9 STEPS TO AVOID COMPASSION FATIGUE WITHOUT FAILING TO CARE

From OperationSAFE, Int'l ...Traumatic Stress is brought on when we experience events that are highly abnormal.  Our organization,OperationSAFE is dedicated to helping children who have gone through trauma such as disasters, abuse, trafficking, and extreme poverty.  

...how to deal with trauma in children we also give them suggestions on how to keep themselves from developing Secondary Traumatic Stress Syndrome, in some degree the same suggestions are helpful for all of us as we struggle to keep a heart of compassion in the midst of unrelenting bad news...

9 Steps to Avoid Compassion Fatigue Without Failing to Care

The Best Way to Care for Others is to Care for Yourself!

In the field we know that lives are depending on us so it is vital that we take care of ourselves so that we can care for them,

• Eat, Sleep and Relax as you normally would,
• Make sure to Exercise Physically to help relieve stress,
• Avoid the use of Chemicals to either enhance performance or induce rest.

Share the Care!

If there is only a one-way flow of stress coming in, it rapidly becomes too much to bear.  One way to reduce the strain is to share it in part with others,

• Talk about the things that are heavy on your heart with friends and supporters,
• Journal, write a blog, send an e-mail to a friend, tweet,
• Pray, meditate, or have a small group discussion with others who care.

Look for Signs of Hope!

Unfortunately, bad news is news.  Good news doesn’t often make the front page unless it is dramatic.  However, there are less dramatic stories of hope that surround us every day.  Be on the look-out for the signs of life returning to normal.

• Make a point of writing or sharing one good thing that happened each day,
• Look for lessons that can be learned even in the midst of the worst situations,
• Celebrate even the smallest victories and personal accomplishments.

I believe that one great contributor to compassion fatigue in the public is that the media overexposes the need and underexposes the great response and difference that is made in people’s lives.  This is the nature of the media of course and it is much easier to report the thousands dead than to find each story of individual lives that recover.  Another contributor to compassion fatigue is the vast scale of donationsthat are given to charities and the lack of communication of the results.  Donors are given a full disclosure of the pain and suffering but are deprived of the hope and results needed to relieve the trauma they have been exposed to.

My recommendation for those who seek to be compassionate without fail is to become personally involved with a smaller charity – volunteer for hands-on work, give time to be on their board, lend them some of your passion and creativity and share in the the reward of seeing lives changed for good.

Written on January 25th, 2010

 

Triage for Emotional Trauma

From Healing the Green Soul

TUESDAY, DECEMBER 22, 2009via @jadt65 & in support of the iranian people following the elections of 2009

1. It is normal to feel "numb" or to have mood swings. It is important for family, friends & loved ones not to criticize.  Pay attention for signs of self-harm or aggression toward others. If a survivor seems suicidal or homicidal, seek professional help immediately!
2. It is important for family, loved ones, & friends to let the survivor know he/she is not alone and they are there to support the survivor.
3. One of the psychic injuries of rape, torture and/or trauma is a lack of control. Allow the survivor to do as much as he/she is able and wants to do.Listen if they want to talk, but do not push for information. This helps decrease anxiety & assists in regaining a sense of control.
4. It is crucial to get professional help as soon as possible from someone trained in providing treatment to survivors. The closer in time treatment starts, the less severe the long-term aspects. For physical & sexual abuse immediate medical attention is crucial.
5. Be aware of "masking," a far away, blank expression with survivors....this is an indicator of "flashbacks" or disassociation ( becoming unaware of the environment but still able to speak, act, ect). If observed, using a "mantra" (repeated meaningful word, ex. safe. home) & gently touching the person(if they are not reactive to touch) or maintain eye contact will help keep the person in the here & now."
6. Nightmares & sleepwalking-Do not wake the person. Try to guide them back to bed. Monitor to prevent injury.
7. It is common for a person to feel fine & not show any symptoms for 6-12 months after the last abuse incident, & then show symptoms (crying, lack of sleep, anxiety attacks). This is part of the reason immediate treatment is crucial...it prevents the development of symptoms.
8. Many times the thoughts and feelings of the abuse are too strong for words. It is helpful for the survivor to write, draw, read poetry, sculpt, paint or create to to let go of these emotions. It also helps the survivor in gaining a sense of control.
9. The survivor might emotional distance him/herself from loved ones & friends. This is similar to a cast for a broken bone. While respecting the individual's space, be there for them....sit in silence with them, eat meals together, walk together. This provides the survivor w/ a sense of belonging and security.
10. Remember, if the person is alive and away from the one who inflicted the abuse...the person is no longer a victim, the are a survivor who is recovering from the abuse.  Caregivers & friends should avid expressions of pity....express admiration for the strength, courage, creativity is took for the person to survive the abuse.
11. Avoid saying what you what to happen to the perpetrator of the abuse....the survivor gains a sense of control and power when deciding consequences for the abuser.
12. Certain sounds, odors, sights, or even movements may "trigger" memories of the abuse. These triggers can cause flashbacks or disassociation. The survivor needs to avoid the triggers until a professional is able to help him/her become desensitized (non-reactive) to the trigger.
13. Caregivers, friends & family member need to avoid projecting their emotions into the survivors experiences. Example: Survivor talks about about being beaten with a baton. Family member says,"You must have been mad". FAIL> the caregiver does not know how the survivor felt; this takes away the survivor's right to feel whatever his/she wants, and the survivor might not be ready to deal w/ the feelings.***  Helpful response: "what were you feeling/thing when that happened?" Caregivers need to be ready to accept the survivor's response.
14. 14. Routine, structure, and predictability are extremely important to undue the shock, unpredictability of trauma & fear/anxiety. This also help decrease symptoms of depression.
15. Attending groups with others who have had similar experiences under the guidance of a professional are helpful to decrease the feelings isolation & help w/feelings of shame & guilt.
16. Family members, friends & caregivers are likely to experience secondary trauma with emotional symptoms similar to a person who has experienced abuse first hand (this is especially true for children whose parent has been traumatized). Professional help & support groups are helpful.

