ABSTRACT

A MINDFULNESS BASED STRESS REDUCTION TRAINING WORKSHOP FOR

SOCIAL WORKERS AND HELPING PROFESSIONALS EXPERIENCING

WORKPLACE BURNOUT: A GRANT PROPOSAL

By

Evelyn Charlotte Howe

May 2015

The significance of human services worker burnout is critical as it can lead to

emotional exhaustion and adversely affect the quality, consistency, and efficacy of direct

care and interventions for clients in need of social services. The use of mindfulness-

based stress reduction (MBSR) training has been shown to be an evidence-based

intervention that can help workers learn stress reduction skills and promote self-care.

The purpose of this project was to develop a grant proposal for Jewish Family and

Children’s Service Center in Long Beach for a training workshop addressing stress and

self-care skills to prevent burnout. The proposed workshop will provide education on

symptoms of burnout and mindfulness-related strategies to help promote coping with

their job-related stressors. The funding source selected for this workshop was The

Weingart Foundation as this program coincided with their funding priorities. The actual

submission or funding for this grant was not a requirement for the successful completion

of this workshop or grant proposal.

A MINDFULNESS BASED STRESS REDUCTION TRAINING WORKSHOP FOR

SOCIAL WORKERS AND HELPING PROFESSIONALS EXPERIENCING

WORKPLACE BURNOUT: A GRANT PROPOSAL

A THESIS

Presented to the School of Social Work

California State University, Long Beach

In Partial Fulfillment

of the Requirements for the Degree

Master of Social Work

Committee Members:

Steve Wilson, Ph.D. (Chair) Mimi Kim, Ph.D.

Julie O’Donnell, Ph.D.

College Designee:

Nancy Meyer-Adams, PhD

By Evelyn Charlotte Howe

B.A., 2013, California State University, Long Beach

May 2015

TABLE OF CONTENTS Page LIST OF TABLES ....................................................................................................... v CHAPTER 1. INTRODUCTION ............................................................................................ 1 Statement of Problem ................................................................................. 1 Statement of Purpose ................................................................................. 4 Definition of Terms.................................................................................... 5 Social Work Relevance .............................................................................. 6 2. LITERATURE REVIEW ................................................................................. 9 Perspectives of Burnout ............................................................................. 9 Symptoms of Burnout ................................................................................ 12 Consequences of Burnout .......................................................................... 13 Burnout and Physical Health ..................................................................... 14 Burnout and Service Delivery .................................................................... 16 Secondary Traumatic Stress ....................................................................... 18 Compassion Fatigue ................................................................................... 20 Interventions .............................................................................................. 22 Mindfulness................................................................................................ 23 Mindfulness Based Stress Reduction Training .......................................... 25 Conclusion ................................................................................................. 27 3. METHODS ....................................................................................................... 30 Identification of Potential Funding ............................................................ 30 The Weingart Foundation .......................................................................... 31 The Jewish Community Foundation .......................................................... 31 National Institute of Mental Health ........................................................... 32 Criteria for Selection of Funder ................................................................. 32 Needs Assessment ...................................................................................... 33

iii

CHAPTER Page 4. GRANT REQUEST .......................................................................................... 35 Mission Statement and Goals of Agency ................................................... 35 Identification of Need ................................................................................ 36 Effectiveness Studies and Therapeutic Stress Reduction .......................... 37 Mindfulness-Based Stress Reduction Addressing Burnout ....................... 38 Project Description..................................................................................... 39 Evaluation of Workshop ............................................................................ 42 Budget Narrative ........................................................................................ 42 5. LESSONS LEARNED...................................................................................... 45 Review of the Study of Burnout ................................................................ 45 Grant Writing Process ................................................................................ 46 Review of the Proposed Project ................................................................. 47 Relevance for Social Work Practice .......................................................... 47 Professional Development ......................................................................... 48 Lessons Learned......................................................................................... 49 REFERENCES ............................................................................................................ 50

iv

LIST OF TABLES

TABLE Page

1. Itemized Budget for Mindulness-Based Stress Reduction Training ................ 44

v

CHAPTER 1

INTRODUCTION

Statement of Problem

The social services profession is often challenging and stressful for many social

workers and helping professionals (Adams, Boscarino & Figley, 2006). According to

Maslach and Jackson (1983) the nature of working in environments that can be

emotionally demanding leaving helping professionals to cope in the workplace with job

related anxiety such as emotional exhaustion, depersonalization, and a sense of

diminished personal job accomplishment in the workplace. Professionals who work with

other people often experience excessive stress that can lead to job burnout (Adams et al.,

2006). The significance of burnout is critical as it can be experienced across a broad

range of social services and helping professions and adversely affects the quality and

consistency of client services (Kim & Lee, 2009).

Helping professionals engage in direct services in differing social service areas

such as mental healthcare, case management, child welfare, crime victim support, crisis

management, grief and bereavement support, addiction counseling, employee assistance

programs, domestic violence, sexual assault crisis, homeless services, and hospice care

(Bride, 2007).. One on one direct service with clients is frequently emotionally charged

with feelings of depression, fear, anxiety, grief, and trauma. Social service providers and

helping professionals face significant challenges in the workplace such as role stress, a

1

lack of job autonomy, high caseloads, and increased job demands that can contribute to

burnout (Acker, 2008).

According to Maslach and Jackson (1981), burnout is defined as an increased

feeling of emotional exhaustion, depersonalization, cynicism, and a perceived lack of

professional achievement. This causes social workers to become increasingly ineffective

and inefficient in providing appropriate services to meet the needs of the client. Ray,

Won, White and Heaslip (2013), further describe burnout as the psychological and

physiological response to prolonged exposure to interpersonal stressors in the workplace.

Job stressors also contribute to the development of increased levels of burnout such as

secondary traumatic stress and compassion fatigue as well (Bride, 2007; Sprang, Clark, &

Whitt-Woosley, 2007).

In a quantitative study, conducted by Bride (2007), social workers engaged in

direct practice with traumatized populations can also develop secondary traumatic stress.

Compassion fatigue consists of negative cynical attitudes and the loss of care for the

client (Maslach & Jackson, 1981). For example, due to worker fatigue, and the absence

of social and supervisory support, helping professionals can also develop resentment and

disdain toward their clients. This can then result in a helping professional beginning to

evaluate their own professionalism negatively thus becoming dissatisfied with not only

themselves but their professional accomplishments in the work place (Maslach &

Jackson, 1981).

According to quantitative research conducted by Berzoff and Kita (2010), the

cognitive, emotional, and behavioral effects of burnout can include lowered

concentration, depersonalization toward clients and colleagues, feelings of depression 2

and irritability, apathy, fatigue, sleep disturbances, and increased health aliments. In a

quantitative research study on workplace stress and burnout also conducted by Acker

(2008), it was found that 56% of the 460 mental health service providers surveyed

expressed feelings of emotional exhaustion associated with stressful work. It was also

reported that 45% of participants in Acker’s study experienced low levels of success and

job satisfaction in fulfilling the needs of their clients as well.

A quantitative study conducted by Sprang et al. (2007), found that burnout was

highly prevalent among the 1,121 mental health providers studied, especially among

social workers in the field of child and mental health services. The research literature

suggests that helping professionals that work in daily contact with the critical needs of

their clients have a high incidence of job burnout due to chronic labor stress. Stress

impairs job performance and the ability to work effectively and efficiently with clients

and colleagues alike (Jenaro, Flores, & Arias, 2007).

The prevalence of social service worker burnout has raised awareness for the need

for increased evidence-based interventions and practices in order to counter and diminish

the effects and impact of burnout (Kanter, 2007). The development of innovative

programs that teach self-care skills to social workers and helping professionals can

contribute to preventative care. Innovative self-care workshops and health development

programs can assist helping professionals at risk for emotional and psychological

problems relative to work stressors that lead to burnout as well (Shapiro, Brown, &

Biegel, 2007). Maslach and Jackson (1981) stress that the potential for burnout is high

for helping professionals who provide continuous direct service and care for clients.

3

A growing body of research suggests that the practice of mindfulness contributes

to the enhancement of psychological and physical well-being (Shapiro et al., 2007).

According to Kabat-Zinn (2003), mindfulness is the practice of awareness of thoughts

and feelings which are recognized in the immediate moment as well as the development

of a nonjudgmental perspective of one’s own reactions and responses to life stressors and

experiences. Meditation is one of the many forms of mindfulness practice. Mindfulness

has been utilized therapeutically for a broad range of disorders such as anxiety,

depression, stress, and anger management (Roth & Robbins, 2004).

