Compassion Resilience Toolkit for Health and Human Services Leaders and Staff

In this toolkit we will explore ways to maintain a compassionate presence in our interactions with clients, their families and our colleagues. The rationale for this work, as described in the introduction, highlights the importance of compassion and resilience within the health care field and points to the many positive outcomes for clients, providers, and organizations as a whole. Our first focus in the toolkit is to ask: What is compassion, what does it look like in action, and what does compassion require of us?

Simply put, Compassion is concern for the wellbeing of others. It includes both the awareness of others’ distress coupled with a desire to alleviate it. At the same time that we desire to alleviate another’s distress, we also are confronted with the reality that we cannot always “fix” another person’s pain or suffering. Throughout this toolkit we will explore our professional role in alleviating client, colleague and other’s distress while maintaining our own well-being. In other words, we will focus on growing our compassion resilience.

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Key Activity

Compassionate Action Steps – Scenarios for Discussion 

Wellness Practice

An Invitation to Accept and Let Go of Resistance

Circle Agenda

Introduction to Staff Circles Agenda
This is a great place to start if your team is not use to receiving training in a circle format. Even if your team is use to circles, there are components of this agenda that would be helpful to include in your first Compassion Resilience circle, such as setting group agreements.  

Staff Circle Agenda, Section One
This document arranges the core content in section one into a 45-60 minute agenda. It is one of many ways to facilitate the content in this section. Please make revisions to fit the needs and time restrictions of your group.  

Core Content Visual to Display in Common Staff Areas

Compassionate Action Steps – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Tips for Moving from Empathy to Engaging the Person in Discerning Best Action

Moving Toward Stigma Free Healthcare

Discussion Guide for Stigma Free Healthcare

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Within this section of the toolkit

Brene Brown Empathy video

Links Specifically for Leadership

Conversations about Compassion – The Compassionate Instinct

In the first section we underscored that compassionate action requires intent and skill. This section of the toolkit provides further definitions that are foundational to all else found throughout the toolkit. We will be introduced to the wellness model we will use in the toolkit and the concept of compassion fatigue. Activities will help us explore our beliefs about self-care and self-compassion.

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Key Activity

Fatigue and Resilience in the Wellness Compass – Reflection

Wellness Practice

STRENGTH and MIND: Want More Energy? Consider Gratitude!
Practicing being grateful, among many other benefits, increases your energy. It turns out that our minds are wired to focus on the negative as a survival strategy. The three good things practice helps rewire your brain to notice the good in your life. You can start now by thinking of three things for which you are grateful and what role you had in them. Research shows writing them down has a longer positive effect on your wellbeing.
Then choose a time of day, every day, to set your mind on gratitude. Give it time, enjoy exploring gratefulness. Hopefully you too will find added positive energy for the important work you do.

If you want to take this concept further, see what the Greater Good Science Center suggests.

Circle Agenda

Staff Circle Agenda, Section Two

Core Content Visual

Self-Compassion – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

What Were Your Childhood Messages About Self-Care?
This is an activity you could facilitate with your teams in addition to or in place of the circle agenda to explore personal messages about self-care.

Self-Compassion Scale
This activity supports content covered in the Core Content Visual and document to distribute listed in the Information Section of the toolkit. The Self-Compassion Scale is also referenced in Section 11.  

Establishing New Self-Care Habits

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Conversations about Compassion
This conversation guide outlines five different conversations related to compassion and gives the resources needed to facilitate these in small groups. In section one you were asked to facilitate a discussion with the leadership team about the instinct humans have to be compassionate. For this section, facilitate a conversation with the leadership team and/or other small group or team within your school on the third topic, self-compassion. As a substitute, you can use the Kristin Neff article for the basis of your group discussion.

Additional Resources

Self-compassion article, Dr. Kristin Neff
This article give more information on self-compassion according to Dr. Kristin Neff.

For the animal lovers among us, this blog provides a wonderful overview of compassion resilience in the context of those who work in animal rescue.

