James Caringi, PhD Presentation at 2016 Science of HOPE Description: Secondary Traumatic Stress (STS) is defined as, “the natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Professionals and caregivers frequently work with individuals, families, groups, and communities who have experienced multiple adverse childhood experience (ACE) traumas and as a result, are at high risk for experiencing STS. Secondary Traumatic Stress can lead to personal health issues, loss of productivity, and turnover and therefore should be a concern for practitioners and administrators. This presentation will address the causes of STS and offer ideas for both prevention and recovery. In addition, findings from empirical research projects examining STS, burnout, and peer support will be reviewed. Methods to create a trauma informed organization that can both prevent and mitigate the impact of STS will be reviewed and critiqued. Finally, the presenter will facilitate an action research process designed to enable participants to begin the development of self-care plans that they can use in their organizations.

1. Adverse Childhood Experiences &
Trauma
The Impact of Secondary Traumatic
Stress on Individuals and
Organizations
Radical Self-Care to Thrive in Your Work
4/19/16
The Science of HopeThe Science of Hope
Foundation for Healthy GenerationsFoundation for Healthy Generations
James Caringi, Ph.D, MSW, LCSW
School of Social Work
University of Montana

2. Presentation Goals
Understand the potential impact of ACEs on helping
professionals :
Personal effects, including ripple effects on families
Professionally, including ripple effects on co-workers and
clients (service users)
Organizationally
Trauma 101 & Trauma Informed Systems
Vision and develop self-care plans
Questions and dialogue welcome!

4. Focus for this morning….
ACEs are common – that means we have them, our
staff have them.. they influence all the environments
we are in.
Impact of secondary trauma stress (STS) / Oxygen Mask
What do we DO about the impact of the work?

5. Training Rules and Norms
Be comfortable
Be open to possibilities
No blaming
All in the same boat
Oxygen mask
Please contribute to the dialogue

6. Tell me about your work..
What do you do and why do you do it?
(partner or small groups)

7. What makes your work hard?
What are the stresses you have on the job?

8. Examples of traumas in the populations
we work with:
 Physical abuse
 Sexual abuse
 Neglect
 Brutality
 School neglect
 Abandonment
 Separation (parental and/or sibling)
 Loss
 Alcohol and substance abuse
 Domestic violence
 Homelessness
 Poverty/hunger
 Exposure to people with untreated mental illness

9. My former ride to work….and my interest in ACEs
/ Secondary Trauma

10. Elements of Joint STS-ACEs /
Impact
Personal
Professional
Organizational

11. Personal Elements of ACES
How are we potentially impacted by our work with
ACES?
Burnout
Vicarious Trauma
Secondary Traumatic Stress
And a positive possibility:
Vicarious transformation
So…what do we do about this??

12. 3 stages of coping with STS
Stage 1: Knowledge – Acquisition of information and skills
(Accomplished by participating in this training.)
Stage 2: Recognition – Identifying risk and exposures
Accomplished with peer support, supervision and reflection)
Stage 3: Responding – Application of skills
(Accomplished with self-care, supervision, peer support and
action)
(from ACS training academy)

13. Twin Responsibilities: Ourselves and Our
organizations
Saakvitne and Pearlman (1996) assert, “Self-care is an
ethical imperative. We have an obligation to our clients-
as well as to ourselves, our colleagues, and our loved
ones-not to be damaged by the work we do.”
Sustainable, high quality service to those impacted by
ACES depends on an STS-free workforce!
An STS-free workforce depends on organizations with
smart leadership—who prioritize early detection and
rapid response STS systems.

14. The Impact of the Work

15. Shonkoff, Boyce, & McEwen, 2009
Types of Stress: Positive

16. Shonkoff, Boyce, & McEwen, 2009
Types of Stress: Tolerable

17. Shonkoff, Boyce, & McEwen, 2009
Types of Stress: TOXIC

18. What is “Trauma”?

20. What is Child Trauma
(NCTSN)?
Child Traumatic Stress:
Child traumatic stress
occurs when children and
adolescents are exposed
to traumatic events or
traumatic situations…
AND

21. Childhood Traumatic
Stress
AND….
When this exposure over-
whelms their ability to cope
with what they have
experienced.

22. Burnout
Maslach & Leiter define burnout as:
"the index of the dislocation between what people are
and what they have to do. It represents an erosion in
values, dignity, spirit and will--an erosion of the human
soul. It is a malady that spreads gradually and
continuously over time, putting people into a downward
spiral ..."

23. Vicarious Trauma
“Negative transformation in the helper that results from
empathic engagement with trauma survivors and their
trauma material, combined with a commitment or
responsibility to help them.”
Disrupted spirituality / world view impact
Loss of meaning and hope
(Pearlman & Saakvitne, 1996)

24. Secondary Traumatic Stress Defined:
Figley defines secondary traumatic stress as “the
natural and consequent behaviors and emotions
resulting from knowing about a traumatizing event
experienced by a significant other, the stress resulting
from helping or wanting to help a traumatized or
suffering person”, (Figley, 1995a).

