Crisis Work in Behavioral Health: Building Self Efficacy and Preventing Burnout in Emergency Settings with Dr. Ellen Dotas, Part 1

Sentara is accredited by the Southern States CME Collaborative to provide continuing medical education for physicians.
 
Sentara designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Sentara Continuing Medical Education adheres to ACCME Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of an accredited activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

To Claim Credit for listening to this episode:

1. Click here and enter 18624 as the Activity ID (number).
2. Then go to the MY CME tab and complete the evaluation.
3. Credit hours will be reflected on your transcript, or you may download your certificate.

For more information, click here.

Transcript

Tommy 0:00
Hello and welcome to Mind and Medicine, a Sentara podcast. I'm Tommy Bateman, your host, and today we have Dr. Ellen Dotas here to talk to us today about behavior health crisis work, burnout, and everything that comes with it. But before we begin, some important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes and now the show.
Tommy 0:30
Dr. Dotas, how are you today?
Dr. Dotas 0:32
I'm good. How are you?
Tommy 0:34
I am wonderful, thank you. And I am so excited about this topic. But before we get going,  why don't you tell us a little bit about yourself and how you got here?
Dr. Dotas 0:44
Well, let's see. I kind of like circled around a little bit for it. I  I started out in education. I was I was actually a music teacher for like eight years and then decided now I really want to do something different. And I was really interested in psychology. , so when the opportunity presented itself, I went back and did a bunch of psychology credits and got into grad school for that. And I got a master's in counseling psychology at McGill University up in Montreal. And then after graduation, I moved down here to Virginia and kind of and started working in emergency services and one of the community services boards, got licensed. , and then now I've been at Sentara for like 19 years. And a few years ago, with COVID and all of the hybrid programs that were cropping up, they changed one of their PhD programs to a hybrid model. So I was able to go back and get my doctorate in counseling and super counseling and supervision. And I  just finished that a year ago.
Tommy 1:44
Excellent. And yeah, there seems to be quite a common pathway, and I sure did it going from  grad school straight to the CSB world. And  I figure given your experience, I kind of know where you're going with this, but where how did you get into  burnout? What got you interested in that topic to begin with?
Dr. Dotas 2:01
Yeah, I mean, I think  it's always been kind of interesting to me since I've worked in this field that the job that you were able to get right out of grad school with a master's and no experience, it was always like emergency services or something like that. And that  I just thought, here's the job that is the you know, the most kind of nerve-wracking at times for people that here you're seeing the people that are really having their worst day ever. And that's the one that you're putting the new person in. And so I just thought it was kind of interesting because some people just love it, other people don't. , but I really love the kind of work. And I always was, you know, kind of frustrated that sometimes there was such a turnover that people would do this, then they would get licensed, and then they'd go off to do private practice. And that's just like, and there is less stress. A lot of times that was, I think, what was behind it. But , just looking at now that I'm in an administrative role here, also, what can we do to just support the people that you know that do this work and just try to avoid burnout in this job or any others in healthcare because it's such a big thing.
Tommy 3:09
So, yeah, let's talk about that. Grad school does not prepare us for this experience. Sure, we have practicums, we have internships, we have, you know,   some basic experience of how to do some counseling. And , but it nothing prepares you for crisis work like this. So let's talk about this a little bit more.
Dr. Dotas 3:29
Well, and the yeah, the crazy thing, when I was in, when I was in my master's program, there was like a little a summer kind of crisis workshop, and that was an elective. And  that was that was your only opportunity for doing any kind of crisis stuff. And the of course I missed doing that one because my son was born like the same the same week as they were as the as that class was starting. So  I didn't end up doing that, but I was really interested in that kind of work, and so it was kind of like this the job was available when I when I moved down here and I was able to start in that. So they luckily they hired me with no experience and just kind of jumped in and did a lot of on-the-job training. But even now,  you know, graduate programs, it's CACREP, the accrediting body has  they've done a lot with making there be some sort of a crisis intervention, I guess, competency that you need to have is some crisis training. But there's still very it's better than you know than it used to be because it used to never be required, but now it is. But it doesn't really tell the schools you this is what you have to do. You have to take this specific course. It's kind of left to the schools to decide how they want to meet that  that mandate. So  I think it's  it's improving, but I still think you don't get a lot of the  the training that you need. You get a lot of theoretical training, but not the kind of the hands-on stuff as much.
