Managing Secondary Traumatic Stress Among Staff Following a Crisis NCCAN 2009 Mary L. Pulido, Ph.D. Executive Director The...
Managing Secondary Traumatic Stress <ul><li>The NYSPCC  </li></ul><ul><li>Dissertation study on 9/11 caregivers </li></ul>...
There is a Cost to Caring <ul><li>STS is the natural consequent behaviors and emotions resulting in knowledge about a trau...
Agenda <ul><li>Overview of Symptoms of Stress, Trauma,  PTSD, Burnout and STS </li></ul><ul><li>Self-assessment for Stress...
What Gives Meaning to My Life? <ul><li>Caregivers often find meaning with their jobs </li></ul><ul><li>List three items ou...
Stress <ul><li>Stress is the response of your body to all demands made on it. </li></ul>
Common Stress Reactions <ul><li>Emotional </li></ul><ul><li>Behavioral </li></ul><ul><li>Cognitive  </li></ul><ul><li>Phys...
Trauma <ul><li>An event or experience that threatens one’s sense of physical or psychological safety </li></ul><ul><li>PTS...
Water Glass Analogy <ul><li>Describes Loss of Coping Skills and emerging PTS symptoms </li></ul><ul><li>As glass fills wit...
Secondary Traumatic Stress <ul><li>Normal  response that helpers that are exposed to painful material experience. </li></u...
Hyper-arousal <ul><li>Trouble concentrating </li></ul><ul><li>Easily startled </li></ul><ul><li>Sudden irritability or ang...
Numbing/Avoidance <ul><li>Avoid thoughts, feelings or conversation  </li></ul><ul><li>Detachment - even from colleagues or...
Intrusion <ul><li>“ Never turn off” from work </li></ul><ul><li>Images of cases stayed in their minds after hours </li></u...
Why does one experience STS? <ul><li>Empathy and Exposure </li></ul><ul><li>Disparity between worker’s expectations and re...
Secondary Trauma  <ul><li>NORMAL response </li></ul><ul><li>Not a sign of weakness, but inevitable aspect of trauma recove...
Burnout <ul><li>A breakdown of the psychological defenses that workers use to adapt and cope with intense job-related stre...
Burnout Symptoms <ul><li>Physical – fatigue, headaches, insomnia, upset stomach </li></ul><ul><li>Emotional – irritability...
ProQOL R-IV <ul><li>Measure for job satisfaction, STS and Burnout </li></ul><ul><li>Last 30 days </li></ul><ul><li>Work li...
Preventing and Managing STS <ul><li>Knowledge </li></ul><ul><li>Recognition </li></ul><ul><li>Responding </li></ul>
Interventions That Help <ul><li>Organizational </li></ul><ul><li>Professional </li></ul><ul><li>Personal </li></ul>
Organizational  <ul><li>Education (job-related & STS) </li></ul><ul><li>Coalition building </li></ul><ul><li>Healthy work ...
Stress Audit Checklist <ul><li>Worker level </li></ul><ul><li>Worker-Team Level </li></ul><ul><li>Organizational Level </l...
Recruiting Considerations <ul><li>Ethical “duty to warn” </li></ul><ul><li>Appropriate time is during the hiring process <...
Supervision <ul><li>Administrative </li></ul><ul><li>Educational </li></ul><ul><li>Supportive </li></ul><ul><li>Supervisor...
Professional Interventions <ul><li>Balance </li></ul><ul><li>Pacing </li></ul><ul><li>Boundary/Limit setting </li></ul><ul...
Work-Team Worker Care <ul><li>Acknowledge toll of work </li></ul><ul><li>Arrange job into manageable parts </li></ul><ul><...
Care for the Caregivers The need to debrief CPS staff <ul><li>Debriefings, defusings, CISD </li></ul><ul><li>Stabilization...
*Crisis Debriefing (RRR Model) <ul><li>Everyone experiences trauma and crisis differently </li></ul><ul><li>Each individua...
Getting Back on Track <ul><li>Have I ever had this reaction before? </li></ul><ul><li>If I have felt this way before, how ...
