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Models for Addressing Vicarious Trauma in Child Welfare
Victoria L. Hummer, MSW, LCSWRobin 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 FatigueCompassion 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 SupportSummary & 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 TimeMental Health(EAP)Personal wellnessCoverage 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 StaffRespite WorkersUse of retired, parttime, or contract workers to fill-in Job sharing (reduce turnover)Buddy system for difficult casesProvision 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 accomplishmentsSharing and celebrating accomplishments or
even getting through a “rough week”
Recommendations – Human Resources
Provide mechanisms for System Improvements by:o Facilitating ongoing evaluation and feedbacko Monitoring sick leave and staff turnovero 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 Self-CareInitial “Support for staff begins at the hiring process”• First interview discussion of vicarious trauma, continues in OrientationOngoing• 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 OrganizationOrganizational Plan of Self-Care & Prevention of Vicarious TraumaOrganization_______________ Overall Goal : Fit with Organizational Culture: 3 Strategies to Implement Goal:• • • Who is Responsible for What?Barriers Identified: Resources Needed:
Resource LinksOrganizational 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.pdf
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/
