applying evidence-informed compassion fatigue techniques
TRANSCRIPT
27th Annual New England School of Best Practices in Addiction Treatment
Best Practices 2019August 19 - August 22, 2019
Waterville Valley Resort, Waterville Valley, NH
Applying Evidence-Informed Compassion Fatigue Techniques 8:00am – 3:30pm Wednesday, August 21
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https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf
November 2016
#NCADCon www.NCADCon.com
https://www.youtube.com/watch?v=Ahg6qcgoay4&t=8s
1:08 Awareness test
A Journey
Rather than a Destination
#NCADCon www.NCADCon.com
1) List 6 levels of compassion fatigue intervention;
2) Summarize why Practitioner Self Care is an ethical responsibility
and reinforce distinction between supervision & therapy
3) Apply HomeBase, an evidence-informed practice to reduce risks
for burnout and compassion fatigue, for personal self-care as well as
coping skills for patients;
4) Leave feeling validated & inspired with
> your Resilience Plan: neurobiological factors of positive self-change
> a Compassion Fatigue-Sensitive Informed Consent Supervision Agreement
5
#NCADCon www.NCADCon.com
Listen, Reflect, Share, Connect
Work
sheet111
KEY point
The World Health Organization (WHO) Redefines Burnout:
A 'Syndrome' Linked To Chronic Stress At Work
▪ The new definition calls it a "syndrome" and specifically ties burnout to "chronic
workplace stress that has not been successfully managed."
▪ WHO calls burnout an "occupational phenomenon" and includes it in a chapter on
"factors influencing health status or contact with health services." . . . not classified as
a medical condition.
▪ characterized by "feelings of energy depletion or exhaustion; increased mental
distance from one's job, or feelings of negativism or cynicism related to one's job; and
reduced professional efficacy.“
May 28, 2019 Morning Edition
https://www.npr.org/sections/health-shots/2019/05/28/727637944/who-redefines-burnout-as-a-syndrome-linked-to-
chronic-stress-at-work
CS-CF ModelProfessional Quality
of Life
Compassion Satisfaction
Compassion Fatigue
BurnoutSecondary
Trauma
The Professional Quality of Life Scale (ProQOL)http://www.proqol.org/Home_Page.php
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http://greencross.org/wp-content/uploads/2017/11/Standards-of-Self-Care-Guidelines.pdf
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Pages
120-122
Best Practices in Clinical Supervision adopted by the ACES Executive Council April 22, 2011
Results of a 2002 survey of *ACES members conducted by their Ethics Interest Network indicated members want more specific guidance for their everyday supervisory practice . . . Often encounter situations not adequately addressed by the Code of Ethics
ACES Best Practices in Clinical Supervision Taskforceformed to create a document that could offer more specific suggestions to supervisors . . . regardless of work setting
*Association for Counselor Education & Supervision (ACES)
Division of American Counseling Association (ACA) AngelaThomasJones.com
Best Practices in Clinical Supervision*ACES, adopted April 22, 2011
7. Ethical Considerations
b. The supervisor continually monitors his/her own level of competence in providing supervision . . .
vi. The supervisor appropriately engages in and models self-care.
9. Evaluation
c. The supervisor encourages ongoing supervisees self-evaluation.
i. . . . requires supervisees to complete self-evaluations . . . .
ii. . . . Helps the supervisee develop self-reflection & self-evaluation skills, and fosters an
expectation of regular, ongoing self-reflection over the supervisees professional lifespan.
11. The Supervisor
d. . . . Engages in self-reflection and other avenues of personal professional development.