25. Conceptual Differences
Burnout happens over time
VT = World view changes (theoretically based)
STS: Mirrors symptoms of PTSD and can happen
virtually out of no where
What this all means from the perspective of practice,
policy, and research

26. A reminder……
Secondary traumatic stress is a NORMAL reaction to
ABNORMAL circumstances……
Secondary traumatic stress is a NORMAL reaction to
ABNORMAL circumstances……
Secondary traumatic stress is a NORMAL reaction to
ABNORMAL circumstances……
So, none of us is immune, and many of us have STS—
but we don’t name it and others don’t know it.

27. Examples of ACEs Potential
Impact
This conference
Hearing about ACES
The work we do!

28. Recognition…. Response…..
Important to recognize this relationship….

30. Approaches to helping…..

31. Naming the trauma
Why name the trauma?
Categories:
 Violent v. Non-violent
 Acute v. Chronic
 Man-made v. Natural
 Violence v. Life Circumstance
 Physical v. Emotional
 Intimate v. Community

32. The “ABC’s”
Awareness
Be attuned to ones needs limits, emotions, resources
Heed all sources of information, cognitive, somatic,
intuitive.
Practice mindfulness and acceptance
Balance
Among work, play, and rest
Connection
To oneself, to others, and to something larger
(Pearlman & Saakvitne, 1996)

33. “Radical Self-care”
“Intentionally and frequently creating opportunities for
respite and replenishment (i.e. to engage in activities
that offer distraction and or personal growth; to
exercise, have fun, rest, relax, and connect with ones
body; and to develop and maintain sustaining, intimate,
family, and other interpersonal relationships) (Pearlman
& Caringi, 2008).

34. Radical Self-Care includes:
Social Support
Consultation
Spiritual Renewal
Working Protectively

35. Suggestions for Addressing
VT
Social Support
Promoting well-being through interpersonal connection
Personal and profession communities
Consultation
Provides forum for processing intense, complex situations
and relationships
Supportive, confidential, trauma-informed, professional
relationship

36. Suggestions for Addressing VT
(continued)
Spiritual Renewal
Promoting one’s own spiritual life
Being transformed positively by the work:
Vicarious transformation
Vicarious resilience
Self-Care
Essential to therapist’s physical and mental health
Intentional and frequent
Ethical imperative

37. Working Protectively
Perspective to aid in the management of VT:
Development of a theoretical basis.
Staying connected to personal experience, while
remaining aware of the present moment and the
treatment frame.
Accepting the inevitability of vicarious trauma, as well
as accepting personal and professional limitations.
Focusing on process rather than outcomes.
Focusing on the positives, and reinforcing desired
behaviors and outcomes.

38. Working Protectively
Practice to aid in the management of
VT:
Engage empathically while still maintaining appropriate
boundaries.
Listen with respect, and with an open mind and heart.
Write progress notes at the end of each session.
Process students material in professional consultation
(supervision).
Do something very different between meetings with
students.
Attend to your own bodily responses and experiences.
Use countertransference responses to promote the
students growth.

39. Policy Implications
Agency, state, & federal policies impact helpers.
“ABC” model of preventing & mitigating VT:
Awareness
Balance
Connection

40. Policy Implications
Continued…
It also means, whenever possible, to disengage from
activities and relationships that are depleting with those
that are sustaining. Such self-care is an ethical
imperative for all therapists, but especially for those
working with complex trauma.
(Pearlman & Caringi, 2008)

41. ORGANIZATIONALORGANIZATIONAL
FACTORS WITH STSFACTORS WITH STS

42. Positive Institutional Factors:
(Caringi, 2010; Bell, 2003;
Catherall, 1995)
1) Stressors are seen as real and legitimate.
2) The problem is seen as an institutional
problem and not limited to the individual.
3) The general approach to the problem is to
seek solutions, not to assign blame.
4) There is a high level of tolerance for individual
needs and support.
5) Support is expressed clearly, directly, and
abundantly in the form of praise, commitment,
and affection.

43. More…..
6) Communication is open and effective; there
are few sanctions against what can be said.
The quality of communication is good;
messages are clear and direct.
7) There is a high degree of cohesion.
8) There is considerable flexibility of roles;
individuals are not rigidly restricted to particular
roles.
9) Resources-material, social, and institutional –
are utilized efficiently.
10)There is no subculture of violence.

