Psychological PPE during COVID -19 – Free Webinar

Dr. Jennifer Russel is a Child and Adolescent Psychiatrist. She graduated from McMaster Medical School in 2005, and completed her Psychiatry Residency at the University of Toronto in 2010. She has been a TEND associate since 2019.

Her main area of focus has been working with youth with complex mental health difficulties such as severe mood disorders, anxiety disorders, psychotic disorders, and neuropsychiatric disorders as well as with their families.


As a psychiatrist juggling work in a tertiary care hospital while homeschooling my two primary school children during this pandemic, I quickly realized that I needed to develop tools to keep myself physically and emotionally healthy -- I needed to grab my psychological PPE.

I reached out to Françoise Mathieu and we developed a web-based presentation for the University of Toronto’s Faculty of Medicine, Continuing Professional Development. Many health care workers across Canada joined on May 27, 2020 to explore best practices to stay well.

We called it Psychological PPE: Exploring Compassion Fatigue and Learning how to Keep Ourselves Psychologically Well.

 

In this presentation, we discuss:

  • Understanding the “COVID-fog” & the impact of the pandemic on our energy and concentration
  • What is in our control and what isn’t
  • The COVID-19 risk and resiliency factors: personal factors, compassion fatigue & burnout
  • The importance of social support
  • How to strengthen our Psychological PPE

Since developing this tool, I have continued to increase my daily wellness practices: regular exercise, virtual coffee dates with colleagues, regular peer support meetings, reducing media exposure and I have also reminded myself of the importance of regular pauses during my busy days.

These strategies have had a powerful positive impact on my energy, focus and ability to self-regulate during challenging days.


For more strategies we recommend:

Mathieu, F. (2020) This is a Marathon Not a Sprint: https://www.tendacademy.ca/marathon-not-sprint-covid19

Pandemic Etiquette: Tips to Manage Communication Expectations for Teams

By Françoise Mathieu, M.Ed, RP, CCC., Executive Director, TEND

Since email came into the workplace, followed by texting and a variety of other modalities to contact one another, the sheer volume of touch points and contact moments has dramatically increased. People expect speedy replies to those messages – no matter how urgent the matter truly is.

I am a Generation-X’er who joined the world of work in the late 1980s, so I remember when we used those pink telephone message pads for returning calls. If you left your office for a while, on your return you would find a large pile of those pink slips waiting for you.

It was a chore, but it was just one way of being encroached upon. Now we have ten ways.

In my opinion, there are two main issues to unpack here:

The first is that this information overload is limiting people’s productivity and ability to focus.

Cal Newport, author and computer scientist at Georgetown University, has written extensively on this topic:

This incessant communication fragments attention, leaving only small stretches left in which to attempt to think deeply, apply your skills at a high level, or otherwise perform well the core activity of knowledge work: extracting value from information.

To make matters worse, cognitive performance during these stretches is further reduced by the “attention residue” left from the frequent context switching required to “just check” if something important arrived.

We know that multi-tasking is a myth. What we are really doing when we attempt to do two things at once is switch-tasking – rapidly shifting our attention back and forth between two tasks. The result is that our productivity tanks and we end up doing worse on both tasks.

The second is that we need to manage expectations about communications.

There needs to be an agreed upon etiquette about the speed of reply, amount of detail and who should or should not be included in responses.

I’m sure we have all had the experience of being included on a “reply all” that was totally unnecessary. Folks, I really don’t need to be included in an email response that says, “Sounds good!” and has been sent to 200 people.

Here at TEND, our team has agreed upon the best ways to reach one another to avoid the “all day meeting” on three different communication platforms. (We revise this as we go, but we have found Slack to be a great way to do all of this.)

Another important aspect of this is being clear about what is truly urgent vs. emergent vs. FYI.  Our team has agreed that, if one of us sends a text asking for an immediate phone call, it is an emergency. We don’t do that unless there is a clear and imminent need for it.

We schedule calls as needed. Our solution has been to compile questions that are less time sensitive and have a weekly team meeting to discuss non-urgent or emerging issues.  

In fields were people feel reactive at the best of times, some co-workers view everything as urgent – when maybe it’s not. This requires some discussion to come to an agreement about what urgent means. “I need to get this off my pile of stuff to do” is not urgent for the team – even though it may make that person feel better.

Each team will have to navigate their unique workplace culture and demands of their workload to come to an agreement about workplace etiquette. Here are some suggestions to consider:

  • Urgent vs. Emergent: What constitutes as an urgent issue in your workplace? Does your team know? Do you know? Have a discussion with your team and institute policies for differentiating between sensitive and non-sensitive messages (for example, flagging urgent matters in the email subject line)
  • Be flexible in response times: For non-urgent matters, is it possible to relax our expectations on response times? Remember, your clients are going through this pandemic too – the person on the other end of that email is likely also juggling pets, kids and other personal responsibilities.
  • Avoid task dumping: Blowing through our to-do list can be feel great, but where do those tasks go? Are you effectively doubling someone else’s workload? What would happen if you waited until tomorrow or next week to delegate that task? As much as possible, we need to be mindful of other’s workload.
  • Set time limits: During the pandemic, it is tempting (and easy) to work around the clock. We need to set limits to when we’re “on call”. Avoid checking emails during your downtime and disable any automatic notifications.
  • Refrain from “Reply-All”: Who really needs to be cc’d on that email chain? If you or your team are uncertain, maybe it’s time to re-evaluate task assignments or review job descriptions.

