Resilience & Wellness Program Development - PowerPoint Presentation

1. Resilience & Wellness Program DevelopmentNYC Health + Hospitals Continuing Professional Education is recognized by the New York State Education Department’s State Board for Social Work as an approved provider of continuing education for licensed social workers and accredited by The Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. NYC Health + Hospitals designate this Live Webinar training for a maximum of 1 contact hour for social workers and 1 AMA PRA Category 1 Credit(s)™.

2. Grounding ExerciseBox Breathing 4x4Sit down in a comfortable placeInhale for 4 seconds through your noseHold your breath for 4 secondsExhale through your mouth for 4 secondsHold your breath for 4 secondsRepeat for 4 times as a set or as many sets as possibleCan be done with limited breathing capacity, for a shorter duration2The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.

3. Overview of Today’s Session Today’s presentation is the fifth and final module1-hour presentation including a panel and Q&A sessionToday we will cover:Creating the Foundation for a Resilient Organization Building Your Wellness Program Steps to Take Today 3

4. 4Learning ObjectivesUnderstand the importance of post-traumatic resilience training and how it impacts individuals and systemsLearn how to identify and target opportunities to support post-traumatic growth and build workforce resilience after a public health emergencyEstablish competence in the steps necessary to create or develop wellness programming

5. Promoting Mental Health & Wellbeing5A Growing Urgency to Address the Psychological Impacts of the COVID-19 PandemicPsychological Trauma Is the Next Crisis for Coronavirus Health WorkersHero worship alone doesn’t protect frontline clinicians from distress Credit: Borge, RHealthcare workers are not just treating a flood of critically ill patients during the pandemicThey are risking their own health, witnessing higher rates of death and experiencing breakdowns of protocol and supportThese acute stresses could lead to mental health issues, yet therapeutic support is lackingScientific AmericanTraumatic Stress in the Age of COVID-19A call to close critical gaps and adapt to new realities Credit: Horesh, D & Brown, ADAbstractTHE ISSUE: Coronavirus-19 (COVID-19) is transforming every aspect of our lives. Identified in late 2019, COVID-19 quickly became characterized as a global pandemic by March of 2020. given the rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society. Although large numbers of people throughout the world will show resilience to the profound loss, stress, and fear associated with COVID-19, the virus will likely exacerbate existing mental health disorders and contribute to the onset of new stress-related disorders for many. PubMed.gov

6. Supporting Your StaffYour staff is your greatest strength and asset! Stress caused by crisis can negatively affect staff’s health and functioning. 6System HealthManaging the staff’s crisis related stress is important in order to…

7. Creating the Foundation for a Resilient Organization7

8. Evidence-Based Approaches for Supporting Staff During the COVID-19 CrisisGood, clear, timely communication, information, and trainingFostering team spirit and cohesionPromoting wellbeing through flexible and responsive resourcingHigh-quality wellbeing and psychological services to staff8

9. The Approach9MitigationPreparednessRecoveryResponse & CopingPrevention measures for recurrence of a similar event or negative adverse exposuresAction measures to reduce vulnerabilitiesEmphasis on and encouragement of sustained copingOrganizational alignment and ongoing current state assessments Countermeasures for maintenance Problem solving activities System-wide reflective learning Effective debriefing for workforce resilience-building Focus on population healthConcrete lines of communication Ongoing training & Refresher courses Environments for healthy decompressionScreenings & AssessmentsReferral networks Effective mental health service pathways both internal & external Acute & long-term treatment for event related holistic health challenges Financial planning to design enhanced support infrastructureBuilding safer processes to meet ongoing concrete needsPrecautionary and proactive measuresImplementing risk mitigation strategies before an emergency occursDevelop response/support plans and establish response teamsTraining, skill, and general awareness buildingProgram planning to maintain effective coping and daily functioning of the workforce Psycho-education, information sharing, and support materials (i.e. posters, brochures, leaflets, videos, etc.) Mental Health & Preparedness plans in actionSystem-wide alignment of directivesProvide emotional support to those in distressEnhance training and skill-building of peer supportersNormalizing reactions and responsesCrisis counseling to meet severity Emphasis on self-careExpansion of response resource capacityIdentify resource gaps (human capacity & system)PDSA cycles

10. Leadership Sets the ToneSo what do we do now as situational leaders? Reinforce Empower Remember Take time Be creative Build10

