USPHS Responders Resiliency Support Training Resiliency and Deployment

USPHS Responder’s Resiliency Support 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, Psy. D

Objectives v Gain basic understanding of core concepts of resiliency v Understand the causes and effects of stress, burnout and compassion fatigue v Be able to assess your own level of resiliency and demonstrate the ability to implement a resiliency plan during all phases of deployment v 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

Compassion Fatigue v 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

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 • Decreased sense of hope/purpose • Anger at God • Questioning of prior beliefs • Loss of compassion • Detachment from Co-workers, not involved in the work • Detachment from family and friends • Shortened tenure in current position

So what happens when…

Burnout

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)).

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

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

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

Five Pillars of Resiliency Emotional Spiritual Behavioral Physical Mental

Resiliency Break Outs (15 min) • 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

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

Emotional Distress • Inability to eat, sleep, or concentrate • Negative outlook or depression • Thoughts or attempts at selfharm • Irritability, Inability to control anger • Impulsive behavior • Feelings of helplessness or hopelessness • Fearfulness, nervousness or anxiety • 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

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

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

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

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

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

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

Behavioral Resilience • Practice healthy sleep hygiene • Positive coping behaviors • Actively involved in selfimprovement 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

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

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

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”

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

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

Tips for Improving Behavioral Resilience • Practice stress management techniques • Practice good sleep hygiene • Exercise • Practice cognitive restructuring/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

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!

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 • ☐ _____________________________________________________________ • ☐ _______________________________

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

Resources: Resiliency • American Psychological Association http: //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-publichealth-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 & Technology http: //t 2 health. dcoe. mil/products/mobile-apps • Behavioral Health Reactions and Ways to Enhance Resilience https: //www. samhsa. gov/sites/default/files/dtac/podcasts/riley-rev. mp 3 https: //www. samhsa. gov/dtac/webinars-podcasts/episode-2 -behavioral-health-reactionsenhance-resilience

Resources: Suicide Prevention • National Suicide Prevention Hotline (800) 273 -TALK(8255) https: //store. samhsa. gov/shin/content/SVP 11 -0155 R. pdf • Suicide Prevention Resource Center http: //training. sprc. org/ • SAMHSA Suicide Safe Mobile App https: //store. samhsa. gov/product/SAMHSA-Suicide-Safe-Mobile-App/PEP 15 -SAFEAPP 1 • Understanding the Connection Between Suicide and Substance Abuse http: //captus. samhsa. gov/archived-webinar/understanding-connection-between-suicide-and -substance-abuse-what-research-tells-us. • Mentalhealth. gov https: //www. mentalhealth. gov/what-to-look-for/suicidal-behavior/ • For family, friends and co-workers http: //reportingonsuicide. org/

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 Locator https: //findtreatment. samhsa. gov/ • SAMHSA’s National Helpline: treatment referral routing service 1 -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/

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 App https: //store. samhsa. gov/product/SAMHSA-Behavioral-Health-Disaster-Response. Mobile-App/PEP 13 -DKAPP-1 • Rethinking Drinking: Alcohol and your Health https: //pubs. niaaa. nih. gov/Order. Form/Enc. Form/order_page

Resilience Activity

Operation Corps Strong RDBHT Initiative

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