[PPT] - Social Workers and LMHCs : How to Obtain Your Continuing Education PowerPoint Presentation

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Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar

Create a Username & Password at the NYU Silver CE Online

Portal :

https://sswforms.es.its.nyu.edu/
Log on to the “Continuing Education Online Portal for the

NYU Silver School of Social Work” page, click on “All Events & Programs” tab

Scroll down & select today’s webinar under “Online

Learning”

Click “Register”
Fill in the billing information, click register, and pay the CE

registration fee Remember: Our system works best with Google Chrome or Mozilla Firefox

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Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar, cont.

After registering, you will receive a confirmation email

with a link to complete an evaluation

Once the evaluation is submitted, within 24 - 48 hours,

log back on to NYU Silver CE Online Portal, go to “Your Registrations” and you will see “Take Assessment” in red next to the name of the program

Complete assessment
Once done, you will be directed how to download your

CE certificate

For Questions: Call us at 212-998-5973 or email us at

silver.continuingeducation@nyu.edu

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Resilience Informed Service Environments (RISE)

ANTHONY SALERNO, PHD JAMES RODRIGUEZ, LCSW, PHD JANUARY 17, 2018

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Agenda

Understanding resilience
The neurobiology of resilience
Research on resilience
Building Resilience

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Poll Questions

Please tell us who you are?
A. Adult Mental Health Providers
B. Child/Adolescent MH Providers
C. Adult Care Manager
D. Child/Adolescent Care Manager
E. Substance Use Provider
F. Supervisor
G. Administrator
H. Other

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Understanding Resilience

THE OTHER SIDE OF THE COIN FROM TRAUMA

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Resilience

“What’s predictable is preventable.”

Robert Anda – Co-Investigator, ACEs Study

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History

Early worked focused on the individual – internal

strengths that protect people against the negative effects of exposure to toxic stress (e.g. the resilient child – invulnerable, invincible)

Picked up by MH researchers interested in the social

determinants of health

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Definition

Resilience. A dynamic process reflecting positive

adjustment despite significant risk or adversity (Luthar

& Zigler, 1991; Garmezy, 1971; Rutter, 1987)

Resilience is…
Context-based/Situational
Domain Specific
Fluctuates over time (fluid)

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Resilience is not…?

Competence
Ego resiliency
Grit

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When has someone demonstrated resilience?

1. Resiliency - No signs of unhealthy coping response

(disorder), despite exposure to Potentially Traumatizing Event (PTE)

2. Recovery – Improving coping response after

unhealthy coping in response to PTE.

3. Prosperity – exceeds expectations and doing better

than before exposure to PTE.

Bonanno and Mancini, 2012

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Three Levels of Protection

Resilience

Individual Strengths (Assets)

Significant

thers

(Resources)

Systems and Culture (Resources)

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Individual characteristics (Assets)

Temperament
Personality traits
Ego resiliency
Competence
Grit
Intelligence
Future orientation
Self-efficacy
Self-esteem

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Significant others (Resources)

Family/Parenting
Attachment,
Parental/Caregiver monitoring/supervision, support
Peers
Mentors
Extended family
Social support

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Systems support (Resources)

Quality Systems
Schools –
Engaging services
Quality care
Evidence-based practice
Practice-based evidence
Trauma Informed Systems
Safety
Connections
Emotional regulation

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Cultural/Context Example

Religion/Spirituality
Ethnic/Racial Identity (Zimmerman et al., 1995)
5 Categories of Resilience in African American males

impacted by poverty (Teti, et al., 2012):

1. Perseverance and refusing to quit despite challenges
2. A commitment to learning/growing from hardship
3. Using reflection and refocusing
4. Creating a positive and supportive environment
5. Drawing on religion/spirituality for strength

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Cultural and Community Resilience

First Nations research (Chandler and Lalonde, 1998)
Self government
Land claims
Education
Health services
Cultural facilities
Police and fire departments
Native Language
Increases suicide rates by cumulative bands
0 = 137.5/100,000
6 = 0.0/100,000

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Recent Research and the Brain

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Sinha et al., 2016

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Neurobiology of Resilience

Genetics Epigenetics Neurochemicals

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Genetics

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Epigenetics

Biological mechanisms that will switch genes on and
ff (What happens around the gene):
Epigenetics control genes
Epigenetics is everywhere
Epigenetics makes us unique
Epigenetics is reversible or plastic

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Epigenetic Factors

Exposure to stress
Environmental toxins
Prenatal environment
Diet
Exercise
Developmental (critical) periods
Aging
Virus/infection

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Epigenetics and Stress

2 4 6 8 10 12 14 16 18 20 1 2 3 4-5 6 or more

ACE Score

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Neurochemicals

Norepinephrine Neuropeptide Y Galanin

CRH Cortisol DHEA Others Dopamine Serotonin BDNF ALLO

Sympathetic NS HPA Axis Others

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Basic Research on Resilience

Resilience is a significant predictor of decrease in self-

reported fatigue after MTBI (Losoi et al., 2014).