Statement of Purpose

Given the negative impact of burnout in the work place, including work related

burnout such as secondary traumatic stress and compassion fatigue that stem from long

term stressors in the fields of human services, there is a clear need for programs to help

mitigate these effects. The purpose of this project is to develop a grant proposal to obtain

funding for a 1 day workshop addressing the effects of stress and burnout on social

workers and other helping professionals in the city of Long Beach. This will be

accomplished by utilizing a mindfulness based stress reduction (MBSR) training

approach to provide education, coping skills, and peer to peer support to decrease and

prevent worker burnout in the many human service professions. The proposed workshop

will be held in the Long Beach community and will educate social workers and other

helping professionals by providing stress management techniques to address workplace

stressors that can lead to burnout. The workshop will also engage in the application of

mindfulness-based techniques such as simple meditation, guided visualization, gentle

stretching, and body scanning and other easily performed techniques in order to promote 4

the lowering of stress and improve mental and physical well-being. This project will be

implemented through the Jewish Family and Children’s Service Center.

Definition of Terms

Burnout

Burnout, as defined by Ray et al. (2013), is a psychological and physiological

response to prolonged exposure to interpersonal stressors in the workplace. Burnout,

according to Maslach and Brown (1981), is a syndrome of emotional exhaustion,

depersonalization, and a perceived sense of negative personal accomplishment due to the

depletion of emotional and physical resources. The helping professionals who work in

human services can be subject to chronic workplace stress that can increase worker

burnout and job dissatisfaction.

Secondary Traumatic Stress

Secondary Traumatic Stress is defined as the continued and close interaction with

trauma survivors. Throughout an extensive period of time of providing direct service

interventions to clients who have suffered trauma can negatively impact and impair the

mental and the emotional well-being of the helping professional through their subjective

interaction with their clients (Kanter, 2007)

Compassion Fatigue

Compassion Fatigue is understood to be a culmination of burnout and secondary

traumatic stress all of which have similar symptoms (Showalter, 2010). Compassion

fatigue is defined as an overwhelming state of tension and preoccupation with the

traumatized client by re-experiencing the traumatic event associated with the client. The

symptoms have more immediate onset of symptoms. 5

Mindfulness

Mindfulness is defined as nonjudgmental attention to one’s present thoughts,

emotions, and physiological occurrences in the immediate moment (Hozel et al., 2011).

According to Kabat-Zinn (2003), mindfulness is the attention and conscious awareness

that can be cultivated by intentionally remaining in the present moment while

acknowledging personal experiences, emotions, and feelings without negative

interpretations or judgment. Meditation, breathing exercises, focused relaxation, and

body scanning as well as creative visualization are examples of mindfulness based stress

reduction techniques.

Social Work Relevance

In research conducted by Acker (2008), it was found that there were cultural and

gender variations in burnout that impact helping professionals. It was found that non-

White human service providers were less subject to the experience of burnout due to

lower levels of emotional and mental exhaustion than White human service and health

care providers (Acker, 2008). Non-White helping professionals were shown to have an

increased realistic expectation of life due to the service providers challenging personal

life experiences. It has also been found that female service providers have increased

physical health ailments due to high stress and job demands than male social workers

(Kim, Ji, & Kao 2011). Another quantitative study conducted by Acker (2012), with a

sample of 460 mental health providers, over 50% of the study participants reported their

consideration of an intent to quit their jobs due the overwhelming stress, job demands,

and emotional exhaustion related to their work as mental health service providers.

6

Social workers and helping professionals should be educated about the

significance of self-care to ensure their capacity to provide quality and effective services

for their clients. An emphasis on self-care is important in maintaining a sense of personal

and professional balance (Jenaro et al., 2007). Sharma and Rush (2014), state that

mindfulness based stress reduction training has gained increasing attention in addressing

stress management and coping skills for social workers and helping professionals.

MBSR training can contribute to the alleviation of the symptoms of burnout,

decrease the negative consequences of burnout, and promote the prevention of burnout

(Jenaro et al., 2007). In turn, this increases mental health and physical well-being,

improves quality and consistent service for clients, and promotes a sense of personal

achievement in the workplace. The intervention utilizing mindfulness based stress

reduction training has been shown to provide an evidence-based and effective tool for the

purpose of combating the negative effects of burnout as well as promoting a decreased

sense of burnout (Sharma & Rush, 2014).

According to the United States Census Bureau (2014), Long Beach is considered

one of the most ethnically diverse cities in the United States. The predominant ethnicities

in the community of Long Beach are White, 40%, Hispanic, 29%, Black 14%, Asian

13%, and 4% constitute all other ethnicities (City of Long Beach Government, 2014).

Social workers and helping professionals provide direct services to all ethnicities and

communities and address critical issues to meet the varying and often critical needs of the

client. In the Long Beach area, The Village Mental Health Agency, The Department of

Social Services, The Department of Children and Family Services, the Long Beach

7

Multi-Service Center, the Department of Health and Social service, and The Long Beach

Veteran’s Healthcare service are significant social service agencies

The host agency, Jewish Family and Children’s Services for which this grant

proposal is being written, offers several different social service programs for all members

of the community regardless of race, ethnicity, religious affiliation, or sexual orientation.

The agency provides counseling and services for older adults, domestic violence

prevention, and emergency assistance to individuals in Long Beach. (C. Goldman,

personal communication, August, 2014).

8

CHAPTER 2

LITERATURE REVIEW

Perspectives of Burnout

Throughout the past three decades, there has been increasing research on the

causes and consequences of burnout and the impact it has on both the professional and

personal lives of social workers and other helping professionals (Wilmar, Schaufeli,

Leiter, & Maslach, 2009). In a quantitative study of 255 social workers conducted by

Papsupuletti, Allen, Lambert, and Cluse-Tolar (2009), it was found that workers in the

helping professions who interact directly with clients on a daily basis face significantly

higher levels of stress and anxiety. Helping professionals engage in direct service and

client centered interactions that are frequently charged with feelings of depression,

trauma, fear, and anxiety. Intensifying these feelings is the need to also cope with

workplace challenges some of which include, but are not limited to; role stress, a lack of

job autonomy, compassion fatigue as well as emotional exhaustion (Acker, 2008).

In a study of 211 human service practitioners, employed in child protective

services and in-home caregivers, conducted by Jenaro et al. (2007) it was found that

organizational factors also lead to burnout such as demanding schedules, inconsistent

work shifts, and conflicting job roles as well as the challenging needs and often

distressful behaviors of their clients. The progression towards burnout can be further

influenced by the imbalance of workplace demands that increase emotional and physical 9

stressors. These stressors can include attempting to manage limited agency resources, a

lack of peer-to-peer support, limited job autonomy, role stress, and the depletion of

emotional and physical resources (Wilmar et al., 2009). Another important issue that

influences the onset of burnout within the workplace is the service provider’s subjective

response to a demanding and stressful work environment (Jenaro et al., 2007).

According to a quantitative study utilizing the survey data of 305 service

employees conducted by DeTienne, Agle, Phillips, and Ingerson (2012), it was found job

stressors such as a lack of supervisory support and increased caseloads can also exceed

the social workers and helping professional’s psychological and physical coping

capacities. This can result in compromising the social service provider’s well-being and

professional achievement further impacting the affects of burnout. It is important to

recognize that burnout has an impact on the social service provider as well as the

interaction and quality of service provided to the client (Acker, 2012).

Acker (2008) determined in a quantitative study of 460 mental health service

providers that additional factors contributing to burnout; are poor work place structure, a

lack of social support, role conflict, and poor job satisfaction. Rossi et al. (2012) state

that, in their study conducted with a staff of 260 Italian mental health workers,

psychiatrists and social workers suffered from the highest levels of burnout overall.

Burnout is considered a syndrome in that social workers and helping professionals

develop a sense of feeling overburdened, increased fatigue, and a lack of professional

motivation therefore experiencing increased mental and physical health disorders (Jenaro

et al., 2007).

10

The research literature, clearly, suggests that helping professionals who work in

daily contact with the critical needs of their clients have extremely high incidences of job

burnout due to chronic labor stressors (Acker, 2008). These stressors are seen to manifest

in client related challenges and workplace interactions that impair job performance and

the service provider’s ability to work effectively and efficaciously with both their clients

and colleagues alike (Jenaro, et al., 2007). Consequently, according to research, it is

suggested that prolonged periods of stress on the job can cause tension, worry, and

anxiety, all of which contribute to emotional exhaustion, physical ailments, and

psychological distress (Jenaro et al., 2009, Papsupuletti et al., 2009, Sprang et al., 2007).

