[Music] Bret: Now, before we begin our segments, I would like for you to watch a video from several corrections leaders about the importance of addressing corrections stress in today's complex and contemporary workplace. [Music] Terri: Dealing with corrections fatigue is one of the top initiatives for corrections leaders today, and it has to be. Mack: It's in the best interest of staff. All agencies want to have a work environment where their staff can feel safe, where they can thrive and feel productive. So, in order to be sensitive to that kind of a work environment, agencies necessarily have to be aware of vicarious and secondary trauma. Betty: it's paramount. It's integral to the success of a well-ran institution that is safe, that is secure, that provides care, custody and control of inmates. If you do not... if you don't value having healthy employees, chances are you are setting yourself upband your institution for trouble. And so, it's important that you care about your employees. Stuart: We have to invest in our most important asset, and that is our staff, and that's the people that do this job that the public will never truly understand what they do. But, we need to understand it and we need to take responsibility for that, and we need to care for each other. Barbara: The most important resource we have is our staff, and if our staff are not healthy and they're not being able to cope with stress appropriately, you'll lead to all sorts of problems. It could be disciplines. It could be loss of life. It could be hurting of clients. It could be distruction in the community. So, it's critical we deal with this in a very productive way. [Music] Bret: Now, based on these corrections leaders' statements, it's imperative we understand and seek remedy for corrections stress. So, let's begin our understanding of corrections stress with a review of segment one's objectives. So, during this segment we will explore challenges of a correctional occupational stressors, their impact on corrections professionals and organizations. Now, to come up with effective and relevant solutions, we must first identify and understand the challenges we are facing. So, our objectives for segment one are going to be we're gonna summarize the elements that contribute to corrections stress, and also we will explain how corrections stress will be experienced by anyone who works in the profession. So, our first presenter is going to be Maureen. So, Maureen, why is corrections stress a relevant topic and why are we focusing on it now? Maureen: This is a really hard profession, and it's not getting any easier. We work with really diverse populations. We have an influx of folks that are challenging with mental health issues. And I think the public really doesn't fully understand what our role is and how challenging the work is. What's interesting is that there has been a fair amount of information that we've seen over the past number of years around correctional stress, but it's really... it's been coming out of law enforcement, it's been coming out of clinical social work, and hasn't been specific to the role within criminal justice, corrections, prisons, institutions and community corrections. But, we're starting to see that information emerge, and what we're learning is really pretty critical. So, what we would like to do in this broadcast is to really draw attention to this topic and to really build some awareness among corrections leadership as well as the staff about things that we can do to address this topic. You know, it's interesting, what's been happening over the past decade, I think in corrections is that we have really been incorporating more practices in our work that have an evidence base and knowledge informed. But, I think that what I'm hearing oftentimes from staff and even training and such, is they'll say, "You know, you're really teaching us about how to improve outcomes with the population, but what about us?" So, I think that's what we really want to accomplish in this broadcast. We want to really move the profession forward in terms of addressing issues that contribute to corrections stress. We heard in some of the clips earlier that our workforce is our most valuable resource. We need to take care of our staff. So I think with the challenges that present themselves on a day-to-day basis, I think, we're going to talk about how we can address some of those things today. Bret: Excellent. And so, moving forward is our goal. So, what are some of the realities of working in corrections? Maureen: Well, we're all people. And, you know, we bring our life experiences into the workplace. You know, something occurs on the outside to us in terms of family issues or financial issues, those things impact us. So we bring our life oftentimes into the institutions or into the profession. And we are exposed to stressful events on a day-to-day basis. So, you might have a day where really nothing out of the ordinary occurs, or you may have a day where things are just coming at you one after another. So, we know that stress goes with the job. I mean, that's a given. And I think that there's been a belief over the years that to acknowledge it means that your staff are not strong, they're weak, that there are issues within our culture, but I think what we really need to do is that we've got to address those issues. We have to acknowledge the fact that stress does occur. We need to prepare our staff and support them when those incidents happen. And we really need to think about building into our policy and practices into our training programs, we need to acknowledge this issue, and we really need to work towards building resiliency with our staff. Bret: That's well said. So, what are some of the occupational stressors associated with corrections? Maureen: Well, you'll see on the... there's a graphic, the word cloud. You see all these terms on the cloud, corrections stress, compassion, fatigue, vicarious trauma, burnout, which is a term we hear about a lot. So, I think what's less important is to know exactly the current... the exact definitions of each of the terms, but I think it's important to know that we'll hear this terminology, that these things do occur in our day-to-day work within the profession. I know that when I was coming up in corrections the term I would hear most often was "burnout." And we now know with the research that is emerging that this topic is much more than burnout, and you'll hear from presenters as we proceed this morning that will give you a bit more information about that. Bret: All right. That's a good explanation. Maureen: But, I think, you