Reducing the Risk of Secondary Traumatic Stress: Caring for Yourself Leslie Anne Ross, Psy.D. Vice President, Leadership Center Co-Chair NCTSN STS Collaborative Group Trauma Informed Care Organizational Transformation Learning Collaborative January 25, 2016
Why are we here together today? To Understand why self-care is critical to best practice in Trauma Informed Care To Learn about the risks associated with working with clients who have experienced trauma To Learn strategies to reduce the impact of Secondary Traumatic Stress and support staff wellness
What to expect from this seminar? Fun and challenging (introspection) You will be invited to take a long hard look at your current work/life balance and the impact of trauma You will not have to: speak in front of large group (if you don t want to) Share any personal/private information with others do role-plays You will be invited to do: Participate in reflective and wellness practices Small group work Dyad work Mathieu, Françoise (2012) www.compassionfatigue.ca
Knowing, Engaging, Vulnerability Secondary Traumatic Stress The natural and consequent behaviors and emotions resulting from knowing about a traumatized event from another person, the stress from helping or wanting to help a traumatized or stressed person. (Charles Figley, 1995)
Adverse Childhood Experiences (ACES) Child Abuse: Emotional abuse Physical abuse Sexual abuse Emotional neglect Physical neglect Household Problems: Mother treated violently Household substance abuse Household mental illness Parental separation/divorce Incarcerated household member Source: Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,... Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245-258.
Long-Term Trauma Impact ACE Pyramid: CDC Death Conception Mechanisms by Which Adverse Childhood Experiences Influence Health and Well-being Throughout the Lifespan
Adverse Childhood Experiences Abuse and Neglect (e.g., psychological, physical, sexual) Household Dysfunction (e.g., domestic violence, substance abuse, mental illness) Impact on Child Development Neurobiological Effects (e.g., brain abnormalities, stress hormone dysregulation) Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy) Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity) Disease and Disability Major Depression, Suicide, PTSD Drug and Alcohol Abuse Heart Disease Cancer Chronic Lung Disease Sexually Transmitted Diseases Intergenerational transmission of abuse Long-Term Consequences Social Problems Homelessness Prostitution Criminal Behavior Unemployment Parenting problems Family violence High utilization of health and social services Source: Putnam, F.,& Harris, W. (2008). Opportunities to change the outcomes of traumatized children: Draft narrative. Retrieved from http://ohiocando4kids.org/outcomes_of_traumatized_children
Traumatic Stress Reactions STS results from exposure to trauma experienced by others, often in the workplace with no real threat of personal harm Secondary trauma symptoms are often indistinguishable from those of direct exposure Nightmares, triggers Avoiding reminders numbing, withdrawal Hyper-vigilance Trouble concentrating Quick to anger (c) Ross 2015
Occupational Stressors: Direct Exposure and Prior History CPS-Related Stressor % witnessing event (N=49) Dangerous neighborhood 92 Drug abuse by client 90 Poverty and homelessness 86 Physical abuse of child 84 Educational neglect 84 Poverty and lack of food 80 Sexual abuse of child 78 Criminal activity by client 76 Poverty and lack of healthcare 69 Death of a client due to illness 47 Death of a client due to accident 33 Death of a client due to unknown cause 33 Death of a client due to murder 24
The Cumulative Effect: Vicarious Traumatization (VT)...refers to the cumulative effect of working with survivors of traumatic life events. Anyone who engages empathically with victims or survivors is vulnerable. A workbook on Vicarious Traumatization - is the transformation of the therapist s or helpers inner experience Simply put, when we open our hearts to hear someone s story of devastation or betrayal, our cherished beliefs are challenged and we are changed. (Pearlman & Saakvitne, 1995)
Burnout / Compassion Fatigue Burnout is a state of emotional, mental, and physical Exhaustion Often with feelings of Hopelessness and difficulty in dealing with work or doing your job effectively. Feels like my efforts don t make a difference The job is changing me into a different person I have a reduced feeling of personal accomplishments Often related to high workload or a non-supportive work environment (c) Ross 2015
Multiple Exposure: Increased Risk Prior Trauma Burnout Traumatic Grief/Loss Systems Failure Direct Exposure Compassion Fatigue Secondary Trauma (c) Ross 2015
Impact on the Individual Cognitive effects Social impact Emotional impact Physical impact Negative bias, pessimism All-or-nothing thinking Loss of perspective and critical thinking skills Threat focus see clients, peers, supervisor as enemy Decreased selfmonitoring Intrusive thoughts Reduction in collaboration Withdrawal and loss of social support Factionalism Conflicts-easily angered Isolation Difficulty trustingworry about getting close Avoidance Helplessness Hopelessness Feeling overwhelmed Depression Worry realistic and unrealistic fears Anger/Irritability Feeling numb Safety concerns Hypervigilance Headaches Tense muscles Fatigue/sleep difficulties Nightmares Stomach problems/nausea Feeling jittery Frequent illness Absenteeism
Cumulative Impact (Child Trauma Handbook, R. Greenwald, 2005) Think about how working with children and mothers may change your beliefs beliefs about the world spiritual beliefs sense of self, groundedness and emotional stability sense of personal and family safety trust of yourself and/or others the way you judge people sense of control ability to be alone, or to be with others relationship to your body
Organizational Stressors: Toxic Work Environment Workplace setting may be an important predictor of STS (Sprang, Craig and Clark, 2012) Unsupportive work environments may have a powerful influence on STS development above and beyond the dose of trauma exposure. (i.e. direct, indirect, prior history, current exposure, etc.)
