Ethics of Burnout Prevention Talking Points.docx

Ethics of Burnout Prevention Talking Points: Introduction/Welcome Welcome and thank everyone for attending and let everyone know where bathrooms are, etc. Introduce myself and mention credentials. Roadmap of the course Explore what the codes of ethics say about burnout (LCSW, LPC/LMFT, and LADC)...

Ethics of Burnout Prevention Talking Points: Introduction/Welcome Welcome and thank everyone for attending and let everyone know where bathrooms are, etc. Introduce myself and mention credentials. Roadmap of the course Explore what the codes of ethics say about burnout (LCSW, LPC/LMFT, and LADC) Define burnout. Explore how it affects healthcare workers and offer statistics Introduce Stress screener to assess level of burnout. If people are looking for more in depth measures of burnout assessments reference paid versions. Explore main areas of impairment and then offer ways to address and cope with those areas. Apply skills learned to 2 case studies Conclusion DISCUSSION: Why is it important to take steps to recognize and prevent burnout? Code of Ethics LCSW: (Source NASW Code of Ethics: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-as-Professionals) “4. Social Workers’ Ethical Responsibilities as Professionals: 4.05 Impairment (a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility. (b) Social workers whose personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others.” LPC (Source: LPC Act and Regulations: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ok.gov/behavioralhealth/documents/ACT%20AND%20REGULATIONS%20-%20LPC%20-%207-25-2010.pdf) “310:405-3-2. Competence: (e) Impairment. LPCs shall not offer or render professional services when such services may be impaired by a personal physical, mental or emotional condition(s). LPCs shall seek assistance for any such personal problem(s) with their physical, mental or emotional condition, and, if necessary, limit, suspend, or terminate their professional activities. If an LPC possesses a bias, disposition, attitude, moral persuasion or other similar condition that limits his or her ability to recommend a course of treatment or decision-making that is indicated, and under such circumstances where all other treatment and decision options are contra-indicated, then in that event the LPC shall not undertake to provide counseling and will terminate the counseling relationship in accordance with these rules. (f) Knowledge of impairment. If a LPC becomes aware that a LPC or LPC candidate is violating an obligation described in Section 310:405-3-2(e), the LPC must, within a reasonable time, report the situation to the Department in accordance with Section 310:405-31-2. LMFT (Source: LMFT Act and Regulations: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ok.gov/behavioralhealth/documents/ACT%20AND%20REGULATIONS%20-%20LMFT%20-%207-25-2010.pdf “310:400-5-3. Professional competence and integrity (c) LMFTs shall seek appropriate professional assistance for their own personal problems or conflicts that are likely to impair their work performance and their clinical judgment.” LADC: (Source: Oklahoma LADC/MH Code of Ethics chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.okdrugcounselors.org/download.php/185/FORM%20216%20-%20LADC-MH%20CODE%20OF%20ETHICS.pdf) “4. Professional Standards: LADC/MH counselors shall maintain the highest professional standards and shall not: - Claim either directly or by implication, professional knowledge, qualifications or affiliations that they do not possess; - Lend their names to, or participate in, any professional and/or business relationship which may misrepresent or mislead the public in any way; - compromise professional status as co-occurring recovery counselors with clients through the association, development and/or promotion of books or other products offered for commercial sale; - Fail to recognize the effect of professional impairment or professional performance and must be willing to seek appropriate treatment for themselves.” Case Manager (Source: Standards and Criteria for Certified Behavioral Health Case Managers chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://oklahoma.gov/content/dam/ok/en/odmhsas/documents/a0001/chapter-50-final-eff-9-5-18.pdf) SUBCHAPTER 7. RULES OF PROFESSIONAL CONDUCT 450:50-7-1. Responsibility and scope of practice (h) Certified Behavioral Health Case Managers shall provide services with populations and in areas only within the boundaries of their competence, based on education, training, supervised experience, consultation, study or professional experience. (2) Certified Behavioral Health Case Managers are eligible to provide services within the scope of their certifications that would not lead to conflict of interest, exploitation of relationship, loss of objectivity and based on education, training or experience. Peer Recovery Support Specialist (Source: Oklahoma Peer Recovery Support Specialist Code of Ethics chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://oklahoma.gov/content/dam/ok/en/odmhsas/documents/a0004/rss-code-of-ethics.pdf) “2. Peer Recovery