Focusing on workplace stress, another quantitative research study regarding

burnout conducted by Acker (2008), further agrees with the existing data. It was found

that 56% of the 460 mental health service providers surveyed, expressed feelings of

emotional exhaustion associated with the stressful demands of direct service work. It has

also been reported that 45% of participants in Acker’s study experienced low levels of

job satisfaction in fulfilling the needs of their clients due to workplace stressors. In a

quantitative study by Sprang, et al., (2007), it was found that burnout was highly

prevalent among the 1,121 mental health providers, especially with those working within

the fields of child welfare and mental health services. The potential and risk for burnout

is highly prevalent among social workers and helping professionals who work with

clients in varying social service fields (Maslach & Jackson, 1981).

11

Symptoms of Burnout

Direct service work is a mentally and emotionally demanding profession. It also

subjects helping professionals to increased job related stressors such as anxiety, distress,

depression, and a broad range of physical ailments. This, in turn, can lead to increased

job burnout for social workers and other helping professionals in the fields of human

service (Adams et al., 2008). The most significant aspects of burnout, as described by

Maslach and Jackson (1981), are increased feelings of emotional exhaustion, cynicism,

and a perceived lack of professional achievement. According to research by Berzoff and

Kita (2010), the cognitive, emotional, and behavioral symptoms of burnout include;

lowered concentration, depersonalization toward clients and colleagues as well as

feelings of depression and irritability, apathy, fatigue, and sleep disturbances.

Ray et al. (2013) further describe burnout as the psychological and physiological

response to prolonged exposure to interpersonal stressors within the workplace. For

example, due to worker fatigue and the absence of emotional, social or supervisory

support, helping professionals often internalize resentment and develop detachment

toward the clients as well as their colleagues. According to Maslach and Jackson (1981),

social workers and helping professionals begin to feel over extended due to the depletion

of the individual’s emotional and physical resources. Likewise, depersonalization or

cynicism is defined as experiencing negative or pessimistic feelings and attitudes that

manifest as detached responses toward clients or colleagues. Lastly, a decreased sense of

personal achievement is experienced as a feeling of dissatisfaction with the social service

workers profession due to a sense of incompetence or ineffective outcomes with client

goals and outcomes (Maslach & Jackson, 1981). 12

Consequences of Burnout

According to Gerber et al. (2013), about 4-8% of the working population report

experiencing symptoms of burnout. In a quantitative study conducted by Acker (2012),

examining burnout among mental health care providers, it was determined over half of

the participants (56%) testified that they experienced moderate to high levels of

emotional exhaustion. Furthermore, a majority of the participants (73%) reported

moderate to high levels of role stress, and exactly half of the participants (50%) reported

that they considered quitting their jobs due to their overall feelings of burnout and fatigue

when interacting with both their coworkers and their clients (Acker, 2012).

A quantitative study by Kim and Lee (2009) emphasized the need for recognizing

that both client direct intervention practice and social service work place stress, overall, is

related to job burnout. The workplace stressors and environmental factors of burnout

contribute to negative symptoms and consequences as well as the efficacy, consistency,

and the quality of effective client interventions and outcomes. Furthermore, social

worker burnout contributes to symptoms of depression that can lead to increased sick

leave absences and self-reported health problems, which also increase the workload and

stress for agency social workers with less job experience (Kim & Lee, 2009).

Another quantitative study of 211 social workers conducted by Kim and Lee

(2009), found that helping professionals who experienced burnout were also more likely

to have a higher turnover rate. As such, further consequences of burnout include;

misinterpretation in assessments, incorrect clinical determinations, and poor goal and

treatment planning. All of which culminate into the diminishment of the social service

workers capacity to develop effective client interaction, increased trust and rapport 13

building, implement appropriate interventions, treatment plans, and productive goal

outcomes (Adams et al., 2008).

According to Adams et al. (2008), when defining the consequences of burnout, it

was found that individuals providing services in the helping professions have

occupational as well as personal caregiving demands that increase adverse psychological

outcomes. Therefore, the risk for burnout, according to Bride (2007), is relatively high

for helping professionals who work with clients who are survivors of many different

types of crisis and critical life challenges. For example; social workers who provide

therapy and care for clients who have experienced sexual assault, military combat, natural

disasters, terrorist attacks, child abuse, domestic violence, and violent crime can

vicariously develop symptoms of burnout (Bride, 2007). Therefore, within the context of

social services, therapy, and interventions for the survivors of trauma can be particularly

stressful upon mental health providers as well as generalist social workers (Adams et al.,

2008).

Burnout and Physical Health

Physical illness can result from workplace and personal life related stressors.

Stressors whether they are subjective or external factors that remain unresolved are

contributing factors to burnout and emotional exhaustion (Mosby, 2008). Burnout has

been linked to common colds, flu-like symptoms, gastrointestinal disorders, muscular

tension, sleep disturbances, headaches, neck and back problems as well as chronic fatigue

(Acker, 2008). According to Kim et al. (2011), a quantitative study of 406 social workers

determined that social workers with higher levels of burnout report increased physical

14

illness and health problems such as cardiovascular diseases, diabetes, systemic

inflammation, musculoskeletal disorders, and strokes.

Three decades of research, regarding workplace burnout, has shown that job-

related stressors have adverse effects on social service workers such as hypertension and

decreased immune system response to negative environmental and physiological

elements (Wilmar et al, 2009). Social service providers and helping professionals

experience a state of physical, emotional, and mental exhaustion caused by long-term

involvement in emotionally demanding work environments and stressful client centered

interactions (Rossi et al., 2012; Schaufeli, Leiter, & Maslach, 2009). The factors that

contribute to burnout, according to Kim et al. (2011), can also encourage social service

providers to engage in high-risk behaviors such as smoking, alcohol and substance abuse

as well as a lack of appropriate nutrition due to an insufficient diet, a lack of exercise, and

poor sleeping habits.

The research pertaining to burnout also addresses the high incidence of various

conditions such as depression, post-traumatic stress disorder, potential suicide, and higher

mortality rates (Acker, 2012). This suggests that burnout from work related stress has a

significant impact on mental health and upon the physical well-being of social service

workers (Sprang et al., 2007). According to a quantitative study by Kim et al. (2011),

over the past decade, out of 750 social workers, it was found that 75% reported having

had trouble with burnout during their careers that caused differing levels of physical and

psychological distress impacting both their personal and professional lives.

In a meta-analysis study conducted by Melamed, Shirom, Toker, Berliner, and

Shapira (2008), it was found that the effects of chronic stress leading to burnout can be 15

linked to several physiological disorders. Healthcare that focuses on individuals

suffering from burnout may better identify health conditions relative to those who are

chronically exposed to workplace and life stressors. This can increase the development

of evidence-based interventions and best practices for social workers and helping

professionals who are no longer capable of utilizing appropriate and effective personal

and professional coping skills to manage overall stressors. Chronic burnout can lead to

the gradual erosion of overall physical health (Melamed et al., 2008).

Burnout and Service Delivery

According to Kim and Lee (2009), social work burnout is a critical issue that

affects the efficient administration of social service agencies and organizations. Burnout

has been shown to promote counterproductive effects on the overall efficacy of quality,

consistent, and effective agency social services. The impact of burnout also contributes

to poor client outcomes and overall consumer service dissatisfaction (Jenaro et al., 2007).

The effects of social worker and helping professional burnout also contributes to

increased job dissatisfaction, absences due to increased sick leave and heightened self-

reported health problems (Acker, 2010).

In a qualitative study conducted by Kim and Lee (2009), it was found that helping

professionals who experience burnout are more likely to have higher turnover rates and

absenteeism from the workplace. In another research study conducted by Acker (2008),

it was found that agencies are negatively impacted by staff resigning from their positions

due to higher levels of burnout. The noted issues that also contribute to factors that result

in job resignation due to burnout are ambiguous role stress, minimal job autonomy, and a

lack of supervisory and coworker support (Kim & Lee, 2009). 16

In light of the implications of burnout, and high turnover rates in social service

organizations, evidence-based interventions such as mindfulness based stress reduction

training has been shown to decrease workplace burnout and in turn improves job

retention (Kabat-Zinn, 2003). This contributes to maintaining job retention within the

broad spectrum of the helping professions as well as decreasing the intent to quit (Kim &

Stoner, 2008). In a quantitative study by Acker (2011), it was found that agencies which

promote personal and professional development programs can maintain a higher

employee retention rate as well as improved social services and a decrease in overall

administrative challenges.

