Hello and welcome, I'm Shereen Khan, Senior Director of Workforce and Organizational Development at Thresholds, Illinois' oldest and largest provider of community mental health services, and I'm also the social work expert for SMI Advisor. I am pleased that you're joining us for today's SMI Advisor webinar, Compassion Fatigue in Clinicians Working with Vulnerable Populations. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now, I'd like to introduce you to the faculty for today's webinar, Jasmine Watkins. Jasmine Watkins is a licensed clinical professional counselor and human resource leader with more than 10 years experiencing providing mental health support to adolescents and adults, as well as directing initiatives to attract and retain top talent. Jasmine earned her Bachelor of Arts degree in Psychology, as well as her Master of Arts degree in Counseling Psychology from Northwestern University in Evanston, Illinois. Jasmine has worked with clients on a wide range of clinical issues, including anxiety, substance use, grief and loss, depression, relationship concerns, trauma, and issues related to major life transitions. She has worked in a variety of settings, including a school-affiliated family clinic, excuse me, sorry, private practice, and community mental health. She has also experienced an assessments program development, leadership training, and clinical supervision. She developed a program aimed at fostering innovative partnerships in order to alternatively fund behavioral health services for vulnerable populations. Jasmine then served as a clinical director of a psychotherapy practice in the western suburbs of Chicago. Jasmine is currently working as the head of talent for a healthcare startup, where her primary role is fostering clinician engagement and burnout prevention. She collaborates with senior leadership to ensure the company is supporting clinician self-care in their operations and through professional development benefits and mentorship. Jasmine, thank you so much for leading today's webinar. Thank you, Shireen. Good afternoon, everyone. I'm so excited to be here to talk about a topic that has always been an essential consideration in the work that we do, but in the last year certainly has moved even further to the forefront. To start us off, I would like to disclose that I do not have any financial relationships with commercial interest or conflicts of interest to report. Today, upon completion of this webinar, you will be able to define secondary traumatic stress and compassion fatigue, identify signs of compassion fatigue and the impact in working with vulnerable populations, as well as identify evidence-based tools and resources to use in response to compassion fatigue. Our agenda for our time together this afternoon is as follows. We are going to do a brief overview of trauma. We'll spend some time discussing compassion fatigue and secondary traumatic stress. We'll review possible reactions and signs of compassion fatigue, as well as some additional considerations, and then we will spend some time talking about organizational and individual tools for addressing compassion fatigue, as well as the process for cultivating resilience through mindfulness and self-care strategies. To start us off, we'll do a quick review here of trauma. One of my favorite definitions is that trauma really encompasses normal reactions to extraordinary circumstances. SAMHSA's definition tells us that trauma results from an event, a series of events, or a set of circumstances that have been experienced by an individual as physically or emotionally harmful or life-threatening, and that have had lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being. At its core, the responses that we experience to trauma are adaptive and biological. When we first learned about adverse childhood events, we found that there was an impact on our physical and mental health problems across the lifespan. This study first defined what adverse childhood events are and took a look at the three categories of abuse, family, household challenges, and neglect. And through surveying over 17,000 individuals regarding their childhood experiences, current health, and current behaviors, the study identified that 67% of the population who were surveyed had experienced at least one adverse childhood event, and 12.6% had experienced four or more. And we saw, again, that correlation that the higher your ACE score, the larger the impact on that physical and mental health problems, which is also what SAMHSA described in their definition of trauma. So we're going to spend a little bit more time kind of talking about that automatic response that is kind of biologically wired in all of us, and then how trauma impacts those mechanisms and results in some of those signs and reactions that we will see in response to trauma. So again, those mechanisms are designed to keep us alive, and when we encounter a threat, our brain sets off an alarm in our body, which is our sympathetic nervous system, and that signal then prompts the release of adrenaline and cortisol. So adrenaline's function is that it increases our heart rate, it elevates our blood pressure and boosts energy supply, so all things that we can start to see as being adaptive and beneficial when we are in a fight-or-flight situation. Its partner hormone, cortisol, increases our blood sugars in the bloodstream, it curbs the functions that would be non-essential, so that includes altering our immune response, suppressing our digestive system, our reproductive system, and our growth processes. So again, the functions, they're not essential when we are kind of running away or fighting some kind of threat. In the case of trauma, what happens is that it can start to feel as though stressors are always present, that we are constantly under attack, and that we are in kind of a persistent state of high alert and high anxiety. And so our fight-or-flight reaction, that alarm system, stays on. We never receive that signal to return to normal functioning, and so the sympathetic nervous system is overly sensitive, it stays aroused, even though there isn't an immediate threat, and it ends up being that we are constantly perceiving threats, and our parasympathetic nervous system stays under reactive, so we never return back to that relaxation state, and we constantly have that adrenaline and that cortisol flowing through our system. This long-term activation of our stress response system and that overexposure to the hormones can disrupt our body's processes, as we spoke to. We know that cortisol has shut down our immune systems, it has shut down our reproductive, and other very adaptive