Compassion Fatigue, Impairment, and Social

Worker Self-care

NASW ANNUAL FALL CONFERENCE, 2015Asheville, NC

Dottie Saxon Greene, PhD, LCSW, LCAS, CCSEast Tennessee State University

Assistant Professor, Department of Social Work423-439-6569

greeneds@mail.etsu.edu

OVERVIEW

RATIONALE FOR THE TOPICCOMPASSION FATIGUE, STS, VT, BO, AND IMPAIRMENTWHAT DOES THE RESEARCH SAY?PROFESSIONAL AND ETHICAL RESPONSIBILITESSELF-CARESELF-ASSESSMENTS

SELF-CARE, SELF-CARE, SELF-CARE, Blah, Blah, Blah….. WHAT’S ALL THE HOOPLAH ABOUT?

YOU ARE THE TOOL!OUR CLIENTS DESERVE THE BEST WE CAN BRING FORTH!YOU DESERVE THE BEST YOU!YOU CANNOT TAKE A CLIENT BEYOND THAT WHICH YOU ARE!SOCIAL WORKERS DON’T STOP BEING HUMANOCCUPATIONAL HAZARDSNASW CODE OF ETHICSCSWE COMPETENICES AND PRACTICE BEHAVIORS

TERMS/CONSTRUCTSCOMPASSION FATIGUE

BURNOUTSECONDARY TRAUMATIZATIONVICARIOUS TRAUMA

IMPAIRMENTSeminal works’ authors

Christine MaslachCharles FigleyBeth StammPearlman & Saakvitne

PROFESSIONAL QUALITY OF LIFE:

Compassion Satisfaction &

Compassion Fatigue

Courtesy of Beth Stamm, PhDwww.proqol.org 5

Professional Quality of Life (PROQL)the quality one feels in relation to their work as a helper

• Compassion Satisfaction– Positive aspects of working as a helper

• Compassion Fatigue– Negative aspects of working as a helper

Burnout– Inefficacy and feeling overwhelmed, unhappiness,

exhaustion, disconnectedness, insensitivity to work environment

Work-related traumatic stress– Primary traumatic stress direct target of event– Secondary traumatic exposure to event due to a

relationship with the primary person6

Compassion Satisfaction

• The positive aspects of helping– Pleasure and satisfaction derived from

working in helping, care giving systems– Work is invigorating

• May be related to – Providing care– The system– Work with colleagues– Beliefs about self– Altruism

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SECONDARY TRAUMATIC STRESS

Preoccupied with thoughts of people helpedFeeling trapped, on edge, exhausted, overwhelmed, and “infected” by others’ trauma

Inability to sleepForgetfulnessInability to separate private life from helper lifeExperiencing the trauma of someone helped

Can be identical to PTSDAvoidance, arousal & numbingRe-experiencing, intrusive recollectionDistress & impairment

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VICARIOUS TRAUMAVT: A process of cognitive [change] resulting from [chronic] empathic engagement with trauma survivors” (Pearlman, 1992, p. 52).

Shift in worldview related to beliefs to core beliefs about

Sense of selfSafetyTrustIntimacyControlSpirituality

(Pearlmann, 1998; Pearlmann & McIan, 1995; Pearlman & Saakvitne, 1995)

Differentiating between ST & VT

According to Figley (1995),STS more related to behavioral sxs rather than intrinsic cognitive changesSTS mimics PTSDVT cognitive change process

BURNOUT“A state of physical, emotional, psychological, and spiritual exhaustion resulting from chronic exposure to (or practice with) populations that are vulnerable or suffering (Pines & Aronson, 1998).A process that occurs over time (indv & organization)Meta-construct

ExhaustionDepersonalizationReduction in one’s sense of personal accomplishment

Professional Quality of Life

Compassion SatisfactionThe positive aspectsof helping“The good stuff”

Compassion FatigueThe negative aspects of helping“The bad stuff’

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Relationships Are Complex

• Multiple spheres– Work environment– “People helped” environment– Personal environment

• Positive (CS) & negative (CF)• Altruism CS can override CF• Compassion Fatigue two parts– Worn out (BO) common– Frightened, traumatized (STS) rarer but

powerful13

Complex Relationships

Professional Quality of Life

Compassion Fatigue

Compassion Satisfaction (ProQOL CS)

Work Environment

Client Environment

Personal Environment

Traumatized by work

Secondary Exposure

(ProQOL STS)

Primary Exposure

Frustration Anger

Exhaustion Depressed by Work

Environment(ProQOL Burnout)

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Impairment Defined

According to Barker (2003),an impaired social worker is one who is unable to function adequately as a professional social worker and provide competent care to clients as a result of a physical or mental disorder or personal problems, or the ability or desire to adhere to the code of ethics of the profession. The problems most commonly include alcoholism, substance abuse, mental illness, burnout, stress, and relationship problem.” (p. 210)

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Manifestations of Impairment

AOD use issuesDepression (3 xs the rate of general pop (Seibert, 2004))

Vicarious trauma Secondary traumatization (PTSD-like sxs)

Burnout (70% lifetime rate (Seibert, 2005))

Compassion fatigueUnethical conductProfessional mistakesFailure to provide competent care

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Manifestations of Impairment, cont.

AbsenteeismCancelled appointmentsLate for workPessimisticHoping for cancellationsImpatience

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Consequences of Impairment

Compromises performanceJeopardizes client safetyDamages reputation of agency/organizationDamaging to the reputation of social work professionRaises questions about the competency of the profession as a wholeHarms experienced by the distressed social worker

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WHAT DOES THE RESEARCH SAY???

Pooler, Seibert, Fual, and Huber (2008)

Social workers who identified the following personal history issues were more likely to experience professional impairment.