In this section of the toolkit we will delve more deeply into the concept of compassion fatigue; how it connects to our understanding of trauma, the stages that one might experience if compassion fatigue is not addressed, and how to assess our levels of secondary trauma, burnout and compassion satisfaction. As we grow in our understanding of the extent and impact of trauma on the clients we serve, their families and our communities, our ability to maintain an open and compassionate approach can be challenged. Compassion fatigue can develop slowly overtime and go unrecognized. This section gives us insights that can guide us to take proactive measures to prevent its progression.

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Key Activity

Stages of Compassion Fatigue – Cats Cycle 

Wellness Practice

“Just Like Me” Exercise

Circle Agenda

Staff Circle Agenda, Section Three

Core Content Visual

Stages of Compassion Fatigue – Cats Cycle – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members.

Supplementary Activities/Handouts

ProQOL Self-Assessment Tool

The ProQOL is a 30 question, self-administered, self-scored, free assessment. This is included in the document to distribute for this section. Facilitators should make time for participants to complete the assessment during their time together or ask them to complete ahead of time.

It can be used on a regular basis as a self-check-in, offered in conjunction with supervisory or mentoring consultations, or as a basis for small group discussion. Please note that it is available on the ProQOL site in many languages. We do not recommend ProQOL’s are collected after being completed by participants, but rather used as a reflection tool.

Facilitators should be prepared to offer resources to staff whose ProQOL outcomes point to significant levels of burnout or secondary traumatic stress. Each district has employee support protocols and resources. Be sure you know those and remind staff that they exists and how to access them.

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Organizational Assessment Tool

Research links organizational culture to staff experience of compassion fatigue1. One strong predictor of compassion fatigue is lack of clarity about the vision and mission of the organization. Leadership’s ability to align staff toward an overarching goal is an important key to staff job and compassion satisfaction.

Creating a trauma-informed culture of support for staff enhances their ability to provide such a culture for the students and families they serve. The STSI-OA is an assessment of the organization’s culture related to preventing and minimizing secondary trauma. The score is calculated online for your organization. Discuss results with your leadership team and consider one action to improve your school’s support for staff related to secondary trauma. http://www.stsinformed.com

1. Condrey, Katherine M. The Relationship between Compassion Fatigue and Organizational Culture. Diss. George Fox University, 2015.

Additional Resources

Center for Health Care Strategies

“Drowning in Empathy: The Cost of Vicarious Trauma”

Second Victim Syndrome Blog Post

Cultivating Compassion – Commonalities Practice

As we have discovered in the previous sections of this toolkit, the goal of compassion resilience can be reached with the application of personal skills and perspectives combined with organizational policies and practices. In this section we will focus on the systemic factors that can negatively impact our compassion resilience and explore our response and potential role in making positive change.

We all work in imperfect systems. When we look outside of our own system to those that we rely on to provide for the health and well-being of the people we serve, we find more imperfection. The first step in lessening the negative impact of the systems in which we live and work is naming what it is about the systems that contributes to our compassion fatigue. The second step is to discover which items on that list we can change, which ones leadership can and will address, and which ones we would best be served by letting go.

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Key Activity

What Can I Control? Activity Write-Up

Toolkit Facilitators and Leadership Team, Please Review Prior to Implementing What Can I Control? Activity
The following is a review of system factors that lead to compassion fatigue and those that are protective. Keep these factors in mind as you facilitate the combined staff and leadership activity, What Can I Control?, and if you are on the leadership team, use this information to prepare and respond to the activity.

What Can I Control (Demo Video)
Watch Sue McKenzie Dicks walk through the What Can I Control? activity with a group of staff. This video only includes Sue leading the Drivers of Fatigue portion of the activity. If you lead this activity, we encourage you to also include the Drivers of Resilience portion of the activity outlined in the circle agenda and activity directions below.