In this new world of remote work, one essential step to working well as teams is to regularly review our team’s communication methods and be open to regularly revising those approaches. What worked well (or, let’s be honest, maybe not so well) six months ago may no longer be the best way to work together now.

We encourage teams to be willing to regularly review and address what is allowing us to do our best work and stay connected and creative during this new work landscape.

In the coming weeks, we will be exploring the key tenets of Compassionate Leadership and research shows that good communication is a pillar of healthy workplaces and of a compassionate leader.


Resources:

[Podcast] Ep. 194 – “The New Future of Work”, Making Sense with Sam Harris

[Book] Digital Minimalism: Choosing a Focused Life in a Noisy World by Cal Newport

[Book] Busy: How to Thrive in a World of Too Much by Tony Crabbe

A New Balancing Act: Resources to Manage Working from Home & Parenting During the Pandemic

By Françoise Mathieu, M.Ed, RP, CCC., Executive Director, TEND

Over the past few weeks, we have heard from many parents and guardians about their experience of trying to juggle new work routines while parenting and/or homeschooling during this pandemic.

It probably won’t surprise you that nearly everyone has been reporting the same feeling: overwhelmed.

During a webinar that I was delivering last week, one worker asked us the following question:

I typically work 3 days/week but am now working 7 days/week to get my work done. During this, my partner and I are trading off caring for my two and four-year-old children. Any strategies to manage this?

I have been mulling over the complexity of the question and my brain went into a flow-chart mode because, of course, the answer to this question is:

It depends.

Is the challenge related to relationships or workload? How many responsibilities are you juggling? What was your situation before the pandemic started? What is it now?

It depends on so many factors. I can put on my couples’ therapist hat and go down one path of suggestions – or I can switch to my organizational health hat and take this in a whole other direction.

The first step is to clarify what your specific caregiver roles are currently:

  • Are you sharing parenting responsibilities with your spouse under the same roof?
  • Are you single parenting with 100% responsibility for your children’s care?
  • Are you co-parenting with a former spouse?
  • Or *insert other family constellation here*

The second step (presuming now that you are living under the same roof as your spouse) is to clarify the work duties of the parties involved. Which of the following situation most closely resembles your situation?

  • Two parents living under the same roof. Both parents are working from home and sharing childcare duties.
  • One parent is working outside the home (perhaps as an essential worker) while one parent is working from home and taking care of children
  • Both parents are working outside the home and struggling to manage childcare

See how complex this quickly becomes?

Now, let’s have a look at your employment situation (and your partner, if it applies). Are you:

  • Self-employed and currently receiving work/contracts?
  • Self-unemployed and actively looking for work?
  • Unemployed with no work options in the near future?
  • Employed and working for an agency, nonprofit, or private entity?

If that is the case, consider the following:

  • Who is your leader and who is your immediate supervisor? Are they role modeling flexibility?
  • Do you have a good trusting relationship with leadership?
  • Would you feel safe approaching leadership to explore a change in your workload or more flexible timelines?

Your unique situation can be further complicated by other caregiver duties, health concerns, resources available in your community and so many more.

Although there are no miracle solutions to this complex challenge, there are some excellent resources available that offer strategies to juggle this very real and difficult reality that so many of us are currently facing. 

Here are some great suggestions from trusted sources:


From the CBC, “New normal’ for parents is struggling with grief, guilt and pandemic demands — but you’re not alone”

Selected quotes from the article:

  • “We cannot expect our role of parent, teacher and employee to be combined — and then fit into the same 24 hours it once took three people to do.
  • If you are unable to use this time to somehow create fun, social-media-worthy memories for your child, that is OK.
  • If all you can do today is get up, stay in your pyjamas and cry into your cereal-for-dinner when your child finally goes to bed, you are not alone.
  • So please, dear parents, give yourself a break. Take a breath, call a friend, text a fellow parent.”

READ THE FULL ARTICLE

From the New York Times, “Agonizing Over Screen Time? Follow the Three C’s”

The Three C’s as according to Dr. Jenny Radesky, M.D., a pediatrician and expert on children and media at the University of Michigan’s C.S. Mott Children’s Hospital:

  1. Child – You know your child better than anyone else and are therefore the best person to decide what and how much media use is the right amount.
  2. Content – Quality matters more than the quantity of time or size of screens being used. [Read the full article for a great list of suggestions, with website recommendations for kids of different ages.]
  3. Context – How we interact with our children around the media — matters too. Dr. Radesky encouraged parents to engage with their kids during their screen time.

READ THE FULL ARTICLE

From the Canadian Pediatric Society “Parenting during COVID-19: A new frontier”

Selected quotes from the article: 

  • The bottom line is that parenting during COVID-19 looks different.
  • Finding small ways to provide opportunities for choice and independence is one way we can support teens during this time of self-isolation.
  • Children and adults thrive on routine…Younger children often have better attention and focus in the morning, while teens tend to focus better in the later afternoon or evening

READ THE FULL ARTICLE

From the New Yorker, “This Is What Happens to Couples Under Stress”: An Interview with Esther Perel”

Selected quotes from the interview:

  • I think, in general, when people live in acute stress, either the cracks in their relationship will be amplified or the light that shines through the cracks will be amplified. You get an amplification of the best and of the worst.
  • I think that couples need to regulate togetherness and separateness all the time, with confinement or without. In a situation like this, whether you are in your tiny studio, or whether you are on the verge of separation, you need autonomy.
  • You need space for yourself and space with other people that are not shared… Your therapy session is private. Your conversations with your best friends are private.
  • Q: What else can you say about how to fight better? A: Stay focused on the task. When you want to talk about the dishes, don’t end up talking about five different things, two of which are years old. Don’t “kitchen sink” it. Keep yourself to the one thing that you’re upset about at this moment.

