social workers and lmhcs: how to obtain your continuing ......1. perseverance and refusing to quit...
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Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar ‣ Create a Username & Password at the NYU Silver CE Online
Portal : • https://sswforms.es.its.nyu.edu/
‣ Log on to the “Continuing Education Online Portal for the NYU Silver School of Social Work” page, click on “All Events & Programs” tab
‣ Scroll down & select today’s webinar under “Online Learning”
‣ Click “Register” ‣ Fill in the billing information, click register, and pay the CE
registration fee Remember: Our system works best with Google Chrome or Mozilla Firefox
Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar, cont. ‣ After registering, you will receive a confirmation email
with a link to complete an evaluation ‣ Once the evaluation is submitted, within 24 - 48 hours,
log back on to NYU Silver CE Online Portal, go to “Your Registrations” and you will see “Take Assessment” in red next to the name of the program
‣ Complete assessment ‣ Once done, you will be directed how to download your
CE certificate ‣ For Questions: Call us at 212-998-5973 or email us at
Resilience Informed Service Environments
(RISE) ANTHONY SALERNO, PHD
JAMES RODRIGUEZ, LCSW, PHD JANUARY 17, 2018
Agenda ‣Understanding resilience ‣The neurobiology of resilience ‣Research on resilience ‣Building Resilience
Poll Questions ‣ Please tell us who you are? A. Adult Mental Health Providers B. Child/Adolescent MH Providers C. Adult Care Manager D. Child/Adolescent Care Manager E. Substance Use Provider F. Supervisor G. Administrator H. Other
Understanding Resilience THE OTHER SIDE OF THE COIN FROM TRAUMA
Resilience
“What’s predictable is preventable.”
Robert Anda – Co-Investigator, ACEs Study
History ‣ Early worked focused on the individual – internal
strengths that protect people against the negative effects of exposure to toxic stress (e.g. the resilient child – invulnerable, invincible)
‣ Picked up by MH researchers interested in the social determinants of health
Definition ‣ Resilience. A dynamic process reflecting positive
adjustment despite significant risk or adversity (Luthar & Zigler, 1991; Garmezy, 1971; Rutter, 1987)
‣ Resilience is… • Context-based/Situational • Domain Specific • Fluctuates over time (fluid)
Resilience is not…? ‣ Competence ‣ Ego resiliency ‣ Grit
When has someone demonstrated resilience? 1. Resiliency - No signs of unhealthy coping response
(disorder), despite exposure to Potentially Traumatizing Event (PTE)
2. Recovery – Improving coping response after unhealthy coping in response to PTE.
3. Prosperity – exceeds expectations and doing better than before exposure to PTE.
Bonanno and Mancini, 2012
Three Levels of Protection
Resilience
Individual Strengths (Assets)
Significant others
(Resources)
Systems and Culture
(Resources)
Individual characteristics (Assets) ‣ Temperament ‣ Personality traits ‣ Ego resiliency ‣ Competence ‣ Grit ‣ Intelligence ‣ Future orientation ‣ Self-efficacy ‣ Self-esteem
Significant others (Resources) ‣ Family/Parenting • Attachment, • Parental/Caregiver monitoring/supervision, support ‣ Peers ‣ Mentors ‣ Extended family ‣ Social support
Systems support (Resources) ‣ Quality Systems • Schools – • Engaging services • Quality care • Evidence-based practice • Practice-based evidence ‣ Trauma Informed Systems • Safety • Connections • Emotional regulation
Cultural/Context Example ‣ Religion/Spirituality ‣ Ethnic/Racial Identity (Zimmerman et al., 1995) ‣ 5 Categories of Resilience in African American males
impacted by poverty (Teti, et al., 2012): 1. Perseverance and refusing to quit despite challenges 2. A commitment to learning/growing from hardship 3. Using reflection and refocusing 4. Creating a positive and supportive environment 5. Drawing on religion/spirituality for strength
Cultural and Community Resilience ‣ First Nations research (Chandler and Lalonde, 1998) • Self government • Land claims • Education • Health services • Cultural facilities • Police and fire departments • Native Language
‣ Increases suicide rates by cumulative bands • 0 = 137.5/100,000 • 6 = 0.0/100,000
Recent Research and the Brain
Sinha et al., 2016
Neurobiology of Resilience
Genetics
Epigenetics
Neurochemicals
Genetics
Epigenetics ‣ Biological mechanisms that will switch genes on and
off (What happens around the gene): • Epigenetics control genes • Epigenetics is everywhere • Epigenetics makes us unique • Epigenetics is reversible or plastic
Epigenetic Factors ‣ Exposure to stress ‣ Environmental toxins ‣ Prenatal environment ‣ Diet ‣ Exercise ‣ Developmental (critical) periods ‣ Aging ‣ Virus/infection
Epigenetics and Stress
02468
101214161820
0 1 2 3 4-5 6 or more
ACE Score
Neurochemicals
Norepinephrine Neuropeptide Y
Galanin
CRH Cortisol DHEA
Others Dopamine Serotonin
BDNF ALLO
Sympathetic NS HPA Axis Others
Basic Research on Resilience ‣ Resilience is a significant predictor of decrease in self-
reported fatigue after MTBI (Losoi et al., 2014).