Wellness Practice

SPIRIT: Humor and Core Values
Reflect on what are you doing when you feel most alive – most like yourself?

The majority of people when asked this question do not immediately go to a situation at work, but rather a place outside of work where they feel most alive. If that’s the case for you, when is a time at work when you feel most alive?

When you go home from your workday, do you have a tendency to share what happened in your day that left you feeling most alive or what was most draining? Our bodies experience the stress we relive in our conversation to some degree as if we were experiencing it again. Sharing the hard parts of our day may be needed to be understood and validated. We can become aware of when it moves from helpful to hurtful. We have a choice about how much time and on what we focus when talking about our work. One practice to play with is to include what made you feel most alive in your day as you talk with friends and family

Circle Agenda

Staff Circle Agenda, Section Four

Core Content Visual 

System Drivers – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

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Additional Resources

The National Academy of Medicine’s all-encompassing conceptual model of factors affecting clinician well-being and resilience is a good resource for those wanting a deeper dive into the external and internal factors that can contribute to both compassion fatigue and resilience: A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience

Family and friends are important support systems as well. This article speaks to using that support to help protect against burnout in the health care field: Ask Your Family for Help with Burnout 

Many of us give the very best of who we are every day, yet all too often struggle to feel like our best is good enough. Understanding, and at times challenging our own expectations and perception of others’ expectations is key to identifying and transforming unrealistic expectations that compromise our ability to approach others with compassion and extend that compassion to ourselves. In this section, we identify the expectations we have for ourselves and for others and question whether these expectations are helpful for us or holding us back.

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Key Activity

Clarifying Expectations (20-45 minutes)
The purpose of this activity is to examine whether our individual expectations are aligned with collective understanding. 

Wellness Practice

Developing Positive Affirmations

Circle Agenda

Staff Circle Agenda, Section Five

Core Content Visual 

Expectations Discussion Prompts – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Setting Helpful Expectations (20-30 minutes)
Many times, our expectations do not align with our own wants, needs, and values, but rather, represent things that are socially expected of us or things we are conditioned to believe. This exercise helps us set intentional expectations that are rooted in our values. 

Handout with Tips for Clarifying an Expectation Concern
Assists staff in clarifying the what, why and how of an expectation across different levels of positional power.

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The recommended activities provide ways to make workplace expectations more transparent and encourage healthy expectations among staff. Provide staff with access to Caregivers’ Bills of Rights, which provides affirmations that help combat negative self-talk and expectations; bonus point for creating your own version with staff. Here are two examples from workplace and family perspectives:

Example 1

Example 2

Read the following article entitled “How to communicate employee expectations effectively” and after doing so, answer the following questions:
— What efforts can you undertake to encourage regular and ongoing conversations with staff regarding expectations?
— How can you more clearly communicate expectations to staff?
— How can you affirm what you, others, or your team are doing well to meet expectations?
— How might you encourage mentoring relationships and collaborative relationships among staff at your school?

Additional Resources

To think about some strategies for how to approach managing the expectations of clients, and the importance of communication, consider reading this article.

“Without boundaries, you will act, sleep, work, groan, feel used and fulfill basic responsibilities rather than make choices to live and love fully, to work hard and nobly, to fulfill your purpose and to contribute passionately to your world.” (Black, J. and Enns, G, Better Boundaries: Owning and Treasuring Your Life. Oakland, CA. Raincoat Books)

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Key Activity

Helpful Adult Behaviors (20-40 min)
This activity is a highly valuable activity to do with school teams or schoolwide at a staff meeting. It will also prepare you for the Staff Culture section of the Toolkit.

Wellness Practice

Preparing to Write Your Mission Statement

Circle Agenda

Staff Circle Agenda, Section Six

Core Content Visual to Display in Common Staff Areas

Tips for Setting Compassionate Boundaries – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Compassionate Boundaries Reflection (15 min)

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Leadership Support for Boundary Setting – Guided Discussion (15-30 min)
The leadership team will address key questions after participating in the Helpful Adult Behaviors activity with the whole staff or a small group of staff members.

