addressing secondary traumatic stress as a link to trauma-informed care
TRANSCRIPT
Addressing Secondary Traumatic Stress as a Link to Trauma-Informed Care
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Re: Robin Tener
Robin R. Tener, Ph.D.Clinical Psychologist
Community Outreach CoordinatorAkron Children’s HospitalNational Child Traumatic Stress Network Grant
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My Double Life…
Executive Director
Northeast Ohio Behavioral Health, Ltd.
• North Canton• Canton• Cuyahoga Falls
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Akron Children’s Hospital and the National Child Traumatic Stress
Network (NCTSN)
• SAMSHA (Substance Abuse and Mental Health Services Administration)
• Four Year, 1.6 million dollar award
• ACH received the only grant that was awarded in Ohio (56 total – Category III)
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Areas of Focus
• Provide leadership, training and consultative services in the area of childhood trauma
• Create a trauma-focused network of care to improve access to treatment
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Community Focus
Create Trauma-Informed Systems of Care
• Child Welfare• Juvenile Justice• Schools• Medical Community
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NCTSN Products Designed for Systems Serving Children
Product Population
Child Welfare Trauma Training Tool Kit Child Protective Services
The Resource Parent Curriculum Foster Care Providers
Think Trauma Juvenile Justice Facilities – Line Staff
Preparing for a Trauma Audit in Juvenile and Family Courts (NCTSN + NCJFCJ)
Juvenile and Family Court Administrators
10 Things Every Juvenile/Family Court Judge Should Know About Trauma
Hearing Officers
Trauma Tool-Kit for Schools Teachers and School Administrators
Psychological First Aid First Responders
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Let’s Be Trauma-Informed!
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What Are You Trying to Sell?
• Where did this TIC stuff come from?
• And why should I “buy” this….now?
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Organizations Did Express Some Interest
But Staff tended to see this as just another…
• Initiative• Buzz-word• Flavor of the Month
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Nobody Will Tell You They Think It’s a Bad Idea to be Trauma-Informed
• “We aren’t trauma-informed, and that’s OK.”
• “Hey! Let’s NOT be trauma-Informed!”
• “Why would we want to be trauma-informed?”
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Most Often, We Think, “I’ve Got This!”
• “We already are trauma-informed.”
• “We see plenty of people who have experienced trauma. We know how to do this.”
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“These Ideas are Very Familiar…”
• But when you take a closer look – has our knowledge of trauma really shaped the way we have been operating historically?
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Isn’t Our Hard Work Enough?
• Are you saying we don’t care about our clients?
• Or that we don’t know what we are doing?
• (We have been working really hard, here…for a long time!)
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State-Wide Initiatives: “Go Forth…and Be Trauma-Informed…Now!”
• One of many, many projects/programs
• Where is TIC on the Priority List?
• “Unfunded Mandate”
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Agencies and Systems of Care are Incredibly Stressed
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How Can We Get Staff Engagement for TIC?
Just about every “system” is talking about it ---
But how does it “get into” an organization?
(And – if we can get it there -- how do we make it stay?)
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What If We Addressed Secondary Trauma vs. Request ‘More’ from the Workforce?
How would understanding Secondary Trauma help staff “focus the lens” on trauma as a driving force in the lives of their clients?
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Secondary Traumatic Stress: Also Known As…
• Vicarious Trauma (Pearlman)
• Compassion Fatigue (Figley, Mathieu)
• Secondary Traumatic Stress
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Definition of Compassion Fatigue:
“The natural and consequent behaviors and emotions resulting from knowing about a traumatized event from a significant other, and the stress from helping or wanting to help a traumatized or stressed person.”
(Figley, 1995)
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Compassion Fatigue: Working Definition
• “….A debilitating weariness brought about by repetitive, empathic response to pain and suffering…
• Compassion fatigue is a result of absorbing and
internalizing the emotions of clients and, sometimes, coworkers…”
Karl LaRowe, MSW
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“Compassion Fatigue” Doesn’t Sound Like a Diagnosis --
• We are involved in this work because we are compassionate
• We can all relate to feeling fatigued as a result of our efforts
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Vicarious Trauma, Secondary Traumatic Stress, & Compassion
Fatigue
• All refer to the cumulative effect of working with survivors of traumatic life events, or perpetrators, as part of your everyday work.
• People who engage empathically with victims or survivors are particularly vulnerable.
(Would we want those who work with victims/survivors to be unempathic? Disengaged?)
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Did we really think we could jump in the water and not get wet?