In a quantitative study conducted by Kim and Lee (2009), it was found that 211

state registered social service workers working in health or mental health settings who

felt burned out and frustrated with their jobs are more likely to experience higher

turnover rates. Social worker turnover is a serious problem as it impacts the quality,

consistency as well as the stability of client services. High levels of worker turnover

within social service agencies is found to create psychological distress in remaining staff

members and increases job stressors among the new and inexperienced social service

workers who fill the vacated social service positions (Kim & Lee, 2009). Social worker

turnover is a significant financial challenge for agency administrations as it also

contributes to deficit profit margins for organizations (Sprang et al, 2007).

According to Acker (2010), many social service agencies have undergone

significant systemic organizational changes to implement cost effective and short-term

services. The movement toward cost effective and efficient treatment modalities has

increased workplace challenges such as increased caseloads, higher service regulation 17

standards, increased documentation, and decreased time spent with case management and

direct service with clients which, in turn, contributes to job burnout leading to many

agencies finding it difficult to maintain job retention with social workers and helping

professionals (Acker, 2010). According to DeTienne et al., (2012) increased job

stressors, greater fatigue, and lower job satisfaction due to burnout is a significant factor

in high job turnover rates in the social services.

Secondary Traumatic Stress

Secondary traumatic stress is defined as continued and close interaction with

trauma survivors for an extensive period of time that can negatively impact and impair

the mental health and emotional well-being of the helping professional through their

subjective interaction with their clients (Kanter, 2007). Helping professionals attempt to

work with a client’s behavioral adjustments and provide emotional support as well as

assisting clients in developing coping strategies following a traumatic life experience

(Adams et al., 2006). This ultimately increases the potential of the helping professional

in developing the symptoms of secondary traumatic stress which can, then, impede the

social service workers capacity to remain objective and determine appropriate client

interventions (Kanter, 2007).

In a quantitative study by Bride (2007) addressing secondary traumatic stress with

282 master’s level social workers, it was found that 97.8 percent of study respondents

indicated that their client population had experienced some form of personal trauma or

had been a witness to trauma. In turn, 88.9 percent of secondary trauma experienced by

social workers in direct service with clients has been shown to be relative to the clients’

personal traumatic issues (Bourassa, 2009). Research indicates that social workers who 18

specialize in direct practice with traumatized clients are highly likely to experience

symptoms of secondary traumatic stress or compassion fatigue (Bride, 2007).

Additionally, according to a quantitative study conducted by Kanter, (2007),

secondary traumatic stress manifests itself through the worker’s exposure to traumatic

events due to the internalization of the client’s detailed description of their personal

traumatic experience. Therefore, a significant implication of working with clients and

their traumatic experiences is the potential development of other aspects of burnout

known as secondary traumatic stress and compassion fatigue. Secondary traumatic stress

and compassion fatigue can contribute to the development of various mental health issues

for the social service provider and other helping professionals (Bride, 2007).

Therefore, it has been found that it is beneficial for the helping professional to

gain appropriate social, supervisory and emotional support to ensure both mental and

emotional health (Bourassa, 2009). This, in turn, aids the social service worker to sustain

their professional efficacy, which is beneficial both to themselves and their client,

develop effective interventions resulting in positive treatment outcomes, improves their

work environment experience, and co-worker interactions. Most importantly, the social

service provider or helping professional is able to engage with efficiency and provide

adequate services to their clients in need of immediate intervention (Sprang et al., 2007).

The symptoms of burnout can be seen as stressors that contribute to secondary

traumatic stress within the helping professions. This impacts both worker and client

relationship in implementing effective interventions and effective services. Burnout is

considered a contributing factor to secondary traumatic stress, but it is also viewed as an

occupational hazard of providing services to traumatized populations (Kanter, 2007). 19

Compassion Fatigue

Another degree of burnout is identified as compassion fatigue. According to

research compassion fatigue can be understood as a culmination of both burnout and

secondary traumatic stress both of which have similar mental and physical health

symptoms (Showalter, 2010). Compassion fatigue is defined as an overwhelming state of

tension, and the continuous preoccupation with the traumatized client via re-experiencing

the traumatic event associated with the client. The symptoms include feelings and acts of

avoidance, numbing of reminders, and a decreased sense of care or compassion for

clients (Ray et.al., 2013). Burnout and secondary traumatic stress have a gradual and

cumulative onset whereas compassion fatigue has a more immediate onset of symptoms

such as anxiety, depression, avoidance of reminders, and a sense of emotional numbing.

Compassion fatigue symptoms have also been found to develop and result from the

experience of a single traumatic event (Figley, 2012, Rossi et al., 2012).

Research indicates that there are specific risk factors that can cause social workers

or helping professionals to be increasingly susceptible to compassion fatigue. The

helping professional’s personal history of unresolved trauma, their personal extent of

exposure to trauma, and their inexperience in working with trauma victims also

contributes to the onset of compassion fatigue (Adams et al., 2006). The issues that

contribute to the development of compassion fatigue within the helping professional,

while working and coping with their clients’ traumatic experiences, can negatively affect

the overall quality and efficacy of care provided to the client (Bourassa, 2011).

Social service providers from a variety of different disciplines cope with

compassion fatigue in professions such as nursing, psychology, psychiatry, case 20

management, social work, and mental health work service providers. Those who work

for extensive periods of time with clients who have experienced trauma can develop

grief, anxiety, depression, sleep disturbances, relational problems, and physical

complaints (Ray et al., 2013). Therefore, compassion fatigue has the potential to erode

the professional’s ability to function at an optimal level in the work place. It also impacts

the professional’s capacity to be fully present while engaging in direct practice with a

client (Showalter, 2010).

The impact of working with trauma victims significantly affects the professional

caregiver’s physical, emotional, and mental health. The accumulated stress, losses,

difficult family dynamics, and the social service provider’s personal experiences of death

all have profound effects on the coping abilities of the service provider’s capacity to

implement efficacious services to their clients (Rossi et al., 2012). The symptoms

include fatigue, depression, avoidance and withdrawal from friends and family, and the

loss of interest in activities that were once enjoyable. Long working hours and high

caseloads of trauma clients have been associated with increased burnout among helping

professionals coping with compassion fatigue (Showalter, 2010).

Compassion fatigue can negatively affect the professional’s ability to provide

services, maintain professional relationships, and contributes to the loss of productivity.

It can also lead to high turnover rates (Showalter, 2010). Overall, compassion fatigue can

manifest in the physiological, psychological, spiritual factors of social workers and other

service providers (Bourassa, 2011).

21

Interventions

Clearly, the symptoms and consequences of burnout, secondary traumatic stress

and compassion fatigue have the potential to disrupt the careers of social workers and

helping professionals, as well as negatively impacting family relationships, according to

quantitative research conducted by Showalter (2010). It has been found that symptoms

experienced through prolonged exposure to distressful conditions such as the symptoms

of burnout are very responsive to various self-care treatments (Kabat-Zinn, 2003). Self-

care is often overlooked by social workers and helping professionals alike. The

acknowledgment of personal health care needs and the setting of defined boundaries

professionally and personally can assist in the restoration of balance and harmony in the

lives of professional service providers in all disciplines. MBSR training intervention is a

needed and a best practice for the benefit of social service providers (Showalter, 2010).

In a quantitative study of 460 mental health service providers conducted by Acker

(2011), it was found that helping professionals who engage in opportunities to pursue

personal development programs such as MBSR training were considerably better

equipped and able to cope with job-related stressors. These stressors include anxiety,

depression, and a sense of client and professional detachment as well as many other

physical health disorders relative to burnout. Consequently, the research pertaining to

MBSR reveals a positive increase in productivity in direct service interactions and

improved collaboration with colleagues and clients (Sharma & Rush, 2014).

Social service providers who are suffering from burnout, including other aspects

of burnout such as secondary traumatic stress or compassion fatigue often find

themselves depleted of mental and physical resources. As shown by the extensive 22

research on the topic, there is not a rapid and stress-free solution in learning and

developing needed self-care skills to prevent job burnout (Campbell & Christopher,

2012). In order for social service providers to overcome the loss of personal wellbeing

and professional efficacy, burnout requires intervention that promotes guidance in self-

care, which in turn, contributes to the restoration of personal and professional well-being

through MBSR training (Kabat-Zinn, 2003).

Through development of self-care techniques, and the identification of self-

healing tools and skills which will be provided in this workshop, social workers and

helping professionals can and do recover from burnout and compassion fatigue

(Showalter, 2010). Another issue that contributes to burnout is that helping professionals

are not aware of their own elevated levels of fatigue. They find that they are unable to

function in the most menial of tasks throughout their daily lives before identifying

personal and professional dysfunction (Showalter, 2010). Learning self-help skills

provided through mindfulness based stress reduction training is considered an effective

technique for promoting the development of self awareness and restoring a healthy

balance in the professional and personal life of the individual (Kabat-Zinn, 2003).