know, just let me jump in here one second. I also want to say that as we talk about the various stresses within doing this work, we'll be looking at three various categories. So, we will be looking at operational stressors, organizational stressors, and we'll also be looking at traumatic stressors. Bret: Yeah, those are on the screen. So then, what are operational stressors? Maureen: Well, I think some examples of that are... well, I'll use community corrections as an example. I mean, we've got probation officers out there that have case loads of 300 people. I mean, how can you adequately address the issues when you have that size of a case load? Within institutions, shift work. So, oftentimes, there's shift bidding, but oftentimes because of vacancies and various issues staff have to work shifts that perhaps they're not accustomed to or not as comfortable for them. And, you know, it can impact sleep patterns. It can impact family life. So, that creates a set of stressors. Vacancies... this is a business that we have a lot of vacancies and are often very difficult to fill and if you have staff vacancies, what naturally that leads to, obviously, are persistent overtime. So overtime can be a perk in this business, but it also can be a stressor, particularly if you are working, you know, back-to-back eight-hour, 12-hour shifts. Again, that can take its toll on folks. Equipment... we are not an organization that is incredibly well-funded. So, we oftentimes will have equipment that perhaps is not available to do our jobs or is not in the best working condition, so that creates an issue. So, I think when we think about this topic, we often think about it in terms of it within institutions. But, even in a corrections setting, there are a lot of challenges. So, I think about folks on parole boards who have to make release decisions and, you know, oftentimes are just concerned that something doesn't blow up. Home visits. I know as a probation and parole officer, I often would do visits late afternoon, in the evening, sometimes on weekends without back-up in rural areas, and that can create some uncomfortable challenges. I know that a lot of probation officers or folks that work in the field have been victims of stalking. I know that I have myself. So there's a lot of things that we face out there that really can create some stress. I think one of the things we talk about a lot are when we do home visits. It's not uncommon to be charged by a dog, and, you know, in a more sort of humorous kind of example, I can remember as a probation officer being out doing a home visit from behind the trailer came this just group of turkeys, you know, and it may sound crazy, but they were pissed, and, you know, so there's a lot of humorous things that happen, but there's a lot of things that are really sort of unexpected and are hard to prepare for. If you read the press, hear, you know, news reports, you know that there have been a number of things that have occurred with corrections staff that have been all over the newspapers, and I think that creates some other challenges because oftentimes, the profession gets painted with a very broadbrush. So, I think what I would like to do now is we have a short clip of an interview with a woman named Sandy Cathcart, who worked at the Anne Arundel County Jail in Maryland and she's gonna talk about some of the operational stressors that she experienced when she was in that role. Bret: Okay. [Music] Sandy: One of the day-to-day operational issues that causes stress is a 24-hour operation of a jail. There is no shutdown time. There is no take a break time. There is no time to regroup and to move forward with the next day's work. It's constant. We have to take orders from the judges, which sometimes have to be carried out right away. We are running back and forth to hospitals to pick up inmates or drop inmates off. We can't wait on those things. So some of things are tim-sensitive and we have to move with it. When the shifts change, we have to pass the information from one shift to the next shift and sometimes there's a hurry to do that because the shift that's on wants to go home so they can get some rest and the shift that's coming on is saying, "Well, what else did you say? What is this? But, do we need to do that?" And so, there is a constant movement in the facility. It does not stop, and that nonstop pressure can cause stress on staff. [Music] Bret: So, Maureen, you give a really good list of operational stressors and so does, Sandy. So, what are some of the organizational stressors that individuals face? Maureen: I think a reallly good example is workplace culture. You know, it's important that you feel supported in your work, that you feel supported by your peers, but oftentimes, we know there are tensions that occur in the workplace that can impact our work. Leadership, I mean, a lot of us, you know, we have a very good sense of what works best for us in terms of leadership and supervision, and this is a profession where leadership changes frequently. You know, you get a new administration in, commissioners change, secretaries change, wardens change and the leadership style changes. So, you may get accustomed to a particular way of working, but when you get new leadership in, it can often just change the whole environment. We need to be supported by our peers, but when there are interpersonal challenges, tensions between staff, that can create issues. I think a really big thing in this profession is role clarity, and I've seen that really as we have become an organization that is integrating more research- based practices, evidence-based practices, I think that it has created some... I think it's professionalized our staff, but I think it's also created some challenges in that often staff will come on board thinking that this is a role. The role is primarily safety and security, but we're also talking with staff about incorporating things like motivational interviewing and evidence-based practice or talking about trauma-informed practices in terms of how you interact with the population. So, I think sometimes staff say, "You know, what hat am I wearing today? You know, am I supposed to be doing safety and security? Am I supposed to be addressing, interacting with offenders in a very different way?" So, I think there can be some challenges around that. I think also that this is work that I mentioned earlier is not often well understood by the general public, and there's a real lack of recognition internally about how hard this job is, about how well the majority of our staff perform. So, I think oftentimes that we... that