Addressing Secondary Traumatic Stress as a Link to Trauma-Informed Care

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Re: Robin Tener

Robin R. Tener, Ph.D.Clinical Psychologist

Community Outreach CoordinatorAkron Children’s HospitalNational Child Traumatic Stress Network Grant

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My Double Life…

Executive Director

Northeast Ohio Behavioral Health, Ltd.

• North Canton• Canton• Cuyahoga Falls

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Akron Children’s Hospital and the National Child Traumatic Stress

Network (NCTSN)

• SAMSHA (Substance Abuse and Mental Health Services Administration)

• Four Year, 1.6 million dollar award

• ACH received the only grant that was awarded in Ohio (56 total – Category III)

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Areas of Focus

• Provide leadership, training and consultative services in the area of childhood trauma

• Create a trauma-focused network of care to improve access to treatment

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Community Focus

Create Trauma-Informed Systems of Care

• Child Welfare• Juvenile Justice• Schools• Medical Community

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NCTSN Products Designed for Systems Serving Children

Product Population

Child Welfare Trauma Training Tool Kit Child Protective Services

The Resource Parent Curriculum Foster Care Providers

Think Trauma Juvenile Justice Facilities – Line Staff

Preparing for a Trauma Audit in Juvenile and Family Courts (NCTSN + NCJFCJ)

Juvenile and Family Court Administrators

10 Things Every Juvenile/Family Court Judge Should Know About Trauma

Hearing Officers

Trauma Tool-Kit for Schools Teachers and School Administrators

Psychological First Aid First Responders

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Let’s Be Trauma-Informed!

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What Are You Trying to Sell?

• Where did this TIC stuff come from?

• And why should I “buy” this….now?

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Organizations Did Express Some Interest

But Staff tended to see this as just another…

• Initiative• Buzz-word• Flavor of the Month

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Nobody Will Tell You They Think It’s a Bad Idea to be Trauma-Informed

• “We aren’t trauma-informed, and that’s OK.”

• “Hey! Let’s NOT be trauma-Informed!”

• “Why would we want to be trauma-informed?”

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Most Often, We Think, “I’ve Got This!”

• “We already are trauma-informed.”

• “We see plenty of people who have experienced trauma. We know how to do this.”

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“These Ideas are Very Familiar…”

• But when you take a closer look – has our knowledge of trauma really shaped the way we have been operating historically?

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Isn’t Our Hard Work Enough?

• Are you saying we don’t care about our clients?

• Or that we don’t know what we are doing?

• (We have been working really hard, here…for a long time!)

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State-Wide Initiatives: “Go Forth…and Be Trauma-Informed…Now!”

• One of many, many projects/programs

• Where is TIC on the Priority List?

• “Unfunded Mandate”

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Agencies and Systems of Care are Incredibly Stressed

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How Can We Get Staff Engagement for TIC?

Just about every “system” is talking about it ---

But how does it “get into” an organization?

(And – if we can get it there -- how do we make it stay?)

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What If We Addressed Secondary Trauma vs. Request ‘More’ from the Workforce?

How would understanding Secondary Trauma help staff “focus the lens” on trauma as a driving force in the lives of their clients?

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Secondary Traumatic Stress: Also Known As…

• Vicarious Trauma (Pearlman)

• Compassion Fatigue (Figley, Mathieu)

• Secondary Traumatic Stress

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Definition of Compassion Fatigue:

“The natural and consequent behaviors and emotions resulting from knowing about a traumatized event from a significant other, and the stress from helping or wanting to help a traumatized or stressed person.”

(Figley, 1995)

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Compassion Fatigue: Working Definition

• “….A debilitating weariness brought about by repetitive, empathic response to pain and suffering…

• Compassion fatigue is a result of absorbing and

internalizing the emotions of clients and, sometimes, coworkers…”

Karl LaRowe, MSW

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“Compassion Fatigue” Doesn’t Sound Like a Diagnosis --

• We are involved in this work because we are compassionate

• We can all relate to feeling fatigued as a result of our efforts

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Vicarious Trauma, Secondary Traumatic Stress, & Compassion

Fatigue

• All refer to the cumulative effect of working with survivors of traumatic life events, or perpetrators, as part of your everyday work.

• People who engage empathically with victims or survivors are particularly vulnerable.

(Would we want those who work with victims/survivors to be unempathic? Disengaged?)

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Did we really think we could jump in the water and not get wet?

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Could Education About Secondary Traumatic Stress Act as a Bridge to Understanding TIC?

