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Self-Care & Healthy Case Management

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Nathan Ferreira

on 26 September 2016

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Transcript of Self-Care & Healthy Case Management

Healthy Case Management
Supporting Self-Care in Refugee Resettlement Work
Establish Professional Boundaries
Why focus on self-care?
Plan for self-care
Build & Sustain a Supportive Work Environment
Learning Objectives
Understand what supports a healthy and sustainable working relationship with refugees

Recognize causes of burn-out and secondary traumatic stress

Know the necessary components of a successful self-care strategy

Appreciate the role that resettlement agencies and community-based organizations can play in supporting the well-being of staff and volunteers
Prevent Burnout
As professionals, self-care is each of our responsibility
Prevent Secondary Traumatic Stress
a loss of enthusiasm for your work
reduced commitment to the profession
becoming emotionally disengaged from clients
feelings of hopelessness
..very similar to Vicarious Trauma, it has been defined, "as the natural, predictable, treatable, and preventable unwanted consequence of working with suffering people, that is, the cost of caring."
"Professional boundaries define your personal space, the area that you feel is under your control and provide a sense of safety."

- Drawing a Line, Massage Therapy Journal
What are they?
Rigid: no meaningful contact can occur, can negatively impact communication and relationship building
Be aware of the times you sacrifice your own needs in order to meet the needs of the another
"Professional self-care is an essential component in competent, compassionate, and ethical social work practice, requiring time, energy and commitment."

- Policy Statement of the National Association of Social Work
Permeable: risk of becoming overly identified with client, may lead to accommodating another's needs at the cost of your own
Semi-permeable: flexible, can create meaningful connection while maintaining the boundaries that you and your organization define
Where are the boundaries?
...benefits you

by maintaining your sense of personal identity
by allowing you to take breaks from the helper role
by protecting your from burn-out
....benefits clients

by decreasing their anxiety through consistency
by having a professional helper who models good boundaries and self care
by increasing their independence and autonomy
Drawing a line....
External Boundaries: have to with our physical surroundings, presentation, field of communication, etc.
Location of Service
Interpersonal Space
Internal or Emotional Boundaries:

Help you take responsibility for your own feelings, thoughts, beliefs, memories, choices, experiences and actions, instead of blaming them on or attributing them to others.

They are also the way you keep from taking responsibility for other people’s thought, feelings and behaviors.
B is for Balance
How do you know when a boundary has been crossed?
With external boundaries, it is much simpler to recognize when a boundary has been violated...

Location: A caseworker who lives within the community where refugee clients live attends a church where many refugees also attend. Clients bring the caseworker case mgmt. tasks while they are at church.

Interpersonal Space: While a refugee requests services he stands very close to the caseworker leaving their faces inches apart.

Touch: A volunteer felt very happy for a refugee after a tutoring session and enthusiastically gave the refugee a hug. The refugee became very rigid and withdrawn following the hug.

Appearance: What an intern is wearing is clearly making the refugees she is transporting uncomfortable.

Language: An interpreter is answering questions from the doctor for the client without asking the clients.

Self-Disclosure: A caseworker shared personal details of his past with a client that are similar to the refugee's past. Though the caseworker was trying to be supportive, the client felt uncomfortable with the information.

Time: A caseworker worked more hours than his or her significant other or spouse was happy with.

Expenses: A caseworker buys a refugee family a bag of rice though there is no fund for reimbursement. It is easier to just buy it than to deal with it seeing if there is extra at the office or teaching the client about food pantries.
Internal boundary violations are more difficult to recognize...
Your gut says, "Oh no, not again," but your mouth says, "one more time can't hurt"
You feel the other's sense of urgency as you own
You find yourself forcing your solutions to problems on the client or solving the client's problems for them
Your own family life, well-being and relationships are suffering as a result of your choices at work
You find yourself regularly making exceptions to your established boundaries
Case Scenario One-

A refugee comes to your office unscheduled and refuses to leave until until you agree to make calls on his behalf regarding his oversees family members and their refugee status. His body language and tone of voice feel somewhat aggressive.