Mindfulness

According to Gethin (2011), the concept of mindfulness stems from the ancient

Buddhist tennet that depicts an active state of mind whereby the individual focuses on his

or her own thoughts upon the immediate moment. This includes attentiveness and

reflection of the individual’s internal feelings as well as their reaction to their

environmental stressors. The therapeutic practice of mindfulness promotes consistent

awareness of what one is thinking and feeling in any given moment (Gethin, 2011). In 23

this respect, mindfulness allows individuals to examine both positive and negative

emotional life experiences and stressors (Fjorback, Arendt, Ornbol, Fink, & Walach,

2011). The practice of mindfulness is considered an effective tool that contributes to the

well-being of the social worker and improves the helping professional’s interactions with

their clients and colleagues (Kabat-Zinn, 2003).

In Western psychology, mindfulness is defined as an awareness that arises

through intentionally recognizing and being attentive to one’s moment-to-moment

experiences in a non-resistant, non-reactive, and accepting perspective of personal

compassion (Kabat-Zinn, 2003). Attempts have been made to precisely define

mindfulness based stress reduction practice by positing three basic elements: (a)

intention, (b) attention, and (c) attitude (Shapiro et al., 2007). Intention, in this instance,

involves understanding the purpose and why one is developing awareness of their inner

thoughts and physiological responses. This requires continual conscious motivation,

purposeful self-discipline, and conscientious personal attentiveness. Attention is defined

as the direct, moment-to-moment awareness and understanding of what is being

experienced within one’s own mind and body. Through the philosophy of mindfulness,

the mind is trained to focus, direct, and sustain attention on personal self-awareness and

habitual responses to external and internal elements. An individuals’ attitude is how one

recognizes and accepts the caring and compassionate as well as the discerning qualities of

mindfulness based stress reduction (Shapiro et al., 2007). Through MBSR training the

mind is trained to focus and sustain attention upon maladaptive responses to encountered

stressors that can be altered to more positive and meaningful experiences (Shapiro, Astin,

Bishop & Cordova, 2005). 24

The adoption of mindfulness as an alternative therapeutic approach has been

shown to improve an individual’s capacity to sustain emotional well-being and develop

compassionate self-regard (Cacciatore & Flint, 2012). MBSR training techniques are

recommended as a useful method for improving mental health and reducing symptoms of

stress, anxiety and depression which are associated with job burnout. A MBSR training

intervention can increase the helping professionals coping skills in order to manage

stressful experiences more effectively (Kabat-Zinn, 2003).

For example, the two common techniques that are utilized to develop mindfulness

are yoga and meditation (Piet, Wurtzen & Zacharise, 2012). The practice of meditation

has been found to increase a sense of higher emotional well-being and yoga been shown

to contribute to the improvement of physical health (Keune & Fortinos, 2010). A pilot

study of 38 health care professionals conducted by Shapiro, et al., (2005), focused on a

mindfulness based stress reduction intervention and found that mindfulness is a natural

human capacity and a skill that can potentially be developed as a mediator of positive

outcomes for many mental and physical disorders. The study also suggests that a MBSR

intervention can be effective in reducing stress, increasing quality of life, and

contributing to self-compassion (Shapiro et al., 2005).

Mindfulness Based Stress Reduction Training

A MBSR workshop can contribute to the overall personal and professional growth

of both the social worker and the helping professional. It has been shown that the

practice of MBSR training effectively teaches self-care skills such as stress and emotional

regulation which represents an important form of treatment in combating burnout

(Shapiro et al., 2007). The quantitative research examining self-care and stress 25

management addresses varying facets of mindfulness and its impact on overall job and

life satisfaction. For example, enhancing self-awareness, increasing emotional self-

regulation, and improving coping skills. This includes, but is not limited to, developing

techniques for physical, emotional, and psychological balance through the utilization of

more effective responses to internal and external stressors (Shapiro, et al., 2007).

The MBSR training workshop developed by Kabat-Zinn (2003), as a clinical

intervention at the University of Massachusetts medical center, is based on the premise

that improving the capacity to be mindful is to focus on the present experience in a non-

judgmental and receptive manner. This over time reduces unregulated emotions,

reactionary responses, and negative self-centered thoughts that can lead to poor mental

and physical health (Kabat-Zinn, 2003). MBSR training is designed to be flexible in its

application to any individual suffering mental and physical distress or pain and is

therefore adaptable to any population (Gethin, 2011).

MBSR training can be efficacious in implementing a positive impact on social

workers and helping professionals. It encourages a sense of personal awareness, attentive

personal and environmental focus, self-compassion, personal empathy as well as an

improved ability to mitigate reactions to stressful events and situations (Campbell &

Christopher, 2012). MBSR training is designed to assist individuals in addressing

habitual behaviors or responses as well as thought processes that impede one’s ability to

view professional and personal experiences intrinsically and with favorable significance.

Social workers and helping professionals learn to acknowledge their thoughts and

feelings in order to engage in emotional self-regulation, which improves client and

colleague interaction and promotes job satisfaction (Hulsheger et al., 2013). 26

MBSR training consists of many practices such as meditation, breathing

exercises, and body scanning for physiological responses to stress. The main purpose of

these practices are to alter the individual’s responses associated with stressful thoughts

and feelings, all of which stem from dealing with distressful events which are generated

through interactions with both clients and colleagues alike (Campbell & Christopher,

2012). Burnout is the ultimate result of emotional fatigue and continued distressful

interactions. Thus, justifying the need for mindfulness based stress reduction training

interventions that promote an improved productive disposition, an increased positive

outlook, and personal self-control of responses to the individual’s situational stressors

(Kabat-Zinn, 2003).

Overall, MBSR is considered a practice that requires personal commitment. It

presents an opportunity for beneficial lifestyle changes that can become a life altering

practice and not simply a superficial intervention (Campbell & Christopher, 2013).

Personal practice requires developing knowledge of an individual’s self and allowing

mindfulness to adjust their experiences, thoughts, and responses to internal and external

factors. MBSR training has been shown to be an effective best practice for fostering

emotional well-being and minimizing psychological distress and physical pain (Sharma

& Rush, 2014).

Conclusion

The clinical research in the area of MBSR shows that the cultivation of

mindfulness is a valuable practice as an intervention for burnout (Kabat-Zinn, 2003). It is

a useful method in overcoming the symptoms of stress, anxiety, and depression.

Mindfulness also helps to provide the social worker and helping professional with 27

improved coping skills and reduced reactionary responses to environmental as well as

internal stressors which then contribute to the minimization of the overall impact of

burnout and compassion fatigue benefitting both helping professionals and their clients

(Hozel et al., 2011). MBSR has been shown to be an effective therapeutic intervention

that provides evidence-based beneficial results (Hozel et al., 2011).

According to a meta-analysis study conducted by Campbell and Christopher

(2014), the practice of mindfulness based stress reduction is beneficial to both the helping

professional and client as it contributes to the overall therapeutic and workplace

experience as well. Mindfulness assists social workers and service providers with a

means to develop and increase their ability to communicate, empathize, and to be fully

present throughout their interventions and treatment with their clients. MBSR also

contributes to an improved sense of well-being and increases the quality of engagement

and professional interaction with their coworkers mentally, emotionally and cognitively.

This helps to improve the overall quality of the therapeutic relationship therefore

generating effective client intervention outcomes (Campbell & Christopher, 2014).

Overarching literature, according to a meta-analysis study conducted by Wilmar

et al. (2009), three decades of research regarding burnout in social services and helping

professions has contributed to vast data and knowledge of the causes, symptoms, and

consequences of burnout on social workers and helping professionals. The literature has

also contributed information regarding the repercussions to social service agencies and

organizations due to social worker and helping professional burnout. Burnout is a

professional liability and is increased by a multitude of internal and external factors such

28

as the helping professionals subjective work experience, workplace job demands, gender

and age as well as the lack of supervisory and coworker support.

MBSR has proven to be an increasingly beneficial practice for social workers and

helping professionals. It is imperative that self-care as well as professional well-being

are correlated and encouraged in order to increase a sense of professional achievement as

well as an improved quality of mental and physical health. The practice of mindfulness

and personal awareness to habitual and reactionary behaviors proves to be realistic and

can be applicable to a wide range of work environments. Mindfulness positively

influences the therapeutic interaction with clients and colleagues. The practice of MBSR

contributes to effective and efficient social services, which is the goal of MBSR training

(Campbell & Christopher, 2012; Kabat-Zinn, 2003; Wilmar et al., 2009).