Alcohol and drug misuse by a parent, partner, family member, or close friend; Having a troubled parentPhysical, sexual, or emotional abuse. Parentification as a child

Fledgling social workers are at higher risk for compassion fatigue (CF) and burnout (BO) compared to those who have longevity in the field and are older in age. (Newell & MacneNeil, 2010; Salloum, Kondrat, Johnson & Olson, 2014) Social workers are more likely to consider leaving the field during their first four years in practice (Whitaker, Weismiller, & Clark, 2006).

Bride, Jones, and Macmaster (2007) found with child welfare workers that 92% of respondents reported at least one symptom of STS at least occasionally.Salloum and associates (2014) reported 30% - 60 % burnout rateSeibert (2005) found 39% practicing SWers currently experiencing BO with a nearly 75% lifetime rate of BO

A study conducted for NASW found additional work-related stressors which contribute to burnout:

having more responsibilities than they can handle;needing to complete routine task that have little intrinsic value;having few opportunities for advancement/promotion;being expected work long hours;receiving few resources to adequately accomplish work tasks;having conflicting or unclear job expectations;getting minimal support form co-workers and supervisors;and, being unable to balance professional and personal life. (Arrington, 2008, p. 3)

PROFESSIONAL & ETHICAL RESPONSIBILITIES:

NASW CODE OF ETHICS & COUNCIL ON SOCIAL WORK

EDUCATION

Codes of Ethics on Therapists Impairment, Burnout, and Self-Care

Ethical principles of psychologists2.06 Personal problems and conflicts

Code of ethics of the NASW2.09 Impairment of colleagues2.10 Incompetence of colleagues

ACA code of ethicsC.2g ImpairmentC2.h Counselor incapacitation…F5b Student & supervisor responsibilities

ImpairmentAAMFT code of ethicsPrinciples of medical ethics (psychiatrists)AMHCA code of ethics

(Zur Institute, n.d.)

NASW’s standard 2.09 mandates that:

(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse , or mental health difficulties, and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations. 26

NASW’s standard 4.05 mandates that:

(a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility.

(b) Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others. 27

NASW POLICY STATEMENT RE: IMPAIRMENT

Since the ability to perceive situations clearly and objectively is pivotal in social work, impairment may compromise performance and, thus, jeopardize the rights of clients and treatment effectiveness (NASW, 2008).

NASW POLICY STATEMENT RE: IMPAIRMENT

NASW recognizes that the prevention, identification, and treatment of professional impairment is vital to protect the welfare of clients, practicing social workers, the work environment, and the integrity of the profession. A multi-systemic approach, focusing on prevention, identification, and treatment, must be used to address professional impairment among social workers (NASW, 2008).

COUNCIL ON SOCIAL WORK EDUCATION: Educational Policy and Accreditation Standards

• Educational Policy 2.1.1—Identify as a professional social worker and conduct oneself accordingly. • Social workers serve as representatives of the profession, its

mission, and its core values. They know the profession’s history. Social workers commit themselves to the profession’s enhancement and to their own professional conduct and growth. Social workers

• advocate for client access to the services of social work; • practice personal reflection and self-correction to assure

continual professional development; • attend to professional roles and boundaries; • demonstrate professional demeanor in behavior, appearance, and

communication; • engage in career-long learning; and • use supervision and consultation.

WHAT’S THE SOLUTION???

NASW POLICY STATEMENT ON SELF-CARE

NASW recognizes and acknowledges the unique and valuable contributions of the professional social worker. NASW supports the practice of professional self-care for social workers as a means of maintaining their competence, strengthening the profession, and preserving the integrity of their work with clients. Education, self-awareness, and commitment are considered key to promoting the practice of professional self-care. (NASW, 2008, p.270)

WHAT IS SELF-CARE???

“Process of purposeful engagement in practices that promote holistic health and well-being of the self” (Lee and Miller, 2013,p. 98).

“Professional self-care can be defined as the utilization of skills and strategies by social workers to maintain their own personal, familial, emotional, and spiritual needs while attending to the needs and demands of their clients” (Figley, Stamm, and NASW as cited by Newell &Nelson-Gardell (2014) p. 431).

Macro barriers to self-careLarge caseloadsCaseloads with high acuity, chronicity, and traumaLack of client resourcesInadequate supervisionRestraints and limitations of bureaucratic systemsInadequate compensationLack of professional support and professional development opportunitiesSafety concernsLack of recognition and autonomyOrganizational culture

(Cox & Steiner, 2013; Lee & Miller, 2013; Napoli & Bonifas, 2011; NASW, 2008; Newell & MacNeil, 2010; Newell & Nelson-Gardell, 2014; Salloum et al., 2015; Seibert, 2005).

PREVENTION & INTERVENTION:SELF-CARE

Mental health hygieneEat wellSleep wellExercise regularly

HumorSpiritualityMindfulnessHobbiesSocial supportPersonal therapyVacation

Work-related self-careDo NOT work overtimeLearn to say “No”Regular supervisionPeer supervisionAdvocate for manageable caseloadsProfessional development activitiesDo NOT bring work homeOrganizational culture of wellness 35

The Burnout Measure, Short Version (Maslach-Pines, 2005)Use the following scale 1 2 3 4 5 6 7never almost never rarely sometimes often very often always

1. Tired ______2. Disappointed with people_______3. Hopeless______4. Trapped______5. Helpless_______6. Depressed_____ 7. Physically weak/Sickly_____8. Worthless/Feel like a failure____9. Difficulties sleeping_______10. “I’ve had it” _______

Up to 2.4 indicates low burnout; between 2.5-3.4 indicates danger signs; 3.5 4.4 indicates burnout; 4.5-5.4 serious problem of burnout; Score of 5.5 requires immediate professional intervention.

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