Beyond the Response: Addressing Compassion Fatigue and ... · presentation of signs and symptoms...

Beyond the Response: Addressing Compassion Fatigue and Behavioral Health Needs for Healthcare Providers

Shayne Brannman, MS, ASPR TRACIE Program Director

Rachel Kaul, LCSW, CTS, ASPR Division for At-Risk Individuals, Behavioral Health, & Community Resilience (ABC)

April Naturale, PhD, ICF

National Healthcare Coalition Preparedness Conference December 3, 2019

UNCLASSIFIED//FOR PUBLIC USE

ASPR’s Priorities: Building Readiness for 21st Century Threats

2 Saving Lives. Protecting Americans. UNCLASSIFIED//FOR PUBLIC USE

Why ASPR TRACIE? ASPR TRACIE was developed as a healthcare emergency preparedness information gateway to address the need for: • Enhanced and rapid technical assistance • A comprehensive, one-stop, national knowledge center for healthcare system preparedness

• Multiple ways to efficiently share and receive information between various entities, including peer-to-peer

• A way to leverage and better integrate support (force multiplier) • Helping prepare deployed and field staff via our technical resources and

subject matter experts


asprtracie.hhs.gov

1-844-5-TRACIE

[email protected]

ASPR TRACIE: Three Domains • Self-service collection of audience-tailored materials • Subject-specific, SME-reviewed “Topic Collections” • Unpublished and S ME p eer-reviewed materials highlighting real-life tools and experiences

• Personalized s upport and responses to requests for information a nd technical assistance • Accessible by toll-free nu mber (1844-5-TRACIE), email ([email protected]), or web form (ASPRtracie.hhs.gov)

• Area for password-protected discussion among vetted users in n ear real-time • Ability to support chats and the peer-to-peer exchange of user-developed templates, plans, and other materials

TECHNICAL RESO URCES


mailto:[email protected]

mailto:[email protected]

http://ASPRtracie.hhs.gov

http://ASPRtracie.hhs.gov

l h() EXCHANGE ?OH Y'OLUMI: 2 IS'll '

Disaster Behavioral Health: What Do the Feds Do?

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Behavioral Health Resource Examples • Disaster Behavioral Health Resource Page • Self Care Modules for Healthcare Providers • Resources at Your Fingertips • Mental/Behavioral Health (non-responders)

Topic Collection • Opioids: Frequently Asked Questions • The Exchange Issue 4: Disaster Behavioral

Health and Resilience • Tips for Retaining and Caring for Staff after a

Disaster

https://asprtracie.hhs.gov/dbh-resources


https://asprtracie.hhs.gov/dbh-resources

Goals

Describe how to identify healthcare provider compassion fatigue and secondary traumatic stress

Identify methods for healthcare executives to conduct stress management assessment, implement mitigation efforts, and improve work satisfaction for providers

Describe ways to develop and implement a Cognitive Strengthening Preparedness Program


Rachel Kaul, LCSW, CTS ASPR Division for At-Risk Individuals, Behavioral

Health, & Community Resilience (ABC)


What is Stress?

A response characterized by physical and psychological arousal arising as a direct result of an exposure to any demand or pressure on a living organism.


Continuum of Stress: Where are you?

Performance

Ready Reacting Injured ill

Stress Level


Continuum of Stress: Where are you?

I I ,o E

~ -..... .c C

Opti'mum, ~

1Effadiv educed effic'iency /

Creat· ve

I Decisive

I Al

I Stl1m111 I tedl

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I Fna tr,at on

./ 'Rust-out

Red u1ced craartivity'

Reduced a11ertness.

overload

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\ Jndec

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' Anx·,aus \

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' B lill'lli1,0U1t

Stress


Defining Stress

Mental or emotional strain resulting from adverse or demanding circumstances.

Acute Chronic Traumatic

Severity of Symptoms


I I I I I I I

I

II

Overview of Stressors Broad

Job Finances Relationships Health Emotional Health Losses

Responders/Providers

Time Awayfrom Family

Personal Safety

Emotional Strain Case-load Work Guilt Work

Pressure


Saving Lives. Protecting Americans.

13

Signs & Symptoms of Stress

• What are possible signs and symptoms of stress? (This can be from knowledge or experience)

• How do you know when you are stressed?

• What would others notice?

13 UNCLASSIFIED//FOR PUBLIC USE


,, / ,

Signs & Symptoms

Diversity in presentation of signs and symptoms

Self reflection Methods for self check?