READ THE FULL INTERVIEW

From the Gottman Institute “ The Marriage Minute” newsletter.

From their website:

It’s a resource of tools, articles, videos, exercises, and more, all founded on Drs. John and Julie Gottman’s four decades of research and clinical experience, delivered straight to your inbox. Our goal is to teach you one thing each day that will deepen your friendship, allow you to use conflict as a catalyst for closeness, and enhance the romance in your marriage.

VISIT THEIR WEBSITE TO SUBSCRIBE

From Greater Good Magazine, “All I Want for Mother’s Day Is an Equitable Division of Labor

Selected quotes from the article:

  • Start by looking inward, to get really clear about what you need. Notice what ticks you off; anger is often a symptom of an unmet need. If you feel resentful whenever you see your [partner] reading on the couch, you probably need more time to relax.
  • Question your limiting beliefs. “I don’t get to decompress after work like my husband does,” a mom recently said to me. Why not? Who made that rule? What would happen if you were better rested or if you did less housework?
  • Agree on the larger goal, which is to arrive at a sustainable division of labor that feels fair to both of you.

READ THE FULL ARTICLE

From the New York Times, “Productivity Isn’t About Time Management. It’s About Attention Management”

Selected quotes from the article: 

  • A better option is attention management: Prioritize the people and projects that matter, and it won’t matter how long anything takes. Attention management is the art of focusing on getting things done for the right reasons, in the right places and at the right moments.
  • Paying attention to timing management also means thinking differently about how you plan your work. I love Paul Graham’s suggestion to divide the week into “maker days” and “manager days.”
  • On manager days, you hold your meetings and calls. On maker days, you block out time to be productive and creative, knowing you’ll be free from distractions that would normally interrupt your flow.

READ THE FULL ARTICLE

From UNICEF, “7 ways employers can support working parents during the coronavirus disease (COVID-19) outbreak”

  1. Assess whether current workplace policies effectively support families.
  2. Grant flexible work arrangements.
  3. Support parents with safe, accessible and affordable quality childcare options.
  4. Promote good hygiene in and out of the workplace.

READ THE FULL ARTICLE

We have also created a new series of webinars to support teams during COVID-19. 

If you’re interested in learning more, click here or get in touch. 

This is a Marathon – Not A Sprint: Part Two -Understanding Reactivity During COVID-19 & Strategies to Stay Grounded

As we continue to face this global crisis, we all need to be mindful about our physical and mental health. How do we understand our knee-jerk reactions to stress and how can we stay grounded in the face of uncertainty? 

This is Part Two of our strategies to stay well in the long-term in the face of the COVID-19 pandemic. 

Understand Reactivity and the Threat Response

Find the Positive (Be Like Velcro)

Remember, Leaders are People Too

Create a Transition Ritual

Final Thoughts

Resources

Read Part One

Some sections adapted from Mathieu, F., Tikasz, D., & Welfare, M. (2016). Niagara Victim Services Toolkit.

 

Understand Reactivity and the Threat Response

The threat response is hard-wired into all of us. Throughout the development of our species, this primitive system prepared our bodies to either flee, fight, or even collapse and play dead in response to a potential threat.

In our modern day, this can cause problems as the threat response is unable to distinguish between a real threat and a perceived threat. Therefore, we do not need to encounter a real sabretooth tiger to activate this system – merely thinking about a tiger can trigger a flood of stress hormones.

During this pandemic, we may find ourselves ruminating (how could we have prepared better?) and re-living past events (could I have helped that person in a better way?) – or we may find ourselves worrying and anticipating an uncertain future.

By doing so, we are igniting our threat response. This puts us in a reactive state that inhibits our ability to problem-solve and do our best work.

What can be done?  

  • With Awareness Comes Choice: Throughout your day, take a moment to check-in with yourself. Notice how you feel and identify what thoughts are coming up. When we become aware of our internal experience, we can avoid being hijacked by stress hormones and instead choose to connect with our problem-solving brain.
  • The Power of the Pause: When we engage the mindful, problem-solving areas of our brain, we also activate the areas of the brain where empathy and compassion are processed. As frontline workers, this is critical during times of crisis. 
  • Find a Ritual: We are all being reminded to regularly wash our hands, and this can be a simple opportunity to pause, breathe and calm our nervous system. Rather than planning out the rest of your day, focus on the warm water, the soap bubbles and the process.
  • Remember to Breathe: During times of high stress, many of us hold our breath or breathe very shallowly. Consciously slowing and deepening our breath activates the parasympathetic nervous system – the system that is responsible for relaxation
  • Model Calmness: In our brains, we have a system of neurons that fire both when we take action and when we perceive others taking action. When we slow down our breathing, others will naturally and unconsciously mirror our slowed breathing rate.

Practicing the Three Minute Breathing Space can help us to cultivate the skills of mindfulness.

Click here for a printable version

 

Find the Positive (Be Like Velcro)

Dr. Rick Hanson has said: “Positive is like Teflon (does not stick) and negative is like Velcro (sticks easily).”

Humans are neurobiologically hard-wired to register negative events far more quickly and clearly than positive events. In fact, we need to focus on a positive event for 20-30 seconds for the event to register – whereas a negative event is registered instantaneously. 

This is related to our threat response and our evolutionary survival instincts – we needed to be on the alert for the negative in order to survive.

This legacy has left us with a negativity bias. In order to combat this built-in bias, we need to be purposeful in focusing on the positive.

However, in the midst of a crisis, it can be challenging to find goodness when we are surrounded with fear, uncertainty and conflicting information.

What can be done?

  • Choose your company wisely: Be mindful of who you spend time with, purposefully choose to speak with calm, level-headed friends and colleagues. Maintain boundaries with people who drain you.
  • Limit/monitor media exposure: Dedicate 10 minutes in the morning or at the end of your work day to check trusted news sources, avoid media that focuses on shock-value or fear mongering.
  • Gratitude: Create a habit of noting something you are grateful for each day. Pair this with another routine such as your first sip of coffee in the morning or brushing your teeth at night.
  • Build a Resiliency Bank: Take a pause during moments of strength, meaning or pleasure to truly acknowledge them. Store these moments in your “resiliency bank” so that you can draw upon them in times of need.

 

Remember, Leaders Are People Too

We recently interviewed Dr. Patricia Fisher, TEND senior advisor, and she reminded us that, although leaders are often perceived as being exempt from stress, they are often the most overloaded people in our organizations.

Leaders are not super-humans. Middle managers especially are facing extraordinary pressure as they balance everything coming down from the top with the responsibilities coming up from those they supervise and the individuals that they serve.

And, like all us, they are also trying to navigate family demands and complex personal situations.

What can be done?

  • Be a role model: If you are in a leadership role, remember that you are a powerful role model for your team. Ensuring that you are well rested and thinking clearly will have a powerful impact on the way the work is done.
  • Stay connected: Connect with your own formal or informal mentors so that you are not alone in carrying the load.
  • What’s in your control? Identify the elements that are within your control or influence and focus on these vs the larger forces that you cannot change.

Check out our interview with Dr. Fisher for more suggestions on staying well as a leader during this pandemic.

 

Creating a Transition Ritual

Most professionals in human service fields are familiar with shift change and handover processes. However, when work pressures are amplified, such as during this pandemic, it is easy to forget how important those debriefing connections are for our mental health.

It is likely that the way in which we do handover has changed: instead of face-to-face interaction, we may be working virtually; or perhaps we are so rushed to get home to take care of loved ones who have been isolated in the house all day that we just can’t find the time to debrief.

Another aspect of transitioning from work to being off duty is finding a way to ground ourselves so that we can have some restorative time.

Our nervous system cannot be “on” 24/7 and we must establish routines and rituals, particularly during times of intense demands and uncertainty.

What can be done?

Debriefing:

Shifting to “off duty”:

  • Tell others what you need: If you share your living space with others, discuss what you all need in order to shift from work to rest mode – a set time to each discuss your work day?; a “no-news” agreement after a certain time of the day? What else?
  • Transition mindfully: If you are working outside the home and are wearing PPES, you have to, by necessity, change clothes and decontaminate yourself. Instead of rushing through this process, use this as a time to mindfully transition. If you are not wearing protective equipment, changing clothes can mark the shift of your day from work to rest.
  • Designate a space: If you are working from home at this time, designate a space that is for work only. If you live in a smaller space, ensure that your work laptop, files, etc. are tucked away for the remainder of your day.
  • Respect your own time: Unless you are on-call, ensure that you have “office hours” and time where you are officially off duty. This is a time to unplug and restore, so avoid checking your email in the middle of the night, etc.

 

Final Thoughts

“In the end, with systems crashing and failing, what mattered most and had the greatest immediate effects were the actions and decisions made in the midst of a crisis by individuals.” Sheri Fink, Five Days at Memorial

Although the scale and impact of the COVID-19 pandemic are unprecedented, there are many lessons learned from the past. Sheri Fink’s Five Days at Memorial highlights the crucial importance of ensuring basic physiological and emotional needs for all service providers and their leaders – this is always true, but particularly during crisis situations.

As Fink says in the quote above, it is in the moment-to-moment decisions that we will make as individuals that will matter most. The good news is that we have a vast body of knowledge about crisis management, human psychology, burnout, compassion fatigue and strategies to manage human physiology during times of crisis to help guide our way.

We won’t be able to control many aspects of this pandemic, but we can control our responses and the ways that we take care of ourselves and one another.

We are in for a marathon, not a sprint – so, remember to take it one step at a time. 

We are in for a marathon, not a sprint – so, remember to take it one step at a time. #COVID-19 #caremongering Click To Tweet

 


Read Part One – This is a Marathon, Not a Sprint: Strategies to Address Wear & Tear in Helping Professionals during COVID-19


 

Resources

Join our mailing list if you would like to stay updated on our latest resources.

Books

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink (2013)

Help for the Helper: The Psychophysiology Of Compassion Fatigue And Vicarious Trauma by Babette Rothschild (2006)

Resilience, Balance and Meaning: Supporting our Lives and our Work in High-Stress, Trauma-Exposed Workplaces by Patricia Fisher (2016)

Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments by Patricia Fisher (2015)

The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization by Françoise Mathieu (2012)

Our Online Courses

Compassion Fatigue 101 with Françoise Mathieu

Organizational Health in Trauma-Exposed Environments Online Course: Essentials with Dr. Patricia Fisher

Resilience in Trauma-Exposed Work with Dr. Patricia Fisher

Staying Grounded in Stressful Work with Diana Tikasz

This is a Marathon – Not A Sprint: Strategies to Address Wear & Tear in Helping Professionals during COVID-19

There is now wide consensus that responding to the COVID-19 pandemic will take months rather than weeks.

As professionals in essential services, we all need to consider strategies that will help us stay well long-term rather than racing to just get through another day.

What can we do to remain clear-headed and balanced during this pandemic? 

Launched into Crisis: The Dangers of Wear & Tear on Helping Professionals

First, Secure the Foundations: Physical & Mental Hygiene

Communication: Keep it Clear & Consistent

Reset & Listen to Your Body

Resources

Read Part Two

Some sections adapted from Mathieu, F., Tikasz, D., & Welfare, M. (2016). Niagara Victim Services Toolkit.

Launched into Crisis: The Dangers of Wear & Tear on Helping Professionals

I am sure that many of you remember the scene in the movie Apollo 13 where the crew is urgently trying to find a way to perform a lifesaving repair on their spacecraft’s air supply. A NASA engineer throws a box of assorted items on a table and says to his colleagues:

“OK people, listen up […] we gotta find a way to make this, fit into the hole for this, using nothing but that.”

The team could only use materials that the stranded astronauts would have access to on their ship. These engineers needed to think fast and creatively – with the eyes of the entire world watching them. Failure to resolve this problem meant certain catastrophe for the crew.

High stakes, lots of pressure, intricate problems and few resources – during this COVID-19 pandemic, many of us feel like those NASA folks and the key challenge is this: 

How do we access creative problem solving when we are stressed and exhausted? How do we retain the ability to think clearly when the reality is that many of us were launched into this crisis already tired and depleted?

 

The Impact of Wear and Tear: A Cautionary Tale

When experts discuss burnout, compassion fatigue and moral distress, they often overlook a crucial contributing factor to provider impairment – plain old fatigue.

In her explosive book Five Days at Memorial: Life and Death at a Storm-Ravaged Hospital, Pulitzer-prize winning journalist Sheri Fink investigates what took place in a New Orleans health care facility in the aftermath of Hurricane Katrina in August 2005.

For several days, the hospital lost power as well as much of its contact with the outside world. Exhausted staff, all of whom were now taking refuge in the sweltering facility, were desperately trying to care for patients – often working with very little sleep, a lack of food, and no sanitation, air conditioning or electricity.

Leadership quickly eroded. Medical professionals who were stuck in the hospital had to contend with a lack of communication about evacuation plans and no hope of respite to come. There were no more established shift schedules, handover, or time for rest.

In her book, Fink shares numerous interviews with staff where they describe overwhelming moral distress, feelings of burnout, and anger towards senior leadership and the government. It is widely agreed that these factors contributed to serious lapses in judgment by some of those health care workers which led to some questionable ethical decisions in the end.

Our organizations experience significant challenges at the best of times and there are many cautionary tales such as those in Five Days at Memorial that describe the dangers of pushing employees past their level of healthy functioning. In the face of this COVID-19 pandemic, we have additional work pressure including supply and equipment shortages; fear of contagion for patients, for ourselves, and our families; difficult ethical decisions; and significant moral conflict.

Five Days at Memorial demonstrates the potentially catastrophic consequences of wear and tear in crisis situations as well as the deterioration of problem-solving skills that can occur when we do not have time to refuel and reset.

What can be done? 

 

First, Secure the Foundations: Physical & Mental Hygiene

Dr. Patricia Fisher, clinical psychologist and senior advisor at TEND, is an expert in organizational stress and burnout in health care and other human service organizations. Dr. Fisher has long expressed concerns about the potentially disastrous impact of ignoring the basics of human physiology of helping professionals and their leadership.

 As she explains in her book Resilience, Balance and Meaning:

We are pretty good at dealing with spikes in stress levels as long as we get back to a relaxed state. Unfortunately, many people are consistently living with higher levels of chronic stress and their bodies are simply unable to experience any respite from the pressure. This has consequences.

Physical and mental health are often the first things that are sacrificed in crisis situations. As we know, in order to maintain our ability to think clearly and to do our work well, we all need to:  

  • Get enough sleep
  • Have a realistic shift schedule
  • Eat quality food at regular intervals (including complex carbohydrates, healthy fats, greens and healthy protein sources)
  • Maintain regular physical exercise (helps to reduce anxiety and boost immunity)
  • Monitor caffeine intake (improve sleep and reduce anxiety)
  • Monitor mood-altering drug intake (such as alcohol)
  • Stay connected with loved ones and colleagues
  • Limit media exposure to once or twice a day, only checking trusted sources
  • Access emotional support (debrief and create a space to respectfully share)
  • Access support to juggle family demands and/or caregiver roles while working front-line

Although these suggestions seem simple, we need to be mindful about checking-in with ourselves and monitoring our physical and mental health.

For leaders, check-in with your staff to ensure that they have what they need –  and don’t forget that your own self-care is important too.

(Check out our most recent interview with Dr. Patricia Fisher – “Leaders are People Too: Staying Well During COVID-19”)

 

Communication – Keep it Clear & Consistent

We are all currently receiving a large volume of rapidly evolving and sometimes contradictory information about COVID-19. As teams, it can be difficult, time consuming and confusing to have to wade through the deluge of information.

What can be done?

  • Establish a communication protocol: Develop a concise, clear and consistent method for communicating important information among teams. Take time to ensure that your communication methods are ones that staff regularly consult. For example, sending emails may not be the best for your team if staff rarely have access to that technology. You may also consider the generational and personal preferences for communication methods.
  • Provide regular updates: Each day, appoint a time to provide your team with necessary updates. Avoid too often (emails every hour) or too infrequent (once a week).
  • Debunk rumours: Nominate one person to fact-check information and then have them report back to the team. Encourage staff to send their questions to this fact-checker and encourage everyone to avoid sharing information prior to this vetting system. This can be a useful system for curbing rumors and avoiding miscommunication.
  • Be honest: If you are a leader and you don’t know something, tell your staff the truth – but also commit to finding out when you can.This is true for information about infection control, access to crucial supplies and referral resources, workload, layoffs and many other crucial factors that can impact the entire team physically and psychologically.

Ensuring that we maintain clear communication is a crucial component of keeping our teams cohesive and functioning well.

 

Reset & Listen to Your Body

The amount of stress we experience during times of crisis depends on many factors including past experiences, personality factors, current life stressors, coping strategies, prior training, personal resilience, and many others. 

Regardless of the level of stress that we experience, it is important that we reset ourselves into a “rest and digest” state rather than some form of fight, flight, or freeze state as quickly as possible after a period of increased stress.

If we pay attention to our body at these times, it will give us clues as to what needs to happen next in order for us to reset ourselves. Often our body knows what to do – for example, bodies often tremble following a crisis event.

Things like crying and trembling are activities of the parasympathetic nervous system that the body uses to reset itself. It is best to allow the body to run through its course rather than forcing yourself to stop. 

What can be done?

Activities of the nervous system that allow the body to metabolize stress hormones include:

  • Trembling or shaking it off
  • Crying
  • Laughing
  • Singing or chanting
  • Moving our body in some way and getting our heart rate up (e.g. jumping jacks, running, climbing stairs)
  • Relaxation activity (e.g. meditation)
  • Connecting with a significant other or a beloved pet

 


Read Part Two -This is a Marathon – Not A Sprint: Understanding Reactivity During COVID-19 & Strategies to Stay Grounded


 

Resources

Join our mailing list if you would like to stay updated on our latest resources.

Books

Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital by Sheri Fink (2013)

Help for the Helper: The Psychophysiology Of Compassion Fatigue And Vicarious Trauma by Babette Rothschild (2006)

Resilience, Balance and Meaning: Supporting our Lives and our Work in High-Stress, Trauma-Exposed Workplaces by Patricia Fisher (2016)

Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments by Patricia Fisher (2015)

The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization by Françoise Mathieu (2012)

Our Online Courses

Compassion Fatigue 101 with Françoise Mathieu

Organizational Health in Trauma-Exposed Environments Online Course: Essentials with Dr. Patricia Fisher

Resilience in Trauma-Exposed Work with Dr. Patricia Fisher

Staying Grounded in Stressful Work with Diana Tikasz

Additional

COVID-19: Resilience Support Toolkit provided by Hamilton Health Sciences

 

Leaders Are People Too: Staying Well During COVID-19 – an interview with Dr. Patricia Fisher

Dr. Patricia Fisher, co-founder and Senior Advisor with TEND, is a clinical psychologist and specialist in organizational health and workplace wellness in trauma-exposed workplaces.

In this interview, Dr. Fisher shares best practice recommendations for leaders amidst the stress of the COVID-19 pandemic.

Free Resource: Self-Care Questionnaires from the Resilience, Balance & Meaning workbook

Skip to key recommendations


Q: Dr. Fisher, you have been an expert in organizational health for many years, with a particular focus on professionals who work in health care, corrections, law enforcement and social services.  How did you become interested in working with high stress, trauma-exposed professionals?

A: Like many of us in this field, I had intense personal experience as a clinical psychologist working with high-stress, high-trauma client groups within highly challenged systems and institutions (e.g. mental health, social services, justice system, etc.).

And this is going back to the late 70’s, before we had much language or knowledge around the effects of this kind of work on individuals and systems.

By the late 80’s and early 90’s, we had a much better handle on trauma as it pertained to victims – but we were starting to see serious challenges arising for the frontline trauma workers and their organizations. At the same time, it was becoming clear that frontline workers were providing critical, life-changing services to the client groups.

So, we had a double bind: there was a growing need for services but at the same time, the workforce and their organizations were losing capacity and, in a sense, victimizing their workers.

Fortunately, pioneering work by Pearlman, Saakvitne, Finklehor and others was looking at the impact of trauma work on practitioners and starting to propose ways of addressing it. In the mid-90’s, I began to look at the risk and resilience factors at play for practitioners working in trauma-exposed environments within highly pressured and constrained organizations. This was the basis of my Complex Stress Model as well as the research, trainings and interventions that were built on it.

Trauma-exposed workers and their organizations provide services that are vital for a civil society. It is imperative that we support those individuals and their systems.

 

Q: In your opinion, how important is leadership during this complex and rapidly evolving situation that we are in currently?

A: Leadership is so important under “normal” circumstances. Under the current situation it becomes critical and central.

It’s important to remember too, that we need to include both formal and informal leaders in our thinking. In these tumultuous times, many frontline individuals will be called upon to take on acting leadership roles in addition to their peer leadership roles.

 

Q: I have often heard you say that “leaders are people too.” Would you mind expanding a bit for our readers what you mean by that?

A: Leaders are often perceived as being exempt from complex stress and their consequences at the personal and professional levels. However, we often find that leaders are some of the most stressed people in organizations.

The pressures on leaders can be so intense at the best of times with everything coming down on them from on top in addition to the responsibilities coming up from those they supervise. In the current situation, these pressures will only amplify, and leaders are even more at risk for developing stress and trauma-related effects.

 

Q: I would like to talk a bit about the basics of staying well as a helping professional during these high stress times. You wrote a wonderful book called Resilience, Balance and Meaning – can you tell our readers about the focus of the book and why that might be more important than ever right now?

A: The workbook is designed as a practical, comprehensive resource to support all those in trauma-exposed work. Based on current research and best practices, it provides an understanding and action plan throughout the three sections:

The first section provides an introduction and orientation to the issues of workplace stress in trauma-exposed environments – what it is, how it works, what helps and what effects it has. The second section provides self-assessment tools that help to determine your current risk and resiliency profile, self-care status, and stress symptom profile. And the final section provides support to build a personal wellness plans for both your personal life and your work life.

Under “normal” conditions we often believe we can limp along without taking ourselves seriously – and that can seem to work for a while. However, with the current surge in stressors, we really must take informed and effective action to care for ourselves and our colleagues.

Free Resource: Self-Care Questionnaires from the Resilience, Balance & Meaning workbook

 

Q: What are your top recommendations for leaders in health care and first responders at this time? 

A: Here are my recommendations:

  • Set your realistic priorities on a daily basis and recognize what you have achieved each day.
  • Take the time to ground yourself as you finish one task and before you take on the next task (e.g. take a deep breath, Feet on Floor)
  • Stay connected with your colleagues in a kind and caring way and appreciate each other and your successes together.
  • Remember to take care of your body: hydrate frequently, make sure you have quick healthy meals and snacks, sleep as much as you can.
  • Unplug from a steady diet of news, rumours and externally imposed anxieties. Focus on what you have some control over. “

 

Q: In your book Building Resilient Teams, you talk about Stephen Covey’s circles of control and influence. I was thinking that this is a very relevant concept right now. What are your thoughts about how Covey’s circles may be a useful tool right now?

A: For readers who may not be familiar with this model, Covey identifies three zones of control:

The smallest part includes things over which we have complete control; the next zone are things we have influence over; and the last and largest zone are things that we have no control or influence.

As you think about looking after your own wellness, it is important to be clear about what you do and do not have control over. When we are faced with situations in the workplace (or in life) that are unpleasant and/or stressful we have four choices:

  • We can accept it
  • We can change it
  • We can change the way we deal with it
  • We can escape from it.

When we are dealing with circumstances outside of our control, such as the current pandemic, we need to focus on the healthiest and most adaptive approaches – either with acceptance and self-care, by changing the way we deal with it, or escape from it. 

It is extremely stressful to feel as though you have no control over the events and circumstances in your life, and your experience of them – and this is why it is so important to understand where you sit in the zone of control for the different issues you are facing right now. We need to recognize that we always have a place to find a sense of control – either over the situation or over how we choose to deal with it.”

 

Q: Finally, what is one message you would like to share with our readers, whether they are frontline workers, managers or senior leaders as we navigate through this unprecedented situation?

A: I believe we all need to keep coming back to principles of kindness – to ourselves, our families, our colleagues and our clients. 

This pandemic calls on us to change the traditional helper belief paradigm from: “Either I take care of you OR I take care of me” – to – “I MUST take care of me so that I can take care of you.”

This pandemic calls on us to change the traditional helper belief paradigm from - either I take care of you OR I take care of me - to - I MUST take care of me so that I can take care of you. Click To Tweet

 


Key Takeaways:

  • We need to support trauma-exposed workers and their organizations as they provide vital services.

  • Leadership during times of crisis is critical and central.

  • Include both formal and informal leaders: frontline individuals will be called upon to take on acting leadership roles.

  • Leaders are often some of the most stressed people in organizations.

  • During this pandemic, pressures will amplify and leaders are even more at risk for developing stress and trauma-related effects
  • Focus on the healthiest and most adaptive approaches when dealing with circumstances outside of your control. 

  • Keep coming back to principles of kindness – to ourselves, our families, our colleagues and our clients.

Concrete steps to take right now:

  1. Set realistic priorities on a daily basis and recognize what you have achieved each day

  2. Take time to ground yourself as you finish one task and before you take on the next task (eg. deep breath, “Feet on Floor”)

  3. Stay connected with your colleagues in a kind and caring way and appreciate each other and your successes together

  4. Take care of your body: hydrate frequently, make sure you have quick healthy meals and snacks, sleep as much as you can.

  5. Focus on what you have control over: unplug from a steady diet of news, rumours and externally imposed anxieties.


Resources

Resilience, Balance & Meaning Workbook by Dr. Patricia Fisher, 2016

Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments by Dr. Patricia Fisher, 2015

The 7 Habits of Highly Effective People by Stephen R. Covey, 2004

Staying Grounded in Stressful Work online course with Diana Tikasz

Resilience in Trauma-Exposed Work online course with Dr. Patricia Fisher

Organizational Health in Trauma-Exposed Environments online course with Dr. Patricia Fisher

Today, spare a thought for the call centre operators

By Françoise Mathieu, M.Ed, RP, CCC., Executive Director, TEND

I was catching up on the news this morning and reading about the long wait times to reach Service Canada to ask about employment insurance; about the days spent on hold by stranded travelers trying to reach airline customer service before the borders close; and other similar situations where callers are experiencing long wait times and high levels of distress and frustration.

We are also hearing about 911 communicators who are receiving large volumes of calls from both the worried-well and the mildly ill while still dealing with life and death matters. (By the way, this isn’t new for emergency communicators – as they will tell you – but the workload is unprecedented right now).

Since my team has had the immense privilege of working with many customer service workers and call centre operators in the past, from every possible industry that you can imagine,  I would like to break down what may be happening at the receiving end of that phone call, live chat or email.