Support Specialists will maintain high standards of personal conduct. Peer Recovery Support Specialists will also conduct themselves in a manner that fosters his or her own recovery.” DISCUSSION: What do you think causes burnout and why do you think it is important to be aware of it to practice ethically? Definition of burnout (Source: Burn-out an "occupational phenomenon": International Classification of Diseases https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases) The World Health Organization noted that Burnout is listed on the International Classification of Diseases – 11 (ICD-11) and gave the following definition: “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” 3 Dimensions of Burnout SAMHSA released an article in September 2022 that expanded upon those 3 dimensions of burnout listed by The World Health Organization (Sources: Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies & Burn-out an "occupational phenomenon": International Classification of Diseases): Feelings of Exhaustion: “Loss of energy Depletion Overextension Fatigue Depersonalization: Withdrawal Increased mental distance from one’s job Feelings of negativism/cynicism related to one’s job Professional Inefficacy: Reduced feelings of accomplishment and productivity” Burnout Prevalence SAMSHA released an article in September 2022 stating that approximately 50% of behavioral health providers are experiencing burnout due to “high levels of stress, low salaries, perceived lack of career advancement opportunities, and high caseloads.” (Source: Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep22-06-02-006.pdf) “A recent (pre-COVID-19) meta-analysis found a burnout (i.e., emotional exhaustion) prevalence rate of about 40% across all mental health professionals (O’Connor et al., 2018).” (CDC The Impact of COVID-19 on mental health providers) “Rates of burnout are typically higher in clinicians who are female, single or without a partner, younger, eager to achieve, highly driven and ambitions, and those who are willing to cross boundaries.” (Source: Therapeutic Strategies to Tackle Burnout https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450185/) Counselors also tend to experience high levels of burnout due to consistent thoughts of not having enough time to tend to their own needs due to the demands of the job, feeling selfish for taking time for themselves instead of continuing to help others, and feeling that they “should have it all figured out.” (Source: Counseling Today: The Battle Against Burnout https://ct.counseling.org/2018/03/the-battle-against-burnout/) During COVID-19, “Holmes and colleagues (2021) found that 99.1% of sampled social workers were experiencing average to high compassion fatigue, nearly half (i.e., 49.6%) reported symptoms of secondary trauma, and over a quarter (i.e., 26.2%) met diagnostic criteria for post-traumatic stress disorder.” (CDC The Impact of COVID-19 on mental health providers).” A qualitative study was published in February 2023 that aimed to gather information on U.S. mental health professionals during their time practicing during June and July of 2020. Results were varied including lots of talk of feeling isolated, increased worry about their clients, higher rates of burnout due to adjusting to teletherapy, loneliness, difficulties disconnecting from work due to working at home and not having separation, and also some experienced a sense of pride and responsibility to do well even though it was hard. The study also suggested a revamping of traditional self-care measures to improve implementation of “mindfulness, self-awareness, and reflection-based supervision and consultation.” (CDC The Impact of COVID-19 on mental health providers) While some of these areas may have improved for mental health professionals, it is hard to deny that we are still may be continuing to process and deal with the difficulties experienced during COVID-19. Burnout Assessment: Explain the Stress screener to participants and give them a few minutes to fill it out. Answer any questions they have throughout. After they are finished, have them process the experience. DISCUSSION: Thoughts of filling out the screener? Were you surprised by the results? Reference other burnout assessments if they are interested in a more in depth look at burnout. Maslach Burnout Inventory (MBI) Strategies to address burnout: (Source: Therapeutic Strategies to Tackle Burnout https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450185/) Individual strategies – Now that we know the main touchpoints, lets take a look at some skills to utilize the main areas burnout effects that we learned earlier. Feelings of Exhaustion (Source: Tips to navigate workload and prevent burnout: https://ct.counseling.org/2022/12/tips-to-navigate-workload-and-prevent-burnout/) Take breaks throughout the day Develop a point system for unwinding Adopt a growth mindset Shift the perspective Spend time doing something for yourself regularly Seek out a qualified counselor Homewood Health Self-Care Starter Kit REVIEW AND PRACTICE Look at Identify Self-Care Needs and give people a moment to fill