Within this Section

Self-Help Alliance, Building Better Boundaries, 2010

Brené Brown video on boundaries and empathy

Additional Resources

In provider-client interactions it can sometimes be easy to cross boundaries and blur the lines between a professional and personal relationship. The University of Wisconsin-Oshkosh and Wisconsin Department of Health Services’ Professional Boundaries for Caregivers provides examples of boundary crossings and offers tips for staying in bounds in specific situations.

One way to maintain professional boundaries is to have a clear line between your professional and personal life, and setting those work/life boundaries is important to building and maintaining compassion resilience and job satisfaction. One strategy is to establish a boundary “ritual” or routine. To explore see more.

“The only thing we have is one another. The only competitive advantage we have is the culture and values of the company. Anyone can open up a coffee store. We have no technology, we have no patent. All we have is the relationship around the values of the company and what we bring to the customer every day. And we all have to own it.”  Howard Schultz, CEO, Starbucks

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Key Activity

Create Positive Staff Culture Agreements (15-30 minutes in small group and 15-30 min in large group)

Example of Staff Culture Agreements

Wellness Practice

Strategy for Self-care – STRENGTH – Stress Resilience
In order to offer a non-anxious presence with our colleagues, clients, and their families, we need to be able to recognize the times when we cannot! In other words, we need to be able to recognize when we need either a new perspective or a break. Often our bodies let us know. The first question we might ask ourselves is, what am I telling myself about this situation and what is another possible story? Here’s a fascinating TED Talk on making stress our friend (also referenced in Section 10).

And, sometimes we really just need a break! It is helpful to have a plan for what we can do and who can assist us in finding a way to take a break. Of course, all of this is successful only if we allow ourselves the vulnerability of needing a break and, if appropriate, asking for help.

Circle Agenda

Staff Circle Agenda, Section Seven

Core Content Visual to Display in Common Staff Areas

What Do You Want to Say About the Culture of Staff? – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Support Begins With Empathy! (10-15 min)

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How to Avoid the Contagion Effect of Sharing Tough Stories between Colleagues
Read the information about low impact debriefing strategies and decide how to share with staff.

Additional Resources

For those in leadership positions, an insightful article that talks about the importance of and elements to a positive staff culture and what you can do as a leader to foster those elements: Proof That Positive Work Cultures Are More Productive

See how DaVita HealthCare Partners created a community culture that dramatically enhanced the wellbeing of the organization, its staff and their clients: It Takes a Village

If you want a deeper dive, the American Medical Association developed an in-depth module on creating positive team culture in your practice, including 10 steps for building a stronger, healthier team culture: Create Healthy Team Culture

“Our fatigue is often caused not by work, but by worry, frustration, and resentment.” – Dale Carnegie 

“The calm and balanced mind is the strong and great mind; the hurried and agitated mind is the weak one.” – Wallace D. Wattles

The four sectors of the compass model -Mind, Spirit, Strength and Heart- not only contribute to our overall wellness, but also provide guidance on strategies to help build our compassion resilience. Before delving in further, you may want to take a self-assessment of your current wellness practices. Hold onto this and notice any that you marked as “this never occurred to me” as you encounter the next four sections of the toolkit.

Mind is the first sector we will explore. Being resilient in this area is exemplified by being well-organized, engaging in meaningful work, and being fully present in the moment. As we learned in Section 1, mindfulness is a contemplative practice of being intentionally aware in the present moment. We have practiced strategies to enhance our mindfulness in various sections of the toolkit. Mindful self-awareness is a key skill for the Mind Section area as well as those that follow: Spirit, Strength, and Heart.  

