Trauma-Informed Supervision Understanding and Addressing Compassion Fatigue in Residential Direct Care Staff

Transcription

1 Trauma-Informed Supervision Understanding and Addressing Compassion Fatigue in Residential Direct Care Staff University of Pittsburgh

2 Agenda Introduction Trauma in the Residential Milieu Emotions in the Residential Milieu Compassion Fatigue: The Cost of Caring Supervisory Strategies for Addressing Compassion Fatigue Questions and Comments

3 TRAUMA AND THE RESIDENTIAL MILIEU

4 What is trauma? A traumatic event is a direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; OR witnessing an event that involves death, injury, or a threat to the physical integrity of another person; OR learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. ~The Diagnostic and Statistical Manual of the American Psychological Association (DSM-IV-TR, 2000)

5 What is Trauma? Traumatization occurs when both internal and external resources are inadequate to cope with external threat. ~Van der Kolk (1989)

6 Let s compare these two definitions DSM-IV-TR (2000) Van der Kolk (1989) A traumatic event is a direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; OR witnessing an event that involves death, injury, or a threat to the physical integrity of another person; OR learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. Traumatization occurs when both internal and external resources are inadequate to cope with external threat.

7 How many of the children who end up in residential care do you think have experienced some form of abuse, neglect, or other adverse event? While major studies have found prevalence rates ranging from 43-94%, it is estimated that 70-85% of youth in residential treatment have experienced trauma in their lives.

8 How Does Trauma Affect People? Trouble sleeping Trouble focusing Insomnia Hopelessness Self-mutilation Fire setting Promiscuity Cognitive distortions Sexual Dysfunction Victimization Withdrawal/isolation Suicidal behaviors Aggression Helplessness Control issues Emotional numbness Fear Depression Guilt Grief Physical Complaints Poor relationships Trust issues Family problems Worthlessness Attachment issues Shame Problems with authority

9 Impact on Residential Workers Working with individuals who have experienced trauma Increased indirect exposure to trauma Increased risk for experiencing secondary traumatic stress

10 EMOTION AND THE RESIDENTIAL MILIEU

11 What is Emotion Regulation? Emotion regulation refers to the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions (Gross, 1998, p. 275).

12 How Emotion Regulation Works Antecedent- Focused Emotion Regulation Situation Selection Situation Modification Attention Deployment Cognitive Change Emotional Response Tendencies (Gross, 1995; 1998) Response- Focused Emotion Regulation Behavioral, Experiential, or Physiological Response Modulation

13 How Emotion Regulation Works Reappraisal Emotional Response Tendencies Suppression (Gross, 1995; 1998)

14 Reappraisal vs. Suppression Decreases adverse physiological responses More expression and experience of positive emotion Less expression and experience of negative emotion No effect on memory Increases social desirability and amount of positive social interactions Increases adverse physiological responses Less expression of both positive and negative emotions Less experience of positive emotions Detrimental impacts on memory Poor social support and desirability (Gross, 2002)

15 How does this relate to residential work???

16 Emotional Labor Emotional labor is the process of regulating experienced and displayed emotions to present a professionally desired image during interpersonal transactions at work (Larson & Yao, 2005, p. 1103).

17 Emotional Display Rules Display rules are the behavioral and emotional expectations of our workplace. We engage in these display rules through deep and surface acting. Deep Acting The employee changes internally felt emotions to align with required emotional expressions of the organization (Morris & Feldman, 1996). Surface Acting On the surface, an employee portrays emotions that are not felt internally (Hochschild, 1983). Deep Reappraisal Acting Emotional Response Tendencies Surface Suppression Acting Grandey (2000)

18 Impact on Residential Workers Deep Acting Surface Acting Job Satisfaction Surface Acting Deep Acting Job Burnout Mastracci, S., Newman, M., & Guy, M. (2009)

19 COMPASSION FATIGUE: THE COST OF CARING

20 Compassion Fatigue: The Cost of Caring Professional Quality of Life Compassion Satisfaction Compassion Fatigue Secondary Traumatic Stress Burnout Figley (1995); Pines & Aronson (1998); Stamm (2009)

