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Secondary Traumatic stress resources
Welcome to Reflect. Refuel. Reset., a hub for resources and tools designed to help prevent and alleviate the impacts of secondary traumatic stress (STS), often affecting CAC and MDT professionals who serve victims of child abuse and their families. To browse available resources, click an icon below.
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New Video Series on the Impacts of Secondary Traumatic Stress in the Workplace
SRCAC is proud to make available to you the Reflect. Refuel. Reset. Secondary Traumatic Stress Video Series. In this video series, SRCAC Project Director Karen Hangartner sits down with three of the foremost experts in the field of secondary traumatic stress (STS)—Brian Miller, Françoise Mathieu, and Pat Fisher—to discuss how individuals, organizations, and supervisors are impacted by STS and what strategies can be utilized to mitigate these impacts. Karen also speaks with NCAC Executive Director Chris Newlin about senior leadership's role in building a healthy, productive culture within a high trauma-exposed organization. There is also a panel discussion with Karen, Brian, Françoise, and Pat.
Filmed prior to the current COVID pandemic, these conversations are even more relevant and applicable as child abuse professionals, MDTs, supervisors, and organizational leaders and boards of directors are dealing with unique challenges that have been further exacerbated by recent events.
Throughout these videos, "Resource Alert" pop-ups will appear letting you know that the mentioned resource is available on this page. See the "Resources" sections in the panels below for this information in addition to the interviewee bios and transcripts of these conversations.
BRIAN MILLER:
SUPERVISION WITH INTENTIONALITY
"The single biggest reason people leave employment in this field is because they are dissatisfied with their supervision. The reason people stay is because of their satisfaction with their supervisor." In this conversation, Brian Miller defines "secondary trauma-informed supervision" and talks about the supervisor's role within a high trauma-exposed environment and how when supervision is done at its best, it is done with intentionality. He also discusses the various aspects of supervision, including hiring, setting up formal check-ins with staff, and effectively managing a staff member who is exhibiting signs of distress. Brian addresses specific considerations around supervision. Do you have to be a clinician in order to provide trauma-informed supervision? Where and how do supervisors get the support and training they need, and what does supervision look like after a particularly tough case? Brian also discusses how to talk about the impacts of STS with external community and MDT partners and why it is so important to address.
Dr. Brian Miller
Dr. Brian Miller provides training and consultation on topics of secondary trauma, trauma informed supervision, and implementation processes nationally and internationally. He is an individual member of the National Child Traumatic Stress Network and chaired the NCTSN Secondary Trauma Supervision Workgroup. He is the developer of the CE-CERT model for intervening with secondary trauma in service providers and the Shielding model of trauma-informed supervision, both of which have been published and disseminated across mental health and child welfare systems. Brian's experience includes tenure as Director of Children's Behavioral Health at Primary Children's Hospital, Director of Mental Health for Salt Lake County; Director of the Trauma Program for Families with Young Children at The Children's Center in Salt Lake City; Clinical Director of Davis Behavioral Health, Associate Director of the Utah State Division of Mental Health; and as a psychotherapist in private practice. He holds a Ph.D. from Case Western Reserve in Cleveland, Ohio, where he was a Mandel Leadership Fellow. He is the past board president for the National Alliance on Mental Illness, Utah Chapter, and serves on the editorial review boards for the journals Traumatology and Contemporary Psychotherapy.
BRIAN MILLER: SUPERVISION WITH INTENTIONALITY
Karen Hangartner:
Hello, I'm Karen Hangartner, and I'm the project director for the Southern Regional Children's Advocacy Center, which is a project of the National Children's Advocacy Center. We are excited to bring this video series about secondary traumatic stress to you. In this video series, we have conversations with three of the foremost experts in secondary traumatic stress. And in these we discuss, how did these effects show up on individuals and how does working in the field of secondary traumatic stress impact organizations, and that how do we conduct supervision in a way that's supportive for our staff?
And then we'll also hear from Chris Newlin, the Executive Director of the National Children's Advocacy Center to talk a little bit about the role that the senior leader plays in addressing secondary traumatic stress in the organization. And how do we go about creating healthy, supportive environments that support the staff that we're working with.
In this video, we're going to have a conversation with Brian Miller. Brian Miller is a psychotherapist who has been working in high-trauma exposed environments and providing supervision for staff in those environments for more than 30 years. He's going to talk about the role that supervision plays in supporting staff as they navigate the impacts of secondary traumatic stress. I'm sure you're going to enjoy this conversation with Brian.
At what point in your career did you begin to understand how trauma exposure impacts child abuse professionals?
There are two threads that I've followed over my career. And the first one began actually in a study I did more than 15 years ago about what are the career sustaining behaviors of long-term psychotherapists? And I put this in terms of the resiliency part of the formula around secondary trauma. And that was such a rich experience to me because after identifying a peer nomination process, where a psychotherapist would nominate who they believed were passionately committed to the field, and then talking to individuals who have been doing it for 20, 30, and even more years, and trying to call what the distinctive characteristics of those individuals are.
Then as I began doing consulting in child welfare and started to get requests for, "We really need support with our own trauma exposure." And starting to find out what is, and isn't there within the field and some of the deficiencies, I think that within this field as it's emerged for some really good concrete skills about how do we deal with this? So it became about, what are the career sustaining behaviors on the one hand and, what are the perils of doing this trauma work and how do we best inoculate ourselves against that?
There is not a clear way from the empirical evidence to demonstrate whether secondary trauma can be prevented or not. I'm just one reporter's opinion saying, I believe that it can be mitigated if not guarded against by the fact that secondary trauma just like trauma is caused by two things. And that is not just the intensity of the situation, but feeling helpless and overwhelmed by that intensity. And if we as supervisors can provide the skills, both the craft skills of dealing with that situation, as well as the emotional management skills of how do you deal with the effect on you? I believe that secondary trauma can be prevented or certainly mitigated.
What is secondary trauma?
I think it's important when we talk about secondary traumatic stress, that we look at the full continuum of what that means. And the beginning of that continuum is just normal stress response that that is in response to exposure to a trauma or a trauma story or a trauma image. So it ranges from just that, the normal stress reaction and extends all the way to the clinical range, and at which point it actually becomes diagnosable PTSD. And so it's the full range of stress responses that are in relation to a trauma exposure.
Everyone who does trauma work will have some secondary traumatic stress. Sometimes very temporary and very minor, sometimes to the extent that it may actually indicate need for clinical treatment.
What are some characteristics or some practices that people who work in these high-trauma exposed environments need to have in place in order to do this work sustainably?
I think that when you use the word characteristics to help them be resilient, that begins to answer the question that I think that is what you're looking for in the selection process. And the way I think about it is that, what I really came to look for more than anything else, anyway you can get at this lean in energy. Trauma-serving work is intense. And that what you are looking for is the ability to flourish in view of that intensity. And I would even go a step further, and that is it is a hunger for the intensity and a willingness to lean into that rather than trying to get away from it when it starts to get to be too intense. And that even includes that we know really from more than 25 years of burnout research, that what predicts burnout more than any other characteristic is avoidant behavior.
People who early in their careers avoid things that cause them distress or unpleasant feelings, those are the individuals that will burn out. I mean, it really was a misnomer to think of that as burnout because the people who burn out are the ones that were never on fire in the first place. And so I think in the interview, that's what you're looking at, are those people who have that. And it is hard to suss out in a particular interview questions or a specific interview question. But I think because it really is almost a vibration. And that I think people who don't flourish in trauma-serving agencies are those who like the idea of doing this work. They like the idea of people, but in fact, they don't really enjoy and hunger the connection with the full catastrophe to use Kabat-Zinn's term, the full catastrophe of the work.
I really think that's what you're trying to get at in whatever questions you use. I really like in the interview process coming to understand what is the personal connection this person has to the work, and I think that there must be some personal connection. It can't be that it's interesting. It's got to be that it's deeply personal to them in whatever way. And of course, they need to be allowed to tell that story, but obviously, we're not trying in an interview process to get them to be too personal, but I want to sense that this work is different than if you were interviewing to be a FedEx driver. This work is I think qualitatively different and it should feel that way. And it must feel personal if they're going to sustain in the work.
Should you ask about someone's personal trauma history in the hiring interview?
I think that's an important question because as I consult with trauma-serving organizations that comes up a lot about we know that the incidents of adverse childhood events in workers is neatly double that of the general population in the first place. We don't have to work in the field very long to know that plays an impact. And frankly the best employees we have, that's what makes it personal to them. That idea that only the wounded healer heals and at the same time, many of the performance issues that supervisors are working with also come from the fact that there's unresolved trauma in that worker that's being triggered or activated by the work. And so both of those are true at the same time.
And so the question about, "Do we ask about it?" We know that it's relevant, but everything about secondary trauma-informed supervision is going to require that we're very clear about our boundaries. And that is an inappropriate boundary for a supervisor to ask or make inquiries about anything that's that deeply personal.
Working in this field does not give me the right to require that you come forward with that. And one of the absolute bedrock principles of trauma-informed work is about personal control. You as the worker have the right to decide whether you're going to disclose that or not. And so that leaves us on the horns of a dilemma. That on the one hand, every supervisor knows how terribly important this is. But on the other hand, it's not really mine to ask.
So by working to an answer to that, you start with the fact that no, that's not a good boundary for you as a supervisor to ask about my history of personal trauma. But a good example of a reasonable question within the boundaries of good supervision is a question like, "Does this case push any buttons for you?" And you can decide at what level you're going to respond to that. But my focus needs to be on the client and your ability to serve that client. That's why supervision exists. Although its supportive supervision, secondary trauma-informed supervision, I think is particularly supportive but it's all in the service of the best care to the client.
How would you define secondary trauma-informed supervision?
I think that it's an emerging definition as the field becomes more informed about trauma and trauma issues, and then about secondary trauma as it affects the workers. And then about the support that we really are emerging into understanding that trauma-informed and secondary trauma-informed supervision to me are one and the same. And the most distinctive characteristic of secondary trauma-informed supervision is that it is about paying conscious oversight to the effect that the trauma work is having upon the worker. It is that the supervisor and the worker both have an implicit, if not explicit agreement that we're going to be watching, because we know that doing this kind of trauma work will affect you. And therefore we will conscientiously pay attention to that. I will be inviting you as the worker to do that, and as your supervisor, I'm going to participate in supporting you with that as well. So it really has to do with the oversight.
Then really to do good secondary trauma-informed supervision, it really requires that as a supervisor, I know what I'm looking for, and I know in what ways to support the worker with their trauma exposure. Françoise talks about the three big areas with secondary trauma that have to do with the physical, the psychological and the behavioral effects that trauma exposure have. Those also become the thing that as a supervisor and you as a worker need to be monitoring, and self-assessing.
In behavioral health, we talk about the most important thing is any marked change. That's what I as a supervisor will be watching for when there has been some marked change in any of those three areas and I observe that. But I think the most fundamental here is just the organizational cultural factor that we acknowledged distress. That we as a team acknowledge when we're experiencing distress, which in most trauma-serving agencies, there is this culture that if you ask me how I'm doing, and if there was a particularly rough case that I just dealt with, and you say, "How are you doing?" Most organizations the cultural norm is I'm going to say, "I'm fine." And there will not be any genuine or sincere self-reflection about how am I doing.
And so we need to as Rumi said make occasional visits to ourselves. And in this work we need to be doing that and we need to have a culture and a supervisor that is continuously encouraging us to make those visits to ourself about how we're doing. And we need to have a culture where it's normalized for me to say, "I'm hurting. I am hurting. That was a difficult case, and it's rocked me a bit."
Do you have to be a clinician or have a mental health background in order to provide secondary trauma-informed supervision?
I'm so glad for that question about whether a non-clinician can do trauma-informed supervision because the answer first and right out of the box is absolutely yes. That in the psychotherapy fields, we have a long tradition going back to Freud of doing supervision, doing clinical supervision. But in the first place, trauma-informed supervision is not clinical supervision, and in the second place for those from the helping professions that are licensed in the clinical arts, we didn't get trained in this kind of supervision either. It was a different kind of supervision.
So in that way, you could even argue that it's almost a disadvantage because it's harder to hold your boundary if you're a clinician doing this kind of supervision, because it might be easier for it to become therapy. And so for non-clinicians to start from a position realizing that's not what this enterprise is about. It's not about doing psychotherapy and I'm not your therapist, I'm your supervisor. And so the kinds of things that I'm going to be doing to support you with your trauma exposure and your secondary trauma are not clinical skills.
Again, it has to do with this oversight. And I am two things. One is that I am the chief source of support to you in this organization as it relates to your trauma exposure, and I'm your supervisor. And again, ultimately, even though this is a supportive process, it is about you giving best care to your client.
How often should trauma-informed supervision happen?
I think a careful answer to that question needs to start with the fact that there are no standardized guidelines to that. But what there is certainly broad consensus about is that the frequency of supervision should match the level of experience of the individual worker. Meaning that you would expect that it's going to be more frequent early in one's career and less frequent later in one's career.
I personally believe that nobody develops to a point where they outgrow the need for supervision. I think some commonly practiced frequency schedules are that certainly within the first year, if not first three years of one's career, that that supervision is weekly. And that even for journeymen workers well into their career, that they get at least a monthly opportunity for that kind of support. And the character of the supervision may change depending on whether this is a newly hired worker, where there's a lot more emphasis on the craft skills of how do you do this? With a journeyman worker in their 20th year, it may have to do more with giving them an opportunity to talk about the work, both the pitfalls and the successes of their work but to continue to exhibit some conscious oversight about their well-being, and how is this work affecting you?
How do you help your staff become aware of what their triggers are in the course of doing this work?
Again talking about secondary trauma supervision parallels trauma-informed care. And that starts with the fact that this really is about given the autonomy and the responsibility to the worker. And so it really is the worker… So my role as a supervisor largely is to ask the very questions to the worker that you've asked of me. And that is about in what, when your buttons are pushed by this, when you are experiencing distress because of a client circumstance or client behavior, what does that look like for you? How is that experience by you? And my role as number one, to ask the question and number two as a supervisor to have a friendly interest in their current circumstance. It is to be able to communicate that I care about what your current circumstance is, but it is not always to know the answer to that question.
What should a supervisor do when a staff member is exhibiting signs of behavioral, emotional, or cognitive responses to trauma?
Trauma-informed supervision, just like all supervision, again, exists primarily for the benefit of the client. That we have built the supervisory processes and to support the employee, yes. But the reason for that is so that they can better serve their clientele. And therefore I like the language of the Americans With Disability Act about reasonable accommodation because I think that that allows this in between space where the accommodations that we do have to be reasonable, but they also are supportive in the sense that we're willing to accommodate for any difficulties that you're having.
And so I think within that language, in that construct, if we've got an employee that's struggling, the first question is, are there accommodations that we can make that will support you here? The focus is they have to be reasonable. They may not be accommodations that I, as a supervisor, I'm able or willing to make. The job has to be done. A reasonable accommodation is not that you stop serving clients. But again, in keeping with the idea of the autonomy of the individual worker, I really want in a sincere way for them to answer the question about what accommodations they need.
That being said again, these clients need to be served. And at some point, this may advance to where it's a fitness for duty question. And one of the things that I can do that's both supportive, but also keeps an eye on their fitness for duty is about referring for therapy or through the employee assistance program. We're willing to do what we can do to facilitate your well-being. But ultimately there is a job that has to be done, and there are clients that need to be served.
How do you feel about using individual assessments like the professional quality of life scale and the secondary traumatic stress scale in the course of supervision?
I think both of the ones that you identify are excellent choices because what they become, I just think that we do best in any role when we have specific targets and humans are just built to do target setting. And I think the real value of those instruments is to know what our targets are. Is it about actually mitigating serious secondary traumatic stress symptoms? Or is it just about increase in the compassion satisfaction of that individual? And I think for me as a supervisor to have an eye on that with you as an individual worker, but also for my team. To have some sense of where my team is collectively but what I think is very important is that it's not just my information as a supervisor, but that you know your own score and that you establish your own targets. And then I'm in a position of how can I help you? How can I help you with that target? And where is the most support indicated?
When using those individual assessments, should staff be required to share their assessment scores with their supervisor?
I believe that never. For one thing, those instruments are such that if there wasn't a need to appear good, it would be very easy to do so. And so I think the only value of those instruments is the individuals own sincere interest in wanting to know what their score is. And so this has to be done in the sense of goodwill and we can't have arm twisting and have that result in anything good, I think.
What role does supervision play as people move along the secondary traumatic stress continuum?
It plays the single most profound role of any organizational factor. And I think that becomes a burden and an opportunity for supervisors. And I say that because the evidence is clear that the single biggest reason people leave employment in the human services is because they're dissatisfied with their supervision. The single biggest reason that people stay in jobs, that stay for a long period of time is that they value the supervision that they receive. And so it really puts the supervisor absolutely front and center at the most important thing an organization can do in ameliorating the effects of secondary traumatic stress.
Where do supervisors go to get the training that they need to provide this reflective supportive supervision?
That's a difficult question to handle because they're really… Well, I want to give what I believe is the best answer to that question, and that is the work that's been done by the National Child Traumatic Stress Network in defining the 10 core competencies of trauma-informed supervision. And I think that that's the best that is out there. And that's been produced by the fact that there isn't much out there because this is a new field.
The importance of supervision has long been noted in the clinical fields, especially, and is becoming of growing importance now to other helping professions. And so this is something that we in many ways are growing together. I think the fact that it is a new field really brings to the fore the importance of peer supervision and us coming together in groups of supervisors as we negotiate this terrain.
Where do you supervisors go to get the support they need for their own well-being?
I think it's a good question in two ways. First, it's important to take a moment to consider the fact that the supervisors themselves may need support and that depending on where they are in that supervision hierarchy, they may be getting that from their own supervisor. But absolutely far and away, my preferred answer to that question is by organization setting up peer supervision. For instance, once a month coming together of the supervisors in which they can discuss the cases and especially the difficult cases that they've worked with.
How does supervision change when someone is going through a personal crisis?
I think this question again raises the importance of being clear about a supervisor's boundaries. And boundaries of course are defined by what it keeps out and also what it allows in. And I think in the case of a supervisor dealing with an employee, that's dealing with their own personal crisis, what that boundary should allow in a supervisor relationship is concern and regard for their worker. And in that way of course, it's okay for them to pay attention to the personal crisis of that individual and the well-being of that individual.
That being said again, the function of supervision is not really about the well-being of that individual and resolving their personal crisis. It's about client care and client care always has to remain in the front of this whole relationship and this whole discussion. And so part of that interest in their well-being is just about asking those questions about how you're doing but also if this is a situation that rises to the level, it's about making appropriate referrals through the EAP program or whatever exists in that organization, and it is not about allowing our supervision time to be swamped by what's happening on the personal front, because frankly we've got work that must be attended to.
What should supervision look like after a really difficult case?
I think in those cases where there's a sentinel event, I value the opportunity to talk about it because for many years in our field critical incident stress debriefing was our go to, and as far back as 2002. So it has been a while since we have really done meta-analysis of the effectiveness of that strategy and found that the use of that does not diminish the stress impact on your workers and furthermore that the Cochrane Collaborative found that it could be injurious to some individuals.
And so in answering the question about what we should do, I think it's significant to look at why critical incident stress debriefing is not the intervention of choice. And specifically that it's believed that some of the damaging effects of doing this is that you are essentially re-traumatizing your worker by asking them to form a narrative when they are still frankly, in the middle of a trauma. And that as Margaret Atwood said in the middle of this event, it's not a story at all. It's just a rack and a burning, and it takes a while after the trauma, before we can formulate that narrative.
And so the supervisor isn't doing in some cases, their worker any favors to force them to tell that narrative before they really have metabolized the fact that this trauma has happened to them at all. And so what do we do instead? I think in the immediate moment, a better analogy is around the evidence-based approach of psychological first aid and that really is about giving some education to the worker about, "Here's the things you need to be watching for in yourself. And I want you to tell me if you're having problems sleeping, if you're having problems with intrusive thoughts, if you're finding yourself on edge and are not recovering from this, I want to know that." And to really use that educational and inoculated approach and being available when they are ready to talk, but that's on their timeline and not on the supervisors.
How do you differentiate when you're trying to figure out whether it's secondary stress reactions that are impacting the quality of work, or it's just poor quality work?
It may be a distinction that isn't within the province of the supervisor to make. I think the supervisor's role is about making the assessment. Again, supervision exists for the benefit of the client to assure that that client is receiving optimal intervention. And the reason why I think really is a negotiation between the supervisor and the worker about what they need, what's getting in the way, but I think it doesn't alter the fact, for instance, if this client is not receiving assertive enough or effective enough treatment, because the worker is having their own trauma response. Then it doesn't change the fact that that consumer is still entitled to absolutely the best care that can be delivered.
Us being supportive of our worker doesn't remove that fact. And so then it becomes an issue still of that worker's fitness for duty. What accommodations or supports do they need in order to provide that, but we've got to keep primary in this discussion, the fact that the client's receiving the best intervention possible.
What do you do when you discover that somebody is not fit for duty?
I think in supervision, and it's certainly true in trauma-informed supervision, we're always trying to negotiate the sweet spot and the sweet spot is between accountability and support. And I think it's note-worthy that trauma-informed supervision doesn't mean that we have reduced the accountabilities we have not, but rather we increased the level of support so that ideally those two are in balance. And what that means is that if this client isn't being served in the best way possible, that must be resolved regardless of whether the source of that is trauma behaviors from the worker, or whether it's from a share inability to do that.
We start from a position of trust for that worker and that where we're going to begin from believing that that worker wants the best for their clients, and they want to do a good job as well. And then I'm going to allow them that level of trust and confidence for as long as I believe that it's warranted. At some point, when I believe that there is negligence either gross negligence or simple negligence of just not being willing or able to do the job, then I think we have now moved into an area when we talk about the dual roles of supervision. There is the accountability role and there is the support role. And at some point, again, we always put the client first. Their well-being has to come first.
And at that point I may move into really more of an accountability role as a supervisor, which really means I begin the process of progressive discipline, which is really just about, and progressive discipline can be as positive or as negative as we mutually allow it to be, but it is about a clear explication of the expectations as it relates to that client. It also includes what supports we're willing to bring in to assure a good faith effort for your success as a worker. And then as any of those expectations are not met, then we move to the next step in that disciplinary chain that I believe really must extend all the way to counseling that person out of this profession.
For agencies and organizations that are doing supervision well, what specifically are they doing?
Supervisors that are getting trauma-informed supervision right are doing it with intentionality. They begin from a place of what is it that I want to accomplish? And presumably what they want to accomplish is supporting the well-being of my worker. And so starting with that intentionality and then building into their supervision predictability. A routine where you as my supervise knows exactly we're going to meet, that meeting is prioritized, which means if a conflict comes up for you or for me that we reschedule it, because that's my way of signaling to you that this is important to me. That there is a regular agenda for when we do meet and that that agenda is going to include, I use the rule of thumb of approximately one third of our time is going to be dedicated to just talking about your well-being and the effect the work's having on you.
What are the top three things that you would recommend for people in this work to maintain their wellness?
And I'm going to respond to that since my topics about supervisors, about what the supervisor is coaching in the worker. And I think that those top three things. One is that it must be about managing the… Let me put it this way. Inquiries about worker distress must be intentional. The supervisor must go in and have an intention to ask the worker about their level of distress or else we unwittingly are going to set up a culture where it's not okay to talk about your distress. So it really begins from the supervisor asking.
And so, number one that I'll suggest on that list is about asking the worker if they are troubled in their evenings about any of the cases that they've worked with that day. And that includes asking them about whether thoughts are intruding or about whether they're sleeping well at night, or actually even losing sleep because of the cases that they work with. And that then allows for the supervisor to begin talking about some strategies about managing the ruminations that may occur during the evening.
I think that also that oftentimes the supervisor must be the one to initiate a discussion after a difficult case encounter in order to facilitate that worker developing a narrative about what happened to them and what impact that has had on them. I think a question that I really like is for the supervisor to ask, "How do you feel like you handled that?" Because it's really a no lose question because the worker then is able to say, "I did okay." And that consolidates their competence around that situation, or they can say, "I blew it I think. I think I was too reactive." At which time the supervisor can say, "How would you handle that differently next time?" Which I think paves away this narrative of advancing competency over these difficult situations.
Then ultimately the third will be about a continual discussion about the level of compassion that the workers are experiencing towards their clients. And it's with an understanding that they always have an ideal of constant compassion for all of my clients and none of us get there. There are difficult clients, they have difficult behaviors and that this needs to be talked about openly in terms of the fact that what makes you a virtuous person is your commitment to be compassionate, but that doesn't mean that you are compassionate a hundred percent of the time and that many of the difficulties, a lot of our emotional energy goes to the fact that we are straining to get to that compassion. And it really helps to have a supervisor where these discussions can be had forthrightly.
Can you talk a little bit about the hazmat metaphor that a lot of people use when talking about responding to secondary traumatic stress?
I'd love to talk about that because I think that hazmat metaphor can take us the wrong direction. And I understand some people talk about it just in terms of it being a skillset to manage difficult emotions, but I worry that it suggests this idea that we have to buffer ourselves from these intense experiences. Whereas in reality, everything we know from trauma work just exposure and work with anxiety disorders is that avoiding those kinds of situations, and specifically avoiding the feelings that are creating in those situations, is actually a recipe for burnout and anxiety.
And so I think instead of that hazmat suit, I think we really need to think in terms of taking our gloves off and really leaning into those intense experiences and just getting better at feeling whatever comes up. Whether that's anger, whether that's fear, whether that is grief and to trust that those feelings will be metabolized rather than trying to avoid them and minimize them when they happen. And again, the supervisor, I think plays a key role in normalizing that and allowing that.
Oftentimes we hear about professionals really ruminating or spinning on cases outside of the office, what are some strategies that you've seen work for professionals?
What I coach to have to do when they find themselves doing that is that the rumination really it's a cognitive event. It's not about the emotions of that experience, but rather that we're conjuring that image in our brain. And when we conjure that in our brain, we get that fight or flight, that feeling of being stirred up, which means we conjure more, which means our limbic system gets more aroused. And now we're in this looping.
And so what I coach workers to do is to break that for as little as two minutes, by moving away from the rumination into any activity, which is focused external to the self. In other words an absorbing activity. To engage in some absorbing activity for really just as little as a couple of minutes to break that looping that we do when we're in rumination. It's also particularly helpful to get out of our own head and engage somebody else in a conversation. It can be really effective at minimizing those ruminations.
When they're middle of the night ruminations, the 2:00 in the morning keep me awake. I can break that rumination cycle just by planning an action plan in my mind about what action needs to be taken as it relates to whatever's causing me to ruminate and to make that action plan very specific and very concrete, and that can be effective at quieting those ruminations down.
Can you give some examples of an absorbing activity?
I think anything that's absorbing to you from again a conversation with another person is top of my list. Reading a particularly absorbing story, physical activity, hobbies. I think anything that you can move to rather effortlessly that holds your attention because the key here is to move from the default mode into task positive mode. And that means that we need something so that we're not thinking about ourselves and stoking that rumination process up again.
If I'm not a clinician and this isn't my comfort zone, how do I start this conversation with other professionals and teams?
I think it's a good practice for agencies to have secondary traumatic stress a feature of every meeting that we do. That's one thing that will normalize it and if that it doesn't, in fact, shouldn't sound clinical in content. It really is about how is everybody doing? And it's about at first individuals who are willing to be vulnerable and then hopefully the cultural norm developing that everybody is free to talk about the fact that they may be struggling with any particular case or at any particular moment. But I think the best way to normalize it is absolutely get it into the water and make it part of a meeting just like you would read the minutes to do a quick check in with people that can be very informal. And just who out there is needing some support from us as a team.
Talk about grace and goosebumps.
That's something that I've done I think with great effect on teams that I've worked with were in the median I just make a call out for any stories of grace and goosebumps and the moments of grace are those moments where knew you were working with a difficult case, perhaps your hope was low about whether this was going to be effective. And then something happened that just created this sense of grace, where everything shifted. And the moments of goosebumps are really just stories where we have these encounters that remind us, "Oh yeah, that's why I wanted to do this."
And I think the beauty of institutionalizing that storytelling is that for everybody, it's a coming back to the personal mission that I'm on as I do this work and that hopefully it extends beyond the meeting when you're telling those stories. And it actually becomes part of your daily habit where I start noticing these because otherwise if we don't savor them and pull them out and tell the narrative, they'll escape our notice and be lost.
Appearing in Brian Miller's Video
Brian Bride, Secondary Traumatic Stress Scale, DSM 5 Revision. Unpublished manuscript. 2013.
Brian Miller and Ginny Sprang, "A Components-Based Practice Model for Reducing Compassion Fatigue by Effecting Clinician Experience." Traumatology 23(2). 2016.
Brian Miller, "Reducing Rumination: How to Prevent Bad Moments from Ruining the Whole Day," Printable quick reference sheet. 2019.
The National Child Traumatic Stress Network (NCTSN). "About Psychological First Aid (PFA)."
The National Child Traumatic Stress Network (NCTSN). "Using the Secondary Traumatic Stress Core Competencies in Trauma-Informed Supervision." Fact sheet, 2019.
Professional Quality of Life Measure (ProQOL), Assessment tool.
S. C. Rose, J. Bisson, R. Churchill, and S. Wessely. "Psychological Debriefing for Preventing Post Traumatic Stress Disorder (PTSD). Cochrane Database of Systematic Reviews. Issue 2. 2002.
FRANҪOISE MATHIEU:
MAINTAINING BALANCE: SELF-CARE, RESILIENCY, AND ETHICAL SERVICE DELIVERY
"We can't do this work running and living on adrenaline, caffeine, sugar, and four hours of sleep. We aren't robots." In this conversation, Françoise reflects on her 20-plus years' experience as a mental health professional, crisis counselor, and trauma specialist to provide insight on the lessons she has learned over her career, what she wishes she had known early on, and characteristics of positive and negative working situations that she's experienced. Françoise talks about the importance of self-care based on her own experiences and concludes that self-care is, in fact, an "ethical duty" on the part of professionals working in high trauma-exposed environments. She talks about the importance of developing an "early warning system" that helps professionals evaluate whether they are operating in the green zone versus the yellow or red zone, which could indicate impaired functioning. Françoise will also discuss how to make self-care a priority whether you have been in your profession for years or are at the beginning of your career.
M.Ed., RP., CCC.
Françoise Mathieu is a Registered Psychotherapist and a compassion fatigue specialist. Her experience stems from over 20+ years as a mental health professional, working as a crisis counsellor and trauma specialist in university counselling, military, law enforcement and other community mental health environments. Françoise is Executive Director of TEND, whose aim is to offer consulting and training to helping professionals on topics related to secondary trauma, compassion fatigue, burnout, self-care, wellness and organizational health. Since 2001, Françoise has given hundreds of seminars on compassion fatigue and secondary trauma across North America to thousands of helping professionals in the fields of health care, child welfare, the criminal justice system and other similar high-stress, trauma-exposed professions. Françoise is the author of The Compassion Fatigue Workbook, which was published by Routledge in 2012 as well as several articles and publications.
FRANҪOISE MATHIEU: TO UNDERSTAND THE PROFESSIONAL IS TO UNDERSTAND THE PERSONAL
Hello. I'm Karen Hangartner, and I'm the Project Director for the Southern Regional Children's Advocacy Center, which is a project of the National Children's Advocacy Center. We are excited to bring this video series about secondary traumatic stress to you.
In this video series, we have conversations with three of the foremost experts in secondary traumatic stress. And in these, we discuss how do these effects show up on individuals and how does working in the field of secondary traumatic stress impact organizations. And how do we conduct supervision in a way that's supportive for our staff. And then we'll also hear from Chris Newlin, the Executive Director of the National Children's Advocacy Center, to talk a little bit about the role that the senior leader plays in addressing secondary traumatic stress in the organization and how do we go about creating healthy, supportive environments that support the staff that we're working with.
In this video, we have a conversation with Françoise Mathieu. Françoise is the Director of the TEND Academy in Ontario, Canada, and she is sought after as a speaker and a consultant to work with organizations to create more healthy work environments. In this conversation, she's going to talk about how working in high trauma exposed environments, how that impacts individuals. And then we're going to talk about some resources and some strategies that are available for you. Any of the resources that you hear mentioned that she talks about, those are going to be available to you to download. So enjoy this conversation with Françoise.
Françoise, let's start with how did you get interested in the field of secondary traumatic stress?
Françoise Mathieu:
So I've been in the field of trauma for 23-24 years, and I worked as a crisis worker in a college town, college setting, and I was also working for the military as a mental health professional. And after about seven years of working at the university, I quit. And a lot of people I knew thought I quit because I burnt out. I actually didn't burn out. I quit because I was angry at the system all the time. I wasn't mad at my clients. I was starting to have some friction with my colleagues, but they didn't know about it. You know that subtle, low level frustration about all the systemic things that were making me mad. And the stories were definitely starting to get to me, and they were interfering to some degree with my personal life.
But what got me interested in this whole topic is that when I left the university, and I left because I had a lot of frustration with the lack of resources and stuff. I went to do heavier trauma work with soldiers who were coming back from combat, and although their stories also got to me, I had better ways to manage and deal with those stories because my working conditions had changed. And so I became interested in this entire topic because I had never been trained in this. No one had ever talked to me about secondary trauma or burn out in my education. And I started noticing it effected me but it wasn't just I heard a terrible story. It's interfered with my sleep or whatever.
And the final piece is I started seeing service providers around me performing sometimes not particularly ethical care. Some were amazing, and some were not. And I wanted to find a solution so that we could all stay in the field of trauma, which is what has always been the love of my life, in a way where we can do good quality care but also stay well, be good members of society, family members. You know what I mean? I thought there's got to be a better way to do this work, and it wasn't actually about burning out. And I didn't leave because of that. So I started digging around, looking for resources in that topic, and that was around 2001.
What do you wish that someone would have told you or how you might have been better prepared to work in a high trauma exposed environment?
Well, there are two things I wish I had received as training. First of all, I wish… I mean, this was in the '90s and things were different, and we didn't know certain things. I wish I'd received trauma training, which sounds weird because I did a master's degree in counseling psychology at very good schools, excellent training on many, many things. We never talked about trauma. We didn't know about the adverse childhood experiences and how those have an impact on the people we serve. I think I would've probably transformed my career in the sense of the quality of work I delivered. I always did my best to be an ethical practitioner. But then there were some… I'm not going to lie. There was some folks I worked with that were deeply, deeply challenging, and my regret is I don't think that I did the best work by them. But I think partly I just didn't have the training.
I also wish we had talked about… I had probably half an hour on self care at some point in my master's degree. Take care of yourselves. But again, the books hadn't been written on the topic. So this is not a condemnation of the people who were training me. We just weren't there. So I think that would've helped, understanding to recognize some of the things that early on in my profession I noticed… I didn't know it was called secondary trauma, but I noticed things were changing for me. And I didn't have a framework for it. So I think those two things would've made the biggest difference for me.
Do you think terminology matters?
I think language is important. I think frameworks are important. I think what we call things is important as far as it helps us understand what's happening. So as you know in the Secondary Traumatic Stress Coalition or Consortium, we develop a think tank, and we have been crafting this Venn diagram that is constantly evolving. But the Venn diagram was really an attempt for all of us to have a framework to see how… We can't just have a one solid definition say, "This is secondary traumatic stress, and if you have these things, if you're high functioning, that's fine. But if you're at the end of it, you have PTSD," that kind of continuum. We started realizing that as service providers it's a lot more complex than that, and there are personal factors that are going on. What's going on in your workplace? What's going on in your society? How much indirect trauma have you got? How much direct exposure do you have? What is the level of your empathic strain? What about moral distress and systems failures?
So I believe in terminology as long as it allows flexibility. I think the problem sometimes with the lack of clarity with the terminology is that it's created a little bit of silos. So physicians use the word burn out exclusively to represent everything we're talking about today. Other people use the word secondary trauma to represent everything we're talking about today. Other people use other words. So I think we need clarity so we can do better research, but as individual practitioners, I think what's really important is more the idea of the Venn diagram to be able to identify what are the real factors that are effecting my functioning and the quality of care that I provide?
Which concepts on the Venn diagram do you think are most important for people to be aware of?
So I think that one of our personal vulnerability factors, I think that's highly important. What are you bringing to the table in terms of your own lived experience? We know that many service providers have their own lived experience, which is absolutely completely fine and normal providing that you've done your work and that you're aware of your triggers. What else is going on in your life? I was just doing a training last week where someone was in a caregiver role where she had to leave session to go and call her nursing home to deal with her mother's… We're all humans. Wasn't it Yogi Berra who said, "We're all bozos on the bus." So we're all bozos on the bus, and that's one really important factor. What are you personally bringing to your ability to function and focus in your work?
Another piece of the Venn diagram of course is anything related to secondary trauma exposure. Some of the folks that are watching this are in very high trauma exposed environments. Maybe they're dealing with child sexual exploitation, internet trafficking. We're not suggesting that they're going to be less effected. Of course you're going to be effected because of the volume and the nature of what you see. So that's a really important factor to look at, which we often call indirect trauma.
The other piece to me that's really important is the moral distress around systemic barriers, and the other one are working conditions. And I think all of those can create a situation where you are doing really well or it allows you to identify what are the problem areas. So if I can go back to my own experience of leaving my job, it wasn't the trauma exposure, per se. I mean, that was significant. But I had tools to manage that. It was really the climate and the context in which I was working that was becoming unacceptable. So having that framework in hindsight is really helpful to try and understand not only what was happening but what are the tools and strategies I can use.
What were some of the tools and strategies that you had in place at that time?
Very little. We had to invent it. Do you know what I mean? So what happened is in 2001, I was working as a crisis counselor and with the military, and of course volunteering on three boards. Like volunteering at the prison. I think like many service providers are doing. Raising a family. And I came across this document called Guidebook on Vicarious Trauma for domestic violence workers. And a colleague of mine, very good friend and I read it, and we were like, "This is us." And we had never heard about it. So we created a very informal, small community of practice, the two of us. So we started talking about self care strategies, how to transition from home to work or from work to home rather. We started making decisions about workplace toxicity because we were working in the same environment. And we made concrete decisions not to leave every staff meeting and lock ourselves in the broom closet to complain about everything we're frustrated with because it started to not be productive.
I started doing a trauma audit of my extraneous trauma exposure in my personal life. So I stopped reading or watching the news. I stopped watching CSI or Law and Order at night. Also I was improvising, I'll be honest. I had this one book with a checklist, and the rest I followed my gut. And then I realized what I really needed was more training to be skilled of working with the people I was working with. So way more trauma training. Way, way more. Yeah.
What were some of the differences in the working conditions of those two places?
Oh. So my second job with the military I was a free agent. So I was self employed. I was service provider for the employee assistance program. So I had my own private practice. So that meant I had complete control over my schedule. So I didn't see my three most challenging people Friday afternoon on a full moon. I might seem them and disperse them. I could interrupt my day to go to the gym or to go look after a family situation. So I had flexibility. So that was huge. I had less job security, but let's be honest, there were a lot of soldiers coming back. I mean, the need was there. I created my own supervision because at my previous job, that hadn't gotten… We lost access to regular supervision. So I had regular supervision that I created for myself with people in the community, flexibility. I have referral resources. So it wasn't perfect but with the VA and with insurance companies, I actually had somewhere to send these folks. And that was highly protective for me because I felt like I was doing ethical work because I could actually help them but also refer them to something. So those were huge differences for me. Even though it was higher trauma work, if that makes sense.
Talk to us a little bit about moral distress.
So moral distress is a term that comes from the field of medical ethics, and as we know every hospital has a medical ethicist on call when there are some very big decisions that have ethical ramifications. And moral distress is defined as when policies, rules, regulations, what have you conflict with what you believe is ethical and right. And we could have a lot of examples of that in a hospital environment. Early discharge of a patient to nothing, ineligibility, they don't have the right insurance so they can't get this treatment. In my work, and I've heard this from probably 100,000 different service providers that I've met over the years. It's when what you believe is the ethical thing to do is not allowed or permitted or possible either because it's the rule of your agency. So this person's not eligible for a service either because the service that you think they deserved doesn't exist anymore. Maybe there's been a cut or maybe they just filled out the wrong form and all of a sudden what they should get isn't available.
And what I'm seeing is moral distress is a huge contributing factor to people burning out because at some point you feel like, "Am I causing harm," or my hands are tied. And I remember very specific case, which I'm happy to share with you if you want, that to me was probably the trigger to make me decide to leave that job. And it's probably a story that a lot of people have heard or experienced in a variety of ways.
So I was working a very high pressure environment, we were seeing a lot of people. We had a lot of cuts at the same time. And I saw a young man who I helped with a very difficult decision to make, and he was going to go to his family and disclose something to them. And he came back at the end of the weekend and it had gone terribly. Every worse case scenario I could image, it happened. And his family basically said, "Never darken our doorsteps again." And as we know when those situations happen, the risk of self harm or suicide are high. It was a time when this young man needed more support than ever before. And my boss came to me and said, "I'm so sorry. You have reached your session limit." And that was a moment where I was like, "You know what, I'm not okay with this. This is wrong." And I understand the bigger systemic issue. But in that moment as a human being that didn't sit okay with me.
I'm sure some of us have had 100, 500, 1000 decisions like that. We can't just quit every time something like that happens. I think that it was an accumulation for me where after seven years of that, I thought, "You know what, I got to do something else."
Tell us a little bit more about the secondary traumatic stress continuum.
So I think the continuum is a really good framework to understand that it is normal to be impacted by difficult stories that we see and hear. In fact, we kind of want to be effected to some degree because otherwise that would be concerning. Now it's also interesting however, as a sidebar, is that when you've been in the field for a very long time, there are certain stories that won't affect you anymore because you've seen and heard so many. So of course there's a certain level of desensitization that takes place. And I'm sure any of you if you remember from when you were a rookie if you've had a lot of experience now, absolutely there are things that used to impact you that now you're like, "Yeah, I've seen hundreds of those." So I think a certain level of desensitization is completely par for the course.
But when we're talking about the continuum, kind of going to being really high functioning and not being negatively impacted or impaired to the end of the continuum where we are really impacted and impaired. And maybe we may actually have symptoms of post traumatic stress disorder. We may need to go on leave or receive some assistance. So there really is a progression if you will along the way, and one of the things we're interested in is looking at what are the points where we can get people to first of all identify what's happening, workplaces to be aware of that. Do these symptoms if you will, do they persevere?
We want to be able to provide service providers with and the people in their units and the teams that they work with is an ability to first of all recognize what are these warning signs; how do I know that I've been particularly affected by either a story or maybe it's a whole volume of stories that are really similar, maybe it's that gradual erosion because you've heard so many things that are similar or maybe there's an outlier of something that is so truly distressing and disturbing that it's really hitched a ride with you. The other factor sometimes, and I'm going to bring the personal stuff back in, is we all have personal vulnerability and resiliency factors.
So I've heard from many people in the field that having their own children or their grandchildren sometimes become a vulnerability factor because they could sort of relate or identify with a particular case because maybe that child is the same age as your child or your grandchild. So it's really about being able to identify along the way is this really causing significant functional impairment, but what we don't want to do is get to people when they're in the red zone. We want to be able to get there where the green zone is when you're doing really well and maybe there are a couple of things that are bothering you. But as you start shifting more to the yellow zone, we want to be able to identify that early so that we can put things in place personally and reach out professionally and even our agency can be able to identify that.
So that's where the strategies come in along the way, and some of them I do believe are self care and wellness strategies. I don't think that we can do this work running and living on adrenaline, caffeine, sugar and four hours of sleep. We're not robots. And I think that self care practice is absolutely have place to be able to refuel and reset. And I think there are a lot of practices in the workplace that can also allow us to ground ourselves moment to moment. I had a colleague who recently said to me, "Self care and grounding skills in this work doesn't mean that you go through the whole day at break neck speed and then collapse on your yoga mat at five o'clock. That's not self care."
How do professionals figure out what their triggers are?
I like to call it the big three warning signs. Of course we may have a whole host of them, but what we found is that identifying these warning signs are actually really robust, and they tend to really withstand the test of time and life and changes. So looking at we break them down into behavioral warning signs and physical warning signs and then more psychological or emotional warning signs. So I really like to start of the basic, and what I believe is in order to understand the professionally, you need to understand the personal. You need to understand yourself. So when I do some training, I'll get people to identify what are their physical warning signs.
You and I were joking earlier that often I get a raspy voice or I lose my voice or there's certain things that… I mean, that's been for 23 years since I've been in the field. Someone else gets migraines or neck and shoulder pain or irritable bowel or whatever. So number one, what are your physical warning signs and how do you know you're headed for trouble.
Number two, what are some of the behaviors that you've noticed. For example, to go back to my story of when I was working in this environment, my number one behavioral warning sign was that I had low tolerance for office chit chat. I was still fine with my clients, but you know all the stuff that people do, they had lunch together and they talk about books. I had no tolerance for that. And I started taking the fire escape to avoid my receptionist to get to my office because she was so cheerful, and she'd be like, "Good morning!" And although I think that sounds funny and light, it really was a warning sign for me because what was happening is that I was shrinking into hyper efficient trauma mode. I was just going to manage and handle my clients, and there was no room left for the gravy and the fun stuff. That's very individual, but I personally have found that when I'm highly trauma exposed, I hunker down, and I diminish things to the smallest units of trying to be really efficient. And I lose my sense of humor. I lose my sense of play. Transition home. So I might get home and someone at home might want to talk about something that had nothing to do with trauma, and I'd be drumming my fingers thinking to myself, "Let's get this done."
So I think that I really believe that all of us need to look at the big three. What are your physical, behavioral and emotional warning signs before we can more to anything else because really self awareness is such a key element. And then in the workplace, I encourage people to have safe and honest conversations about what do you look like when you're in the yellow zone.
So I was working with an agency last week where it was a brand new group of people. So some people have been there for four days. They hired a whole bunch of new people, and they needed to have conversations about one person said, "Look, I'm in introvert. And when I'm heavily exposed to trauma, I need quiet. I need solitude. So if my office door is closed, it's not a get out of my face. It's actually self care." But if you didn't know that, can you imagine? It's like a brand new person. Her door is closed and you're thinking, "Well, what's wrong with her?" So I also think it can lead to misunderstandings and conflicts that are completely avoidable and can then help not having a toxic work environment.
How does an employee lead up in order to facilitate change in their organization?
So it's a great question because you're right, not every workplace is engaged, aware, or even interested in this. And we all have to make individual decisions about how we conduct ourselves personally and professionally, even if we don't have control over the larger organization. So I'll give you an example. I have worked several times with agencies in the correctional system. And as many of us know, those can be extremely high trauma and pretty toxic working environments. And yet, I found some people along the way who were actually well. Service providers who were well. And I really wanted to know about that. How do you stay well when you are in an environment that is really… Where you have no control and it can be pretty toxic. And there's some really interesting research on that as well about what our individual decisions and practices we make.
You remember Stephen Covey Circles of Influence and Control? And I really like that idea where there's certain things that are absolutely in your control, and not to sound facetious but what is within my control is maybe whether I bring a healthy lunch. But it's also whether I engage in office gossip with my colleague or whether I make a positive strategic alliance, not to bully other people but to not also engage in some of the stuff that really leads us to having a negative interaction with one another. So I think what's also in the circle of control is who I choose to be with, who I choose to be at work.
A dear colleague of mine said to me one day, she said she was working in a really tricky place. And she said, "I have a choice every day on my way to work to be a negative, a positive, or a neutral influence." And she said, "Sometimes I choose neutral because positive's not possible for whatever reason." She goes, "But I have a choice in that." So that's second circle of what you influence is really huge. And I like to focus on those too. Who you spend time and how do you choose to discuss and talk about the people you serve, the people you work with? I think that's within everyone's purview.
What can individuals do to be more resilient?
Well, it's an exciting time to be in the field because we're having more and more research. For example, looking at neuroscience and looking at ways to reduce our own reactions, looking at ways in the moment we can ground ourselves literally before, during, and after we're being exposed to difficult stories. And that's not research that we had 10-15 years ago. Those aren't tools that were available. When I read about it at first, we were all told, and I'm sure you were too 15-20 years ago is we were all supposed to do yoga and breathe more, and that was going to fix everything. And don't get be wrong, I believe in those things, and I really do believe that practices such as yoga are essential ways to widen our window of tolerance and be able to deal with life as it comes. So I absolutely believe in that. But I really like to break it down into individual strategies and then personal strategies, professional strategies, things we can do as a team, things that agencies can do. I mean, there are many, many different layers and levels of what can make a difference.
So personally, I'm going to sound like a broken record, but I really think that getting more training so that you are skilled and competent in helping folks and feeling like you're not an imposter. The imposter syndrome. I'm sure we've all had it at the beginning of our career where someone came in front of us and we totally faked it. Deep inside, we're like, "You should really see someone about that." You realize, "Oh, that's me." And the same is true for people who put in, thrust into a supervisory roles where they haven't had time to learn and train. And we need time.
So number one is training. The problem is that when there are cut backs, the very first thing that goes by the waist side is backfill and funding for people to receive training. So I think that's a fatal mistake. The more equipped we are, the more context we have. If I had the knowledge 20 years ago that I have now about the adverse child experiences, about complex developmental trauma; if I knew that, I think I would've been more effective at my work. And then I would have been less depleted because I was more effective.
There's certain things though, I mean, trauma exposure and seeing and hearing terrible stories of children being harmed I don't think will ever get easy. But I think that there's some interesting research that needs to be done to look at how much is too much. Are there certain type of ways where we could vary caseloads? Is there certain way to look at evidence, forensic evidence that could be less harmful? We're beginning to look at that, and I think those are really interesting roots to look at as well.
And I also think I do a lot of workshops where sometimes I think an agency is horrified about what I'm about to say because they've hired me to come in, and I say, "I really am a big believer in quitting." First of all, I dot think everyone's cut out to do this work. I think that when we look at trainees and new recruits, I think that some people go into this field to process their own unresolved traumas. And you understand the distinction. I think a lot of us have lived experience, but I see people who are still struggling. And I also think certain things are really hard to teach. I think it's really hard to teach empathy. I mean, you can teach people skills, but if you don't have it at the beginning… I think there's certain things where some people are just really cut out for this and some others are not.
I also think that some of us it's better to do a different type of work in the trauma field than certain other things. I can give you an example. I have a dear friend of mine who can never work in the animal care community. She can't deal with animals being harmed. That's just soul crushing for her. But she can work in child welfare. So I think there are a lot of individual factors that make us go to that or not.
How do you make self care a priority?
I get that question all the time about guilt. And I hear it from a variety of places. I hear it from people saying, "I'm a person of privilege. It feels like how dare I take this time for myself when the people I serve have so little." So kind of that piece. And in her book Trauma Stewardship, Laura van Dernoot Lipsky has a wonderful story about that. I believe it was a director of a women's shelter just comes back to the shelter after quite frankly a wonderful weekend. She'd had a wonderful weekend, and she gets back and one of the residents in the shelter says, "How was your weekend?" And she was like, "Oh, it was fine." And she said basically she felt somehow guilty that if she said, "Oh, I had a wonderful weekend," it was somehow an insult or disrespectful to this woman who was suffering. And Laura talks about how do we somehow internalize this that we have to dampen down and not be allowed to celebrate the fact that maybe we had a lovely weekend or things happened.
The same is true conversely by the way too. So we have to show our professional selves, and maybe we've actually had a terrible weekend. Maybe we had a fight with our partner. Maybe we're going through a divorce, and that's the other part that we also have to suppress. So the piece about guilt and self care I find really interesting because I started seeing clinicians, in particular, who are working what I consider to be quite frankly unethical levels of caseloads. I had some serious concerns about their ability to be present. So I actually flip it around, and I think that self care is an ethical duty. We think nothing of people who do… I give this example often, but my brother works for Cirque du Soleil, and we think it's completely normal that these Olympic level acrobats take exquisitely good care of their body so that they don't have an injury or fall or hurt themselves. Everyone agrees with that. But when I come into our fields, people will say to me, "I haven't taken a vacation in three years. Check me out." I think that's unethical respectfully.
So I think of it in a different way. I take good care of myself. So personally a big one for me is sleep. It's not for everybody, but I get a lot of sleep. I try to get some exercise and not fill myself with stimulants all day so that I can be present so that when you need me, I'm on. I'm not distracted. I'm fully there for you. So that's how I think of it. I think it's my professional duty to take care of myself.
How do you balance the expectations of yourself, donors, and other professionals with knowing what your own boundaries are?
I think that talk to anyone in this field who's been around for more than 15 years, 20 years, 30 years. And I think everyone if they're being honest will say that they've burnt out or close to it several times in their career. I think I always say I'm a deeply flawed individual, and I only realized that in my 40s. It was the most liberating thing in the world because in my 20s and 30s I had to prove probably to myself and to the world that I had it all figured out. And it was such a relief to realize that I make mistakes, I over commit, I over extend myself, and sometimes that ends up not going well.
So I can give a personal example. This summer I had yet again done that, and I had a trusted advisor who's a really good friend of mine. And I wrote about this in a blog, and then she went back and she's like, "Am I the trusted advisor?" It was very cute. And I call the blog post Disappoint Someone Today, and I started realizing that one of the things that I think a lot of us who were attracted to this field, and you called it a calling. Truly, for us it's a calling. I think that we were helpers long before we went into this field. I think that we were the go-to for people in our personal lives, in our social lives. I certainly know that's true for me and for many people I've talked to. And I know that I received powerful messages about responsibility, about somehow that we had a responsibility to contribute to our society. And I don't regret receiving those messages, but the flip side is that there are times where, to bring back the subject of guilt. That there are times where you can have tremendous guilt when you don't do your A++ 100%.
Kristin Neff talks about self compassion. I think that that's where the inner critic becomes really active about I could do more; I should've done more. Or Heaven forbid, maybe we actually do get disciplined or reprimanded at work, which can be devastating. So I think this is a life's work that if we are truly called to do this work, we do have to have an ongoing reflection process about what's happening, how am I doing, where am I at, why does this feel too much or maybe it is too much. But what do I do if my agency tells me I'm supposed to see twice as many people as what feels right. And this is also where, it's funny, we stopped talking somehow in the last decade about accessing personal counseling for ourselves. That used to be a thing that was almost a requirement that we have access to our own clinical supervision, our own personal counseling is needed. And I think we need to bring that back in. I certainly have gained tremendous insights and value from going to see people I trust, whether they're in a professional capacity or personal when I need to process and reflect. And I feel like we lost that somewhere along the way.
How do we begin to set those boundaries so that we're not overextending ourselves?
I'm reading a great book right now by Tony Crabbe. It's called Busy, and I believe he's an organizational psychologist. And he talks about we have a limited bandwidth. And we have limited capacity, that is just a fact. And I was reflecting on that a couple of months ago. I was on a trip with my spouse, and my spouse has twice as much energy and needs half of much sleep as me. So it was very interesting journey because as we were going through the day, I was like, "I can only do this much." So that's just a capacity and bandwidth thing.
So here's the thing. This summer when I decided to set some limits because I was maxed out, what I had to do was disappoint a much of people. And the thing about setting limits is that it doesn't always go well. We have, and I'm not blaming ourselves, but we have trained people in our worlds to expect a lot and we deliver. We work to deadlines. We work beyond. And when we start setting limits, the thing that's not really fun about saying no is the response if it's not a compassionate one. And so I found that to be really interesting exercise is I went out and disappointed a whole bunch of people. I said no. I set limits. And they were not happy. They were disappointed, and to me, I don't know if it's true for other people, but disappointing someone is worse, almost worse than anything.
And I remember this story where my daughter was driving home from somewhere. So she called me on speakerphone, and the car's full of all her friends. Public. And she says, "Mom, you left an appliance on." I think I left an iron on at home, and she said, "I'm not angry, but I'm disappointed." Right? And I thought it was so… Where do you think she learned that? And so I really think that the problem sometimes is that we have given people the illusion that we have endless energy and stamina. And by the way, it maybe true when you're younger. I look around, and I have a team that are younger than me and they actually do. They have more stamina. But you know what I have, I have… And I'm not trying to say I'm wiser than them, but I have experience. And I have competence, and I do have wisdom. And there's certain things where I do think I work smarter than I did before. I've learned a lot. But it's not sustainable, and yet when we set limits, sometimes there are consequences. I think would be a lie to say, "Go and say no. Do what you want."
There's a book that said, "Do what you love. The money will follow." Well, I don't know that's true. Go make earrings, you'll be rich. Well, maybe not. You might be happy, but you might be poor.
Can you give some examples of how this work impacts us in positive ways?
Oh my goodness. What a good conversation. I have on my screensaver this picture of a little boy. I got it off Instagram I think, and he's about four or five years old. And he's holding this cabbage that he's just harvested. And he is laughing like head thrown back. And looking at that photo fills me with joy every single time I look at it. And I think that there was some work done on vicarious resilience. Some members of our think tank have been looking at that. What are the things that make you think in your day to day interaction with the people you serve? What a privilege it is. I am in awe of your courage. I am in awe of your resourcefulness. And having talked to many, many people in the field, I don't think those moments have to happen even daily or weekly. I think we cherish them because if we have had the honor, the privilege of being a tiny part of that person's journey towards that. I don't know about you, but that makes it all worth it for me.
Is secondary traumatic stress caused my carrying too much?
Originally, 20-25 years ago, when researchers were trying to put a name to something that they were seeing happen. And it was a real thing, and it didn't have a label or a name or a diagnosis or strategies or anything else. And we need to remember that what they were observing were service providers who were working in high trauma situations who were being very negatively effected by this indirect exposure. That's really the beginning of this process. So by then, we had the diagnosis of PTSD for people who had been in combat and people who had been in those types of situations. But we didn't have a word or a framework to understand what is happening to us when we're indirectly being effected by this. So we need to remember that was where it started, and there were a lot of different words that were being used to try and tease out the difference between is it a shift in your world view and your construct of the world; is it an erosion of your ability to care. And I think that process and that exploration was really important and valuable. And I think we're somewhere a little further along in terms of that exploration.
The word, for example, compassion fatigue was used for a really long time either interchangeably with secondary trauma. In fact, it was created as a more user friendly term, kind of less pathologizing term. But then it took a life of its own, and some people started saying is it the cost of caring too much. Somehow we cared too much for the people we served, and that's why we became negatively effected. And then some other folks in the field started saying, "Wait a minute, you can't run out of compassion. It's kind of like love." I've two biological children and 17 other kids that I take care of in a variety of ways. And it's not like one more gets added and I'm like, "Oh, I'm sorry, Trevor. I'm all out of love." It doesn't work like that. It's an endlessly replenishing resource. I believe that so is compassion.