staff don't get enough credit or recognition for the really good work they're doing in a really challenging environment. So, you know, I think that's just some of the issues that we see that are considered organizational kinds of challenges. Let's hear again from Sandy Cathcart. She'll talk about some of the experiences that she saw when she was in Anne Arundel County. [Music] Sandy: In my experience, one of the main administrative culture issues is that administrators want things done now, and not everything is required now, and so you'll have administrators telling staff, "I need this ASAP," or just not even asking, "What are you doing right now? Do you have time to do this?" And so, that invisible "Give it to me, now" attitude is very stressful on staff. And I've encouraged staff over the years to tell me what it is they're doing or ask, "Are you busy? Can you do this for me? And can you give it to me by such and such time?" It's important for administrators to tell their staff when they really need the work done. Everything is not an emergency. [Music] Maureen: We have another clip that I want to have folks take a look at and this clip is from sheriff Peter Koutoujian out of the Middlesex County Sherrif's Department in Massachusetts. And it's a really interesting program that they did. They actually worked with the Office of Justice Program Diagnostic Center and actually you'll hear from one of our panelists who was involved in that study. What Sherrif Koutoujian did is he conducted an interviewer survey with his staff around some of the stress within their work and they learned some very interesting aspects of the work. So, let me show you the clip. [Music] Sheriff Koutoujian: One of the efforts we undertook with the diagnostics center was a survey that we would pass out to all of our employees in the Middlesex Sheriff's office. The number one issue that they identified for us was the fact that communication was lacking, and I think this is probably not uncommon for any paramilitary organization. But, what we found was, in our estimation, that it wasn't just communication from up, down, or downstream, but it was really important that we accept information upstream, as well. That we understand what's going on and be more open to accepting it back upstream. We also found our EAP program should probably take a shift. We had an internal person running our EAP program. We got the sense many people weren't maybe going to be open to someone on the inside with whom they worked because they were afraid of confidentiality issues, even if they were assured. We also stepped into greater appreciation efforts. The fact is in corrections, many times so often or too often, people are hearing when something is going wrong. They don't hear when they're doing something right and it's really leadership. It's really good leadership that will bring the good things back down to people and say, "Thank you for doing a good job. Thank you for heroic effort. And sometimes, just thank you for doing a very good job, even if it's nothing fancy, even if it was nothing heroic. Just doing your job very good, every day and night is really important because quite honestly, that's what saves lives. [Music] Bret: All right, Brandon. It looks like, you know, we've gotten a really good picture some of the operational and organizational stressors that people can face. So, from your experience, what are some examples of trautmatic stressors? Brandon: So, traumatic stressors are those events that occur in a correctional setting, either in institutions, out in the community or in the field that are traumatic, that cause that, "Oh, man! what did I just get myself into?" And those things are things such as assaults, serious assualts, threats of violence against yourself, against others, homicides, suicides, sexual violence. It's those "Oh, man" moments. Bret: Yeah. We can see the graph on the screen for that. So then, what's the difference between indirect and then direct exposure to trauma? Brandon: Well, direct exposure are those events where you're actually there. You're living it. You're there. So, you're the first responder to a suicide. Or you're responsible for assisting in breaking up a fight. You are the one that got assaulted or were threatened by an inmate or an offender. So, you're directly involved. Indirect is when you're hearing about it at a later time. It could be examples of at briefing the next day or a buddy calls you at night, "You're not going to believe what happened today," and describes it to you. It could be the person that's putting the reports together. They're responsible for getting all the photographs together, ensuring all the memorandums are written correctly. Making sure all of the documentation is there. Or out in the field, in community corrections. Oftentimes, there's is indirect exposure. You know they're reading reports. They're doing the victim interviews. You know, they're responding to, you know, one of their clients that committed suicide or overdosed or reading the report at a later date. So, direct is when you're directly involved. You're right there. And indirect is where you're almost getting the information secondhand or secondary to the actual event. Bret: All right. I think those are good explanations. Now, we have a video that's going to give us some more information about the effects of indirect and direct exposure to traumas. It's called "They Call Me Fragile." Let's watch that. [Music] Bret: And, I thought nothing was wrong with me, but reality is when you come home from work and your shift and your family goes [blows air] disappears and you're here by yourself, something is wrong. Not with them. Something is wrong with you. Something is wrong with you. You know and that's not normal. It's not cool that your family all leave. And even the dog takes a hike from you. Anessa: I feel like, you know, my personal life has been affected by this... dramatically. Bret: You may, you know, think, "Well, I'm gonna handle it this week by drinking a bottle or I'm gonna handle it this week by blowing up at dog or I'm gonna kick my dog. Or I'm gonna kick my family or, you know, that's how it releases. Because if you just keep on piling it and piling on top yourself, it's going to explode some time. It's like, you know, a pop bottle that's shaken up and all that has to go somewhere. All that pressure has to go somewhere. And, yes, we have psychologists and people to talk to, but in this field, you know, most guys see if you're weak if you go talk to somebody. Most guys say, "Hey, you know, if I really go talk to somebody, if I really go to my