"Social workers can suffer from moral injury too" - NACSW

"Social workers can suffer from moral injury too" - NACSW

Social workers can suffer from moral injury too Dr. Lanny Endicott Oral Roberts University [email protected] Cell: 918-830-1523 Workshop Objectives Define the terms moral injury (moral

distress) and post traumatic stress along with their consequences on the professional social worker Discuss options, including spiritual resources, for addressing moral injury Address systems issues important for social workers and their administrations that contribute to staff experiencing moral injury and compassion fatigue Moral Injury & the Soldier

Though MI has been around since the beginning of time, more recent efforts to study the issue came about to help explain the high rate of suicide among soldiers (warriors, veterans), both those in and discharged from the military This presentation, Social Workers Can Suffer from Moral Injury too, begins with a brief look at MI experienced by military personnel Moral-Spirit Injury

a Wounding of the Soul Prepared by Moral Injury committee of the Warrior Partnerships of Eastern Oklahoma Community Service Council 1604 South Baltimore, Tulsa, Oklahoma www.csctulsa.org 4

Moral Injury or Wounding of the Soul Service members can have experiences which run counter to, insult, or betray their personal values, moral code, or sense of honor 5 Something Happens:

... something done, ... failed to do ... witnessed ... by acting alone or as part of a group ... an experience such as assault or betrayal 6 The Consequence: Suffering from confusion, perplexity, guilt, shame,

or self-judgement... even if there's a rationale to the contrary 7 How it develops? Military provides extensive training for tactical, strategic, & individual decision-making But decisions made during complex situations may create questioning or regret afterward

...a beginning to moral injury 8 Moral Injury...Immediate to Long-term Damage to self-esteem or personal integrity

Complicated by receiving awards and recognition from the military or civilians reminding of a line crossed now regretted 9

Complication > reluctance to talk "I can't believe I did that" "I wish I hadn't seen..." "I'm bothered that I enjoyed..." "I can't believe...happened to me" 1 Important Responses hopelessness,

frequent crying, listless, sorrow, grief, guilt, regret, shame, alienation 1 Talking About It A trusted family member Friend Fellow service member Coffee Bunker participant

Counselor, moral authority 1 PTSD and Moral Injury: similar yet different 13 http://projects.huffingtonpost.com/moral-injury/the-grunts Key Antidotes Forgiveness & Honor

1 To help: Non-judgmental, Non-shock Listening Referral 1 From The Pacific, Episode 2, at 39.36 min., Amazon Prime Father (medical doctor) to his youngest son, after

checking his sons heart beat: The worst things about treating those combat boys from the Great War wasnt that they had had their flesh torn. It was that that they had their souls torn out. And I dont want to look in your eyes someday and see no spark, no love, nono life. That would break my heart. Give me some time to break the news to your mother. Some Contacts: Coffee Bunker - 6365 E. 41st., Tulsa, OK 74135 918637-3878, https://www.coffeebunker.org Look for Coffee Bunker on Facebook

Veterans Crisis Line: 1-800-273-8255, Press 1 Confidential Chat at VeteransCrisisLine.net or text to 838255 1 Some Key Terms Compassion Fatigue (CF) - general term related to addressing client trauma & work place stress Secondary Traumatic Stress (STS) - experiencing trauma from client situations & stories Vicarious Trauma (VT) - reliving events of trauma from

stories provided by others - overly empathetic Primary Exposure - experiencing trauma directly Secondary Exposure - experiencing trauma indirectly through others stories Moral Injury - conflict in one conscience: values, morals 1 Moral & the Social Worker MI & the Social Worker Experiencing feelings also related to:

perpetrating failing to prevent or witnessing actions that transgress deeply held moral beliefs Nursing uses the term moral distress http://www.socialworktoday.com/news/eoe_021814.shtml Some Examples

Being involved in the removal of children from their homes Termination or scaling back of services to vulnerable clientele Lies told to clients by agency staff/colleagues Witnessing unethical agency practices Experiencing agency transition to maximizing profits Forcing workers to follow questionable policies/practices

Pain of believing that ones actions or inactions has caused harm in another Being involved in cases of extreme maltreatment to children and those vulnerable Have any of us encountered MI as defined here? Our Clients Can Suffer from MI Too Clinicians in a wide variety of settings encounter

clients who struggle with moral injury: Parents who have abused their children Police officers mistakenly shooting an innocent bystander or testifying in court against a falsely accused defendant Couples extramarital affairs 2 Some Consequences for the Social Worker Compassion Fatigue

Demoralization Anxiety Alienation Workplace Isolation Anger Powerlessness Somatic Complaints Chemicals Depression

Sense of Use of Health Issues PTSD and Moral Injury: similar yet different 26 http://projects.huffingtonpost.com/moral-injury/the-grunts Nursing Moral complexity:

emerges when events do not fit within learned rules Moral distress: the condition of knowing the morally right thing to do, but institutional, procedural, or social constraints make doing the right thing nearly impossible can threaten core values and moral integrity Moral resilience: the ability and willingness to speak and take right and good action in the face of an adversity that is moral/ethical in nature 2

Leadership Can: 1. Encourage members to revisit past situations to understand current dilemmas 2. Leaders and staff formulate policies that encourage discussion of concerns in morally complex cases, without threat of retribution 3. The talk and actions of leaders are in sync with a culture that supports an ethical work environment 2 Aids to Moral Injury

Speaking with a trusted colleague(s) Listening without showing shock or judgement Ascribing attribution: percentages of blame Adaptive disclosure Forgiveness of self and/or others Client/Family Me/My Team

Agency/System Dr. Erv Janssen 30 Compassion Satisfaction Encouragers I gain pleasure from helping I perceive my agency as supportive I personally enjoy this work

I have supportive personal relationships Im able to do the work I see my work as fulfilling I think I have a calling to this work Adapted from Beth Stamm 31 Compassion Fatigue Discouragers o

o o o o o Im missing pleasure from helping I dont see my agency as supportive Im not enjoying this work Im missing supportive personal relationships I question my ability to do the work

Im unfulfilled, feel disillusioned in my work 32 Dimensions of Compassion Satisfaction Personal Self-Care Practice Workplace Encouragers "Compassion" Fatigue

Secondary Traumatic Stress Vicarious Trauma Primary Exposure Secondary Exposure Moral Injury Workplace Discouragers Burnout 33 ProQOL 5 Professional Quality of Life Sale: A 30 Question selfassessment covering Compassion Satisfaction,

Compassion, and Burnout. Developed by Beth Stamm, Ph.D, now retired See: http://www.proqol.org/About_us.html 3 35 Some Strategies for the Workplace Making use of the Unit, Team, Informal Group Intentional or natural" opportunities to share

Nurturing an encouraging atmosphere Keeping personal information confidential Spending social time together Maintaining an atmosphere of safety Evaluate 36 Some Moral Injury Resources http://projects.huffingtonpost.com/moral-injury http://projects.huffingtonpost.com/moral-injury/the-grunts http://www.huffingtonpost.com/news/moral-injury/

http://www.npr.org/2014/11/11/363288341/moral-injury-is-the-si gnature-wound-of-today-s-veterans http://nation.time.com/2013/04/17/moral-injury-a-profound-sen se-of-alienation-and-abject-shame/ 3 Epstein, E.G., Delgado, S., (Sept 30, 2010) "Understanding and Addressing Moral Distress" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 1. Lachman, V.D. (2016). Moral resilience: Managing moral distress and moral residue. MEDSURG Nursing, 25(2), 121-124.

Clebourn-Jacobs, Toya V., "How Does a High Profile Child Death Impact Child Protective Service Workers?" (2013). Doctorate in Social Work (DSW) Dissertations. 44. http://repository.upenn.edu/edissertations_sp2/44 Reamer, Frederic. Moral Injury in Social Work. http://www.socialworktoday.com/news/eoe_021814.shtml Janssen, Scott. Moral Distress in Social Work Practice - When Workplace and Conscience Collide. http://www.socialworktoday.com/archive/052416p18.shtml Compassion Fatigue Resources Beth Stamm, ProQOL5: http://www.proqol.org

Headington Institute: http://www.headington-institute.org/Default.aspx?tabid=1379 Authentic Happiness Website: http://www.authentichappiness.sas.upenn.edu/Default.aspx David Baldwin Trauma Information: http://www.trauma-pages.com/disaster.php Figley Institute: http://www.figleyinstitute.com/indexMain.html Compassion Fatigue Awareness Project: http://www.compassionfatigue.org/ Veterans Administration Resources for addressing PTSD: http://www.ptsd.va.gov/index.asp Sidran Institute: http://sidran.org

International Society of Traumatic Stress Studies: http://www.istss.org/ The National Child Traumatic Stress Network: http://www.nctsn.org/products/secondary-traumatic-stress-fact-sheet-childserving-professionals%20 3 9 Mayo Clinic. (2015). Stress management. Retrieved from: http:// www.mayoclinic.org/healthy-lifestyle/stress-management/in-de

pth/social-support/art-20044445?pg=1 Simmons University. (2015). Self care tips. Advice from professional clinicians. Retrieved from: https://socialwork.simmons.edu/self-care-tips-advice-from-profe ssional-clinicians/ University of Buffalo: School of Social Work. (2017). Our self care starter kit. Retrieved from https://socialwork.buffalo.edu/resources/self-care-starter-kit.ht ml 40

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