Mood Swings

Personal Hygiene

Social Isolation

Low Energy

Aches & Pains

Appetite Change

FrequentSickness

Increased Acne

Insomnia Anxiety

Headaches Depression

Irritability

Libido Changes


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Consequences for Responders/Providers

• Impacts on decision making • Increased risk of mistakes • Professional burnout • Impact on systems outside of work (family, friends, etc.) • Mental/physical health implications


Secondary Trauma

• Traumatic event Secondary trauma • Risk for health care responders/providers?


atients

Employment Pressures

Disaster Environment

P

j 1

Consequences: Burnout

•

• •

Cumulative emotional exhaustion and withdrawal as a result of workload and institutional stress. Occurs over time. Presents: Decreased performance Increased absenteeism Poor morale/attitude


Consequences: Compassion Fatigue • Related to exposure working with those suffering from traumatic or distressing events.

• Onset can be early • Prolonged exposure = Risk for responders/providers

• Presents: Detachment or numbing, Over-engagement Blurred boundaries/roles

• Often very hard to self-diagnose


Post the Symptoms!

• List symptoms of stress on Post-Its

• These can be symptoms experienced personally or ones you’ve seen.

• Match the symptom to the “condition”


Individual Coping Mechanisms

Emotional Outlets Nutrition Fitness

Personal Hygiene

Meditation/ Faith

Sexual Health

Social Life Safe Space

Creating Boundaries

• •

•

•

•

What are your stressors? How do you know when you are stressed? Consider feasibility of coping mechanisms/strategies Do they fit you and your lifestyle? How will you follow through?


Reaching Out and Reflecting Personal • Who can you turn to? • Existing support systems? • What are you already doing? • One thing you could change/do Consider • What other tools could assist you? • Are there resources you need?


April Naturale, PhD Disaster Recovery and Community Resilience

Senior Manager, ICF



Organizational Stress Management The Executive Leadership Level

• Dedication to cause • Managing staff not just tasks • Fostering collaboration • Developing strengths




Organizational Stress Management The Executive Leadership Level

• Clear mission, roles, and responsibilities

• One direct line of authority • Avenues to express concern



Organizational Stress Management The Management/Supervisor Level

Supervision, Guidance, and Support


26

Organizational Response to Traumatic Stress Events

• PFA • Drills • Referrals • Team training • Information / psychoeducation meetings

• Groups for highly exposed • Individual crisis intervention • Focus on resilience and coping


Organizational Readiness Tools


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• • • •

Organizational Assessment Stress Audit Checklist ProQOL-5 OVC Vicarious Trauma Toolkit




Experience and Training

• Professional skills development • Sense of confidence and competence



r I ., ~ --~ I

Stop • Look -. Reframe

Cognitive Strengthening Program

• Cognitive restructuring / reframing • Attention diversion • Mindfulness training • Adaptive engaging • Adaptive affective expression



Attention Diversion

• Purposeful emotion regulation • Decreases intense feelings • Temporary



About Mindfulness • Cognitive strengthener • Any level is positive • Focus on present moment • Acknowledge things as they are

Mindfulness Exercise

• • • • • • • •

Sit in quiet place Feet on ground Hands on lap

Thoughts come and go

Close your eyes Focus on breathing

Inhale positivity Exhale stress



Adaptive Engaging

• With others who understand and accept you

• In helpful activities o Increase coping skills o Build resilience

• Maintain integrity, dignity, and civility • Avoid toxicity • Avoid negative coping behaviors



Adaptive Affective Expression

Identify distressing emotions Express emotions in healthy ways Identify your prodromal activities Identify and plan for triggers



Summary

• Compassion fatigue and burnout can have negative individual and organization-wide effects

• Interventions can mitigate these effects • Organizational wellness is possible with agency-wide supports and structures

• Cognitive strengthening programs can help



Audience Discussion and Q&A



Additional Resources

• ASPR TRACIE: www.asprtracie.hhs.gov • Division for At-Risk Individuals, Behavioral Health & Community Resilience (ABC):www.phe.gov/Preparedness/planning/abc

• SAMHSA Disaster Technical Assistance Center (SAMHSADTAC): www.samhsa.gov/dtac

• National Center for Posttraumatic Stress Disorder: www.ptsd.va.gov

• Professional Quality of Life (PROQOL): http://www.proqol.org

37

http://www.asprtracie.hhs.gov/

http://www.phe.gov/Preparedness/planning/abc

http://www.samhsa.gov/dtac

http://www.ptsd.va.gov/

http://www.proqol.org/

Beyond the Response: Addressing Compassion Fatigue and ... · presentation of signs and symptoms...

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