Tommy 5:01
Absolutely. And I guess I could say it feels validating to hear that that feeling of unpreparedness is pretty universal.
Dr. Dotas 5:09
Yeah. And I mean, and I think a lot of programs, well, like at the community services board that that I got my first job at, they would they did an awful lot of training. And you did a lot of training and shadowing, and you had to become certified to be a pre-screener. , so they kind of made up for that gap by, you know, everything that they could do to try to train their employees to do to do this work. , but then I think about the people that don't go into like an emergency services role or any kind of crisis work. Let's just say you get a job in a practice and you're going to be a counseling resident and doing outpatient counseling, you still need to be able to do that kind of a risk assessment to for any of your clients. Because I would say every counselor out there, counselor, social worker, there any therapist, whatever your area is, you're going to see people that are in crisis at some point. And you need to know how to ask, you know, ask the right questions so that you can either you know work through that problem with them, or if they need to be moved to like a higher level of care, how you can work on getting that referral in for them and convincing them to  to help get that help.
Tommy 6:22
Yes, I was very thankful to have that sort of experience early on to you know how to protect myself legally, clinically, and ethically pretty early on in my career.
Dr. Dotas 6:33
Yeah, I mean that's it. It's like  when we get a new a new therapist or you know, new person on our team, it's always, or you know, or even when we've had interns in the past, it's always been the gathering the information is that's the easy part. You know, it's just kind of like everybody learns how to do that in grad school. You learn how to do an intake with a new client, you know. So you're gathering all of the information about them and about why they're here. , and then the hardest part, it's I guess it's just like an airplane. It's like landing a plane. That's the hard part. Being in the air is maybe okay, but it's just when you're headed toward the ground, you need to know what to do. So that's the thing for our assessments is that if you're working with somebody that's in crisis, finding out what you know, what's what are they thinking, how long, what's the cause behind it, where did this come from? Just asking all of those core those questions that come up, and then deciding now I'm to the point where what's my safety plan or how safe are they and what do I do next? And that that is the part that I think takes that extra level of training so that you know what, you know, you want to the main thing is safety. I mean, anything we do, it's safety is always the main point. And I think that's the same thing. If even if I was working in a private practice, I need to know is this something I can process with my client and we can work through it and  make plans for when we're going to meet again, or do I immediately, you know, try to get them out to the hospital? Because sometimes if somebody just brings up, well, I've had some bad thoughts and they the therapist is immediately on the phone calling 911, they're not going to want to talk about that again, you know, because they're like, wait a minute, I just needed to talk to you, and you immediately sent me out to the hospital. You know, it's  I think we need to all learn where, you know, what do we do with that information we've gathered.
Tommy 8:21
And in all that, you mentioned so many skills that a clinician has to build up over time. And  what you  just reminded me of, the concept you sent to me beforehand,  self-efficacy.  tell me more about that.
Dr. Dotas 8:34
So, like self-efficacy is kind of the that belief that you that we all have inside ourselves that I whatever your job is, I believe I can do my job well. I have that confidence in what I'm doing, and I just that that okay, I you know, maybe, maybe not a hundred percent of the time, but you know, I can I know what I'm doing here, you know, I understand my job. And the and the time that we run into problems there, it's like, and then it ties into burnout, is just if you're, you know, if you don't feel like you know what you're doing, like somebody cut gets a job and they're like, I don't know what's going on. I don't feel confident in the decisions I'm making. I don't feel confident in the skills I have. I mean, that's going to lead to burnout because eventually you're just going to be so like kind of demoralized, , your empathy is going to go down, you're physically and emotionally tired. It just gets harder and harder to do your job. , there's some other studies too that show that if somebody is doing their doing their job, but they're just getting so burnt out at it, you know, that they're just, I'm just this is just too much, then their self-efficacy starts to go down after a while too. That, you know, so it's kind of which came first, the chicken or the egg. But, you know, I think they're both really closely connected.