STS Management Techniques <ul><li>Grounding through breathing </li></ul><ul><li>Centering and Containment </li></ul><ul><l...
Mirroring <ul><li>Three observable aspects of feeling states: </li></ul><ul><li>Facial expression </li></ul><ul><li>Postur...
Mirroring <ul><li>Become conscious of your tendencies to mirror </li></ul><ul><li>Change posture, facial expression, breat...
Personal Interventions <ul><li>Physical </li></ul><ul><li>Social </li></ul><ul><li>Psychological/Spiritual </li></ul><ul><...
Physical Interventions <ul><li>Body work </li></ul><ul><li>Exercise </li></ul><ul><li>Engage in self-care behaviors </li><...
Social Interventions <ul><li>Reach out for social support.  </li></ul><ul><li>Talk, share feelings with others </li></ul><...
Psychological & Spiritual Interventions <ul><li>Therapy </li></ul><ul><li>Relax!!!!! </li></ul><ul><li>Contact with nature...
Closing Exercise <ul><li>Name one event or action that you conducted on the job that brings you a sense of accomplishment,...
Upcoming SlideShare
Loading in …5
×

Care for the Caregivers: Managing Secondary Traumatic Stress

1,427 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,427
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
25
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Care for the Caregivers: Managing Secondary Traumatic Stress

  1. 1. Managing Secondary Traumatic Stress Among Staff Following a Crisis NCCAN 2009 Mary L. Pulido, Ph.D. Executive Director The New York Society for the Prevention of Cruelty to Children [email_address] April 2009
  2. 2. Managing Secondary Traumatic Stress <ul><li>The NYSPCC </li></ul><ul><li>Dissertation study on 9/11 caregivers </li></ul><ul><li>NYC Medical Reserve Corps </li></ul><ul><li>Consultant for NJ, NY, CT </li></ul><ul><li>Consultant State Dept of Texas </li></ul><ul><ul><ul><li>Hurricane Katrina/Rita first responders </li></ul></ul></ul><ul><li>The Restoring Resiliency Response </li></ul><ul><ul><ul><li>NYC CPS Crisis Debriefing </li></ul></ul></ul><ul><ul><ul><li>Child Fatality Review Team </li></ul></ul></ul>
  3. 3. There is a Cost to Caring <ul><li>STS is the natural consequent behaviors and emotions resulting in knowledge about a trauma experienced by another person. </li></ul><ul><li>It’s also the stress resulting from helping or wanting to help a traumatized person. </li></ul>
  4. 4. Agenda <ul><li>Overview of Symptoms of Stress, Trauma, PTSD, Burnout and STS </li></ul><ul><li>Self-assessment for Stress & STS </li></ul><ul><li>Effective interventions to alleviate STS risk </li></ul><ul><li>Overview of the Crisis Debriefing Program for ACS staff </li></ul>
  5. 5. What Gives Meaning to My Life? <ul><li>Caregivers often find meaning with their jobs </li></ul><ul><li>List three items outside of the workplace - people, events, or activities that bring you enjoyment or pride. </li></ul>
  6. 6. Stress <ul><li>Stress is the response of your body to all demands made on it. </li></ul>
  7. 7. Common Stress Reactions <ul><li>Emotional </li></ul><ul><li>Behavioral </li></ul><ul><li>Cognitive </li></ul><ul><li>Physical </li></ul><ul><li>Tolerance of differences </li></ul>
  8. 8. Trauma <ul><li>An event or experience that threatens one’s sense of physical or psychological safety </li></ul><ul><li>PTSD or PTS symptoms </li></ul><ul><li>Intrusive </li></ul><ul><li>Avoidance </li></ul><ul><li>Hyper-arousal </li></ul>
  9. 9. Water Glass Analogy <ul><li>Describes Loss of Coping Skills and emerging PTS symptoms </li></ul><ul><li>As glass fills with stressors, coping skills flow out, one can feel “pushed to the limit” </li></ul><ul><li>Find ways to lower the water level again by utilizing coping techniques </li></ul>