Current Research: Other Factors Related to STS in the Workplace Compassion Satisfaction, Compassion Fatigue, and Burnout in a National Sample of Trauma Treatment Therapists (Craig and Sprang 2010) Continuous and prolonged exposure to the stress of working with the myriad of trauma related stressors experienced by clients can lead to various responses... Case-load percentages of PTSD clients predicted levels of compassion fatigue and burnout. Younger therapists experiences more burnout while more experienced therapists reported more compassion satisfaction. Implementing EBP s generally reduced reported compassion fatigue and burnout. (c) Ross 2015
Wellness and Resilience Building are Critical to Trauma Work Wellness is multidimensional and holistic, encompassing, environment, lifestyle, mental and spiritual wellbeing National Wellness Institute
The Self-Care Gauge What are your warning signs?
What s the first thing to go when you are stressed and overloaded? Exercise Sleep Relaxation Mindfulness Healthy eating Connecting to your support system
Promoting Protective Factors Buddy/Support System Supportive Work Environment Reflective Supervision Compassion Satisfaction Experience: Time on the Job Training/Risk Reduction Wellness Practices (c) Ross 2015
Where Do You Begin? Increasing your self awareness about what is going on in your life Identifying what you can change and Deciding where to begin Mathieu, Françoise (Mathieu, Françoise (2012) www.compassionfatigue.ca Mathieu, Françoise (2012) www.compassionfatigue.ca
Making a commitment to Wellness 1% change (c) Ross 2015
Work/Life Balance Plan Daily activities you do for yourself Weekly activities you do for yourself Monthly activities you do for yourself Activities you do for yourself on special occasions
My Self-Care Practices What are you taking away today that will help you know: 1. What to do in the moment? 2. What to do in the workplace? 3. What daily practice will you commit to in order to increase wellness and resilience?
TendAcademy.com Tend Academy Francoise Mathieu and Pat Fisher
Trauma Mastery Trauma Stewardship www.traumastewardship.com (c) Ross 2015 Laura van Dernoot Lipsky Founder and Director of the Trauma Stewardship Institute and author of Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, has worked directly with trauma survivors for 26 years.
There is an App for that Sleep Stream 2
Superbetter.com SuperBetter is a gamified tool created by game designers at SuperBetter Labs and backed by science to help build personal resilience: the ability to stay strong, motivated and optimistic even in the face of difficulty challenges. Resilience has a powerful effect on health - - by boosting physical and emotional well-being. - Jane McGonigal
Rick Hansen, Ph.D. Just One Thing free e-newsletter that suggests a simple practice each week that will bring you more joy, more fulfilling relationships, and more peace of mind and heart. www.rickhanson.net A small thing repeated each day adds up over time to produce big results; a small thing that is in your power to do in a world in which so many things are not. Just one small thing that could change your life!
NCTSN Resources!! www.nctsn.org NCTSN STS Fact Sheet STS Webinar Series Culture Organizations Schools Judges Terrorism and Disaster Early childhood 0-6 Child Sexual Abuse (c) Ross 2015
Thank you! Resources & Contact Information: Leslie Anne Ross, Psy.D. lross@childrensinstitute.org @leslieanneross LeslieAnneRoss.com Children s Institute, Inc. www.childrensinstitute.org National Child Traumatic Stress Network www.nctsn.org