45. Definition of Trauma-
Informed Child- and
Family-Service System
A trauma-informed child- and family-service system is one in which
all parties involved recognize and respond to the impact of traumatic
stress on those who have contact with the system including children,
caregivers, and service providers. Programs and agencies within such
a system infuse and sustain trauma awareness, knowledge, and skills
into their organizational cultures, practices, and policies. They act in
collaboration with all those who are involved with the child, using the
best available science, to facilitate and support the recovery and
resiliency of the child and family.
45
Source: National Child Traumatic Stress Network. Retrieved from http://www.nctsn.org/resources/topics/creating-trauma-informed-systems

46. Trauma-Informed System
“A program, organization or system that is trauma-
informed realizes the widespread impact of trauma and
understands potential paths for recovery; recognizes the
signs and symptoms of trauma in clients, families, staff,
and others involved with the system; and responds by
fully integrating knowledge about trauma into policies,
procedures, and practices, and seeks to actively resist re-
traumatization” (SAMHSA, 2014)
46

47. Trauma and Trauma Informed
Systems

48. What is Child Trauma
(NCTSN)?
Child Traumatic Stress:
Child traumatic stress
occurs when children and
adolescents are exposed
to traumatic events or
traumatic situations…
AND

49. Childhood Traumatic
Stress
AND….
When this exposure over-
whelms their ability to cope
with what they have
experienced.

50. How Common is Trauma?
1 out of 4 children who attend
school has been exposed to a
traumatic event
Screening results indicate in some
communities that upwards of 70%
of children have been exposed to
trauma and are experiencing
traumatic stress symptoms
50

51. Fight, Flee, or Freeze (toFight, Flee, or Freeze (to
protect)protect)
Hypothalamus
Release of
adrenaline and
cortisol
Heart rate and
blood pressure
increase
Breathing rate
increases
Hippocampus

52. Resilience
Variables that buffer
children from adversity…
Optimistic temperament
Social competency
Secure attachments
Living in supportive families and
communities
52

54. Why Do We Need Trauma
Informed Systems?
When children experience
trauma it affects
Ability to learn
Ability to make friends/social
skills
Behaviors in the classroom
54

55. Trauma Informed
Systems?
You may be the first to notice
symptoms
You can provide
social/emotional
strategies to help

56. Impact of Trauma on Cognitive
Development & School Performance
Reduced ability to focus, concentrate,
organize, and process information
Adversely affects memory and
attention
Less experience with executive
functioning (problem solving, making
choices, understanding consequences)
56

57. Impact of Trauma on Cognitive
Development & School
Performance
Decreased reading ability
Decreased communication skills
Increased absenteeism and drop out rate
More suspension/expulsions
Possibly feelings of frustration with school

59. Responsibility of Self-Care
“Self-care is an ethical imperative. We have
an obligation to our clients (students)-as
well as to ourselves, our colleagues, and our
loved ones-not to be damaged by the work
we do.”
Pearlman & Caringi (2008)

61. Self-Care Planning

62. Cognitive Strategies

63. Cognitive Behavioral Interventions for Trauma and
School (CBITS)
Students, Trauma, and Resilience (STAR)

64. Thoughts Impact Your
Behavior
Stress comes from our perception of the situation
The actual situation is not itself stressful, our
perceptions make it so
Sometimes we are right, sometimes we are wrong

65. Thought Behavior Emotion
Cycle

66. Techniques
Thought stopping
Positive self-statements

67. Evaluation and Monitoring
Stress Log

68. Personal
Making personal life a priority
Personal psychotherapy
Leisure activities: physical, creative, spontaneous,
relaxation
Spiritual well-being
Nurture all aspects of yourself: emotional, physical,
spiritual, interpersonal, creative, artistic
Attention to health

69. Professional
Supervision / consultation
Scheduling: client / student load and distribution
Balance a variety of tasks
Education: giving and receiving
Work space

70. Organizational
Collegial support
Forums to address STS & work stress
Supervision availability
Respect for workers and clients / students
Resources: mental health benefits, space, time

71. In All Realms
Mindfulness and self-awareness
Self-nurturance
Balance: work, play, rest
Meaning and connection

72. Self-Care Planning
Daily Weekly Monthly
Personal
Professional
Organizational

73. ExerciseBegin in small groups, discuss what is needed for next
steps for you and/or your agency.
Personal
Professional
Organizational
In all realms
Make a personal list and CIRCLE the ones you will begin
implementing.
As a large group we will discuss.

74. Questions, comments, thoughts…
NEXT STEPS….

75. National Child Traumatic Stress
Network (NCTSN) Resource
http://www.nctsn.org/resources/topics/secondary-traumatic-s

76. STS Wrap-Up

77. Next Steps, Wrap-Up,
Questions
STS plan: Personal, Professional, Organizational
What inter-professional and organizational change do
you need to create?
Make it so! We can be healthy and do the important
work we do!!

78. Thank You!
…for all you do to prevent and treat the impact of
ACEs.
Please contact me if I can be a resource to you.

79. Contact
James Caringi, MSW, Ph.D, LCSW
Associate Professor / MSW Program Director
 University of Montana School of Social Work
 Voice: 406-243-5548
 Email: james.caringi@umontana.edu