xiii. . . . Engages in critical self-reflection and self-care,
and avoids professional stagnation and burnout
*Association for Counselor Education & Supervision (ACES)
Division of American Counseling Association (ACA)AngelaThomasJoes.com
NAADAC CODE OF ETHICSupdated October 2016
▪ • Principle I: The Counseling Relationship
▪ • Principle II: Confidentiality and Privileged Communication
▪ • Principle III: Professional Responsibilities and Workplace Standards
▪ • Principle IV: Working in A Culturally-Diverse World
▪ • Principle V: Assessment, Evaluation and Interpretation
▪ • Principle VI: E-Therapy, E-Supervision and Social Media
▪ • Principle VII: Supervision and Consultation
▪ • Principle VIII: Resolving Ethical Concerns
▪ • Principle IX: Publication and Communications
▪ http://naadac2016.sitewrench.com/assets/2416/naadac-code-of-ethics-033117.pdfAngelaThomasJones.com 12
NAADAC Code of EthicsVIII-9 Crossroads
Addiction Professionals may find themselves at a crossroads when
the demands of an organization where the Provider is affiliated
poses a conflict with the NAADAC Code of Ethics. Providers shall
determine the nature of the conflict and shall discuss the conflict with
their supervisor or other relevant person at the organization in question,
expressing their commitment to the NAADAC Code of Ethics. Providers
shall attempt to work through the appropriate channels to address the
concern.
VIII-10 Violations without Harm
VIII-11 Violations with Harm
http://naadac2016.sitewrench.com/assets/2416/naadac-code-of-ethics-033117.pdf
https://www.naadac.org/assets/2416/naadac-nccap-code-of-ethics11-04-16.pdf
III. Professional Responsibility & Workplace Standards
VII. Supervision & Consultation
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cont. NAADAC Code of Ethicshttp://naadac2016.sitewrench.com/assets/2416/naadac-code-of-ethics-033117.pdf
VII-12 Boundaries
Clinical Supervisors shall intentionally develop respectful and relevant
professional relationships and maintain appropriate boundaries . . . in all
venues. Supervisors shall strive for accuracy and honesty in their
assessments of students, interns, and supervisees.
VII-15 Monitor
. . . . Supervisors shall empower and support supervisees as they prepare . .
. .
VII-17 Impairment
. . . supervisees, students, interns shall monitor themselves . . . and seek
cont. NAADAC Code of Ethicshttp://naadac2016.sitewrench.com/assets/2416/naadac-code-of-ethics-033117.pdf
VII-Counseling
. . . shall not provide counseling services to supervisees. . . .
VII-21 Gatekeepers
. . . . Supervisors shall assist supervisees in securing timely corrective
assistance as needed, including referral of supervisee to therapy when
needed. . . . Supervisors shall seek supervision-of-supervision and/or
consultation and document their decisions to dismiss or refer supervisees
for assistance.
VII-24 Current
. . . shall ensure . . . program content and instruction are based on the
most current knowledge and information available in the profession. . .
cont. NAADAC Code of Ethicshttp://naadac2016.sitewrench.com/assets/2416/naadac-code-of-ethics-033117.pdf
Principle VIII: Resolving Ethical Concerns
VIII-2 Understanding
. . . . Lack of knowledge or understanding of an ethical
responsibility is not a defense against a charge of
unethical conduct.
Inherent RisksADVANCING COLLEAGUE ASSISTANCE IN PROFESSIONAL PSYCHOLOGY APA (2006)
It is in the nature of professional work that individuals may develop personal difficulties
that impede or impair their personal and professional functioning.
page 5
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Risks to the practitioner
29% of their sample of 800 psychologists reported suicidal feelings
at some point during their career and 4% of professionals had
attempted suicide
2% of professionals had attempted suicide (Deutsch,1985)
61% of psychologists have reported experiencing clinical
depression at some time in their lives (Ukens, 1995)
ADVANCING COLLEAGUE ASSISTANCE IN PROFESSIONAL PSYCHOLOGY,
American Psychological Association, page 9 (2006)
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Intervening With an Impaired ColleagueMichael F. O’Connor, Ph.D., with the assistance of the members of the APA Board of Professional Affairs Advisory Committee on
Colleague Assistance
Impairment, while heightening the risk for
ethical violations, does not infer such
violations.
