Stress Management in Child Stress Management in Child Welfare PracticeWelfare Practice

Marcy WilliamsonMarcy Williamson

May 11, 2011May 11, 2011

Objectives:

As a result of this training, participants will be able to:

☼Identify positive and negative effects of stress and distinguish between them

☼Assess at least two possible sources of stress in the workplace as a child welfare worker and state at least two strategies to mitigate these stressors

☼Identify the differences between Burnout and Secondary traumatic stress

What Is Stress?

Hans Selye’s view in 1956 was that “stress is not necessarily something bad – it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental.” Selye believed that the biochemical effects of stress would be experienced irrespective of whether the situation was positive or negative.

What is Stress?

The most commonly accepted definition of stress (mainly attributed to Richard S. Lazarus) is that stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize.

Is Stress Bad for You?

Some types of Stress Are…

The human body chemically responds to emotionally

charged situations

When you are under pressure or additional demands have been made your body reacts – fight or flight. Humans naturally want to defend themselves in challenging or difficult situations.

What happens when my body perceives changes?

Messages travel through the SNS sympathetic nervous system in a bi-directional (two-way) flow. Efferent

messages can trigger changes in different parts of the body simultaneously. For

example, the sympathetic nervous system can accelerate heart rate; widen bronchial passages; decrease motility (movement) of the large intestine; constrict blood vessels;

cause pupil dilation, piloerection (goose bumps) and perspiration (sweating); and

raise blood pressure.

Stress Feelings

WorryTenseTiredFrightened

ElatedDepressed

AnxiousAnger

Internalizing Stress

Most of the stress we experience is self-generated. How we perceive life; whether an event makes us feel threatened or stimulated, encouraged or discouraged, happy or sad - depends to a large extent on how we perceive ourselves.

Ever feel like that “straw”

just landed on your back?

Types of Stress

o Negative stressIt is a contributory factor in minor conditions, such as headaches, digestive problems, skin complaints, insomnia and ulcers. Excessive, prolonged and unrelieved stress can have a harmful effect on mental, physical and spiritual health.

o Positive stressStress can also have a positive effect, spurring motivation and awareness, providing the stimulation to cope with challenging situations. Stress also provides the sense of urgency and alertness needed for survival when confronting threatening situations.

Exhaustion

In chronic stress situations, sufferers enter the exhaustion phase: emotional, physical and mental resources suffer heavily, the body experiences ‘adrenal exhaustion’ leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

Ever feel like you

can’t believe

you made it through another

day?

Symptoms of Stress

Stress has been related to such illnesses as

Cardiovascular disease

Immune system disease

Asthma Diabetes Digestive disorders

Ulcers Skin complaints -

psoriasis Headaches and

migraines Pre-menstrual

syndrome Depression

Cost of StressStress helps account for two-thirds of family doctor visits and, according to the U.S. Centers for Disease Control and Prevention, half the deaths to Americans under 65. It has been implicated in heart, stomach and mental disorders, along with the more ordinary headaches, backaches and high blood pressure and cholesterol. Kiecolt-Glaser's 10-year study of medical students found decreased levels of the body's natural killer cells, which fight infections and tumors, during even the familiar stress periods of exams.

Source Sickness Can Be Price of Unbridled Stress By Kevin Lamb

Secondary Traumatic Stress,

Compassion Fatigue, Vicarious Trauma &

Burnout…

Do they mean the same thing?

How are they different?

Compassion Fatigue

Although often used as a synonym for Secondary Traumatic Stress, it is different.

The combination of burnout and Secondary Traumatic Stress results in Compassion Fatigue.

Vicarious Trauma

Another name forSecondary Traumatic Stress

Does Secondary Does Secondary Traumatic StressTraumatic Stress

==

Burnout?Burnout?

Activity:Differentiating STS

from Burnout

Does Secondary Does Secondary Traumatic StressTraumatic Stress

== Burnout?Burnout?