  10. 10. Secondary Traumatic Stress <ul><li>Normal response that helpers that are exposed to painful material experience. </li></ul><ul><li>Worker develops signs and symptoms that mirror client reactions. </li></ul><ul><li>PTSD/STS handout </li></ul>
  11. 11. Hyper-arousal <ul><li>Trouble concentrating </li></ul><ul><li>Easily startled </li></ul><ul><li>Sudden irritability or anger </li></ul><ul><li>Hyper-vigilance – feeling “on guard” or uncomfortable constant watchfulness </li></ul><ul><li>Treat others with more suspicion. </li></ul>
  12. 12. Numbing/Avoidance <ul><li>Avoid thoughts, feelings or conversation </li></ul><ul><li>Detachment - even from colleagues or family </li></ul><ul><li>Restricted range of affect </li></ul><ul><li>“ Felt hard or immune” as a protective measure </li></ul>
  13. 13. Intrusion <ul><li>“ Never turn off” from work </li></ul><ul><li>Images of cases stayed in their minds after hours </li></ul><ul><li>Insomnia </li></ul><ul><li>Nightmares or dreams about the consumers </li></ul><ul><li>“ non-stop worry” and anxiety </li></ul>
  14. 14. Why does one experience STS? <ul><li>Empathy and Exposure </li></ul><ul><li>Disparity between worker’s expectations and realities of work </li></ul><ul><li>Divide between how you view your role and how others perceive you </li></ul><ul><li>Dealing with unsympathetic systems, i.e. judicial, corrections, medical… </li></ul><ul><li>Prior personal trauma </li></ul><ul><li>Information overload </li></ul><ul><li>High level of accountability </li></ul>
  15. 15. Secondary Trauma <ul><li>NORMAL response </li></ul><ul><li>Not a sign of weakness, but inevitable aspect of trauma recovery work </li></ul><ul><li>Not burnout </li></ul>
  16. 16. Burnout <ul><li>A breakdown of the psychological defenses that workers use to adapt and cope with intense job-related stressors. </li></ul><ul><li>Increased workload and institutional stress are precipitating factors </li></ul>
  17. 17. Burnout Symptoms <ul><li>Physical – fatigue, headaches, insomnia, upset stomach </li></ul><ul><li>Emotional – irritability, depression, anxiety, guilt, helplessness </li></ul><ul><li>Behavioral – callousness, pessimism, cynicism, defensiveness </li></ul><ul><li>Work-related - quitting, tardiness, absenteeism, poor performance </li></ul>
  18. 18. ProQOL R-IV <ul><li>Measure for job satisfaction, STS and Burnout </li></ul><ul><li>Last 30 days </li></ul><ul><li>Work life only </li></ul>
  19. 19. Preventing and Managing STS <ul><li>Knowledge </li></ul><ul><li>Recognition </li></ul><ul><li>Responding </li></ul>
  20. 20. Interventions That Help <ul><li>Organizational </li></ul><ul><li>Professional </li></ul><ul><li>Personal </li></ul>
  21. 21. Organizational <ul><li>Education (job-related & STS) </li></ul><ul><li>Coalition building </li></ul><ul><li>Healthy work setting </li></ul><ul><li>Making sure staff understand policies and procedures </li></ul><ul><li>Access to leaders, supervisors </li></ul><ul><li>Adequate human resource policies </li></ul>
  22. 22. Stress Audit Checklist <ul><li>Worker level </li></ul><ul><li>Worker-Team Level </li></ul><ul><li>Organizational Level </li></ul><ul><li>Review every quarter </li></ul>
  23. 23. Recruiting Considerations <ul><li>Ethical “duty to warn” </li></ul><ul><li>Appropriate time is during the hiring process </li></ul><ul><li>Describe caseload/clinical issues </li></ul><ul><li>Explain agency support/supervision </li></ul><ul><li>Explore candidate’s resources for handling stress </li></ul>
  24. 24. Supervision <ul><li>Administrative </li></ul><ul><li>Educational </li></ul><ul><li>Supportive </li></ul><ul><li>Supervisor discusses STS issues in supervision </li></ul><ul><li>Identify cases, discuss issues, validate reactions, self-care </li></ul>
