MA by course work and research report, Community-Counselling Psychology, Faculty of Humanities, University of the Witwatersrand, 2010

Indiana University-Purdue University Indianapolis (IUPUI) / Burnout is the emotional, mental, and physical strain associated with prolonged work stress (Maslach, Jackson, & Leiter, 1986). Although this is a problem in many professions, mental health providers are at a heightened risk of burnout (Salyers et al., 2015). One of the reasons for this increase in burnout may be the demands put on mental health workers to manage their own emotions while dealing with the intense emotional and mental health situations of their clients. Emotional labor, or the management of emotions at work, is conceptualized as two different emotion regulation strategies: surface acting and deep acting (Grandey, 2000). Surface acting, or faking emotions, has been associated with significant mental health and job-related problems, including burnout in populations such as call center employees and service workers. The psychological impact of deep acting, or internally attempting to change your emotions, is less clear, and may actually be associated with positive outcomes (Hülsheger & Schewe, 2011). However, little work has looked at the impact of emotional labor on mental health providers. The current study aims to examine how surface acting and deep acting are related to burnout over time in mental health providers. The proposed study is secondary analysis from a Patient Centered Outcomes Research Institute (PCORI) funded trial “The impact of burnout on patient-centered care: A comparative effectiveness trial in mental health (Salyers et al., 2018). 193 Clinicians reported burnout symptoms and frequency of employing emotional labor strategies at baseline, with 127 clinicians completing all four time-points: baseline, 3 months, 6 months, and 12 months. Data were analyzed using multiple regression analyses and cross-lagged panels to examine the impact of surface acting and deep acting on burnout over the course of 12 months. Surface acting was significantly associated with all three dimensions of burnout (emotional exhaustion, depersonalization and reduced personal accomplishment) cross-sectionally. Using cross-lagged panel models, depersonalization at baseline significantly predicted surface acting three and six months later. Surface acting and personal accomplishment had a bidirectional relationship: increased surface acting at baseline was associated with personal accomplishment at three months and decreased personal accomplishment at baseline and was associated with increased surface acting at three and six months. Deep acting moderated the relationship between surface acting and personal accomplishment at baseline, but not longitudinally. The current study is the first study that has examined the relationship between surface acting and burnout in community mental health professionals. While surface acting may not result in burnout three months later for dimensions other than personal accomplishment, two dimensions of burnout (depersonalization and decreased personal accomplishment) were associated with higher levels of surface acting three and six months later. This suggests that surface acting may have consequences for feelings of accomplishment at work, but more so, may be used a coping mechanism in reaction to some aspects of burnout.

<p>Burnout is the emotional, mental, and physical strain associated with prolonged work stress (Maslach, Jackson, & Leiter, 1986). Although this is a problem in many professions, mental health providers are at a heightened risk of burnout (Salyers et al., 2015). One of the reasons for this increase in burnout may be the demands put on mental health workers to manage their own emotions while dealing with the intense emotional and mental health situations of their clients. Emotional labor, or the management of emotions at work, is conceptualized as two different emotion regulation strategies: surface acting and deep acting(Grandey, 2000). Surface acting, or faking emotions, has been associated with significant mental health and job-related problems, including burnout in populations such as call center employees and service workers. The psychological impact of deep acting, or internally attempting to change your emotions, is less clear, and may actually be associated with positive outcomes (Hülsheger & Schewe, 2011). However, little work has looked at the impact of emotional labor on mental health providers. The current study aims to examine how surface acting and deep acting are related to burnout over time in mental health providers. The proposed study is secondary analysis from a Patient Centered Outcomes Research Institute (PCORI) funded trial “The impact of burnout on patient-centered care: A comparative effectiveness trial in mental health (Salyers et al., 2018). 193 Clinicians reported burnout symptoms and frequency of employing emotional labor strategies at baseline, with 127 clinicians completing all four time-points: baseline, 3 months, 6 months, and 12 months. Data were analyzed using multiple regression analyses and cross-lagged panels to examine the impact of surface acting and deep acting on burnout over the course of 12 months. Surface acting was significantly associated with all three dimensions of burnout (emotional exhaustion, depersonalization and reduced personal accomplishment) cross-sectionally. Using cross-lagged panel models, depersonalization at baseline significantly predicted surface acting three and six months later. Surface acting and personal accomplishment had a bidirectional relationship: increased surface acting at baseline was associated with personal accomplishment at three months and decreased personal accomplishment at baseline and was associated with increased surface acting at three and six months. Deep acting moderated the relationship between surface acting and personal accomplishment at baseline, but not longitudinally. The current study is the first study that has examined the relationship between surface acting and burnout in community mental health professionals. While surface acting may not result in burnout three months later for dimensions other than personal accomplishment, two dimensions of burnout (depersonalization and decreased personal accomplishment) were associated with higher levels of surface acting three and six months later. This suggests that surface acting may have consequences for feelings of accomplishment at work, but more so, may be used a coping mechanism in reaction to some aspects of burnout. </p>