supervisor and say, hey, you know what? I don't want to deal with this today, I don't want to be part of it today," that's why a lot of officers call in sick. And we have sick time. It's abuse of sick time. But, I think the supervisors forget that some officers and throughout the day, sometimes you're at a boiling point where you say, "You know what? I don't want to deal with it today. I'm not going to deal with it today so I'm going to stay home." Wesley: So much of the time your family doesn't understand. You can tell people what it's like, and they still don't understand. [Music] Bret: Brandon, you know, it looks like from the testimony of these corrections officers that corrections stress is a real thing. So, can three types of stressors kind of occur simultaneously? Brandon: Oh, most definitely. You know, a great example would be currently, in Oregon, one of the biggest issues we face is mandatory overtime. So, you know, you're working a shift, you have plans after work. You know, you're gonna pick up your kids, promised you are gonna take them out for ice cream. But, here it is, you know. We have a lot of vacancies, mandatory overtime. Next thing you know, you're mandated to work. Not only are you mandated to work, but you're working for that lieutenant or captain you don't see eye to eye with. It's not the best leader, not the ideal person you want to work for. Now you know, you know, you add that home stress. Now, I have to figure out who is going to pick up my kids, how am I going to explain to the children we'll get ice cream next time. You know, then next thing you know there's a call, suicide in progress. You're the first responder. You're there. So, you have all this going on in your head already. Now, you have to put that game face on and do the best for that person in distress and do the right thing. All that just compounds and adds up. Bret: All right. Those are great examples. So, in the workfile that Maureen kind of showed us before, there's two terms. It was job stress and burnout. How do those affect individuals? Brandon: Well, you know, burnout is that exposure over and over. You know, every day that stress tends to mount and continues to build. And, oftentimes, we don't seek help. We don't intervene. We don't do anything about it. We just continue to let it build and think that, hey, that's just corrections. That's what I signed up for. This is what I do. And, you know, it leads to your work's not meaningful anymore. You know, you let yourself go physically. You start to noticethat people put on a little weight, they look tired, a little more gray in the hair, they're not as personable. You know, start to detach from your peers. You have that emotional exhaustion. So, you start to change. What we do is accredit hey, -that's what corrections will do to you. You must have been in the field for ten years now. Bret: That's a tough thing to endure, but good examples. Thank you. So, one of the things we're going to do now is take a minibreak and go to an interlude that helps us understand how to deal with stress from more of a humorous format. So we have a series of vignettes that we titled, "You Might Work in Corrections." So, let's take a look at them. [Music] Bret: Yeah, you know, we're laughing here on the set and we hope that you are too because humor can work. So now, in this part of the discussion, we're going to look at corrections stress from both a research lens and then a practical lens. So, Caterina, you are going to tell us more about what the research says regarding corrections stress. And then, Brandon, we want you to tell us more about the symptoms that kind of play out from the corrections' stress from a corrections setting. so, Caterina, in your research, you analyze corrections fatigue. So, what is corrections fatigue? Caterina: Well, thanks, Bret. This is a term I coined. I looked at the effects of burnout and looked at the effects of trauma, traumatic exposure, and I realized that through my treating corrections personnel and training them for several years, that we determined to capture the effects of both trauma and burnout as a umbrella term, a global term simply because those effects happen simultaneously sometimes in close succession. And those events happen and it's really hard to separate the effects. You cannot really say, "Oh, this is because of traumatic exposure and this reaction is because of on organizational stressors or the operational stressors. They're really impossible to separate. So we needed a term that captures the whole ball of wax, the whole outcome. So that's corrections fatigue and one brief analogy that can be used is mental fatigue that materials engineers talk about even with very strong steel, if you have it repeatedly stressed, like trucks driving over a bridge, the metal weakens over time. The effects accumulate. So , corrections fatigue is really about additive effects, cumulative effects over time of those operational, stressors, organizational stressors and traumatic stressors interacting and co-occurring sometimes. And so, it's a term that has to do with outcomes over those stressors, and I can see it as success on the continuum and the term is supported by research and it is based on treating and training. And we see on the graphic here that the way to conceptualize it is it may that occur from mild signs or no signs, all the way to very severe signs. And for one person throughout their career, they could be at different places on that continuum, and so it's not a clinical term, I would like to point that out, it's just descriptive of the global cumalitive outcome of all -those stressors impinging on the individual. Bret: All right. Very good explanation. Thank you. So, Brandon, how might corrections fatigue play out in a corrections setting? Brandon: Well, the way I kind of look at it, is, you know, day one, new employee orientation. You know, you start off the whole group. They're excited. You know, I just got a great job working for the county or the state, or the federal government. You know, I've got a good paycheck. I 've got benefits. I'm going to have sick leave and vacation and gonna be able to provide for my family and do those things a good career does. You know, you start off happy. The next thing, you know, you're in a year to it, you make it off trial service, you're excited that, "Hey, I'm moving on." You start to get more involved in the field, you get put on specialty teams, you bid to work the most difficult assignments, you know, might be working special housing, you're exposed to some more of the stressors, respond to a few traumatic events and, you