29

CHAPTER 3

METHODS

Identification of Potential Funding Sources

In search of funding sources for the MBSR training workshop for social workers

and helping professionals the grant writer utilized the world wide web search engines

such as Yahoo, Google and Google scholar in order to gather information pertaining to

funding resources that would be suitable for the funding of this workshop. Resources

that provide grant funding such as grants.gov, promindful.org, the Long Beach Non Profit

Partnership, Robert Wood Johnson Foundation, and The Archstone Foundation were

examined for potential grant funding. Key words and phrases that were utilized for the

searches and the topic are: funding, grants, social worker burnout, compassion fatigue,

secondary trauma stress, social workers, human service providers, social service worker

stress, helping professional stress, job place stress reduction, helping professionals,

mindfulness based stress reduction, burnout prevention, social work stressors, mental

health, anxiety, depression, and self-care. Through the search of various funding

foundations the grant writer determined three potential grant funding resources such as

The Weingart Foundation, The Jewish Community Foundation, and the National Institute

of Mental Health. The Weingart Foundation and the National Institute for Mental Health

were selected for further review as potential sources for grant funding for the mindfulness

based stress reduction workshop. 30

The Weingart Foundation

The Weingart Foundation was founded in 1951 by Ben and Stella Weingart and is

located in Southern California. The foundation is operated as a private and nonprofit

grant foundation. The foundation provides grants and other support designed to improve

the capacity and sustainability of nonprofit agencies and organizations. The grants are

awarded in order to assist and improve communities by providing effective services in

the areas of health, human services, and education (The Weingart Foundation, 2014).

The foundation supports nonprofit organizations throughout six Southern

California counties. Throughout the past 40 years, the Weingart Foundation has granted

more than $976 million to support educational and community programs and various

social service agencies and organizations that meet the needs of the disenfranchised or

economically challenged in the areas of older adults, low income children and youth, the

homeless and those suffering from disabilities. The foundation continues to serve the

needs of Southern California’s nonprofit organizations in order to promote new and

improved community services and a broad range of social services (The Weingart

Foundation, 2014).

The Jewish Community Foundation

The Jewish Community Foundation, a non-profit organization, has contributed for

60 years to institutions, individuals, and professional advisors on promoting the greatest

possible impact on both the Jewish community and the overall community at large. They

are the largest manager of charitable assets and leaders in planned granting solutions for

the Greater Los Angeles area. In 2013, the foundation and its more than 1,000 donors

distributed $65 million in grants to hundreds of organizations. In 1954 the Jewish 31

Federation of Greater Los Angeles established the Jewish Community Foundation of Los

Angeles to serve as a permanent philanthropic resource for the community as a whole

(The Jewish Community Foundation, 2014).

The organization's main objective is to provide funding resources to assist in

meeting the community’s needs. The foundation awards grants on a competitive basis to

nonprofit organizations and programs. This foundation, according to the listing of grant

recipients, shows that it strongly supports social and human service agencies for a variety

of needs such as programs for gang intervention, health and wellness promotion, and

women and children’s education (The Jewish Community Foundation, 2014).

National Institute of Mental Health

The National Institute of Mental Health is a government institute whose mission

is to transform the understanding and treatment of mental illnesses through basic and

clinical research. This institution’s research paves the way for prevention, education,

recovery, and cures for various mental disorders. The National Institute of Mental Health

believes that to fulfill this health mission, it must promote innovative thinking to ensure

that novel perspectives are used to further the knowledge of the brain, behavior, and the

experience of the individual. This division of the National Institute of Mental Health

supports studies that assess the effectiveness of preventative interventions and treatment

for mental health illnesses (National Institute of Mental Health, 2014).

Criteria for Selection of Funder

Following the assessment of the three potential funders, the foundation chosen as

the most potential grant funder for the mindfulness based stress reduction training

workshop is The Weingart Foundation of Southern California. The determining factor of 32

which funder would be most suited for this grant was a review of the application criteria

as well as an assessment of the selection of agency and program grant recipients

previously awarded grant funding. The review also examined the grant funds allotted to

varying types of social service and human service agencies. The Weingart Foundation is

unique in that it promotes The Small Grant Program which supports grant funding for

human and social services under $25,000.

Needs Assessment

The assessment for the need of the proposed MBSR training workshop will be

determined based upon the responses to a self-reported questionnaire addressing burnout

in the workplace. The questionnaire will be disbursed to various social service agencies

in the Long Beach area, including the host agency, The Jewish Family and Children’s

Service Center. The questionnaire will provide data and feedback, pertaining to burnout

in the workplace, which will be utilized to determine the needs of social workers and

helping professionals providing direct services throughout human and social service

agencies in the Long Beach area.

Following a review of the literature pertaining to social worker burnout and

mindfulness based stress reduction training, it is evident that there is a need for evidence-

based interventions to assist social workers and helping professionals in improving their

professional capacity as well as successful client interaction and outcomes (Hulsheger et

al., 2013). Approximately 4-8% of the working population reports experiencing

symptoms of severe burnout (Gerber et al., 2013). In a quantitative study conducted by

Acker, (2012) the results suggested that over half of the 460 participants (56%)

experienced moderate to high levels of emotional exhaustion. A majority of the 33

participants (73%) also expressed moderate to high levels of role stress and half of the

participants (50%) had considered an intention to quit their jobs due to feelings of

burnout.

34

CHAPTER 4

GRANT REQUEST

This grant request of $15,390.00 has been prepared for submission to The

Weingart Foundation on behalf of the Jewish Family and Children’s Services in order to

implement the mindfulness based stress reduction training workshop. The purpose of this

workshop is to provide education and mindfulness based skills and techniques in order to

decrease stress and burnout experienced by social workers and helping professionals

providing direct service within the social service fields. Specific elements of The

Weingart Foundation grant proposal application criteria have been excluded for the

purposes of this thesis. The sections of the small grants program application that have

been omitted include: the letter of inquiry, fiscal sponsor information, board of director’s

information, financial documentation, and various program specific documents.

Mission Statement and Goals of Host Agency

The mission and goals of the Jewish Family and Children’s Services of Long

Beach is to provide a broad range of social services to all community members regardless

of race, ethnicity, disability, or sexual orientation in facing life’s challenges. The Jewish

Family and Children’s Service’s goal is to provide compassionate, professional and

affordable individual, family and group services in a trusting, safe, and healing

environment. The staff of Jewish Family and Children’s Service’s consists of licensed 35

clinical social workers, marriage and family therapists, psychiatrists, geriatric specialists,

and case managers. The agency also serves as a field placement center for graduate

students from local universities and colleges. The services available for members of the

community in need of assistance or intervention are: adult clinical services, professional

counseling, domestic violence programs, older adult services and support and group

services as well as the The Center for Children, Youth, and Families. Other services

available to the overall community are various support groups for specific needs such as

caregiver and grief and bereavement support groups as well as emergency financial

assistance, and information and referrals to community resources (Chris Goldman,

personal communication endorsing this project and validating the need for this workshop,

August, 2014).

Identification of Need

Social service work is challenging yet is also stressful to many social workers and

other helping professionals (Adams, et al., 2013). Social workers and other helping

professionals interact with individuals facing challenging life situations or crisis and

provide direct services in order to promote successful outcomes with those in need of

interventions (Papovic, 2009). In a quantitative study conducted by Papsuletti, et al.,

(2009), it was found that social service workers and helping professionals who work with

clients on a daily basis face significantly higher levels of stress and anxiety.

Research suggests that MBSR programs can contribute to the enhancement of

psychological and physical well-being of those workers who are at risk for job burnout.

MBSR is an educationally-based program focusing on training in the Eastern

contemplative practice of mindfulness. The essence of mindfulness involves awareness 36

and acceptance of whatever is occurring in the present moment (Gethin, 2011). The act

of mindfulness is a form of meditation originally derived from the Theravada tradition of

Buddhism. Though it has its roots in Buddhist meditation, MBSR is a secular practice

that is a practice developed by Jon Kabat-Zinn in the late 1970s. Since that time,

numerous studies have documented the physical and mental health benefits of

mindfulness in general for use in numerous human services settings (Kabat-Zinn, 2003).

