USPHS Responder’s Resiliency Support Training

1. USPHS Responder’s ResiliencySupport Training Resiliency and Deployment Behavioral Health Team (RDBHT) CAPT Josefine Haynes-Battle, MSN, BSN, RN CDR Marivic Fields, LMSW, BCD CDR Indira Harris, LCSW, BCD CDR William Bolduc, MS, LCSW, BCD LCDR Joy Mobley, PsyD

2. Objectives • Gain basic understanding of core concepts of resiliency • Understand the causes and effects of stress, burnout and compassion fatigue • Be able to assess your own level of resiliency and demonstrate the ability to implement a resiliency plan during all phases of deployment • Be able to locate resources to support one’s own needs, and the needs of family, fellow officers and/or colleagues during all phases of deployment

3. Compassion Fatigue • A state of exhaustion and impairment, biologically, physiologically, and emotionally, as a result of prolonged exposure to trauma experienced by others. • Natural • Predictable • Manageable • Treatable

4. What does Compassion Fatigue feel like/look like? • Intrusive thoughts • Decreased attention span • Thoughts of harm to self or others • Reduced sense of safety • Suspiciousness • Rapid heartbeat • Breathing difficulties • Aches and pains • Dizziness • Exhaustion • Poor sleep • Appetite changes • Hyper vigilant • Argumentative • Self-medicating • Powerlessness • Anxiety/Fear • Anger/Irritability • Numbness • Shame • Detachment from Co-workers, not involved in the work • Detachment from family and friends • Shortened tenure in current position • Decreased sense of hope/purpose • Anger at God • Questioning of prior beliefs • Loss of compassion

5. So what happens when…

7. Burnout

8. Not just bad for responders, bad for business… The United States federal government identified burnout as one key factor driving the “major problem” of retaining competent staff in “treatment organizations and state behavioral health systems” (p. 16, (Hoge et al., 2007)).

9. Associated with… • Increased depression and anxiety • Sleep problems • Impaired memory • Frequent headaches and muscle pain • Alcohol consumption • Decreased motivation • Absenteeism

10. Isolated Areas • Lack of anonymity • Increased ethical dilemmas • Fewer total Officers and scarcity of specialized resources

11. What is Resiliency? • Sustain good health and well-being in stressful conditions • Become stronger and better year after year • Cope well with non-stop change • Overcome adversity • Convert misfortune into good luck • Bounce-back easily from setbacks

12. Five Pillars of Resiliency Emotional Spiritual Physical Behavioral Mental

13. Resiliency Break Outs (15min) • Group 1: Emotional Resiliency/Distress • Group 2: Physical Resiliency/Distress • Group 3: Spiritual Resiliency/Distress • Group 4: Behavioral Resiliency/Distress • Group 5: Mental Resiliency/Distress

14. Emotional Resilience Coping with stress Optimism Positive Relationships • Self-awareness • Acceptance • Bouncing back

15. Emotional Distress Feeling emotionally numb or detached Inexplicable sadness Flashbacks to a traumatic event Confusion or disorientation Extreme mood swings Loss of work ethic or social functionality Poor self-care • Inability to eat, sleep, or concentrate • Negative outlook or depression • Thoughts or attempts at self-harm • Irritability, Inability to control anger • Impulsive behavior • Feelings of helplessness or hopelessness • Fearfulness, nervousness or anxiety

16. Physical Resilience Avoiding substance abuse Taking care of yourself Regular check-ups • Knowing your limits • Eating a balanced diet • Balanced physical activity

17. Physical Distress Unexplained exhaustion Insomnia Poor eating habits Poor safety habits • Recurring pain in joints, muscles, or elsewhere in the body • High Body Mass Index (BMI) • Difficulty breathing • Abuse of substances

18. Mental Resilience • Outlook and Perspective • Self-Belief • Positive Self-Talk • Ability to re-frame any negative thoughts • Sustained Focus • Setting Boundaries • Setting realistic goals • Relax and Let Go • Ask for Help • Count on Friends • Breathing • Visualizing • “Chunking” • Gratitude • Self-acceptance

19. Mental Distress • Difficulty letting go of mistakes • Negative perception of oneself • Depression • Frequent expressions of negativity • Paranoia • Mental exhaustion • High levels of anxiety • Powerlessness • Hopelessness • Increased frustration/anger • Confusion/Disorganization • Difficulty concentrating • Forgetfulness

20. Spiritual Resilience Balancing one’s personal needs Personal values and beliefs Acting compassionately • Contemplating your purpose • Achieving greater mindfulness • Harmony with one’s surroundings

21. Spiritual Distress • Loss of direction • Lack of purpose • Sense of emptiness/feeling alone in the world • Hopelessness and helplessness • Withdrawal from family and friends • Self-destructive language • Bitter or jaded outlook on life • Fearfulness, dissociation • Anger at God/higher power

22. Behavioral Resilience • Practice healthy sleep hygiene • Positive coping behaviors • Actively involved in self-improvement activities • Maintain physical health fitness regimen • Meditation/Mindfulness • Responsible use of alcohol/smoking/prescribed medications • Participation in support groups • Awareness of resiliency level • Possess ability to engage in healthy coping behaviors

23. Behavioral Distress • Poor grooming/physical appearance • Unusual behavior or sudden change in behavior • Poor work performance • Difficulty maintaining normal activities • Reduced work productivity • Irritability • Increased frustration/anger • Sudden loss/increased weight • Illness/physical problems • Defensiveness/overly suspicious • Gambling or overspending • Increased alcohol use • Increased smoking

