1. 4/25/ :01 AM
Compassion Fatigue, Impairment, and Social Worker Self-care NASW ANNUAL FALL CONFERENCE, 2015 Asheville, NC
Dottie Saxon Greene, PhD, LCSW, LCAS, CCS
East Tennessee State University
Assistant Professor, Department of Social Work
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2. OVERVIEW RATIONALE FOR THE TOPIC
COMPASSION FATIGUE, STS, VT, BO, AND IMPAIRMENT
WHAT DOES THE RESEARCH SAY?
PROFESSIONAL AND ETHICAL RESPONSIBILITES
SELF-CARE
SELF-ASSESSMENTS

3. SELF-CARE, SELF-CARE, SELF-CARE, Blah, Blah, Blah…
SELF-CARE, SELF-CARE, SELF-CARE, Blah, Blah, Blah….. WHAT’S ALL THE HOOPLAH ABOUT?
YOU ARE THE TOOL!
OUR CLIENTS DESERVE THE BEST WE CAN BRING FORTH!
YOU DESERVE THE BEST YOU!
YOU CANNOT TAKE A CLIENT BEYOND THAT WHICH YOU ARE!
SOCIAL WORKERS DON’T STOP BEING HUMAN
OCCUPATIONAL HAZARDS
NASW CODE OF ETHICS
CSWE COMPETENICES AND PRACTICE BEHAVIORS

4. TERMS/CONSTRUCTS COMPASSION FATIGUE BURNOUT SECONDARY TRAUMATIZATION
VICARIOUS TRAUMA
IMPAIRMENT
Seminal works’ authors
Christine Maslach
Charles Figley
Beth Stamm
Pearlman & Saakvitne

5. Courtesy of Beth Stamm, PhD www.proqol.org
PROFESSIONAL QUALITY OF LIFE: Compassion Satisfaction & Compassion Fatigue
Courtesy of Beth Stamm, PhD

6. Professional Quality of Life (PROQL) the quality one feels in relation to their work as a helper
Compassion Satisfaction
Positive aspects of working as a helper
Compassion Fatigue
Negative aspects of working as a helper
Burnout
Inefficacy and feeling overwhelmed, unhappiness, exhaustion, disconnectedness, insensitivity to work environment
Work-related traumatic stress
Primary traumatic stress direct target of event
Secondary traumatic exposure to event due to a relationship with the primary person

7. Compassion Satisfaction
The positive aspects of helping
Pleasure and satisfaction derived from working in helping, care giving systems
Work is invigorating
May be related to
Providing care
The system
Work with colleagues
Beliefs about self
Altruism

8. SECONDARY TRAUMATIC STRESS
Preoccupied with thoughts of people helped
Feeling trapped, on edge, exhausted, overwhelmed, and “infected” by others’ trauma
Inability to sleep
Forgetfulness
Inability to separate private life from helper life
Experiencing the trauma of someone helped
Can be identical to PTSD
Avoidance, arousal & numbing
Re-experiencing, intrusive recollection
Distress & impairment

9. VICARIOUS TRAUMA
VT: A process of cognitive [change] resulting from [chronic] empathic engagement with trauma survivors” (Pearlman, 1992, p. 52).
Shift in worldview related to beliefs to core beliefs about
Sense of self
Safety
Trust
Intimacy
Control
Spirituality
(Pearlmann, 1998; Pearlmann & McIan, 1995; Pearlman & Saakvitne, 1995)

10. Differentiating between ST & VT
According to Figley (1995),
STS more related to behavioral sxs rather than intrinsic cognitive changes
STS mimics PTSD
VT cognitive change process

11. BURNOUT
“A state of physical, emotional, psychological, and spiritual exhaustion resulting from chronic exposure to (or practice with) populations that are vulnerable or suffering (Pines & Aronson, 1998).
A process that occurs over time (indv & organization)
Meta-construct
Exhaustion
Depersonalization
Reduction in one’s sense of personal accomplishment

12. Professional Quality of Life
Compassion Fatigue
Compassion Satisfaction
The positive aspects of helping
“The good stuff”
The negative aspects of helping
“The bad stuff’

13. Relationships Are Complex
Multiple spheres
Work environment
“People helped” environment
Personal environment
Positive (CS) & negative (CF)
Altruism CS can override CF
Compassion Fatigue two parts
Worn out (BO) common
Frightened, traumatized (STS) rarer but powerful

14. Complex Relationships
Professional Quality of Life
Compassion Fatigue
Compassion Satisfaction (ProQOL CS)
Work Environment
Client Environment
Personal Environment
Traumatized by work
Secondary Exposure (ProQOL STS)
Primary Exposure
Frustration Anger
Exhaustion
Depressed by Work Environment
(ProQOL Burnout)