‣ Associated with healthy lifestyles, wellness: • Healthy eating, Exercise, Tobacco use (Wagnild 2015)
• Fatigue (Losoi et al., 2014)
‣ Depression, Anxiety (Alena et al., 2014; Wagnild, 2015)
‣ Life satisfaction (Alena et al., 2014)
‣ Religiosity (Mosquito, 2015)
Outcomes of Resilience Based Intervention ‣ Self efficacy and personal functioning in people with
severe mental Illness (Maxan et al., 2013)
‣ Decreased adolescent substance use (Hodder, et al., 2011)
‣ PTSD Symptoms and positive emotional health (Kent et al., 2011)
‣ Quality of life and self-concept for people with TIC D/O (Storch et al., 2012)
‣ Psychological, physiological and self-management for African Americans with Type II Diabetes (Steinhardt et al. 2015)
Components of RB Interventions ‣ All provide psycho-education on resilience ‣ Finding positive meaning in the context of disease –
reframing disease (Steinhardt et al., 2015) ‣ Emotion regulation and social connectedness (Kent et
al., 2011; Maxan et al., 2013). ‣ Storch et al., (2012): typical CBT components with
focus on: (1) talking to others about tics, (2) responding to bullies, and (3) not limiting activities because of tics.
Research on Resilience in Children ‣ Therapeutic Foster Care can affect cortisol levels in
children and adults (Fisher, 2016) ‣ Social Emotional Learning increases resilience:
emotional control, goal setting, perspective taking, problem solving (Durlak et al., 2011)
‣ Treating maternal mental health and improving parenting helps (Goodman and Garber 2017)
‣ Individual characteristics (e.g. self-efficacy) at least one supportive adult relationship help overcome adversity (Werner and Smith, 2005)
What You Can Do
Ways of Building Resilience 1. Build on strengths – whether assets or resources 2. Increase protective factors 3. Reduce exposure to risk 4. Prevention: Primary, Secondary, Tertiary
Implications for the work in behavioral health services The bifocal lens of trauma and resilience • Assessing the severity and chronicity of a person’s risk
exposure • Assessing comprehensive resiliency promoting personal
and environmental factors
A practical and immediate clinical focus that aligns with building resilience ‣ Maintaining a very comprehensive and continual
focus on personal strengths and opportunities to utilize the people, places and things in the person’s life that are reliable and helpful resources.
‣ Assisting clients to identify, engage and develop strong social bonds is critical.
What practitioners need to know ‣ Practitioners and service systems can strengthen a
persons resilience (ability to more effectively manage the impact of highly stressful events in the past, present and future)
‣ In contexts of higher exposure to adversity, environmental factors may be more important to resilience than individual factors.
‣ Even maladaptive patterns of coping may be signs of resilience in challenging contexts.
Assessing Risk ‣ Age of initial exposure and duration of adversity ‣ Severity and duration of adverse events and conditions ‣ Number of adverse events experienced ‣ Current challenges and difficulties associated with
adversity ‣ Cultural/familial/religious beliefs and values about:
◦ What constitutes an adverse event- what the term trauma means ◦ Why bad things happen to good people ( role of sin, punishment, forgiveness) ◦ How people are expected to deal with highly stressful life events (prayer, penance) ◦ Self disclosure to strangers, keeping or disclosing secrets ◦ Gender related expectations
Measuring Resilience Connor Davidson Scale: 4 Resiliency Factors ‣ Factor 1: Flexibility to Cope with Changes/Challenges • I can handle unpleasant feelings • I tend to bounce back after illness or hardship • I can make unpopular or difficult decisions ‣ Factor 2: Social and Familial Support • My family is willing to help me make decisions and listen
to me • My friends are willing to help me make decisions and
listen to me • I have close and secure relationships
Connor Davidson (continued) ‣ Factor 3: Spiritual Support • Sometimes fate or god can help • Things happen for a reason ‣ Factor 4: Being Goal-Oriented • I like challenges • I work to attain my goals • I have pride in my achievements • I have a strong sense of purpose • I have few regrets in life i can achieve my goals
Connor KM, Davidson JR. Development of a new resilience scale: The Connor Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18(2):76-82. PMID: 12964174.
Resiliency Scale for Adults: Two Major Factors ‣ Factor I: Personal Competence
• Follow through with plans • Manage one way or other • Able to depend on self more than anyone
‣ Factor Il. Acceptance of Self and Life
• I usually take things in stride • I seldom wonder what the point of it all is • I take things one day at a time • I can usually find something to laugh about
Wagnild, G. and Young, H.M.,(1993) Development and Psychometric Evaluation of the Resilience Scale. Journal of Nursing Measurement, Vol. 1, No. 2
Brief Resiliency Scale: Single Resiliency Factor
1. I tend to bounce back quickly after hard times
2. I have a hard time making it through stressful events
3. It does not take me long to recover from a stressful event
4. It is hard for me to snap back when something bad happens
5. I usually come through difficult times with little trouble
6. I tend to take a long time to get over set-backs in my life
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The Brief Resilience Scale: Assessing the Ability to Bounce Back. International Journal of Behavioral Medicine, 15, 194-200. http://dx.doi.org/10.1080/10705500802222972
Questions we need to answer ‣ Are there clinical cutoffs or specific dosages of protective
factors (individual and environmental) that mitigate the impact of stressors and prevent psychological and behavioral problems?
