THE SECONDARY TRAUMATIC STRESS WEBINAR WILL BEGIN MOMENTARILY

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THE SECONDARY TRAUMATIC STRESS WEBINAR WILL BEGIN MOMENTARILY If you interested in receiving APA or PSNA continuing education credits for your attendance of this webinar, you must log

1 THE SECONDARY TRAUMATIC STRESS WEBINAR WILL BEGIN MOMENTARILY If you interested in receiving APA or PSNA continuing education credits for your attendance of this webinar, you must log on to the webinar as an individual. Individuals who view the webinar in a group will not be eligible to receive PSNA or APA credit. Please take this time to make necessary adjustments.

2 SECONDARY TRAUMATIC STRESS Impact on Providers, Patients and Families January 23, 2018

3 CONTINUING EDUCATION If you are interested in receiving APA or PSNA continuing education credits, you must log on to the webinar as an individual. Individuals who view the webinar in a group will not be eligible to receive credit. 3

4 CONTINUING EDUCATION Nursing Continuing Education Accreditation Statement 2.0 Continuing Nursing Education Contact Hour Children's Hospital is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Disclosure Statement All individuals who have the ability to control or influence the content of this educational activity have completed and signed the CHOP PSNA COI Form, affirming that neither they nor their spouse/partner have or have had in the past 12 months any relevant relationships with a commercial interest that could be perceived as a conflict of interest with this educational activity. American Psychological Association Continuing Education Accreditation Statement This program is approved for 2 CE credit. Level: Intermediate This seminar is free and open to CHOP faculty, staff and students. The Children s Hospital of Philadelphia is approved by the American Psychological Association to sponsor continuing education for psychologists. The Children s Hospital of Philadelphia maintains responsibility for this program and its content. Disclosure Statement: The presenters have no actual or potential conflict of interest or relevant financial relationships with any commercial interests to report in relation to this lecture. 4

5 DISCLOSURE STATEMENT There are no financial relationships or financial affiliations to disclose. Questions? Contact Kim Slouf 5

6 SPONSORED BY CHOP S VIOLENCE PREVENTION INITIATIVE A CHOP-wide, evidence-based effort to protect youth from violence, VPI s traumainformed programs prevent violence and aggression, support at-risk populations, and help our patients heal by providing the right care to the right children at the right time. Visit us at : chop.edu/violence 6

7 TODAY S MODERATOR Nancy Kassam-Adams, PhD Associate Director for Behavioral Research at the Center for Injury Research and Prevention Director of Training for Violence Prevention Initiative 7

8 GOAL FOR TODAY What can you do to address secondary traumatic stress in yourself and your workplace? 8

9 OBJECTIVES Describe secondary traumatic stress and its impact on health care providers Identify the signs, symptoms, and risk factors of secondary traumatic stress Describe how secondary traumatic stress impacts care of patients and families Explain the importance of engaging in self care Identify ways organizations can support employees related to self care and secondary traumatic stress

10 SECONDARY TRAUMATIC STRESS IMPACT ON PROVIDERS, PATIENTS AND FAMILIES 10

TECHNICAL DIFFICULTIES Please check your latest email from WebEx.

11 TECHNICAL DIFFICULTIES Please check your latest from WebEx. It will contain a link to download WebEx Manager. The audio for today s webinar is accessed through your computer s speakers. Please turn them on. 11

12 TODAY S PARTICIPANTS Nurses Social Workers Psychologists Physicians Child Life Specialists Counselors 12

TODAY S PRESENTERS Laura Vega, MSW, LCSW Violence Prevention

MSS, MLSP Training Manager at the Center for Injury Research and

program Kristen Kohser, MSW, LSW Program Manager, the Center for

13 TODAY S PRESENTERS Laura Vega, MSW, LCSW Violence Prevention Supervisor for the VPI's Violence Intervention Program Carol Murray, MSS, MLSP Training Manager at the Center for Injury Research and Prevention, and a lead trainer in VPI s Trauma-informed training program Kristen Kohser, MSW, LSW Program Manager, the Center for Injury Research and Prevention, and a lead trainer in VPI s Trauma-informed training program 13