But the idea that there can be a strain, and some people have been using the term more empathic strain right now. Is there a possibility where being in that hopefully deeply connected professional relationship where you are there to assist someone who has experienced very difficult things, is it possible that that gets strained either because you're exposed to an incredibly large volume of them? And I know so many people have said to me, "I've seen thousands of stories that I could almost fill out the paperwork before they start. I know where it's going. I know what's happened. I just don't have the same level of engagement that I had at the beginning." I think that's probably realistic. Or maybe it's a case where the person sabotages every single thing you've tried to do.
I was working in a women's shelter last week, and they were saying, "I found housing. I found a job. She didn't show and it's the seventh time. And I'm done." And I think that experience, I don't think that's secondary trauma. I think it's something else on the Venn diagram that we're currently calling empathic strain. I think that really is an emotional and physical exhaustion, a depletion that can happen in our personal lives too. I often give the example if you've ever had a friend who went through the world's longest ever break up and they went back and back again, I think at some point in our bandwidth and in our capacity, there is an erosion. And so I think that's the way to think about that piece about this wear and tear. And so I think the notion of strain is a more accurate one.
So the notion from Richard Harrison, the beautiful term that he used called exquisite empathy. And this was a study, it was a small study, but they looked at award winning, peer nominated counselors in their community. These were really the people considered the best in the west so to speak, and they had all been in practice for a long time. And through interviews, he identified I think there was 17 different factors that every single one of these clinicians practiced these 17 things. A little less exciting than exquisite empathy, which I'll go back to, but they all had an external practice of some kind. They all had a life outside of work.
But exquisite empathy was really this notion of this moment by moment ability to retain equanimity. So the ability to remain present in the face of coming at you, not waiting until the end of the day to process all the stuff that you've been exposed to. So it really was a moment by moment presence. And I think that those are tools that we need to explore more as opposed to the idea of arming ourselves to go away and then at the end of the day decontaminating ourselves. I think that I like those ideas better.
How do we integrate some of these healthy practices into our every day lives?
I was working with an agency last week where the director's wonderful, and as we know, leadership matters so much. And she said to her staff, "You're seeing too many folks. You're not taking breaks in between. You're cramming." And she said, "That's not how we work here." This is a workplace where people were brand new, and she was saying, "This is not how…" And this is a sexual assault center. She said, "This is not how we work here. That's not sustainable. I need you to pace yourself so that you can stick around and do a good job." But that's really tough because first of all personally I don't know about you, but a lot of us, we multitask. We get a lot of stuff done. We may feel that that's not a good use of our time.
I recently had to do some physiotherapy, and it was something I was supposed to do every day. It takes 30 seconds, and for a month I didn't do it. 30 seconds. So what I did is I built my habit in now that when my coffee's brewing in the morning, I do my physio. So what we found also there's some really interesting research on whether people adhere to healthy habits, and what's been found is that if you combine it with something pleasant or you have an immediate reward, you're much more likely to do the things that are little less pleasant or feel like more like a chore. And by a reward, I don't mean a chocolate. It could be something, a small thing. So for me, for example, I do the physio, and then I get the coffee. Does that make sense? So I think that some of those can be absolutely built in to our day to day work environment because they don't take long, but once they become a practice, they become also embedded in our… It becomes metabolized. We learn and our brain and our body learn to reset as we go through the day.
What are three strategies that you recommend for professionals to incorporate into their every day life?
All right. So the first one is drink some water. Not caffeinated drinks. Not sugary drinks. Drink some water. Flush out those stress hormones. Number two, my colleague Pat Fisher has developed something she calls the hot walk and talk. So when there's a lot going on and you're feeling really activated and you need to process, find a colleague you trust. Don't slim them necessarily with the details. You don't need to debrief with the graphic nature, but walk it out with them. Go on a walk, drink some water, talk about it. Those things can take minutes being able to process that.
I have a colleague who works in a prison, and what she does when she's been exposed to something very upsetting is she does the stairs or 10 jumping jacks. This is not a workout. This is about flushing out those stress hormones. So I guess that would all fall into one category. Drink some water, hot walk and talk, metabolize what's going on. So that's the first one.
There's some really good strategies out there now if you look at some of the websites like Calm.com or Headspace, there's one that's called Three Minute Breathing Space. Those things don't take long. Three minutes. There's some really good grounding techniques like the Hakomi, five, four, three, two, one that's very easy. You can find it online. And again, these are resetting activities that you can do in the moment. You can even do them in court. Nobody knows.
And the third one is I really think you need to have a transition ritual between sessions or as you leave the day behind.
Explain your low impact debriefing model.
All right. So this model came out of this one liner that we read in Laurie Anne Pearlman and Karen Saakvitne's book years ago, and she talked about or they talked about limited disclosure. And they were talking about strategies so that we can protect one another. And my colleague Robin Cameron and I looked at that, and this is going to age us a little bit. But you remember high impact aerobics? Some of you remember that. And then we all got shin splits because we were bouncing… Anyway, so Robin and I started thinking about, "Wait a minute, is there a way to think about this that would be a low impact aerobics, a low impact way to debrief one another as we need without retraumatizing or contaminating people with the graphic nature of what came up?" So that's the history of it.
And so we call it the acronym is LID, but not like keep a lid on it fully. More like the pressure cooker. So let the steam out gradually. So there are four steps to low impact debriefing, and it's very simple. And once people know them, you can use it anywhere. And the steps are the following: so the first one is I'll go through them and I'll explain what they are. So the first one is self awareness. The second one… I switched them around all the time, but the second is fair warning. The third one is consent. And the fourth one is actually limited disclosure.
So the first piece I invite everyone to think about is when is it the appropriate time to share graphic details of something. I have been to many child abuse conferences. I go to them all the time, and I have found that there are times where the keynote speakers, the trainers will… Now we use a term sliming. It's very informal, but I think people get the image. Where people, it is not debriefing situation. It's not even a case consultation. It's a training. They will share very, very graphic images and stories to the world without… Just saying to people, "This could be upsetting. I'm going to push play." That doesn't cut it with me. So I started becoming concerned about the informal way in which we were all flinging trauma at one another partly because I think a lot of us are quite desensitized. So we could eat a sandwich and be like, "Oh, that's nothing. Wait until you hear what I saw." And I see this a lot in first responders, for example, and child abuse investigators for example. And I wanted to explore a way where we could do that in a way that first of all is consent based but also controlled.
So low impact debriefing would look like this. First of all, it's not a water cooler chat. It's not at the soccer game sitting on the… It is something where I know that I have seen or heard something distressing that I need to process, and I think many of us, it's quite an immediate need. It's not like I'm going to wait until tomorrow. It's like now, which I totally understand. And so if I worked with you, the first step is I would have the self awareness to know that what I actually need right now is a debriefing, not a water cooler chat.
Number two, I would give you fair warning that that's what I'm about to do because I don't know if you've ever had someone deliver bad news to you and you didn't know that was coming. It's like a punch in the gut. Whereas if I said to you, "You better sit down. I have some bad news," it allows us to prepare ourselves. So I would say to you, "Karen, I need a debrief," so you know what that means. Secondly, I'd say, "It's about," fill in the blank so that you can know. And then I would say, "Do I have your permission?" And you might say, "Listen, I'm in the red zone today. Go tell so-and-so instead." And I would respect that because we work together. It might also be that it's about something that's actually quite close to home right now.
So something happened recently in my family. Everyone's fine, but something very upsetting happened. And if you wanted to debrief something similar, I'd probably say, "Can you pass just for now?" Or you might actually say, "Bring it. I'm all yours." But that's a very different setup.
The final piece of low impact debriefing is do you say cliff notes in America? The coals notes, the cliff notes. So tell me the cliff notes. So I like to draw. When I do this, I draw an outer circle. And in the middle I call it the full Monty. That's what you'd hear in court in the pictures. The whole thing. Don't start there. Start with the cliff notes, and gradually I may tell you more. I may need to tell you more. You might not need to hear more. But that transaction, even if I end up telling you the whole thing and showing you all the pictures and stuff, I think that's really, really different experientially for you as the recipient than me just blurting it out, "Have you got a minute?" And I think that allows you to ground yourself and process. And it may not be upsetting to you. Maybe you've heard thousands of stories like that. But it's almost etiquette. It's just an extra little step that we can take. What's the harm in not oversharing, and I do think it prevents a certain amount of contagion. And I think it's good practice.
Appearing in Françoise Mathieu's Video
Tony Crabbe, Busy: How to Thrive in a World of Too Much, New York: Grand Central Publishing, 2014.
Patricia Fisher, "Protocol for the Hot Walk and Talk." TEND Academy website. 2012.
Richard Lawrence Harrison, "Preventing vicarious traumatization of mental health therapists: Identifying protective practices." Thesis. 2007.
Pilar Hernandez-Wolfe, Kyle Killian, David Engstrom, and David Gangsei. "Vicarious Resilience, Vicarious Trauma, and Awareness of Equity." Journal of Humanistic Psychology 55 (2). 2015.
Adapted from Françoise Mathieu, The Compassion Fatigue Workbook. "Developing an Early Warning Sign System," Editable PDF worksheet. Routledge, pages 59-60. 2012.
Françoise Mathieu, "Disappoint Someone Today," Blog post. Tend Academy website. July 23, 2018.
Leslie Anne Ross, Multiple Exposure: Increased Risk Venn diagram.
Southern Regional Children's Advocacy Center, "Got Mindfulness?" Compilation of best-rated apps for meditation and mindfulness. Printable card. 2019.
TEND Academy, "Low-impact Debriefing." Printable quick reference card. 2019. (Full version available).
Janet Yassen, "Preventing Secondary Traumatic Stress Disorder," from Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Charles Figley, Ph.D., ed. Routledge. 1995. (Table 1, Chapter 9,
"The Personal Impact of Secondary Traumatic Stress," and Table 2, Chapter 9, "Impact of Secondary Traumatic Stress on Professional Functioning.")
CHRIS NEWLIN:
LEADING ORGANIZATIONS BY EXAMPLE
"The most important thing for a senior leader to do is to create a healthy working environment for their staff." From his perspective as the Executive Director of NCAC, Chris will discuss how important it is for senior leaders of trauma-exposed organizations to model the behavior that they want to see from their staffs and managers, particularly in regard to self-care and setting boundaries between work and home. In this conversation, Chris shares his thoughts on effective hiring processes for this work, how to recognize when staff and managers are struggling with STS and what to do about it, and how compensation and benefits can be creatively used to help maintain staff's well-being and resiliency. Finally, Chris talks about how organizations can create a culture where it is acceptable for staff to be open about how the work is affecting them. He will also discuss the Wellness Plan and Operational Values that were developed by NCAC senior leadership and how and why these were created.
Chris Newlin
MS LPC
Chris Newlin, MS LPC, is the Executive Director of the National Children's Advocacy Center where he is responsible for providing leadership and management of the NCAC and participating in national and international training and leadership activities regarding the protection of children. The NCAC was the first Children's Advocacy Center (CAC) in the world and provides child abuse prevention and intervention services in Huntsville/Madison County; and also houses the NCAC Training Center, the Southern Regional Children's Advocacy Center, the NCAC Virtual Training Center, and the Child Abuse Library Online (CALiO™). Chris has more than 22 years of experience working in CACs as a Forensic Interviewer, Victim Advocate, Therapist, Clinical Director, and Executive Director. Chris has provided diverse training related to the Children's Advocacy Center Model, the multidisciplinary response to child abuse, the international development of Children's Advocacy Centers, forensic interviewing, best practices in child abuse intervention and response, and additional child maltreatment and exploitation topics in more than 30 countries throughout the world. He has worked in both urban and rural Children's Advocacy Centers. Chris received his Master's in School Psychology from the University of Central Arkansas, is a Licensed Professional Counselor, and has completed coursework at the Harvard University Business School Executive Education Program.
CHRIS NEWLIN: LEADING ORGANIZATIONS BY EXAMPLE
Hello, I'm Karen Hangartner and I'm the Project Director for the Southern Regional Children's Advocacy Center, which is a project of the National Children's Advocacy Center. We are excited to bring this video series about secondary traumatic stress to you.
In this video series we have conversations with three of the foremost experts in secondary traumatic stress and in these we discuss how do these effects show up on individuals and how does working in the field of secondary traumatic stress impact organizations in that how do we conduct supervision in a way that's supportive for our staff?
And then we'll also hear from Chris Newlin, the Executive Director of the National Children's Advocacy Center to talk a little bit about the role that the senior leader plays in addressing secondary traumatic stress in the organization and how do we go about creating healthy supportive environments that support the staff that we're working with.
In this video, you're going to hear Chris Newlin, who's the Executive Director of the National Children's Advocacy Center, talk about what is the role of the senior leader in creating secondary traumatic stress informed organizations. What do senior leaders need to be aware of and what do they need to be doing to create organizational cultures that are supportive and protective for staff?
At what point in your career did you become aware of how working child abuse cases was impacting you and your coworkers?
I think those are two different questions. I recognized that it was affecting people pretty soon after I got involved. Because some people that have been there longer, you could hear some of the comments they make. You could see some of how they would interact with others in a non-confrontational setting or when there wasn't some high stakes. And then you would see maybe how they react in another setting. You could see it didn't take them long to get from zero to 50, and so that was one side and I thought maybe it was a little bit different for me because I was new in the field and I was so focused on the uptake of knowledge and learning things and seeing things that I was just still filling up myself with all this stuff. So I was so focused on knowledge acquisition that I thought, well I can do this work. It's not an issue. This is interesting to me. There's a lot of intellectual curiosity. There's all this activity than stuff that taking in.
But then I think you reach a point, and I, for me personally, when you've taken in a lot of information, you suddenly reach this tipping point where it's like, okay, I don't need more information. I'd like a little peace and quiet now. So I think those were different times for me.
How has your thinking and philosophy on secondary trauma evolved over time?
Well, I guess I'd probably, maybe, a analogy of our understanding of using batteries to power cars. There was a time we knew nothing. And when I first started in this field, absolutely nobody was talking about this issue. It was about this is stuff you do and this is the way you go and people, but there was no real talk about this having some impact on us.
Again, this was back in the 80s, so there's many years ago and we just didn't think about it. We didn't talk about it. We were so focused, again, like the example of our personal journey, at that point we were so focused on just trying to figure out what to do, what works, what the issue is, how much of a problem is it, that it was very basic issues and being able to think about impacting people, definitely over the last decade, I would say, have taken a much greater appreciation for this issue. So much to the point that now, in many respects, this is the most important thing for a senior leader to do is to create a healthy working environment.
What trends do you see in the field of child abuse that impact how organizations and individuals are impacted by secondary trauma?
Several things. I can't say just one. One is just the stereotype, and unfortunately in our field sometimes we've created a culture of sacrifice that the greatest heroes are those who have sacrificed so much of themselves to try to move the needle. And I'm not sure that's really a healthy thing for us to aspire to. Instead of it being a culture of sacrifice, we need to have a culture of healing and support for both the clients we're working with and the content that's so powerful, but also for ourselves. That way we can be most effective. I really began to realize this when I would see turnover happening so fast in other organizations and people are like, "I don't want to do that."
So there's a lot of issues that affect it. There's not a lot of prestige in this work. You're almost a pariah. "I don't see how you do the work you do." Those things like, okay, so I guess I'm strange. I guess I'm different. And a lot of that stuff where we're not part of the mainstream of society in a way, where it's not accepted, is an issue. So I think if we're responding to the issue of children being sexually abused, which mot parents might identify as one of the worst things that can happen in childhood, if we're responding to that and trying to do the right thing and trying to help people heal, shouldn't people be really excited about this? But there's still the stigma that creates some challenge with it really being able to feel whole at times.
How do you recognize when staff members are struggling with the effects of secondary traumatic stress?
It's different because different staff have different personalities and we all show it in a different way. It's like this idea that with child sexual abuse, people always say, what are some signs that we should look for? Well all over the place. Different kids. Different things. Different ages. Just like for us as individuals, how we react to stress is different, so it's hard to necessarily pinpoint.
I would say that people, the biggest things that I see most commonly, the most common themes, would be people who are taking a very yes, no, black, white, quick decision. They hear a few facts and they're already jumping to their working hypothesis, which is already starting to be etched in stone. So that's when I see people who making snide comments that are beyond what you would expect. And then I see people who are having disrupted peer relationships with our colleagues that's one that I would say that I see. And then people who just aren't doing their job. People who just are coming unprepared. If on every case you say, "I just didn't have time to get to it," what did you have time to get to? I think those are the ones that I see most commonly.
What role does compensation, benefits, and organizational support play in protecting staff from secondary traumatic stress?
I think there's a vast array of things that play an impact in that, but just because we work in a nonprofit doesn't mean all of our staff took a vow of poverty and they are going to sacrifice anything just because they get to do stuff that means something. We all are maybe called in a different way to certain types of work. So I think it's important for the broader public to better understand that just because you work in a nonprofit doesn't mean you can't have a revenue positive year or people can't be compensated a fair wage for the work that they do. Especially given all the impacts that child maltreatment has on our nation's health and economy many, many years into the future.
I would say overall compensation, two big things, three big things, I would say, that are important to employees in building a sense of support is compensation, how they're being compensated, compassion, and then communication. I think those are three really big pieces that are a part of providing that supportive environment. Benefits as part that overall compensation.
The reality is we try to benchmark salaries and all that, but for people to know they have a safety net that if something were to happen that's something they don't have to keep in their forefront. I can't imagine being in a situation where I was worried about what support I had and I didn't feel much support. So it goes well beyond benefits. Benefits is one part of it. And trying to provide benefits that actually employees view as beneficial. It doesn't really help us to say, we're offering these benefits ABC and you're like, I don't really use A, B or C. I was really hoping to have D and E. That's one thing. And that is a broad human resources discussion.
But there's a lot of other things. Having employees make sure they have the training they need so they can be successful in their job, making sure they have good supervision that is supporting them. Making sure they have clear goals from the time they start in their first 90 days, and then feedback so they're getting that feedback all along about how they're doing and also checking out they're feeling about their work. And then having all the business tools you need. Having the lights on, the AC working, having the necessary equipment to perform your job that is up to date. All of those things.
There's a myriad of things, but I think at a bottom line, as a senior leader, I look at it as when people come to work, they don't have to worry. There's a whole bunch of stuff that we've taken care of. We have good wifi. We have good internet. We have all this stuff. All that stuff they can set aside. They can focus the energy they have on their work and on their clients. And that way they don't have to try to figure out, well, I need to do IT support for my three neighbors because we don't have any support. So having all those supports there, is really important and maybe more important than the actual benefits that we offer.
NCAC has created a really healthy organizational culture and part of that was the creation of a wellness plan. Can you talk a little bit about what's included in the wellness plan?
We broke that plan into a lot of different phases. Our preemployment and employment screening activities, the onboarding for staff, the benefits that we provide to them, what we're doing from a training perspective and supervision. All of these areas are different components within the wellness plans.
It started off as let's just start jotting down these ideas. Now it's turned into about a four page document at this point. There's some specific things that we did. One is we include questions in our interview process and we acknowledge this issue that working in this field can be challenging and difficult and what that might be like. So it's looking at that issue. It's also in our benefits about we now provide an additional four hours of leave every month that you have to use or lose that month for full time employees. It encourages them to be taking their time off.
When we do our performance evaluations, we like to get the reports of how much people are utilizing their time. If you have someone who's using a lot of their leave time, maybe there's a need to have a discussion about what's going on. If there's someone who's hardly at all using theirs, is that really healthy? We can also look at their average hours, how many hours are they actually working per week, and see if we have someone who's not taking a leave time and is consistently working 92 hours every two weeks, maybe that's not the healthiest thing. Maybe where there needs to be a conversation about that.
So part of our effort was, hey, you get these four hours, use it or lose it, and people can take a Friday afternoon off, or they can take and leave an hour early every Friday, each month, whatever they choose, it's a tangible way to get them.
Training all of our staff on how to provide supervision and reflective supervision. And we've also now provide a training series for all of our supervisors. Anybody who's a supervisor can come to these regularly scheduled meetings to learn about supervision related issues and how to be supportive and how to be engaging.
