Transcript Models for Addressing Vicarious Trauma in Child Welfare

Models for Addressing Vicarious
Trauma in Child Welfare
Victoria L. Hummer, MSW, LCSW
Robin Ragan, MSW
What is Vicarious Trauma?
A shift in our world view
and core beliefs in the
therapist as a result
of repeated exposure
to traumatic imagery
and empathic
engagement with
trauma victims/survivors.
Other Work Stress Related Conditions
Burn-Out
Predictable, cumulative effects from a depletion of our resources that
leads to job dissatisfaction and potential health issues.
Compassion Fatigue
Compassion fatigue (CF), also called secondary trauma (STS) and is
related to Vicarious Trauma (VT), Compassion Fatigue concerns your
work-related, secondary exposure to extremely stressful events. The
symptoms of CF/STS are usually rapid in onset and associated with a
particular event. They may include being afraid, having difficulty
sleeping, having images of the upsetting event pop into your mind, or
avoiding things that remind you of the event.
•
B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction
and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm.
Primary vs. Secondary Exposure to
Trauma
• Primary – Your work puts you directly in the
path of danger, such as being a soldier or
humanitarian aide worker,
• Secondary – You are exposed to others’
traumatic events as a result of your work, such
as in an emergency room or working with
child protective services.
Vulnerability to Trauma
Individual, life circumstances, and organizational
factors can influence one’s vulnerability to
symptoms of vicarious trauma.
Good Stress?
• Invigorating and Motivating
• Helps us meet our deadlines
• Inspires quick and creative thinking
How many of us really do our best work in the
absence of stress?
Too much stress results in “Distress” -WHICH IS
ALWAYS NEGATIVE
- Online course created by Department of Children and Families Human Resources
Department in the Southern Region- last revised 07/09/09.
“To keep the lamp burning we have
to keep putting oil in it.”
-Mother Teresa
7
April Lott
President & CEO,
Directions for Mental Health, Inc.
Clearwater, FL
Statewide
Trauma-Informed Care
Workgroup on
Professional Support
Summary &
Recommendations
Acknowledgments to the Workgroup
• Saundra Roach, Alfred Edmond, Claire Rowell; Denise
Hunter; Dennise Parker; Diane Gomez; Mary Cagle; Lisa
Cue; Stacy Hipman, Bill Daiuto, Robin Ragan - DCF
• Sandy Neidert -Florida Courts (created our Continuum of
Care Chart)
• Toby Pina – Child and Family Connections of Palm Beach
County
• Irene Rickus - Kids Central, Inc.
• Victoria Hummer – Dept. of Child & Family Studies in the
College of Community & Behavior Sciences at USF
Short & Long Term Goals
• Short term: Begin to address vicarious trauma as
it relates to frontline staff. Recognize that there is
a causal relationship between trauma, stress and
staff turnover
• Long Term: Recognize that addressing vicarious
trauma and supporting staff will reduce staff
turnover and staff absenteeism due to sick leave.
This should result in a reduction of employee
costs.
Objectives
1. Manage professional and personal stress
2. Address Vicarious Trauma through ongoing
support throughout the career of child
welfare professionals
3. Develop appropriate critical incident
responses
Key Principles in Child Welfare
 Adopt Key concepts in recognizing Vicarious Trauma
 Recognize that the difficult work of providing social services
to individuals, families, and communities can take an
emotional and psychological toll on the worker.
 Stress comes not only from responding to people in crisis
but also from the organizational demands.
 Improved job satisfaction, resilience, optimism, self-care
and social support decreases stress, burnout and attrition,
and can result in improving the quality of child protective
case practice and affect the broader child welfare
outcomes
The Approach within the Organization
·
We need to change the culture of Florida’s Child
welfare system, including
 How the needs of the frontline worker are addressed
 Integrating ongoing trauma-informed practices to
support staff throughout their careers
 Ensuring appropriate debriefing protocols
 Respecting personal time (don’t condemn for time
off)
The Approach on a Personal Level
Ensure that supports are available and
encouraged when needed
Personal Time
Mental Health(EAP)
Personal wellness
Coverage following
critical incident
Recommendations - Debriefing
 Develop local Critical Incident Teams for high profile cases.