14 WHAT IS TRAUMA-INFORMED CARE? SAMHSA definition of a trauma-informed approach to providing services 14

15 SIX KEY PRINCIPLES OF TRAUMA INFORMED CARE Safety Trustworthiness and Transparency Peer Support Collaboration and Mutuality Empowerment, Voice and Choice Cultural, Historical, and Gender Issues 15

16 16 ELEMENTS OF FAMILY-CENTERED AND TRAUMA-INFORMED PEDIATRIC CARE

17 WHAT IS SECONDARY TRAUMATIC STRESS Secondary Traumatic Stress is the emotional duress that results when an individual is exposed to the firsthand trauma experience of another; its symptoms mimic those of Posttraumatic Stress Disorder (PTSD). 17 The National Child Traumatic Stress Network

18 RELATED CONCEPTS Secondary traumatic stress Work-related exposure to the trauma of others May have reactions similar to PTSD symptoms Burnout General occupational stress Emotional exhaustion, reduced sense of personal accomplishment Not specific to indirect trauma exposure Compassion fatigue / Compassion satisfaction The National Child Traumatic Stress Network

19 TRAUMA INFORMED: ADDRESSING STS ENHANCES EMPLOYEE ENGAGEMENT Sustains connection and commitment to work Impacts the patient family experience Supports employee health and longevity Promotes communication and support among staff 19

20 EVERYONE CAN EXPERIENCE SECONDARY TRAUMATIC STRESS Clinical Staff Security Front Desk Staff Research Staff Environmental Service Workers Administrative Staff All employees are at risk 20

21 RECOGNIZE: IMPACT ON THE PROVIDERS Authors Year Study Setting Sample Size Rate Robins et al 2009 Large tertiary pediatrics facility Czaja et al 2012 Large tertiary pediatrics facility Johnson 2014 Three pediatric facilities Berger et al 2015 Large tertiary pediatric facility Branch and Klinkenberg 2015 Large tertiary pediatric facility Ahsa et al 2018 Pediatric Critical Care practices in US 314 RNs, social workers, allied health, CLS, others 39% of staff at moderate to high risk of compassion fatigue 173 RNs 21% of nurse respondents had strong PTSD symptoms 463 RNs 11% of staff have high rates of compassion fatigue; facilities range from 8.6% to 16.0% 239 RNs 27% of staff have high levels of secondary traumatic stress; 29% have high levels of burnout 274 RNs, therapists, CLS, others 27% of staff have high levels of secondary traumatic stress; 31% have high levels of burnout 253 Physicians 49% scored some form of burnout (at least one of 3 subscales): 21% reported severe burnout 21

22 QUESTIONS AND DISCUSSION Please type your questions in to the Chat text box in the bottom right of your screen. Only the moderator and presenters can see your questions. 22

23 POTENTIALLY TRAUMATIC EVENTS Child suffering and illness Child death Family loss and grief Child abuse and neglect 23

24 RECOGNIZE: REACTIONS TO TRAUMATIC EVENTS Traumatic Stress Reactions Re-experiencing Avoidance Arousal Changes in mood Impairment in functioning Quality of life Relationships 24

25 TRAUMA RESPONSE Lack of Predictability Sense of Chaos Loss of Control 25 Judith Herman (1992)

26 SYMPTOMS OF STS Hypervigilance Hopelessness Guilt Avoidance Survival Coping Social Withdrawal Minimizing Anger and Cynicism Sleeplessness Insensitivity to Violence Illness Fear Chronic Exhaustion Physical Aliments Disconnection Poor Boundaries Inability of Embrace Complexity Inability to listen or avoidance of clients Diminished Self- Care

27 FACTORS MODERATING THE IMPACT OF STRESS Social support Increased immune functioning Optimism More adaptive coping Conscientiousness Fostering better health habits Autonomic reactivity Cardiovascular reactivity to stress