know, you start to show intermediate signs where you start to withdraw a little bit. You know you're not as happy, starting to let yourself go physically. Then, you know, that continues on and the next thing you know you're 20 years in and even more stressed and more exposure. The next thing you know you're that 20-year employee that, "Ahhh, that's just Jim. He has been in corrections too long. It's time for him to retire. It's time to move on. That's when you are starting to show the more severe signs. Bret: That's a good grounded example. So, Caterina, you know, let's focus more on the corrections fatigue model that you designed, for just a moment. So, based on your research, can this model tell us about the impact of corrections fatigue? Caterina: Yes, in a nutshell, the model you see up on the screen and also in your participant guide. At the top we see the three arrows, the operational stressors, organizational stressors and traumatic stressors like raining down on an individual working in corrections, impinging upon them, affecting them. And over time, their effects add up, the outcomes add up and they start showing negative changes that can also increase over time. We'll discuss those briefly, like changes in the personality, how they tend to behave and act. It can be changes in the health and functioning in negative ways, physical health or psychological health. Or even spiritual health. And it can also be negative changes in the way of how they think, their core values, their beliefs. They start getting tainted and become not very functional -- they become counterproductive and if we have enough individuals in an organization or an office or a facility that exhibit those changes, then the whole culture takes that color, so to speak. It becomes that way, and people tend to behave like that, and it's seen as the norm, and people get to accept it like Brandon said, Oh, this is corrections for you. This is what corrections will do for you. This is the way we are. It's accepted as normal, and okay, when it really is unhealthy and counterproductive or even destructive in some cases. Bret: That's a good example. Sounds like corrections fatigue can cause a lot of changes in an individual. So, Brandon, what have you observed in the ways of corrections fatigue or corrections stress and how the changes have affected people from your environment? Brandon: Well, you know, as we prepared for this broadcast, and I got to thinking, you know, I looked back at the people I started with, you know, and I can remember when we first started and we would see each other around the in the institution, you know, everything was always, "Hey, how is it going?" "Oh, life is great! You know, I'm doing good. Kids are this, kids are that. You know, I'm going fishing tomorrow." Next thing you know, it'sk, "Hey, how is it going?" "It's all right. I'm doing okay." Before you know it, no response, just a wave, a nod, you know, no more talk about how the kids are doing. I look back and see those people that I've seen withdraw and start to let themselves go physically or get a little bit more snappy, you know, when you have a conversation or, you know, they snap back at somebody. You know, be it an inmate or co-worker. So, you can see it. You know, you see people change. And, you nkow, like I've said before, I've always chalked it up to, that's just corrections, or he must have had a bad day. Must not be working somewhere he likes today. But, in reality, it's just that change, that correctional fatigue wearing on you over the years. Bret: Yeah, seems like you get this progressive change over time. So, we're gonna watch a video from corrections professionals and see how they talk about the effects of corrections stress over time on them. [Music] Art: That is what professionals get after years or months or weeks sometimes of dealing with people who have very serious crimes, heinous criminal behavior, or in some cases, just dealing with people who were deathly and dying. Mack: So, in the community setting, the focus is different because the exposure to the trauma is much more about who you're working with. Again, you are working with perhaps very, very violent individuals who may have done really terrible things to a community. So, frankly, one of the risks of that is in order to deal with it, you kind of dull your own senses and your own feelings. Another risk in a community setting, again, is just repeated exposure to victims and what the victim experiences have been. Tremendous risks sometimes of the staff without recognizing the trauma that they're dealing with, falling into a place of hopelessness. Veronica: We had staff members who have gone to homes where there was a shooting. They had experienced domestic violence during their home visits. They had seen people overdose on drugs. So, again, you just can't say, "Oh, well, it's in a day's work." People who get compassion fatigue and suffer vicarious traumatizations aren't your bad people, aren't your people that -- they don't care. These people care. That's the biggest difference. They care. So, yes, you want to keep those people who care. [Music] Bret: So, Caterina, they show real effect, here. So, your research describes nine dimensions of corrections fatigue. Highlight a couple of those and tell us what the research says. Caterina: Yes, we have nine dimensions and they're described in the participant guide, what each one them are, and all the way from behavioral functioning to staff supportiveness, and I'll just pick a couple. They're all important and very relevant. None of them is more important than another. And so, we have, let's say, morale, which a lot of people talk about morale and I remember somebody saying to me, "Oh, well. It's nonexistent in our facility." That's a pretty negative appraisal. And let's say morale is about optimism about the future, it's about satisfaction with life, it's about pride in one's work, about positive mood. And then, correctional fatigue sets in and keeps progressing, picking up speed downhill, people don't take pride in their work anymore. They feel very dissatisfied with their lives. They lose their optimism and hope about the future. Their mood is down. Another one is outlook or disposition and that has to do with a person's, like we have negative thinking in the case of corrections fatigue. We have different degrees of people feeling emotional disconnected from loved ones, having difficulty feeling or expressing compassion, having difficulty with distressing memories. They're bothered by distressing memories of events, what happened at work. They feel compelled to take a