11. 11Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K., Phillips, E., and Hall, L.W. (2010) Caring for our Own: Deployment of a Second Victim Rapid Response System. The Joint Commission Journal on Quality and Patient Safety. 36(5):233-240. TIER 1TIER 2TIER 3Expedited Referral NetworkEmployee Assistance ProgramChaplain, Social WorkClinical Psychiatry, PsychologyDomestic Violence SupportThe Wellness CenterTrained Peer SupportersProvide 1:1 crisis intervention, group debriefing, support, and referral to Tier 3 as needed.Local (Unit/Department) SupportEveryone having knowledge of crisis response, normalization of discussing difficult events, and supporting each other.

12. Crisis Response ReflectionCreates a space for reflective learning and helps us understand how we have all been impacted Supports the needs of staff to positively impact burnout, attrition, dropout, and engagementImproves environments and moraleInstitutes a structured, cohesive, and standardized culture of communication for feedback from frontline staff; up-and-down/lateral communicationAssists with recognition of emotional commonalities and shared experienceCorrects cognitive distortionsMakes needed changes, engages all levels of staff, and tends to emotional and psychological needs of the workforce12Start With WhyWHYHOWWHAT

13. What Is Peer Support?Peer Support ChampionPeer Counselor Licensed Mental Health ClinicianHost individual/group debrief with coworkers:Provide practical organized solutions Establish a safe environment to talk freely about personal affects. Sharing can be intimate, interpersonal, and mutual Assist staff to feel they are not alone Support colleagues when they are upset; help reduce work distressAre not substitutes for professional help should that be neededProvide an approved Medicaid service where peers help peers:Must meet state requirements, take approved classes, and pass a state testFulfills various duties, based on the effectiveness of assistance and support from people with shared life experience who are living in recoveryUse their own stories in helping others develop hope and improve their livesProvides support in many settingsDeliver caring and support with a one-way focus:Provides service where one member’s emotional needs are centralHosts inherent power differential with responsibility Offers support with strict boundaries State licensure13

14. Empathy BuildingEmpathy is the ability to identify and understand another’s situation, feelings, and motivesEmpathy allows us to form trust, helps us understand how or why others are reacting to situations, and sharpens our “people acumen” Empathy is an emotional and thinking muscle that becomes stronger the more we use it 14

15. It’s All in the ApproachSo how can a Peer Supporter help?Establish safety and trustKnow your roleMeet the individual where they are Provide practical assistance Normalize when appropriate Reflect strength Illuminate stress reactions and appropriate coping Remind them to express and explore what is healthy and productive for themEmpower the individual Follow through and check back in15Adapted from Dr. Tobi Fishel

16. Application of EmpathyEstablish contact and introduce the goal of the debriefProvide practical assistance to address immediate needsDo not critique the incidentAllow time to express emotions in a confidential mannerAsk, “Are you OK?” and “What do you need?”16Anatomy of a Peer Support Empathetic Encounter / DebriefIntroductionExplorationHow do you feel about what happened?What was your first thought after the situation?What has been challenging for you personally?What is your experience? Provide containment, safety, and comfortStabilization and orientation to move forwardScott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M. M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider second victim after adverse patient events. Journal of Quality and Safety in Health Care, 18, 325-330.

17. Application of EmpathyGather information to assess needsValidate normal reactions to an abnormal eventProvide information (brochures, contact info, self-care ideas, etc.)17Anatomy of a Peer Support Empathetic Encounter / DebriefInformation “Normalizing”Follow-Up (Referral, Next Discussion)Determine if additional support is needed and assist with connection/scheduling Refer to your facility team leader for resources (Patient Safety, Risk Management, EAP, Chaplain, etc.)Offer guidance on how to cope and adaptively function Provide connection to immediate support and internal resourcesCollaborate with external services/promote social engagement outside of work Track documentation: complete a quality assurance encounter formScott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M. M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider second victim after adverse patient events. Journal of Quality and Safety in Health Care, 18, 325-330.