28 FOUR DOMAINS Physical Emotional Secondary Traumatic Stress Behavioral Cognitive 28

29 SYMPTOMS Physical Emotional Cognitive Behavioral Back pain Anxious Lack of concentration Alcohol use Headaches Anger Forgetfulness Smoking Dizziness Confusion Nightmares Drug use Hair loss Mood changes Racing thoughts Grinding teeth Stomach aches Irritability Ruminating Pacing/tapping Jaw pains Sadness Dissociating Yelling Weight loss/gain Feeling helpless Intrusive Thoughts Nail biting Fatigue Guilt Rationalizing Social withdrawal Weakness Fear Minimizing Changes in eating Twitches Hopelessness Avoidance +/- appetite Nervousness Diminished self-care indigestion Nausea Chest pains High blood pressure +/- sleep Increased sweating

30 POLL Have you ever experienced any of these symptoms related to your work? 30

31 THE GOOD NEWS Secondary Traumatic Stress Very common Normal response to abnormal external events It is not caused by an individual deficit Many tools and practices to prevent/reduce STS The presence of symptoms does not mean you have PTSD 31

32 32 ASSESSMENT TOOL: PROVIDER RESILIENCE APP Professional Quality of Life (ProQOL)

33 RISK FACTORS Women Highly empathic Type of work Unresolved personal trauma Heavy caseloads/dose of exposure Socially or professionally isolated Feel professionally compromised due to inadequate training Fewer years in field Young age

34 EMPATHY Can increase our risk for STS but it is also a protective factor If we are exposed to an extensive amount of trauma, we run the risk of absorbing too much pain, loss, and injustice We also absorb the positive effects of connecting and being in a trusting relationship with patients We also absorb the strength, resilience, and transformation that we witness

35 PERSONALIZATION When we practice from a slightly less personalized lens, we are not absorbing the trauma or loss that our patients often encounter We are able to best serve our patients from this approach and also increase our own capacity, longevity, and personal health in this work

36 POSTTRAUMATIC GROWTH Increased spirituality Increased personal strength Closer relationships Greater confidence Greater openness with others More Compassion for others

37 QUESTIONS AND DISCUSSION Please type your questions in to the Chat text box in the bottom right of your screen. Only the moderator and presenters can see your questions. 37

38 RESPOND: IMPACT OF POTENTIALLY TRAUMATIC MEDICAL EVENTS Culture Systems approach Health Care System Family Child 38

39 RESPOND: IMPACT ON THE ORGANIZATION Culture Systems approach to self-care Relationships Community Family Health Care System Provider 39

40 IMPACT ON ORGANIZATION Erickson et al (2007) Decreased productivity Higher number of sick days Higher levels of burnout Higher levels of turnover intention. Meadors et al (2008) Negative impact on culture of the organization Leading to increased patient harm Decreased care quality 40

41 IMPACT ON EMPLOYEE ENGAGEMENT AND PATIENT CARE Shanafelt et al. (2002) Surveyed 117 internal medicine residents 51% with burnout reported suboptimal patient care practices at least monthly (compared to 21% without burnout) Hass et al. (2002) Surveyed 166 physicians & 2620 patients Higher healthcare satisfaction associated with higher job satisfaction 41

42 IMPACT ON ORGANIZATION Heutsch and Green (2016) CNO s at 49 pediatric hospitals Small hospitals (<250 beds) more likely to rate emotional distress as a problem Large hospitals (>250 beds) offered adequate support efforts Both however focused more on support after patient death vs. prevention programs 42

43 CHOP ENGAGEMENT STATS Stress And Burnout 38% of CHOP employees reported feeling supported in dealing with stress and burnout 35.8% at Main 43

44 ORGANIZATIONAL SUPPORT: SELF CARE MODEL Source: 44

45 ORGANIZATION SUPPORT: AWARENESS The Secondary Traumatic Stress-Informed Organization Assessment (STSI-OA) Promotion of resiliencebuilding activities Evaluation? Promotion of sense of safety Are organizational policies and practices STS-informed? Are leaders STS-informed? (University of Kentucky, Center on Trauma and Children) 45

46 RESPOND: ORGANIZATIONAL SUPPORT FOR SELF-CARE Workplace Resiliency Essential Elements Recognize the impact of STS on workforce Recognize exposure to trauma is a risk of the job Understand that trauma can shape the culture of organizations in the same way that trauma shapes the world view of individuals. Understand that a traumatized organization is less likely to effectively identify its clients past trauma or mitigate or prevent future trauma. Develop the capacity to translate trauma-related knowledge into meaningful action, policy, and improvements in practices. 46