out some of the items. Reference the Developing a Self-Care Plan hanout and hit high points such as desk exercises, etc. 500+ free printable workbooks, manuals and self-help guides: https://mindremakeproject.org/2018/11/12/free-printable-pdf-workbooks-manuals-and-self-help-guides/ Be intentional about implementing a plan and be reflective about changing it when needed. Implementing self-care strategies are often complicated because everyone has their own unique challenges and needs that change over time. Being mindful about what you need in a given point in time and shifting your focus is an important skill to have. (Source: Counseling Today: The Battle Against Burnout https://ct.counseling.org/2018/03/the-battle-against-burnout/) Depersonalization: Somatic Experiencing Therapy was developed by Peter Levine and has a focus on addressing trauma using a “body-mind” approach. Lots of focus is placed on checking in how the body is feeling and utilizing body scans, physical touch and grounding techniques to improve ones coping skills. Lets take a look at couple items and then we will practice them. Grounding and Evoking Kindness. 8 Therapeutic Techniques for your practice (Source: Somatic Experiencing Therapy: 10 Best Exercises & Examples https://positivepsychology.com/somatic-experiencing/) Let participants know that we will be practicing some of the skills and that I will prompt when we practice them: “Noticing Physical Comfort – Feeling physical support and experiencing your physical boundaries in a safe space can bring feelings of comfort. Self-Soothing Touch – Boundaries are usually broken with trauma, and it is essential to recover this by working with the body. Touch can instill containment and create a soothing sensation. – Practice this one, one hand across and under arm, the other crossed and grabbing the arm and then giving a gentle squeeze. PRACTICE Soothing Breath – Breath and touch can help soothe both the body and the mind. Slow deep breathing can activate the parasympathetic nervous system, bringing a feeling of relaxation and calmness. Grounding and Centering – People commonly experience a loss of grounding and are thrown off balance. Grounding allows feelings of safety and inner strength to emerge. (Source: 4 Somatic Therapy Exercises for Healing from Trauma https://psychcentral.com/lib/somatic-therapy-exercises-for-trauma) “Run water over your hands. Start by running cold water over your hands. Focus on how the temperature feels on each part of your hand, from your wrist to your nails. Switch to warm water and focus on how the sensation on your hands changes. Do this for a few minutes until you calm down. Focus on your breathing while you control how you inhale and exhale. You can start by inhaling to the count of 4, holding for 3 seconds, and then exhaling for another count of 4. You could also repeat what you consider a happy word after each inhalation. For example, safe, peace, easy, or gone.” PRACTICE Evoking Kindness – Remembering a time when you experienced kindness from someone can evoke pleasant physical and emotional sensations. Recalling Being Yourself – Coming back to yourself can provide a greater sense of being grounded and feeling comfortable in your own skin. Guided meditation: Self-Compassion – Soles of our feet (5 minutes). Be intentional about connection (Source 10 ways to relieve depersonalization) If you notice that you are becoming more withdrawn at work or withdrawn in general, assess triggers, and find ways to connect Perhaps it is going to a company sponsored event or possibly outside of work things such as visiting a friend. Professional Inefficacy: Self-compassion by Dr. Kristin Neff Dr. Kristin Neff is a psychologist who has done extensive studies on self-compassion. She has written books and also created a scale to measure a person’s self-compassion approximately 20 years ago. Lets take a look at a short video explaining what is self-compassion. Show Self-Compassion video https://self-compassion.org/videos/ Review the 3 Elements of Self-Compassion https://self-compassion.org/the-three-elements-of-self-compassion-2/ Self-Kindness vs. Self-Judgement Show video: Self Kindness https://self-compassion.org/videos/ Instead of harsh judgement, we meet our difficulties with a kind, compassionate view. Recognizing that the area is difficult and that we need to give ourselves some space to feel and understand that we are not perfect. Think meeting difficulties with a gentle understanding instead of getting angry with what happened to us. Common humanity vs Isolation Show video: Common humanity https://self-compassion.org/videos/ Reminding ourselves that we are not alone in experiencing difficulties and embracing connection with others instead of feeling like we alone and pushing others away. Mindfulness vs Over-identification Show video: Mindfulness: https://self-compassion.org/videos/ Being mindful of our thoughts and experiences can be a way to be self-compassionate as well Show where to find the self-compassion test https://self-compassion.org/self-compassion-test/ Show where to find the exercises and do