 Utilize the Crisis Debriefing Services Division of Child
Protection Operations
 Institute protocol that a debriefing session will
automatically be made available to child protective staff
after any of the following incidents:
 Child fatality
 Parent fatality known to and/or witnessed by children involved
in an investigation
 Severe sexual or physical abuse
 Assault on staff while working in the field
Recommendations – Training &
Coaching
 Train supervisors so that they acknowledge recognize
and can appropriately assist with staff trauma
 Establish standard trauma informed customer service
training
 Create support groups – pair trauma clinician and
supervisors:
 Develop “trauma support” or “Trauma
Champions”positions
 Identify occupational hazards and provide basic safety
training to address those situations that can be harmful
Recommendations – Workloads,
Coverage & Time Off
Begin to address workload and ensure adequate
coverage of frontline staff through:
Development of Pool Staff
Respite Workers
Use of retired, parttime, or contract workers to fill-in
Job sharing (reduce turnover)
Buddy system for difficult cases
Provision of adequate leave
Recommendations - Recognition
Develop ways to acknowledge and recognize the
work being accomplished by:
Giving meaning to the work through
participation in conferences, other
educational opportunities & interaction with
leadership
Recognizing staff accomplishments
Sharing and celebrating accomplishments or
even getting through a “rough week”
Recommendations – Human Resources
Provide mechanisms for System Improvements
by:
o Facilitating ongoing evaluation and feedback
o Monitoring sick leave and staff turnover
o Often distributing surveys about job
satisfaction
o Ensuring that exit interviews include questions
that address stress and trauma
Best Practice Models for
Addressing Vicarious Trauma
Hospice - A Systems Approach to SelfCare
Initial “Support for staff begins at the hiring process”
• First interview discussion of vicarious trauma, continues in Orientation
Ongoing
• The teams work intensely together and process any issues that arise together
• Weekly team meetings include a discussion of compassion fatigue
• Management observes staff for signs of stress and fatigue.
• Crisis events are immediately processed and de-briefed by the team.
• Grief support groups (offered to the public, clients and their families) are also
offered to staff.
• Monthly Lunch and Learn meetings offer training on VT topics
• Team Building activities occur frequently
• Mentor programs for new hires involves a weekly meeting between new staff and
an experienced staff member.
• Continuing Education classes are offered on topics related to their job..
External
• EAP is available and encouraged
• Hospice Speaker Network
• Trainings and conference participation is supported
Sanctuary Model ©
• Commitment to nonviolence and provision of physical, psychological,
social, and moral safety for staff and clients
• More participation and inclusion – “flattening the hierarchy of authority
and control”
• Confrontation of systematic cultural and racial divides and prejudices –
often the program and agency hierarchy parallels that of the children who
have experienced injustices of race and class
• Training is done with ALL staff together
• Open and honest communication is encouraged and honored
• Plan for treatment of work stress and vicarious traumatization
• Staff have their own safety plans on the back of their work badges
• Staff participate in community meetings daily
• A de-briefing or “red flag meeting” can be called by anyone at anytime
Bloom, S.L. (2005). The Sanctuary Model of Organizational Change for Children’s Residential Treatment.
Therapeutic Community; The International Journal for Therapeutic and Supportive Organizations 26
(1):65-81.
The Resilience Alliance Project
Through an increase in mutual support, and
enhancing resiliency skills, an initiative of Mt. Sinai’s
Children’s Trauma Institute was able to improve
resilience, optimism, job satisfaction, coworker
support, supervisory support, and decrease reactivity
to stress and burnout among 182 child protection
workers in a large child welfare agency.
http://www.cwla.org/voice/0903stress.htm
The Resilience Alliance Project is currently looking for other sites willing to
rigorously test and implement their approach. For more information, contact
Claude Chemtob at [email protected] or Erika Tullberg at
[email protected].
A Plan for Your Organization
Organizational Plan of Self-Care & Prevention of Vicarious Trauma
Organization_______________
Overall Goal :
Fit with Organizational Culture:
3 Strategies to Implement Goal:
•
•
•
Who is Responsible for What?
Barriers Identified:
Resources Needed:
Resource Links
Organizational Prevention of Vicarious Trauma (article)
http://new.vawnet.org/Assoc_Files_VAWnet/PrevVicariousTrauma.pdf
Organizational stress for child welfare and mental health agencies (article)
http://www.coachingforlife.com/storage/Organizational%20Stress%202011.p
df
The Compassion Fatigue Awareness Project
http://www.compassionfatigue.org/pages/CompassionFatigueSelfTest.html
(includes test and at the end of document find several links to additional
resources)
Supporting Child Protective Services (CPS) Staff Following a Child Fatality and
Other Critical Incidents (article)
http://www.nyspcc.org/nyspcc/new/attachment_23.pdf
The Sanctuary Model © http://www.sanctuaryweb.com/