18. Building Your Wellness Program18

19. The Foundation of ProgrammingStrategic GoalExecutive SupportPublicityCentral Corporate Steering TeamEstablish Wellness LeadsFacility-Based Steering CommitteesTrainer & Peer Support Champion IdentificationTrainingWebsitesResource SheetsPeer Support Activation Workflows (by site)Support for the Supporters (e.g., wellness events, support groups)Measurements for SuccessImprovement Plans19

20. How to Build a Wellness ProgramGap AnalysisCommunicationPlanFirst Train-the-TrainerIT InfrastructureGrow More Trainees/ PeersGrow ResourcesSustainability PlanSupport the SupportersBuild a CoalitionGovernance StructureInventory ResourcesIdentify Risk AreasQuality Improvement PlanBurning Platform20

21. Burning PlatformCommunicate the whyHighlight how post-traumatic stress, crisis responses, and resilience-building affect organizations-at-largeFind evidence in literature, media, and professional circlesPoint to gaps that illuminate vulnerability and riskCreate an elevator pitch21

22. Build a CoalitionIdentify cheerleaders and supporters who will help you champion the initiativeContact departments and services where you need internal buy-in and supportPartner with colleagues who think similarly and are aware of resilience programming effectivenessFind a co-leadWhere should you look?Wellness Committee, Behavioral Health, Social Work, Chaplain Services, Hospital Police, Risk Management, Quality, Patient Safety, Human Resources, Labor Partners, Occupational Health Services, EAP, etc.22https://www.diplomacy.edu/blog/digital-diplomacy-three-graphs

23. Roles & Responsibilities RoleResponsibilitiesExamplesExecutive SponsorProvide support and resources from facility or system levelCEO, CMO, CNO, CQO, CWOEmotional & Psychological Lead(s) & Master Trainer(s)Point person for wellness team, chairs, steering committee, project leadCQO, PSO, BH Lead, any clinical or non-clinical championSteering Committee MemberRepresent their respective unit/department/discipline, contribute to strategy and operationalization of H3 teamWellness Committee Lead, Psychologist, Psychiatrist, Social Worker, Schwartz Rounds Lead, GME Lead, Nursing Champion, Physician Champion, Resident ChampionPeer Support ChampionAttend Peer Support Champion trainings, provide support in daily work, activated for 1:1 and group debriefsAnyone within the facility or system23

24. 24Governance StructureExecutiveSponsorCentralized Steering CommitteeFacility-Based Steering TeamTier 2 Master TrainersTier 3 Leads (RM, HP, SW, Psych, Chaplain)Tier 2 Peer Support ChampionsAcute H3 LeadPost-Acute H3 LeadAmbulatory H3 LeadPerformance Improvement AdvisorSubject Matter ExpertsCommunity CareFacility-Based Steering TeamTier 2 Master TrainersTier 3 Leads (RM, HP, SW, Psych, Chaplain)Tier 2 Peer Support ChampionsFacility-Based Steering TeamTier 2 Master TrainersTier 3 Leads (RM, HP, SW, Psych, Chaplain)Tier 2 Peer Support ChampionsFacility-Based Steering TeamTier 2 Master TrainersTier 3 Leads (RM, HP, SW, Psych, Chaplain)Tier 2 Peer Support Champions

25. Identify Risk AreasBe proactive and conduct your risk assessment with a group of innovatorsAssess likelihood for failureIdentify the greatest barriers, risks, and challengesHave crucial conversations to mitigate riskTrack evidenced needs and gap fulfillment via needs assessments25

26. Inventory ResourcesIdentify what you already have in placeComb for hidden champions/initiativesBe sure to look at all resources available to different employees within your organization Wellness CommitteeSchwartz RoundsEmployee Assistance ProgramOther community-based resources26

27. Gap AnalysisIs your facility/system ready for a wellness and resilience program? Have we ever conducted an assessment?If not, what needs to happen to get there? What resources are missing?What are the key internal resources we need to launch our wellness programming? 27

28. Why Assess?28Objective: Gather organizational, structural, and workforce-specific emotional health, wellbeing, and resilience-related information, in order to inform policy and program development, and improvement.Organization: structure and leadershipWorkforce: entire workforce and unique groups General and crisis event-specific assessmentsBaseline and ongoing monitoring TargetsElementsImpactsUnderstand systematic readiness, including resources and gapsUnderstand the general and crisis event-specific support needs of the entire workforce and unique sub-group needsSupport policy and program development that support staff emotional health and wellbeingMonitor satisfaction with existing programs for gap analysis, program development, and improvement