21 Identifying the Symptoms of Compassion Fatigue: A Case Study Approach

22 Compassion Fatigue: The Cost of Caring The Effects of Compassion Fatigue Increased risk of making poor professional judgements, distressing emotions Bride, Radey, & Figley (2007) Absenteeism, chronic lateness Collins & Long (2003) Tension, preoccupation with trauma, intrusive imagery, avoidance, hyperarousal, anxiety, and emotional numbing, depression, somatic difficulties, difficulty concentrating, substance abuse, withdrawal from friends and family Emotional exhaustion, depersonalization, cynicism, feelings of incompetence Figley (2002a, 2002b) Maslach, Schaufeli, & Leiter (2001) Low workplace morale, lack of empathy Meldrum, King, & Spooner (2002) High turnover rates Meyers & Cornille (2002) Decreased quantity and quality of work, low motivation, higher likelihood of making mistakes, avoidance of trauma-related tasks Yassen (1995)

23 Compassion Fatigue: Prevalence Chrestman (1995) Findings Those who help disturbed or traumatized people are at an increased risk of changes occurring in their own psychological functioning. Meldrum, King, & Spooner (2002) Findings 17.7% of mental health professionals had enough criteria to meet qualifications for secondary traumatic stress disorder, with a further 18% of participants falling slightly below these qualifications. Conrad & Kellar-Guenter (2006) Findings 49.9% of Colorado child protection workers had elevated levels of compassion fatigue.

24 Compassion Fatigue: Prevalence Bride (2007) Findings 70.2% of participants experienced at least one symptom of compassion fatigue in the past week. 15.2% of participants met diagnostic criteria for post-traumatic stress disorder as a result of working with the traumatized, a prevalence rate nearly twice that of PTSD in the general population.

25 Compassion Fatigue: Risk Factors Personal trauma history Length of time in the field Working more than 40 hours a week Gender differences Work environment Acuity Supervisory and Organizational Support Eastwood & Ecklund (2008); Meyers & Cornille (2002)

26 The Effect of Compassion Fatigue on the Client-Caregiver Relationship Valent (2002)

27 A Call for Action Myers & Cornille (2002) Figley (2002a) Collins & Long (2003) Eastwood & Ecklund (2008) Lakin, Leon, & Miller (2008) We need to address compassion fatigue through effective programming that includes improving training, handling onthe-job victimization, providing a supportive work environment, limiting work hours, and encouraging personal care. We need to have open discussions about compassion fatigue in the workplace to promote awareness. We need more than self-care practices. We need personal, professional, and organizational support to prevent and mediate the risks relating to the development of compassion fatigue. We need to encourage self-care practices, integrate these principles into the work setting, and evaluate compassion fatigue through effective supervision. We need effective management, resources, and education programs to aid in the prevention of compassion fatigue.

28 TRAUMA-INFORMED SUPERVISION: ADDRESSING COMPASSION FATIGUE IN RESIDENTIAL TREATMENT WORKERS

29 Encourage Self-Care Practices Influence Organizational Policy and Procedure Supervisory Approaches to Addressing Compassion Fatigue Daily Operations Monitor and Measure

30 Encouraging Self-Care Practices Encourage employees to engage in self-care practices, such as exercise, relaxation, and proper nutrition Advocate for a working environment that supports these self-care practices Promote the use of both personal and co-worker support networks Beware toxic co-worker support networks Emphasize the importance of emotion regulation, using the framework of emotional labor to discuss emotions at work Don t forget the oxygen principle! Eastwood & Ecklund (2008); Perry (2003)

31 Daily Operations Provide frequent individual and group supervision Open discussions about compassion fatigue and emotional competence Provide professional development opportunities relevant to the staff s daily work environment Maintain adequate staffing ratios to permit for short breaks Allow appropriate time to debrief critical incidents Eastwood & Ecklund, 2008

32 Measure and Monitor Compassion Fatigue Levels The Professional Quality of Life (ProQOL) Scale 30-item self-report measure that measures Compassion Satisfaction and Compassion Fatigue Can be used as a self-monitoring device or as a group monitoring device to gain information about the levels of compassion satisfaction, burnout, and secondary traumatic stress organization-wide The ProQOL is free and available at: Stamm, 2009