Though this is not really a service that your office provides and you know that calling will not likely result in any change, you agree to make the calls to get him to leave.
Case Scenario Two-

You are a caseworker for a refugee resettlement agency, a refugee and you live among refugees from your country of origin. You receive a knock at your door in the middle of the night from a non-English speaking client who reports that her husband has been hitting her and has threatened to kill her. She has a toddler and infant with her.
What to do when a boundary has been crossed?
What the pros say...
A is for Awareness
Establish organizational practices that support staff well-being
Establish policies and procedures that encourage dialogue and create an inclusive environment
Advice From Refugee Resettlement Caseworkers
Five Distinct Characteristics of a Resilient Worker (Bell, 2003)

Sense of competency around coping skills
Maintaining an objective motivation
Resolving personal traumas
Drawing on positive role models of coping
Having buffering personal beliefs
Self-care is a lifelong practice consisting of three primary processes (Baker, 2003)

Developing Self-Awareness
Becoming Skilled at Self-Regulation
Balancing connections between self, others and a larger community

If you determine that you want to speak about a boundary violation with a client consider the following:
It takes two to repair a relationship
Is this more about you or about the client?
Does this promote the refugee's well-being and autonomy?
Is this healthy for me? Is this healthy for the client?
What do the ethical standards suggest about this issue?
What does this issue or request mean to them?
1. Talk to a trusted co-worker or your supervisor
"Burnout is an element of compassion fatigue that can be brought on when people feel that their efforts have no lasting impact, when the workload is too great or from a non-supportive work environment"
- Stamm, 2009
2. Consider the social and cultural implications
3. Decide what you need to do and act
Some signs of organizational cultural competence
Policies reflect the values of the organization and create a sense of safety and equity for staff, volunteers and clients
Orientation and trainings encourage staff to increase their knowledge and awareness of their own and other's cultural histories and practices
Leadership prioritizes cultural competency and creates an environment where diversity is viewed as an asset, not a problem
Managers can encourage activities that increase job satisfaction

Create opportunities for staff to experience new challenges

Mentor a colleague, a volunteer or an intern

Develop cross training experiences

Make sure people use their time off and take breaks, especially during stressful times

Develop a team approach

Offer professional development opportunities

Don't assign staff tasks that reinforce inappropriate boundaries or at least try to limit

Check in with staff on a regular basis, not just at an annual review

When possible, be willing to adjust people's jobs to their strengths

Create on the job wellness opportunities
Help staff maintain an effective work load
Case Scenario Three-

You have been very clear with refugee clients in your community about your organization's work hours and what they can do when they need help outside of business hours. Several clients have begun to go to your spouse's workplace and ask him or her to deliver work related messages to you.
What is he talking about?

Working with people who have experienced trauma is traumatizing!

Having a response to hearing people's traumatic stories that includes symptoms similar to Post Traumatic Stress Disorder is normal.

Burn-out and Compassion Fatigue are not the same thing as Secondary Traumatic Stress or Vicarious Trauma.

Secondary Traumatic Stress are Vicarious Trauma are very similar concepts, but were developed by different researchers.
“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting that we be able to walk through water without getting wet.”

Rachel Remen, Kitchen Table Wisdom
"Separate your work role from your from your personal life. Take the time to explain to clients the difference."
"Know your limits."
"Move out of the community."
"Turn off your phone outside of work hours."
"Remind clients to call the office during work hours and in emergencies call the E.R. phone."
Diversity can be seen as the human characteristics that affect individuals values, opportunities, and perceptions of self and others.

They include characteristics of age, ethnicity, gender, mental and physical ability, race, sexual orientation, education, family status, organizational role, work style, first language, religion, where you live, your income, work experience and more.
- Loden, 1996
C is for Connection
Connect with yourself regularly..

Remember your individual psychological strengths
What supports your resiliency?
Pay attention to your self-esteem
Are you intellectually challenged?
What provides meaning for your life?
Monitor your boundaries
What makes you happy?

Identify your external supports

Formal social connections
Organizational Connections
A supportive work team
Supervision and Mentoring
Training and Education

Spending unscheduled time with friends and peers
Faith or Spiritual groups
Family Time
Conversation with trusted others
Organization sponsored targeted conversation and training
Knowing your hooks, triggers, transferences, your limits, etc.
Mindfulness activities (meditation, prayer)
Spiritual Direction
Group Process
Training/increased knowledge of internal processes
Supervision/Peer Supervision
Intentional self reflection
Job announcements, interviews and hiring are sensitive to cultural and physical differences
Management fosters open dialogue cultural around culture and for staff to talk through times when they feel like they have made mistakes
Remember that cultural competence is a process, not an end in itself
"Use humor as a coping strategy."
"Talk to someone about your experience, don't isolate yourself."
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