Monday, January 4, 2016

Compassion Fatigue: Who's At Risk?...

A case manager is supposed to do just referrals and that's it, but many times ... you're the first one that they're telling ... everything to. ... You end up hearing everything as if you were their psychologist and (it is hard to know) how to deal with those emotions when sometimes we don't have training aside from whatever we review.

Case Manager, Los Angeles Children's Hospital

Hello, everyone,

It's the beginning of a new year, so I thought we could go back to the basics today and take a fresh look at who is at risk for Compassion Fatigue (CF).

The primary criterion for determining CF risk is exposure to the trauma stories of the people we serve.  (Other vulnerability and protective factors also come into play but this is the primary contributor.) The greater and more graphic the accumulated trauma exposure, the more likely we are to develop CF.

These days, we are quite used to thinking of moderate CF as a natural consequence of working as first responders (paramedics, physicians, nurse practitioners, fire and police professionals, and humanitarian and victim assistance volunteers) or other helping professionals like nurses, teachers, social workers, lawyers, prison workers, mental health professionals and clergy. On the other hand, there are helpers at risk of CF who don't come to mind so readily.

In one of the best written articles on CF I've read in a while, Sophie de Figueiredo and her colleagues at Children's Hospital, Los Angeles and USC describe the cross-diciplinary experience of CF among service providers for highly traumatized children and adolescents, focusing much of their attention on case managers

We rarely think of medical receptionists, medical office assistants or case managers as being at risk and yet, of course, they are. Not only are they often the first to hear peoples' trauma stories and crises, they can be obliged to write or re-tell these stories again and again as they communicate information to other helpers, thus increasing their exposure exponentially. Hear some of the case manager risk factors de Figueiredo reports in her 2014 article in Traumatology:

Descriptive findings provide evidence to suggest that case managers may be more susceptible to CF than other providers. Their caseloads were significantly larger than those of other provider groups. They were less likely to report having access to reflective and individualized supervision and reported higher dissatisfaction with the amount of supervision they received. Generally, they were younger and reported fewer years of education. Case managers were also less likely to receive trauma-specific training in traumatic stress or on the effects on providers of working with traumatized populations... Unfortunately, these providers received the least amount of support to address and combat the development of (CF and burnout).   (p 293)

Also at risk are middle managers and administrators who may hear the most difficult of the trauma stories and situations, ones that can't be dealt with lower in the hierarchy, and yet have no primary "hands-on" contact with the trauma survivors and thus are left holding painful stories without an outlet of direct action to alleviate suffering (the survivors' or their own).

This fall, I've also been surprised to speak with a number of 5th Step volunteers in 12 Step Programs who have developed CF over years of hearing others' 5th Step stories. (The 5th Step = "We admitted to God, ourselves and to another human being the exact nature of our wrongs.") Hearing "the exact nature" of others' behaviours while in the throes of addictive behaviour can be more than a little traumatizing, though I have to admit I hadn't thought to include these folk within the fold of CF risk.

Others who might be at risk but not necessarily cross our minds as needing education and support are the translators/interpreters and community volunteers who are making significant time, energy and emotional commitments to the Syrian refugees coming to Canada over the next few months. These helpers may have little or no understanding of the potential impact of refugees' trauma stories on their lives. It will be crucial to provide these caring folk with CF information before they become overwhelmed by trauma stories of the people they seek to help.

Not-for-profit workers in food banks, meal programs, community outreach programs and disease-specific support organizations may also be at risk and unprepared.

Even librarians can suffer CF in some circumstances. Librarians and library techs in home library programs form strong, long-lasting bonds with homebound patrons who can experience the abuses and/or traumas and losses of chronic ill health and disability. During harsh weather and harsher economic times, the homeless and displaced may also seek shelter in community libraries and spend time sharing their stories with kind but untrained and unprepared helpers.

These are just a few of the under acknowledged at-risk populations that come to mind this morning. I'd be interested to hear of any others you believe to be poorly recognized.

No comments: