So, good evening, everyone. I'm very happy to have the opportunity to be here with all of you this evening. And I will just say by way of very brief introduction that my name is Paul Warren. My pronouns are he and they and I am currently a research project director at the New York State Psychiatric Institute. I'm also a senior staff trainer and curriculum writer for the Northeast and Caribbean Addiction Technology Transfer Center. And yes, that does mean that there have been times when I've been forced to go to Puerto Rico, St. Thomas, or St. Croix to deliver training. I haven't been forced in a very long time, but I hope spring's eternal and I'll get back there. I'm also very fortunate to be a member of an international organization called MINT, which stands for the Motivational Interviewing Network of Trainers. And I'm in and does fantastic. And OK, good. Very good. Yeah, so I'm I am very fortunate. I don't know if there are any other mentees that are in our learning community this evening. But I'm fortunate to be a member. Oh, wonderful. The last thing I'll tell you in regard to just by way of a brief introduction, because we do have limited time and I want to make sure we get to. Hopefully, all of the content that I've prepared for us to discuss is the learning community this evening. I am a social worker by training and I'm a graduate of Hunter College School of Social Work. And Dr. George Goetzel was my mentor. And I began my social service career in 1991, providing direct services to people living with HIV and AIDS. And I did that work for a little over 12 years until 2003, where I made the transition into focusing on workforce development. And the development and delivery of training and technical assistance programs and interventions. So, again, very, very happy to have the opportunity to be here with all of you this evening in hopefully what will be a learning community conversation. And and I know that a couple of you, because you've tested your mics already, which is fantastic. I know that you're able to unmute. So my hope is, is that we will have a conversation for this brief time that we have together to focus on honestly, from the provider perspective, is a very, very important and consequential topic to really focus on, which is compassion fatigue. So having said that, folks, again, thank you for making the time to be here. I'm going to share my screen and we'll take care of a little bit of logistical business. And I want to I want to preface a question that I'd like us to discuss, and I'll just throw it out here before we take care of the logistics. I'm going to state three terms. And what I hope we'll be able to talk about a little bit and if people will be willing to unmute and comment on this. I want to throw out the concept of burnout. The concept of compassion fatigue. And the concept of vicarious trauma. So I'm throwing those three concepts out for you to kind of ponder a bit while I'm just covering a couple of logistical details. Burnout, compassion fatigue, which we know is real, and vicarious trauma. So having said that, folks, and as you ponder, I'm going to share my screen. And if you could just use the chat to confirm for me by typing the letter Y or N, Y for yes, N for no, that you can see the slide and that you're able to see it full screen. So if you're able to see that full screen, just type the letter Y. Three of you have responded already. Fantastic. Let's hear from everybody. Thanks, John. Let's hear from everybody if we can. Fantastic. All right. So compassion fatigue is real. That's the title of our conversation for today. And again, the idea of acting to manage compassion fatigue and to prevent it. So I also want to introduce this idea that we can proactively take actions to prevent the accumulation or the development of compassion fatigue. I will also just say that our time is brief, but I will say that if you have any comments, if there's any information you want to add, if there's a question that you want to add, please don't hesitate to interrupt me mid-sentence and just unmute and say, Hey, I'd like to comment on this, or hey, I'd like to add this. You're more than welcome to do that, and it's greatly appreciated. What I would ask, though, as sort of one overarching guideline for our time together is that let's say Shannon has the floor and Shannon is commenting on something or sharing some information or reacting to something, that no one else in the learning community, including myself, interrupt Shannon or anybody else. You can interrupt me, but please don't interrupt each other if you have the floor. So this learning community conversation is funded and brought to you by the Opioid Response Network. These learning community conversations and the technical assistance that is also offered is meant to be relevant to what you're actually doing. So what we talk about, what comes out of our conversation may not necessarily reflect the official positions of the funder, and that's perfectly okay because it is meant to be relevant to what you are doing. And again, this is a little bit more information about the ORN, and one thing I will particularly underline is that if your learning community does have other educational or training needs, please do reach out to your colleagues who arranged this training to request them, because there is a coordinator that is