Associated with healthy lifestyles, wellness:
Healthy eating, Exercise, Tobacco use (Wagnild 2015)
Fatigue (Losoi et al., 2014)
Depression, Anxiety (Alena et al., 2014; Wagnild, 2015)
Life satisfaction (Alena et al., 2014)
Religiosity (Mosquito, 2015)

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Outcomes of Resilience Based Intervention

Self efficacy and personal functioning in people with

severe mental Illness (Maxan et al., 2013)

Decreased adolescent substance use (Hodder, et al., 2011)
PTSD Symptoms and positive emotional health (Kent et al.,

2011)

Quality of life and self-concept for people with TIC D/O

(Storch et al., 2012)

Psychological, physiological and self-management for

African Americans with Type II Diabetes (Steinhardt et al. 2015)

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Components of RB Interventions

All provide psycho-education on resilience
Finding positive meaning in the context of disease –

reframing disease (Steinhardt et al., 2015)

Emotion regulation and social connectedness (Kent et

al., 2011; Maxan et al., 2013).

Storch et al., (2012): typical CBT components with

focus on: (1) talking to others about tics, (2) responding to bullies, and (3) not limiting activities because of tics.

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Research on Resilience in Children

Therapeutic Foster Care can affect cortisol levels in

children and adults (Fisher, 2016)

Social Emotional Learning increases resilience:

emotional control, goal setting, perspective taking, problem solving (Durlak et al., 2011)

Treating maternal mental health and improving

parenting helps (Goodman and Garber 2017)

Individual characteristics (e.g. self-efficacy) at least
ne supportive adult relationship help overcome

adversity (Werner and Smith, 2005)

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What You Can Do

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Ways of Building Resilience

1. Build on strengths – whether assets or resources
2. Increase protective factors
3. Reduce exposure to risk
4. Prevention: Primary, Secondary, Tertiary

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Implications for the work in behavioral health services

The bifocal lens of trauma and resilience

Assessing the severity and chronicity of a person’s risk

exposure

Assessing comprehensive resiliency promoting personal

and environmental factors

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A practical and immediate clinical focus that aligns with building resilience

Maintaining a very comprehensive and continual

focus on personal strengths and opportunities to utilize the people, places and things in the person’s life that are reliable and helpful resources.

Assisting clients to identify, engage and develop

strong social bonds is critical.

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What practitioners need to know

Practitioners and service systems can strengthen a

persons resilience (ability to more effectively manage the impact of highly stressful events in the past, present and future)

In contexts of higher exposure to adversity,

environmental factors may be more important to resilience than individual factors.

Even maladaptive patterns of coping may be signs of

resilience in challenging contexts.

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Assessing Risk

Age of initial exposure and duration of adversity
Severity and duration of adverse events and conditions
Number of adverse events experienced
Current challenges and difficulties associated with

adversity

Cultural/familial/religious beliefs and values about:
What constitutes an adverse event- what the term trauma means
Why bad things happen to good people ( role of sin, punishment, forgiveness)
How people are expected to deal with highly stressful life events (prayer, penance)
Self disclosure to strangers, keeping or disclosing secrets
Gender related expectations

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Measuring Resilience

Connor Davidson Scale: 4 Resiliency Factors

Factor 1: Flexibility to Cope with Changes/Challenges
I can handle unpleasant feelings
I tend to bounce back after illness or hardship
I can make unpopular or difficult decisions
Factor 2: Social and Familial Support
My family is willing to help me make decisions and listen

to me

My friends are willing to help me make decisions and

listen to me

I have close and secure relationships

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Connor Davidson (continued)

Factor 3: Spiritual Support
Sometimes fate or god can help
Things happen for a reason
Factor 4: Being Goal-Oriented
I like challenges
I work to attain my goals
I have pride in my achievements
I have a strong sense of purpose
I have few regrets in life i can achieve my goals

Connor KM, Davidson JR. Development of a new resilience scale: The Connor Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18(2):76-82. PMID: 12964174.