Tommy 9:48
So while there's a chicken and the egg situation here, my follow-up to that is, you know, let's just say an individual that has feelings of low self-efficacy is doing the job just fine objectively, but they still have those feelings. , you know, despite how well they do at their job, does this mean they are more likely to experience burnout?
Dr. Dotas 10:10
I mean, I would say, I would say, yeah, you're at a heightened level of risk for that because even if, you know, on the surface, I, oh wow, Tommy's doing a great job. He does everything, and inside you're not feeling that, well, you know, then it's like, well, then how do we, how do we address that with, you know, with your staff, if you're with your coworkers, with your supervisees, whoever, you know, how do you address that with the people that you're working with that, , you know, do you feel like you're doing a good job? Maybe that's the thing, because it's like, doesn't matter what I think, I could say, yeah, I think you're doing a great job. And if you don't believe it, that's you know, that's going to just let you kind of go on, continue along, feeling not like you're like you're burnt out or like you're not in the right place. I mean, I know some people talk about kind of imposter syndrome that I'm I shouldn't be here. I don't, why did they hire me? I'm not doing, you know, and it just sort of builds, it messes with your head. So I think being able to find a way to check in and get that support and that, you know, I don't know, support, that connection, whether it's through supervision or just kind of peer support. I know a lot of times with new clinicians, you want to be talking with them either if you're doing supervision for licensure or maybe as a group, kind of I know the place where I was at, we used to have like a group of everybody that was not that was new and not licensed, and they would talk, you know, talk to us about our cases and what we're doing, and just to try to help build that confidence that, okay, I'm doing this, everybody else would have done the same thing. Okay, we're on the same page with this, or this worked out well, and this is how I know that it worked well. And, you know, you're just building that kind of skill set so that they can  hopefully start to build their professional identity and their confidence level.
Tommy 11:54
So what I'm hearing there is that self-efficacy is not necessarily built internally on its own. It can't be built in a vacuum. You need, you need others, right?
Dr. Dotas 12:05
Yeah, I would agree with that because I mean, , you know, there's we can all have like kind of our internal motivation for doing things and you can feel good about it. But I feel like especially something like this, those that external feedback that you get, whether you're doing things right, whether  whether other people are supporting you, and just knowing sometimes knowing that you have that support, there's such a great push for  just having like either an a peer, a supervisor, a mentor, you know, mentorship,  when you're just through shadowing, through doing chart reviews, through discussion. I mean, there's so many ways you can get this, but having that support and that feedback to you, especially when you're a new clinician, I think is really important because that just kind of lets you know that you're I'm on the right track.  I'll build that experience as I get as I continue on. But , yeah, okay, I'm getting it. And I think that that's important.
Tommy 13:05
Yeah, and that's absolutely insane. That CSB work was, that crazy fire drill that it was, it really did, you know, prepare me, harden me, I guess, for you know, the zaniness of I don't know, MCO work or any other type of  work afterwards.
Dr. Dotas 13:25
Yeah, but and you make a good point there too, is that you learn that, you know, you talk about resilience and coping and then to avoid while you're building your self-efficacy up and your confidence and doing your having the ability to do your job, hopefully that's helping you avoid burnout because there is that kind of a you know negative correlation that you know if you're feeling good about your job, you're not going to be, you're not as likely to be developing burnout. But  you also learn those resilience skills, whether it's kind of that, you know, you get used to the, I think you said get used to the zaniness. Sometimes it's like, yeah, anything can happen day. Every day is anything can happen day because you know, you walk in and you don't know if it's going to be, you know, just a easy, easy, smooth day, or if it's going to be one of those days where everything is, you know, falling from the sky. So you have all these different things, but you learn that resilience of how do I cope with it? How do I cope with it? And both CSBs and emergency departments, they're kind of notorious for a little bit of a dark sense of humor at times, but sometimes it's not that it's a lack of empathy. It's just that sometimes behind the closed doors, you just have to figure out a way to make sense out of it and be able to just roll with it. And I think that's what's an important skill.