The other thing we did for our direct care staff is we actually went through a secondary traumatic stress workbook and it was some guided, facilitated conversations for those that were interested to be able to do that.
Providing an orientation where people really get a good understanding of the NCAC is important. There's so much goes in there that is all about that building resilience.
How do children's resilience parallel professional's resilience?
What is it that can help make kids more resilience and it's amazing that the findings from what kids who may have experienced trauma, those who are most resilient, and professionals who work in the field is it's people who feel like this work means something. This work not only means something in the world, it means something to me. This is important. I feel like I'm making a difference. People who have a sense of good healthy relationships with others where there's some sense of connectedness, and those who have supportive supervisors in their life, or parents, or adults in their life. So those things support resilience in kids who may experience trauma, but they also support resilience and our staff who are working in the same arena. So being able to attend to those types of issues.
Why do you want to work here? Which can be a powerful question. But also even with our staff, we've done surveys before where we just said write down one reason, the number one reason, why you work at the NCAC, and to go through those answers and see that this work, I want to do something that means something to me and makes a difference in the world and helps others who are in need. That's the person who that really resonates with that meaning making in life, which is a supportive and resilience building concept that we really benefit from having those people onboard.
How can the community and a board of directors play a role in supporting staff?
I think everybody has a role, board included, and actually I would even extend that beyond, the broader community. Thanking people for the work that they do. Recognizing that we have staff that are putting themselves right in the front line of all this trauma that they're exposing. They're sacrificing a part of themselves to help out those who are vulnerable and in need. I think that's a great thing.
So people play a role in increasing the credibility and the belief and the support for people working with traumatized populations as a broad and reducing some of the stigma around that I think is the broader community.
The board absolutely plays a role, so we make sure that they're informed about secondary traumatic stress and the impact it has on our workforce. We're overseeing our programs and processes so that we're trying to remove as many institutional barriers that cause people frustration. And so the board, absolutely.
The other thing is our big focus this year is having the board present more, for them to be much more seen and engaged by our staff. Not that we want to interfere with our staff work, but just for them to know that here are people from the community who are volunteering their time to support the work that we're doing. I think that can be powerful.
What are some specific things that the board can do to support the executive director or senior leader?
The board of directors plays an important role at the CAC. Ultimately, they have one big decision, which is, do we keep the director or let the director go and go a new direction? That's their one big decision every time, which is about oversight and their responsibility. But our board asked really a great question, which was, instead of them asking me questions all the time, was a question of, "What do you need from us? You're here every day with these folks. You're here running this. What is it that we can do that's going to help you and the organization as much as possible?"
Asking that question and allowing the director to share that can be very empowering and very supportive to the organization. So I would encourage boards to have that dialogue about, "What is it you need from us? There's some things that we may try to give you that you don't need, but what is it you really need?" And for a director to spend the time thinking about that and to share that and then to work on that as clear plans. There should be a theme in everything that the board's trying to do, that it should help support those initiatives.
Now if the board says, "That makes no sense to us. We don't understand that," well, maybe that person doesn't have the vision that's aligned with the board, I don't know. But having that dialogue about really what the board can do to be supportive, because then that all flows out to the staff too about how the board are being supportive.
Every year we do a holiday party. All of the gift cards on the tree, all of that going to employees, all comes from board members. It's a clear way, a tangible way, they can show the staff they care and they want to be supportive of them.
How do you build your own circle of support?
As far as my wellness, I think it's been a real journey for me. I will acknowledge that there's been times when I have worked way too many hours and part of that was I felt like in a way maybe I needed to prove myself. I felt like I needed to show that I was going to work as hard as anybody else, which is, I guess, important is you don't want to role model that, hey, the executive director works 24 hours a week and gets paid full time and while that's happening, we're all here. You don't want to do that.
But I was initially in my life so interested in learning and stuff, you couldn't overwork me. I'd be doing stuff all the time it felt like, because I was just so intellectually curious. But I began to realize that you need to prove that you're going to work hard, you're going to be as committed to this as I want others to be, and what I didn't realize is I reached this point of inflection where I began to see it from a different perspective that, okay, I've proven the point, but now all I'm doing is modeling this culture of sacrifice that I'm talking against. I'm continuing to perpetuate this. And people are like, "Well, Chris is here till 6:00 on Thursday night. I guess I need to be staying longer," which becomes a very negative and unhealthy flywheel.
This was brought to my attention by our leadership team, which is, I think this is about good, open communication. One day, finally, somebody just brought it up and said, "When I get emails from you on the weekends, it makes me feel like maybe I need to be working and the rest of y'all feel that."
Well, great. That was awesome that they brought it up. I had no awareness. My thought process was, hey, sometimes I get up early in the mornings and I'm thinking about stuff. I'd maybe push out some emails, but nobody's going to look at that until Monday. No, it was popping up on their phone. It was popping up on their computer. They saw it. Whatever. And it was like this subtle message, hey, you need to be working seven days a week. You need to be getting up at 5:00 AM like crazy, Chris. Those kinds of things.
And I'm like, whoa, that's really informative. So now I don't send any emails out on the weekend unless it's an urgent issue and that probably more so a text, just to give people the space. I've also started working more reasonable hours and not working these ridiculous hours because I recognize that it's for my own well-being and my family's important to me and other activities are important to me, but it's also a way of modeling for the other staff that you can have boundaries and it actually is a good thing to have boundaries.
How do you create a structure within the organization that supports a more secondary trauma informed multidisciplinary team?
I think there is this awareness, even with the supervisors. Typically supervisors are a little maybe more removed from the direct work and maybe a little more removed from understanding some of that. So part of it is, the first thing is really putting it on the table and saying, this is an issue and acknowledging our own vulnerabilities, our own staff's vulnerabilities, with us. And it's hard for anybody to deny that this work has some impact on them.
I'll give you a great example. We had a detective who had an acute incident occur. Details aren't that important. But the supervisor talked to her right after this incident, the Chief Deputy, the Sheriff all came in and spoke with her about this and she said, "I want to go over to the CAC," because there's some sense of support because we're all in this together.
It's a small part of what they do. It's a huge part of what we do. We build this sense of community. But what the supervisor did was smart. He called me. He just didn't say, okay. He called me and said, "Hey, I want to let you now this is what's going on. This is the most information we have. This is what's happening. This individual is on their way over there, can you try to be supportive?" That's informed to know to call me and to give me the heads up so that we can help be supportive and we're not coming from this, we don't even know what's going on. There's more support and understanding.
We bring it up at all of our supervisors meetings for us to be talking about this issue and what we can do to be supportive. And part of it is, again, more of the proactive stuff. Making sure our team has the training. For there to have some autonomy and control over their life. Like, hey, we got this symposium coming up, what's content you'd like to be able to see presentations on?
Being responsive to them and supporting them is, I think, very important. But doing it at all levels. So the frontline professionals with the supervisors, even with the senior leaders. For the senior leaders to be aware and they're here with our board members often, and for them to reaffirm the interagency agreement that we have and just a small piece of them being recorded in media talking about the importance of their institution, their organization, being involved in this work and how the collaboration is so key, that sends a message that this is a priority. This is something that we support. And that is supportive to employees who may otherwise feel like, I don't even know if anybody recognizes what I'm doing over here.
Do you think senior leaders of multidisciplinary teams are open to talking about and being educated on the effects of secondary traumatic stress?
Well, I think it's all a matter of how it's presented and how it's shared. I recently heard someone talking about if you talk about teaching someone relaxation exercises versus tactical breathing, that puts it into a nomenclature. But they also know this stuff. Think about the firing range. You use tactical breathing at the firing range. You take a deep breath, you exhale, you focus, you center yourself. Basically what they're teaching, without knowing it, is mindfulness. Really getting into that moment, shutting out everything else. That's the same thing. So they do it, but they don't use the same language.
So we need to make sure we're communicating to them in a way that makes sense. Because my supervisor's like, "Well, I can only keep folks over here for three years." Okay, so you're basically saying, yes, I recognize this work has an impact on people. Well, how do we mitigate that? How do we make sure that if they are here three years that it's the most successful and healthy three years, and when that three years is up, this person isn't completely spent and almost ineffectual in continuing their career because of trauma that we've exposed them to without that consideration.
If organizations want to actively address secondary traumatic stress, where do they start?
First, hopefully, they wouldn't say I have all the answers. So I want to be humble in trying to respond. I think we're still trying to figure that out and for us to say, I've got this, this is a no brainer. No. We have a wellness plan that we've developed here at the NCAC. It's a living, breathing document. We come up with new ideas. We expand on that. So it's something that continues to evolve. We ever say we have it, I would say that's a problem.
I would say some of the things that I would say are necessary but not necessarily sufficient is people who are talking about this openly and a senior leader who is definitely talking about this issue and creating a culture where it's okay to talk about this issue. Implement where there is really the support for implementing practices that help foster wellness within our employees to assure that they're going to have the best supports that we can provide to them. Having a facility and a sense of team with where their support between colleagues, where they feel a sense of support both from their peers but also their supervisors, where there's always situations where there's reflective supervision and supervising, or asking that most important question near the end of any conversation, is there anything I can do to help you, or what can I do to help you, where that is openly invited.
Those are some hallmarks that I would say have to absolutely be there. We just can't continue this culture of sacrifice and feel like we're ever going to truly make progress. The progress that we desire.
What do you look for during the interviewing and hiring processes that lets you know that a person has the ability to work in these high trauma exposed environments?
I think it can depend maybe on the role. Some people have more direct exposure to it than others, so there's obviously a difference between maybe a forensic interviewer or a clinical director, and, let's say, a finance director who's going to be a bit more removed. But everybody, is at some depth of the pool. We are all in the pool. Some people are in maybe a little bit of deeper water than others and we move around from time to time, but I would say probably the most impactful thing, there's a couple of things that really stand out to me.
The first would be is really the use of our operational values as a way to help identify those who will probably best fit. We know that our best employees are employees who really embrace those four areas of going above and beyond, that commitment to excellence in everything we do, teamwork and innovation, those are our four core operational values. We know that our best performing employees are people who really embrace those.
So including in the interview process, specifically querying about those. Some of the background experience and stuff is important, but finding people, and I'm not saying everybody needs to be monolithic, we are incredibly diverse, but people who have these themes of innovation and a commitment to excellence and going above and beyond, and teamwork, where they can really talk about that in a meaningful way. That's, I think, one very important part.
And also during your reviews of that reflective supervision about look, going back to those and what they've done, where they've maybe struggled, is really helpful.
The second piece, to me, that is really important is having a candid conversation in the interview process about how it might be for them to work in this type of setting. I had a candidate for a position who was an outstanding candidate, was on that short list, and this individual had never worked in child abuse, but had some really amazing talents. And at the end of the interview, near the end, we spent some time talking about, "How do you think it might be to be working in this environment around this issue and, although not directly exposed to it, talking about this issue?" And the person, said, "That's really something I probably should think about. Thanks for asking that." And I said, "Just take some time." And we identified a time at which point she would get back in touch with me.
That day comes that day goes, no response. Hope everything's okay. Ultimately, a few days later, after I reach out, I get a response back and that question was important. That person really spent some time thinking about it and basically came to the decision, "As much as I believe in the work that you do and as much as I will actually continue to be a donor, I just, for myself, don't think that that's the right setting for me. I'm not sure it's going to be healthy for me.
Well, I'm glad we knew that, both of us knew that, before we actually made a hire or an offer. So being able to have that candid conversation with candidates about this is really important and that we recognize that we talked about this issue.
How do you create a sense of trust and safety that allows staff to be open about the impacts of secondary traumatic stress?
This is a slow flywheel turn. You can't rush this. The more you rush it, the more it won't happen. You have to be consistent. You have to do what you say and say what you do. You have to provide at all levels support and recognition of this issue. You can't rush it. It's just something that takes time and you have to be patient and you have to be committed to it so there is no magic panacea that happens overnight. The magic is when you start to really build that and continue to support that and people really build true relationship with one another and we are looking out for each other and feel like the organization is looking out for us, where it's not always the man's out to get me kind of thing.
When you can get to that point, which takes time and commitment and consistency, I think you goes back in some ways to we model what we want and working reasonable hours, having reasonable expectations, sometimes saying, no, I can't do this now, and really identifying what are the most important things we need to pay attention to and what are some things maybe that we can let go. Those are very important.
But also it's important to monitor and acknowledge for ourselves. There have been times in this work that I have felt like I've really done something valuable. I have truly made a difference. I moved the needle in a big way. There are other times where I've felt like, what am doing? Why does this board continue to employ me? I'm so ineffectual. I can't figure this out.
I think it's okay to acknowledge I'm not hitting on all cylinders today for whatever reason, and I think making it okay is one thing. The other is acknowledging that we all make mistakes and when people make mistakes of being supportive, while still there's some accountability, but still being supportive. I think showing that, that modeling, is everything for a senior leader.
What do you wish you had known about the impact of working child abuse cases when you first started out in this career?
I think there's a level of understanding and intimacy sometimes that people who work together in this issue just have an understanding, hey, we've been there, we know what that's like, that's hard sometimes to communicate to family members and those who we're in relationship with, and it's hard for them to really understand maybe where we're coming from, and being able to communicate about that more effectively would have been great. Even just the awareness that sometimes when I come home from work I'd be perfectly happy to just put on a pair of shorts and tennis shoes and go out and mow the grass and not talk to anybody, just because it's a way to center myself. There is something oddly repetitive and there's a little bit of very basic mindfulness about just following the line. I don't have to think too much, but I am doing something. I can sit back at the end of it and look at it and say, oh my gosh, the grass looks really nice. I feel good about it. Plus I've sweat, and that felt good to get some exercise.
All whilst when I go in the house, when I'm feeling, oh man, that was good. I had a good day at work and I was able to do this, so my mind's a little clearer, and it's like, "How come you don't want to spend time with us?" So I think being able to better communicate and understand this when I was younger, might've been really nice. It would have been helpful.
Appearing in Chris Newlin's Video
National Children's Advocacy Center. Wellness Plan. 2019.
National Children's Advocacy Center. Operational Values. 2019.
Pat Fisher:
The Ethics and Pragmatic Reality of Creating Healthy Organizations
"It's one of those happy circumstances where the ethics of creating a healthy organization is in exact alignment with the pragmatic reality of this. Organizations need to have the healthiest possible staff in order to be maximally functional and to be able to meet their mandates." In this conversation, Pat Fisher talks about what a trauma-informed organization looks like and how an organization begins to think about creating working environments that are supportive for staff and specific strategies that organizations can implement. Pat shares her insights and knowledge gleaned from her career as a researcher and consultant to staff and leaders of high trauma-exposed organizations. She will also discuss her 12-Factor Organizational Health Model, which helps to understand and predict human behavior and attitudes in the workplace as well as how these behaviors and attitudes can determine how well or not your organization functions. Pat will also address high turnover in the workplace and how organizations can address productivity.
Dr. Pat Fisher
R.Psych
Dr. Pat Fisher is a clinical psychologist and specialist in organizational health and workplace wellness in trauma-exposed workplaces. As the founder of Fisher & Associates, over the past 25 years she has developed a host of research-based training programs, assessment tools and solutions for trauma-exposed workplaces and the staff and managers who work in them. Pat develops research-based training programs, assessment tools and solutions for trauma-exposed workplaces and the staff and managers who work in them and is a Senior Advisor and co-founder of TEND. She consults with organizations looking to develop solutions to the complex challenges that often accompany high stress and trauma-exposed sectors. Pat has authored numerous books addressing trauma-exposed workplace issues including: Resilience, Balance & Meaning: Supporting our lives and our work in high stress, trauma-exposed workplaces, Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments.
Pat Fisher: The Ethics and Pragmatism of Creating Healthy Organizations
Hello, I'm Karen Hangartner. I'm the Project Director for the Southern Regional Children's Advocacy Center, which is a project of the National Children's Advocacy Center. We are excited to bring this video series about Secondary Traumatic Stress to you. In this video series, we have conversations with three of the foremost experts in Secondary Traumatic Stress. In these, we discuss how did these effects show up on individuals, and how does working in the field of Secondary Traumatic Stress impact organizations, and how do we conduct supervision in a way that's supportive for our staff?
Then we'll also hear from Chris Newlin, the Executive Director of the National Children's Advocacy Center, to talk a little bit about the role that the senior leader plays in addressing Secondary Traumatic Stress in the organization, and how do we go about creating healthy, supportive environments that support the staff that we're working with.
In this video, we're going to have a conversation with Dr. Pat Fisher. She's going to talk with us about how does Secondary Traumatic Stress show up in our organizations, how do they impact our organizational cultures? Then what are some of the strategies that we need to be implementing to create a Secondary Traumatic Stress informed organization? Enjoy this fascinating conversation with Pat.
Question 1. How did you get interested in the field of Secondary Trauma?
Dr. Pat Fisher:
Let me turn this into a 30-second version. I'm a Clinical Psychologist. My early research, going back over 30 years ago now, was in the field of women, adult survivors of childhood sexual abuse. They were also, many of them, coming into the Mental Health Center with assault histories and really serious conditions. That was at a time when work around sexual assault and child sexual assault was in the very early stages. In fact, we were pushing rocks uphill back then, because the psychiatric textbooks were still saying only one in 10,000 families experienced incest. It was the really early days.
I specialized and developed a lot of training protocols, evidence-based treatment protocols, assessment stuff, all of that. I did a great deal of work over that next decade with adult survivors of all forms of abuse and violence in all kinds of settings. In all of that work, I also became a specialist with sex offenders and the whole forensic system. It was a full tour of duty around all the ways that trauma occurs with people. Then what became really evident, round about the early to mid to '90s, was the impact that doing this work was having on all of our folks, the people who are working with these highly traumatized populations.
I, along with the other folks in the field at that point, became really concerned with how do we understand what this is about, why it's having that kind of impact with us. That was at the stages, too, when folks, Laurie A. Pearlman, [Sarah Quitney 00:04:48], David Finkelhor. People are starting to look at issues around compassion, fatigue, precarious trauma, Secondary Traumatic Stress. All of those notions were starting to bubble up and work was happening.
I started my own research protocols, looking at the whole characteristics of our workplace, which were not only our exposure to trauma, both indirect trauma and direct trauma, but also what was going on in terms of the amplification of stressors that were happening for people in our workplaces. Because the way work was being done was also rapidly shifting at that point, with the whole drive towards leaner, meaner and restricting resources. We were seeing this hugely amplified stress environment for people. That was sort of the direction I was coming at this from, both as a researcher, a practitioner, a policymaker, all of that.
For that first decade, through the mid-90s through the first five years of this century, I was really looking at how do we address this and provide really good resources and training for people who are exposed to all of this? So all of that programming. The next thing that seemed really important to me was, what was the role of supervisors and managers in these systems? Because it was also very clear that our supervisors and managers were under tremendous amounts of pressure. The way they were doing their work and intersecting with the frontline people was having a great deal of impact on whether it was either mitigating these stress effects, or whether it was amplifying them.
Again, a lot of research and programming, and resources around that. More recently, in the last 10 years actually, is looking at what are the characteristics of organizations, which are dealing with trauma-exposed populations? Because, again, that next level up, they look different from other kinds of organizations. So again, all the research, practice, etc. around how do we address this? What's going on there, and what do we understand? I think one of the most pressing issues, in many ways, is that in this last decade, 15 years, there's been the huge impact of the demographic turnover. And that, high levels of turnover, all sorts of new generations coming into the workforce, and of course what's that meant in terms of technology, communication, the information revolution.
All of these factors have played a really big part. Many of them hold opportunities to potentially mitigate stressors, and others of them are providing a great deal more stress. We actually are in sort of in much more turbulent systems these days, while we're dealing with really high impact material. The systems we're looking at that have so many moving parts. I think one of the really important pieces here is that you're dealing with so many moving parts in these hyper complex systems now. That's actually the good news, because it means there are so many avenues that we can start intersecting with, to start moving things in a better direction.