able to entertain and often respond to those particular requests. And again, these are some of the goals of the OAR. In addition to what we are specifically going to focus on today is the idea that there can be consequences to unacknowledged compassion fatigue. You know, we can intellectualize and know, yes, that it's real, and if it's not attended to, there certainly can be consequences. Also, hopefully our learning community conversation will help you to revisit, focus on, have an opportunity to consider how compassion fatigue, how you may actually experience it, or how it may manifest for you. And I'm going to pause for a minute to share just one thought that comes to my mind, because having had this conversation in a number of learning communities in the past, there have been individuals who've participated in the conversation who've talked about that their compassion fatigue became so acute that they developed emotional and physical symptoms and ultimately had to leave the profession, the particular position that they were actually in. And clearly, that's an extreme situation. And again, the title, Compassion Fatigue is Real, those consequences, of course, are potential outcomes of unacknowledged, unmanaged compassion fatigue. Also, I want to be very clear that the purpose of this learning community conversation is not for me or anybody else in the learning community to suggest what you should do in regard to your own wellness and self-care. This is an opportunity for you to reflect on that and maybe to consider the activities that you engage in or the activities that you did engage in and maybe stopped engaging in. And possibly to consider as a post-learning community conversation, what might be some of the next steps that you may engage in to support and promote your own individual professional wellness. And again, my role is to help facilitate that conversation. My role is not to tell anybody in this learning community what they should be doing to maintain, establish, or define their own wellness or self-care. Again, we will define compassion fatigue, burnout, and vicarious trauma, and we're going to talk about that in a minute. Those are the terms that I asked you to consider. Again, hopefully you'll list some of your own personal signs and symptoms that you're aware of, because my manifestations of compassion fatigue may be very different than yours. Again, thinking about what is the rationale for managing, and every one of us is going to have our own rationale for managing and preventing compassion fatigue. And again, the idea of developing strategies to identify and address any barriers that you may have to the management of compassion fatigue. And I'm actually, well, I'll advance the slide and put those terms kind of visually in front of us. So I wanted to share this book with you. I don't know how many people in the learning community may be familiar with this book by these two sisters, Emily and Amelia Nagoski. They wrote this book, and if you're familiar with this book, type an F in the chat. If you're unfamiliar, type a U, just so I can get a sense. And don't be clear. I'm not endorsing necessarily this book, but what I am going to share with you from the book Unfamiliar. Okay, so it seems that some people haven't seen this book. So, and again, I just will share it. It's a very, it can be a very helpful resource. The thing that I really, really wanted to share with you from this book is something that they call the stress cycle. And the book has a lot of things in it that I think anyone in our learning community might find beneficial. Not everybody really is into books, but if you like books and if this is a topic of interest of yours, it can be very helpful. This idea of the stress cycle is something that I wanted to kind of put on the table for all of us to discuss, and they make some recommendations based on the research that they've done, and that they include in the book, about strategies that are particularly effective at completing the stress cycle. And I'm going to actually just say that you can think about completing the stress cycle as releasing or letting go of what you've been exposed to. So I just want to put that frame around it as I walk us through this idea of the stress cycle as they present it in this particular resource. So what they suggest is that, you know, human beings have evolved and developed a physiological and emotional system of responses in order to effectively respond to stressors. And what they suggest is, let's say just for the purposes of illuminating their conception of the stress cycle, the stressor is wherever we are and we come across a lion. And what they are suggesting is that we then have an emotional and physiological response to that stressor, which causes us to run away our fight, flight, fawn, or freeze responses. In this case, the person is exposed to the stressor, they run away, they escape, and they get to a place of safety. And in that place of safety, their system re-regulates, they relate the story to their community, they're safe, and then they go on with their life. So there's the stressor, there's the reaction, there's the physiological, the physical flight response, and then the reaching of safety and communicating with one's support networks, what happened, the debrief basically. And then the stress is released, the experience is integrated, and the person goes forward. And that's the conception of what they call the completed stress cycle. And again, one thing I'd like you to consider in regard to this is that in this completed stress cycle, there's no accumulation of what has occurred as a result of the stressor. What was experienced is sort of released, and that's what they consider a completed stress cycle. Again, during the course of this, any comments, any reactions, any thoughts, feel free to unmute and say, you know, comment or add or what you would like. Now they say, they suggest that where we are today in our lives is there's something called the modern day stress cycle. And essentially, they've replaced the lion with, in this instance, an employer who does not seem too happy at this particular moment. And what they suggest is that stress occurs possibly from this employer, we have a reaction, and our impulse to flee is blocked because we're in a modern day situation and we can't just sort of run out of the room or escape. Therefore, we don't get to a place of safety where we can re-regulate and sort of debrief about the situation. We're actually stuck in sort of a repetitive loop. And what they suggest is that this modern day stress cycle, this repetitive loop, and again, think about what you're exposed to. And I don't necessarily mean, what I mean is the narrative or the affect of the people that you may be interacting with on a daily basis. You're being exposed to their narrative, to their affect, to possibly difficult interactions between you and them. And what they suggest is in the modern day stress cycle, there's an accumulation because there's not enough of an opportunity to discharge or let go of the stress that's there. And they suggest that the reason that we accumulate this unresolved stress could be because we have chronic stressors in the work. We were in the business of sitting across from people who have potentially experienced historic, intergenerational or current trauma or traumas because of the social appropriateness of the modern world. And in some situations we may not respond. We may not get a chance to debrief because it may be safer for us not to. And ultimately what that does is that creates this accumulation. And I'll go back to what John was saying, kind of this accumulation of on the way down in terms of the impact of unresolved accumulated stress. Now, I'm going to advance to the next slide, but I'm going to... So again, they're suggesting in this book that there's evidence that these activities actually help to complete the stress cycle and they help us to let go of what we've been exposed to and what we may be holding on to. First one is physical activity. And to me, I'm not at all surprised about this based on my, I'm making an I statement here, based on my own personal experience and also based on much of what I've ever read or seen about compassion fatigue, vicarious trauma management, how physical activity in a variety of forms that can be as simple as walking, it can be hiking, biking, any kind of physical activity, anything that gets the heart pumping and gets the person into a different space can help complete the stress cycle. Also, and Jennifer, I'm thinking of you as I look at this, connection and positive social interactions. And those can be at work and also outside of work. I'll make an I statement here as well. I mentioned to you all that when I started my social service career, I started by providing direct services to people living with HIV and AIDS. And what I can tell you in the staff that we had, there was a lot of social interaction between staff members. And it became very clear to me that if I allowed that to be my exclusive social circle, I was gonna be underwater. Because when we were together, we talked about work. And I needed to have additional connection and positive social interactions with, so I did community theater and I did other things that got me connected to other people where I wasn't always focusing on the work. And those other activities, those other connections fed me and helped me sort of let go of some of what I experienced from my day-to-day experience doing that work. I love this photo. I am a big proponent and a beneficiary. I get a lot of healing and a lot of release from laughter. I love this photo because I don't know if these three people are actors or if they're a real family, but they really, if they're actors, they're good actors because they look like they're having a really good time being in each other's company laughing. And as I look at this picture, it reminds me of the people that I love to be in their company and laugh with them. There's all kinds of studies and research that talk about sleep, meditation, and rest. And if you think about it, folks, and again, I'm thinking, Kim, how you started us off in this conversation by mentioning being aware of colleagues, changes in other colleagues. And when you start to notice changes in your ability to sleep or your appetite or your sex drive, all of those things can be indicators of cumulative, possibly unresolved stress. So the fact that we're getting enough sleep that we possibly choose to make time to meditate and allow ourselves to actually be in a resting place can be very, very supportive in managing stress. And it's interesting, I'll just add this in regard to sleep. I know in terms of having worked with folks who experienced depression, that some people that I've worked with have reported having very light sleep where they don't go into a deep sleep. And during that deep sleep is where we oftentimes work out stressors and stress in our lives. So a change in sleep patterns is something to be paid attention to. Creative expression. It's funny, I'm gonna hold something up to the camera. I don't know if you can see this, but this is an antique fountain pen. And I'm sharing this with you simply because part of my creative expression of late is that I learned how to repair broken fountain pens. I mean, it's not the same thing as painting a picture, but it's being mechanically creative. And I find it very satisfying and I'm not thinking about anything other than what I'm doing. And it's so satisfying to take a pen that didn't work and get it to work and then use it to be able to write notes and things. So creative expression in whatever form can be a great way for people to manage stress, affection from other human beings and beloved animals that we have in our lives. Also, and again, I think we need to be mindful that crying can also be an indication of unresolved stress. And some people experience crying as cathartic or release. So we don't wanna just put a general sort of disclaimer that quote unquote crying is a way to relieve stress. Sometimes crying is a cry for help. It is a sign of distress and there are distinctions to be made there. So just keeping that in mind that sometimes having an expressing tears can be a stress manager. Again, we'd wanna know more, we'd wanna pay close attention because labile affect or easily brought to tears can be a sign of unresolved stress or some other issues going on. This slide, I think kind of sums up all those non-revelatory activities really well that the idea that wellness is not a state of being but a state of action. Keeping in mind that we can intentionally choose what we're going to do in order to complete the stress cycle for ourselves. And what Laura may choose may be very different than what I may choose. So it's about finding out what activities, what kinds of company, what kinds of interaction actually work for us. And I will add one other element. Depending on what we're exposed to, depending on what's going on in our lives, what we may need may change. So our actions may need to evolve as our needs evolve and change. Now I'm showing you a picture here and I think this is the first time I've ever been in a learning community with anybody that's here this evening. I'm wondering, does anybody know what this is a picture of? And I'm very happy to report and proud to report that I actually took this photograph. So does any, yeah, go ahead, Jennifer. What do you think? What's this a picture of? Is this the Grand Canyon? It is. Have you been there? I have, I was just there, I think last March, April. Fantastic, fantastic. So Jennifer gets the prize if there were one. Sadly, Jennifer, there is not, but this is definitely the Grand Canyon. And Jennifer, can I ask you a quick follow-up question? Sure. For extra, extra credit, is this the North Rim or the South Rim of the Grand Canyon? I mean, I don't know what size, the whole, you know, Top Canyon, you know, town was that, but I'm gonna say it is the North. Okay, well, read what Rebecca wrote in the chat. Okay, it's the South, it's the South. It is, it is, it's the South Rim. And I have to acknowledge that I've been to the Grand Canyon, the North and the South Rim. I've been there 11 times. So I'm showing you this for a very intentional reason. I'm also showing you this for an intentional reason. This is my dog and his name is Imhotep. And if you know where that, we call him Imo, I-M-O for short, but if you know where the name Imhotep comes from, write it in the chat. This is my dog. And then the other thing I'm showing you, this is a clock. Now I'm showing you these three things. Let's see, somebody just put something in the chat. Maybe they know where Imhotep comes from. Yes, Kimberly, Egyptian God, yes. It also has a cinematic reference, if anybody knows. I'm also showing you this clock because these are things that are idiosyncratic to me. When the year 2000 came and everybody thought the world was gonna end, I thought to myself, if the world were gonna end because we're going into the new millennium, where would I wanna be? So I decided to spend New Year's Eve at the Grand Canyon because that's where I wanted to be. Now, somebody may look at that picture and think, I would never go there. Yes, it is the mummy. It is the movie, The Mummy. No, it's not Moses, Kim, it's The Mummy. The evil character, although our dog is not evil, but the evil character in The Mummy is named Imhotep. So I wanted to show you these three things, folks, to underline the fact that your wellness, what gives you joy, what feeds you, is going to be unique to you. And we are all, as professionals, engaged in human service work, are responsible for managing what we're exposed to so that it doesn't accumulate and keep us from doing what we're doing and doing it in the way that is gonna be best for the participant and the client and is also going to maintain our wellbeing and wellness. So this is gonna be unique to each of us. Now, what we're gonna spend the last remaining few moments focusing on together in our time is a couple of what I call micro activities that any of us can engage in at various moments when we feel the need to manage what we may be exposed to. Kim writes, I also think that is why MI is important. We are not guessing what the client is thinking. They are able to answer in an open and honest way. Yeah, and it's funny, Kim, that you say that about MI. And I hope maybe in the future, as a learning community, that's something we may get to focus on together. But to Kim's point, many providers actually report that when they learn motivational interviewing and when they use it, their stress actually decreases because they have released themselves from the pressure of getting the person to change. They help the person to find their own motivations to change so that they can take those actions. So absolutely, Kim, it's a very appropriate and normal connection. So this first micro activity is a breathing activity and it's called the pause. And I'm gonna explain what I'm gonna invite all of us to do. And we're just gonna do this. You can do it individually. And you're gonna be, of course, breathing in your own way. But I'm gonna ask you to breathe in the fashion of a pause. So I'll explain it and then we'll do it together and we'll do it for three breaths, okay? But let me explain it first. So the way a pause works, and this is an activity that you can do at any moment that you feel would benefit you, where you take a breath in, you pause, you let the breath go, you pause, and then you take your next breath in, okay? And then you pause and let it go, pause, and so on. And that's called a pause. Now, what I'm gonna invite all of us to do, and we can all do this together, and when you've completed it, type the letter Y in the chat, and I will type Y in the chat too when I've completed. But I'm gonna ask us to take three pause breaths together. So you're gonna, and you'll do it in your own time. And when you've done three, just type the letter Y in the chat. I'm gonna do my three now too. Typing my y in the chat now. Excellent. Now what I'm also going to ask everybody to do is if you could use one word to describe how you feel right now. And there's no right or wrong here. It's just whatever word describes your feeling state. So if you could type in one word in the chat about how you feel right now, go ahead and type that word into the chat after having taken the three pause breaths. And there's no right or wrong. Tammy writes relaxed. John writes mindful. Relaxed. I feel like I need a yawn. Go right ahead. Ori, calm. Shannon, relaxed. Laura, relaxed. Sleepy, sleepy. Yep. Madison, Jennifer, sleepy. Yep. Laura, relaxed. And again, a pause is a micro activity that you can employ at any moment during your day and you can start over again. So a pause can be a great way to kind of put space between what came before and what will follow. Another activity that you can do is what we call focusing your attention. And you can focus your attention on your body, your thoughts, and your emotions. And what you can simply do, and I'm just going to talk us through this. We're not going to necessarily do it together, but I'll talk us through this, is that you intentionally start at the bottoms of your feet and you scan through your entire body, bottoms of my feet, my ankle, my calves, my kneecaps, and so on. And as you intentionally move through, focusing your attention throughout your body, anywhere you feel stress or tension, when you exhale, you let that tension and stress go. Another area of focus can be your thoughts. You simply get quiet and you ask yourself, what's on my mind? What am I thinking about? Is there something that keeps coming back to me? And can I let that thought go for a moment? Can I set it aside so I can simply rest? And the third area of focus is you can ask yourself, yes, Kim, it is very similar to grounding because you're assessing where you are in the moment. Yes. And you can also focus your attention in regard to your emotions. What am I feeling right now? Oh, and Kim writes, I go out barefoot in the grass, et cetera. Fantastic. Yeah. Because you can feel you're making a physical connection. Absolutely. And you're aware of the physical connection. So you're in your body and you're feeling what's going on in your body. So this is another set of micro activities that you can choose at any moment to employ in order to come back to yourself. I'm not sure if people are familiar with this acronym HALT. And these are four questions that you can ask yourself. And this is really borrowed from recovery literature. And I'm not sure if people have ever heard this phrase before, but you can ask yourself, am I hungry? Am I hungry? Am I angry? Am I lonely? Or am I tired? And if you answer yes to any of these, if you're able to, you can meet that particular need. Maybe it's time for you to take your lunch or maybe it's time for you to check in with somebody because you're carrying a resentment. You're still angry about something, or maybe you need to connect with somebody, or maybe you need to rest. So you can ask yourself these four questions. And if you're able to meet the need in the moment, you can do that. If you're not able to meet the need in that moment, and sometimes we're not able to, what you can do is you can say to yourself, I want to acknowledge that I'm lonely, and that when I can, I will reach out to X and I will connect. So if you can't meet the need in the moment, you can acknowledge the need and agree to meet it when you can. And again, this is drawn from recovery literature. And keeping in mind that managing compassion fatigue and preventing compassion fatigue, self-care, your wellness is the key to that. And first and foremost, we have to acknowledge that the fact that we are exposed to the material and the affect that we're exposed to has an impact on us. We're human beings providing services and care. We are exposed to the stories, to the trauma, to what's going on in the moment, the affect that's in the room. Acknowledging that that actually does have an impact on us. We can't help but be impacted by that. Also, as Kim mentioned earlier, she was aware of when colleagues were sort of showing signs of stress, either in their bodies or their reactions. We can learn to do that for ourselves. What is sort of the tell, or how am I feeling or behaving that's an indication that I'm experiencing some stress right now, and I may need to take some actions to manage it? And there's a word, and I wasn't sure if it was Jennifer who said this, or if it was somebody else who wrote it in the chat, but that we can be intentional about, maybe we need to take a pause. Maybe we need to check out, scan through our body, maybe scan through our thoughts, scan through our emotions. Oh, here's something big in the chat. Let's read that. Kim writes, I used to do this with my kids and sometimes with my clients. If they weren't listening or were really reactive, I would use it as a redirecting tool. Hey, Sally, looks like you're struggling a little bit this morning. Have you had a chance to have lunch today? How did you sleep? Et cetera. Moving through off topics sometimes got their attention. And again, these things are great for clients. And again, I think it raises the question, if we're helping our clients to manage their own stress, are we following our own guidance in regard to that? So Kim, you raise a very interesting sort of perspective because it's very easy to be thinking about how we can help our clients do this. Are we willing to intentionally do the same for ourselves? Because if we don't, I go back to what our colleague put in the chat, we won't be able to continue to do what we're doing. Also, keeping in mind that we don't do this work alone and that we can talk through it, you plus one other person or more, the debrief can be very critical and important. And if possible, and you're able to take time away as needed and when it's possible. And sometimes it's not always possible. Again, very similar to the hall. You know something? I know I need time away and I'm going to take it when I can. And making an I statement here, I'm going to take it when I can. And I'm going to take it when I can. And I'm going to take it and I'm going to take it when I can. And making an I statement here, I one year lost 365 hours of paid vacation time because I didn't take it. And that was a very stark lesson for me to learn that like, this is a benefit that I have as a result of my job. And I'm the only one who can activate the use of that benefit. And I can assure you that when I had that wake up call, I changed my behavior and I use my vacation time now. And some employers have employee assistance programs or other sponsored benefits, like I just said, paid vacation time, that only we can access those things. Jennifer writes, doing that tomorrow, taking a day and going deep sea fishing. Oh my gosh, that's so exciting. Thanks for sharing that, Jennifer. That's great. I hope we are going to be in a learning community going forward. I want to hear about what that adventure was like. It sounds very exciting. And then the idea of keeping in mind, folks, that we can intentionally choose to pursue outside of work fulfillment. Our work is probably fulfilling. Our colleagues and our interactions with our colleagues are probably fulfilling. In terms of managing and preventing compassion fatigue, we don't want to put all our eggs in one basket. We don't want to put all our We don't want to put all our eggs in one basket. It's important to think about outside of work fulfillment. Again, I'm only stating the obvious here, and I'm stating it just as a way of reminder. So final thought to consider, and again, I can't thank you enough for the opportunity to be here with all of you today and to engage in this conversation. This is actually a quote from Bill Miller, or Bill Wilson, sorry, in terms of not William Miller from MI, but Bill Wilson, who helped create the 12-step movement. And I feel that this is very relevant to managing compassion fatigue and preventing it, because we can't, this quote, and this is his quote, you can't think your way into right action, but you can act your way into right thinking. And I want to connect that to what we said earlier about that wellness is more a state of action than a state of being. And I want to make the connection between that and this, that what we intentionally choose to do can have a positive and stress management impact on our thinking and our feeling and our behavior.

compassion fatigue

burnout

vicarious trauma

stress management

Motivational Interviewing Network of Trainers

Opioid Response Network

workforce development

self-care strategies