24. Tips for Improving Emotional Resilience • Get to know yourself • Keep a journal • Practice optimism • Learn to manage stress • Seek advice from a trusted professional

25. Tips for Improving Physical Resilience • Maintain a diverse exercise schedule • Listen to your body • Cook more, eat out less • Little adjustments go a long way • Practice “sleep hygiene”

26. Tips for Improving Mental Resilience • Mental flexibility (flexible thinking) • Incorporating multiple views • Perseverance • Endurance • Ability to Adapt • Confidence • Ability to Bounce Back • Mindfulness • Self-Awareness • Purpose • Self-Care • Decision-Making • Positive Thinking • Problem Solving

27. Tips for Improving Spiritual Resilience • Find some “quiet time” • Say something. Preferably out loud • Ask the big questions • Find out what you believe • Be true to yourself

28. Tips for Improving Behavioral Resilience • Practice stress management techniques • Practice good sleep hygiene • Exercise • Practice cognitive re-structuring/re-framing • Accepting change • Learn from mistakes • Nurture a positive view of oneself • Set goals and be proactive in pursuing your goals • Have an accountability an buddy

29. Deployment Resilience Steps for Developing a Self Care and Resiliency Plan • Prepare for your deployment and understand its mission • Assess your initial self care level • Develop your personal self care strategies • Incorporate your plan into everyday life • Monitor your progress • Practice Practice Practice!

30. Example - Healthy Coping Strategies Check List • ☐ Practice breathing • ☐ Practice muscle relaxation • ☐ Repeat positive coping statements • ☐ Using breathing and coping statements together • ☐ Visualize a comforting scene/person • ☐ Practice thought stopping • ☐ Listen to music • ☐ Read a book • ☐ Take some private time to relax • ☐ Talk to another person • ☐ Move around/engage in physical activity (e.g., walking, hiking, stretching, yoga) • ☐ Stay in the present • ☐ Engage in simple, repetitive activity • ☐ Focus on something • ☐ Express yourself Add three of your own favorites • ☐ _____________________________________________________________ • ☐ _____________________________________________________________ • ☐ _____________________________________________________________

31. What is your Resiliency Level? • Self-Test • Resiliency Self-Assessment • (Siebert, 2005)

32. Resources: Resiliency • American Psychological Associationhttp://www.apa.org/helpcenter/road-resilience.aspx • National Resilience Resource Center (NRRC)http://www.nationalresilienceresource.com/Resources.html • Johns Hopkins Preparedness and Emergency Response Learning Center http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-public-health-preparedness/training/online/mental-health-trainings.html • Self-care after disasters: National Center for PTSD https://www.ptsd.va.gov/public/treatment/cope/self_care_after_disasters.asp • National Center for Telehealth & Technologyhttp://t2health.dcoe.mil/products/mobile-apps • Behavioral Health Reactions and Ways to Enhance Resiliencehttps://www.samhsa.gov/sites/default/files/dtac/podcasts/riley-rev.mp3https://www.samhsa.gov/dtac/webinars-podcasts/episode-2-behavioral-health-reactions-enhance-resilience

33. Resources: Suicide Prevention • National Suicide Prevention Hotline(800) 273-TALK(8255)https://store.samhsa.gov/shin/content/SVP11-0155R/SVP11-0155R.pdf • Suicide Prevention Resource Centerhttp://training.sprc.org/ • SAMHSA Suicide Safe Mobile App https://store.samhsa.gov/product/SAMHSA-Suicide-Safe-Mobile-App/PEP15-SAFEAPP1 • Understanding the Connection Between Suicide and Substance Abusehttp://captus.samhsa.gov/archived-webinar/understanding-connection-between-suicide-and-substance-abuse-what-research-tells-us. • Mentalhealth.govhttps://www.mentalhealth.gov/what-to-look-for/suicidal-behavior/ • For family, friends and co-workershttp://reportingonsuicide.org/

34. Resources: Behavioral Health • Tricare https://tricare.mil/ • North Region 1-877-TRICARE (1-877-874-2273) • South Region 1-800-444-5445 • West Region 1-877-988-WEST (1-877-988-9378) • SAMHSA Treatment Locatorhttps://findtreatment.samhsa.gov/ • SAMHSA’s National Helpline: treatment referral routing service1-800-662-HELP (4357) • Surgeon General’s Report: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.https://addiction.surgeongeneral.gov/

35. Resources: Deployment Preparedness • The Understanding Compassion Fatigue and Compassion Satisfaction: Tips for Disaster Responders (25:19) (link is external) • Mass Casualty: Support and Response (47:33) (link is external) • The goal of the Deployment Supports for Disaster Behavioral Health Responders (27:18) (link is external) • Self-Care for Disaster Behavioral Health Responders (56:47) (link is external) • SAMHSA Behavioral Health Disaster Response Mobile Apphttps://store.samhsa.gov/product/SAMHSA-Behavioral-Health-Disaster-Response-Mobile-App/PEP13-DKAPP-1 • Rethinking Drinking: Alcohol and your Health https://pubs.niaaa.nih.gov/OrderForm/EncForm/order_page

36. Resilience Activity

37. Operation Corps Strong RDBHT Initiative

38. Operation Corps Strong RDBHT Initiative • Group Members: • CAPT Josefine Haynes-Battle (Nurse) • CDR Marivic Fields (Social Worker) • CDR Indira Harris (Social Worker) • CDR Bill Bolduc (Social Worker) • LCDR Joy Mobley (Psychologist)