  25. 25. Professional Interventions <ul><li>Balance </li></ul><ul><li>Pacing </li></ul><ul><li>Boundary/Limit setting </li></ul><ul><li>Peer support </li></ul><ul><li>Supervision </li></ul><ul><li>Debriefing sessions* </li></ul><ul><li>Professional Training </li></ul><ul><li>Job Commitment </li></ul><ul><li>Plans for Coping </li></ul>
  26. 26. Work-Team Worker Care <ul><li>Acknowledge toll of work </li></ul><ul><li>Arrange job into manageable parts </li></ul><ul><li>Reduce isolation </li></ul><ul><li>Help each other keep good work boundaries </li></ul><ul><li>Supervision reduces STS risk </li></ul><ul><li>Case review/debriefing </li></ul>
  27. 27. Care for the Caregivers The need to debrief CPS staff <ul><li>Debriefings, defusings, CISD </li></ul><ul><li>Stabilization and support </li></ul><ul><li>Not just for disasters and emergency personnel </li></ul><ul><li>Critical Incidents: child fatalities, serious on-the-job injuries, suicides, and events that attract considerable media interest </li></ul>
  28. 28. *Crisis Debriefing (RRR Model) <ul><li>Everyone experiences trauma and crisis differently </li></ul><ul><li>Each individual is an expert in their own recovery process </li></ul><ul><li>Each person may be at a “different place” in terms of participation </li></ul><ul><li>Participants learn “normal” stress reaction to traumatic events </li></ul><ul><li>Strength-based and culturally sensitive </li></ul>
  29. 29. Getting Back on Track <ul><li>Have I ever had this reaction before? </li></ul><ul><li>If I have felt this way before, how did I manage it? </li></ul><ul><li>What have others done to manage their reactions? </li></ul><ul><li>If I haven’t experienced this reaction before, or it isn’t going away, who can assist me? </li></ul>
  30. 30. STS Management Techniques <ul><li>Grounding through breathing </li></ul><ul><li>Centering and Containment </li></ul><ul><li>Mirroring </li></ul>
  31. 31. Mirroring <ul><li>Three observable aspects of feeling states: </li></ul><ul><li>Facial expression </li></ul><ul><li>Posture </li></ul><ul><li>Breathing pattern </li></ul><ul><li>Unconscious empathetic resonance </li></ul><ul><li>Arousal of autonomic nervous system </li></ul>
  32. 32. Mirroring <ul><li>Become conscious of your tendencies to mirror </li></ul><ul><li>Change posture, facial expression, breathing, stretch, write notes </li></ul><ul><li>Not breaking client contact, just regulating our degree of attunement </li></ul>
  33. 33. Personal Interventions <ul><li>Physical </li></ul><ul><li>Social </li></ul><ul><li>Psychological/Spiritual </li></ul><ul><li>Develop a self-care plan </li></ul>
  34. 34. Physical Interventions <ul><li>Body work </li></ul><ul><li>Exercise </li></ul><ul><li>Engage in self-care behaviors </li></ul><ul><li>Adequate sleep </li></ul><ul><li>Adequate nutrition </li></ul><ul><li>Regular medical & dental check-ups </li></ul>
  35. 35. Social Interventions <ul><li>Reach out for social support. </li></ul><ul><li>Talk, share feelings with others </li></ul><ul><li>Reduce isolation </li></ul><ul><li>Life balance, maintain a diversity of activities </li></ul><ul><li>Family, friends and colleagues </li></ul><ul><li>Social Activism – sense of a shared mission, professional societies </li></ul>
  36. 36. Psychological & Spiritual Interventions <ul><li>Therapy </li></ul><ul><li>Relax!!!!! </li></ul><ul><li>Contact with nature </li></ul><ul><li>Creative expression </li></ul><ul><li>Meditation </li></ul><ul><li>Spirituality – organized worship </li></ul><ul><li>Humor </li></ul><ul><li>Three things that give your life meaning… </li></ul>
  37. 37. Closing Exercise <ul><li>Name one event or action that you conducted on the job that brings you a sense of accomplishment, satisfaction or pride. </li></ul><ul><li>Name one thing that will reduce stress that you’ll do for yourself today. </li></ul>

×