UCLA Integrated Substance Abuse Programs - … 2/Workshop_T.pdfUCLA Integrated Substance Abuse...
Transcript of UCLA Integrated Substance Abuse Programs - … 2/Workshop_T.pdfUCLA Integrated Substance Abuse...
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Addressing Compassion Fatigue in the Context of Service Delivery
Integrated Care ConferenceUniversal City
October 24, 2019
Gloria Miele, Ph.D. and Beth Rutkowski, MPHUCLA Integrated Substance Abuse Programs
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ATTC Language Matters slide
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Seminar Goals• Define compassion fatigue• Summarize morbidity & mortality associated
with the SUDs, especially opioids • Identify factors that may contribute to
compassion fatigue • Describe strategies to address compassion
fatigue and burnout
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What is Compassion Fatigue?
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• The sympathetic consciousness of another's others' distress coupled with a desire to alleviate it.
• Different from empathy – which may have a negative impact.
Definition of Compassion
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Compassion Fatigue (CF)• CF=Secondary traumatic stress + burnout • Concept of emotional contagion: experiencing emotional
responses parallel to that person’s actual or anticipated emotions
• Common among people working in the helping professions• Impacts professional quality of life & compassion
satisfaction• Impacts individual’s physical & emotional health, as well as
work-place productivity
“Emotional, physical and spiritual exhaustion from witnessing and absorbing the problems and suffering of others.”
--Hunsaker et al. (2012)
SOURCE: Wijdenes et al. (2019) Journal of Nursing Administration
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Compassion fatigue
Vicarious TraumaFeeling along with the client
Secondary Traumatic
Stress Developing
individual/personalreactions
3 distinct and interrelated
negative responses to stress
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Understanding the Difference
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• Post Traumatic Stress Disorder (PTSD)• Post Traumatic Stress Symptoms• Critical Incident Stress
DIRECTexposure to
trauma
• Post Traumatic Stress Disorder (DSM-V, 2013)• Post Traumatic Stress Symptoms• Empathic Strain• Secondary Traumatic Stress Symptoms• Vicarious Traumatization• Compassion Fatigue
INDIRECTexposure to
trauma
Work-Related Trauma Exposure
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(Bonach and Heckert, 2012; Slattery and Goodman, 2009; Bell, Kulkarni, et al, 2003; Cornilleand Meyers, 1999)
Personal• Trauma history• Pre-existing
psychological disorder• Young age• Isolation, inadequate
support system• Loss in last 12 months
Professional• Lack of quality supervision• High percentage of trauma
survivors in caseload• Little experience• Worker/organization
mismatch• Lack of professional
support system• Inadequate orientation and
training for role
Risk Factors
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Consequences of CF: Individual
• Increase in health-related problems• Burnout• Lack of empathy• Desensitization• Hopelessness or helplessness
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Consequences of CF: Organization
• Lost productivity• Decrease job satisfaction• Lower quality of care• Staff turnover• Poor morale
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Consequences of CF: Community
• Increased stigma• Decreased believe that recovery happens• Blaming individuals for drug use• Decreased interest in supporting prevention & treatment
programs
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AUDIENCE PARTICIPATION
To what extent does CF impact your organization in each area: individual, organization, community?