Substance use disorders among the baby boomer generation are steadily increasing, but knowledge and training satisfaction regarding older adult substance use disorders among behavioral health providers (BHPs) has not been explored. Using the Kirkpatrick evaluation model, this quantitative study involved an examination of the knowledge and training satisfaction of four behavioral provider groups: addiction counselors, licensed professional counselors, marriage and family therapists/social workers, and psychologists. Each participant (N = 154) completed a demographic questionnaire, satisfaction questionnaire, and the Alcohol and Older Adult Questionnaire to measure knowledge level on older adult substance use disorders. The results showed that licensed professional counselors held significantly higher levels of knowledge than any other BHP group. There were no significant differences between BHPs regarding satisfaction with training on older adult substance use disorders. No relationship was found between BHP satisfaction and BHP knowledge scores, even when considering the number of years, a BHP was licensed. Therefore, the findings of this study may encourage more training for BHPs aside from licenses professional counselors as well as future research on BHPs treating older adult substance use disorders.

Millions of children are suffering from mental health issues causing impairment in their lives (Center for Mental Health in Schools, n.d -a). Many of these children face barriers which impede the receiving of mental health services (Hodges, Nesman, & Hernandez, 2001). School counselors are in a position to provide mental health assistance. Collaboration is one role of the counselor used to enhance mental health services to children. Therefore, the purpose of this study was to describe the perceptions and experiences of elementary school counselor's collaborative efforts with community mental health providers. A phenomenological research design was used to better understand the essence of the collaborative experience. Ten elementary school counselors participated in two face-to-face, in-depth interviews. Triangulation of various data sources, including participant interviews, field notes, and reflexive journal entries, was conducted. These three data sources and a demographic survey were used for data analysis purposes. Data analysis included the process of code mapping of data. Six themes resulted from the data analysis. School counselor participants identified many types of interactions that occur through collaboration, including the sharing of knowledge, goal setting, conflict management, and the acting on information. They also determined school counselors and community mental health providers must be committed to the process for collaboration to be effective. Participants indentified several benefits to collaboration, including access to additional resources and support, consistency of counseling services, improvement of the student, time, and good business. It was also determined that there were several components to effective collaboration. Effective collaboration involved consistent communication, relationship building, networking, and logistics. Several barriers to collaboration were identified, including systemic, personal and/or environmental barriers. Participants also stated various changes needed for collaboration. These changes included more collaboration, consistency, networking, and communication. Implications of the findings indicate a need for more collaboration between elementary school counselors and community mental health providers. As school counselors, it is an ethical responsibility to advocate for time to collaborate. School counselors also need to allow time to network and build relationships with community mental health providers. These relationships increase the likelihood that collaboration will occur. / Ph. D.

Working in health care professions involves many emotional and interpersonal job stressors. Difficulties in handing such stressors commonly lead to a distinctive combination of emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (RPA), a syndrome known as burnout. Although most helping professionals contend with similar demands, mental health workers are faced with many unique pressures. The problem addressed by the proposed research was burnout of mental health providers. More specifically, the current study sought to identify organizational and individual factors that may lead to less--or more--burnout in providers who report having a majority of clients with long-term mental illness and/or substance use disorders (LTMI). Several hypotheses were tested. It was proposed that each of the organizational and personality characteristics would be significantly associated with all three dimensions of burnout and that the majority of the assessed variables would significantly contribute to the prediction of burnout. Exploratory moderation analyses were also conducted. Participants were recruited from regional community mental health centers, social service agencies, and chemical dependency programs. Participants included direct care staff who reported that the majority of work performed was face-to-face with clients diagnosed with LTMI. Demographic information was assessed in addition to three self-report measures. Results of this investigation demonstrated that, contrary to a priori hypotheses, levels of burnout in social services workers serving mostly LTMI clients were generally low. Most of the occupational and personality variables did not account for as much variance of each burnout dimension as expected. However, the full sets of chosen demographic, organizational, and personality variables significantly predicted each dimension of burnout. Psychological demands were most predictive of EE, job insecurity and agreeableness accounted for a significant portion of variance of DP, and none of the organizational or personality variables uniquely contributed to the prediction of RPA. The lack of significance of the proposed predictors may be attributed to several factors, especially the uniqueness of the current sample, nonrandom selection, and potential socially desirable responding. Additional empirical research including a burnout intervention for larger samples of social services workers who work with LTMI is indicated. Practical implications are discussed.