47 ORGANIZATIONAL SUPPORT: BALANCE AND CONNECTION Organizational Support for Self Care Is there a self-care culture in the organization? Recognize contributions and effort Incorporate trauma informed principals with staff/each other Policy and Procedures: Obtain staff input on policy and procedure development Make changes to reduce organizational sources of stress Recognize staff have their own trauma histories 47

48 ORGANIZATIONAL SUPPORT: BALANCE AND CONNECTION Psychoeducation Skills training Staff retreats Clinical Group Supervision Case conferencing Self-report screening Workplace selfcare groups Work/Life balance Flexible scheduling Employee Assistance Programs Use of evidencebased practices 48

49 ORGANIZATION SUPPORT FOR EMPLOYEE HEALTH Implementation of Stress Prevention Programs in hospital settings: 50% reduction in medication errors 70% reduction in malpractice claims NIOSH Pub , last updated

50 POLL Is there a self-care culture? Within your department/ workplace/unit? 50

51 HOW TO ADVOCATE WITHIN YOUR WORKPLACE Champion in workplace Trainings within your department Getting buy-in from your manager Assess the stress level of your worksite Raise awareness 51

52 QUESTIONS AND DISCUSSION Please type your questions in to the Chat text box in the bottom right of your screen. Only the moderator and presenters can see your questions. 52

53 CASE EXAMPLE - CHOP Diversity Gratitude Connection Mission Empowerment Recognition Respect Safety Self-Care 53

54 CASE EXAMPLE - CHOP Taking Care of Yourself Sept 5, 2017 Communicating with Each Other Sept 11, 2017 Making Children Our Highest Priority Nov, 13,

55 CHOP SPECIFIC RESOURCES Redbrick Health Coaching Track Gift Card Incentive Program Employee Assistance Program Penn Behavioral Health Work/Life balance program PTO Legal Services Discount Programs 55

56 CHOP SPECIFIC RESOURCES Free Classes at Main and Roberts Also at 3550, KOP, and more Care for Colleagues Peer Support Sessions Practicing Presence Rounds in the Tradition of Sister Alice Monthly forum for staff Share experiences 56

57 CHOP SPECIFIC RESOURCES Physician Wellness Program Raising Awareness Expanding programs Wellness Office Main Hospital, 2 NW 2484 Office of Diversity and Inclusion Training and Education Open House 57

58 CHOP SPECIFIC RESOURCES Mindfulness Program Violence Prevention Initiative: Trauma- Informed Care Training Program Stress Less Initiative 58

59 CASE EXAMPLE In-person mindfulness sessions Mondays from 12:15-12:45 pm in Colket 9058 Mindfulness teleconference sessions Fridays from 12:15-12:30 pm. Outside CHOP call , participant code Inside CHOP call or x 60000, participant code RedBrick Health Coaches Trained in mindfulness practices and can incorporate this practice into their coaching encounters. To learn more and also to earn RedBrick rewards for attending mindfulness events, visit 59 CHOP Mindfulness Collaborative, 2017

60 CASE EXAMPLE: VIOLENCE PREVENTION INITIATIVE Free 60 minute seminars Can customize to meet team s needs Work around your team s schedule Offerings: An Introduction to the Delivery of Trauma-Informed Care in Medical Settings One Kind Word Secondary Traumatic Stress and Self Care Implementing Trauma Informed Care (in development) Contact: Carol Murray or Kristen Kohser 60

61 STRESS-LESS INITIATIVE Increase team trust, safety, and cohesion Organizational support Normalize and validate STS symptoms Increase awareness Learn new strategies Early identification of STS, VT, and BO Goals of the Model Celebrate the rewards

62 STRESS-LESS INITIATIVE 4 Components (ALPS) 1. Assessment (10min) 2. Learning (20min) 3. Process (30min) 4. Skill (30min)

63 STRESS-LESS INITIATIVE Decrease in STS symptoms Benefits Increased supervisor/peer awareness, empathy, and support Professional/Personal Development Increased awareness of stress reactions

