Managing Secondary Traumatic Stress Among Staff Following a Crisis

NCCAN 2009

Mary L. Pulido, Ph.D.Executive DirectorThe New York Society for the Prevention of Cruelty to Childrenmpulido@nyspcc.orgApril 2009

Managing Secondary Traumatic Stress

• The NYSPCC • Dissertation study on 9/11 caregivers• NYC Medical Reserve Corps• Consultant for NJ, NY, CT• Consultant State Dept of Texas

• Hurricane Katrina/Rita first responders• The Restoring Resiliency Response

• NYC CPS Crisis Debriefing • Child Fatality Review Team

There is a Cost to Caring

• STS is the natural consequent behaviors and emotions resulting in knowledge about a trauma experienced by another person.

• It’s also the stress resulting from helping or wanting to help a traumatized person.

Agenda

• Overview of Symptoms of Stress, Trauma, PTSD, Burnout and STS

• Self-assessment for Stress & STS

• Effective interventions to alleviate STS risk

• Overview of the Crisis Debriefing Program for ACS staff

What Gives Meaning to My Life?

• Caregivers often find meaning with their jobs

• List three items outside of the workplace - people, events, or activities that bring you enjoyment or pride.

Stress

Stress is the response of your body to all demands made on it.

Common Stress Reactions

• Emotional

• Behavioral

• Cognitive

• Physical

• Tolerance of differences

Trauma

• An event or experience that threatens one’s sense of physical or psychological safety

• PTSD or PTS symptoms

• Intrusive

• Avoidance

• Hyper-arousal

Water Glass Analogy

• Describes Loss of Coping Skills and emerging PTS symptoms

• As glass fills with stressors, coping skills flow out, one can feel “pushed to the limit”

• Find ways to lower the water level again by utilizing coping techniques

Secondary Traumatic Stress

• Normal response that helpers that are exposed to painful material experience.

• Worker develops signs and symptoms that mirror client reactions.

• PTSD/STS handout

Hyper-arousal

Trouble concentrating

• Easily startled

• Sudden irritability or anger

• Hyper-vigilance – feeling “on guard” or uncomfortable constant watchfulness

• Treat others with more suspicion.

Numbing/Avoidance

• Avoid thoughts, feelings or conversation

• Detachment - even from colleagues or family

• Restricted range of affect

• “Felt hard or immune” as a protective measure

Intrusion

• “Never turn off” from work

• Images of cases stayed in their minds after hours

• Insomnia

• Nightmares or dreams about the consumers

• “non-stop worry” and anxiety

Why does one experience STS?

• Empathy and Exposure• Disparity between worker’s expectations and

realities of work• Divide between how you view your role and how

others perceive you• Dealing with unsympathetic systems, i.e. judicial,

corrections, medical…• Prior personal trauma• Information overload• High level of accountability

Secondary Trauma

• NORMAL response

• Not a sign of weakness, but inevitable aspect of trauma recovery work

• Not burnout

Burnout

• A breakdown of the psychological defenses that workers use to adapt and cope with intense job-related stressors.

• Increased workload and institutional stress are precipitating factors

Burnout Symptoms

• Physical – fatigue, headaches, insomnia, upset stomach

• Emotional – irritability, depression, anxiety, guilt, helplessness

• Behavioral – callousness, pessimism, cynicism, defensiveness

• Work-related - quitting, tardiness, absenteeism, poor performance

ProQOL R-IV

• Measure for job satisfaction, STS and Burnout

• Last 30 days

• Work life only

Preventing and Managing STS

• Knowledge

• Recognition

• Responding

Interventions That Help

• Organizational

• Professional

• Personal

Organizational

• Education (job-related & STS)

• Coalition building

• Healthy work setting

• Making sure staff understand policies and procedures

• Access to leaders, supervisors

• Adequate human resource policies

Stress Audit Checklist

• Worker level

• Worker-Team Level

• Organizational Level

• Review every quarter

Recruiting Considerations

• Ethical “duty to warn”

• Appropriate time is during the hiring process

• Describe caseload/clinical issues

• Explain agency support/supervision

• Explore candidate’s resources for handling stress

Supervision

• Administrative

• Educational

• Supportive

• Supervisor discusses STS issues in supervision

• Identify cases, discuss issues, validate reactions, self-care

Professional Interventions

• Balance• Pacing• Boundary/Limit

setting• Peer support• Supervision

• Debriefing sessions*

• Professional Training

• Job Commitment• Plans for Coping

Work-Team Worker Care

• Acknowledge toll of work

• Arrange job into manageable parts

• Reduce isolation

• Help each other keep good work boundaries

• Supervision reduces STS risk

• Case review/debriefing

Care for the CaregiversThe need to debrief CPS staff

• Debriefings, defusings, CISD• Stabilization and support• Not just for disasters and emergency

personnel• Critical Incidents: child fatalities,

serious on-the-job injuries, suicides, and events that attract considerable media interest

*Crisis Debriefing (RRR Model)

• Everyone experiences trauma and crisis differently

• Each individual is an expert in their own recovery process

• Each person may be at a “different place” in terms of participation

• Participants learn “normal” stress reaction to traumatic events

• Strength-based and culturally sensitive

Getting Back on Track

• Have I ever had this reaction before?• If I have felt this way before, how did I

manage it?• What have others done to manage

their reactions?• If I haven’t experienced this reaction

before, or it isn’t going away, who can assist me?

STS Management Techniques

• Grounding through breathing

• Centering and Containment

• Mirroring

Mirroring

• Three observable aspects of feeling states:

• Facial expression• Posture• Breathing pattern• Unconscious empathetic resonance• Arousal of autonomic nervous

system

Mirroring

• Become conscious of your tendencies to mirror

• Change posture, facial expression, breathing, stretch, write notes

• Not breaking client contact, just regulating our degree of attunement

Personal Interventions

• Physical

• Social

• Psychological/Spiritual

• Develop a self-care plan

Physical Interventions

• Body work

• Exercise

• Engage in self-care behaviors

• Adequate sleep

• Adequate nutrition

• Regular medical & dental check-ups

Social Interventions

• Reach out for social support.

• Talk, share feelings with others

• Reduce isolation

• Life balance, maintain a diversity of activities

• Family, friends and colleagues

• Social Activism – sense of a shared mission, professional societies

Psychological & Spiritual Interventions

• Therapy• Relax!!!!!• Contact with

nature• Creative

expression

• Meditation • Spirituality –

organized worship• Humor• Three things that

give your life meaning…

Closing Exercise

• Name one event or action that you conducted on the job that brings you a sense of accomplishment, satisfaction or pride.

• Name one thing that will reduce stress that you’ll do for yourself today.