33 Preventative Institutional Policies and Procedures Be aware of risks and costs of working with the traumatized. Commitment to lower the risks and costs. Adequate applicant screening for resilience and awareness Adequate policies and procedures to educate and protect workers Figley (2002)

34 Preventative Institutional Policies and Procedures Work group attitudes and action plans The 5:1 ratio rule Critical incident stress debriefings and stress management plans Humor and other stress reduction methods Low tolerance for substance abuse Facilitation of coworker health and self-care Individual actions Letting go of work Figley (2002)

35 Selected References Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work Journal, 35(5), doi: /s Chrestman, K.R. (1995). Secondary exposure to trauma and self reported distress among therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self care issues for clinicians, researchers, and educators (pp ). Lutherville, MD: Sidran Press. Collins, S. & Long, A. (2003). Working with the psychological effects of trauma: Consequences for mental health-care workers a literature review. Journal of Psychiatric and Mental Health Nursing, 10, doi: /j x Conrad, D., & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout, and compassion satisfaction among Colorado child protections workers. Child Abuse and Neglect, 30, Doi: /j.chiabu Decker, J. T., Bailey, T. L., & Westergaard, N. (2002). Burnout among childcare workers. Residential Treatment for Children and Youth, 19, doi: /J007v19n04_04 Eastwood, C. D., & Ecklund, K. (2008). Compassion fatigue risk and self-care practices among residential treatment center childcare workers. Residential Treatment for Children & Youth, 25(2), doi: / Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20). New York, NY, Brunnar/Mazel. Figley, C. R. (2002a) Compassion fatigue: Psychotherapists chronic lack of self care. Journal of Clinical Psychology, 58(11), doi: /jclp Figley, C. R. (2002b). Introduction. In C. R. Figley (Ed.) Treating compassion fatigue (pp.1-13). New York, NY, Routledge.

36 Grandey, A. A. (2000). Emotion regulation in the workplace: A new way to conceptualize emotional labor. Journal of Occupational Health Psychology, 5(1), Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, doi: S Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology Science and Practice, 2(2), Harms, T., Jacobs, E. V., & White, D. R. (1996). School-age care environment rating scale. New York, NY: Teachers College Press. Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. Berkeley: University of California Press. Lakin, B. L., Leon, S. C., & Miller, S. A. (2008). Predictors of burnout in children s residential treatment center staff. Residential Treatment for Children & Youth, 25(3), doi: / Larson, E.B., & Yao, X. (2005) Clinical empathy as emotional labor in the patient-physician relationship. Journal of the American Medical Association. 293, Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, doi: / Mastracci, S., Newman, M., & Guy, M. (2009) Emotional labor: Why and how to teach it. Journal of Public Affairs Administration. 16(2) McCrea, K. T., & Bulanda, J. J. (2008). The practice of compassion in supervision in residential treatment programs for clients with severe mental illness. The Clinical Supervisor, 27(2), doi: /

37 Meldrum, L., King, R., & Spooner, D. (2002). Compassion fatigue in community mental health case managers. In C.R. Figley (Ed.), Treating compassion fatigue (pp ). NY: Brunner/Rutledge. Meldrum, L., King, R., & Spooner, D. (2002). Compassion fatigue in community mental health case managers. In C.R. Figley (Ed.), Treating compassion fatigue (pp ). NY: Brunner/Rutledge. Meyers, T. W., & Cornille, T. A. (2002). In C.R. Figley (Ed.), Treating compassion fatigue (pp ). NY: Brunner/Rutledge. Morris, J. A., & Feldman, D. C. (1996). Managing emotions in the workplace. Journal of Managerial Issue, 9(3), Pines, A., & Aronson, E. (1988). Career burnout: Causes and cures. New York: The Free Press. Valent, P. (2002). Diagnosis and treatment of helper stresses, traumas, and illnesses. In C.R. Figley (Ed.), Treating compassion fatigue (pp ). NY: Brunner/Rutledge. Yassen, J. (1995). Preventing secondary traumatic stress disorder. In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp ). NY: Brunner/Mazel Contact Information: Christina L. Scanlon