My New Year's Resolution: Moving from "self-care" to a culture of staff wellness and resiliency

 
Over the last few months Clare and I  have been traveling across the nation to visit the Mobilizing Action for Resilient Communities (MARC) sites. One thing we've consistently heard from members of the ACE and resilience networks we've met is what they have learned about prioritizing what many refer to as "self-care for staff."
 
In Kansas City, Patricia Davis' (LCSW) full-time job is to integrate trauma-informed practice at Children's Mercy Kansas City Hospital  (how great is that!). Davis shared that they had to shift their approach and focus first on what they refer to as "staff wellness and resilience"before they could even address their other pillars of trauma informed care, share knowledge and raise awareness about trauma and adversity and integrating trauma sensitive practices into patient care. Like many other organizations, Mercy Children's started their journey to become a trauma informed organization by providing foundational training on trauma and ACEs. They soon found that staff could not be open to the information until they, themselves, felt safe and cared for by the organization. This led them to begin prioritizing how the organization attended to staff wellness and resilience.
 
Several things about the Mercy Children's story struck a chord for me.
 
First, of course it made total sense that staff safety, wellness and resilience are paramount; like Maslow's Hierarchy of Needs, it must come first. Isn't this what we teach when we use the analogy of putting one's own oxygen mask on before assisting others?
 

Second, I really liked that they broadened the terminology  from the oft used "self-care" to "staff wellness and resiliency." I've become increasingly uncomfortable with the emphasis that many workshops, trainings, books, articles, and tool kits on trauma informed care (including those offered by my own organization) place on employee "self-care" as the key preventive measure and antidote to secondary traumatic stress or vicarious trauma. To me, prioritizing self-care places far too much of the responsibility on the individual employee and far too little responsibility on organizations and systems to integrate practices, protocols and policies that support and nurture staff so they can, in turn, support and nurture those they serve.

So, what do I mean by practices, protocols and polices that support and nurture staff and prevent and ameliorate secondary traumatic stress?  Here are a few ideas.

  • Educate all staff about the signs and symptoms of secondary traumatic stress and self-care.
  • Provide meaningful and creative opportunities for professional development (e.g. brown bag lunches on topics of interest to staff, book club discussion groups, etc.)
  • Provide opportunities for staff to safely explore their own trauma histories.
  • Provide reflective supervision, a model which gives staff an opportunity to meet regularly and collaboratively with their supervisors to reflect on how their work affects them and deepens their understanding of parallel process.
  • Offer on-site opportunities for employee self-care and social connection such as physical activity, birthday celebrations, knitting circles, yoga, meditation, etc.
  • Make the creation of individual safety and self-care plans an organizational practice for all staff.
  • Empower employees and provide opportunities for them to contribute their ideas to organizational improvement, staff wellness and resilience.
  • Ensure that the physical environment where staff works  is safe.
  • Ensure that staff have psychological safety at work (e.g. have and enforce strong policies condemning bullying, harassment, discrimination, racism, sexism, etc. in the workplace)
  • Provide health and mental health care benefits and access to employee assistance programs.
  • Provide paid sick and family leave.
  • Provide a living wage.
 
My resolution for 2017 is to work toward changing the lexicon as a starting point for changing the culture. From here forward I hope you will join me in promoting the concept of and using the phrase "staff wellness and resilience" rather than "self-care" as primary in any organization wanting to become trauma informed.
 
Over the year I hope to share more stories from our MARC site visits, about where and how staff wellness and resilience is happening and what I've learned from you. Please feel free to share your stories with me.
 

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Such great feedback from your journeys, Leslie! Thank you! I'm transitioning into a new role (for me and for the agency) next week in which I'll be working directly with governmental systems (local juvenile court, local sheriff's department, and local county government) who have signed on to have their entire system assessed and transformed into trauma-informed systems. I've long held that social service and government agencies should hold more of the onus for the "self-care" of their workforce. So I really appreciate hearing these practical ideas. I'll be sure to follow the stories of your MARC sites as I'm sure there will be lots to learn! 

Nina Esaki posted:

Thank you, Leslie, for a great article. Having been in the corporate HR world prior to switching into the human services field as an organizational change researcher, I also believe in the importance of concepts such as organizational trust and organizational justice. In addition to some of the "softer" aspects of organizational health, research suggests that healthy (and resilient) organizational cultures are also mindful of building structural systems - such as HR policies and processes (e.g., compensation, hiring and promotion, performance inspiration - a term I like to use rather than "management"), IT systems and financial systems that are supportive of employees and their work. There is burgeoning research that shows that organizations that have both the relational AND structural systems that support, rather than hinder, employees contribute to employee well-being (physical, mental, psychological, and emotional) and outperform those that do not.

