. COMMENTS QUESTIONS "Keeping the conversation going"

28. Jim Lyall jlyall@csctulsa.org Lanny Endicott lendicott@oru.edu Erv Janssen janssenmd@cox.net