64 SELF CARE MODEL 64

65 SELF-CARE STRATEGIES Taking a Time Out Mindfulness Social Support Self Compassion Gratitude / Happiness / Neuroplasticity 65

66 SELF CARE STRATEGIES: TAKING A TIME OUT Strategies that can be done in 2 minutes: Breathe Stretch Daydream Laugh Doodle Strategies that can be done in 5 minutes: Listen to music Chat with a co-worker Step outside for some fresh air 10 minutes?? 30 minutes?? Acknowledge your accomplishments Say no to a new responsibility Give yourself a compliment Look out the window Share a joke Have a snack Make a cup of tea/coffee 66 From What About You: A Workbook for Those Who Help Others, National Center on Family Homelessness, 2008

67 SELF-CARE STRATEGIES: MINDFULNESS Graphic from: Chopra, D. (April 29, 2013) The Conscious Lifestyle: Awareness Skills, LinkedIn blog. CHOP Mindfulness Collaborative,

68 SELF-CARE STRATEGIES: MINDFULNESS Formal Practice Better able to cope with stress Better listening and communication Informal practice Mindfulness Tuning in to life s small pleasures Mindfulness qualities Mindful awareness of the present moment Increased focus Increased awareness of physical and mental health needs 68 CHOP Mindfulness Collaborative, 2017

69 MINDFULNESS The practice of bringing your attention again and again to what is happening right now, in the present moment. Gently returning attention to the anchor Attention to a mindfulness anchor Nonjudgmentally noticing that attention has wandered Attention wanders Mindfulness Anchors Breath Eating Walking Interaction Movement Sound Sensation Gratitude 69 CHOP Mindfulness Collaborative, 2017

70 MINDFULNESS Physical Health Reduced Stress Mental Health Behavior Change Cognitive Performance Reduced stress is the most frequent and reproducible finding of studies of mindfulness across a broad range of subjects, both healthy people and people with chronic physical and mental illness 70 CHOP Mindfulness Collaborative, 2017

71 RESEARCH ON MINDFULNESS: AFFECTS ON HEALTHCARE PROVIDER BURNOUT Change in perceived stress as measured by the Perceived Stress Scale. ***p <.001. Change in personal, work, and client burnout as measured by the Copenhagen Burnout Inventory. *p <.05. ***p <.001. Bazarko D et al., CHOP Mindfulness Collaborative, 2017

72 SELF-CARE STRATEGIES: SOCIAL SUPPORT Reblin, et al (2008) Social and Emotional support can be protective for health High quality/quantity of social support decreases the risk of mortality Social isolation was id d as a risk for all-cause mortality APA Stress in America Survey (2015) Emotional support is important protective factor for dealing with difficulties Avg stress level for those with ES was 5 out of 10, compared to 6.3 for those w/out support 72

73 SELF-CARE STRATEGIES: SELF COMPASSION 73

74 SELF-CARE STRATEGIES: SELF COMPASSION 74

75 75 SELF-CARE STRATEGIES:

76 TOOLS AND RESOURCES: APPS Headspace (Headspace Meditation Limited) Great explanation and rationale for mindfulness meditation for all ages Offers additional relaxation training for additional fee Stop, Breathe & Think (Tools for Peace) Guided meditations geared toward kids and teens but can still be used by grownups Calm (Calm.com, Inc) Helps you with meditation, sleep, relaxation and focus 7 guided meditation sessions from 2-30 minutes for any break during the day Insight Timer (Insight Network Inc) Guided meditations geared towards teens and adults Includes timer for silent meditations 76 CHOP Mindfulness Collaborative, 2017

77 RESOURCES Website for Health Care Providers: 77

78 RESOURCES ACEs Connection: Practicing Resilience for Self-Care and Healing: An ACEs Connection Community What About You? A Workbook for Those Who Work with Others National Center on Family Homelessness 78

79 QUESTIONS AND DISCUSSION Please type your questions in to the Chat text box in the bottom right of your screen. Only the moderator and presenters can see your questions. 79

80 THANK YOU FOR YOUR PARTICIPATION! Laura Vega Carol Murray Kristen Kohser 80

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