essential functions that we have in our body. And so what initially is life-saving reactions can result in that disruption and increased risk of health problems. So this kind of summarizes, beyond the emotional and the mental health impact of trauma, we are also seeing physiological and even medical impact in those who are experiencing trauma reactions. What we've learned is that the effects of traumatic events can extend beyond those directly affected, and so certainly in the work that we do, clinical work, we are frequently exposed, and directly exposed to firsthand accounts and vivid recounting of trauma by survivors. Our work involves empathic engagement with the narratives of others' traumatic experiences, as well as discussion of details, role play, and dramatic reenactment of the events. And in response to all of those, we actually subsequently start to create our own cognitive or emotional representation of the event, and though all of these processes are essential to the therapeutic process, they can have an adverse emotional impact that results in elevated stress, similar to what we see when individuals who are experiencing a traumatic event experience elevated stress in their sympathetic nervous system. And so what starts to happen is what we call secondary traumatic stress, as well as compassion fatigue. Both of these terms refer to the indirect form of trauma that affects the psychological well-being of mental health workers. So even when a therapist is not actually involved in a client's trauma, they can still experience that trauma vicariously in their nervous system, and we see a result of symptoms and physiological reactions that parallel post-traumatic stress disorder. So when we start to think about possible reactions and signs tied to secondary traumatic stress and compassion fatigue, I find it's helpful to maybe conceptualize them as things that a clinician might experience on a personal level, as well as reactions and signs that they might experience in their professional setting. But of course, we know that there's going to be overlap and we are the same human beings moving through kind of both of those domains of our life, and so certainly we'll see that there are reactions and signs that we experience in both places. But some of the things that might impact our personal life would be symptoms of social withdrawal, problems with intimacy, avoidance, mood instability, grief, sleep disruption, de-concentrating, functional impairment, physiological arousal, anxiety, we might have intrusive imagery, loss of interest in activities, a heightened sense of vulnerability, physical and emotional exhaustion, anger and irritability, shame, increased use of alcohol and drugs or relapse, fear, dread, altered cognitive schema, a disruption to our worldview, existential despair and loneliness, disconnection from our sense of identity, and bitterness or cynicism. When we start to think about how secondary traumatic stress and compassion fatigue might manifest itself in more of a professional setting for a clinician, some signs and reactions that we might start to see would be a reduced ability to feel sympathy and empathy, either hypersensitivity or insensitivity to emotional material that might be expressed by their clients, emotional numbing, difficulty separating work life from personal life and maintaining boundaries, absenteeism could be a sign, impaired ability to make a decision and care for clients, dread of working with certain clients, diminished sense of enjoyment of their career, avoidance of clients' experiences, pushing clients too quickly in an effort to master their own responses, and just a general ineffective response to trauma survivors. And so certainly we want to spend some time talking about how we can help to prevent and certainly respond to those reactions and signs in clinicians, whether it be ourselves or those that we're working with. And so in order to do that, we at first want to develop an understanding of what are the risk factors and what are the things that are potentially predictive of compassion fatigue so that we can start to be on the lookout for them, mitigate them. And again, in the events that secondary traumatic expense stress and compassion fatigue are experienced, that we're able to address them and ameliorate the situation for clinicians. So some factors that we want to be on the lookout for include insufficient training, a clinician's identification with survivors, especially over-identification, insufficient support and resources in the workplace, as well as a poor relationship with a clinician's immediate supervisor, a competitive work environment, and the lack of opportunity and an inability to participate in decision-making around clinical and organizational policies are all factors that are potentially predictive of compassion fatigue, as would be an insufficient social support, any feelings of helplessness following exposure to a trauma narrative on the part of a clinician, poor job satisfaction, a prior personal history, high case loads of clients with trauma-related disorders, and then being younger in age, which likely or sometimes can mean being newer to the field with little clinical experience or training around trauma-related conditions. So again, all risk factors that we want to be on the lookout for and work to mitigate against. And later on here, when we talk about organizational and individual tools, we'll start to get a sense of how we can do that. So we talked about high case loads of clients with trauma histories being a risk factor, and so want to spend some time speaking more in depth about the experience of working with vulnerable populations and the relationship that that has to a clinician's kind of chance of experiencing secondary traumatic stress and compassion fatigue. So when we're talking about working with vulnerable populations, who are we speaking about? We're talking about individuals who may be chronically traumatized because of the profound impact that potentially their mood disorder and psychosis has had on daily functioning and their personal identity. These are also individuals who we classify as being part of a vulnerable population because they have a high risk of exposure to acute traumatic events, and so that could be physical or sexual assault. Maybe they have witnessed or had their own suicide attempt or heard about it in others. Sudden homelessness and involuntary hospitalization are also things that we think of as potentially acute traumatic incidents that could be brought forth within the therapeutic relationship within the context of the therapy with their clinician. So given that, clinicians