Effectiveness Studies and Therapeutic Stress Reduction

Recent studies reveal that interventions such as the proposed program for JCFS

such can be effective in addressing symptoms of burnout. A recent analysis of 25

burnout prevention intervention studies conducted by Awa, Plaumann, and Walter (2010)

demonstrated that 82% of person-directed interventions such as relaxation, music

therapy, adaptive coping instruction, and cognitive behavioral counseling can be effective

in reducing symptoms of burnout including the promotion of enhanced job performance,

increase stress management skills, and improved personal coping (Awa, Plaumann, &

Walter, 2010; van der Klink, Blonk, Schene, & Dijk, 2011).

Another study conducted in Sweden showed that cognitive-behavioral therapy in

combination with elements of yoga exercises show promising results in reducing stress-

related symptoms commonly associated with burnout (Granath, Ingvarsson, Thiele, &

Lundberg, 2006). Additionally, other studies have shown that use of yoga movements

can help promote positive physiological (Murugesan, Govindarajulu, & Bera, 2000) and

psychological outcomes (Malathi, Damodaran, Shah, Patil, & Maratha, 2000).

37

Mindfulness-Based Stress Reduction Addressing Burnout

Burnout, as originally identified in a study conducted by Maslach and Jackson

(1981), can be experienced by human services workers due to prolonged exposure to

workplace stressors that can cause emotional exhaustion, depersonalization, and a lack of

feeling or regard toward client services and interventions as well as a sense of loss in

personal accomplishment and achievement. The significance of burnout is critical as it

can adversely affect the quality, consistency, and efficacy of direct care and interventions

for clients in need of social services (Kim & Lee, 2009). The cognitive, emotional, and

behavioral effects of burnout include lowered concentration, feelings of depression

apathy, fatigue, anxiety, as well as increased mental health and physical disorders

(Berzoff & Kita, 2010). Excessive work-related stress and emotional exhaustion leading

to burnout can impair job performance including high absenteeism and a high turnover

rate as well as the capacity to work effectively and efficiently toward successful client

interventions and outcomes (Jenaro et al., 2007). The phenomenon of social service

worker burnout has raised awareness for the need of evidence-based interventions that

can promote self-care skills (Kanter, 2007, Jenaro et al., 2007).

Clearly, research demonstrates that mindfulness interventions has been

therapeutically utilized for a broad range of disorders such as chronic stress, anxiety,

depression as well as physical disorders (Shapiro et., 2007, Roth & Robbins, 2004). The

utilization of MBSR as a complementary practice along with traditional therapeutic

interventions can be useful in the reduction of stress, anxiety, and depression associated

with burnout (Cacciatore & Flint, 2012, Kabat-Zinn, 2003).

38

The introductory workshop proposed here can provide attendees with improved

coping skills and reframed reactions and responses to workplace and environmental

stressors through education and the application of relaxation techniques, simple yoga

activities, and creative visualization in the context of MBSR (Hozel, et al., 2011). As a

result of the intervention, participants will learn about the nature of mindfulness and

practice some of the skills to learn of its utility in promoting cognitive restructuring of

stressors to promote improved client service and job satisfaction, while preventing the

negative impact of job burnout (Hulsheger et al., 2013, Hozel, et a., 2011).

Project Description

The 6 hour mindfulness based stress reduction-training workshop will be a 1 day

workshop that will be held three times throughout the year at the Jewish Family and

Children’s Service center. The participants will be recruited through referrals from

various social service agencies in the Long Beach area and through advertising in The

Jewish Chronicle, which is distributed at numerous social service agencies throughout

Long Beach. Each workshop will consist of 15 participants who have expressed

symptoms of burnout or stress. The workshop participants will be screened by the

workshop coordinator to assess their eligibility and if the workshop will be beneficial for

them. If so, participants will be scheduled for the workshop accordingly.

The overarching goal of the workshop is to provide education on the values of

MBSR and to practice simple skills that can help alleviate symptoms of stress and

potential for burnout. The objectives of the workshop will be to:

1. Provide education regarding stress and burnout and their impact on both

mental and physical health; 39

2. Provide education regarding mindfulness-based stress reduction as a stress

reduction tool;

3. Provide mindfulness-based stress reduction skills to help increase coping skills

with work stressors.

A contracted specialist in mindfulness-based stress reduction will facilitate the 6-

hour workshop. The workshop coordinator will assist with all preparations pertaining to

the workshop as well as manage and address issues throughout the duration of the day.

Although the curriculum will be modified based upon the expertise of the contracted

trainer, the proposed topics to be covered during the workshop will address the following:

The first phase of the workshop will include the educational portion of the

workshop. This will include the causes and consequences of burnout and its

manifestation on the body and mind. This information delivered through lecture and

discussion will help participants develop an awareness of the situations that can lead to

burnout, the psychological and physiological reactions to stressors, and the stress

response cycle and how stress impacts personal well-being.

Next, there will be open discussion of personal experiences of the participants

regarding their personal work stressors. The purpose of this discussion will be for

recognizing the universality of feelings and sharing common experiences regarding stress

and the potential for burnout. Discussed with participants will be both the causes of

personal exhaustion and suggested alternatives for helping alleviate the symptoms of

these conditions.

Following this, the next phase of the workshop will focus on informing

participants about mindfulness-based stress reduction and its practical value in reducing 40

stress-related conditions commonly associated with burnout. The history of mindfulness

will be discussed and how the Buddhist tradition can be utilized today in helping

participants gain a better sense of control and mastery over their stress as well as their

emotional reactions to trigger situations they shared earlier. This information portion will

cover the purpose of mindfulness practice, how mindfulness can be utilized in decreasing

stressors, and simple techniques could help increase participants overall individual well-

being.

The next phase of the workshop will be the application of mindfulness techniques

to help alleviate symptoms of stress. The skills taught will include use of tools and

techniques of simple meditation through breathing techniques and creative visualization

as well as simple stretching techniques which are both low impact and non-assertive.

These exercises and tools will inform the participants about the utility of these practices

to help participants cope with their individual stressful situations.

Next, participants will process their feelings and reactions regarding the use of the

mindfulness-based skills techniques taught and how they might be applied to their life

situation. The facilitator will show the direct relationship to the practice skills taught and

how they can physiologically impact the overall mental health and physical health of

human service workers who experience excessive compassion fatigue.

The workshop will conclude with the participants engaging in discussion with the

facilitator regarding the usefulness of these techniques to their life situation. Also, the

participants will be asked to complete posttest evaluation materials in order to measure

their knowledge gained as a result of the workshop. Additionally, informational

materials on the home use and workplace practice of mindfulness techniques with further 41

resources will be distributed for follow-up if needed. The use of the techniques taught

and demonstrated throughout the workshop can help social service participants gain

awareness of mindfulness-based strategies to help alleviate their stressful situations that

also contribute to their feelings of compassion fatigue and job burnout.

Evaluation of Workshop

It is proposed that the MBSR training workshop will increase education regarding

stress and burnout as well as increase coping skills through the utilization of mindfulness-

based stress reduction techniques. In order to determine the effectiveness of the

workshop, a self-reporting questionnaire will be created for post evaluation. The

workshop participants, following the end of the workshop, will complete the

questionnaire for the purpose of determining if the participants had gained any

knowledge, skills and techniques, or personal insight regarding stress, burnout, and

mindfulness that was beneficial to them from the workshop. The questionnaire will also

allow participants to provide feedback and suggestions on which areas of the workshop

could be improved, information that would be of further assistance to participants and

how to improve the workshop for future use and participants. It is the objective of the

workshop to increase up to 90% participant education regarding stress and burnout as

well as increasing the development of skills and techniques that can be utilized for stress

reduction.

Budget Narrative

The determination of the direct cost for a mindfulness based stress reduction

training specialist for three workshops along amounted to $3,000.00, was calculated by

contacting various Los Angeles based mindfulness training centers that provide 42

workshops as well as individual mindfulness instruction and training. The workshop

coordinator, an MSW social worker, amounted to the direct cost with benefits @ 25%

amounted to $7,500.00. The conference room rental and equipment in-kind fees of

$1,950.00 are a contribution from the Jewish Family and Children’s Center. The indirect

costs of supplies such as handouts, post-evaluation forms, small journals for participant

note taking, and pencils were determined by office supply store estimates of $1,200.00,

and the indirect cost of refreshments and lunch for participants of $1,500.00 was

calculated by contacting various restaurants that provide catering in the Long Beach area.

The indirect cost of printing and advertising of $600.00 was determined by contacting

various printing shops and the community advertising office of The Jewish Chronicle.

The majority of foundation grant funding will apply to direct expenditures such as

the contracting of a mindfulness based stress reduction training specialist at $3,000.00

and the MSW workshop coordinator at $7,500.00 for the entirety of three workshops.

The remainder of funds will apply to indirect expenses such as printing, advertising,

refreshments, and supplies and materials as well as administrative costs.