March 17, 2011 http://www.apapracticecentral.org/update/2011/03-17/new-guidelines.aspx
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What is impaired practice?ADVANCING COLLEAGUE ASSISTANCE IN PROFESSIONAL PSYCHOLOGY, page 6, (2006)
. . . impairment defined . . . as interference of professional functioning in one or more of the following areas:
1) an inability and/or unwillingness to acquire and integrate professional
standards into one’s repertoire of professional behavior;
2) an inability to acquire professional skills to reach an acceptable level of
competency;
3) an inability to control personal stress, psychological dysfunction and/or
excessive emotional reactions that interfere with professional functioning
Lamb, Presser, Pfost, Baum, Jackson, and Jarvis (1987), page 598
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Stress Distress
Impairment
Improper behavior
Intervention Sanctions
ADVANCING COLLEAGUE ASSISTANCE IN PROFESSIONAL PSYCHOLOGY , 2006
Chapter 5, Assessment & Intervention (pgs 30 – 33)
Chapter 6, Operational Strategies (pgs 34 – 40) http://www.apapracticecentral.org/ce/self-care/colleague-assist.aspx
http://www.apapracticecentral.org/ce/self-care/intervening.aspx
Stress – Distress - Continuum
AngelaThomasJones.com
#NCADCon www.NCADCon.com
Work
sheet111
Martha Teater and John Ludgate, PESI, Inc., 2014
Chapter 2:
Put on Your Oxygen Mask First
What is your Self-Care for
managing these challenges?
> 11 item survey to approximately 200 professionals
> While external surveys have a 10-15% response rate,
> We received a 17% response rate.
Integrated
Delivery
Network
Community
Health Center
Regional
Hospital
70.59%Concerned about patientsafety due to workforce shortage
50% Family History
29.41%Do not haveSupervision Agreement
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Copies available for sale from the National Academy Press; call (800) 624-6242 or (202) 334-3313 or visit the NAP home page at www.nap.edu.
The full text of this report is available at http://www.nap.edu/books/0309068371/html/
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Responding to Call for Action: an Individual CHOICE
https://www.youtube.com/watch?v=rKOxRF2JzC0&feature=youtu.be
How one community chose to define RESILIENCE
selections from
http://www.bouncebackproject.org/
7:00
Biology of Stress and Science of HOPE
Good judgment comes from experience — and a lot of that comes from bad experience - Will Rogers
http://gofile.me/4tU2M/q38ymGLpr
https://www.youtube.com/results?search_query=brene+brown+empathy+vs+sympathy
Listen, Reflect, Share, Connect
Key point
What is predictable
can be preventable
Biology of Stress and Science of Hope
RESILIENCE (James Redford ) 2:10
https://www.youtube.com/watch?v=We2BqmjHN0k&list=PL8uX4Xr_dkJk8S6GRX04uVJUQGrqZZjjX
Adverse Childhood Experiences (ACES)https://www.youtube.com/watch?v=ccKFkcfXx-c
calculate your ACE scorehttp://acestudy.org/ace_score
AngelaThomasJones.com
▪ Table 1 Compassion Fatigue in different professional groups. page 20
▪ Table 2 Incident of burnout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 20
▪ Table 3 Incidence of stress and psychiatric morbidity in different
professional groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 20
▪ Table 4 Three studies of therapists self-care activities. . . . . . . . page 116
Teater and Ludgate, PESI, Inc., 2014
HomeBase
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Rewards
Page 29Workplace
page 109
Resiliency
Inventory
p.49-51
3:40 Dan Harris, Panic on ABC Newshttps://www.youtube.com/watch?v=_qo4uPxhUzU
RESILIENCE: a skill
sustainable change
Anatomy of
BreathingD. Coulter, 2001
Anatomy of Hatha Yoga
The Journal of the American Medical Association. May 17, 2000
Key point
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HomeBase
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Feet flat on floor
Long Spine
Relaxed Throat
Soft Jaw
Challenge of “fitting in” Self-care
https://www.youtube.com/watch?v=A1JNopo3Qfg
start 4:32 child & family services Dan Harris TOUR (2:00)
5:04 cops
5:48 intense conflict end 6:22
Listen, Reflect, Share, Connect
Self-care
page 35
Self-care
page 71What gets in your
way of Self-Care?
HomeBase
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Feet flat on floor
Long Spine
Relaxed Throat
Soft Jaw
Stress Distress
Impairment
Improper behavior
Intervention Sanctions
ADVANCING COLLEAGUE ASSISTANCE IN PROFESSIONAL PSYCHOLOGY , 2006
Chapter 5, Assessment & Intervention (pgs 30 – 33)
Chapter 6, Operational Strategies (pgs 34 – 40) http://www.apapracticecentral.org/ce/self-care/colleague-assist.aspx
http://www.apapracticecentral.org/ce/self-care/intervening.aspx
Stress – Distress - Continuum
AngelaThomasJones.com
Intervening With an Impaired ColleagueBy Michael F. O’Connor, Ph.D., with the assistance of the members of the APA Board of
Professional Affairs Advisory Committee on Colleague Assistance.
