Christine Runyan, PhD, ABPP Clinical Associate Professor

1. Burnout Among Integrated Behavioral Health Providers: We Can't Save the World Without Saving Ourselves Christine Runyan, PhD, ABPP Clinical Associate Professor University of Massachusetts Medical School Session # F6 Period F Track 5. Workforce Development and Inter-professional Education 10:45 AM to 11:30 AM 45 minutes CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A.

2. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Define the components of burnout and how to assess burnout in integrated behavioral health clinicians. • Articulate several reasons behavioral health providers are at conspicuous risk for burnout in an integrated care setting. • Respond to burnout iby practicing specific wellness and resiliency methods.

3. Faculty Disclosure The presenter of this session has NOT had any relevant financial relationships during the past 12 months.

5. "There is a pervasive form of modern violence to which the idealist...most easily succumbs: activism and over-work. The rush and pressure of modern life are a form, perhaps the most common form, of its innate violence. To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence. The frenzy of the activist neutralizes his (or her) work... It destroys the fruitfulness of his (or her)...work, because it kills the root of inner wisdom which makes work fruitful." ~ Thomas Merton

6. How have you changed because of your work? • Are there ways in which your sense of commitment and responsibility to your work might hurt you? How? • What are two ways you feel your work has had a positive influence on the way you see the world, yourself, or what matters to you (your sense of meaning and purpose, hope and faith)? • What are two ways you feel your work has had a negative influence on the way you see the world, yourself, or what matters to you (your sense of meaning and purpose, hope and faith)?

7. Burnout

8. Emotional Exhaustion Depersonalization Decreased Efficacy & Personal Accomplishment

9. Physician dissatisfaction is extensive and growing with 54% of US physicians reporting at least one symptom of burnout in 2014; up from 46% in 2011. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.

11. BH Clinicians ??? Source: Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.

12. Physician Lifestyle Report, 2015

13. Risk Factors for Burnout

15. No Data on BH Outcomes or Impact of BH Clinician Burnout

16. Integrated BH Clinicians • Measured by making other’s lives better • Boundary setting is a learned skill – How is the job constructed • We don’t get the mental health equivalent of an ear infection • A lot of integration is in training settings with underserved populations • Exposure to vicarious trauma … Suicide • Competing demands (clinical, teaching, training, academic advancement) • Ethical Challenges • Many of us are solo practitioners • We are supposed to know how to do this ... This is what we teach, right? • Despite emphasis on interprofessional practice, focus is on MDs (e.g., Physician Health Services, etc.) • What Else?

17. Vicarious Trauma • The process of change that happens because you care about other people who have been hurt, and feel committed or responsible to help them. • Over time this process can lead to changes in your psychological, physical, and spiritual well-being. • Ongoing • Cumulative • When you identify with the pain of people who have endured terrible things, you bring their grief, fear, anger, and despair into your own awareness and experience.

18. Personal Risk Factors • Personality and Coping Styles • Social Support • Personal History • Current Life Circumstances • Spiritual Resources • Work Habits

19. Awareness ---- Balance ---- Connection

21. Rest • Play • Escape

22. Skills: Sense of Meaning and Purpose • Aligning personal values with organizational mission • Making value driven choices vs. goal directed behavior • Narrative Medicine

23. Imperfect Compassion I flinched. I wonder if he noticed. No training had prepared me and I felt myself judge him with my body and eyes. Subtle, but real. Despite his shame, entrusting me with his secret. My maternal defense for my own daughter, the same age, prevailed. Who did I fail? Someone was bound to be disappointed.

24. Skills: Cognitive Flexibility • Being able to “try on” multiple views & perspectives • Ability to adapt to a given situation • Skill … can be taught and strengthened • Foundation of problem solving and conflict resolution skills • Associated with multiple indicators of psychological health • Lower rates of burnout, Higher job satisfaction, Higher empathy, Improved resiliency

25. Body Skills: meditation, mindfulness, mindful movement

26. Skills: Building Resilience, Distress Relief and Health Behaviors • Connection -- Build positive nurturing professional and personal relationships • Maintain positivity / Humor • Develop emotional insight • In The Moment: • What are your grounding practices in real time? • How do you wash away the echoes from trauma stories?

27. Skills: Building Resilience, Distress Relief and Health Behaviors • Cultivate Spirituality • Personal Reflection • Health Habits – sleep, nutrition, exercise, social support • Self-Compassion (Kristen Neff; www.self-compassion.org)

28. Think About … • Your early warning signs of burnout? • What are a few individual or situational risk factors that may currently be placing you at risk? • What are a few individual or situational protective factors that may currently be helping protect you? • What might you try to incorporate to protect you even more?

29. "To experience peace does not mean that your life is always blissful. It means that you are capable of tapping into a blissful state of mind amidst the normal chaos of a hectic life. ” Jill Bolte Taylor

30. This is a conversation we need to have. The resource is too precious to ignore.

31. Learning Assessment • T/F • Burnout is comprised of 3 domains including emotional exhaustion, depersonalization, and lack of personal accomplishment. • T/F • Burnout among behavioral health clinicians is known to be at the same epidemic level as physicians in the US. • T/F • Behavioral health clinicians practicing in collaborative care models are at risk for burnout and vicarious trauma due to some of the unique aspects of practice in this model. • Two ways to address (prevent or reduce) BH clinician burnout include: ____ and _____

32. Bibliography / Reference West, C., Dyrbye, L., Erwin, P., and Shanafelt, T. (2016) Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 16. Epstein, R. and Privitera, M. (2016). Doing Something about physician burnout. The Lancet, 16. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13. Pearlman and McKay. Understanding and Addressing Vicarious Trauma. http://www.headington-institute.org/files/vtmoduletemplate2_ready_v2_85791.pdf Physician Lifestyle Report, 2015.

33. Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you!