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Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC

Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the District of Columbia. Here’s What’s Coming. Job Effectiveness & Satisfaction Impairment The Disorders The Warning Signs The Train Wreck

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Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC

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  1. Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the District of Columbia

  2. Here’s What’s Coming • Job Effectiveness & Satisfaction • Impairment • The Disorders • The Warning Signs • The Train Wreck • Drinking and Drugging • Wellness

  3. Two Essential Coping Skills

  4. An impaired professional is one who has an illness or problem that prevents him or her from adequately performing required occupational duties.

  5. I Can’t Get No Satisfaction

  6. Impairment Arenas

  7. Occupational Impact • Not as good as I used to be • Not as good as I could be • Not as good as I need to be

  8. Impairment Levels

  9. Sources of Impairment

  10. 7 Work-related Contributors • Excessive, un-realistic demands • Monotony • Compassion fatigue • Bullied or rejected • Workplace conflict • Lack of mechanisms for resolution or venting • Triggering events (counter transference)

  11. Defining Mental Health How a person thinks, feels, and acts when faced with life’s situations. Mental Health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore their choices. This includes handling stress, relating to other people, and making decisions.

  12. Threats to Wellness • Lifestyle Choices, Job Changes, Tragedy, Sickness • Substance Use Problems • Mental Health Problems

  13. Mental Health Continuum Wellness MH Problems Common MH Problems Disorders Mental Illness

  14. Common Mental Health Problems • Stress • Grief & Loss • Adjustment Difficulties • Anxiety • Juvenile Misbehavior • Marital or Family Discord • Discontent & Dissatisfaction • Unhappiness

  15. Mental Disorder

  16. Borderline Personality Disorder and Impairment • Unstable relationships; extremes; shifting views of others • Fear of being abandoned • Feelings of emptiness and boredom • Frequent displays of inappropriate anger • Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting • Intolerance of being alone • Repeated crises and acts of self-injury, such as wrist cutting or overdosing

  17. 10 Warning Signs • Increased incidence of professional errors and oversights • Shows a decreased concern for defendant well being • Increased defendant complaints about the quality of service or manner, style, and tone of communications

  18. 10 Warning Signs • Increased absence from work, social functions, or family outings • Frequently disappears for extended periods during the day • Deterioration of personal hygiene and/or appearance • Appears sleep deprived or distracted

  19. 10 Warning Signs • Appears under the influence at work • Emotionally labile • Crying spells or uncharacteristic outburst

  20. Five Ways to Wreck Your Career • Deny • Deflect • Deceive • Detach • Detonate

  21. New DSM-5 • Diagnostic Statistical Manual of Mental Disorders (5th edition) • “Substance use disorder” and “addiction”, instead of “substance abuse” or “substance dependence” • Underlying change in brain circuits that may persist beyond detoxification for those with severe disorders

  22. Substance Use Disorder and other Addictive Disorders A maladaptive pattern leading to clinically leading to clinically significant impairment or distress for at least 12 months. • 10 classes of drugs; 11 criteria (symptoms)

  23. The Symptoms Two or more of: • Recurrent substance use leading to failure to fulfill major obligations • Associated social and interpersonal problems • Use in situations that are physically hazardous • Tolerance • Withdrawal effects

  24. The Symptoms Two or more of: • Taking the substance in larger amounts and for longer than intended • Unsuccessful efforts to stop or cut down • Spending excessive time to obtain or use the substance • Giving up other activities • Continuing use despite the problems • Craving the substance

  25. Substance Use Disorder

  26. SubstanceRelated Disorder

  27. How Many?

  28. Addiction: A New Definition A medical condition characterized by impairment within the brain’s reward center and resulting in compulsive, repetitive, self-destructive behaviors

  29. Medial Forebrain Bundle Prefrontal Cortex Ventral Tegmental Area Nucleus Accumbens

  30. Neurotransmitter Action Reuptake Release of NT Receptor

  31. How Drugs Work • Interact with neurochemistry • Results: • Feel Good – euphoria/reward • Feel Better – reduce negative feelings

  32. Drug-Interacting Neurotransmitters • Dopamine – excitement & reward • Serotonin – feel – “normal” • Endorphin/Enkephalin – pain relief, reward, craving • GABA – lowers anxiety

  33. Behavior Pathways • Rewarding behaviors urgently pursued • Obsessive, preoccupation, compulsion • “Subconscious” control of the behavior • Difficult to extinguish behaviors • Resistant to change

  34. Brain Command Center Delay Discounting Demand Elasticity

  35. Dopamine Tone • Amount of dopamine produced • Length of time dopamine is available • Number of dopamine receptors

  36. Five Ways to Preserve Your Career • Decompress • Deliberate • Depend • Delegate • Deposit

  37. Get Support • Employee Assistance Program • Human Resources • Professional Treatment • Faith Community • Support Groups • Trustworthy Colleague • Management Team

  38. Social Work Code of Ethics Social workers who have direct knowledge of a social work colleague's impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

  39. Social Work Code of Ethics Social workers who believe that a social work colleague's impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

  40. Reaching Out • Established, positive working relationship: • Raise the issue • Encourage them to get help • Discuss with supervisor • Honor your professional obligations • Don’t gossip

  41. Healthy Agencies… Encourage personal wellness and work-life balance Create safe environments for staff to acknowledge impairment Don’t punish disclosure Provide support Expect the impaired to take responsibility for restoration

  42. Working Wounded: Preventing and Coping with Impairment in Helping Professionals Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the District of Columbia Terrencedwalton@gmail.com

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