If you're dealing with a really simple system and there's only two levers to pull, if you can't pull either of those levers, you're kind of hooped. Whereas, we've got really complex systems, so there's so many avenues of entry. The more we're understanding the complexity of these systems and all of these different components, the more opportunity we have to be able to meet an organization or a system where it is right now, and then see where does it make sense to start moving at? What's the order of the possible here?
Question 2. What role does the organization play in creating work environments that are supportive and protective for staff?
That's such an interesting question. Because I think if you sort of pull way, way back and look at it, when you hold an awareness of the consequences to the capacity of any organization or any system, when it's carrying such a high burden of people who are struggling and who are really impacted by the high press of the word and you're seeing all of those stress effects. Clearly, that's not really optimal. So this is one of those happy circumstances where the ethics of this actually are in exact alignment with the pragmatic reality of this.
We need to have the healthiest possible staff in order to be maximally functional and to be able to meet our mandates. I come from the farm originally. The kind of notion would be, "We're going to run a dairy farm with a bunch of starving cattle who are not being well-fed and never get to see any pasture." You're not going to have a great output. We need healthy organisms in order for them to function in the best way possible. That's the pragmatic part.
All of us, I think, can also buy into clearly the moral and ethical imperative in this. I think there's another piece in this, which is a kind of congruence. We're doing the work because we believe it is important and it holds moral value in the world. How do you hold congruence, if you say, "We're going to do this really important work, and we're going to fry our people out." That is so asymmetric. That can't work. It's not sustainable. I think most people get it in their gut. We come back to the whole notion of awareness and people knowing how this stuff works. Then they can hold some accountability for that at the organizational level.
Question 3. What does a Secondary Trauma informed organization look like?
I think that you're not going to find one answer to that. I think, again, because we have so many moving parts involved in this. Parts that will be important underlying all of it, is first of all a literacy around the issues of Secondary Traumatic Stress and the outcomes. That literacy flows across the entire system, so all the way from frontline people through supervisors, through senior management, through Board members. When you've got that kind of full literacy and awareness, then you're in a position to start moving into practical approaches that make sense inside of the way that organization functions. Again, you're going to have all kinds of ecological differences between different organizations. You're not going to be able to work with what's going to be most effective here, if you don't even have literacy that we have an issue, and that it's safe, and it's trustworthy and we can talk about this.
Question 4. Can organizations, themselves, become traumatized?
Absolutely. Many of us in the field have either worked in them or we have colleagues who have worked in them. A traumatized organization, in many ways, looks an awful lot like a traumatized person. It's just scrambling to do the basics, things are falling off the table all the time. It is not able to do forward thinking. It's in crisis management mode all the time. Part of what will happen there is that when people and organizations are in crisis management mode, they're doing that black and white reactive thinking. Something comes up, there's a huge reaction to it, and then the next reaction, and then the next reaction. And then they're finding, they're spending so much of their time and energy dealing with unintended consequences of those reactive decisions that they made. Because they couldn't be grounded to see what are the consequences, if we go this way, that way, and understanding things in a much more complex frame. There are tough places to be in. They fry people out, and fried people don't make the best decisions.
Question 5. How does an organization make it safe and normal to talk about Secondary Trauma at every level?
Again, in our experience, because we get to work with organizations all across North America, it kind of depends on the organizational culture and what the starting point is. In organizations, typically what we end up seeing is organizations who are at one or the other end of the spectrum. Organizations that are actually doing pretty well and they want to do better. They may not know anything about Secondary Trauma. They're capable groups. They actually have an appetite to learn, "What is this? How does this work?" So you're walking into a pretty stable environment. So that first piece is developing awareness and literacy and normalizing, "How does this stuff work? What are normalized outcomes for it?" Then there's room to start working with, "What then what must we do?" That's the optimal side of it.
The other side, which we tend to see more often, is organizations who have bottomed out. They're in real trouble at this point. They're really suffering. In those situations, typically, we, or others that do the kind of thing that we do, would come in because it's a massive crisis at this point. They're just bleeding out. They're losing staff. Their turnover is through the roof. They're just having terrible challenges. So at that point, it's not unlike being taking an individual into therapy. First you're needing to stabilize system a little and then be able to start moving into, "What then can we do?"
Part of stabilizing the systems, too, though is that psycho ed. piece, with normalizing, what they're experiencing. Fitting their experience into our understanding of what happens to individuals, teams and organizations in a high trauma exposed environment. All of a sudden that stops removing some of that individual stigma and introducing more compassion in the system. From there, you can then start leveraging up about what we need to do at the sort of frontline individual level for people, how we need to help and support supervisors, and then how we need to support senior management.
Question 6. What are some specific strategies organizations can implement to create more supportive and protective environments?
The first stage for an organization is for them to actually have a grasp of how much stress and press they're experiencing. How high is their exposure? That's the first piece for them to get onboard. Again, we can't hold people accountable for not knowing what they don't know. That first piece is, "Holy cow! We really are in a very high trauma exposed environment. We've got a lot coming at us." Okay. If we get that one locked in, then the next piece, given that, is what do we need to start moving? I think the first piece is typically training, psycho ed. Training around, "How does this work? What are the characteristics of STS and the overall high stress environment that we're working in? What are the kinds of outcomes that come with it?" Absolutely normal outcomes.
What are some of the imperatives, first at all, at the individual level, in terms of self-care that we can do? What are some of the basics that we can use inside of our teams? Just begin that first awareness and equipping people to start looking at how they can actively start mitigating this and moving this forward. The next step, I think, is how we start training our supervisors and managers, our leadership people. Because, again, they're the meat in the sandwich and they are so often neglected, but they're critical for how this is going to play out. Again, equipping them and giving them training around how this works for them, as leaders, with the teams that they're supervising. What are the team needs? Again, frameworks around how to understand that, and then processes that will be helpful for them.
Then also, what are their needs as supervisors and how are those being met? As we move this forward, we kind of go from the place of, first of all, the needs assessment. We got that it's a big deal. Then we start looking at what we can do that's helpful to learn how to address it, and so there's a lot of actual training and learning there. Then the third step really is, how far along are we in implementation? Because we can get to the place where people have information, but that doesn't mean that they're applying it. So then what are the things that will help them move this forward? What are some of the barriers to it?
It's very much an evolutionary or developmental kind of process in an organization. So you're trying to build in something that is sustainable, self-replicable. You're building competency into the full organization. But often, you're starting from a place where they don't even know they have a problem. They know they have a problem, but they have no idea what this really is and how STS fits into this.
Question 7. What are some good policies you've seen organizations implement?
I think that, again, given the social ecology of each organization, it's going to look a little bit different and it's going to grow out of the basic principles. I think some of the basic principles involved are how are people at all levels feeling connected with the values and meaning of their work? That is one of the bigger protectant for folks. If we can keep grounding in that what we're doing holds real value. Everything from how that's incorporated into good supervision, and supervision at all levels. We don't just supervise frontline people. We have supervision and peer supervision for supervisors. For people in leadership series.
People feeling really equipped to do the job, and not at the end of the diving board, and feeling a real sense of safety and community. Again, supervision, peer supervision groups. All the ways in which we build safe, trusting relationships for folks. That gives so much support for people. It also comes into how we're shifting the culture. Because at the end of the day, we're really embedding a different cultural set here. Many of the helping professions have this kind of implicit bias that you are supposed to give all. And if you have maybe a little teeny fraction left over at the end, you might give some of that to self-care. Well, given the level of press that people are under, this is not sustainable.
We all know how difficult it can be for people. So I think one of the big things too, is we need to start shifting and normalizing all the way through the system. I like to think of it as the metaphor that we move from that old equation, in the helping profession, which is, "Either I will help you, or I'll help me. If I help me, I'm selfish and bad, so I'm just going to help you, and you, and you, and you. And I may get some crumbs at the end." It doesn't work.
You need to move from that equation to one of the airline metaphor, "I have to be breathing oxygen. I have to be intact so that I can help you." So it moves from an either/or equation to an and equation. That is a huge cultural shift. Of course, one of our problems is, is that when any of us is under press and stress, what we're going to do is we're going to regress to the old way of doing things, not a new more cognitively complex way. We also have to be able to have cultural support from each other, to be able to say, "Uh, oxygen mask. They're running off into that other place again." We need to be really be looking at a thorough way of how we can have congruence between how we are taking care of ourselves, so that we can take care of each other, so we can take care of our clients over the long-term and remain healthy.
Practices that support that in different organizations are going to look different. If you've got a centralized organization, you probably have some real opportunity to have a lot of team activities, frequent meetings, peer debriefing groups, all sorts of things that you can start doing, and you can have all sorts of options too, in terms of management. Being able to support each other. When you have more decentralized teams, then you start looking at, "Okay. How do we start effectively making this happen?" when there may be a huge geographic separation.
In some of those, we're seeing people using new technologies. So they're having video meetings on a weekly basis. The conference call with the thing in the middle of the table typically is absolutely dreary and deadly and never works. I never advocate for those. We need to see each other's eyes. It most effective if we can be in the same room, but if we can't… If we can see each other and we can build strategies around that.
One of the things that we've done a lot with is developing and providing sets of strategies and ways at coming at all of this. But the strategy on its own, when it's segregated from why we're doing it, it's not going to be useful. We really need people to understand the whys. Then from there, they can start looking at, "What's going to help us do these things?"
Question 8. After a really tough case, is Critical Instance Stress Management a good strategy for organizations to use?
The traditional CISM approach has been well-researched certainly over the last 20+ years. Certainly there are real concerns about how effective that is. In fact, in some cases and instances for people it can be counterproductive and not helpful. I think, again, if you have a well-informed workforce and supervisory group and you already have in place individual and group supervision, you have a resource there that you can start stepping into when critical incidents happen.
One of the big characteristics around trauma is that when something really awful happens to you, you haven't had any control over it. What we don't want to do is duplicate that in an effort to help you. You have no control over it. I'm forcing you to come, and I'm forcing you to speak in front of all of these people. We can just be enhancing the whole trauma response. So we're always wanting to look at, "What is going to helpful for that individual? Where are they sitting with this? How well do they understand their own needs, and how can we support them?" We never, ever want to force somebody to do anything. We certainly want to invite them into a range of options that we've already discussed with each other and we know are available when things like this happen and then support the individual stepping into what it is they need. And continue to check in with them, but not in a stalky kind of way.
Question 9. Can you explain the complex stress model?
Again, this one came about because, with the emergence of the initial work around Secondary Traumatic Stress and all the work that we already knew about the impact of primary trauma, the direct trauma that happens to somebody. We're looking at our organizations where we have exposure to both direct and indirect trauma. So we know the trauma story and how that works. That clearly wasn't covering the full flavor of what people were experiencing. The other piece of it is all of the systematic-based stressors. That's to do with organizations in the workplace, across all workplaces. IBM, Wendy's. Wherever we're going, we're going to have elements of these. Again, that whole area is very well-minded out.
There's this major categories under the Systemic Stressors for Organization. The first of them is all of the job stress literature. Everything we know about job stress and the characteristics of demand, control, social support, etc., etc. There's about 13 factors in there. Then all of the burnout literature we have, in terms of just press and inside of any kind of workplace, that can lead to classic Maslach style burnout, where the person really is suffering very serious injury at the further end of it.
Then all of the issues around discrimination, bullying, harassment. That cluster all falls into the systemic stressors. What we'd often find when we'd go into some organizations, certainly in the earlier years, is people would say, "I can handle the clients, but it's the kind of stuff that's going on that I'm being subjected to inside the way the work is structured that's killing me." So being able to see, when we have both of these kinds of vectors of stress coming in on people, the traumatic stressors and the systemic stressors. What we were finding is two, three, four times the level of negative outcome than we would be looking out for folks who were only dealing with one side of that equation. They actually kind of cross potentiate each other. It's a much, much more escalated stress environment that way.
Coming back, that again, gives us so many more levers to work with. There are elements of some of the traumatic stressors that we're subjected to. Like the nature of the population, the kinds of stories, or the kind of stuff that we're going to be subjected to, that we can't change. But the way we encounter the workplace can make a lot of difference in mitigating how much that's going to impact us. Some of the things that keep coming up top of heap, are things like the quality of social support and engagement we have with our colleagues. We all know, when we have a really good connection with our colleagues that's safe, it's trusting, we are so much more robust.
But if we're isolated, either geographically or socially, we're that much more vulnerable. The kinds of issues around just working conditions. There's a lot we can do to optimize that. Then, of course, the harassment, bullying and all of that kind of stuff is absolutely deadly. So you can think about this kind of assaultiveness going on for somebody in any workplace is a big deal. For that to be going on for somebody who is also dealing with really high level trauma exposure, that's crushing. You start seeing how these are intersecting with each other and how many points of entry you have, to turn it the right way around, and to really increase the overall resiliency of folks.
Question 10. What's the intersection between basic organizational health and individual traumatic stress?
What's helpful in the organizational health model, and this is the one that's 10 years old, 12 years old now, anyhow. If you are able to see the graphic, really what determined this, is there's really 12 factors we're looking at when we're describing organizational health. What's most important about them is the way they're related to each other. What we sort of found conceptually and theoretically is that there are three base factors, and everything else is an outcome of. Is employee health and wellness, leadership, the capacity of leadership, and succession planning, the turnover piece.
So the employee health and wellness is a cornerstone. When we're going into the organizations that we work with, typically what we'll be finding is often around 25 to 30+% of folks would meet diagnostic criteria for clinical depression. Anxiety spectrum disorders typically in 40+% of folks. Serious sleep disturbance in well over 50% of folks. Those are just a few of the metrics. You start looking at this and you're thinking, "We're expecting phenomenal performance from a group of people who are carrying such a burden of stress effects." That's not fair. It won't work.
This is the piece where the complex stress model and the outcomes of stress will sit there as a cornerstone, in terms of the actual capacity of the individuals that we have in our organization. That goes over next door to the quality of the leadership. Leaders are people, too. So many of them are really struggling. We need our leaders to be as well trained. And again, most people who have gone into leadership roles, just kind of get plunked there. Nobody's giving them training. They're doing their best, but they don't have the support and the knowledge base to really support them in doing the work they're doing.
That piece critical. That middle piece is the foundation level is the succession planning piece. That's the part that really speaks to this tremendous shift in our workforces over the last 20 years. From what were typically pretty stable groups of folks with low turnover, to areas now where we're looking at very high levels of turnover. So you're seeing how that plays out. We know that when someone is new in position… It may be an experienced worker, but it's a new position. It's typically one year till they're up to basic competency, and two years till they're getting up to full expertise. If we have a system where we have 10 people and we've got… In the good old days, 9 of them, really well experienced and say they're all healthy. They're working 100%. One person is struggling.
The capacity of that 10 group of people would be sitting at about 95%. But our reality now is we've got that group of 10 people? We've got 5 of them who are brand new. They're not up to full capacity yet, because they're brand new. Some of them are not very healthy. They're really struggling emotionally and physically. So their capacity is cut down even further. Then we've got the real experienced who are fried, because we've got so many new people that the experienced people are having to work triple time to try to compensate for the other.
All of a sudden the functional capacity of that group of 10 people, has shrunk down to about 52%. But what we, as organizations are typically saying, is, "You've got 10 bodies and 10 seats. We expect you to be at full capacity and handle a full caseload." Well, that's not structurally possible. Part of it too, is looking at, "How do we keep people well? How do we stabilize turnover? How do we support our leaders, so that they can be in the best shape possible?" So we're going to stabilize our system and equip it.
Then the other outcome variables of work health start making sense. Communication capacity goes up. Respect and sort of interpersonal regard, the ability for people to lead more balanced and healthy lives. When you start looking further up, too. Training, and how our training environment is sticking. Again, you could have the best training in the world, but if you're providing it to people who are anxious, burnt, fried and they think, "I only was given this yesterday, because they probably think I'm a loser." How well is that training going to stick?
So as we move further and further up the ladder of the characteristics of organizational health. The capacity to work effectively in teams, turnover issues. All of these things are going to be much implicated by what is our base here, in terms of the health and wellness of individuals, capacity of leadership and stabilizing that turnover?
Question 11. What causes high turnover in the workforce?
Oh, that's such a wonderful, complex question. We could go on for days about that one. I think part of it is, if we did a flashback, a before and an after, a lot of things start flushing out. If we go back before, we're looking 20 years ago, 25 years ago. The way the workplace was organized was completely different. We weren't embedded in the midst of the full IT information revolution, and the vast majority of our workforce were the Baby Boomers. Their whole cultural imperative was to get into the job, stay there and then retire, and they used telephones and they wrote letters. They actually had reflective time to problem-solve. There was much more connection inside of the system. Everybody knew where the bodies were buried because they'd all been around forever.
We flash forward to now, and we've essentially shed the Baby Boomers and they're not there anymore. We've got now three different, four different generations of workers in the workforce. The largest majority of our workers are on this side of the digital divide. They have grown up with all of that digital media and that literacy. They actually function and think very differently and there's a much different kind of pace.
We have that proportion… probably around 40% of our workforce now, which is on the older side of digital divide. They're folks who are still… This was not their first language. They're not native speakers of it yet. So many of them are feeling sort of real pressure and they're slightly alienated. They have kind of a different way of wanting to go about work. The younger generations typically are looking at staying in jobs not much more than five years. We're lucky if we can hold onto them for five years. This again, is leading to a lot more turbulence in our system, because the expectations are different.
Because we shed so many people with the turnover originally, we moved into a situation, too, where we have a much higher rapid movement through hierarchies and systems. Then if we come back again to the notion of one year for competency, two years for expertise? When we have systems that are in this constant kind of tumult, we have an enormous shrinkage in the capacity of that system. It's also an increased stress inside of that system and everybody's feeling it.
So if ever there was a need for people to take it down 14 notches and get grounded, it's even more imperative now than it's ever been. We are more challenged with that now than we have ever been. I think it's helpful to be aware that we're at a position in human history right now, which we have never encountered before, in that the density and intensity of information that we're having to manipulative is greater than it's ever been. Our challenge to separate signal from noise is immense and the level of expectation for performance has never been higher. In some ways, it's almost like a perfect storm right now.
We don't have a lot of history in this. We're right now, at this really creative space, of figuring out what can work? How do we harness this? How do we move this into functional long-term sustainable kinds of systems, that are delivering in our whole trauma exposed field? We're delivering the services that are necessary, if you're going to have a civil society. At the biggest level, this is absolutely critical that we make this stuff work.
Question 12. How does a Secondary Trauma informed organization address productivity?
This is such an important issue. If we come back to the understanding of how much impact on capacity we're seeing by workers and people in our system, who are struggling with symptoms and outcomes of the stress overwhelm. And also looking at the turbulence piece. If we go back to that graphic, I think we need to think about productivity in a very different way, in a much more sophisticated way than we used to. We used to think that, "If I've got a team of 10 people and I've 10 bodies in there, it makes perfect sense that we're going to have caseloads of X, and that should be achievable."
That came from the golden old days, when we had 10 people in there, who were fully up-to-speed, had been doing it forever, who were really well connected with each other. They were very well trained and the work that they were doing wasn't as complicated as it is now, because we have much more knowledge base than we had then.
It can be really frustrating for people in leadership to say, "Well, you've got all your positions filled. How come you're not being able to keep up with it?" This is where we have to have the more sophisticated view of it. In those 10 people, I have got six who are brand new at this. They're not at 100% capacity. Even if they're healthy, they're not at 100% capacity. And, in fact, typically, about half of them are going to be really struggling. So they're even at less capacity.
Then my experienced people… Well, one of them is actually off on stress leave, and they're not contributing anything, and we don't have any backfill these days, because we don't have money for that. So of the remaining four, three of those four are struggling to various degrees, because there is so much additional pressure on them. Of course, the new people in there are not going to those experienced people any more than they absolutely have to because they can see that these people are struggling. So the new people are floundering and they're making some errors. So they're actually being counterproductive in some ways.
As we look at the total functional capacity of this group of 10 people, it has now shrunk immensely. We're lucky if we're getting 50%, and that's a reality. When we're sitting there pounding on our desk, and saying, "Why can't you do 100%?" Well, they can't. It's kind of looking at a marathon runner whose got double pneumonia and saying, "I want you to post your best time." You can't do it.
So our task is to have a more realistic appreciation of what is the actual capacity of this given group of people, and then what can we do to enhance that capacity? For starters, we want them all to be as well as they can possibly be, because that's going to increase capacity obviously. Then we want to stabilize the movement through, so that people are able to get past basic competency up to some levels of expertise. This is really going to shift things.
What we also work with… We've got numbers of tools around this and metrics for folks to look at their teams. Say you are also in a situation where you have a team, where people have been there forever with each other. They're really a very high productive team. What you need to do is to prepare for the next three to five years. They're probably a really productive because they've been there forever with each other and half of them are going to retire in the next two years. All of a sudden that team is going to catapult into a team where it's got a whole mess of brand new people, and probably even a brand new leader. The level of capacity is going to shrink dramatically.
So how much does it behoove us to start preparing for that? Doing the cross- training, getting people who can step in, who can be at a higher level of capacity than just brand new. And that we're already starting to build the kind of collegial connections between folks. Because that piece, the relational piece inside of that team is so critical. We need to look at where we are right now, where we've been and where we're going to be in a much, much more realistic way.
Question 13. I've heard you say that professionals have an ethical obligation to ensure that job is doable by one person. Can you talk a little bit about that?
We see that a lot, and I think it is also deeply embedded in cultural norms, inside of organizations. Again, it's sort of helpful if we look backwards to where we come from. Again, if we go back 10, 15 years, the norm was almost this kind of mission-driven martyrdom place. What we're doing is so darn important that I'm going to give my life over to it entirely. People would over-function hugely. That was normalized. It was celebrated. It was part of culture. That was primarily the Boomers' generation.
As they've waved out, we had the folks that they supervised and trained. You know, that mid generation people who are sort of in their mid-40s, up to their mid-50s-ish now, and upper 50s. Some of them certainly took that on. As we look generationally down, for the most part, we're finding people who are younger, in their 30s and 20s, that is not their culture, and they do not want to sacrifice their lives for their work. They want to have lives and meaningful work. So we've got this shifting kind of culture benchmark.
One of the real imperatives at this point for us, in any kind of leadership role or supervisory role, is we need to look at, by the time we're leaving, is the job that we're doing a doable job for somebody else in a same kind of way? It means, in some ways, we're shifting our notion of what's the moral, right and ethical thing to do. I don't know how many times, particularly with Boomers, I saw them crawling up to the end of their career with their last blood and doing their damnedest handing off the torch off to the next person, who's one or two generations below them. That next person realizing very swiftly, "This was not a doable job." Then they would leave that job. Then it would go to the next. The job, itself, degraded and minimized and minimized, because you didn't have anybody who could really do it.
The capacity and the information retention inside of that system is just reducing and reducing. If we want sustainable systems, it's a moral imperative really for us to make our jobs doable, so that we can then bring along new people. Hold the torch off to them. They can step into it with increased capacity. They can actually have a life and be healthy human beings, and do that job. That's a real difference, and it's a culture difference.
Appearing in Pat Fisher's Video
Patricia Fisher, "Understanding Our 12-Factor Organizational Health Model," TEND Academy website. 2015.
Karen Hangartner sits down with Pat Fisher, Brian Miller, and Françoise Mathieu for a panel discussion on a wide range of issues related to organizational leadership; supervision; and the personal impacts of STS. Specific topics include: the STS continuum and how it can be used to help to inform strategies for mitigating the impacts of STS and creating healthy work environments; supervisors' duty to warn when hiring; the value of "contracts" that outline mutual expectations of both the worker and agency; how to handle situations where staff may not recognize their own functional impairment or believe that they are invulnerable to the effects of this work; and finally what can organizations, supervisors, and staff do in the aftermath of a particularly difficult case. The panelists bring to these issues their personal experiences, research, and firsthand knowledge gained from years of treating and advising individuals and organizational leaders who work in high trauma-exposed environments.
Hello. I'm Karen Hangartner, and I'm the project director for the Southern Regional Children's Advocacy Center, which is a project of the National Children's Advocacy Center. We are excited to bring this video series about secondary traumatic stress to you. In this video series, we have conversations with three of the foremost experts in secondary traumatic stress. And in these, we discuss how do these effects show up on individuals. And how does working in the field of secondary traumatic stress impact organizations. And how do we conduct supervision in a way that's supportive for our staff?
And then we'll also hear from Chris Newlin, the executive director of the National Children's Advocacy Center, to talk a little bit about the role that the senior leader plays in addressing secondary traumatic stress in the organization. And how do we go about creating healthy, supportive environments that support the staff that we're working with.
In this video, I sit down with Françoise Mathieu, Pat Fisher, and Brian Miller to have a discussion about what secondary traumatic stress looks like in children's advocacy centers. And what do we need to know and what strategies do we need to be implementing in order to create supportive protective environments for our staff so that they can do this work sustainably. Enjoy this conversation.
So in our individual conversations, we have been talking about this conceptual model that secondary trauma might exist on a continuum. So I think it would be really interesting for us to talk about what are some things that individuals and organizations can do at each step along the continuum to create supportive protective, environments for their staff.
Dr. Brian Miller:
I like the idea of thinking of the organizational response in terms of a continuum. Because too often, I think we start at the deeper end of that continuum when those symptoms have become actually an impairment to the worker. And by thinking of it more in terms of a continuum, we can get upstream and start looking at normal stress reactions before they become symptoms, before they become an impairment. And that really means it really involves a belief that we can do something about secondary traumatic stress in an organization, in a trauma serving organization. So if we get upstream and just start talking about normative stress reactions, then we can begin to formulate how we move in that can at least mitigate the effect and at best prevent it.
I like too, how that really does speak to the normalization of this. That this work doesn't impact people because they're weak or they just don't have the stuff to do this work necessarily. But that there is a normal expectation that you're going to be impacted by doing this work in positive and negative ways. So Pat, talk a little bit about as you look at the continuum from an organizational point of view and how we can think about how to implement strategies.
Dr. Patricia Fisher:
Well, I think there's a model that we can borrow from public health that's really useful when we look at this. And that's that notion of primary, secondary, and tertiary levels of intervention and prevention. And typically, for example what we do is we ignore primary prevention, which is really the place where we want to put the most emphasis. And that's the place where how do we minimize the risk for people in the first place? So what are the ways and strategies that we can use so that the exposure level is minimized or ameliorated to some extent? And then secondary prevention is where we're looking at given that people are going to be exposed to this stuff, what are the things that we can do to help them manage it, mitigate it, deal with it in ways that it's less likely to go on to become really problematic.
And tertiary prevention is typically where we put all of our effort. And that's when damage has happened. And tertiary prevention is the big ticket item. And that's where people are injured, they're leaving, we've got turnover, we've got all of those other kinds of really serious challenges. So when we look at the investments that organizations typically make even from a fiscal point of view, there's an awful lot more going to the tertiary level intervention. Not so much going to secondary, and often virtually nothing going to primary prevention. What we want to do is turn that the other way around so it's a good pyramid. So we're sitting on a really robust primary and secondary prevention model. And then you don't have as many people escaping up into need for the really heavy duty supports and treatment.
So it's really shifting the way we look at things and getting in front of the horse or getting the horse in front of the cart, that way round. And too often, we do it the other way.
I think the way this contract has unwittingly been written is that the organization brings you in knowing that you will be subjected to a certain level of trauma exposure. We bring you in, we ask you to do this job, and now it's your job to do self-care. And to do something about that, do self-care when you go home. And only when you are so impaired because of your exposure that you're not functional as employee does the organization take any responsibility. So I think everything we're talking about is about getting in there earlier and the organization starting from a position that we know we are asking you to be exposed to trauma. And therefore as an organization, we're going to do what we can to support you with that.
Françoise?
Well, one of the interesting challenge that we've run into is at the training level at the school. So college, university level. Some programs have been really interested in having some education around these topics. And I think that's really important. But what's really been difficult for the new recruits or the rookies is sometimes when they haven't done field work yet, some of this feels theoretical, but it doesn't actually land for them. And I get that question all the time from really well-meaning supervisors, educators, trainers, who say, "How soon should we talk about this?" And I always say we should talk about it all the time at every level. Because there's some parts … I like to go for example, in a college program, once they've done a placement. Because I think that it lands more for them once they've at least had their chance to go in an organization. And I'll often ask them any of you walked in and the minute you walked in, you could sense it in the ventilation system. The positive or negative atmosphere. And they know exactly what I'm talking about now. So I think some of this has to be anchored and experience, but it doesn't necessarily have to be extensive. And then it needs to be revisited all the time.
Because the other thing that we see of course is that the more senior folks in agencies are often the ones who don't go to ongoing education and training. They delegate, they send someone else to the conference or to the courses. And I think that this is part of what needs to be reviewed at every stage in our career as well.
Yeah. And it's also the place too where there's often that assumption that STS is only going to be an issue for frontline people. And of course, what we really know is yes certainly, they're getting direct exposure, but so too are the admin support staff. So too are the supervisors and leaders, as we're moving through the whole system. Everybody has a piece of this. And the flavor may be a little bit different, but everybody's in this tent. And I think that message is starting to sink in. In numbers of organizational settings and others, it's still a novel notion. So part of this is shifting that discussion so that we know we're all in this. And then that also has the additional merit of incorporating senior leadership and middle management into supporting the kinds of initiatives that are necessary.
So let's think about then the front end of that continuum. We're talking about you're being exposed. You're either hearing children's disclosures of abuse or you're looking at images that are traumatic. So before we even get people in the door, before we even start the hiring process, what are some concrete things we should do? What is our right, our duty to warn? And how do you frame those messages when you're even starting the process of hiring somebody?
That's a really interesting question. And some jurisdictions outside of North America, it's actually come up as a legal issue. And it comes in as a sort of a duty to warn and informed consent. Because we know enough now about the potential risks for people coming into this really high end stuff for it to impact them negatively. And there have been cases, notably in Great Britain, where an individual came into this kind of a work and got into trouble and was successfully able to sue the employer saying, "You didn't tell me that this would happen to me." So that there is some sort of spotty notions out there that we really do have some informed consent issues here. Now it hasn't gotten into jurisprudence in North America. But I think we need to think, because we know enough now. That when somebody is interested in coming into the field, that we have a full disclosure. That coming to this field can be a wonderful professional choice.
But it also bears some risks. And we know from the research literature that some of these factors might put you variously a little more risk and others might be somewhat more protective. But you need to make an informed choice about coming in here.
So even before somebody walks in the door, I think there's some things that we can start doing. And then of course, you've got the whole interview process and the selection criteria in people who are doing that selection process to be well informed and being able to ask good questions. I know Brian you had some really good thoughts around that.
Well, I really like the language that you're using Pat. Because I think regardless of any legal precedence, just the ethics of the situation are that as an organization, I have an obligation to give you a fair warning. This is what we are going to be asking you to do. And then you have the ability to then give informed consent. So I like thinking in the terms of duty to warn and informed consent. Because that, I think an honest contract now with my potential hire.
And if we go back to…I think it was in Beth Stamm's book in the late '90s, her secondary trauma book. And I think it was Munroe who actually had a chapter with a sample of a contract like that. And in it, there's a section where it's also the duties and responsibilities of the employer or the workplace towards you. So it wasn't just informed consent. I acknowledge that by doing this work, I will be affected or potentially harmed. But also here's what we engage ourselves and promise to offer you to mitigate and acknowledge those. And I really like that.
Which is a fascinating question then. If an agency, if a children's advocacy center is getting ready to hire a forensic interviewer and they're talking about, "Okay, here's what you can expect from us." What would be your advice of what would be essential to be in that document about here's what this agency is going to do for you to be supportive and protective? So who wants first stab?
Okay, let's start. We will offer you the training you require in a timely fashion with no penalty to … we will release time for you to require the training and master the training that's required.
And here's where I think the organization needs to commit to regular ongoing supervision. We will provide you with the supervisory support to check in on your well-being.
And we will match your caseload to your capacity as it evolves over the time with us.
Like that, going back to that capacity. So the expectation is not that as a new therapist, you're going to have a full case load right off the bat. We're going to give you time and space to develop those skill sets.
And supports in supervision. And in other ways in the training.
I'd like to pick up on that. How about also balancing case loads to reflect the severity or the nature of the cases that you're being referred?
That's right. So you have a ranking of some of the more severe cases and some of the maybe less severe, so that they're a little more balanced. That's one of the challenges for those of us in the children's advocacy center world is that caseloads are always 100 trauma. So the not having all of trauma cases on your caseload is really not an option for us. So we have to get creative in how we-
Triage.
Yeah. Triage that. Yeah.
Just the straight severity piece.
What else do you think is essential to be in that, that an organization should be doing?
I love the idea of it being contractual, but I think the organization needs to make at least an ethical commitment that we will provide you a functional team that will participate with you in difficult cases, as well as providing you support.
You said something earlier yesterday about no one person carries his case and we all carry this case. Please say that again.
Yeah. I'd like to be, because it actually becomes something of a chant. And that is that in this agency, this work is so difficult that every difficult case is carried by each of us and by all of us. And we're not going to leave you alone with that extraordinarily difficult case. That we're going to be involved, and that in short, we've got your back.
That just sounds so supportive. I'm thinking if I'm going to need therapist or any forensic interviewer coming into this practice. That just sounds like I'm giving time and space to learn, to breathe, to figure out how to deal with these tough cases.
And I think some of the other pieces are embedding in the contract, what values we hold and we're going to manifest inside of this organization. And one of them is collegial support and team cohesion. And that only happens because folks are able to get together and talk. So we're going to have regular team meetings. We're going to have those kinds of supportive processes that fit to the specific work we're doing. But we're not going to have people fractioned off, overworked, all on their own. That this is part of what we see as being really vital.
Another big piece, which we've seen in the literature is about flexibility. And I know that some work places can't be as flexible as others. Obviously people sometimes say to me, "I'm in court," or, "I'm in clinic." But we know that a certain amount of flexibility can make a tremendous difference in terms of people's ability to manage life outside of work as well.
So as some of our colleague, Kyle Killian's research showed, being able to interrupt your day to attend to a family appointment or some type of other event and come back can release so much stress. And yet, it can be quite a minor impediment in a way. Having a workplace where you have a sense of that, and that there's a certain element of trust. Because I think that I was in an agency last week that had experienced collective punishment. So one person had violated a rule like that, and then everyone lost that benefit. And you can imagine the incredible, the damage that was caused not just by the violation, but by the collective punishment. So there's got to be a certain amount of trust that we're all professionals and we're going to get our work done. But I think that within that, if you have that flexibility, what a tremendous relief it can be.
And also the ability … you remember you and I when we had the privilege of meeting that social media person a few years ago, who talked about how they ran their content moderator divisions. And it was fascinating to us. I mean, I know their budgets are very different, but it was fascinating to us to hear what they had implemented to allow for folks to do really, really difficult work. And they had very low attrition rates. And a big part of that was flexibility. And the other one was recognition.
Okay. So we've talked about the need to give some fair warning in the hiring process, communicate that. And we talked about the contract about what the individual can expect doing this work, but what they can also expect from the agency and the ways that this agency is going to be supportive of them.
So then what's next after that? What happens when they do, they start the job and now they're experiencing some stress reactions? I would imagine that would happen within the context of supervision, probably. How do you help a new hire understand and manage those stress reactions?
You know, Françoise talks about flexibility. That if we're going to get serious about getting up the continuum to where we're just experiencing normal stress reactions, then consideration's got to be given for how do we give our workers white space during the day. Where it isn't about one trauma case, after another, after another. So that when you go home at night, then you can take that sigh of relief and start to breathe again. It's got to be about building white space. A lot of that can come through the team. But it is about number one, just starting with the fact that we're serious about this. You're going to be experiencing stress during the day. There's certain latitude that you need. And there's a lot of things we can create during the Workday that give you that sense of some white space. Little practices like moving for five minutes every hour. They get up and walk and go get fresh air. And just that kind of of emotional hygiene during the day to take care of us.
I'm thinking about if I'm a brand new worker though, or even new at an agency, and I've been somewhere before. Do I feel guilty taking time away? Am I going to look like a slacker that I'm not working hard enough because I'm taking a walk every hour?
I was thinking about that as you were saying it for two reasons. I was talking to a group last week were there were a lot of newcomers. They weren't necessarily new to the field, but new to that workplace. And the first place is they wanted to make sure that that was actually really true. So there was a real trust issue about is that actually true? If I do it, will I get reprimanded?
But the second one I hear a lot, particularly with who do forensic interviewing is, "I don't need a break. I'm fine." Remember a couple of years ago, we were talking to investigators about being mandatorily rotated out of that position. Because research has shown that ideally, they should only be there for X amount of time. And some of them really resented that cause they said, "Well, I'm fine." And I don't have the objective measure. I don't know if they were or not. But I think that that's where role modeling matters and where education matters. Because I agree with you. I think white space is essential, but if people don't know why it's happening, then we're missing a piece, right? So it's part of that education about lowering our stress levels, having our blood sugars be … using that education so that people understand why it's happening. But I think sometimes we do, and I'm sure you both have encountered that pushback from the superheroes. And I don't mean to take over the interview, but I'd like to know what your thoughts are about that. How do we deal with the folks who think they're invincible?
That's a great question.
I think it's also a culture question that we're stepping into here too. Because it leads us into the critical importance of doing the training and the psycho ed training around what does stress look like here? What are absolutely normative kinds of responses? De-stigmatizing the whole thing and developing a kind of literacy in everybody about what this stuff is, what it looks like, and what are some of the basic, and then what other more advanced things we can do.
And if we have that shared literacy, then the person who says, "No, I've been doing this for 14 years, I'm never going to not do anything else." And then they start having more permission to look at it differently. Or at the least, the other folks in there can look at this person and say, "Oh my goodness, that's a symptom that they're terrified of moving or doing anything differently." But you're starting to shift the conversation in what is normal. And it's a much more supportive and typically a much more compassionate environment from workers with each other when they're sharing that. So I think that first literacy piece is really important.
And I think you're right when you talk about it being about the organizational culture. So you've got the individuals you're talking about, Françoise's heretofore have been rewarded for that kind of martyrdom. The fact that they work without break, that they haven't taken a lunch hour ever since they worked here. And that they're in early and out late. I mean, we really have unwittingly reinforced that kind of behavior.
And that's why I think it really falls to the team and to the culture that we number one, we value our mission. And we are here only for the sake of that mission. And in order to accomplish that mission, we take care of ourselves. And we take time to breathe during the day. And that workaholics may be very effective in the short run, but they're not going to be in the long run. And that's not the behavior we want to recognize.
I think one of the most important things that we've talked about in these conversations is that the importance of at the very top of these organizations, that senior leaders are bought in to really creating the kind of culture change you were just talking about Brian. Because oftentimes, I'm hearing from people and they're starving for this kind of conversation. They're starving for help to do this. They know that they're not doing well. But they're having trouble convincing them, the people above them.
And I think the people above them to be quite honest, they're struggling with how do I manage the productivity and the demands of funders, and multidisciplinary team partners, and manage the needs of my staff. So it's not that they're not well-intended, they are just struggling with their own burden. So I think changing that culture to come to understand that, because I believe that yes, we cannot do good work if we are not well and healthy. I actually believe we can do damage to kids if we're working from a place of depletion. And that is directly an opposition of our mission and why we're here. So we really do have to think about this just like we wouldn't put a forensic interviewer in a room with a kid without good forensic interview training and supervision. We should not be putting people in these positions without good training and supervision around these issues as well.