15. Impairment Defined According to Barker (2003),
an impaired social worker is one who is unable to function adequately as a professional social worker and provide competent care to clients as a result of a physical or mental disorder or personal problems, or the ability or desire to adhere to the code of ethics of the profession. The problems most commonly include alcoholism, substance abuse, mental illness, burnout, stress, and relationship problem.” (p. 210)

16. Manifestations of Impairment
AOD use issues
Depression (3 xs the rate of general pop (Seibert, 2004))
Vicarious trauma
Secondary traumatization (PTSD-like sxs)
Burnout (70% lifetime rate (Seibert, 2005))
Compassion fatigue
Unethical conduct
Professional mistakes
Failure to provide competent care

17. Manifestations of Impairment, cont.
Absenteeism
Cancelled appointments
Late for work
Pessimistic
Hoping for cancellations
Impatience

18. Consequences of Impairment
Compromises performance
Jeopardizes client safety
Damages reputation of agency/organization
Damaging to the reputation of social work profession
Raises questions about the competency of the profession as a whole
Harms experienced by the distressed social worker

19. WHAT DOES THE RESEARCH SAY???

20. Pooler, Seibert, Fual, and Huber (2008)
Social workers who identified the following personal history issues were more likely to experience professional impairment.
Alcohol and drug misuse by a parent, partner, family member, or close friend;
Having a troubled parent
Physical, sexual, or emotional abuse.
Parentification as a child

21. Fledgling social workers are at higher risk for compassion fatigue (CF) and burnout (BO) compared to those who have longevity in the field and are older in age. (Newell & MacneNeil, 2010; Salloum, Kondrat, Johnson & Olson, 2014)
Social workers are more likely to consider leaving the field during their first four years in practice (Whitaker, Weismiller, & Clark, 2006).

22. Bride, Jones, and Macmaster (2007) found with child welfare workers that 92% of respondents reported at least one symptom of STS at least occasionally.
Salloum and associates (2014) reported 30% - 60 % burnout rate
Seibert (2005) found 39% practicing SWers currently experiencing BO with a nearly 75% lifetime rate of BO

23. A study conducted for NASW found additional work-related stressors which contribute to burnout:
having more responsibilities than they can handle;
needing to complete routine task that have little intrinsic value;
having few opportunities for advancement/promotion;
being expected work long hours;
receiving few resources to adequately accomplish work tasks;
having conflicting or unclear job expectations;
getting minimal support form co-workers and supervisors;
and, being unable to balance professional and personal life. (Arrington, 2008, p. 3)

24. PROFESSIONAL & ETHICAL RESPONSIBILITIES:
NASW CODE OF ETHICS & COUNCIL ON SOCIAL WORK EDUCATION

25. Codes of Ethics on Therapists Impairment, Burnout, and Self-Care
Ethical principles of psychologists
2.06 Personal problems and conflicts
Code of ethics of the NASW
2.09 Impairment of colleagues
2.10 Incompetence of colleagues
ACA code of ethics
C.2g Impairment
C2.h Counselor incapacitation…
F5b Student & supervisor responsibilities
Impairment
AAMFT code of ethics
Principles of medical ethics (psychiatrists)
AMHCA code of ethics
(Zur Institute, n.d.)

26. NASW’s standard 2.09 mandates that:
(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse , or mental health difficulties, and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.
(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

27. NASW’s standard 4.05 mandates that:
(a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility.
(b) Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others.

28. NASW POLICY STATEMENT RE: IMPAIRMENT
Since the ability to perceive situations clearly and objectively is pivotal in social work, impairment may compromise performance and, thus, jeopardize the rights of clients and treatment effectiveness (NASW, 2008).

29. NASW POLICY STATEMENT RE: IMPAIRMENT
NASW recognizes that the prevention, identification, and treatment of professional impairment is vital to protect the welfare of clients, practicing social workers, the work environment, and the integrity of the profession. A multi-systemic approach, focusing on prevention, identification, and treatment, must be used to address professional impairment among social workers (NASW, 2008).

30. COUNCIL ON SOCIAL WORK EDUCATION: Educational Policy and Accreditation Standards
Educational Policy 2.1.1—Identify as a professional social worker and conduct oneself accordingly.
Social workers serve as representatives of the profession, its mission, and its core values. They know the profession’s history. Social workers commit themselves to the profession’s enhancement and to their own professional conduct and growth. Social workers
advocate for client access to the services of social work;
practice personal reflection and self-correction to assure continual professional development;
attend to professional roles and boundaries;
demonstrate professional demeanor in behavior, appearance, and communication;
engage in career-long learning; and
use supervision and consultation.