***Often when people are imprisoned or abused for a long time they develop Stockholm syndrome (builds a positive emotional relationship with the perpetrator----this functions as a survival mechanism). Trained professionals need to work through Stockholm Syndrome w/ the survivor due to the sensitivity of the thought & emotional issues.

Special considerations for children

1. Children who have been sexually abused are especially vulnerable because the have not been exposed to sexual issues. A talk about "good touch/bad touch" helps & keeping "private parts" private.
2. Children tend to "play out" what they do not understand. Abused & traumatized children need to be supervised w/ peers & redirected if they try to "play out" the abuse. It is important to have traumatized children work w/ a professional who specializes in doing trauma specific therapy to help the child in developing appropriate interaction skills with other children.
3. Children usually do not have the words to talk about what happened and their feelings. Encourage drawing, painting, and puppet/ doll play to help them "work things out"
4. Help the child identify their "special people" (those who the child has a bond with) to go to when the child does not feel safe. It is helpful to have the child carry a picture or some other kind of remembrance of the person. Special toys (stuffed animals, dolls, action figures) are also helpful in this regard.

The most important thing to do to help a survivor of abuse, rape, torture or imprisonment...

Believe what they tell you about their experiences

****This information is "first response", it is important to work with a local counselor, therapist, psychologist familiar with trauma-specific therapy on a regular basis as soon as possible.******

Psychological First Aid Provider Care

 Psychological First Aid Provider Care
Providing care and support in the immediate aftermath of disaster can be an enriching professional and personal experience, enhancing satisfaction through helping others. It can also be physically and emotionally exhausting. The following sections provide information to consider before, during, and after engaging in disaster relief work.

Before Relief Work
In deciding whether to participate in disaster response, you should consider your comfort level with this type of work and your current health, family and work circumstances. These considerations should include the following:
Personal Considerations
Assess your comfort level with the various situations you may experience while providing Psychological First Aid:
• Working with individuals who are experiencing intense distress and extreme reactions, including screaming, hysterical crying, anger, or withdrawal
• Working with individuals in non-traditional settings
• Working in a chaotic, unpredictable environment
• Accepting tasks that may not initially be viewed as mental health activities (e.g. distributing water, helping serve meals, sweeping the floor)
• Working in an environment with minimal or no supervision or being micro-managed
• Working with and providing support to individuals from diverse cultures, ethnic groups, developmental levels, and faith backgrounds
• Working in environments where the risk of harm or exposure is not fully known
• Working with individuals who are not receptive to mental health support
• Working with a diverse group of professionals, often with different interaction styles
Health Considerations
Assess your current physical and emotional health status, and any conditions that may influence your ability to work long shifts in disaster settings, including:
• Recent surgeries or medical treatments
• Recent emotional or psychological challenges or problems
• Any significant life changes or losses within the past 6-12 months
• Earlier losses or other negative life events
• Dietary restrictions that would impede your work
• Ability to remain active for long periods of time and endure physically exhausting conditions
• If needed, enough medication available for the total length of your assignment plus some extra days
1Provider Care
Family Considerations
Assess your family’s ability to cope with you providing Psychological First Aid in a disaster setting:
• Is your family prepared for your absence, which may span days or weeks?
• Is your family prepared for you to work in environments where the risk of harm or exposure to harm is not fully known?
• Will your support system (family/friends) assume some of your family responsibilities and duties while you are away or working long hours?
• Do you have any unresolved family/relationship issues that will make it challenging for you to focus on disaster-related responsibilities?
• Do you have a strong, supportive environment to return to after your disaster assignment?
Work Considerations
Assess how taking time off to provide Psychological First Aid might affect your work life:
• Is your employer supportive of your interest and participation in Psychological First Aid?
• Will your employer allow “leave” time from your job?
• Will your employer require you to utilize vacation time or “absence-without-pay time” to respond as a disaster mental health worker?
• Is your work position flexible enough to allow you to respond to a disaster assignment within 24-48 hours of being contacted?
• Will your co-workers be supportive of your absence and provide a supportive environment upon your return?
Personal, Family, Work Life Plan
If you decide to participate in disaster response, take time to make preparations for the following:
• Family and Other Household Responsibilities
• Pet Care Responsibilities
• Work Responsibilities
• Community Activities/Responsibilities
• Other Responsibilities and Concerns
2
Appendix C: Provider Care
During Relief Work
In providing Psychological First Aid, it is important to recognize common and extreme stress reactions, how organizations can reduce the risk of extreme stress to providers, and to how best to take care of yourself during your work.

Common Stress Reactions
Providers may experience a number of stress responses, which are considered common when working with survivors:
• Increase or decrease in activity level
• Difficulties sleeping
• Substance use
• Numbing
• Irritability, anger, and frustration
• Vicarious traumatization in the form of shock, fearfulness, horror, helplessness
• Confusion, lack of attention, and difficulty making decisions
• Physical reactions (headaches, stomachaches, easily startled)
• Depressive or anxiety symptoms
• Decreased social activities
Extreme Stress Reactions
Providers may experience more serious stress responses that warrant seeking support from a professional or monitoring by a supervisor. These include:
• Compassion stress: helplessness, confusion, isolation
• Compassion fatigue: demoralization, alienation, resignation
• Preoccupation or compulsive re-experiencing of trauma experienced either directly or indirectly
• Attempts to over-control in professional or personal situations, or act out a “rescuer complex”
• Withdrawal and isolation
• Preventing feelings by relying on substances, overly preoccupied by work, or drastic changes in sleep (avoidance of sleep or not wanting to get out of bed)
• Serious difficulties in interpersonal relationships, including domestic violence
• Depression accompanied by hopelessness (which has the potential to place individuals at a higher risk for suicide)
• Unnecessary risk-taking
3
Appendix C: Provider Care
Organizational Care of Providers
Organizations that recruit providers can reduce the risk of extreme stress by putting supports and policies in place. These include:
• Limiting shifts so that providers work no more than 12 hours and encourage work breaks
• Rotation of providers from the most highly exposed assignments to lesser levels of exposure
• Mandate time off
• Identify enough providers at all levels, including administration, supervision and support
• Encourage peer partners and peer consultation
• Monitor providers who meet certain high risk criteria, such as:
- Survivors of the disaster
- Those having regular exposure to severely affected individuals or communities
- Those with pre-existing conditions
- Those with multiple stresses, including those who have responded to multiple disasters in a short period of time
• Establish supervision, case conferencing, staff appreciation events
• Conduct trainings on stress management practices
Provider Self-Care
Activities that promote self-care include:
• Manage personal resources
• Plan for family/home safety, including making child care and pet care plans
• Get adequate exercise, nutrition, and relaxation
• Use stress management tools regularly, such as:
- Accessing supervision routinely to share concerns, identifying difficult experiences and
strategizing to solve problems
- Practicing brief relaxation techniques during the workday
- Using the buddy system to share upsetting emotional responses
- Staying aware of limitations and needs
- Recognizing when one is Hungry, Angry, Lonely or Tired (HALT), and taking the appropriate self-care measures
- Increasing activities that are positive
- Practicing religious faith, philosophy, spirituality
- Spending time with family and friends
- Learning how to “put stress away”
- Writing, drawing, painting
- Limiting caffeine, cigarette, and substance use
As much as possible, providers should make every effort to:
• Self-monitor and pace their efforts
4
Appendix C: Provider Care
• Maintain boundaries: delegate, say no, and avoid working with too many survivors in a given shift
• Perform regular check-ins with colleagues, family, and friends
• Work with partners or in teams
• Take relaxation / stress management / bodily care / refreshment breaks
• Utilize regular peer consultation and supervision
• Try to be flexible, patient, and tolerant
• Accept that they cannot change everything
Providers should avoid engaging in:
• Extended periods of solo work without colleagues
• Working “round the clock” with few breaks
• Negative self-talk that reinforces feelings of inadequacy or incompetency
• Excess use of food/substances as a support
• Common attitudinal obstacles to self-care:
“It would be selfish to take time to rest.”
“Others are working around the clock, so should I.”
“The needs of survivors are more important than the needs of helpers.”
“I can contribute the most by working all the time.”
“Only I can do x, y, z.”
After Relief Work
Expect a readjustment period upon returning home. Providers may need to make personal reintegration a priority for a while.
Organizational Care of Providers
• Encourage time off for providers who have experienced personal trauma or loss
• Institute exit interviews to help providers with their experience – this should include information about how to communicate with their families about their work
• Encourage providers to seek counseling when needed, and provide referral information
• Provide education on stress management
• Facilitate ways providers can communicate with each other by establishing listservs, sharing contact information, or scheduling conference calls
• Provide information regarding positive aspects of the work
Provider Self-Care
Make every effort to:
• Seek out and give social support
• Check in with other relief colleagues to discuss relief work
• Increase collegial support
5
Appendix C: Provider Care
6
• Schedule time for a vacation or gradual reintegration into your normal life
• Prepare for worldview changes that may not be mirrored by others in your life
• Participate in formal help to address your response to relief work if extreme stress persists for greater than two to three weeks
• Increase leisure activities, stress management, and exercise
• Pay extra attention to health and nutrition
• Pay extra attention to rekindling close interpersonal relationships
• Practice good sleep routines
• Make time for self-reflection
• Practice receiving from others
• Find things that you enjoy or make you laugh
• Try at times not to be in charge or the “expert”
• Increase experiences that have spiritual or philosophical meaning to you
• Anticipate that you will experience recurring thoughts or dreams, and that they will decrease over time
• Keep a journal to get worries off your mind
• Ask help in parenting, if you feel irritable or are having difficulties adjusting to being back at home
Make every effort to avoid:
• Excessive use of alcohol; illicit drugs or excessive amounts of prescription drugs
• Making any big life changes for at least a month
• Negatively assessing your contribution to relief work
• Worrying about readjusting
• Obstacles to better self-care:
o Keeping too busy
o Making helping others more important than self-care
o Avoiding talk about relief work with others.