‣ How do different levels of exposure to adversity, different contexts, and different cultures, affect these cutoffs?
‣ In which contexts and under what conditions are children likely to develop maladaptive coping strategies as a pathway to resilience?
‣ What is the relationship between higher levels of resilience and a child’s recovery from a mental disorder?
‣ Which resilience-promoting interventions are the most effective with which specific populations of children?
Systemic Pillars of Healing
Creating Safety (Individual) ‣ Discuss safety • People, places and things that make someone feel safe or
not. ‣ Creating a Safe (Enough) Place • Thinking of a safe place (i.e. present or past, person,
religious/spiritual) • Make it as vivid • Deep experience (i.e. thoughts, feelings, sensations) • Readjust if necessary ‣ SUDS Ratings (1-10) ‣ Repeated checks
Creating Safety (Provider System) ‣ Changing environment • Waiting areas • Staff training • Privacy/Confidentiality ‣ Survey people, providers
Connections (Individual) 1. Motivational Interviewing 2. Processing transference 3. DBT Chain Analysis (e.g. Chain Analysis) 4. Interpersonal Psychotherapy - Resolving
Interpersonal Role Disputes
Connections (Provider System) ‣ Groups • Opportunities to make connections • Development communication skills • Peer/social support ‣ Social events ‣ Play/Physical Activity
Connections (Community) ‣ Identify extent and quality of social networks ‣ Explore involvement of social supports in treatment ‣ Design service planning to strengthen connections to
community resources (e.g. religious, cultural, social)
Managing Emotions (Individual) ‣Stress Inoculation Training: • Breathing/Breathing retraining • Muscle relaxation • Cognitive coping ◦ Self-dialogue/Self-talk ◦ Thought-stopping ◦ Role playing
• Exposure ◦ In-vivo ◦ Imaginal ◦ Narration
Managing Emotions (System) ‣ Adjunctive group: • Yoga, • Meditation, • Other stress reduction opportunities, ‣ Mindfulness based group interventions ‣ Psychological First Aid training (Community)
Twelve Ways to Build Resilience (APA) 1. Making Connections 2. Avoid seeing crisis as insurmountable 3. Accept that change is a part of living 4. Move towards a goal 5. Take decisive action 6. Look for opportunities for self-discovery 7. Nurture a positive view of self 8. Keep things in perspective 9. Maintain a hopeful outlook 10. Take care of self 11. Learn from past 12. Stay flexible
APA (2017) Road to Resilience available at: http://www.apa.org/helpcenter/road-resilience.aspx
Accepting Reality ‣ Teaching Radical Acceptance • Accepting reality as it is • Pain is a reality of life • The past can’t be changed • Turning the mind – a Half Smile activity ‣ ACT metaphors • The Person on a Bus metaphor • The Book metaphor
Finding Meaning ‣ When you have a great sense that life has meaning,
what are you doing? What are you aware of?
‣ What leaves you without much of a sense of meaning or a sense that life has no meaning?
‣ What could you do to gain or regain a sense of meaning?
Poll Question What topics would you be interested in hearing more about regarding the topic of resilience? Check top 3 A. Understanding resilience B. Interventions to build resilience (children/youth) C. Interventions to build resilience (adults) D. Organizational resilience E. Neurobiology of resilience F. Service provider resilience G. Resilience and culture H. Resilience building strategies I. Others (please chat in)
Poll Question ‣ What resilience related activities would you be
interested in attending if offered by the CTAC? Check all that apply
A. Webinars B. In-Person training C. Learning Community D. Consultation E. Other (please chat in response)
Q & A
Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar ‣ Create a Username & Password at the NYU Silver CE Online
Portal : • https://sswforms.es.its.nyu.edu/
‣ Log on to the “Continuing Education Online Portal for the NYU Silver School of Social Work” page, click on “All Events & Programs” tab
‣ Scroll down & select today’s webinar under “Online Learning”
‣ Click “Register” ‣ Fill in the billing information, click register, and pay the CE
registration fee Remember: Our system works best with Google Chrome or Mozilla Firefox
Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar, cont. ‣ After registering, you will receive a confirmation email
with a link to complete an evaluation ‣ Once the evaluation is submitted, within 24 - 48 hours,
log back on to NYU Silver CE Online Portal, go to “Your Registrations” and you will see “Take Assessment” in red next to the name of the program
‣ Complete assessment ‣ Once done, you will be directed how to download your
CE certificate ‣ For Questions: Call us at 212-998-5973 or email us at