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SOURCE: https://www.cdc.gov/drugoverdose/data/statedeaths.html
Overdose Deaths, 2017US: Rate 21.7 per 100k OH: Rate 46.3 per 100k (N=5,111)
~192 drug deaths per day in the United States
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Drugs Driving Overdose
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Epidemic Consequences
SOURCES: Jimenez-Trevino et al. (2011); Degenhardt et al. (2013); Hser et al. (2006); Kessler et al. (1996)
Premature Death
Opioid Overdose
Death
Infectious Disease (HIV,
HEPC)
Comorbid Mental Health
problems
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Impact on Families & Kids
SOURCES: Radel et al. (2018); Allen et al. (2017); Gaither et al. (2016)
Family Dissolution Children Witness Overdoses
Accidental Opioid Poisoning Among
Children
Economic Burden on Child Assistance
Programs
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Opioid Use Disorders & Trauma• Patients receiving treatment
for OUD have higher rates of adverse childhood events– Physical abuse– Sexual abuse
• Rates are very high among women with OUD
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Who experiences trauma?• One study of trauma prevalence found:
– 71.6% reported witnessing trauma– 30.7% experienced a trauma resulting in injury– 17.3% reported psychological trauma
(El-Gabalawy, 2012)
• 90% reported at least one lifetime exposure to a traumatic event• 59% of women and 47% of men reported being the victim of
interpersonal violence(Kilpatrick, et al., 2013)
409
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AUDIENCE PARTICIPATION
When you think of someone who uses drugs, what images come to mind?
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Myths and Stigmatizing Beliefs About Individuals Using Illicit Drugs
• People don’t want help• Addiction is a choice, not a disease• Underserving of help• Flawed character• Moral failing
Perpetuated by misinformation & stigma
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WHAT DRIVES COMPASSION FATIGUE?
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Fueling CF• Continuous increasing death rate despite
efforts to increase prevention/treatment services
• Increased overdose fatality rate due to novel opioid synthetics
• Depletion of financial resources & competing demands
• Challenges to linking clients with timely & comprehensive services
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Gap=1 Million
Limited Treatment Capacity
SOURCE: Jones et al. (2015) APHA
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What emotions are you experiencing?
FrustrationSadness
HopelessIncompetent
FailureVulnerable
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AUDIENCE PARTICIPATION
What do you think is driving CF in your community or organization?
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How Can Providers
Avoid Burnout?
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Why are we concerned about burnout?
• Average annual turnover rate for counselors is 33% (Eby, 2010) • Higher than the national average for HHS (20%)• Higher than the national average for teachers (12%)• Higher than the national average for nurses (12%)• 36% of individuals leaving an organization do not intend to re-
enter the field
SOURCE: White et al, 2011
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Lost ProductivityDecreased morale, cohesion, communication, collaboration, quality of services
Staff TurnoverTime and resources needed to hire and train new staff drains remaining staff
Poor Organizational
HealthErosion of concentration,
focus, decision making, motivation, performance
When Organizations Don’t Address Compassion Fatigue: Loss of Potential
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Creating Resiliency
“Just having positive experiences is not enough. They pass through the brain like water through a sieve, while negative experiences are caught. We need to engage positive experiences to weave them into the brain.” – Rick Hanson, PhD
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Personal Sources of Resiliency
Physical Emotional
Mind Spirit
SOURCE: Schwartz, T. 2007
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Personal Sources of Resiliency: Physical
• I get enough sleep to feel rested while at work• I take regular breaks throughout the day• I eat meals away from my desk• My body feels energized at work• I get adequate physical movement during the workday• I pace myself so I do not feel unhealthy levels of stress
Physical
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Personal Sources of Resiliency: Emotional
• I express appreciation to co-workers often enough• I enter my workspace with positive feelings on a daily basis• I leave my workspace with positive feelings on a daily basis• I have a healthy balance between time spent with work, family,
and other interests• I do not take work home with me • I get deep satisfaction from many work tasks
Emotional
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Personal Sources of Resiliency: Mind
• I focus on one task at a time• I do not let email interrupt my tasks• I have an organized task list• I focus equally on short-term and long-term tasks• I have adequate opportunity to use my creativity skills• I have adequate time for long-term visioning
Mind
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Personal Sources of Resiliency: Spirit
• I spend considerable time at work doing the tasks I love to do• I use the power of my own life difficulties as a source of
strength• I am aware of and have adequate opportunity to use my
primary gifts and talents at work• I believe my workgroup is making a substantial contribution
to the world• There is little difference between what I say is important
about my work and what I do at work• I have a regular spiritual practice
Spirit
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Personal Sources of Resiliency
• Which of the four main areas is your strongest?
