SELF CARE: PERSONAL & ORGANIZATIONAL IMPERATIVES

By: Lanny Endicott

Presented at: NACSW Convention 2012

October, 2012 St. Louis, MO

6262ndnd A l NACSW C tiA l NACSW C ti6262ndnd Annual NACSW  ConventionAnnual NACSW  ConventionOctober  25October  25‐‐28, 2012  28, 2012  ‐‐ St. Louis, MissouriSt. Louis, Missouri

““S lfS lf C P l &C P l &““SelfSelf‐‐Care: Personal & Care: Personal & Organizational Imperatives”Organizational Imperatives”Organizational ImperativesOrganizational Imperatives

Lanny EndicottLanny EndicottOffice: 918Office: 918‐‐495495‐‐65436543Cell:     918Cell:     918‐‐830830‐‐15231523

lendicott@oru.edulendicott@oru.edu

http://drlannyendicott.com.tripod.comhttp://drlannyendicott.com.tripod.com

AgendaAgendaAgendaAgenda

Discuss: Compassion SatisfactionDiscuss: Compassion SatisfactionDiscuss: Compassion Satisfaction, Discuss: Compassion Satisfaction, Compassion Fatigue, Secondary Traumatic Compassion Fatigue, Secondary Traumatic Stress BurnoutStress BurnoutStress, BurnoutStress, Burnout

Apply: Self assessment (ProQOL5), SelfApply: Self assessment (ProQOL5), Self‐‐care care plan Support Group Organizational Selfplan Support Group Organizational Self CareCareplan, Support Group, Organizational Selfplan, Support Group, Organizational Self‐‐CareCare

Deep BreathingDeep BreathingDeep BreathingDeep Breathing

Life is in the breathLife is in the breathAPPS:APPS:

PTSD CoachPTSD CoachPTSD CoachPTSD CoachTactical BreatherTactical BreatherB th 2R lB th 2R lBreathe2RelaxBreathe2RelaxT2MoodTrackerT2MoodTrackerSound SleepSound Sleep

Breath PrayerBreath Prayer________________________________________________

SelfSelf‐‐CareCarelflf i “ ” ii “ ” iSelfSelf‐‐care is “very” important care is “very” important 

Why?Why?

Professional SelfProfessional Self‐‐Care: Care: l kl kSocial WorkSocial Work

SelfSelf‐‐care is critical to the survival andcare is critical to the survival and

growth of the social work professiongrowth of the social work profession ––growth of the social work profession growth of the social work profession 

for the health of every social workerfor the health of every social worker

NASW Code: 4.05 ImpairmentNASW Code: 4.05 ImpairmentNASW Code: 4.05 ImpairmentNASW Code: 4.05 Impairment

aa Personal problems can disrupt yourPersonal problems can disrupt youra.a. Personal problems can disrupt your Personal problems can disrupt your judgment and ability, and can damage judgment and ability, and can damage th l t i t h lth l t i t h lthe very people you trying to helpthe very people you trying to help

bb Social workers (helpers) should getSocial workers (helpers) should getb.b. Social workers (helpers) should get Social workers (helpers) should get counseling, adjust workloads, or end counseling, adjust workloads, or end 

li ith th t t t thli ith th t t t thcounseling with others to protect themcounseling with others to protect them

Compassion SatisfactionCompassion SatisfactionCompassion SatisfactionCompassion Satisfaction

•• PPositives of helpingositives of helpingPPositives of helpingositives of helping–– Pleasure and satisfaction from helping othersPleasure and satisfaction from helping others

Feeling good giving counseling and careFeeling good giving counseling and care–– Feeling good giving counseling and careFeeling good giving counseling and care

–– Encouraged by the organizationEncouraged by the organization

E j i k ith thE j i k ith th–– Enjoying work with othersEnjoying work with others

–– Having positive beliefs about yourselfHaving positive beliefs about yourself

F li i i l f lfill (“ k i lli ”)F li i i l f lfill (“ k i lli ”)–– Feeling spiritual fulfillment (“work is a calling”)Feeling spiritual fulfillment (“work is a calling”)

