Stress Management in Child Welfare Practice

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Stress Management in Child Welfare Practice

• Trainer
• Date

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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

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LAUGH
You can't really be strong until you see a funny
side to things." Ken Kesey
and the world laughs with you...
The most thoroughly wasted of all days is that on
which one has not laughed. Nicolas Chamfort
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What Is Stress?

• Hans Selyes 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.

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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.

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Is Stress Bad for You?
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Some types of Stress Are
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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.

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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.

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ENJOY FRIENDS
A friend is a person with whom I may be sincere.
Before him I may think aloud."- Ralph Waldo
Emerson
Friendship is the only cement that will ever hold
the world together"- Woodrow Wilson
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Stress Feelings

• Worry
• Tense
• Tired
• Frightened

• Elated
• Depressed
• Anxious
• Anger

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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.

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Ever feel like that straw just landed on your
back?
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Types of Stress

• 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.
• 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.

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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.

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Ever feel like you cant believe you made it
through another day?
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Symptoms of Stress
high blood pressure
diarrhea
Headache
stomach upset
tooth grinding

clenched jaws
back pain
shortness of breath
skin problems
Chest pain
Weight gain or loss
constipation
sleep problems
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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

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Cost of Stress

• Stress 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
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EXERCISE
with friends and family
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Secondary Traumatic Stress, Compassion Fatigue,
Vicarious Trauma Burnout
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Do they mean the same thing?
How are they different?
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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.

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Vicarious Trauma

• Can be used interchangeably with
• Secondary Traumatic Stress

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Does Secondary Traumatic Stress Burnout?
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ActivityDifferentiating STS from Burnout
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Does Secondary Traumatic Stress Burnout?
?
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The time to Relax is when you dont have time for
it. Unknown
XA
REL
Tension is who you think you should be.
Relaxation is who you are." Chinese Proverb
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Burnout

• Gradual Onset

• a state of physical, emotional and mental
  exhaustion caused by long term involvement in
  emotionally demanding situations.
  (Nelson-Gardell, 2003)

• the index of the dislocation between what people
  are and what they have to do. (Maslach, Leiter,
  1997)

• describes a syndrome that goes beyond physical
  fatigue from overwork. Stress and emotional
  exhaustion are a part of it, but the hallmark of
  burnout is the distancing that goes on in
  response to overload. (Maslach, 1997)

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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
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Secondary Traumatic Stress

• The pain and helplessness of the children we come
  into contact with can be passed on to those
  around them
• A trauma is a psychologically distressing event
  that is outside the range of usual human
  experience. Trauma often involves a sense of
  intense fear, terror and helplessness
• Trauma is an experience that induces an
  abnormally intense and prolonged stress response

Source Child Trauma Academy
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Secondary Traumatic Stress

• Sudden Onset

• The response a person experiences after listening
  empathetically to the traumatic events in someone
  elses life. (Nelson-Gardell, 2003)

• 38 of Social Workers experience moderate to high
  levels of secondary traumatic stress. (Cornille
  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 childs 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.
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Who is at risk of Secondary Trauma?

• Historically
• Emergency Services Professionals
• Police officers
• Fire fighters
• Emergency Medical Technicians
• Nurse Crisis workers

• Recently
• Professionals who work with children families
  in crisis
• Pediatricians
• Psychologists
• Psychiatrists
• CPS Social Workers
• Juvenile Probation
• Foster Parents
• Teachers

Source Child Trauma Academy
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SMILE
A smile is something you cant give away, it
always comes back to you. Unknown
Start every day with a smile and get it over
with. W.C. Fields
Wrinkles should merely indicate where smiles have
been. Mark Twain
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Research

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

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Exposure

• Child Welfare Social Workers are exposed to
  different forms of traumatic events on a daily
  basis. They are required investigate child abuse,
  remove children from their homes, interact with
  angry, hostile parents, the court and all the
  while be supportive and nurturing while listening
  to horrible stories of child abuse and neglect.

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Why are you at risk?

• Empathy Social Worker internalization of the
  childs 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 shakes 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
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Risk Factors-Child Abuse History

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

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

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Risk Factors-Coping Styles

• Defensive Coping
• Turn away or deny problems exist
• Self- deception
• Reality distortion
• Protect self from emotional pain or trauma
• Primarily unconscious
• Not always maladaptive

• Constructive Coping
• Confronting problems
• Realistic expectations of self
• Recognize potentially disruptive reactions to
  stress
• Protecting self against the physical effects of
  stress

(Source Weiten, W. 2008)
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Risk 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)
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Cognitive Schemas

• Power
• Esteem
• Intimacy
• Control

• Safety
• Trust/Dependency
• Independence

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

(Source McCann Perlmann, 1990 and Bride, 2007)
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Signs and Symptoms of STS

• Tired
• Less socializing
• Lower productivity
• Hopelessness
• Despair
• Cynicism
• Question humanity

• Persistent anger or sadness
• Disturbing mental images
• Anxiety
• Nightmares
• Decreased sense of safety

(Siegfried, 2008)
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Strategies to Combat Secondary Trauma

• Activity

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Strategies to Combat Secondary Trauma

• Build Resilience
• Healthy Self-esteem is necessary to effectively
  work in child welfare and minimize the effects of
  secondary trauma
• Be open to lifes opportunities.

• Developmental Psychology

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Strategies to Combat Secondary Trauma

• Build a Supportive Team Environment
• Reduce caseloads
• Hire and retain quality social workers
• Educate on Secondary Trauma
• Offer mental health services to support social
  workers
• Encourage time off
• Offer peer support groups
• Demonstrate support to the community and media
• Recognize Secondary trauma as a real issue

• Organizational
• Psychology

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Not an appropriate Organizational approach
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Strategies to Combat Secondary Trauma

• Build a Social Network
• Spend time with emotionally healthy children to
  encourage hope
• Maintain friendships outside of work
• Engage in peer support groups

• Social
• Psychology

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STS is NOT a sign of Social Worker weakness

• Secondary Trauma is a real issue for child
  welfare social workers. Although there is likely
  no way to avoid it altogether, there are ways to
  mitigate the effects. Just as individuals need
  take responsibility for their own emotional
  health, organizations need to take responsibility
  for their employees well-being

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The soul would have no rainbow had the eyes no
tears. John Vance Cheney
Sometimes you just have to CRY
What soap is for the body, tears are for the
soul.  Jewish Proverb
Tears are the safety valve of the heart when too
much pressure is laid on it.  Albert Smith
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When experiencing high levels of stress
Do
Dont

• Make big decisions
• Blame others
• Expend energy complaining
• Try a quick fix

• Reframe
• Determine other approaches to the issue or
  concern ask advice from co-workers
• Think outside the box

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(No Transcript)
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Activity

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

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Build on Coping Skills

• Pay attention to nutrition
• What are your eating habits?
• Exercise regularly
• Consistency vs. intensity
• Have regular check-ups
• Medical and dental care
• Relax, relax, relax
• Meditation, yoga, reading, taking a nap

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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.

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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 dont be afraid to ask for help.

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Develop Self-Help?
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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.

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Stress Management 3 Simple Movements

1. Step Back
2. Take a Deep Breath
3. Dive Back In

(Source Stress Management, Denham, T.)
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Some- times we have to be Real !
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WELL? DID YOU?
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Thank You!Have a Great Day

• ?