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Key Activity

Appreciative Inquiry Reflection on Competence (15 mins-45 mins)

Wellness Practice

Wellness Compass Practices Assessment

Circle Agenda

Staff Circle Agenda, Section Eight

Core Content Visual to Display in Common Staff Areas

Mindsets – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Power of the Positive Word (15 minutes-30 minutes)

Practicing Mindfulness – The Body Scan and Pause (3-10 minutes)

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Name and Celebrate Staff Competence

Showing appreciation to your staff and fellow co-workers is a part of a healthy, productive, and encouraging work culture. Here are some options to encourage appreciation and focus on the specific competencies of staff or staff teams that combine to produce your school’s positive outcomes.

1. Create a process where staff can nominate each other for staff appreciation
2. Create and maintain an ongoing list of assets of your team or workplace — Something everyone can add to and see in the teachers’ common gathering space
3. Develop a gratitude board, or employ other strategies to foster a workplace attitude of gratitude, such as the ideas provided here

Additional Resources

Link to resources, videos, and tools to learn more about and develop a growth mindset.

A popular and reliable time management approach, “Five Simple Steps That Apply Order to Chaos”

A toolkit from AMA on using appreciative inquiry to foster positive culture, including how to incorporate it into daily work to maintain positivity in your organization.

Spirit is one of the four sectors of the compass model for self-care. Each area contributes to and helps build our compassion resilience. Spirit encompasses connecting to our sense of purpose with intentionality, exposing ourselves to resilience in those we serve, and recreating ourselves through rest and play.

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Key Activity

Sharing Stories of Resilience (5-10 min)
Institute the regular practice of sharing stories about current and past students’ resilience.

Wellness Practice

Developing Your Professional Mission Statement (15-30 min)

Circle Agenda

Staff Circle Agenda, Section Nine

Core Content Visual to Display in Common Staff Areas

Rest and Play Reflection – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

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Mission and Vision Statements — Making Them Meaningful (30-40 min)

“Creating a Meaningful Vision Statement”

“5 Ways to Put Meaning Behind Your Hospital’s Mission, Vision and Values”

“An Oath for New Physicians”

Additional Resources

5 Elements of a Powerful Company Mission Statement

Rogers InHealth Video Library, Stories of Recovery

Know Your Why, Michael Jr.
Comedian Michael Jr. shares an example of the power of knowing your “why” in your work. 

In the compass model the four sectors, Mind, Spirit, Strength and Heart, not only contribute to your overall wellness, but also provide guidance on strategies to help build your compassion resilience. Strength is one of the sectors. Strength encompasses stress resilience and care for the body. Stress resilience allows us to maintain a non-anxious presence as we encounter the inevitable stressors of our job. Developing our ability to care for our bodies and listen to the signs that our bodies give us supports our whole health and minimizes any unhealthy responses to stress. Becoming stress resilient and caring for our bodies often require assistance from others. Help seeking is a key skill for both of the areas in the strength section of the Wellness Compass.

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Key Activity

Listening and Responding to Stress in Your Body (10-15 min)

Wellness Practice

Care for Body – Develop Your Plan (10-15 min)

Circle Agenda

Staff Circle Agenda, Section Ten

Core Content Visual 

Choose Nourishing vs. Depleting! – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Identifying Nourishing vs. Depleting Activities (15-30min)

Dr. Kelly McGonigal’s TED Talk on How to Make Stress Your Friend explores a perspective shift on stress.

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Additional Resources

This article discusses the stages of change applied to emotional resilience. The website offers many brief articles on topics included in this toolkit.

In the compass model the four sectors, Mind, Spirit, Strength and Heart, not only contribute to your overall wellness, but also provide guidance on strategies to help build your compassion resilience. Heart is one of the sectors. This section will take a deeper look at our emotions and our relationships—both with ourselves and with others. We will be invited to focus on our self-compassion as we seek to be compassionate in our relationships with clients, their families and our colleagues.

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Key Activity

A Self-Compassion Exercise (10min) Dr. Neff
If Self-Compassion Scale was completed in Section 2, use developing an emotional regulation plans listed in the Supplementary Activities/Handouts section as your key activity asking staff to complete one for themselves.