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Could Education About Secondary Traumatic Stress Act as a Bridge to Understanding TIC?
• Acknowledge the “nature of the work” -- its difficulties and stresses
• It’s OK to help the helper – it makes us better helpers!
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Could We Help Agency Staff Develop a “Trauma-Focused Lens…”
• By taking a look at how working with traumatized people impacts us – vicariously?
• By observing our own reactions to life events we can better understand trauma-related responses?
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If Staff Understood the Impact Their Work Had on Their World View…
Could we encourage staff acceptance of our request that they conceptualize clients in a new/different (trauma-aware) way?
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• By examining how our World View may have changed – or shifted in response to the work that we do –
• Could we improve our ability to discern the client’s perspective?
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We might begin to understand what we “helpers” might really represent to those we wish to help
– and where/why we unintentionally fail to help
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If We Understand OUR “Triggers”
Could it make the impact of trauma on our clients an issue worthy of “real” consideration?
“If I can be triggered…so can somebody else!”
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If We Know “What’s in Our Suitcase”
• Might we better appreciate the possible contents of somebody else’s baggage?
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Would We Handle That Person with Greater Care…?
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The Big Question:
• Could we introduce TIC concepts while we addressed Secondary Trauma --- and increase awareness of how we might facilitate a provider/client relationship toward better outcomes?
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Agency Factors
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There is no “Dull Day” in the life of an organization that serves people impacted by traumatic life events!
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STS is Not Just Client-Related
• Must address agency and system factors that contribute to a lack of energy to initiate changes needed to promote TIC
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If an Organization Acknowledges STS --
It can address factors that can effectively undermine or defeat any initiative –
(Even the best-intentioned and even one with very obvious value!)
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Awareness + Skill-Building
• Acknowledgement sends a positive message• • Organization support for TIC is vital --
• It is not enough to educate about STS
• What do we DO about it?
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Resiliency Skills - OVCResiliency Characteristics
1. Self-Knowledge and Insight
2. Sense of Hope
3. Healthy Coping
4. Strong Relationships
5. Personal Perspective and Meaning
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If We Focus on Building Our Resilience as Service Providers
• We cope with frustration a lot better
• It gives us energy to “look beyond the obvious”
• We can reach out more effectively vs. feel depleted
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Four STS Projects
• Stark County Department of Job and Family Services
• Stark County Family Court
• Richland County Children Services
• Summit County Juvenile Court CASA Program
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Common Components
• Agency Survey (2)
• Recommendations to Management Team (2)
• STS Education (3)
• Resiliency Skill-Building (2)
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Stark County Family Court Project: Phase 1
Agency Survey: 33 questions derived from:
• ProQOL (Professional Quality of Life Scale)
• Emotional Drivers of Employee Engagement (Dale Carnegie)
• Compassion Fatigue (9)
• Compassion Satisfaction (9)
• Organizational Culture (6)
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What We Wanted to Learn
Staff Needs/Receptivity to Intervention (3)
Opinion re: Management Awareness and Support of impact of STS (1)
• Desire to learn more about Resiliency, Secondary Trauma/Compassion Fatigue (3)
• Receptivity to action plans (2)
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Principles of TIC Embedded within The Stark County Family Court Project
• Safety
• Trustworthiness
• Transparency
• Peer Support
• Voice and Choice
• Cultural, Historic and Gender Issues
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Phase 2: Feedback to Management
• Directly related to Survey results
• Submitted to upper-level management
• Menu of Options re: interventions
• Trackable Outcomes: can repeat Survey to assess changes in perception
• Entirely Management-Driven
• Consultation Offered
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Phase 3: Individual Debriefings
• Allow them to “go beyond the survey”
• Engagement/Trust
• History/Culture
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Phase 4: STS Presentations
• Hearing Officers and Administrative Staff
• Probation Staff• Intake Staff• Support Staff integrated
with Line Staff
• Supervisory Staff
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Compassion Fatigue: An Occupational Hazard
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“What To Do When Your Job Requires you to…”
• Offer something that is not really wanted
• Step into a difficult / dangerous situation
• Reach out to someone that is not receptive – or may misinterpret what you are trying to do
• Walk right into an environment where anything might happen
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Or …
“What to Do If No Matter What You Do, It Really Doesn’t Feel Like it is Enough…
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Presentation Focus: Educate and Engage for Phase 4
• “STS 101”
• Introduce Resiliency Skills – “Test Drive” a few of them
• Organize Peer-Supported Resiliency Groups
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Sharing is Optional
Emphasize:
• Safety
• Trustworthiness
• Voice and Choice
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Phase 5: Resiliency Skill-Building
• 12 Group Sessions conducted over six months
• Secure/private Location
• “Take-Away” Activity
• “Menu of Options”
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Skill #1: Self-Knowledge and Insight
Strengthen:
• Self-Esteem
• Sense of Control
• Independence/Assertion
• Self-Compassion
“Take-Away Skills:”
• “What can you do by next Tuesday?”