Tommy 14:42
And you got me thinking as I sit here alone in the middle of a field in a cottage, you know, how do you build self-efficacy doing this site type of  remote work?  you know, I I'm I could feel so disconnected from my team sometimes, especially since we're all so busy right now. So what do you recommend in that kind of situation, especially for new folks jumping into remote work?
Dr. Dotas 15:06
That's a I mean, that's a really good question because I think with kind of the advent of all of the telehealth that we've seen over, gosh, I think since COVID hit, all of a sudden telehealth has just like exploded. , and we have a lot of people that work remotely. We're trying to right now trying to figure out how can we how can we build that that kind of a connection with people? Because if you just if you don't have a connection with somebody, you know, it if they need, let's say , if I know people really well, hey, so-and-so is going out, you know, her whatever, her kid is sick, and so she needs to leave work early that day, oh, of course I'll help. You know, yeah, I want her, you know, you have that connection where you're sometimes more likely to adjust your own plans to help someone else. If it's somebody that you don't know at all, you know, you might just because you're a nice person, but other times you might be like, you know, okay, whatever. , yeah, I'm sorry, I'm busy tomorrow. Somebody else will have to sort it out. , I think that once you build those connections with people, so we're trying to, we try to do that by, you know, different like just staff meetings, by supervision, , you know, and having  virtual things. I know  in our meetings there's been a greater push now that instead of everybody sitting with their cameras off, turn your camera on. That's how we'll get connected. You know, that's how you can see somebody rather than then just this little icon of their initials or their name, you know, or a picture of them.  we try to like look at people so we can build a little bit more of a live, like real-time connection with them. , I think we're talking about other things that we can do to try to bring people together. , our team is, you know, is all around the state. And we're so we're trying to figure out ways that we can have like a gathering once or, you know, maybe a couple times a year just to get people together just to meet their coworkers. And so we're trying to do things that will build, build some rapport there and build just kind of that connection. , we've tried to send out like just kind of newsletters and things that just tell about the people on your team and just try to build more of these connections that way. But it really is hard. I think  on the professional side of it, like who do you go to if you're sitting at home and you've just had a really difficult evaluation with somebody? , you know, we're having  like some leadership on  on every shift so that there is that there is a leader that you can go to if you need. And we also encourage people to just be a support for each other. If you're having a terrible shift and you feel, hey, I need to just, you know, take a break for a little bit, or , you know, can I talk to one of you guys for a little bit? Of course, do it, you know. We want people to be there for each other.
Tommy 17:40
Yeah, it's nothing like you know, going through a battle with your crisis teammates and being able to come back and really debrief with everybody. It's really hard to replace that.
Dr. Dotas 17:55
It was easier. And I think I think about like one  when I was at the CSB, yeah, we had it was like a big kind of a bullpen. Everybody had their desks and you know, and we would be talking to people. And if you knew that somebody was getting like maybe a crisis call about somebody that wasn't in a good place, we could all, you know, go in there and kind of like send them a little note. Do you need me to call, you know, call for a welfare check or something? And we could kind of we were there to kind of support each other. Granted, technology is a wonderful thing. So I've had people be on a call with someone and something is not going well, and suddenly I start getting a text from their cell phone, you know, hey, I'm on a call and this is what's going on. You know, what do I do next? And you know, we've kind of sorted it through. So they're on the phone with somebody and I'm texting back and forth with them. So  kind of where there's a will, there's a way. We can get them the support.
Tommy 18:49
All right, and I think that's a good place to stop. And when we come back in part two, I'd like to talk more about what burnout is, what it looks like, and how it affects those that work in our field. Thank you, Alan. You've been listening to Mind and Medicine, a Sentara podcast. As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode. That's it for now, but keep an eye out for another episode and more evidence based education for healthcare providers on the go. Be well.