Wellness Practice

Mindful Self-Compassion Break

Circle Agenda

Staff Circle Agenda, Section Eleven 

Core Content Visual

Colleague Conversations – Use this Visual and Display in Staff Break Areas
Posting this visual in common staff areas will serve as a reminder of content covered to staff and perhaps serve as a future conversation started for deeper reflection among staff members. 

Supplementary Activities/Handouts

Developing an Emotional Regulation Plan

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Fostering Relationship Building among Staff

Additional Resources

Article discusses, from the perspective of nurses, workplace relationships, specifically trust and how it contributes to feeling accepted and valued by colleagues.

This article offers a brief introduction and tips for developing better communication skills through structured dialog and communicating your trust distinctions.  

“Engagement is often viewed as synonymous with involvement. Involvement in services is important, but real engagement goes beyond that. Families can be involved and compliant without being engaged. Engagement is motivating and empowering families to recognize their own needs, strengths and resources and to take an active role in changing things for the better. Engagement is what keeps families working in the sometimes slow process of positive change” –Sue Steib (2004).

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Key Activity

Compassionate Connections with Families or Caregivers 

Wellness Practice

Bringing It All Together Through My Hands — An activity to summarize compassion and self-compassion found in the document to distribute in the information section of the toolkit

Supplementary Activities/Handouts

Responding to Challenging Interactions with Families – handout and possible role-play activity

Communicating Difficult News to Clients and Their Families

Stages of Change Applied to Family Conversations

Adopting a Strengths-Based Approach

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Additional Resources

Family members often become caregivers outside of the health care setting, and offering support is essential. The Schwartz Center offers various links to resources to help family caregivers.

The article “Few hospitals dedicate space for family caregivers, but that could change” discusses supporting family caregivers through dedicated spaces and other resources, and the importance of family caregiver well-being on client well-being.

The core concepts of Patient- and Family-Centered Care are used widely in efforts to better engage families in the delivery of care. To learn more about incorporating such an approach into your work in order to better engage with families consider visiting the Institute for Patient- and Family-Centered Care website.

An Introduction to the Compassion Resilience Toolkit

The Business Case for Promoting Compassion

Provider Perspective Shift

Crisis Response for Significant Disclosures and Reactions

Whether we are growing our compassion resilience to prevent compassion fatigue or to address existing compassion fatigue, this intentional shift often includes changing attitudes and behaviors that no longer serve us well. The Stages of Change offers a model for people to understand the complex path towards successful change and how to support our own change efforts as well as the change efforts of colleagues and those we supervise. This model identifies effective action and responses at each stage to avoid the unintended negative consequences of mismatched efforts.

James Prochaska, John Norcross and Carlo DiClemente are the researchers and architects of the Stages of Change model. It is also known as the Transtheoretical Model. The model assesses an individual’s readiness to act on a new, healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance.

The Stages of Change Powerpoint provides an overview of the Stages of Change model. View the slides in the mode that allows you to read the notes for each slide or as pdf.

Leadership Activity

What’s the Stage? What’s My Response? This brief activity lists statements to practice identifying the stage they represent. It will build leaders’ ability to identify what stage someone is at so they can choose effective supports for that person’s desired behavior change. Pages two and three provide a chart that takes the statements from the What Stage activity and suggests helpful responses to support that person in their current stage of change.

Staff Activity

Navigating Your Way Through the Stages of Change handout that describes each stage and gives self-help hints for those looking at their own change behaviors and hints for how to help others as they navigate change.

Individual Reflection Worksheet The individual names a target change and goal behavior, identifies the stage of their current change, and completes questions based on their stage of change.

Support for Providers in Early Years of Career

References

Before facilitating Health and Human Services Compassion Resilience groups, please reference these tips for facilitating small groups and the engaging participants with questions resource.

Tips for Facilitating Small Groups

Engaging Participants with Questions Resource