Impairment therefore refers to
circumstances where professional ability
is compromised . . . .
Impairment, while heightening the risk for ethical violations,
does not infer such violations. . . .
March 17, 2011 http://www.apapracticecentral.org/update/2011/03-17/new-guidelines.aspx
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inter-professional collaboration contributes to self-care
“Who is right” becomes
“what is right”Inter-Professional Collaboration
by R Jeffrey Goldsmith, MD, DLFAPA, DFASAM | March 22, 2016 AngelaThomasJones.com 45
KEY point
Listen, Reflect, Share, Connect
Where is the responsibility for change?
Who holds the power?
Biology of Stress
Science of Hope
Key Point
Resilience can be learned
Repetition is KEY
1:58 SENTIS Neuroplasticity & Neurogenesis https://www.youtube.com/watch?v=ELpfYCZa87g&t=5s
the science of Repetition Repetition!
48
#NCADCon www.NCADCon.com
Stephen Porges
Polyvagal TheoryAngelaThomasJones.com
HomeBaseFeet on the floor
Long Spine
Soft Throat
Relaxed Jaw
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Risk
Factors
p18
Assessing
Risk
p19
Client
Stressors
p27
External
Internal
p60
60
Unique features of Trauma-related symptoms
van der Kolk describes the
structure of our brain is similar to other animals, however,
We have the unique ability to choose how we respond.
This ability allows us to attach meaning and logical thought to our
experiences as well as anticipate long-term consequences of our actions.
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Somatic
Inventory
of Burnout Signs
p 31
(Mischke-Reeds)
2018
~ Informed Consent Resilient Supervision Agreement ~
Sustainable Change
Neuro-Biology of Stress: chronic = risks
Science of HOPE: Resiliency is a learned SKILL =
Key Point
Reflection-in-action is a rigorous professional process involving acknowledgement of and reflection on uncertainty and complexity in one’s practice leading to ‘a legitimate form of professional knowing’
p 68, 1983
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Self-awareness(in the moment)
Critical thinking(without judgement)
Reflection(choice)
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Schon
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My
Indicators
p53
Compassion
p105
Seeking
Help
p111
111
105
#NCADCon www.NCADCon.com
Professional
Resilience
Plan
Eric Gentry, PhD
Moving forward withResiliency Planning
▪ Individual, personally
– The ProQOL can help you plan where to put your energy to increase your resilience
▪ Organizational planning
– Can help organizations find ways to maximize the positive aspects and reduce the negative aspects of helping
▪ Compassion Fatigue-Sensitive Supervision
– The ProQOL can be used as information for discussions and to track change
The Professional Quality of Life Scale (ProQOL) http://www.proqol.org/Home_Page.php
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#NCADCon www.NCADCon.com
https://nam.edu/initiatives/clinician-resilience-and-well-being/commitment-statements-clinician-well-being/
https://nam.edu/initiatives/clinician-resilience-and-well-being/
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WHAT NEXT?1st step for yourself
1st step for your workplace
Report in/Group Discussion
#NCADCon www.NCADCon.com
The most beautiful things in the world are not seen or
touched, they are felt
with the Heart~ Helen Keller
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Overcoming Compassion Fatigue:A Practical Resilience Workbook
Martha Teater and John Ludgate, PESI, Inc., 2014
Rewards . . . . . . . . . . . . . . p29
Self-care . . . . . . . . . . . . . . p35
ProQOL . . . . . . . . . . . . p45-48
Resiliency Inventory . . . . . . . . p49-51
My Indicators . . . . . . . p53 & 71
Compassion . . . . . . . . p105
Workplace . . . . . . . . . p109
Seeking Help . . . . . . . . . p111
Table 1: CF by profession . . . . . . p20
Table 2: Burnout by profession . . p20
Table 3: Studies of Therapists’
Self-care Strategies . . . p116
Table 5: Factors that Sustain &
Deplete Professional Self
p117