Absolutely. And I think this is one of those places where there's a perfect alignment between what is the ethical and correct thing to do, and with what is the practical and most efficient, and expedient thing to do. Because you're going to have better practice. It is a best practice to move into this. So it's really enlarging the whole notion of what are best practices from an organizational point of view, from a team point of view, from an individual practitioner point of view.
And I know you guys have done a lot of work around making the business case to actually address this. And that's found on you guys' website. So yeah, I think that's a really important thing of even the ethical and other arguments don't work, that making the business case does. Because it takes a lot of time and money to train staff.
Absolutely. And as you're saying this, I was thinking about going a couple of years ago to, what was it called? Victim centered think tank or something. So the aim was everyone who was there was a service provider or a stakeholder representing the rights of victims. And they were all there to discuss this code of how to deliver services that are victim centered.
And what was incredible to me is that in that room of about 50 different stakeholders, I was the only one there that was there to represent service providers. So basically, it was really interesting. So they're producing this kind of document, the tablets from Moses coming down from the mountain saying, "Thou shalt be, you will be compassionate. You will be present." And at the end I was like, "Just respectfully, where here have we talked about our responsibility as organizations towards ensuring that our service providers can actually deliver these victims services, that victim centered services?" And they were like, "We hadn't thought of that."
So that didn't come from a place of ill will, it came from a lack of knowledge. And I'm quite surprised. There are times where the range out there, some organizations are completely on board with this. We don't need to make the business case. They were, "Show us where to go quickly. We want resources that are ready to rock and roll." And other organizations, we still are having to go way back and educate, convince the decision makers why this makes good business sense. And that's actually a little bit surprising to me that we still have to do that, but that's okay. Because once they adopt it, then we're in business and they are really open to it. But that education phase-
As I listen to you, it occurs to me that if you asked someone in a secondary trauma informed organization, "Does this organization balance more, is it more of an accountability based organization or support based organization?" That their response if it's truly a secondary trauma informed organization is it's the same. I couldn't say it's more accountability than it is support. So it ultimately is about balancing those two. And I think sometimes we go wrong because we do have to hit certain productivity and serve certain economic realities in this organization. "I do need you to see clients. We are here for a mission." So because of that, we don't believe that we can offer these kinds of supports, this kind of white space and reasonable accountability with the case loads. And when in fact the organizations are not only the best place to work, but actually the best client outcomes are actually balancing those two. They're not taking their eye out from either one of those.
You've brought up an issue of a concern that we hear quite a bit. And I don't know when you do training, if you've heard this. We were recently contacted by an agency we'd already done some work with, and really great organization, great leader. And they said to me, "Our supervisors feel that bringing up these issues create an epidemic in our workplace." So I found that really, really interesting. And I'd love to hear people's thoughts on that.
Absolutely. And that question always feels like such a 1995 question to me. If we talk about it, we're going to create it. And then there'll be this epidemic and awful thing will happen. And I think that as we well know, whatever challenges are presently there are there. If we talk about them, we can surface them. We can deal with them, and we can address them. We're certainly not creating them.
And when we look at some of the organizations that we worked with over the years, and I'm thinking particularly going back 10, 12 years in the early stages with this. When the first set of trainings and literacy came in, they would have a bump up in their usage of the EAP and other resources for people. Because they had been in trouble for a long time. But then when they stretched it out, those people recovered. They came back and the actual usage went down, and the turnover went down because they dealt with the resident already challenges and harm that had happened. But then they were able to mitigate and move forward in a place that was much healthier. So I think you also have to open up the time window. But that is such a 1990s kind of approach.
And we see the full spectrum out there in the world. From folks who are really on board with this and get it, and others for whom it's really new. And I think I have to keep reminding myself that I can't hold somebody accountable for not knowing what they don't know. But it tells me about their occupational culture and that this is news for them. So how do we move into some of those and start encouraging them to get into the water because it's warm? Yeah.
But maybe in fairness to that skeptic that's asking that question. Maybe they have observed an organization that took their eye off of one of those twin pillars. And we would, I don't know if we would create an epidemic, but we certainly would create a problem. If the mission of our organization became to support you as a worker. That's not our mission. That is in service of our mission. And once we get clear about that, we realize these aren't competing objectives, but rather they're in service of the same thing. And that is about the mission. The way we accomplish our mission of serving clients is we take care of our workers and keep them healthy.
I'm glad you said that because that was the second point that I was alluding to that … so this wonderful director I'm referring to this wonderful leader I'm referring to who calls me and she said, "Listen. At the end of the day, we still have a job to do." And in her case, they were folks who were saying, "I have secondary trauma or compassion fatigue," or what have you, "I can't go to court." And she said, "No, your job is to go to court. And I will support you to do that." And I really love the way that you're representing those two pillars and how they both need to be served. And I think that's a wonderful way to talk about it. Yeah.
I think the interesting thing too, and we haven't really talked about this quite in this way so far. But there is this sense. Yes, there is an obligation on the part of the agency. There is a responsibility. What's the responsibility of the individual? Because it is a dual responsibility. You just brought that up. Our mission as an agency is not to support you as an employee solely. So what is that individual responsibility?
I have so many thoughts about this. So I think first of all, I really love going back to Laurie Ann Perlman's original personal, professional, organizational kind of framework. I think that we all have an ethical responsibility to bring the best self that we are to our work. And I understand that there are life circumstances. All of us have lost sleep because we had a sick child, or we had an illness, or a family emergency. I mean, I absolutely understand that.
But I think that we make daily decisions about the way that we conduct ourselves at work. So that's a daily decision about whether I engage in office toxicity or gossip, or nay-saying. It's a decision about whether I show up and take the training that was offered to me. I think that it's a decision about whether, and no judgment here, but whether I stay up for four hours too late because I'm watching a show and I know I'm going to be burnt out or physically exhausted the next day.
I think that we have daily decisions that we make about that. And I also think that certainly as a clinician, I know that my best skill set is being on. And what does that mean? Right? So a lot of us don't necessarily have a lot of hard skills. We have a lot of soft skills, and they're unique and they're precious. And I can't carry out those soft skills unless I'm well.
So I think it begins there where I make a decision about this is a profession. and it's a very serious responsibility. And how do I honor that? And when I can't, if life is really disrupted, as we all have those ups and downs. That I also have a responsibility to make sure that I access the resources I need.
And one concern I have sometimes is I've met some pretty disgruntled employees who said to me, let's say they weren't getting EAP covered or something. And they'd say, "I'm not going to do that because it's going to cost me money." And I said, "I understand that that's not necessarily fair. And it would be nice if you had benefits." But in England they say cutting your nose to spite your face. It's kind of like, "Well, I'll show them. I won't get help." And I said, "Well, who's going to suffer the most?" So I think that it really begins with self.
I think another couple of individual aspects of the contract is one, a simple one is about acknowledging distress. That I have an obligation to let my team and my supervisor know when I am. And by that, I just mean when somebody says, "How are you doing?" That I answer that forthrightly.
And then in the bigger way, in fact in the biggest of ways, the individual responsibility is about joining the mission of this organization. Which actually is the most protective thing that you can do as it relates to your trauma exposure. This trauma exposure must make sense. And it makes sense if it's because I'm participating in this mission. So in parallel, the twin pillars of the organization with the individual. I've got to sign up for the mission and I've got to believe in it at a personal level.
And I think all of this also nests so beautifully inside of the notion of zone of control. Because as individuals, what part of our life and our work do we have absolute control and discretion over. And those are all of those elements. What are the parts that we have some influence over? So we're going to make decisions and representations. And what's the stuff that's completely outside of our control?
And one of the things that we'll often see when somebody is starting to get into a really not good place and really disgruntled, they're focusing all of their energy on the stuff they have no control over. And my life can't get any better at all until they do this, or this changes, or the budget has shifted. But that's the stuff they have no control over. And they have abandoned themselves and their own very legitimate control over the choices that they can make that could be helpful for them. So I think that's one of those symptomatic pieces sometimes in there. So again, supporting folks to take legitimate authority over their own needs and their own self-care. And that's not the whole story, but it's sure an important one. Central.
I agree. And I think kind of reframing not just the organizational piece around the importance of the organization taking care. I have to assume that responsibility too. Not everybody can do this work, but for some reason I can. Therefore I need to a good steward of the gift to be able to do that.
So here's a question too, because one of the things that we've talked about is how important knowing why you're doing this work. And I hear oftentimes about people working in the CAC world, they talk about it as a calling. Which we know can be protective. If that's what brings you here is that real calling, that real connection to the mission, which I see all over our field.
But then even in some conversations we've had, we've heard where people have a hard time staying connected to that. How do we help people stay connected, revisit that why I do this work? What brought you to it? What are some concrete things or strategies that people can use to revisit that even on a daily basis?
I think that it needs to become part of the routines of that organization. That this is something we talk about which is the mission. Not just the rules and regulations and productivity requirements, but we're talking to all of the time about cases that have moved us in a particular way. That that's actually built into our staff meetings and our staffings where we're taking the space to tell the stories that are moving and profound to us. And that we're getting back to the speech that we used when we hired for the job. We're reminding ourselves of that speech on a daily basis. And in that, we are practicing ourselves savoring those. Noticing them in the first place and then savoring the rewards of the job when it occurs.
I think you had a lovely example of that at the meeting that we just came out of when you talked about what you do with the group. If you could share that, I thought that was-
Something that I do in training that that has almost without exception been quite profound to the group and to me doing it. And that is to invite people to envision a child that they have worked with that embodies why they wanted to do this work at all. And as they conjure an image of that child or that adult, to stand when they have that image clearly in mind. And to say out loud, "I stand for Logan." and everybody in turn to do that. It's extremely powerful. As you realized the 20, the 30, the 40 people in that group, each have in their mind this story of a life that they changed.
And I love that. When I hear that, I think about that term exquisite empathy. And how I think everybody, anybody that's worked in this field can think of one time … somebody, I heard them describe it one time as a prideful moment. But I think there's also power in visual representations of that. I was visiting a children's advocacy center one time, that they had their therapy clients. They did a mask, painted a mask when they came into therapy. And then they would paint a mask when they were leaving therapy. And they were all displayed along the hallway, the before and the after. And you could visually see the healing that was taking place in the lives of these kids, through the services of that center.
And I think there are just some people in this field that intuitively know how to do some of those things that are protective. Have y'all ever seen any other visual representations that people have used that are powerful?
I'd have to think about it. That one's so good.
I kind of collect those kinds of stories. We have a history of a steps picture that the story behind it is that there was a nine year old girl that visited a CAC in Ponca City, Oklahoma. And she had a forensic interview. And in the interview she disclosed some abuse and it was pretty traumatic. After the interview, the executive director was watching the child and her younger siblings in the backyard of the CAC. And the ED is mainly corralling the younger children. And the girl that had the forensic interview, she goes and she sees some sidewalk chalk. And she says, "Hey, can I use the sidewalk chalk?" And the director said, "Sure, just write anywhere that there's concrete." This executive director turned around. And this child who had just disclosed this abuse had written on these steps, leading up to the back door of the CAC. "When you step here, you have hop. When you stepped here, you are loved. When you step here, you are ready."
So we use that illustration. Now I go in a lot of places and I see that steps picture up in other children's advocacy centers across the country. It speaks to us. It's the vicarious resilience piece of it. That too often, we focus on the stories that are harmful for us, that haunt us. And we give those so much time and energy. And we don't take the time and intention to look for those examples of resilience. And when we find them, shamelessly share them everywhere. Not just with our staffs, but with our most disciplinary teams and other professionals.
That's amazing. Speaking of goosebumps stories, that definitely wins. A few years ago, I was in Florida at the large DCF summit, 3,000 people there, so on and so forth. And there was a panel. And one of the panelists was a child protection investigator. And he talked about an experience of meeting up a young man, a 19 year old in the mall who he didn't recognize. And finally this young man said, "I've been wanting to say thank you since I was six years old." And so on. And the CPI said he could now go for the rest of his career. I mean, that filled his cup. And of course he told it far more eloquently than I did just now. But it was also vicariously actually a moment of profound warmth for me. So it's also, even that was a vicarious resilience story that we all 3,000 of us heard. And that was a gift as well.
I think when we get comfortable and we start intentionally sharing those stories, it does. So it conjures up those times when I've experienced that. So it just kind of has that, just keeps rippling out there for us.
And I think until that really gets out in the water, an organization can make it happen by actually building it into the schedule. Whatever it's called, but to tell those stories. Alice Miller uses that term of enlightened witness, which so many people in child welfare play that role of being the enlightened witness, who was the first person ever to an effect witness to that child that there's nothing wrong with you. There's something wrong with the world that allowed this to happen to you.
So to have opportunities to have those stories of when I was able to be an enlightened witness. And for every one of those kids that you encounter as a young adult saying, "I always wanted to say thanks." There will be scores that you didn't happen to run into. But you bent the arc of their life, and don't even know it.
Okay. So I think one of the things that we need to talk about, because I've seen CAC supervisors struggling with this. What happens when you have a staff member who is experiencing, they've gone through the STS symptoms and now they're really having some functional impairment. So it's that struggle. Though it's caused by the work, but how do you balance that? How do you support a staff member who's experiencing functional impairment in their job as a result of this exposure to trauma?
I think we can start with where that might first be noted, which takes us back to the importance of supervision and the importance of continuous monitoring of that supervision. Where as a supervisor, my contract with you is that I'm going to not only ask you, but I'm also going to be watching for indications of your well-being on the one hand, or workplace strain on the other. So the supervision hopefully is active enough, that's where we're going to notice this. That's where we're going to be able to have the requisite conversations.
I think when there is impairment, it's good to think in the analogy of any workplace injury. That if you have injured your back in a pallet accident, that because it happened here on the job, we're not going to turn our back on you figuratively. And now it's yours to get well. We are going to make the referrals, and trust that we have the insurance benefit package that's also going to pay for your follow on. And that we already have defined processes for EAP referrals and what other psychotherapy or other supports, as well as the team continuing to support this all being done in the same sense of non-judgmentalness, of normalizing this for some sensitive individuals. And that the team's not going to turn our back on you. But that this time, these referrals are important.
My thought is as you were saying that, I agree with everything you've said. The question I hear a lot is what if the individual themselves does not recognize that they're that there.
How do you handle that?
Because that means that the supervisor in that very unfortunate situation is in a position where they by putting the client first, that may mean that they make this referral actually as part of a job requirement. We need to be assured that you are fit for duty. That in that case, our client's interests and your interests are the same. We want you to be well. So we there are times where we have to make that unfortunate call, without the agreement of the word.
And it raises an issue. I completely agree with you. It raises an issue of something I encounter a lot dealing with supervisors and some leaders. Is in our field, it feels like a lot of us are afraid of conflict. And I get that question almost every week. And it seems to me that an area of further training and skill building that we all need, but particularly in a supervisory role are conflict management skills.
And I can't help but think Brian, when you're talking about that being a requirement. We haven't done a great job in the CAC world of HR management. That really is a growing edge for us. And I think we need to sometimes think about what are our capacities in that. And we found that oftentimes getting an HR lawyer on your board of directors is a great way to kind of meet that need so that you have somebody that can help you walk through when you're having those kinds of challenges with staff.
And short of that, I think just for me as the individual supervisor. To make sure that if I'm going to have this crucial conversation, and I'm worried about that, it's hard for me to deal with the conflict that might be involved. That I go up the stream, even if I don't have an HR professional that's going to kind of take that burden away from me. I want to talk to my supervisor and get guidance as I do that.
But I'd say it in strong language. I have an ethical duty here. I actually, in all sincerity am looking out for the well-being of the worker as well. Even if they disagree. But I have an ethical duty to act here. And I can't just turn the other way because I'm uncomfortable with conflict.
And it's something that I hear a lot too. And I'm absolutely agreeing with everything you're saying, from supervisors and people in leadership roles. There's a very large proportion of them who don't feel skillful about it. They're very awkward feeling about the whole thing. And then others who actually are feeling this is easy. I can do this stuff. So that takes me again, back to the need for supervisors to have peer support groups and their own peer supervision groups. Because typically in a group of supervisors, you're going to have a variation in skill sets around it. So rather than leaving our poor supervisors sitting out in the end of the diving board all by themselves, we need them to have that again, echoes of the support through to help them be able to cope with these things.
Because it's an important point. And again, the parallel just as we don't want to leave that worker with a difficult case all by themselves. That for me as a supervisor, I need some other shoulders to help me carry the weight of this. And frankly, just to advise me about how to best handle this.
And even if it's someone like you who's very, very skilled with this. If you're in a group of other supervisors, a bunch of them won't be. So your ability to talk this through and modeling and all that information is helping lift everybody up on the way through this.
So here's another question. Oftentimes in a children's advocacy center, they're going to see there's certainly the day in day out cases that they see. But then there are often times some real over the top traumatic cases that they see.
I think sometimes when began to think I've seen everything that I can see, something else comes along. What are some of the best ways to after one of those really critical incidents or those really tough cases that are taking a toll on staff members? What are the best ways to address that as an organization?
I think first of all for the organization technology that they happen. Be that people may have a range of different needs in the after event of that. And that it's not necessarily one size fits all. I think that part's really important.
And to look at the sort of ripple effect. Because you may have the one worker who was directly impacted. They were at ground zero with it. But then you've got their immediate colleagues, other people who hear about it slightly second hand, people who care about that person. and they're being impacted. And then it reverberates through the whole organization in terms of did you hear about in the rumor mill and all that kind of magnification can happen. So when you're looking at these signal events, you've got a number of constituencies in here that you're going to need to address with different kinds of modalities. And certainly really clear communication to the extent that you can clearly communicate an accurate narrative to everybody, to help folks to ground in what actually happens so it doesn't get up any further.
And then inside of that particular team, what is it that that team needs? And they may need a group process of some sort. But again, you're never going to force anybody in a trauma event to do anything. It always has to be an invitation and that discretion, and really respectful of the individual boundaries. And in the same way for the person who was directly impacted at ground zero, an invitation to them for what processes, we provide numbers of processes that might be helpful to them. But again, you're never going to force somebody to do something.
But having people inside of that team and organization already equipped to know that there's a range of appropriate resources. We know what we can do in this event. That helps so much, rather than a signal event happens and everybody's scrambling saying, "What should we do?" So that's part of that whole backdrop that they're equipped and that supervisors are equipped. And everybody through the system is ready to respond with a flexible array of options, depending on what makes sense.
Thank you guys so much for being here and having these conversations with me. It's been so much fun. I feel like I've learned a lot. And I think this will be really beneficial. I know you guys are as passionate about this topic as I am. Because I think at our core, we all fully believe that kids deserve healthy clinicians, therapists, forensic interviewers, child abuse professionals. So thanks so much for contributing to this. Thank you.
"The most important thing for a senior leader to do is to create a healthy working environment."
"In order to understand the professional, you need to understand the personal. You need to understand yourself."
"Organizations need to have the healthiest possible staff in order to be maximally functional and to be able to meet their mandates."
Pat Fisher
"One-third of the supervisor's and worker's time together should be dedicated to the well-being of the worker."
"We need to have a culture where it is normalized for me to say, 'I'm hurting. That was a difficult case, and it has rocked me.'"
"We model what we want. This means working reasonable hours, having reasonable expectations, and asking yourself, "What are the things that I need to pay attention to and what are some things that I can let go of."
This project was supported by Award No. 2019-CI-FX-K003 awarded by the Office of Juvenile Justice and Delinquency Prevention, Department of Justice. The opinions, findings, and conclusions or recommendations expressed on this website are those of the authors and do not necessarily reflect the views of the Department of Justice.
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