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Resiliency Scale for Adults: Two Major Factors

Factor I: Personal Competence
Follow through with plans
Manage one way or other
Able to depend on self more than anyone
Factor Il. Acceptance of Self and Life
I usually take things in stride
I seldom wonder what the point of it all is
I take things one day at a time
I can usually find something to laugh about

Wagnild, G. and Young, H.M.,(1993) Development and Psychometric Evaluation of the Resilience

Scale. Journal of Nursing Measurement, Vol. 1, No. 2

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Brief Resiliency Scale: Single Resiliency Factor

1. I tend to bounce back quickly after hard times
2. I have a hard time making it through stressful events
3. It does not take me long to recover from a stressful event
4. It is hard for me to snap back when something bad happens
5. I usually come through difficult times with little trouble
6. I tend to take a long time to get over set-backs in my life

Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The Brief Resilience Scale: Assessing the Ability to Bounce Back. International Journal of Behavioral Medicine, 15, 194-200. http://dx.doi.org/10.1080/10705500802222972

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Questions we need to answer

Are there clinical cutoffs or specific dosages of protective

factors (individual and environmental) that mitigate the impact

f stressors and prevent psychological and behavioral

problems?

How do different levels of exposure to adversity, different

contexts, and different cultures, affect these cutoffs?

In which contexts and under what conditions are children

likely to develop maladaptive coping strategies as a pathway to resilience?

What is the relationship between higher levels of resilience

and a child’s recovery from a mental disorder?

Which resilience-promoting interventions are the most

effective with which specific populations of children?

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Systemic Pillars of Healing

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Creating Safety (Individual)

Discuss safety
People, places and things that make someone feel safe or

not.

Creating a Safe (Enough) Place
Thinking of a safe place (i.e. present or past, person,

religious/spiritual)

Make it as vivid
Deep experience (i.e. thoughts, feelings, sensations)
Readjust if necessary
SUDS Ratings (1-10)
Repeated checks

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Creating Safety (Provider System)

Changing environment
Waiting areas
Staff training
Privacy/Confidentiality
Survey people, providers

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Connections (Individual)

1. Motivational Interviewing
2. Processing transference
3. DBT Chain Analysis (e.g. Chain Analysis)
4. Interpersonal Psychotherapy - Resolving

Interpersonal Role Disputes

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Connections (Provider System)

Groups
Opportunities to make connections
Development communication skills
Peer/social support
Social events
Play/Physical Activity

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Connections (Community)

Identify extent and quality of social networks
Explore involvement of social supports in treatment
Design service planning to strengthen connections to

community resources (e.g. religious, cultural, social)

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Managing Emotions (Individual)

Stress Inoculation Training:
Breathing/Breathing retraining
Muscle relaxation
Cognitive coping
Self-dialogue/Self-talk
Thought-stopping
Role playing
Exposure
In-vivo
Imaginal
Narration

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Managing Emotions (System)

Adjunctive group:
Yoga,
Meditation,
Other stress reduction opportunities,
Mindfulness based group interventions
Psychological First Aid training (Community)

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Twelve Ways to Build Resilience (APA)

1. Making Connections
2. Avoid seeing crisis as insurmountable
3. Accept that change is a part of living
4. Move towards a goal
5. Take decisive action
6. Look for opportunities for self-discovery
7. Nurture a positive view of self
8. Keep things in perspective
9. Maintain a hopeful outlook
10. Take care of self
11. Learn from past
12. Stay flexible

APA (2017) Road to Resilience available at: http://www.apa.org/helpcenter/road- resilience.aspx

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Accepting Reality

Teaching Radical Acceptance
Accepting reality as it is
Pain is a reality of life
The past can’t be changed
Turning the mind – a Half Smile activity
ACT metaphors
The Person on a Bus metaphor
The Book metaphor

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Finding Meaning

When you have a great sense that life has meaning,

what are you doing? What are you aware of?

What leaves you without much of a sense of meaning
r a sense that life has no meaning?
What could you do to gain or regain a sense of

meaning?

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Poll Question

What topics would you be interested in hearing more about regarding the topic of resilience? Check top 3

A. Understanding resilience
B. Interventions to build resilience (children/youth)
C. Interventions to build resilience (adults)
D. Organizational resilience
E. Neurobiology of resilience
F. Service provider resilience
G. Resilience and culture
H. Resilience building strategies

I. Others (please chat in)

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Poll Question

What resilience related activities would you be

interested in attending if offered by the CTAC? Check all that apply

A. Webinars
B. In-Person training
C. Learning Community
D. Consultation
E. Other (please chat in response)

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Q & A

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