Compassion FatigueCompassion Fatigue

•• NNegative results from helpingegative results from helpingNNegative results from helpingegative results from helping–– Being overwhelmed giving counseling and careBeing overwhelmed giving counseling and care

Discouraged by the organizationDiscouraged by the organization–– Discouraged by the organizationDiscouraged by the organization

–– Poor work relations with othersPoor work relations with others

N ti b li f b t lf (d l )N ti b li f b t lf (d l )–– Negative beliefs about yourself (dreams, values)Negative beliefs about yourself (dreams, values)

–– Unfulfilled in your workUnfulfilled in your work

Secondary Traumatic StressSecondary Traumatic StressSecondary Traumatic StressSecondary Traumatic Stress

–– Working with people who have traumaWorking with people who have traumaWorking with people who have traumaWorking with people who have trauma

–– Absorbing the trauma of othersAbsorbing the trauma of others

–– Personal exposure to traumaPersonal exposure to traumaPersonal exposure to traumaPersonal exposure to trauma

–– Retreating, avoidance, anxietyRetreating, avoidance, anxiety

BurnoutBurnoutBurnoutBurnout

•• BurnoutBurnoutBurnoutBurnout–– Feeling hopeless and helplessFeeling hopeless and helpless

Feeling worn outFeeling worn out–– Feeling worn outFeeling worn out

–– Burnout takes timeBurnout takes time

Si il t S d T ti St b t t kSi il t S d T ti St b t t k–– Similar to Secondary Traumatic Stress but takes Similar to Secondary Traumatic Stress but takes longerlonger

Burnout        Secondary

Trauma

BurnoutBurnoutBurnoutBurnoutEmotionalEmotional exhaustionexhaustion depersonalizationdepersonalizationEmotional Emotional exhaustionexhaustion, , depersonalizationdepersonalization, , and and reduced personal accomplishmentreduced personal accomplishmentth t th h dth t th h dthat can occur among those who do that can occur among those who do “people“people‐‐work” of some kind. work” of some kind. 

DisillusionmentDisillusionmentDisillusionmentDisillusionmentFatigue or frustration caused byFatigue or frustration caused byFatigue or frustration caused by Fatigue or frustration caused by devotion to a cause, way of life, or devotion to a cause, way of life, or relationship that failed to produce relationship that failed to produce thethe expected rewardexpected rewardthe the expected rewardexpected reward

•• Fatigue Fatigue •• Frequent illnessFrequent illness•• Frequent illnessFrequent illness•• Sleep problemsSleep problemsp pp p•• Disillusionment with workDisillusionment with work

•• Cynicism toward organization orCynicism toward organization orCynicism toward organization or Cynicism toward organization or clients clients 

l l /h ll l /h l•• Helplessness/hopelessnessHelplessness/hopelessness•• Powerless to change eventsPowerless to change eventsPowerless to change eventsPowerless to change events•• Anger toward the organization or Anger toward the organization or ““ li t l ”li t l ”““clientele”clientele”

•• Depression and isolationDepression and isolation

•• Staying away from coStaying away from co‐‐workersworkers

•• Being absentBeing absent•• Being absentBeing absent

•• Being harsh with other workersBeing harsh with other workersgg

•• Reduced commitment to workReduced commitment to work

•• Consumption of chemicalsConsumption of chemicals

Burnout: A Gradual ProcessBurnout: A Gradual Process

•• Unaware it is happeningUnaware it is happening

•• Work harder Work harder –– accomplishing lessaccomplishing less

E h t dE h t d di ill i d ddi ill i d d i l t di l t d•• ExhaustedExhausted, disillusioned, and , disillusioned, and isolatedisolated

• Results to the organization:• Results to the organization:–Low morale

–Absenteeism–High turnover 

Loss of MeaningLoss of MeaningLoss of MeaningLoss of Meaning“Moral Injury”“Moral Injury”