Background: Providing care to individuals with multifaceted mental health needs can be very demanding and in turn leave mental health professionals at an increased risk for compassion fatigue (CF). Comprised of Burnout (BO), Secondary Traumatic Stress (STS), and a lack of Compassion Satisfaction (CS), CF is the state of exhaustion and dysfunction, emotionally, biologically, and physiologically, due to prolonged exposure to compassion stress. CF can leave healthcare providers at an increased risk for experiencing their own health issues, contributing to tardiness and absenteeism, as well as increasing the risks for such adverse effects as clinical and medication errors, poor treatment planning, and decreased patient satisfaction. Purpose: The purpose of this paper is to identify the risk factors for CF and describe the perceptions of CF among outpatient mental health providers employed in urban community-based mental health outpatient organization. Method and Sampling: A qualitative descriptive study design utilizing two focus groups, each having four participants was conducted to assess outpatient mental health providers’perceptions of CF. Purposeful sampling of current providers in two community-based mental health outpatient organizations was performed to protect the privacy and enhance the comfort of each participant as they discussed elements of CF. Findings: Five themes were identified from the focus group analysis: the participant’s perceived definition of CF, participant perceptions of prevalence of CF in the mental health setting, participant perceptions regarding the triggers, perceived participant causes of CF, and self-care practices. These results reflect data collected in a mental health setting however, the findings are consistent with current research contributed from other specialties. Conclusion: Personal descriptions of the experiences and insights of these providers expand the current CF literature and will contribute to the development of quality improvement projects committed to reducing compassion fatigue among outpatient mental health providers.

With the wars in Iraq and Afghanistan lasting over a decade, hundreds of military mental health providers have deployed to hostile environments and some on multiple occasions. Military mental healthcare providers can experience symptoms of acute and chronic stress resulting from exposures to horrific events while caring for soldiers in a deployed environment. Indeed, in treating these soldiers, clinicians may continue to experience the same traumatic events as their clients. The purpose of this phenomenological study was to understand and describe shared trauma and resilience for military mental health professionals who have deployed. The concept of shared trauma was defined as the experiences providers faced as they attempted to deliver clinical services while simultaneously addressing the same issue within their own lives. The concept of resilience was explored as how stressful situations were interpreted in relation to individuals' overall life experiences. The principle research question for this study examined how military mental health providers described dilemmas faced as they attempted to navigate the personal and professional aspects of shared trauma. This study utilized a purposive sample of 7 military mental health veterans who deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Data were collected through semi-structured interviews and analyzed using Moustakas's 5 steps of heuristic analysis. Key findings indicated participants' interpretations of experiences involved posttraumatic growth, lessons learned, and changes in belief systems. Findings of this study can assist military mental health leaders in developing support and protection programs to assist this overwhelmed population, ensuring service members receive the proper care they are entitled.

Objectives. The transformation of the mental health system toward a recovery-orientation has created a growing demand for training and education to equip providers with recovery competencies. The purpose of this thesis is to develop a recovery competency framework addressing the most salient components of recovery competencies required for providers practicing in in-patient contexts and to construct and test an education program accordingly. Methods. This thesis involved three phases. Phase One used competency development strategies to develop a recovery competency framework. Data collection methods included a literature review and 15 key informant interviews. In Phase Two, based on the recovery competency framework, a recovery education program was constructed and validated. In Phase Three, a pilot study with a pre-test/post-test design was used to examine the effectiveness of the education program. Twenty-six in-patient providers from three hospitals were recruited. Outcome measures included the Recovery Knowledge Inventory, two investigator-developed questionnaires rating participants’ sense of recovery knowledge application and perceived recovery-related dilemmas, and a group evaluation. Results. Two conceptual models were developed in Phase One to address key tensions and enabling processes for in-patient providers. Derived from these two models, a recovery competency framework consisting of eight core competencies was developed. Phase Two was comprised of a two-part education program. Part One was a self-learning program introducing recovery concepts in the in-patient context and the recovery competency framework. Part Two was a group learning program focusing on real-life dilemmas relevant to the in-patient context and applying the Appreciative Inquiry approach to address these dilemmas. In Phase Three, providers who participated in the education program showed improvement in recovery knowledge and sense of recovery knowledge application after the self-learning program. Participant evaluations of the group learning program were positive. The results indicated that in-patient providers may benefit from this education program. Conclusions. This thesis addressed tensions related to recovery and highlighted the important role providers play in promoting recovery through the development and validation of the context-specific competency framework and education program. The broad dissemination of the study results will be an important step in promoting recovery in in-patient settings. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-02-21 10:22:05.808

Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with STI patients and health providers in twenty-four clinics located in four provinces. Indepth qualitative interviews were also conducted with a sub sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with STI's is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage STI patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.