mental health day. They just try to block out thoughts of work while they're away from work and there's a general sense of stress and negative world view, like all other people are all bad. Bret: Good example. So, Brandon, considering that list of the nine dimensions, how do you know when these things are occurring in your workplace? And then what do you do about them? Brandon: Well, you know, I think the three that really stand out to me are morale, outlook disposition and staff reliability. I mean, I think you notice that by just paying attention to the workforce and going out there and having conversations. You know, instead of making excuses for how we're acting, we need to find solutions. We have to find interventions, and not just wait for the traumatic stressors to kick in. But, pay attention to the orginizational and operational stressors, as well, and start making a difference. So, I think the main thing is getting out and communicating and having a feel of the institution or the field when you're out there and getting to know your employees and talking with them. Bret: Caterina, you want to add? Caterina: The one thing I wanted to add is that there's a snowball effect with those issues. As they build up, you can imagine if somebody has struggles with low morale or very negative outlook and disposition. They create sometimes problems for themselves and they may have a run-in with a supervisor, they get written up for an incident, they get a bad evaluation or hurt. And that compounds their stress and adds to it and also people around them, working around them. If someone has an issue with low morale it becomes contagious and affects the folks around them, the co-workers. So the effects, outcomes of course, fatigue, can then become causes, sources of more fatigue and it keeps snowballing. Like when people call the vicious cycle. It keeps adding up. That's why we need to intervene and stop, prevent, counter as early as we can before things build up and permeate the whole workplace culture. And affect everybody. Bret: I think snowball is a good word. So, Brandon, on the screen we have this graphic of two buckets. One is being filled up by a spigot that is just rushing out water and filling up quickly, and then the other one is more about indirect trauma and its effects and how it slowly drips. Ultimately it fills up the bucket, as well. When you see these, how do the effects of indirect trauma impact correctional environments and also what can we do about these? Brandon: I think, as you look at those two graphics, we do very well at the direct impacts. You know, we activate our employee assistance programs and our interventions that everybody responded to a suicide. So, we make sure we get them help, we get them those three counseling sessions that are free, let them talk to peer support. Then next week, we expect them to go back to their job and do it again and we'll intervene again on those traumatic events. It's the indirect we're not doing well at. We're ignoring that. We're just letting that be part of the job. So, I think what we need to do is have ongoing programs and interventions, not just wait for an event to occur, but have that ongoing presence, that ongoing process or intervention as agencies, that understand this is going to happen. No matter how well we think we are, things are going to happen and it's going to beat you down. So, we need to get involved now and be involved from day one and not wait until all the signs are there. Bret: Thank you, Brandon. So, Caterina, why don't we pay attention to the effects of indirect trauma? Caterina: Well, that's a very good question, Bret. I think there has been a -- across the board not just in corrections a lack of understanding of the cumulative effects of indirect exposure like the graphic showed, even if the faucet's barely dripping, if it drips long enough, it will fill up a cup, bucket or whole lake. So what happens in corrections is, first of all, there is so much indirect exposure, and so people -- it becomes a way of life and becomes the norm. People accept it. It's like, "Oh, yeah, I'm gonna see the pictures, hear the stories, read those files." Also, it is a machismo culture. People don't want to go to their supervisor and say, "You know what? I'm really haunted by this, reading this story. I keep having nightmares about this kid" or whatever it might be that is bothering them. And they may reason with themselves, I wasn't there, it didn't happen to me, so it shouldn't bother me. So, when it does bother them, it's like what is wrong with me, but they keep it to themselves because there may be a sense of shame, like, am I weak? What's the matter with me? Then, there is this deluge, of course, of paperwork and all the operational stressors, Maureen was talking about. People have to keep up with paperwork, and other assignments they don't have time to stop and process and think and digest what they were just exposed to. So it keeps adding up and compounding and compounding over time. Bret: Great examples. This is another opportunity for us to take a little short minibreak and, again, watch the vignettes called "You Might Work in Corrections If..." [Music] Bret: Hopefully, some of you can identify with some of those But, so, Caterina, you know, we talk a lot about these repeated exposure effects. What might some of those look like and how do they affect people? Caterina: Well, I mean they can build up the generic stress response. I mean, tension, anxiety, some irritability, negativity, and as they continue to accumulate and if they are severe enough, and maybe one severe incident or it could many little ones people may start developing more diagnosable disorders, even like generalized anxiety, panic disorder, depressive disorder, or traumatic stress disorder due to their exposure to trauma. Bret: So one extreme end of PTSD, what do we need to know about that, Caterina? I'm sorry what do we need to know abaout that? Caterina: Well, it's a serious condition that needs to be addressed. It cannot be swept under the rug and our research shows that a substantial number of corrections professionals do have enough symptoms to meet diagnosable conditions such as PTSD, and we have a number of clusters of symptoms that occur and they are identified as intrusive memories, meaning people are bothered and distressed when they have unwanted, unwelcome, involuntary memories pop up in their mind maybe while they're driving, while they're sleeping of an incident or incidents, avoidance behaviors like people want to avoid that distress. They want to block out those memories. So, they may avoid