W ki i h i i f b dW ki i h i i f b d•• Working with atrocities of abuse and Working with atrocities of abuse and maltreatment that transgress deeply held maltreatment that transgress deeply held moral beliefs and personal valuesmoral beliefs and personal valuesmoral beliefs and personal valuesmoral beliefs and personal values

•• Moral expectations are rooted in religious or Moral expectations are rooted in religious or spiritual beliefs cultural valuesspiritual beliefs cultural valuesspiritual beliefs, cultural values, spiritual beliefs, cultural values, organizational and/or grouporganizational and/or group‐‐based rules based rules about fairness, the value of life, etc.about fairness, the value of life, etc.about fairness, the value of life, etc.about fairness, the value of life, etc.

http://www.ptsd.va.gov/professional/pages/moral_injury_at_war.asp

Secondary Traumatic Secondary Traumatic yyStressStress

A natural consequence A natural consequence and and byby‐‐qq yyproduct of caring for, listening to, product of caring for, listening to, and helping thoseand helping those with traumawith traumaand helping those and helping those with traumawith trauma

‐‐eveneven‐‐

Learning about, hearing stories of Learning about, hearing stories of ith tith tpersons with traumapersons with trauma

Three Categories ofThree Categories of SymptomsSymptomsThree Categories of Three Categories of SymptomsSymptoms“Is it helper PTSD?”“Is it helper PTSD?”

11 Intrusive thoughts images sensationsIntrusive thoughts images sensations1.1. Intrusive thoughts, images, sensationsIntrusive thoughts, images, sensations2.2. Avoidance of people, places, things Avoidance of people, places, things 

and experiences which elicit memories and experiences which elicit memories of the traumatic experienceof the traumatic experience

3.3. Negative arousal in terms of Negative arousal in terms of hyperhyper‐‐vigilance, vigilance, sleep disturbances, sleep disturbances, g ,g , p ,p ,irritability and anxietyirritability and anxiety

Emotional IndicatorsAnger

Physical Indicators

H d hAngerSadness

Prolonged griefi

Headaches

Stomach aches

LethargyAnxietyDepression

Lethargy

Sleep problems

P l I di t W k I di tPersonal Indicators

Self‐isolation

Cynicism

Work Indicators

Avoids certain clients

Missed appointmentsCynicism

Mood swings

Irritability with spouse/family

Missed appointments

Tardiness

Lack of motivationLack of motivation

Vicarious TraumaVicarious TraumaVicarious TraumaVicarious Trauma

A Key risk: Working with Traumatized A Key risk: Working with Traumatized h ldh ldChildrenChildren

•• EmpathyEmpathy•• EmpathyEmpathy

•• Experiencing children with traumaExperiencing children with trauma

•• Not enough time to recoverNot enough time to recover

•• Unresolved personal traumaUnresolved personal trauma•• Unresolved personal traumaUnresolved personal trauma

•• Poor support from the organizationPoor support from the organization

Spiritual Compassion Spiritual Compassion ‐‐ FatigueFatigue

•• Having pityHaving pityHaving pityHaving pity

•• Having love and mercyHaving love and mercy

•• Being torn of heartBeing torn of heart

•• Having deep feelingsHaving deep feelings•• Having deep feelingsHaving deep feelings

•• Losing heartLosing heart

•• Becoming faint and wearyBecoming faint and weary•• Becoming faint and wearyBecoming faint and weary

Stress develops Stress develops when when you perceive you perceive Stress develops Stress develops when when you perceive you perceive Stress develops Stress develops when when you perceive you perceive that that demandsdemands exceed exceed your personal your personal Stress develops Stress develops when when you perceive you perceive that that demandsdemands exceed exceed your personal your personal and social and social resourcesresourcesand social and social resourcesresources

Demands ResourcesDemands Resources

Demands of:• Family• Work

Resources of:• Good health

• Work • Sickness/health problems• Friends

• Positive self-thoughts• Social support• Positive past experiences• Self-expectations