who are working with individuals who are part of a vulnerable population may then be subject to more frequent exposure to trauma narrative in their clients, and then if they are working with a higher percentage of trauma survivors, we know that clinicians are more likely to report more symptoms and greater disruptions about themselves and others, and that increased time that is spent with traumatized clients can also increase the risk of stress reactions in clinicians, and so also the risk of compassion fatigue. We know that working with trauma survivors often involves multiple long-term services, and linking our clients with these adjunct services supports them, but it also decreases the workload of clinicians, and we saw previously that having kind of a high level of caseload and kind of increased workload is also seen as a risk factor, so this linkage to adjunct services does start to serve as a protective factor and a way to mitigate that risk. That could be self-help groups for our clients, connecting and working with medical professionals for the assistance of medication, maybe in or out patient hospitalization could be something that kind of increases level of care temporarily in a way that will help us to not have as much stress necessarily with working with a client, resources for paying, and then we know that developing these collaborations in our work with clients who have maybe increased exposure to trauma can really provide support to both clinicians and also prevent a sense of isolation and frustration. I also wanted to spend some time talking about the intersection of culture and trauma, so working with vulnerable population is one potential consideration when we're talking about compassion fatigue. We also know that working with individuals from a different culture, depending on the clinician and their trauma and training, excuse me, can also provide a source of stress, and so I wanted to spend some time talking about the impact there and ways that clinicians can start to manage that stress and be successful in their work. So different cultures attach different meaning to trauma, and the responses certainly can vary. Culture can influence the perception of acceptable responses to trauma and how distress gets expressed, and so clinicians who are not culturally competent may interpret maybe a collective values as a sign of resistance or avoidance in dealing with traumatic stress, and if they are responding to that resistance or that perception of resistance or avoidance, that can certainly impact their own sense of efficacy and job satisfaction, things that we start to see as risk factors, and instead we should frame culture as a source of strength that kind of can provide unique coping strategies and specific resources for our clients and work with our clinicians and with ourselves to make sure that we are conducting a thorough cultural assessment because we know that it is essential for appropriate diagnosis and care. Kind of a subset here, just to double-click into culture and trauma, is race-based traumatic stress, and so that this is going to be traumatic stress that is experienced in response to race-based incidents that can cause psychological pain and distress. The emotional and physiological damage that results from the stressors of racial harassment and discrimination also constitute race-based traumatic stress, and traumatic discrimination can include a spectrum of behaviors from micro aggressions to overt acts of violence. So given there is a prevalence of race-based traumatic stress, it is likely that clinicians will hear client reports of race-based trauma, so we start to see a phenomenon known as race-based secondary traumatic stress, and those client reports could be incidents in which clients were made to feel like outsiders, as well as incidents where clients were treated unfairly due to their race and ethnicity, and so with that race-based secondary traumatic stress, counselors and clinicians may be affected by those accounts of the racial trauma that is described by clients of color. Being familiar with advocacy competencies and also knowing how to use culturally appropriate clinical interventions and techniques can help with decrease the chances of experiencing that race-based secondary traumatic stress and counselors should also work towards increasing awareness of their own cultural identities and accompanying values, biases, and assumptions. Again we know that when we feel effective in our work that really can help to decrease and help to manage some of the stress that we might be experiencing in the role. We'll now start to spend some time thinking about at an organizational level as well as an individual level. What are some tools that we can use when we are either experiencing compassion fatigue ourselves or supporting those in our team who might be experiencing and displaying some of those reactions and signs that we mentioned. So here are some domains we're going to speak first around professional and organizational strategies and then also speak about those individual strategies so the personal and just general coping strategies. Personal would be respecting limits and maintaining balance. Professional therapy kind of engaging in our own therapy can also be something that can help to prevent compassion fatigue. Self-care and self-nurturing which we'll speak a little bit more about later is also a general coping strategy as is seeking that connection with others and then on a professional level connecting to a sense of accomplishment and efficacy as we've talked about. Seeking that training and trauma-informed services and being mindful of maintaining a balanced and diverse caseload as we talked about in our work with vulnerable populations is another strategy that is useful for preventing compassion fatigue. And then at an organizational level wanting to make sure that systems support and encourage sufficient time away from work, that there is a safe physical space and then team culture and cohesion is something on kind of a broad scale that can create a strategy that is helpful for prevention. And so in terms of that team culture and cohesion we really want our organizational team culture to acknowledge that compassion fatigue is a normative reaction to working with trauma survivors similar to how we say that trauma is you know kind of a normal reaction to extraordinary events. The culture should acknowledge that secondary traumatic stress and compassion fatigue are systemic issues and making sure that we are not pathologizing the individual clinician. We want to incorporate professional well-being in the organization's mission as well as its vision. Adopt value of workplace balance in order to guide behaviors that promote resilience which we'll be speaking on a little bit here. Leveraging team building and employee recognition are really great prevention strategies as are supporting our staff in creating a work-life balance that allows them to activate and their natural coping abilities and really support that activation. If we do all of these things in theory our organizational and team culture will provide a supportive environment for our clinicians to address the effects of their work in their own lives and it also gives clinicians permission to take care of themselves and really engage in some of those personal and just general coping strategies that we know are effective at preventing compassion fatigue but also in responding to it in the event that we start to experience it. Being trauma-informed is another strategy that organizations can adapt to help prevent and respond to compassion fatigue. Ways that organizations can be trauma-informed are of course creating safety and so ensuring the physical, psychological, emotional, and social safety of clinicians, cultivating trustworthiness so maintaining appropriate boundaries, providing clear and consistent expectations, fostering collaboration so emphasizing working together on goals, valuing feedback and opinions of everyone on the team, providing supportive relationships, creating space for choice so prioritizing autonomy and incorporation of the clinician's perspective especially on some of those factors that we know to be risk factors for compassion fatigue so allowing our clinicians to weigh in on types of trainings that would be beneficial, approaches to clinical care that are going to be valuable, staying really mindful of those caseloads and having clinicians be able to weigh in on caseload construction and making sure that the hours that we are expecting of our clinicians are reasonable and of course support that work-life balance integration. And then finally an organization that fosters and kind of provides encouragement is really going to be working towards being trauma-informed so constructive criticism more than critical ensuring that there's a positive affirming attitude on the part of leadership, training opportunities, aligning clinician values with tasks so kind of drawing on acceptance and commitment therapy here at an organizational level and as leaders making sure leaders top down or modeling and teaching effective self-soothing, self-regulation and coping strategies and then again just generally encouraging and practicing self-care which is something that we'll spend some time speaking on. So again just creating that safe environment, providing supportive relationships, modeling effective self-care, self-soothing and self-regulation, encouraging practicing self-care can think of it as five C's as a way just to really remind ourselves what those key components are going to be when at the organizational level we're implementing strategies to prevent compassion fatigue. Supervision is also a really key tool that we have in our toolbox at the organizational level making sure that we prioritize, make space and kind of protect time for supervision is essential. We know that the number of times a clinician receives supervision and the number of hours of supervision are positively related to lower levels of compassion fatigue so a really effective prevention strategy and the quality of supervision so in addition to the quantity as well as the quality of that supervisor and clinician relationship can really lessen the impact of compassion fatigue when it is being experienced. So how do we know our supervision is quality? First and foremost we want to make sure that supervision is creating a non-judgmental and safe space for expressing any fears or concerns. This also allows for processing traumatic material and any effects that the clinician might be experiencing, helps us to normalize those reactions, also teaches clinicians how to recognize and prevent and then treat compassion fatigue. It provides support and information about the nature and the course of trauma and then want to make sure that it's expanding beyond just case consultation and case management. Though those are effective and important, want to just expand there to create that space for normalizing and processing any reactions to trauma. So we'll spend some time now speaking about cultivating resilience which we know is something that is also effective at the personal level in preventing compassion fatigue. So within us there is a stillness and a sanctuary to which we can retreat at any time and be ourselves and so that really kind of starts to help us turn inward and reflect on how to cultivate that resilience. Just to define it, resilience is the ability to withstand, adapt, and recover, rebound, or even grow from adversity, stress, or trauma. Resilience is also the capacity to respond to stress in a healthy way such that our goals are achieved at minimal psychological and physical cost. So when we are cultivating resilience, that is what we are striving towards. We know that cultivating and sustaining resilience can buffer the impact of occupational stressors on clinicians and increase satisfaction. So both cultivating resilience and then mindfulness, which we'll touch on here in a moment, in clinicians can also assist in preventing psychological distress and compassion fatigue, which is the goal here with our prevention strategies. It also helps to improve self-regulation, enhance relationships, and increase feelings of connection. We know that those feelings of connection can be a protective factor, so that's essential. And then we want to acknowledge that cultivating resilience is changing and complex, that happens kind of in its own systemic context, and a really kind of useful tool in promoting well-being and cultivating resilience as well as mindfulness is self-care, and so we'll spend some time talking about different self-care strategies that can be employed by clinicians to help prevent that secondary traumatic stress and compassion fatigue. When we speak of self-care, we are talking about the deliberate and self-initiated attempt to take care of oneself, and we know that it is a widely accepted essential tool to enhance clinician well-being. We know that there are strong theoretical associations with post-traumatic growth and positive kind of adjustment and rebound in response to compassion fatigue and secondary traumatic stress, and we also know that just that commitment and greater time invested in self-care is associated with lower levels of compassion fatigue. So really important to start to think about a self-care routine that is kind of consistently something that we're engaging in to really shore ourselves up against compassion fatigue. So that consistency is crucial. It's also really important to maintain a regular sleep schedule when we start talking about self-care. Other ways that we can engage in self-care include spending time outdoors, whether that's engaging in physical activity or just relaxing, kind of taking care of our bodies, so eating regular meals that incorporate a healthy diet, doing things that we enjoy during non-work hours. So really taking advantage of hopefully being within an organizational system that prioritizes work-life balance. Maybe we've had the opportunity to weigh in on our caseload and the number of hours that we're working and so gotten to a good place in terms of organizational strategies but want to then make sure on a personal level that we are taking advantage of that and holding ourselves accountable to our own self-care routine. And that could be taking additional time for hobbies, exercising regularly again to take care of our physical health, and then engaging with a personal practice of meaningful spirituality. So likely things that we maybe have started to put in our toolkits in the past year have started to move away from but really essential to kind of re-engage with in a consistent daily way to kind of maintain and start to develop that resilience. Wellness activities can be an additional way to engage in self-care and begin cultivating or further cultivating that resilience in ourselves, which is going to be one of those personal preventative strategies for avoiding compassion fatigue. We've got our relaxation strategies. We've got our meditation, breathing exercises, massage, yoga, tai chi, adult coloring. Maybe we like to use a natural light simulator or guided imagery as some of those wellness activities that are going to help us to cultivate resilience and also mindfulness. So what is mindfulness? We are talking about the psychological factor that is associated with cultivating resilience. Typically when we think of mindfulness, it is an exercise that is intended to maintain a sense of non-judgment and focused awareness of all of our thoughts, feelings, and emotions. And it is also an exercise that is designed to reduce that stress and anxiety responses. And so when we think about working with clients who might be experiencing trauma and maybe we're finding ourselves having our own experiences during session, mindfulness can really help us to increase that awareness, bring us inward while we're listening to the trauma narratives and begin identifying the ways in which we might be impacted by the stories that we are listening to. And then once those feelings are brought into awareness, it helps us to also think about how we can start to reduce our stress, engage with some of our self-care activities that we've built into our routine, and then also how to respond to any anxiety that might be coming up for ourselves. So really mindfulness is about attending to present moment and also accepting it. So it's not enough just to identify, increase that awareness. We also want to accept the present and then that helps us to be able to move forward again with deploying some of those self-care strategies. And so it helps us to move past that stress and anxiety. Mindfulness allows us to develop flexibility and adaptability in responding to those emotional experiences. Certainly with the acceptance comes that then ability to adapt and move forward. We talked about how it reduces stress and then emotional numbing. And emotional numbing is one of those reactions and signs that we do see from individuals who might be experiencing secondary traumatic stress and compassion fatigue. So really knowing that mindfulness can help us prevent some of those reactions. But if we are starting to see those signs and reactions, it can be helpful in addressing them and managing them. Mindfulness helps to increase kind of more positive personal coping styles. And with that self-reflection, it gives us then the opportunity to pivot and maybe do some work on developing coping strategies that could be more positive and potentially more adaptive and effective for ourselves. It increases our ability to find meaning in adversity. And that's essential when we are listening to trauma narratives that are understandably distressing to our clients, but then also do start to have that impact on ourselves. And so that along with that personal sense of spirituality can really go a long way towards responding to and managing our compassion fatigue. Mindfulness also increases just general empathy and sensitivity towards our clients' emotional state. So kind of helping to reduce that numbing, engage back kind of on an empathic level with our clients, increasing our connection with them, and just generally increasing our effectiveness. So again, cultivating resilience, this mindfulness is going to be a really essential individual tool when we're talking about both prevention strategies for compassion fatigue, as well as ways for clinicians to start to respond to and address any stress and signs and reactions that they might be observing within themselves. So to sum it up, mindfulness decreases the likelihood of experiencing compassion fatigue as a result of exposure to our clients' trauma-related narratives. And then we can expand on this and say that it also then provides us a really effective and useful tool to use when we have identified that we are experiencing that compassion fatigue. I want to spend our kind of last moments here together talking about an additional evidence-based tool that really at an organizational level and an individual level that we can start to put into place in order to respond to compassion fatigue. It's a strategy that is another tool in our toolbox, and it is called the Accelerated Recovery Program. And the Accelerated Recovery Program for compassion fatigue is a five-session model that is designed to reduce the intensity, frequency, and duration of compassion fatigue symptoms. So a really nice program for kind of giving organizations an opportunity and a method for responding to clinicians who might be experiencing compassion fatigue. We talked about supervision being a really essential organizational strategy. And so kind of being familiar with this recovery program and components of it can really help to give supervisors a tool during kind of supervision for them to help kind of empower clinicians who are experiencing those symptoms to really have a method for decreasing that intensity, frequency, and duration. The program promotes resilience, which is what we just kind of went through, self-efficacy as well as self-compassion. It also provides a framework for identifying risk by reviewing personal and professional history. So really, again, having that component of prevention strategies and really that assessment tool so that we can increase awareness and really kind of respond in a way that front loads all of those prevention strategies that we just walked through. And then also a way to respond and reduce the impact overall. It focuses on the restorative quality of self-awareness and then also promotes debriefing and the sharing of narratives. Again, something that we've talked about at the organizational level, making sure that our organizational framework is saying, kind of naming, normalizing, creating space to talk through the impact of being the recipient of trauma narratives, and then also talking about our own experiences within community, within those connections that we have with our team members. In order to support the development of resilience skills and tools, the Accelerated Recovery Program focuses on the following, so self-care, which we spent a lot of time just reviewing just now, as well as that just overall revitalization. So working to make sure that clinicians are engaged in the work that we're they're doing, increasing kind of the their capacity to experience empathy and have an emotional kind of a healthy boundary to emotional reaction to what their clinicians are sharing with them, being re-energized by the work. We do know that poor performance, lack of productivity, changes in productivity, that absenteeism, those are all signs and reactions that we can see with compassion fatigue. And so by through self-care and interventions that focus on revitalization, we can help to respond to those reactions and signs. The program also again facilitates connection and support through the debriefing, through the sharing of narratives, through providing tools to supervisors, so that within the context of our professional relationships, we've got some strategies there that we can go to to help in a decrease the impact of compassion fatigue. The Accelerated Recovery Program supports the development of intentionality, and so helping our clinicians to shift from kind of reactive behavior to more intentional behavior. So those prevention strategies, making sure through education and just knowledge of secondary traumatic stress, compassion fatigue, and some of the risk factors that we are at an organizational and an individual level able to really put things in place on the front end, kind of have checkpoints, have touch points. Through cultivating resilience and our self-care strategies and mindfulness, make sure that we are shoring ourselves up so that as we're listening to those narratives, we are at decreased risk of developing compassion fatigue. Self-regulation, so some of that comes through the mindfulness and the wellness activities that we talked through. So really being able to intentionally control and lessen the activation of the automatic nervous system, the sympathetic nervous system, while we're engaging in the everyday activities that are involved in clinical work. So this is real-time learning how to incorporate deep breathing and other types of things that we know we're going to have the parasympathetic nervous system come online, which will return us back to that steady state, kind of that more relaxed state, bring us out of that heightened state that starts to result in the reactions and signs that we see with secondary traumatic stress. So this program really helps to develop that tool and that practice for clinicians. Then finally, this concept of perceptual maturation, and so just refining our general perceptions of ourselves towards being one of resilient clinicians and adjusting the perceptions of the workplace so that they are less toxic. So again, kind of a broader, higher-level organizational strategy that we can focus in on and when clinicians feel that their organization is acknowledging, you know, compassion fatigue is a risk in the work that they do and is doing everything that they can to be intentional about being trauma-informed and setting up practices and procedures and supports and structures that are conducive to debriefing and talking through the realities of the work, creating space for clinicians who are experiencing increased stress to be able to process that with their supervisor, have that be normalized, that just knowing that your workspace is a place that is in support and is employing all of those organizational strategies can also go a long way towards preventing compassion fatigue. So to summarize kind of all of what we've walked through this afternoon, we've learned that naming the stress of our work, of clinical work, is a huge step forward towards helping clinicians feel supported. It gives us permission to engage personal solutions for whatever stress they may be experiencing. We've also identified that wellness is embedded and it's important that it be embedded in the culture of organizations in order for some of those organizational strategies to be feasible. And then the prevention and also intervention strategies that are focused on workplace culture and environment, including ongoing training, group support, overall workload and supervision, as well as resources for self-care, are all needed to address compassion fatigue. Thank you very much. Thank you, Jasmine, for such an interesting presentation. So before we shift into the Q&A, I just want to take a moment and let you know that SMI Advisor is accessible from your mobile device. So use the SMI Advisor app to access resources, education, and upcoming events. You can complete mental health grading skills and even submit questions directly to our team of SMI experts. So download the app now at smiadvisor.org. So the first question that we have for you, Jasmine, is about supervision and it's a two-parter. So the first piece is that how do you draw the line in supervision to avoid becoming somebody's therapist? You know, some of the points that you mentioned were things such as providing support, not just case consultation. So how is that, how can you draw that line? And then also the second part to that is can you ever mandate that somebody seeks out their own therapist from, you know, an HR perspective? Yeah, those are both really great questions and I think that first thing is something that we certainly have to really consider. I think a good way to do that is at the onset of the supervisory relationship, really almost coming up with, I wouldn't call it a crisis response plan, but the intent would be similar. So thinking through, you know, as you're educating your supervisee on what compassion fatigue is, kind of talking about what some of those signs and symptoms might be so that they have that awareness and they're able to kind of have that self-reflection. And then also start to think with them, think through, hey, if you're going to be experiencing maybe some of these symptoms or you start to find yourself having some of those, you know, signs and reactions, what are some of the supports that you know that you can employ to kind of help respond to that and kind of help address that? And I would say kind of in kind of planning that response plan with the supervisee, include personal therapy, and then that way, kind of real-time, if you have a supervisee who is coming to you and they are talking about how they are feeling and it gets to a space where you do want to set that boundary, you've already set up the framework that as your supervisor, you know, it is my role to let you know and kind of to signal that it's time to start engaging some of those external supports, maybe in a larger way or to a larger degree, and you can kind of direct them to their therapist. And so what that does is, hopefully, because it's something that has been an expectation that has been set on the outset, we help to decrease the chances of the supervisee maybe feeling like that was a completely unempathic response or feeling shut down when they're trying to kind of come to you and be open and transparent, and instead, it'll feel like you are partnering with them and holding them accountable in some of their own self-care things and kind of engaging with some of those resources that they've identified would be helpful. In terms of mandating a clinician to participate in therapy as kind of a term of employment, that is something that can certainly be built into progressive discipline. We see that in a variety of different professions, so it's not uncommon for maybe an individual who is, you know, their primary role is driving trucks, and they have some kind of instance with substance use, and so their employer can say, hey, we need you to go kind of manage that, kind of, you know, kind of manage your substance use as kind of the conditions of employment because of the expectations that we've set forth. I think always we want to, in kind of a rehabilitative way, help people kind of come to that space where they see that as kind of essential for their job function, but if we don't feel that we can kind of ethically and safely work with our clients, that is something that we can require of our employees. Thank you. The second question is about self-care from an organizational perspective. So, you know, the term self-care gets brought up quite a bit, and I think individuals at this point, you know, try to understand how they can provide self-care to themselves, but do you have any ideas about how to enact a culture of self-care, so any type of self-care strategies that can be applied during the workday and not just for people to do on their own time or by taking time off? Yeah, absolutely, and that's something within my current organization that we strive to do, and so I think some of the wellness challenges that we kind of put in place can be a really great way to encourage people to focus on some of the physical health aspects of self-care, so sit-stand desks or walking meetings or, you know, challenges for steps or drinking water are all things that people can do for themselves, but when we bring it into the work environment, maybe we attach a competition or an incentive or some accountability. It's a way to kind of bring it into the workplace as well. I would say just really encouraging a culture where, you know, lunchtime is something that happens. People block it off on their schedule. Maybe it's built into their time sheet, especially for our hourly employees. That's essential, and then maybe we have a system where we're sharing recipes or food prep tips and just really kind of creating space to make sure people are eating. We know that's a kind of a crucial aspect of self-care for employees. We can start off meetings with a moment of mindfulness and taking some, you know, time for a few breaths to kind of bring ourselves to the space before we start kind of diving into our agenda, so I would say kind of small things like that can really go a long way towards prioritizing day-to-day and kind of within the structure of the workday. I also think benefits is a really great way for companies to communicate their value of wellness and prioritization of self-care, and so having a wellness subsidy that might help clinicians be able to, from a financial perspective, access a gym membership or a yoga studio subscription or maybe exercise equipment. We at my organization, we actually have a travel subsidy, and so we allow our employees to reimburse plane tickets, and so the idea there is we want you to go someplace where you literally can't work, where you have to be off the grid. Go where there's no cell service. We'll facilitate you getting there so you can really kind of take that time to rest and recharge and come back rejuvenated. Similarly, policies around PTO and how your supervisors are modeling that time off in a planful way and holding you accountable, saying, hey, I've seen your face for, you know, a month straight here, and I don't see any requested time off. Let's whip out a calendar. Think of a Friday, a Monday, so you can have a long weekend, are all things that, as an organization, we can really help to facilitate and do that kind of within the work environment for people. Thank you. I personally would love the travel voucher. The last question I will have time for today is about the COVID and the re-entry to work, so there's, you know, we have some evidence coming out that, you know, the isolation and other effects of COVID and anxiety will have impact not only on the people that clinicians serve but also clinicians themselves, and, you know, as we start to explore the idea of returning to work, do you have any ideas about how we can kind of help people with that re-entry so to avoid, you know, going full speed at once and putting people at risk immediately for compassion fatigue? Absolutely. Yeah, so I think being planful and really kind of having a plan that kind of identifies what some of those, you know, kind of risks might be, and then also providing education, just making sure that we are naming what everyone might be experiencing, that we are providing kind of that psycho education to our supervisors of what to be on the lookout for, again, providing that information to clinicians so they can kind of self-monitor, and then I would say kind of an employee assistance program, if that's something that an organization has, now is a really great time to re-familiarize people with that benefit, make sure that we are normalizing access to it, making sure people are very clear on how to access that resource or any other kind of similar type of mental health benefit that you might have in your organization, and I think really making sure that leaders are expecting and encouraging of maybe more frequent kind of but planful still time away, understanding that people might not be able to go quite as long before they need a break, and maybe if we're noticing, you know, that someone is starting to exhibit those signs, even recommend, hey, is there a way we can look at your schedule so that, you know, Wednesday half day, we can, you know, kind of start to use time off similar to that, reminding people that there is such a thing as intermittent FMLA, and if an individual's kind of mental health gets to a space where they and their doctor is determined that kind of there is a limit to the amount of time they can work in a consistent stretch, that's something that your HR teams should be able to support with implementing so that a schedule can be built that really takes that into considerations and sets your employees up for success. Thank you so much for answering those questions and for your presentation. If you have follow-up questions about this or any topic related to evidence-based care for serious mental illness, our clinical experts are now available for online consultations. Any mental health clinicians can submit a question and receive a response from one of our SMI experts. Consultations are free and confidential. SMI Advisor is just one of many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We'd encourage you to explore the resources available on the Mental Health Addiction and Prevention TTCs, as well as the National Center of Excellence for Eating Disorders and the Suicide Prevention Resource Center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. Thank you again for joining us today, and thank you to Jasmine Watkins, and until next time, take care. Thank you for participating in today's free course from SMI Advisor. We know that you may have additional questions on this topic, and SMI Advisor is here to help. Education is only one of the free resources that SMI Advisor offers. Let's briefly review all SMI Advisor has to offer on this topic and many others. We'll start at the SMI Advisor website and show you how you can use our free and evidence-based resources. SMI Advisor's mission is to advance the use of a person-centered approach to care that ensures people who have serious mental illness find the treatment and support they need. We offer several services specifically for clinicians. This includes access to education, consultations, and more. These services help you make evidence-based treatment decisions. Click on consult request and submit questions to our national experts on bipolar disorder, major depression, and schizophrenia. Receive guidance within one business day. It only takes two minutes to submit a question, and it is completely confidential and free to use. This service is available to all mental health clinicians, peer specialists, and mental health administrators. Ask us about psychopharmacology, recovery supports, patient and family engagement, comorbidities, and more. You can visit our online knowledge base to find hundreds of evidence-based answers and resources on serious mental illness. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Harvard, Emory, NAMI, University of Texas at Austin, and more. Browse by key topics or search for a specific keyword in the search bar. Access our free education catalog to find more than a hundred free courses on topics related to serious mental illness. You can search the education catalog by topic, format, or credit type to find courses that fit your needs. SMI Advisor also offers live webinars each month that let you learn about evidence-based practices and participate in live Q&A with faculty. Check out our education catalog often to find new courses and earn continuing education credits. For individuals, families, friends, people who have questions, or people who care for someone with serious mental illness, SMI Advisor offers access to resources and answers from our national network of experts. The individuals and families section of our website contains an array of evidence-based resources on a variety of topics. This is a great place to refer individuals in your care for information about their conditions. They can choose from a list of important questions that individuals who have SMI typically ask. SMI Advisor worked with experts from the National Alliance on Mental Illness to develop these important questions and many of the resources in this section. Watch videos on important topics around SMI, such as what to know about a new diagnosis. They can also find dozens of fact sheets, infographics, and links to other important resources. To access even more evidence-based resources for individuals and families, visit our online knowledge base. All content in our knowledge base is reviewed by our team of national experts from the American Psychiatric Association, Mental Health America, National Alliance on Mental Illness, and more. Browse by key topics and select view all to uncover a list of resources on each topic. SMI Advisor offers a smartphone app that lets you access all of the same features on our website in an easy-to-use, mobile-friendly format. You can download the app for both Apple and Android devices. Submit questions, browse courses, and access clinical rating scales that you can use in your practice with individuals who have SMI. SMI Advisor also created My Mental Health Crisis Plan, a smartphone app that helps individuals in your care to create a crisis plan. The app is available on both Apple and Android devices. It helps people prepare in case of a mental health crisis. They can make their treatment preferences known and specify who should be contacted and who should make decisions on their behalf. The app even guides individuals through the process to turn their crisis plan into a psychiatric advance directive. Thank you for your interest in SMI Advisor. Access our free education, consultations, and more on smiadvisor.org at any time. you

Compassion Fatigue

Clinicians

Vulnerable Populations

Mental Health Field

SMI Advisor Program

Evidence-Based Care

Secondary Traumatic Stress

Trauma-Informed Care

Organizational Strategies

Accelerated Recovery Program