Burnout

““a state of physical, a state of physical, emotional and mental emotional and mental exhaustion caused by long exhaustion caused by long term involvement in term involvement in emotionally demanding emotionally demanding

situations.”situations.” (Nelson-Gardell, (Nelson-Gardell, 2003)2003)

Gradual Onset

““the index of the the index of the dislocation between what dislocation between what people are and what they people are and what they

have to do.”have to do.” (Maslach, Leiter, (Maslach, Leiter, 1997)1997)

““describes a syndrome that goes describes a syndrome that goes beyond physical fatigue from overwork. beyond physical fatigue from overwork. Stress and emotional exhaustion are a Stress and emotional exhaustion are a part of it, but the hallmark of burnout is part of it, but the hallmark of burnout is the distancing that goes on in response the distancing that goes on in response

to overload.”to overload.” (Maslach, 1997)(Maslach, 1997)

Burnout: Indicators

Erosion in values, dignity, spirit and will-an erosion of the human soul

Over time; imbalance of what you can give and provides less than what you need

Feel overworked, undervalued, no longer in control of the job you do

Presence of negative emotions and the absence of positive ones

Sensibilities, Inc. 2005

Secondary Traumatic Stress

The pain and helplessness of the children we The pain and helplessness of the children we come into contact with can be passed on to come into contact with can be passed on to those around them…those around them…

A “trauma” is a psychologically distressing A “trauma” is a psychologically distressing event that is outside the range of usual event that is outside the range of usual human experience. Trauma often involves a human experience. Trauma often involves a sense of intense fear, terror and helplessnesssense of intense fear, terror and helplessness

Trauma is an experience that induces an Trauma is an experience that induces an abnormally intense and prolonged stress abnormally intense and prolonged stress responseresponse

Source: Child Trauma Academy

Secondary Traumatic Stress

The response a person The response a person experiences after listening experiences after listening empathetically to the empathetically to the traumatic events in traumatic events in

someone else’s life.someone else’s life. (Nelson-(Nelson-Gardell, 2003)Gardell, 2003)

Sudden Onset

38% of Social Workers 38% of Social Workers experience moderate to experience moderate to high levels of secondary high levels of secondary

traumatic stress.traumatic stress. (Cornille & (Cornille & Meyers, 1999)Meyers, 1999)

Contrary to popular belief it is not just the horrendous cases of abuse, like child deaths or serious injuries, that are secondarily traumatizing for caseworkers. Secondary trauma is cumulative. Even the small things, like seeing sadness in a child’s eyes when a home visit ends, can be traumatizing for a caseworker. Witnessing these events over and over again can have a negative effect on even the most compassionate and resilient caseworkers.

Who is at risk of Secondary Trauma?

Historically:– Emergency Services

ProfessionalsPolice officersFire fightersEmergency Medical

TechniciansNurse Crisis workers

Recently:– Professionals who

work with children & families in crisisPediatriciansPsychologistsPsychiatristsCPS Social WorkersJuvenile ProbationFoster ParentsTeachers

Source: Child Trauma Academy

Research

There has been a great deal of There has been a great deal of research on the effects of listening to research on the effects of listening to other people’s traumatic stories as it other people’s traumatic stories as it relates to mental health professionals, relates to mental health professionals, post 9/11 service personnel, crisis post 9/11 service personnel, crisis counselors, doctors, and nurses. But counselors, doctors, and nurses. But only recently have researchers begun only recently have researchers begun to look at the phenomena of to look at the phenomena of Secondary Trauma and how it effects Secondary Trauma and how it effects Child Welfare Social Workers Child Welfare Social Workers

Exposure

Child Welfare Social Workers are Child Welfare Social Workers are exposed to different forms of exposed to different forms of

traumatic events on a daily basis. traumatic events on a daily basis. They are required investigate child They are required investigate child abuse, remove children from their abuse, remove children from their homes, interact with angry, hostile homes, interact with angry, hostile

parents, the court and all the while be parents, the court and all the while be supportive and nurturing while supportive and nurturing while

listening to horrible stories of child listening to horrible stories of child abuse and neglect. abuse and neglect.

Why are you at risk?

Empathy: Social Worker internalization of the child’s trauma related pain

Insufficient Recovery Time: Listening to children describe horrific situations over and over again without enough time to process

Unresolved Personal Trauma: Your own traumatic experience can be “re-activated” when working with someone in a similar circumstance

Children are the most vulnerable members of our society: At times, the senseless nature of some of the trauma inflicted on children shake’s ones sense of humanity

Isolation & Systemic Fragmentation: Individual service delivery vs. team oriented practice and high turnover decreases your ability to handle stress

Lack of Systemic Resources: Lack of economic and personal investment in front line services

Source: Child Trauma Academy

Risk Factors-Child Abuse Risk Factors-Child Abuse HistoryHistory

Personal history of Personal history of child abuse child abuse increases the risk increases the risk of a social worker of a social worker experiencing experiencing secondary trauma secondary trauma (Nelson-Gardell, 2003) (Nelson-Gardell, 2003)

Personal choice to Personal choice to enter social work enter social work after being abused after being abused as a child might as a child might indicate indicate overcompensation overcompensation (Adler, 1917, 1927)(Adler, 1917, 1927)

Risk Factors-Coping StylesRisk Factors-Coping Styles

Defensive CopingDefensive Coping– Turn away or deny Turn away or deny

problems existproblems exist– Self- deceptionSelf- deception– Reality distortionReality distortion– Protect self from Protect self from

emotional pain or emotional pain or traumatrauma

– Primarily unconsciousPrimarily unconscious– Not always Not always

maladaptivemaladaptive

Constructive CopingConstructive Coping– Confronting Confronting

problemsproblems– Realistic Realistic

expectations of selfexpectations of self– Recognize potentially Recognize potentially

disruptive reactions disruptive reactions to stressto stress

– Protecting self Protecting self against the physical against the physical effects of stresseffects of stress

(Source: Weiten, W. 2008)

Risk Factors-EmpathyRisk Factors-Empathy

A key feature of child welfare work is building relationships with children and their families. Empathy, interpersonal sensitivity and caring are crucial to making the needed relationships happen. Although necessary, empathy makes the social worker vulnerable to secondary traumatic stress.

(Source: Educating Child Welfare Workers about Secondary Traumatic Stress, Pryce & Shackleford, 2007)

Cognitive SchemasCognitive Schemas

Research shows that the cognitive schemas are altered after working with trauma clients These traumatic experiences become integrated into the social worker’s cognitive schemata

(Source: McCann & Perlmann, 1990 and Bride, (Source: McCann & Perlmann, 1990 and Bride, 2007)2007)

SafetyTrust/DependencyIndependence

PowerEsteemIntimacyControl

Signs and Symptoms of STSSigns and Symptoms of STS

TiredTired Less socializingLess socializing Lower productivityLower productivity HopelessnessHopelessness DespairDespair CynicismCynicism Question humanityQuestion humanity

Persistent anger or Persistent anger or sadnesssadness

Disturbing mental Disturbing mental imagesimages

AnxietyAnxiety NightmaresNightmares Decreased sense of Decreased sense of

safetysafety

(Siegfried, 2008)

Strategies Strategies to Combat to Combat Secondary Secondary

TraumaTrauma

Build ResilienceBuild Resilience

– Healthy Self-esteem is Healthy Self-esteem is necessary to necessary to effectively work in effectively work in child welfare and child welfare and minimize the effects of minimize the effects of secondary traumasecondary trauma

– Be open to life’s Be open to life’s opportunities.opportunities.

Developmental Developmental PsychologyPsychology

Strategies Strategies to Combat to Combat Secondary Secondary

TraumaTrauma

Build a Supportive Build a Supportive Team EnvironmentTeam Environment

– Reduce caseloads Reduce caseloads – Hire and retain quality social Hire and retain quality social

workers workers – Educate on Secondary TraumaEducate on Secondary Trauma– Offer mental health services to Offer mental health services to

support social workers support social workers – Encourage time offEncourage time off– Offer peer support groups Offer peer support groups – Demonstrate support to the Demonstrate support to the

community and mediacommunity and media– Recognize Secondary trauma as Recognize Secondary trauma as

a real issuea real issue

OrganizationalOrganizational

PsychologyPsychology

Not an appropriate Organizational approach…

Strategies Strategies to Combat to Combat Secondary Secondary

TraumaTrauma

Build a Social Build a Social NetworkNetwork

– Spend time with Spend time with emotionally healthy emotionally healthy children to encourage children to encourage hope hope

– Maintain friendships Maintain friendships outside of workoutside of work

– Engage in peer support Engage in peer support groupsgroups

SocialSocial

PsychologyPsychology

STS is NOT a sign of Social Worker weakness

Secondary Trauma is a real issue for Secondary Trauma is a real issue for child welfare social workers. Although child welfare social workers. Although

there is likely no way to avoid it there is likely no way to avoid it altogether, there are ways to mitigate altogether, there are ways to mitigate

the effects. Just as individuals need take the effects. Just as individuals need take responsibility for their own emotional responsibility for their own emotional

health, organizations need to take health, organizations need to take responsibility for their employee’s well-responsibility for their employee’s well-

being being

When experiencing high levels of stress

Make big decisionsBlame othersExpend energy

complainingTry a quick fix

Reframe: Determine other

approaches to the issue or concern; ask advice from co-workers

Think outside the box

Don’t Do

Activity

What are some of the things you have done or techniques you have used to reduce your stress at work?

Build on Coping Skills

Pay attention to nutrition

What are your eating habits?

Exercise regularly Consistency vs.

intensityHave regular check-ups Medical and dental

careRelax, relax, relax Meditation, yoga,

reading, taking a nap

Develop Self-Help

Social workers frequently ask clients who are their support systems when case planning, but do social workers think about their own support system.

How often does a social worker rush to say something to a client or other collateral parties on a case? Do you take time to ‘breathe’ before speaking.

Develop Self-Help

Ask for help - express to your supervisor how you may be feeling overwhelmed. Top performers can be burned out very easily by constantly handling complex,

emotionally charged cases which can be stressful - To de-stress, discuss caseload

with supervisor and don’t be afraid to ask for help.

Some- times

we have to be “Real”

!

Guidelines for Successful Stress Management

☻Establish clear, specific obtainable goals.

☻Start small changes to managing stress.

☻Start from where you are, and build towards your goal.

☻Make one change at a time.

☻Plan ways to manage stress.

☻Reward yourself for good work.

☻Look for ways to control your life.

☻Manage stress on a daily basis.

☻Find humor and laugh.

Stress Management: 3 Simple Movements

1. Step Back

2. Take a Deep Breath

3. Dive Back In

(Source: Stress Management, Denham, T.)

friedsocialworker.com

Family

Laugh

Travel

LoveTalk

Play

Cry

Friends

Thank You!Have a Great Day

☻

ReferencesReferences

Bride, B., Jones, J., MacMaster, S. (2007). Correlates of Secondary Traumatic Stress in Bride, B., Jones, J., MacMaster, S. (2007). Correlates of Secondary Traumatic Stress in Child Protective Services Workers. Hawthorne Press, Inc. Retrieved on August 1, 2008 Child Protective Services Workers. Hawthorne Press, Inc. Retrieved on August 1, 2008 from from http://web.ebscohost.com.ezp.waldenulibrary.orghttp://web.ebscohost.com.ezp.waldenulibrary.org