• Which of the four main areas is your weakest?
• Which single item are you most proud of?
• Which single item are you most concerned about?
Physical Emotional
Mind Spirit
SOURCE: Schwartz, T. 2007
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Vicarious Resilience• The positive effects experienced by witnessing people who
have positively adapted to past or current adversity/adversity
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STRATEGIES TO ADDRESS COMPASSION FATIGUE
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Agency Support
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How Can Organizations Help?
• Recognize and accept that the work is stressful• Learn to identify signs of burnout in employees• Offer assistance and solutions to those who are struggling:
– Consider increasing responsibility (allows workers more accountability and a greater sense of purpose)
– Supportive services – workshops, support groups and retreats
SOURCE: HRSA, 2007.
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Proven Strategies• Role models• Wellness committee• Health screenings• Quality supervision• Rapid response to stressful events• Professional ethical standards• Personal development opportunities• Flexible schedules• Wellness incentives
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Role of Supervisor
Teacher
Coach
Consultant
SuperviseesBeginning: dependent; need structure and instruction
Intermediate: moving between dependency and autonomy
Advanced: autonomous; interdependent; seek challenge
Developmental Stages: Supervisees
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SAMHSA Tip 57: Trauma-Informed Care
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Changing Communities Through Change in Practice
Emotional/Physical
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Workplace Scan
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A Grass Roots Effort
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STRATEGIES FOR INDIVIDUALS
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What does wellness mean to you
What does wellness mean to you?
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Changing Communities Through Change in Practice
Skills Toolbox
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Defining Values
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Cultivate Self-Awareness
• Set your intention • Be aware• Create space• Practice• Interact with others
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Measuring CF
• Professional Quality of Life Scale (Pro-QOL) (Stamm 2005)– Compassion satisfaction– Burnout– Compassion fatigue/secondary trauma
• Compassion Fatigue Short Scale (CF-Short Scale) (Adams et al. 2006)– Burnout– Secondary trauma
• Secondary Traumatic Stress Scale (STSS) (Bride et al. 2004)
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Put Your Oxygen Mask on First
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Learning STOP!
• S (Slow Your Breathing) • T (Take Note) • O (Open Up) • P (Pursue Your Values)
Be Present, Open Up, Do What Matters
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Self-Care: Develop a Plan
• Personal: tending to physical needs (adequate rest, nutrition), participating in fun activities, identifying relaxing activities to engage in regularly
• Professional: obtain ongoing professional development, recognition by organization of the process of vicarious trauma, developing a professional support network
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Self-Care Doesn’t Have to Be Complicated
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Self-Care: Develop a Plan
• Eat regularly• Eat healthy• Exercise• Seek regular medical check-ups
and care when needed• Do something you enjoy• Get enough sleep• Just say no
• Take time off• Read for fun• Identify ways to reduce stress• Listen to your thoughts, feelings• Find activities that increase your
curiosity• Spend time in nature
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SMART GoalSpecific - Measurable – Achievable – Relevant - Thrilling
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MAKE TIME FOR SELF CARE
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Well Body Program
https://www.bhwellness.org/resources/toolkits/well-body
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Resources
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Questions and Discussion
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ATTC Resources
• Compassion Fatigue Online Serieshttps://attcnetwork.org/centers/mountain-plains-attc/compassion-fatigue-online-series-opioid-epidemic-increasing-knowledge
• Self Care Curriculumhttps://drive.google.com/file/d/0B9ywu77vFpW1bkNZbXRjTlh0a1pFZW4zVXd6dWtNREFHX1Fr/view
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Thank You!
Gloria [email protected]
Beth [email protected]
http://uclaisap.org/ca-hubandspokehttps://attcnetwork.org/centers/pacific-southwest-attc