triggers like external triggers. They may not drive down a certain route or they may not want to go to work, even putting the uniform on might become a trigger They may try to block their own thinking. So they might as a result drink themselves into a stupor every night so they don't have nightmares. Another cluster of symptoms is a negative world view and a negative mood. So, folks may have very negative views of others and blame others or themselves about how something happened, how it was handled or not handled, may be down, there may be this general withdrawal socially. And then we have the increased physiological in the body arousal and reactivity. And, that's very pronounced. In our research, we found of the four clutsters, this fourth one is the most pronounced one, where people are prone to anger outburst, they're very irritable, they have difficulty sleeping, they're really having a hard time relaxing, always a guard and as a result, of course, you can imagine relationships are affected and they may act recklessly and overreact to things. Bret: So, Brandon, in terms of PTSD symptoms, what have you seen? Brandon: Well, I think, you know, over time, as I said, preparing for this, is looking back at some subordinates, friends, co-workers and looking at how they were when they first started, or if we go to executive meetings and sit in a room and start analyzing the people in that room, of "I remember when, when that person was fit," or "that person was very jovial, or loved to talk and now, they're sitting in the corner, they don't get involved much. I have seen it, over time, you start to change and unfortunately, oftentimes we ignore it. We just let it be, you know. Don't want to really recognize that it happens. And, you know, an event that happened this past year, as we were preparing for this, that I really reflect on how sometimes we deal with it in corrections is a co-worker that was under a lot of stress on the job, at home, drank a lot, everybody knew it, you know. Couple people tried to intervene, but continued to drink. Next thing you know, he drank himself to death,you know, and he died. We all go to the funeral, but what do we talk about? At the end of the funeral we're all going to meet up at the local bar and have a last few drinks in his memory. So, that's what we do. That's the support we give and that's not the correct support. We need to find other ways to intervene and provide the support that's going to help us get better. Bret: Okay, yeah. So, it sounds like some of the common stress symptoms are not just emotional outbursts. These folks are affected in real ways. So, Caterina, what happens to the brain when we experience a threat? Caterina: Well, the brain is wired to protect our lives, to preserve our lives. So, it mobilizes when it perceives a threat. Big or small, it mobilizes to counter the threat and keep us alive. So, all kinds of chemicals are released in the brain to mobilize the whole body and our thinking process, and multiple areas are involved, obviously, and I'll just focus on three that do get affected also by posttraumatic stress disorder and has been shown by research in the field. So, three of them are, I'll start with the right one, the Amygdala, which is like a sentry that watches for dangers, scans for the danger night and day and that's its job to send out an alarm when it perceives a threat. Another one is the Hippocampus. Its job is to sort and categorize incoming information so it can know what is is what and the context. And the third one is the green part. The Hippocampus is the blue. The third one is the green part, the Prefrontal Cortex, Ventromedial Prefrontal Cortex. Big word and that part is our logical thinking, strategizing brain that wants to take in a lot of information and assess and check things out. Well, what happens with repeated exposures to traumatic situations, the shortcircuiting happens. The brain goes into a megaself-preservation mode. So, it starts jumping the gun. It draws conclusions on very few data, like a profiling system in our head and it really quickly decides what may be a threat and react to it, and the problem with that can be is that it draws the wrong conclusion without checking the context, additional details and thinking it through. So, a person may find themselves overreacting to a situation that was benign and not really a threat and that can get them in trouble. Now, if, of course, it is a threat, it can save their life. But, if it isn't, due to that short-cutting procedure, they are overreacting to a bunch of things. That's part of the tension and inability to relax. Bret: So, Brandon, have you seen some of these sort of threat reactions play out in your work setting? Brandon: Oh, definitely. I mean, I think it really happens. You know, unfortunately, as administrators, this is where we need to educate ourselves and we need to get a clear understanding of what's going on. Because, for the most part, a lot of us grew up in the field, went through the ranks, you know, started as a probation officer or correctional officer and worked our way up into administration and never really got the understanding of what's happening to us because it was that taboo subject. We didn't talk about it. We just said that's part of being in corrections. So, I think as administrators, we need to recognize it first and get a clear understanding. And quite frankly, until I got involved in this and a wellness project in my agency, I didn't fully understand it. That was just me. That was part of the job I did. I think we need to recognize it and put a name to it but also develop programs and interventions to deal with it. Bret: All right. Those are good examples. So, how might a corrections organization struggle following up with exposure to trauma for folks? What are some other ways? Brandon: Well, you know, I think they struggle because we don't have anything in place. You know, oftentimes, our reaction is, "Suck it up." "Been there, done that." "You know, you'll do it better next time. That's just part of the job." So, I think we're not really using the tools or things out there that can help us to prevent. The professional intervention. There are a lot of resources to help us and we're not really identifying those. Too oftentimes, we're just chalking it up to the job. Bret: So, we talked a lot about sick leave being one of those issues. So, Caterina, what does the data tell us about sick leave for individuals who are experiencing corrections stress? Caterina: In one of our studies, we asked people to indicate how many days they took off the last year and we also were