• Day-to-day conflicts• Transportation

Positive past experiences• Coping skills• Stress management skillsp

• Financial problems• Environment (noise, crime)

• Healthy diet & exercise• Spiritual discipline • Balanced life• Balanced life• Positive work relationships

It rains—sometimes pours

We carry this invisible barrel

Stress felt inStress felt in neck, shoulders, and back

Expand hole in the barrel to lighten the load

Your Resources

Caring for YourselfCaring for YourselfPersonal LevelPersonal Level

Self Assessment Healthy Activities1. Examine personal 

traumatic experiences A t i

y1. Sleep2. Exercise

Assess triggers

2. Manage stress outside of work

3. Diet4. Writing/journaling5 S i it l di i li

See “Healthy Activities”

3. Feedback F il f i d

5. Spiritual disciplines6. Hobbies7 In‐the‐moment Family, friends

co‐workers 

7. In‐the‐moment8. Deep breathing and 

imagery

Work LevelWork Level

1. At WorkD il b i i

3.   SystemO i ti lf— Daily beginnings –

endings

— Fatigue check

— Organization self‐care 

plan

— Support groupsg

2.   Professional— Support from others

Support groups

— Social activities

— Safety planpp

— Consulting

— Hopefulness

y p

AssignmentAssignmentAssignmentAssignment

Take & ScoreTake & Score ProQOLProQOL Take & Score Take & Score ProQOLProQOL

Create a SelfCreate a Self‐‐care plancare plan Create a SelfCreate a Self‐‐care plancare plan

Discuss OrganizationalDiscuss OrganizationalDiscuss OrganizationalDiscuss Organizational

SelfSelf‐‐Care planCare planpp

What is your organization doingWhat is your organization doingWhat is your organization doing What is your organization doing for worker stress?for worker stress?

Embrace Corporate Care!Embrace Corporate Care!

http://www.sanctuaryweb.com/sanctuaryhttp://www.sanctuaryweb.com/sanctuary‐‐p y yp y ymodel.phpmodel.php

Assessment Instruments & ResourcesAssessment Instruments & ResourcesIdaho State UniversityIdaho State University

P QOL5 i t t f Id h St tP QOL5 i t t f Id h St tProQOL5 instrument from Idaho State ProQOL5 instrument from Idaho State University:University:

http://www.isu.edu/~bhstammhttp://www.isu.edu/~bhstamm//

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HeadingtonHeadington InstituteInstituteHeadingtonHeadington InstituteInstitute

http://www headingtonhttp://www headingtonhttp://www.headingtonhttp://www.headington--institute.org/Default.aspx?tabid=institute.org/Default.aspx?tabid=13 913 913791379

Authentic Happiness WebsiteAuthentic Happiness Website

http://www.authentichappiness.sas.d /D f lupenn.edu/Default.aspx

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University of Texas (Austin)University of Texas (Austin)University of Texas (Austin)University of Texas (Austin)

http://www cmhc utexas edu/stress htmlhttp://www.cmhc.utexas.edu/stress.html

Resources for PTSD and the militaryResources for PTSD and the militaryhttp://www.ptsd.va.gov/index.asp

Gift from Withinhttp://www.giftfromwithin.org/http://www.giftfromwithin.org/Sidran Institutehtt // id /i d fhttp://sidran.org/index.cfmInternational Society of Traumatic StressStudieshttp://www istss org/Home htmhttp://www.istss.org/Home.htm

National Child Traumatic Stress kNetwork

• http://www nctsn org/products/secondary‐http://www.nctsn.org/products/secondarytraumatic‐stress‐fact‐sheet‐child‐serving‐professionals%20professionals%20

LannyLanny EndicottEndicottOffi 918Offi 918 495495 65436543Office: 918Office: 918‐‐495495‐‐65436543Cell:     918Cell:     918‐‐830830‐‐15231523

lendicott@oru.edu@

http://drlannyendicott.com.tripod.com