Disaster Responders

Psychological First Aid: Field Operations Guide  

For disaster responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning. It is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. The 5th appendix consists of Handouts for Survivors (PDF).

NOTE: The latest version of Adobe Acrobat Reader* is needed to download these files. Not having the latest version (8) of this reader may cause error messages that the PDF file is "damaged".

Hardcopies of the PFA Field Operations Guide can be purchased at www.castlepress.net/nctsn* for around $10 each.

The Psychological First Aid Manual Contents

Chapter/ Topic	Title of Chapters and Topics
Complete Guide With Appendices	PFA Manual complete with Appendices (PDF 60mb)
Complete Guide Without Appendices	PFA Manual without Appendices (PDF 1.6mb)
Chapter 1	Introduction and Overview
Chapter 2	Preparing to Deliver Psychological First Aid
Chapter 3	Core Actions
Topic 1	Contact and Engagement
Topic 2	Safety and Comfort
Topic 3	Stabilization
Topic 4	Information Gathering: Current Needs and Concerns
Topic 5	Practical Assistance
Topic 6	Connection with Social Supports
Topic 7	Information on Coping
Topic 8	Linkage with Collaborative Services
Appendices (5) for Psychological First Aid Manual
1	Overview of PFA (PDF 379k)
2	Service Delivery Sites and Settings (PDF 381k)
3	Psychological First Aid: Provider Care (PDF 900k)
4	Provider Worksheets (PDF 491k)
5	Handouts for Survivors (PDF 2.1mb) Includes:

Available in other languages on the National Child Traumatic Stress Network website: PFA in Chinese, Japanese, and Spanish*

Training on PFA

• Training in PFA: Psychological First Aid Online.* Login to learn about this intervention.
• Subscribe to PFA Channel and View the PFA Online Videos.*

PFA was created with the Terrorism Disaster Branch of the National Child Traumatic Stress Network as well as others involved in disaster response. Production of this information was supported by SAMHSA.