Most operators were already experiencing very high-pressure work environments before this pandemic unfolded.

Large volume of calls, angry and distressed clients, not enough time for proper breaks, and even physical injuries from poorly designed workstations are just some of the stressors that call centre workers deal with on a daily basis. Many are also struggling with low pay, long hours, low reward jobs and a wide range of workplace climates from the very healthy to the, quite frankly, straight-up toxic.

I used to provide employee assistance to a call centre that had a three-month turnover rate – that’s how long their staff lasted before they quit. That being said, I have mostly worked with incredibly supportive customer service leadership – however, they are still grappling with the complex challenges of the workload and difficult callers.

The types of calls that they receive are highly varied – even during normal circumstances.

These calls can range from callers who are seriously mentally ill, suicidal, uttering threats, being verbally abusive, or even just someone who is calling the wrong service and is very upset that the operator is unable to help them.

They rarely have the power to fix your problem beyond what they have the scope to do.

Call centre operators are working within the same mess that we are all in right now including slow websites, lack of information from high above, and rapidly changing policies, rules, regulations and procedures. Yelling at them will not make them more powerful than they are – and will likely just make everyone more stressed out and upset.

In some instances, you can ask to escalate the call to a supervisor for more answers, but that can be done politely.  

Sometimes they do have some discretion to do a few extra things.

Yesterday, as I was busy working with some of my health care agencies on Zoom, my internet provider called to say that they had to interrupt my service for some not-very-urgent reason.

When I nicely told the operator about the work that I do, he genuinely thanked me for my service, and said that he would postpone the service interruption. In my experience, being kind to customer service workers goes a long way. 

Most of them are not trained in mental health first aid.

Unless they work in a highly specialized service that provides mental health assistance, most operators do not have this kind of training. Yet, many call centre operators must manage callers who are emotionally dysregulated, and this can take a real toll on them.

They almost never get closure.

Many call center operators and communicators have told me that a challenging aspect of their job is that they rarely get closure on how the story ends. This may not be particularly distressing for someone who is trying to help you activate your cell phone but can be a very real source of emotional stress for those who receive calls about stressful or traumatic situations. Some of them have told us that these calls can “hitch a ride with them” and there is rarely time for proper debriefing afterwards.

They are going through this pandemic too.

Operators have financial concerns, families, and toilet paper shortages just like the rest of us (sorry I couldn’t help myself!). But truly, these folks are rarely highly paid, and this work is how they feed their families. Perhaps their spouse is out of work right now or maybe they are trying to take these calls from a crowded, quarantined house full of kids. We just never know what’s going on in the lives of others.

My aim today is to invite all of us to show some kindness and consideration for those communicators and call centre operators, even if they can’t help us to our satisfaction. They are dealing with an unprecedented volume of requests and are working as fast and as hard as they can.

So, please spare a thought for the folks at the other end of that phone line, customer service email or live chat and when you finally get a real human being at the other end, please thank them for their service.

Dealing with Stress & Uncertainty

By Françoise Mathieu, M.Ed, RP, CCC., Executive Director, TEND

We all have different ways of dealing with stress and uncertainty.

Even at the best of times, I am not particularly good at going with the flow to see where things land. I like to map out the flow, control its direction and, if possible, alter where it’s going to end up.

Since this has been a core element of my personality as far back as I can remember, I have developed three essentials tools that help me stay grounded, healthy and thinking clearly even when I don’t have much control at all.

First, I go back to the books.

As an avid reader, I always start by returning to the science to find guidance from past events.

There were some very important lessons learned from the way the SARS outbreak was managed in 2003 in Toronto hospitals – both in terms of infection control and in ways that we could have provided better psychological support to our exhausted health care staff.

In an article published in 2003, Mount Sinai’s Dr. Robert Maunder outlined those recommendations and placed a huge emphasis on the importance of social support; allowing time for workers to reflect and reset between patients; acknowledgement from leadership that there has been a change in workload; and staff feeling supported by their managers.

Second, humans need social support.

Connecting with loved ones, friends and colleagues over Skype or by phone can help us ground ourselves. I just went for a long walk and chatted with my 78-year old father for an hour while getting some exercise and fresh air. I also reached out to two members of our team for a catch-up today.

Try taking a break from the news cycle and connect with real humans that you love and care about.

“…When facing such a crisis it is crucial to feel that one is not alone. All efforts to overcome interpersonal isolation, from sharing jokes on the nursing station to conference calls, serve an important role in times of intense strain and stress.”

– Dr. Robert Maunder, 2003

Third, rest, exercise and resetting.

TEND team member Diana Tikasz, MSW, RSW, is a specialist in grounding skills and the neurobiology of stress. She reminded me of the “Power of Pause” during our chat today and the importance for all of us to take short breaks in the rush of our days to reconnect with our breath and remain present to ourselves.

“If all else is going wrong around us, we always have the ability to pause and choose where to focus. Don’t believe everything you think—we cannot control the thoughts that pop in our head, but we can be aware of them. With awareness comes choice.”

– Diana Tikasz, 2018

In his post-SARS article, Dr. Maunder wrote that we are “normal people dealing with extraordinary events” which I loved. He reminds us that the people that we serve will continue to need us, as will our loved ones, but that we are not alone.

Let’s support each other with compassion, kindness and presence. Let’s connect to share tools that work for us during uncertain times.

Resources:

Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., et al. (2003). The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ, 168(10), 1245-1251.

Feet on the Floor – Grounding Technique with Diana Tikasz

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