  

Brohl, K. (2006). Understanding and Preventing Worker Burnout: Do I have burnout, or Brohl, K. (2006). Understanding and Preventing Worker Burnout: Do I have burnout, or am I just fatigued by my compassion? Child Welfare League of America. Retrieved on am I just fatigued by my compassion? Child Welfare League of America. Retrieved on August 11, 2008 from August 11, 2008 from http://www.cwla.org/voice/0609management.htmhttp://www.cwla.org/voice/0609management.htm

  

Caringi, J.C. (2007). Secondary Traumatic Stress in New York State Child Welfare Caringi, J.C. (2007). Secondary Traumatic Stress in New York State Child Welfare Worrkers. Dissertation, University at Albany, State University of new York. Retrieved Worrkers. Dissertation, University at Albany, State University of new York. Retrieved on July 18, 2008 from on July 18, 2008 from http://proquest.umi.com.ezp.waldenulibrary.org/pqdweb?http://proquest.umi.com.ezp.waldenulibrary.org/pqdweb?index=0&did=1421616261&SrchMode=2&sid=1&Fmt=2&VInst=PROD&VType=PQDindex=0&did=1421616261&SrchMode=2&sid=1&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1218849102&clientId=70192&RQT=309&VName=PQD&TS=1218849102&clientId=70192

  

Horwitz, M. (1998). Social Worker Trauma: Building Resilience in Child Protection Social Horwitz, M. (1998). Social Worker Trauma: Building Resilience in Child Protection Social Workers. Smith College Studies in Social Work, 68(3). June 1998. Retrieved on August Workers. Smith College Studies in Social Work, 68(3). June 1998. Retrieved on August 1, 2008 from 1, 2008 from http://web.ebscohost.com.ezp.waldenulibrary.orghttp://web.ebscohost.com.ezp.waldenulibrary.org

  

References, References, con’tcon’t

Nelson-Gardell, D., Harris, D. (2003). Childhood Abuse History, Secondary Traumatic Nelson-Gardell, D., Harris, D. (2003). Childhood Abuse History, Secondary Traumatic Stress and Child Welfare Workers. Child Welfare League of America. Retrieved on Stress and Child Welfare Workers. Child Welfare League of America. Retrieved on August 6, 2008 from August 6, 2008 from http://web.ebscohost.com.ezp.waldenulibrary.orghttp://web.ebscohost.com.ezp.waldenulibrary.org

  

Perry, B. (2003). The Cost of Caring: Secondary Traumatic Stress and the Impact of Perry, B. (2003). The Cost of Caring: Secondary Traumatic Stress and the Impact of Working With High-Risk Children and Families. The Child Trauma Academy. Retrieved Working With High-Risk Children and Families. The Child Trauma Academy. Retrieved on July 7, 2008 from on July 7, 2008 from http://www.childtrauma.org/ctamaterials/SecTrma2_03_v2.pdfhttp://www.childtrauma.org/ctamaterials/SecTrma2_03_v2.pdf

  

Siegfried, C. (2008). Child Welfare Work and Secondary Traumatic Stress. National Center Siegfried, C. (2008). Child Welfare Work and Secondary Traumatic Stress. National Center for Child Traumatic Stress, UCLA. Module 6, Activity 6C. Retrieved on July 18, 2008 for Child Traumatic Stress, UCLA. Module 6, Activity 6C. Retrieved on July 18, 2008 from from http://www.nctsnet.org/nctsn_assets/pdfs/cwt3_sho_sts.pdfhttp://www.nctsnet.org/nctsn_assets/pdfs/cwt3_sho_sts.pdf

  

Weiten, W. (2008). Psychology Themes & Variations (7Weiten, W. (2008). Psychology Themes & Variations (7thth ed.). Belmont, CA. Thompson ed.). Belmont, CA. Thompson Learning, Inc.Learning, Inc.