TY - JOUR
AU1 - Alenkin, Nikola, R
AB - As the largest employer of master’s-level social workers in the United States, the U.S. Department of Veterans Affairs (VA) employs more than 12,000 social workers. In addition, the VA provides clinical internships for more than 900 graduate-level social work students from more than 100 graduate schools of social work (VA, 2018). The VA Greater Los Angeles Healthcare System (GLA) main hospital and services center is located in Los Angeles and is also referred to as the West Los Angeles VA Medical Center (WLAVAMC). There are other satellite and ambulatory clinics within the GLA located in downtown Los Angeles (Los Angeles Ambulatory Center), in Sepulveda (Sepulveda Ambulatory Care Center), and in other parts of Los Angeles County (VA, 2017). The Los Angeles County area has the largest concentration of veterans of any county in the United States, with over 1.4 million veterans within the service area (VA, 2017). WLAVAMC provides a broad range of medical, surgical, and psychiatric care in areas such as internal medicine, cardiology, and infectious diseases. WLAVAMC also offers major surgical subspecialties including orthopedics; urology; neurosurgery; ophthalmology; plastics; ear, nose, and throat; podiatry; and cardiac surgery (VA, 2017). To complete the continuum of care, there are two 120-bed community-living centers located on the grounds that are offered to veterans. Also on-site is a residential-care 289-bed Domiciliary Residential and Rehabilitation Treatment Program (DRRTP) that provides rehabilitation programming in a therapeutic environment to prepare veterans for reentry into the community (VA, 2017). WLAVAMC employs more than 500 social work staff, which includes more than 30 graduate social work student interns from the local social work graduate programs (for example, University of Southern California; University of California, Los Angeles). It also employs more than 100 psychologists whose primary duty is the psychological testing and diagnosis of veterans, along with individual and group therapy. Role of Occupational Setting and Stress and Coping The occupational settings in which social workers operate may affect how much stress they experience; consequently, development of self-care within these settings becomes vitally important. Social workers are employed in various practice settings within health care, including inpatient hospital settings (for example, primary or acute settings), skilled-nursing facilities, residential settings, and outpatient care settings (Gehlert & Browne, 2006). Social workers perform a variety of tasks within these specific practice settings, from assessment of the patient’s needs to advocacy for end-of-life issues. Within health care settings, inpatient care has historically been the single largest employer of clinical social workers (Ginsberg, 1995). Social workers who practice in inpatient settings are tasked with screening for admissions, psychosocial assessments, discharge planning, and postdischarge follow-up (Diwan & Balaswamy, 2006). However, in more recent years hospitals have moved toward expanding the role of social workers to providing services in outpatient settings. Social workers in outpatient settings provide services such as group facilitation, case management, and crisis intervention to help stabilize clients while they are in the community. This often means collaborating with physicians and community health organizations outside of the hospital setting (Mizrahi & Berger, 2005). The health care setting creates greater occupational stress as role ambiguity and ideological work philosophies become sources of conflict for social workers. Social workers struggle to work in an environment that relies on medical-model approaches to work when their own training and education ask them to work within psychosocial models (Pockett, 2003). The increased stress as a result of this role confusion can exacerbate stressors and, without development of self-care by the individual or organization, can be detrimental to social workers and the clients to whom they provide services. Other organizational characteristics of the health care setting that may increase occupational stress include high caseloads; a sense of “devaluation” of the social worker; a quick turnover in patient populations; and ongoing exposure to patients who may have experienced traumatic accidents, acute or chronic illness or injury, and psychiatric conditions (Badger, Royse, & Craig, 2008; Dane & Chachkes, 2001; Gellis, 2002). Stress As Experienced by Social Workers within a VA Setting The DRRTP is the largest residential program on campus, housing 289 veterans, with seven interdisciplinary teams. Each team comprises social workers, addiction therapists, psychologists, and vocational rehabilitation specialists. These teams are tasked with case management services, discharge planning, and linkage to other services respective to individualized treatment plans. Each team is tasked with caseloads of 20 to 60 veterans; as is typical of the veteran population, many present with posttraumatic stress disorder (PTSD) symptoms, substance abuse issues, and other psychosocial concerns. In 2011 I conducted a study that found at least 50 percent (n = 63) of social workers rated their secondary stress symptoms as “mild” or “moderate” and 9.6 percent (n =12) rated them as “high” or “severe” (Alenkin, 2011). Social workers were also asked to report “belief in” and “time spent” on coping strategies such as self-care (for example, engaging in exercise, eating well), supervision (for example, access to supervision), and research and development (for example, engaging with other professional social workers, conducting research). Self-care such as meditation and exercise has been shown to be helpful in mitigating stress for social workers. A recent National Association of Social Workers (NASW) study found that 70 percent of social workers who worked in an identified health practice area described “fatigue” as a stress-related health concern, and 74 percent of the participants also reported exercise as a useful coping strategy (Arrington, 2008). This coping strategy was rated highest among both genders and several ethnicities (Arrington, 2008). This same study also found that exercise was the highest-rated coping strategy (75 percent) for those in a health practice area. Other notable coping strategies identified by social workers in this study were meditation and therapy (Arrington, 2008). If social workers are to effectively engage in work with clients, especially veteran populations that are complex in nature and may present with many psychosocial issues (for example, PTSD, substance abuse, traumatic brain injury), self-care must be accessible at the individual and organizational levels. Organizational values and culture often set expectations for work in social work and how the individual uses organizational supports in their respective settings. It is important that organizations providing services to traumatized populations acknowledge the impact of trauma not only on the individual worker, but also on the organization as a whole. Professionals who experience stress within organizations affect the clients with whom they work; workplace stress can affect social services delivery in the areas of client diagnosis, treatment planning, and patient care, including errors such as misdiagnosis of clients, poor treatment planning, or abuse of patients (Munroe, 1999; Williams & Sommer, 1999). Role of Organizations and Stress Current trends in organizations to reduce administrative costs have led to increases in paperwork, increased workloads, and further elimination of social supports for mental health professionals. A work environment that is safe and comfortable for both employees and clients can reduce stress responses. Education about work with traumatized populations can be another possible way to manage or prevent the impacts of secondary traumatic stress (STS). As newer and inexperienced professionals are brought into the organization, Munroe (1999) suggested that organizations have an ethical duty to warn new professionals about the risks of work with traumatized populations. This may include a discussion about the impacts of STS during employee orientation. NASW also recognizes that self-care can be a strong foundation for a practice that is effective and ethical in nature (Arrington, 2008). Organizational resources that provide self-care are also vitally important in the management or prevention of stress. Using a self-care framework can allow organizations and administrators to focus on aspects of self-care practices and policies that promote self-care rather than contribute to stressful organizational environments. These aspects are (a) workload and time management, (b) attention to professional role, (c) attention to reactions to work, (d) professional social support and self-advocacy, (e) professional development, and (f) revitalization and generation of energy (Lee & Miller, 2013). Development of Self-Care Programs within Organizations Within GLA, a renewed emphasis on self-care began in the spring of 2011, with the development and implementation of a train-the-trainer model of mindfulness and compassion practices geared toward providers for use with veterans. This program, VA Compassionate Action Learning Modules (VA CALM), provided clinicians and veterans with the access to learn mindfulness-based stress-reduction techniques with the goal of extending these mindfulness-based practices for use with veterans. In 2012 the program was expanded to include a full-time mindfulness instructor (a psychologist by discipline), the first position of its kind within the VA system. The program was further enhanced with the development of the first Mindfulness Facilitator Training Certification program within the entire VA system in 2014 to further educate and train clinicians in mindfulness-based stress-reduction techniques and practices. Within the DRRTP, these efforts inspired our social work services to develop a mindfulness-based stress-reduction “drop-in” session for clinicians in 2017. Every morning, clinicians within DRRTP were offered the opportunity to sit together a set time (8:15 a.m.) to listen to a guided self-love meditation. Clinicians soon began to habituate to this practice and saw it as a part of their daily work, in turn creating a mindfulness practice within the workplace. The elements that led to the development of this practice and the five recommendations that follow may be considered by others within a similar setting to create a self-care program. Define a space that is used for the practice alone. We use a clinician’s office space, but any dedicated space for this practice can allow a unique sense of detachment from the work role into a “mindfulness role.” Work within the organization and not against it. Although the 2011 study I conducted indicated high levels of stress and little in the way of organizational efforts to assist in managing this stress, it was an opportunity. The opportunity became the recognition that programs like VA CALM had utility within the organization, which led to our efforts in 2017 in developing our mindfulness sessions. Incorporate a period of trial and error to assist