29. Why Assess?Organizational Assessments 29Determine existing programming, resources, and needs for implementing best practices around supporting workforce emotional health, wellbeing, and resilienceHelp prioritize needs and resource allocation for program development and implementation Leadership and others in decision-making role about staff wellbeing: buy-in is essentialOrganization, facility, department level assessment: comprehensive approach Unit level assessment: focused/specialized approachObtain input from a variety of stakeholders across departments and levelsSeek consensus for actionsDocument how well policies and procedures are being followedObjectivesStakeholders & LevelsImplementation

30. Why Assess?Organizational Assessments30

31. Why Assess?Workforce Assessments 31Determine prevalence of adverse health symptoms and behaviors as well as positive behaviors, coping, and resilienceIdentify programming and resource needs based on concerns or problems in workforceIdentify individuals in need of supports or servicesCan be offered to all staff or certain staff typesObtain both executive level sponsorship and unit/department champions to encourage participationDetermine mode of administration (self-administered and anonymous, through employee assistance programs)Develop plan to promote participationObjectivesStakeholders & ParticipantsImplementation

32. Why Assess?Workforce Assessments32

33. Communication PlanBuild awareness of the general workforce to know about wellness programming and why it is importantConduct or attend Town Hall meetings to disseminate system-wide correspondenceTarget messaging to managers/supervisors and leadershipTarget frontline staff to peak their interest to either support or become part of the initiative, and utilize programs33ContentConversationConnectivity

34. First Train-the-Trainer CohortCreate a solid strategy to identify participants who will become part of the change management cultureSelect naturally empathetic and engaging people in departments who will lead the way towards successSeek wide representation reflective of the workforce including clinical and non-clinical departments, disciplines, and service-linesEnsure all tours/shifts are represented34Training PhasesStep 1: Master Train-the-TrainersWellness Leads, Behavioral Health Administrators, Nursing Leads, Patient Safety, Educators Step 2: TrainersPsychiatry, Social Work, Nursing, Medicine, & Dept. ManagersStep 3: Peer Support ChampionsAppointed Emotional & Psychological Peers that Provide Support

35. IT InfrastructureLeverage your workforce-facing intranet for wellness programmingOptimize intranet portals, links, etc., so workforce can engage with programming to offer feedback Map out communication and process workflows for activation and response to emotional & psychological need requests Create data input forms and collection methods to monitor and track Enhance external internet page for community-based partnerships and general awarenessCreate live hyperlinks to community and supplementary resources35

36. Grow More Trainees/SupportersThink about how to keep original train-the-trainers and champions engaged after the first master trainingContinuously train and recruit new trainers and champions so that programming is sustainableEstablish a consistent facility-based training plan (monthly, quarterly, department-based, discipline-specific, New Employee Orientation, etc.)Define a recruitment strategy that will not overburden youOngoing targeted communication to remind people of the value of wellness programming 36

37. Grow Support Resources Continue to create pathways to expedited internal referrals and supportEnsure equity and accessibility of all resources and spread across your facility/systemUtilize feedback to fill gaps as they emerge Establish anonymous outside support forumsPartner with the community to further enhance resourcesEstablish resources to support varying levels of clinical/non-clinical needs & severity 37

38. Sustainability PlanIntegrate into related, pre-established forums/meetings and initiatives (e.g. safety huddles, RCAs, rounds, etc.)Scale up and spread (e.g., departments that don’t have trainers and champions)Standardize across departments, shifts, etc. Reinforce workflow and response reliabilityHave one Champion in every tour, department, discipline, and overnight shift Leverage administrators on duty to support gaps as build-out occurs (e.g., on holidays, early mornings, etc.)Continue engagement and alignment of leadership and steering teamsUtilize tools to track progress and data Keep training and sustain the programs that promote resilience38

39. Support the SupportersMost peer support-based wellness programs are not fully comprised of licensed mental health professionalsYou can transfer the emotional and psychological trauma from the frontline staff to the peer supporters, champions, and trainersMonitor for burnout of those helping othersPrevent burnout by going to different champions to provide supportOffer ongoing refresher trainings, supporter debriefs, and wellness events39

40. Quality Improvement PlanUse qualitative and quantitative data to guide improvement opportunitiesConsider domains of improvement work (e.g., communication and marketing strategy, training, workforce wellness events, resource pathways, data collection, program integration)Query frontline staff about how to make wellness and resilience programming more valuable to themContinue to run small tests of change when experimenting with potential improvementsContinue to optimize IT and organizational infrastructure40