• Acknowledge the “nature of the work” -- its difficulties and stresses

• It’s OK to help the helper – it makes us better helpers!

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Could We Help Agency Staff Develop a “Trauma-Focused Lens…”

• By taking a look at how working with traumatized people impacts us – vicariously?

• By observing our own reactions to life events we can better understand trauma-related responses?

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If Staff Understood the Impact Their Work Had on Their World View…

Could we encourage staff acceptance of our request that they conceptualize clients in a new/different (trauma-aware) way?

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• By examining how our World View may have changed – or shifted in response to the work that we do –

• Could we improve our ability to discern the client’s perspective?

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We might begin to understand what we “helpers” might really represent to those we wish to help

– and where/why we unintentionally fail to help

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If We Understand OUR “Triggers”

Could it make the impact of trauma on our clients an issue worthy of “real” consideration?

“If I can be triggered…so can somebody else!”

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If We Know “What’s in Our Suitcase”

• Might we better appreciate the possible contents of somebody else’s baggage?

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Would We Handle That Person with Greater Care…?

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The Big Question:

• Could we introduce TIC concepts while we addressed Secondary Trauma --- and increase awareness of how we might facilitate a provider/client relationship toward better outcomes?

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Agency Factors

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There is no “Dull Day” in the life of an organization that serves people impacted by traumatic life events!

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STS is Not Just Client-Related

• Must address agency and system factors that contribute to a lack of energy to initiate changes needed to promote TIC

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If an Organization Acknowledges STS --

It can address factors that can effectively undermine or defeat any initiative –

(Even the best-intentioned and even one with very obvious value!)

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Awareness + Skill-Building

• Acknowledgement sends a positive message• • Organization support for TIC is vital --

• It is not enough to educate about STS

• What do we DO about it?

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Resiliency Skills - OVCResiliency Characteristics

1. Self-Knowledge and Insight

2. Sense of Hope

3. Healthy Coping

4. Strong Relationships

5. Personal Perspective and Meaning

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If We Focus on Building Our Resilience as Service Providers

• We cope with frustration a lot better

• It gives us energy to “look beyond the obvious”

• We can reach out more effectively vs. feel depleted

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Four STS Projects

• Stark County Department of Job and Family Services

• Stark County Family Court

• Richland County Children Services

• Summit County Juvenile Court CASA Program

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Common Components

• Agency Survey (2)

• Recommendations to Management Team (2)

• STS Education (3)

• Resiliency Skill-Building (2)

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Stark County Family Court Project: Phase 1

Agency Survey: 33 questions derived from:

• ProQOL (Professional Quality of Life Scale)

• Emotional Drivers of Employee Engagement (Dale Carnegie)

• Compassion Fatigue (9)

• Compassion Satisfaction (9)

• Organizational Culture (6)

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What We Wanted to Learn

Staff Needs/Receptivity to Intervention (3)

Opinion re: Management Awareness and Support of impact of STS (1)

• Desire to learn more about Resiliency, Secondary Trauma/Compassion Fatigue (3)

• Receptivity to action plans (2)

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Principles of TIC Embedded within The Stark County Family Court Project

• Safety

• Trustworthiness

• Transparency

• Peer Support

• Voice and Choice

• Cultural, Historic and Gender Issues

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Phase 2: Feedback to Management

• Directly related to Survey results

• Submitted to upper-level management

• Menu of Options re: interventions

• Trackable Outcomes: can repeat Survey to assess changes in perception

• Entirely Management-Driven

• Consultation Offered

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Phase 3: Individual Debriefings

• Allow them to “go beyond the survey”

• Engagement/Trust

• History/Culture

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Phase 4: STS Presentations

• Hearing Officers and Administrative Staff

• Probation Staff• Intake Staff• Support Staff integrated

with Line Staff

• Supervisory Staff

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Compassion Fatigue: An Occupational Hazard

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“What To Do When Your Job Requires you to…”

• Offer something that is not really wanted

• Step into a difficult / dangerous situation

• Reach out to someone that is not receptive – or may misinterpret what you are trying to do

• Walk right into an environment where anything might happen

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Or …

“What to Do If No Matter What You Do, It Really Doesn’t Feel Like it is Enough…

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Presentation Focus: Educate and Engage for Phase 4

• “STS 101”

• Introduce Resiliency Skills – “Test Drive” a few of them

• Organize Peer-Supported Resiliency Groups

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Sharing is Optional

Emphasize:

• Safety

• Trustworthiness

• Voice and Choice

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Phase 5: Resiliency Skill-Building

• 12 Group Sessions conducted over six months

• Secure/private Location

• “Take-Away” Activity

• “Menu of Options”

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Skill #1: Self-Knowledge and Insight

Strengthen:

• Self-Esteem

• Sense of Control

• Independence/Assertion

• Self-Compassion

“Take-Away Skills:”

• “What can you do by next Tuesday?”