Hi Nina,

Thanks for this response.  There is so much we can learn from the corporate world and I love the concept of "organizational trust and justice" and couldn't agree more that attention to relational and structural issues is imperative.  I will resolve to add these ideas to my thinking on staff wellness and resilience this year too.

 

Thanks, Jane, for your great question. Yes - I am familiar with organizations that have used ACEs science to support trauma-informed organizational change, but given the qualitative data I've gathered through focus groups, coupled with research and discussions with organizational health thought leaders (primarily from the business sector as well as from countries such as Canada and Denmark that have federal agencies funding research on this topic), I believe we would benefit from incorporating some underutilized organizational tools. For example, while in the corporate HR field, we used the Balanced Scorecard - a more well-rounded way to look at organizational performance than just finances (there is a heavy emphasis placed on human capital), and behavioral interventions (e.g., quarterly Town Hall meetings, internal customer satisfaction surveys to assess staff satisfaction with support received from the administrative departments, satisfaction with supervisor surveys, efficiency Action Teams to look for ways to streamline operations etc.). Believe these data driven, research-informed organizational tools promote organizational safety, trust and justice - critical to creating a healthy, resilient and high-functioning organization. We need data-driven human resources processes to track how healthy and resilient we truly are. Would welcome an e-mail offline to Nina@orgnavigator.com if anyone might be interested in discussing further. Thanks!

Thank you, Leslie, for a great article. Having been in the corporate HR world prior to switching into the human services field as an organizational change researcher, I also believe in the importance of concepts such as organizational trust and organizational justice. In addition to some of the "softer" aspects of organizational health, research suggests that healthy (and resilient) organizational cultures are also mindful of building structural systems - such as HR policies and processes (e.g., compensation, hiring and promotion, performance inspiration - a term I like to use rather than "management"), IT systems and financial systems that are supportive of employees and their work. There is burgeoning research that shows that organizations that have both the relational AND structural systems that support, rather than hinder, employees contribute to employee well-being (physical, mental, psychological, and emotional) and outperform those that do not.

Leslie,

Thanks for the suggestion of a new lexicon "staff wellness and resilience. "  Yes, an over emphasis on "self-care" by agencies or trainers can feel like one more burden for the professional caregiver- and may unwittingly exonerate agencies from creating healthier environments in which workers can safely share their stories and experiences of secondary trauma and feel supported. 

In our documentary film, "PORTRAITS OF PROFESSIONAL CAREGIVERS: Their Passion. Their Pain", we illustrate structures of staff support in child welfare, hospice work, and emergency management (firefighters/ EMTs). It was important to us in producing this film to move beyond the simplistic notion of "well, just take care of yourself more..."

Thanks for your fine article!

Vic    (www.caregiversfilm.com)

 

I really appreciate this article Leslie.  I agree that the concept of self-care indicates that the responsibility lies solely on the individual employee.  Time and time again, I've seen this fail when the organization doesn't take steps to support it.  I also thought it was great that you provided some examples of steps an organization can take to move in the direction of building a culture of staff wellness and resiliency.  It can be simpler than we imagine it to be.  Thanks for sharing the insight you've gained in your site visit.  Looking forward to more.

Thank you so much for this. I love this piece and especially the emphasis on an organization, department, group taking responsibility for this as opposed to an individual.

It's a great model for parents and schools and communities to shift from what is wrong with who and why and how to fix it, the disease model, to asking if and how all are well and how wellness can be promoted, across the board.

I remember in grade school having a dentist come in to say, "If you aren't true to your teeth, they will be false to you" as a part of a talk on the importance of brushing. That stuck with me. Other times, when I was singled out by a teacher (for bed wetting), it just caused shame, didn't get at the original issue and made me feel bad. I'm a huge fan of emphasizing wellness for all while also understanding why this isn't available or intuitive or easy to everyone and how some might actually need a lot more support than others learning or letting go of trying not to die or be harmed. And what a brilliant model to start with our own work communities so we are practicing being self-healing communities as well as talking and teaching and sharing why and how it's useful.

Yes! Yes! Yes!
Cissy 

I think your point about talking about community responsibility for wellness is a really important one, Leslie. We really need to create a culture of wellness for all community members, including parents. That means treating burnout and overwork as signs that something that isn't working rather than achievements that are worthy of kudos.

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