41. Steps to Take Today41

42. What Can You Do Today?Start talking about crisis response, post-traumatic stress, and spread the word that we are all human and are not invincible Monitor colleagues on an ongoing basis and continue to advocate for wellness and resilience programming Combat stigmaDetermine a way that you can make an individual differenceIf you have a personal story, share it with a colleague in needBe there for each other!42

43. Get the Ball RollingBegin providing 1:1’s and call small socially distanced group debriefs – you don’t need permission and you don’t have to wait for the formal program!Call for backup when you need it, start finding your partners to support your staffExplore your facility for existing debriefs/huddles: join them as an observer and/or participantBegin to assess your own comfort level and ability to open up more emotion-based conversations in various settingsEncourage requests that you can personally manage and support through supervisors, an internal website, e-mail, or word of mouth43

44. Wrap UpToday we have learned:How to promote the importance of building resiliency via training and wellness programmingThe impact wellness programming can have on individuals and systemsWhy empathy skill-building is important for individual and system health Approaches you can take to identify opportunities to support post traumatic growth and build workforce resilience after a crisis eventConcrete steps to build or develop wellness programming 44

45. Thank YouSpecial thanks:Eric Wei, MD, MBA, Senior Vice President, Quality and Safety & Chief Quality Officer, NYC Health + HospitalsJanette A. Baxter, RN, MS, Esq., Corporate Risk Manager, NYC Health + HospitalsTina Lee, Assistant Vice President, Communications and Special Events, Greater New York Hospital AssociationKate Bastinelli, Senior Director, Digital Communications & Design, Greater New York Hospital Association

46. Please share your questionsAre there tools we did not mention that you find helpful with coping?What additional resources would help?PanelistsJeremy Segall, MA, RDT, LCAT, Chief Wellness Officer, Office of Quality & Safety, NYC Health + HospitalsMonika Eros-Sarnyai, MD, MA, Best Practices Specialist, Disaster Preparedness and Response, NYC Department of Health and Mental HygieneRebecca Linn-Walton, PhD, LCSW, Assistant Vice President, Office of Behavioral Health, NYC Health + HospitalsJames Curt West, MD, Associate Professor, Psychiatry & Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health SciencesJared Bosk, Vice President, Survey and Outcomes Research, Greater New York Hospital Association46Panel Discussion and Q&A

47. ResourcesScott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K., Phillips, E., and Hall, L.W. (2010) Caring for our Own: Deployment of a Second Victim Rapid Response System. The Joint Commission Journal on Quality and Patient Safety. 36(5):233-240. Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M. M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider second victim after adverse patient events. Journal of Quality and Safety in Health Care, 18, 325-330.Leadership development: https://hbr.org/2020/03/the-best-leaders-are-versatile-ones CDC “ADDIE” Model: https://www.cdc.gov/trainingdevelopment/develop_training.html CDC training standards: https://www.cdc.gov/trainingdevelopment/standards/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ftrainingdevelopment%2Fstandards%2Fstandards.html SMART objectives: https://www.cdc.gov/phcommunities/resourcekit/evaluate/smart_objectives.html https://www.managementtraininginstitute.com/5-leadership-skills-best-manage-crisis/ Brene Brown: Empathy: https://www.youtube.com/watch?v=1Evwgu369Jw https://disastermilitarymedicine.biomedcentral.com/articles/10.1186/s40696-016-0013-8 Psychological Trauma Is the Next Crisis for Coronavirus Health Workers: https://www.scientificamerican.com/article/psychological-trauma-is-the-next-crisis-for-coronavirus-health-workers1/ Traumatic Stress in the Age of COVID-19: A Call to Close Critical Gaps and Adapt to New Realities: https://pubmed.ncbi.nlm.nih.gov/32271070/ Psychological Effects on Military Personnel Assigned to Humanitarian Assistance And Disaster Response Mission: https://www.researchgate.net/publication/305734953_PSYCHOLOGICAL_EFFECTS_ON_MILITARY_PERSONNEL_ASSIGNED_TO_HUMANITARIAN_ASSISTANCE_AND_DISASTER_RESPONSE_MISSIONS The Kings Fund: Responding To Stress Experienced By Hospital Staff Working With COVID-19: Guidance For Planning Early Interventions: https://www.kingsfund.org.uk/audio-video/stress-hospital-staff-covid-19 47