• “What can you do in the next 30 seconds?”
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Resiliency Skill #2: Sense of Hope
Strengthen:
• Sense of Humor
• Ability to Have Fun
• Optimism
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How is a Sense of Hope Built?
Practice:
• “Looking for the Good”
Optimism – It Can be Learned
Time/Energy Wasting:
“This always happens to me.”
• Inaction• Resentment• Avoidance• Helplessness• Conflict
Focused Energy:
• What parts can I control?
• How will I take care of myself, in light of what I can’t control?
• I have done what I can reasonably do --- and that’s all I can reasonably do.
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#3: Healthy Coping
Strengthen:
• Ability to recognize and address the negative aspects of the work
• Planning• Skill Recognition• Creative problem-solving• Debriefing
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“23 Hazards of Practice”
What would it be like if you analyzed the different ways/reasons a case can be difficult or stressful – and had a plan or a thought process in place to manage each one?
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#4: Strong Relationships
• Strengthen:
• Attachments to others
• Seeking and giving support
• Speaking up for change/Assertive self-expression
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#5: Personal Perspective and Meaning
Components:
• Morality and Integrity• Spirituality• Coherent Life Meaning
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Strategies:
• Narrative story-telling• Daily “reflective practice”
What is my“Something Bigger?”
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Stark County Department of Job and Family Services
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It Started with One Case Aide…
A “Grass Roots” Effort to address worker stress…byusing space in a file room…
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Over Time, the Special Room Took Shape..
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Walls were repaired and painted ---
The files were moved elsewhere –
A phone and a computer were installed --
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A Couch !?
Recognition of Quiet Space on Family Services Floor, for Case Workers and other staff
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Additional Efforts: Stark County Department of Job and Family Services
• Worker Meetings within Agency Units
• Presentation to Management
• Supervisors/Program Directors
• All-Staff Presentation
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Richland County Children Services
Awarded an ODJFS Efficiency and Innovation Fund Grant:
A variety of interventions designed to strengthen the agency, including Trauma-Informed Care Consultation and Training
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Agency Survey: March, 2015
Framework: 12 Foundational FactorsDr. Patricia Fisher – Organizational Change
Researcher
Additional Questions:
• Perceptions of Supervision (2): Line Staff only• Needs of Supervisors (8): Supervisory Staff only• 124 questions – all inclusive
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“Bottom Layer”
• Leadership (17)• Trust and Respect (10)• Training and
Development (14)• Ability to Adapt (5)
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“The Next Tier”
• Succession Planning (3)• Communication (11)• Vision (4)• Commitment (12)
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“The Top Layer”
• Employee Health (9)• Work/Home Balance (7)• Rewards/Recognition
(12)• Teamwork (10)
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Premise:
• It is possible to design interventions to address these factors
• It is possible to provide interventions at all levels of the organization
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Same Factor – Different Interventions
• Supervisors• Line Staff• Management
Staff at all levels have a stake in activities designed to strengthen this factor --
Employee Health: Self-Care/STS
• Policy• Inquiry is integrated into
supervision• Agency supports self-
care activities at work• Debriefing• Peer Mentoring
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Intervention Team: 20 + Members
• Supervisors• Program Director• Support Staff• Newer Case Workers• Experienced Case
Workers
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More TIC Activities
• Organization and selection of Implementation Team targets
• Ongoing Evaluation of Outcomes
• Presentation to RCCS Board re: Survey
• Presentation to RCCS Staff re: Implementation Team Projects and Survey Results
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Trainings Adapted to Service Provider Populations
• Education re: Secondary Trauma
AND
• A Follow-Up Resiliency Skill-Building
Training Series
CASA Program – Summit County Juvenile Court
Family Recovery and Reunification Court (FRRC) Team
What if Resiliency Skill-Building was Incorporated into Your Everyday Life?
• What could you do for yourself, individually, each day?
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Is Your Level of Skill re: Resiliency REALLY the Highest Level You Can Achieve ---
• For your organization?
• For yourself?
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• Might STS be a way to accomplish the goal of implementing TIC?
Thank You!
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