clinicians and organizations in identifying the “best fit” for their program. Starting small with one or two clinicians and expanding to others through word of mouth is the key to growing these programs. Integrate research efforts to validate and create sustainability for these types of self-care programs. Within the efforts of VA CALM and the Mindfulness Facilitator program, research was done to substantiate their effectiveness, which further enhanced sustainability and expansion of the programs. Integrate these practices within the role of the work itself. Social workers often face multiple issues of role strain or role ambiguity that create stressors for them, particularly in hospital settings (Pockett, 2003). When self-care exists within the role of the clinician, it assists in reducing the level and severity of role strain and ambiguity. Starting small is the key to development of larger programs. Conclusion The demand for social workers and social services delivery will only increase in the coming years. As this demand rises, so too will the stress that these professionals will face. Organizations that can offer self-care methods to their staff can create environments where self-care becomes second nature to the work environment, and the resulting impacts of reduced stress will help in facilitation of service delivery. Organizations such as the GLA, although large in scope, can begin to implement programs similar to this one, with very little cost and time expenditure. Our critical roles as change agents are not only meant to be used toward our consumers and groups, but also within organizations and institutions as well. As we turn to look at ourselves, we can see incremental change throughout these organizations. Nikola R. Alenkin, PhD, LCSW, is supervisory social worker, West Los Angeles VA Medical Center, and full-time lecturer, School of Social Work, California State University, Los Angeles. Address correspondence to the author at West Los Angeles VA Medical Center, Department of Veterans Affairs, 11301 Wilshire Boulevard, Building 217, Los Angeles, CA 90073; e-mail: Nikola.Alenkin@va.gov. This material is the result of work supported with resources and the use of facilities at the West Los Angeles VA Medical Center. References Alenkin , N. R. ( 2011 ). Secondary traumatic stress: Social workers in a Veterans Affairs health care setting. Loma Linda University, ProQuest Dissertations and Theses. Available at http://search.proquest.com/docview/881096430?accountid=14537 Arrington , P. ( 2008 ). National Association of Social Workers Membership Workforce Study—Stress at work: How do social workers cope? [Report]. Washington, DC : National Association of Social Workers . Google Preview WorldCat COPAC Badger , K. , Royse , D. , & Craig , C. ( 2008 ). Hospital social workers and indirect trauma exposure: An exploratory study of contributing factors . Health & Social Work, 33 , 63 – 71 . Google Scholar Crossref Search ADS WorldCat Dane , B. , & Chachkes , E. ( 2001 ). The cost of caring for patients with an illness: Contagion to the social worker . Social Work in Health Care, 33 ( 2 ), 31 – 50 . Google Scholar Crossref Search ADS WorldCat Diwan , S. , & Balaswamy , S. ( 2006 ). Social work with older adults in health-care settings. In S. Gehlert & T. Browne (Eds.), Handbook of health social work (pp. 417 – 447 ). Hoboken, NJ : John Wiley & Sons . Google Preview WorldCat COPAC Gehlert , S. , & Browne , T. (Eds.) ( 2006 ). Handbook of health social work . Hoboken, NJ : John Wiley & Sons . Google Preview WorldCat COPAC Gellis , Z. D. ( 2002 ). Coping with occupational stress in healthcare: A comparison of social workers and nurses . Administration in Social Work, 26 ( 3 ), 37 – 52 . Google Scholar Crossref Search ADS WorldCat Ginsberg , L. ( 1995 ). Social work almanac (2nd ed.). Washington, DC : NASW Press . Google Preview WorldCat COPAC Lee , J. J. , & Miller , S. E. ( 2013 ). A self-care framework for social workers: Building a strong foundation for practice . Families in Society, 94 , 96 – 103 . Google Scholar Crossref Search ADS WorldCat Mizrahi , T. , & Berger , C. S. ( 2005 ). A longitudinal look at social work leadership in hospitals: The impact of a changing health care system . Health & Social Work, 30 , 155 – 165 . Google Scholar Crossref Search ADS WorldCat Munroe , J. F. ( 1999 ). Ethical issues associated with secondary trauma in therapists. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, & educators (2nd ed., pp. 211 – 229 ). Lutherville, MD : Sidran Press . Google Preview WorldCat COPAC Pockett , R. ( 2003 ). Staying in hospital social work . Social Work in Health Care, 36 ( 3 ), 1 – 23 . Google Scholar Crossref Search ADS WorldCat U.S. Department of Veterans Affairs . ( 2017 ). VHA social work . Retrieved from https://www.losangeles.va.gov/about/index.asp U.S. Department of Veterans Affairs . ( 2018 ). VHA social work . Retrieved from https://www.socialwork.va.gov/index.asp Williams , M. B. , & Sommer , J. F. ( 1999 ). Self-care and the vulnerable therapist. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, & educators (2nd ed., pp. 230 – 246 ). Lutherville, MD : Sidran Press . Google Preview WorldCat COPAC © 2019 National Association of Social Workers This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Self-Care in Large Organizations: Lessons Learned at a U.S. Department of Veterans Affairs Residential Program
JF - Social Work
DO - 10.1093/sw/swz041
DA - 2020-01-07
UR - https://www.deepdyve.com/lp/oxford-university-press/self-care-in-large-organizations-lessons-learned-at-a-u-s-department-EAx5oMDja5
SP - 91
VL - 65
IS - 1
DP - DeepDyve
ER -