• “What can you do in the next 30 seconds?”

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Resiliency Skill #2: Sense of Hope

Strengthen:

• Sense of Humor

• Ability to Have Fun

• Optimism

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How is a Sense of Hope Built?

Practice:

• “Looking for the Good”

Optimism – It Can be Learned

Time/Energy Wasting:

“This always happens to me.”

• Inaction• Resentment• Avoidance• Helplessness• Conflict

Focused Energy:

• What parts can I control?

• How will I take care of myself, in light of what I can’t control?

• I have done what I can reasonably do --- and that’s all I can reasonably do.

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#3: Healthy Coping

Strengthen:

• Ability to recognize and address the negative aspects of the work

• Planning• Skill Recognition• Creative problem-solving• Debriefing

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“23 Hazards of Practice”

What would it be like if you analyzed the different ways/reasons a case can be difficult or stressful – and had a plan or a thought process in place to manage each one?

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#4: Strong Relationships

• Strengthen:

• Attachments to others

• Seeking and giving support

• Speaking up for change/Assertive self-expression

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#5: Personal Perspective and Meaning

Components:

• Morality and Integrity• Spirituality• Coherent Life Meaning

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Strategies:

• Narrative story-telling• Daily “reflective practice”

What is my“Something Bigger?”

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Stark County Department of Job and Family Services

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It Started with One Case Aide…

A “Grass Roots” Effort to address worker stress…byusing space in a file room…

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Over Time, the Special Room Took Shape..

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Walls were repaired and painted ---

The files were moved elsewhere –

A phone and a computer were installed --

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A Couch !?

Recognition of Quiet Space on Family Services Floor, for Case Workers and other staff

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Additional Efforts: Stark County Department of Job and Family Services

• Worker Meetings within Agency Units

• Presentation to Management

• Supervisors/Program Directors

• All-Staff Presentation

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Richland County Children Services

Awarded an ODJFS Efficiency and Innovation Fund Grant:

A variety of interventions designed to strengthen the agency, including Trauma-Informed Care Consultation and Training

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Agency Survey: March, 2015

Framework: 12 Foundational FactorsDr. Patricia Fisher – Organizational Change

Researcher

Additional Questions:

• Perceptions of Supervision (2): Line Staff only• Needs of Supervisors (8): Supervisory Staff only• 124 questions – all inclusive

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“Bottom Layer”

• Leadership (17)• Trust and Respect (10)• Training and

Development (14)• Ability to Adapt (5)

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“The Next Tier”

• Succession Planning (3)• Communication (11)• Vision (4)• Commitment (12)

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“The Top Layer”

• Employee Health (9)• Work/Home Balance (7)• Rewards/Recognition

(12)• Teamwork (10)

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Premise:

• It is possible to design interventions to address these factors

• It is possible to provide interventions at all levels of the organization

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Same Factor – Different Interventions

• Supervisors• Line Staff• Management

Staff at all levels have a stake in activities designed to strengthen this factor --

Employee Health: Self-Care/STS

• Policy• Inquiry is integrated into

supervision• Agency supports self-

care activities at work• Debriefing• Peer Mentoring

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Intervention Team: 20 + Members

• Supervisors• Program Director• Support Staff• Newer Case Workers• Experienced Case

Workers

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More TIC Activities

• Organization and selection of Implementation Team targets

• Ongoing Evaluation of Outcomes

• Presentation to RCCS Board re: Survey

• Presentation to RCCS Staff re: Implementation Team Projects and Survey Results

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Trainings Adapted to Service Provider Populations

• Education re: Secondary Trauma

AND

• A Follow-Up Resiliency Skill-Building

Training Series

CASA Program – Summit County Juvenile Court

Family Recovery and Reunification Court (FRRC) Team

What if Resiliency Skill-Building was Incorporated into Your Everyday Life?

• What could you do for yourself, individually, each day?

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Is Your Level of Skill re: Resiliency REALLY the Highest Level You Can Achieve ---

• For your organization?

• For yourself?

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• Might STS be a way to accomplish the goal of implementing TIC?

Thank You!

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Robin Tener, Ph.D.

robin.r.tener@gmail.com

(330) 329-3678