one. https://self-compassion.org/category/exercises/ We are going to take a look at couple exercises to practice this: Exercise 1: https://self-compassion.org/exercise-1-treat-friend/ We are going to take a look at Exercise 7 and take a few moments to fill that out. https://self-compassion.org/exercise-7-identifying-really-want/ Show them the other activities and guided meditations that are available. Organizational Strategies: It is important to note that a key component of burnout is effected by how the agency itself treats its employees and also about the individual being mindful if the organization is good fit. If an individual tries the previous strategies and still are having trouble managing burnout, it is important to determine if it is time to take a break from the organization or if they need to seek employment elsewhere because of various items (not aligning with the organization’s mission, values not meshing like they used to, new policies that you are strongly against, etc.). Source: SAMHSA Burnout chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep22-06-02-006.pdf) Organizational level strategies are often cited as the most effective measure to combat burnout. (4 Steps) Build a Planning and Implementation Taskforce Conduct a Needs Assessment Identify Resources and Strategies Plan for Sustainability (Source: Counseling Today: The Battle Against Burnout https://ct.counseling.org/2018/03/the-battle-against-burnout/) Be mindful of having employees leave on time and encourage them to take vacation days. Process in supervision ways for them to implement self-care and safety plans when they express, they are having difficulties or if you notice a change in their work. Utilize staff meetings to process tough cases and give each other support. Educate staff on how to handle stress, setting appropriate boundaries, and documentation skills such as collaborative documentation. Case Studies Angie Ben Doug Next steps – Remind them of taking the burnout assessment again in 3-6 months and choosing a skill or two to start implementing on a regular basis. If there is time for it, end with a longer guided meditation (16:00 minutes) Soften, Soothe, Allow: Working with emotions in the body – Self- Compassion If I need an even longer one, use Compassionate Body Scan (24 minutes) Conclusion References: (Source NASW Code of Ethics: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-as-Professionals) LPC Act and Regulations: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ok.gov/behavioralhealth/documents/ACT%20AND%20REGULATIONS%20-%20LPC%20-%207-25-2010.pdf LMFT Act and Regulations: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ok.gov/behavioralhealth/documents/ACT%20AND%20REGULATIONS%20-%20LMFT%20-%207-25-2010.pdf (Source: Oklahoma LADC/MH Code of Ethics chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.okdrugcounselors.org/download.php/185/FORM%20216%20-%20LADC-MH%20CODE%20OF%20ETHICS.pdf) Standards and Criteria for Certified Behavioral Health Case Managers chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://oklahoma.gov/content/dam/ok/en/odmhsas/documents/a0001/chapter-50-final-eff-9-5-18.pdf PRSS Code of ethics chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://oklahoma.gov/content/dam/ok/en/odmhsas/documents/a0004/rss-code-of-ethics.pdf (Source: Therapeutic Strategies to Tackle Burnout https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450185/) (Source: Burned Out – and at risk chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://naswassurance.org/pdf/PP_Burnout_Final.pdf) (Source: Social Worker Self-Care – The Overlooked Core Competency https://www.socialworktoday.com/archive/051214p14.shtml) (Source: Counseling Today: The Battle Against Burnout https://ct.counseling.org/2018/03/the-battle-against-burnout/) (Source: 4 Somatic Therapy Exercises for Healing from Trauma https://psychcentral.com/lib/somatic-therapy-exercises-for-trauma) (Source: Tips to navigate workload and prevent burnout: https://ct.counseling.org/2022/12/tips-to-navigate-workload-and-prevent-burnout/) Source: CDC The Impact of COVID-19 on mental health providers file:///C:/Users/jgambill/Downloads/cdc_129376_DS1.pdf Self-Compassion Test https://self-compassion.org/self-compassion-test/ Self-Compassion Guided Practices and Exercises https://self-compassion.org/category/exercises/ Self-Compassion https://self-compassion.org/ 10 Tips for Coping with Emotional Exhaustion: https://www.elevatecounseling.com/blog-post/10-tips-for-coping-with-emotional-exhaustion Burn-out an "occupational phenomenon": International Classification of Diseases https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep22-06-02-006.pdf 10 ways to relieve depersonalization https://psychcentral.com/lib/10-simple-ways-to-relieve-depersonalization Resources for Clinicians (Don’t necessarily go over, but link them to links and books for further study): 500+ free printable workbooks, manuals and self-help guides: https://mindremakeproject.org/2018/11/12/free-printable-pdf-workbooks-manuals-and-self-help-guides/ Maslach Burnout Inventory https://www.mindgarden.com/117-maslach-burnout-inventory-mbi