measuring how many met criteria for PTSD with an assessment and also moderate to extreme depression, who fell in that category and we found, we broke that down into four categories. One was, okay, sick leave days reported per year. If people had not met criteria for PTSD and were not in the depression category, depression positive, they said, "Hey, we took eight days this past year." People who only met criteria for PTSD took 11 days. Three more. People who only met criteria for depression, one more. Four days more. Twelve days total they said they took. And people who met criteria for PTSD and also in the moderate to extreme depression category, they reported a whopper of 17 days. I mean, we were stunned by that. Seventeen days. Nine more days than the people who had neither condition and that was a big, big red flag for us that how functioning is affected by these conditions and how, yes, you can discipline somebody or they get in trouble for sick leave abuse, but the root of the issue is not addressed, and they're not getting the help they need to make true changes, and really getting in better shape to be showing up at work. So, again, that points to the fact that we need to understand, as Brandon said, what is happening here, not just look at the final results, but trying to trace it back to the cause and address the cause. And, hopefully, that will bring real changes that are sustainable. Bret: So, so far, you guys have given great examples. But we're hearing this variety of effects of corrections stress. So, from a bad attitude, all the way to an alarming number of days that people are missing and taking off. So, the elephant in the room seems to be this risk of suicide. So, Caterina, what does the data say about the increased risk of suicide. Caterina: You know, there are mortality data, actual death data in three studies in corrections for corrections officers only. They don't study other professionals working in corrections. But, those studies consistently show that the corrections folks, corrections officers had an increased risk and of course, rate of suicide. So, it is a real, real issue that needs to be addressed. I believe it's probably outcome. We have hopelessness due to severe depression, substance abuse, maybe to try to cope, posttraumatic issues and all these converge and a person reaches a breaking point that they feel hopeless, that there's nothing they can do about their life anymore, there won't be any change, and, as a clinician, I'm very aware of the fact that in any audience that are people who are struggling with emotional pain and practical difficulties in their lives. So if you're out there and you are hurting and you think there's no hope and you think you should exit, I plead with you, I beg you to not take that choice, but to get yourself some help, even starting right this minute, calling the National Suicide ifeline: 800-273-8255, and we'll give you that resource again later. 800-273-8255. Make a call and talk to somebody. Make a call with your family physician. Make a call to the medical provider. Talk to a peer supporter. There are solutions. There are options we want you well and we want you here. Bret: Amen. So, we talked about a lot of negative effects. So, are there positive effects, Caterina? Caterina: Yeah, the good news is that sometimes pain leads to gain, and we grow, and it's a matter of choice in some ways and attitude that how we choose to look at things and next segment we'll disus attitude and choice quite a bit. But, if people can really grow from posttraumatic experiences that broke their hearts, even if they also have posttraumatic symptoms at the same time, they grow in the sense of maybe greater appreciation of relationships and social support, deeper spirituality, deeper capacity for compassion for their fellow human beings or any living creature, gratitude for being alive, appreciation of every day. So their heart kind of, like breaks, but then can grow bigger and larger. Bret: So, Brandon, you know, we talked somewhat about resiliency and in your initiative in Oregon, you do a lot of work with that. So give us some -- just real brief some examples. Brandon: You know this morning, we spent a lot of time talking about stressors, but at the end of the day we're a resilient workforce. We come to work every day and do our job and do it well. And there are a lot of positives in corrections, as well. So, we need to focus on that and that's what Oregon has recognized. We're taking on an initiative of staff wellness. That rather than just talking about it or making it something we say we care about, it's actually something we care about. So it's maybe one of our top initiatives. We're going to focus on where we're seeing at now, not for health benefits, but where our staff really are. So, our initiative is making it about you, the employee. You can take it in for real. Bret: All right. That's a good approach. So, we talked about resiliency and positive effects and so that's what we're going to expand on in the next section. So, at this point, I would like to offer each of you to give just one brief key message. So, Maureen, what's one thing that you would say? Maureen: I think that stress is part of the profession, but we need to have a willingness to recognize and address the topic. We need to do it through training, through policy and practices and through informal and formal support to staff. Bret: Good examples. Brandon, how about you? Brandon: Just that we need to remember it's not the big events. It's not those big traumatic events. It's all the little stuff. It's the day-to-day work. It's out in the field doing the interviews, doing the home visits, walking tiers, doing count. We need to recognize that and quit just chalking it up to that's the field. We need to do something about the day-to-day exposures. Bret:All right. Good message and, Caterina, one thing. Caterina: One thing, like Maureen said, the inevitability of the correctional stressors impinging upon staff. It's a moral imperative and also good business practice, in my estimation, given the sick leave example we gave, that it be addressed aggressively. People go after it. And try to provide evidence-based practices and for more research to be done, to provide effective trainings and other resources and interventions to promote resilience, to promote well-being. Ideally, to prevent things before they start, like, start at the training academy with the new hires and new recruits and go on from there on a very regular basis because the wellness and health of the staff will affect and permeate everything that occurs in those agencies.