31. WHAT’S THE SOLUTION???

32. NASW POLICY STATEMENT ON SELF-CARE
NASW recognizes and acknowledges the unique and valuable contributions of the professional social worker. NASW supports the practice of professional self-care for social workers as a means of maintaining their competence, strengthening the profession, and preserving the integrity of their work with clients. Education, self-awareness, and commitment are considered key to promoting the practice of professional self-care. (NASW, 2008, p.270)

33. WHAT IS SELF-CARE???
“Process of purposeful engagement in practices that promote holistic health and well-being of the self” (Lee and Miller, 2013,p. 98).
“Professional self-care can be defined as the utilization of skills and strategies by social workers to maintain their own personal, familial, emotional, and spiritual needs while attending to the needs and demands of their clients” (Figley, Stamm, and NASW as cited by Newell &Nelson-Gardell (2014) p. 431).

34. Macro barriers to self-care
Large caseloads
Caseloads with high acuity, chronicity, and trauma
Lack of client resources
Inadequate supervision
Restraints and limitations of bureaucratic systems
Inadequate compensation
Lack of professional support and professional development opportunities
Safety concerns
Lack of recognition and autonomy
Organizational culture
(Cox & Steiner, 2013; Lee & Miller, 2013; Napoli & Bonifas, 2011; NASW, 2008; Newell & MacNeil, 2010; Newell & Nelson-Gardell, 2014; Salloum et al., 2015; Seibert, 2005).

35. PREVENTION & INTERVENTION: Self-Care
Mental health hygiene
Eat well
Sleep well
Exercise regularly
Humor
Spirituality
Mindfulness
Hobbies
Social support
Personal therapy
Vacation
Work-related self-care
Do NOT work overtime
Learn to say “No”
Regular supervision
Peer supervision
Advocate for manageable caseloads
Professional development activities
Do NOT bring work home
Organizational culture of wellness

36. Disappointed with people_______ Hopeless______ Trapped______
The Burnout Measure, Short Version (Maslach-Pines, 2005) Use the following scale never almost never rarely sometimes often very often always
Tired ______
Disappointed with people_______
Hopeless______
Trapped______
Helpless_______
Depressed_____
Physically weak/Sickly_____
Worthless/Feel like a failure____
Difficulties sleeping_______
“I’ve had it” _______
Up to 2.4 indicates low burnout; between indicates danger signs; indicates burnout; serious problem of burnout; Score of 5.5 requires immediate professional intervention.

37. References
Arrington, P. (2008) Stress at work: How do social workers cope?. NASW Membership Workforce Study. Washington, DC: National Association of Social Workers Barker, R. L. (2003). The social work dictionary. Baltimore, MD: NASW Press Council on Social Work Education. Commission on Accreditation (2008) EPAS Handbook. Retrieved from Handbook.aspx Cox, K. and Steiner, S. (2013). Self-care in social work: A guide for practitioners, supervisors, and administrators. Washington, DC: NASW Press. Lee, J. J. & Miller, S. E. (2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society: The Journal of Contemporary Social Services, (94) 2, doi: / Napoli, M. & Bonifas, R. (2011). From theory toward empathic self-care: Creating a mindful classroom for social work students. Social Work Education, 30(5), doi: / Maslach-Pines, A. (2005). The burnout measure, short version. International Journal of Stress management, 12(1), National Association for Social Workers (2006). Professional impairment. Social Work Speaks (7th ed.). Washington, DC: NASW Press. Newell, J. M. & Nelson-Gardell, D. (2014). A competency based approach to teaching professional self-care: An ethical consideration for social work educators. Journal of Social Work Education, 50, doi:10,1080/ Newell, J. M. & MacNeil, G. A. (2010). Profession burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: Review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practice in Mental Health, 6(2), Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: Norton Pearlman, L. A. & McIan, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Jounral of Psychology: Research and Practice, 26(6), (1998) Pooler, D. C., Siebert, D. C., Faul, A. C., & Huber, R. (2008). Personal history and professional impairment: Implications for social workers and their employers. Administration in Social Work, 32(2), doi.org/ /j147v32n02_05 Seibert, D. C. (2003). Denial of AOD use: An issue for social workers and the profession. Health and Social Work, 28(2), doi.org/ /hsw/

38. Siebert, D. C. (2004). Depression in North Carolina social workers
Siebert, D.C. (2004). Depression in North Carolina social workers. Social Work Research, 28(1), doi.org/ /swr/ Siebert, D.C. (2005). Personal and occupational factors in burnout among practicing social workers: Implications for researchers, practitioners, and managers. Journal of Social Services Research, 32(2), doi.org/ /j079v32n02_02 Siebert, D.C. (2005). Help seeking for AOD misuse among social workers: Patterns, barriers and implication. Social Work, 50(1), doi.org/ /sw/ Stamm, B. H. (2015). PROQL.org. Retrieved from Whitaker, T., Weismiller, T., & Clark, E. (2006). Assuring the sufficiency of a frontline workforce: A national study of licensed social workers. (Executive summary). Washington, DC: National Association of Social Workers. Retrieved from Zur. O. (n.d.). Codes of ethics on therapists' impairment, burnout and self-care. Retrieved from Zur Institute website: