1. RESISTING THE RIPPLE EFFECT UNDERSTANDING THE IMPACT OF SECONDARY TRAUMATIZATION AND THE IMPORTANCE OF SELF CARE. JANELLE VON STORCH, LPC ARKANSAS FAMILIES FIRST, LLC

2. EACH YEAR MORE THAN 10 MILLION CHILDREN IN THE UNITED STATES ENDURE THE TRAUMA OF ABUSE, VIOLENCE, NATURAL DISASTERS, AND OTHER ADVERSE EVENTS. THESE EXPERIENCES GIVE RISE TO SIGNIFICANT EMOTIONAL AND BEHAVIORAL PROBLEMS THAT CAN PROFOUNDLY DISRUPT THE CHILDREN’S LIVES AND BRING THEM INTO CONTACT WITH CHILD- SERVING SYSTEMS. - NATIONAL CHILD TRAUMATIC STRESS NETWORK, SECONDARY TRAUMATIC STRESS

3. “ ” FOR THOSE OF US IN THE HELPING PROFESSIONS WHO ARE INVOLVED IN THE CARE OF TRAUMATIZED CHILDREN, THE ESSENTIAL ACT OF LISTENING TO THEIR STORIES MAY TAKE AN EMOTIONAL TOLL THAT COMPROMISES OUR PROFESSIONAL FUNCTIONING AND CAN DIMINISH OUR QUALITY OF LIFE. NATIONAL CHILD TRAUMATIC STRESS NETWORK, SECONDARY TRAUMATIC STRESS

4. A DEFINITION OF TERMS

5. COMPASSION SATISFACTION THE POSITIVE FEELINGS DERIVED FROM COMPETENT PERFORMANCE AS A TRAUMA PROFESSIONAL. IT IS CHARACTERIZED BY POSITIVE RELATIONSHIPS WITH COLLEAGUES, AND THE CONVICTION THAT ONE’S WORK MAKES A MEANINGFUL CONTRIBUTION TO CLIENTS AND SOCIETY.

6. TRAUMA EXPERIENCES THAT CAUSE INTENSE PHYSICAL AND PSYCHOLOGICAL STRESS REACTIONS. IT CAN REFER TO A SINGLE EVENT, MULTIPLE EVENTS, OR A SET OF CIRCUMSTANCES THAT IS EXPERIENCED BY AN INDIVIDUAL AS PHYSICALLY AND EMOTIONALLY HARMFUL OR THREATENING AND THAT HAS LASTING ADVERSE EFFECTS ON THE INDIVIDUAL’S PHYSICAL, SOCIAL, EMOTIONAL, OR SPIRITUAL WELL-BEING. - HTTP://WWW.SAMHSA.GOV/SAMHSANEWSLETTER/VOLUME_22_NUMBER_2/TRAUMA_TIP/KEY_TERMS.HTML

7. SECONDARY TRAUMATIC STRESS TRAUMA-RELATED STRESS REACTIONS AND SYMPTOMS RESULTING FROM EXPOSURE TO ANOTHER INDIVIDUAL’S TRAUMATIC EXPERIENCES, RATHER THAN FROM EXPOSURE DIRECTLY TO A TRAUMATIC EVENT. SECONDARY TRAUMA CAN OCCUR AMONG BEHAVIORAL HEALTH SERVICE PROVIDERS ACROSS ALL BEHAVIORAL HEALTH SETTINGS AND AMONG ALL PROFESSIONALS WHO PROVIDE SERVICES TO THOSE WHO HAVE EXPERIENCED TRAUMA (E.G., HEALTHCARE PROVIDERS, PEER COUNSELORS, FIRST RESPONDERS, CLERGY, AND INTAKE WORKERS). HTTP://WWW.SAMHSA.GOV/SAMHSANEWSLETTER/VOLUME_22_NUMBER_2/TRAUMA_TIP/KEY_TERMS.HTML

8. COMPASSION FATIGUE A LESS STIGMATIZING WAY TO DESCRIBE SECONDARY TRAUMATIC STRESS. OFTEN USED INTERCHANGEABLY WITH SECONDARY TRAUMATIC STRESS.

9. VICARIOUS TRAUMA CHANGES IN THE INNER EXPERIENCE OF THE PROFESSIONAL RESULTING FROM EMPATHETIC ENGAGEMENT WITH A TRAUMATIZED CLIENT. IT IS A THEORETICAL TERM THAT FOCUSES LESS ON TRAUMA SYMPTOMS AND MORE ON THE COVERT COGNITIVE CHANGES THAT OCCUR FOLLOWING CUMULATIVE EXPOSURE TO ANOTHER PERSON’S TRAUMA.

10. Professional Quality of Life Work Environment Client Environment Personal Environment Compassion Satisfaction Compassion Fatigue Exhaustion Frustration Anger Depressed by work and environment Traumatized by work Secondary Exposure Primary Exposure ELEMENTS OF PROFESSIONAL QUALITY OF LIFE Stamm, B.H. (2010), The Concise ProQOL Manual, 2 nd Ed., Pocatello, ID: PQOL.org.

11. STS/VT AMONG CHILD SERVING PROFESSIONS FIRST RESPONDERS AND CHILD WELFARE WORKERS SHOW HIGH LEVELS OF PTSD SYMPTOMS BETWEEN 6 AND 26% OF ALL THERAPISTS WHO WORK WITH TRAUMA ARE AT RISK FOR DEVELOPING STS. WHEN COMPARED WITH MENTAL HEALTH PROFESSIONALS AND SOCIAL SERVICE WORKERS, ATTORNEYS WERE CONSISTENTLY HIGHER ON BOTH SECONDARY TRAUMA AND BURNOUT SCALES. A SURVEY OF 105 JUDGES IN CRIMINAL, FAMILY AND JUVENILE COURT REPORTS THAT 63% OF JUDGES EXPERIENCED SYMPTOMS OF VICARIOUS TRAUMA.

12. RISK FACTORS FOR STS/VT WOMEN ARE MORE SUSCEPTIBLE THAN MEN PEOPLE WHO ARE HIGHLY EMPATHETIC BY NATURE, WHO ENGAGE CLIENTS THAT ARE DIFFICULT TO ENGAGE THOSE WITH UNRESOLVED TRAUMA THOSE WITH HEAVY CASELOADS OF TRAUMA THOSE WHO ARE SOCIALLY OR ORGANIZATIONALLY ISOLATED FEEL PROFESSIONALLY COMPROMISED DUE TO INADEQUATE TRAINING JUGGLING WORK WITH HOME AND FAMILY RESPONSIBILITIES – LITTLE “SELF-CARE”

13. RISK FACTORS FOR LAW PROFESSIONALS WORK IN CRIMINAL, FAMILY, OR JUVENILE LAW CASELOADS LADEN WITH HUMAN-INDUCED TRAUMA HIGH EXPOSURE TO GRAPHIC EVIDENCE ON A DAILY BASIS GRIM SOCKETS OVER AN EXTENDED PERIOD OF TIME HIGHER CASELOADS LIMITED SUPPORT THOSE WHO WORK ALONE THOSE WHO WITH A HIGH NEED FOR CONTROL OVERLY DEDICATED PERFECTIONISTIC IDEALISTIC THOSE WITH UNREALISTIC EXPECTATIONS THOSE WITH LOW COPING ABILITIES Chambers, Anne. "Judges and Compassion Fatigue: What Is It and What to Do About it." The Missouri Bar

14. ANY PROFESSIONAL WHO WORKS WITH TRAUMATIZED CHILDREN ARE AT RISK FOR SECONDARY TRAUMATIC STRESS

15. “THE EXPECTATION THAT WE CAN BE IMMERSED IN SUFFERING AND LOSS DAILY AND NOT BE TOUCHED BY IT IS AN UNREALISTIC AS BEING ABLE TO WALK THROUGH WATER WITHOUT GETTING WET.” -RACHEL REMEN IN KITCHEN TABLE WISDOM: STORIES THAT HEAL (1996)

16. RECOGNIZING THE SIGNS OF SECONDARY TRAUMATIZATION

17. SIGNS OF SECONDARY TRAUMATIZATION NEGATIVE EMOTIONS INTERPERSONAL PROBLEMS FEELING OVERWHELMED AVOIDING WORK DUTIES HEALTH PROBLEMS BELOW PAR PERFORMANCE SUBSTANCE ABUSE FEELING OF MEANINGLESSNESS AND DIMINISHED SELF WORTH

18. STS SELF CARE ASSESSMENT

19. STS SELF-CARE ASSESSMENT: WHAT GETS TO US? HOW DO WE KNOW WHEN WE ARE BEING AFFECTED BY THIS WORK IN WAYS THAT MAY BE HARMING US? WHEN TRIGGERED BY TRAUMA CUES WE ARE AT HIGH RISK OF? OVERREACTING EXPERIENCING STRONG FEELINGS AS INTOLERABLE NUMBING, OR SHUTTING DOWN FEELING HOPELESS, OR OVERWHELMED OFTEN WE DO NOT HAVE THE OPPORTUNITY TO PROCESS WHAT WE ARE EXPERIENCING. -HTTP://LEARN.NCTSN.ORG/COURSE/CATEGORY.PFP?ID=3

20. STS SELF CARE ASSESSMENT EXERCISE 1.THINK ABOUT YOUR MOST UPSETTING OR DISTURBING CASE. 2.THINK ABOUT WHAT ASPECTS CAUSED YOU THE MOST DISTRESS: WHAT HAPPENED? WHAT WERE YOUR SYMPTOMS/EXPERIENCES? HOW DID YOU NOTICE WHAT WAS WRONG? WHAT DID YOU DO ABOUT IT? 3.WHAT DID YOU NOTICE? - HTTP://LEARN.NCTSN.ORG/COURSE/CATEGORY.PHP?ID=3

21. STS SELF ASSESSMENT: WHAT GETS TO US? HOW HAS WORKING WITH TRAUMATIZED KIDS AFFECTED YOUR: Beliefs about the worldSpiritual Beliefs Sense of Self, groundedness and emotional stability Sense of personal and family safety Trust of yourself and/or others The way to judge people Sense of control Ability to be alone or to be with others Relationship with your body Ross, L.A, Psy.D, Osofsky, J.D., Ph.D., Emotional Challenges and Self Care for Those Working with Young Traumatized Children

22. THE IMPORTANCE OF SELF CARE

23. “ ” WE HAVE AN OBLIGATION TO OUR CLIENTS, AS WELL AS OURSELVES, OUR COLLEAGUES AND OUR LOVED ONES, NOT TO BE DAMAGED BY THE WORK WE DO.

24. WHAT ARE SOME OF THE BARRIERS TO SELF CARE?

25. PREVENTION STRATEGIES ITS IMPORTANT TO DO SELF MONITORING FOR: IRRITABILITY ISOLATION CYNICISM SOMATIC COMPLAINTS AVOIDING WORK ACTIVITIES FATIGUE DETACHMENT

26. PERSONAL PREVENTION MAINTAIN ADEQUATE SELF CARE KNOW AND HONOR YOUR PERSONAL LIMITATIONS, RECOGNIZE RISKS FOR YOURSELF FIND A WAY TO DEBRIEF DISTRESSING MATERIAL EXERCISE COMPASSION FOR YOURSELF WORK ON SELF AWARENESS MAINTAIN APPROPRIATE BOUNDARIES WITH CLIENTS STAY EMOTIONALLY CONNECTED WITHOUT BECOMING OVER INVOLVED – “WHOSE NEEDS AM I MEETING?” LEAVE WORK AT WORK

27. BUFFERS FOR BURNOUT USE OF HUMOR REGULAR EXERCISE ADEQUATE SLEEP KEEPING IN TOUCH WITH FRIENDS HAVING HOBBIES VACATIONS BEING A PART OF A TEAM SEEK PERSPECTIVE AND SUPPORT FROM COLLEAGUES, TRUSTED ADVISORS Chambers, A., LCSW, Director, Missouri Lawyer’s Assistance Program, Judges and Compassion Fatigue: What Is it and What to do About It, The Missouri Bar.

28. COPING AT WORK MONITOR AND BALANCE CASELOAD REFRAME PROBLEM TO REDUCE ANXIETY IMPROVE EATING AND EXERCISE TAKE BREAKS SEEK SUPPORT FROM OTHERS LEARN RELAXATION TECHNIQUES TO INCORPORATE INTO YOUR DAILY ROUTINE

29. WHEN YOU RECOGNIZE THE PRESENCE OF SECONDARY TRAUMA REFLECT ON THE SITUATION AND THE SIGNS THAT LEAD TO IT RESET THE BOUNDARIES OF WORK/LIFE BALANCE IDENTIFY ACTIVITIES THAT REJUVENATE AND HEAL YOU REDUCE STRESS LOAD SET REALISTIC GOALS RENEW YOUR PROFESSIONAL BATTERIES

30. APPS AT YOUR FINGERTIPS SELF AWARENESS/SELF MONITORING MOOD JOURNAL MINDFULNESS AND COPING VIRTUAL HOPE BOX MINDFULNESS COACH PERSISTENCE – GOAL AND HABIT TRACKER ADULT COLORING BOOK APPS

31. “ ” ANYTHING THAT IS HUMAN IS MENTIONABLE, AND ANYTHING THAT IS MENTIONABLE CAN BE MORE MANAGEABLE. WHEN WE CAN TALK ABOUT OUR FEELINGS, THEY BECOME LESS OVERWHELMING, LESS UPSETTING AND LESS SCARY. THE PEOPLE WE TRUST WITH THAT IMPORTANT TALK CAN HELP US KNOW WE ARE NOT ALONE. - FRED ROGERS

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