43

TABLE 1. Itemized Budget for Mindulness-Based Stress Reduction Training

Expenses Amount In Kind

Direct Expenses STAFFING 1 Workshop Coordinator (MSW) $ 6,000.00

$2000.00 x 3 workshops Benefits @ 25% $ 1,500.00

1 Mindfulness Based Stress Reduction Specialist $ 3,000.00 $1000.00 x 3 workshops

TOTAL SALARIES WITH BENEFITS $10,500.00

INDIRECT WORKSHOP COSTS Printing and Advertising $ 600.00

$200.00 x 3 workshops Refreshments $ 1,500.00 $500.00 x 3 workshops Supplies (paper, pens, pencils, etc.) $ 1,200.00 $400.00 x 3 workshops Conference Room Rental $ 1,350.00

450.00 x 3 workshops Equipment $ 600.00

(office, laptops, etc.) 200.00 x3 workshops TOTAL INDIRECT WORKSHOP COSTS $ 5,250.00 TOTAL DIRECT AND STAFFING COSTS $15,750.00 INDIRECT WORKSHOP COSTS Administrative @10% $ 1,590.00 TOTAL WORKSHOP COSTS $17,340.00 Total Expenses $15,390.00

44

CHAPTER 5

LESSONS LEARNED

Review of the Study of Burnout

The social services profession is challenging and stressful for many social

workers and helping professionals. The nature of working in environments that can be

emotionally demanding leaves helping professionals to cope in the workplace with job

related anxiety such as emotional exhaustion, depersonalization, and a sense of

diminished personal job accomplishment (Maslach & Jackson, 1981).

Helping professionals that work in daily contact with the critical needs of their

clients have a high incidence of job burnout due to chronic labor stress. Stress impairs

job performance and the ability to work effectively and efficiently with clients and

colleagues alike (Jenaro et al., 2007). The significance of workplace burnout is critical as

it can be experienced across a broad range of social services and helping professions and

adversely affects the quality and consistency of client services (Kim & Lee, 2009).

According to Kanter (2007), the prevalence of social service worker burnout has

raised awareness for the need of increased evidence-based interventions. The

development of evidence-based programs that teach self-care skills to social workers and

helping professionals can contribute to decreasing stress and burnout. Self-care

workshops and programs can assist helping professionals at risk for emotional and

45

psychological problems relative to work stressors that lead to burnout as well (Shapiro,

Brown & Biegel, 2007).

A growing body of research throughout the last three decades suggests that the

practice of mindfulness contributes to the enhancement of psychological and physical

well-being and can decrease stress and anxiety (Shapiro et al., 2007). Mindfulness is the

practice of awareness of thoughts and feelings which are recognized in the immediate

moment and developing a nonjudgmental perspective of one’s own reactions and

responses to life’s stressors (Kabat-Zinn (2003). Meditation is one of many forms of

mindfulness practice. Mindfulness has been utilized therapeutically for a broad range of

disorders such as anxiety, depression, stress, and anger management (Roth & Robbins,

2004).

Grant Writing Process

The grant writing process is a new format of writing for the writer which required

an in depth study of grant writing through the analysis of previously published grant

proposals in order to develop and understanding of the format and requirements of grant

writing. The writer experienced a transition in writing styles from general research

writing to a form of technical writing. Grant writing is non subjective in context and

must be factually concise, clearly detailed in relevant literature pertaining to the chosen

problem to be addressed, the needs of the population affected must be detailed, and the

goals and objectives of the proposed intervention clearly defined and measurable for the

potential success of the proposed goal.

The grant writer developed new skills in researching for literature and data,

gained knowledge in searching for potential funding foundations, and also learned how to 46

refine internet and database research skills in order to obtain precise literature pertaining

to the proposed topic for the request of a grant. The process of locating various funding

foundations proved to be very interesting in examining the foundations goals and

missions as well as the types of recipients and agencies that received funding for a variety

of innovative interventions and projects. The foundation search process was also a

unique study of the criteria necessary simply to apply for a grant proposal.

Review of the Proposed Project

The proposed project in addressing burnout among social workers and helping

professionals was determined through research and discussion with other professionals

regarding the experience of workplace burnout. Through the combination of research

and discussions it became apparent that burnout was a serious problem that impacted the

quality and efficacy of a social service providers interaction with clients and colleagues.

The literature defined the symptomology of burnout as well as the negative

impact burnout ultimately has on service delivery and client interventions. The research

on mindfulness based stress reduction training revealed that professionals can gain

coping skills and techniques in addressing stress, anxiety, and depression in overcoming

challenging workplace stressors through mindfulness and positive awareness of their

personal responses and reactions to stressors. As a social worker, according to research,

developing an awareness of burnout and its repercussions is beneficial in developing an

increased professional perspective of the necessity for self-care.

Relevance for Social Work Practice

It is the goal of social workers to deliver effective and quality services to clients

and communities in order to gain the maximum positive interventions and goal outcomes. 47

Social workers provide resources, counseling, therapy, and crisis care in many respects,

yet often, due to the demanding nature of social work, self care is often over looked.

Although social workers are informed of evidence-based interventions for their clients

many do not practice personal interventions of self care to increase the quality of their

own well-being and personal lives. The writer feels that the promotion of self-

care in human and social services is critical to quality delivery of services.

The writer, through the research for this grant proposal, learned that there are

many negative factors relative to burnout and the impact it has on both the worker and the

delivery of services. For example; workers often engage in high risk behaviors, develop

mental and physical health problems, and contribute to a high rate of agency worker

turnover. It is also apparent that many social workers are not aware of the symptoms of

burnout and do not realize the consequences until burnout has increased negative

responses to stressors and a lack of interest in care and interaction with both client and

colleagues.

There is a broad range of research regarding the prevalence of burnout in the

workplace. Yet, there is limited research in alternative means for social workers and

those working in the helping professions to address their experiences coping with

burnout. The writer feels that it is critical to the profession of social work to be educated

in the area of stress and burnout as well as the necessary skills to be utilized in order to

prevent burnout and promote self-care.

Professional Development

The grant writer developed an increasing appreciation for the concise, factual, and

technical writing process and wishes to acquire further expertise in grant writing skills as 48

well as gain experience in collaborating with agencies, increasing knowledge of funding

foundations, and develop networking skills needed to acquire further knowledge of the

process of acquiring grants for increasing the funding for the development of

interventions and community projects.

The writer feels that the skill of grant writing is paramount to the enhancement of

social services. Developing skills and refinement in the area of grant writing is the goal

of this writer as research and writing are a significant aspect in the field of social work.

The writer’s intentions are to continue to develop skills in grant writing and seek out

innovative interventions and projects that will benefit the field of social services as well

as communities as a whole.

Lessons Learned

The writer feels that the grant writing experience increased her skills in seeking

out assistance, managing multiple tasks and workloads, as well as developing

mindfulness based coping skills for self care throughout the process of study and

literature research. The writer was inexperienced in writing grant proposals, but

throughout the process the writer continued to gain skills, increased motivation, higher

levels of personal discipline and determination to learn and grow from the demands of the

grant writing experience.

49

REFERENCES

50

REFERENCES

Acker, G. (2008). An examination of the relationships between workers and agencies: Charcteristics and three outcome variables: Burnout, role stress, and intent to quit. American Journal of Psychiatric Rehabilitation, 11(4), 295-309. doi: 10.1080 /15487760802186311

Acker,G. (2011). The challenges in providing services to clients with mental illness:

managed care, burnout and somatic symptoms among social workers. Community Mental Health Journal, 46(6),591-600. doi: 10.1007/s10597-009-9269-5

Acker, G. (2012). Burnout among mental health care providers. Journal of Social Work,

12, 475. doi: 10.1177/1468017310392418 Adams, R.E., Figley, C.R., & Boscarino, J.A. (2006). Compassion fatigue and

psychological distress among social workers: A validation study. American Journal of Orthopsychitary,76(1), 103-108. doi: 10.10370002-9432.76.1103

Adams, R.E., Figley, C.R., & Boscarino, J.A. (2008). The Compassion Fatigue Scale: Its

use with social workers following urban disaster. Research on Social Work Practice, 18, 238-250.

Awa,W., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of

intervention programs. Patient Education and Counseling, 78, 184-190. Berzoff, J., & Kita, E. (2010). Compassion fatigue and countertransference: Two

different concepts. Journal of Clinical Social Work, 38, 341-349. doi: 10.1007 /s10615-010-0271-8

Bourassa, D. (2011). Examining self-protection measures guarding adult protective

services social workers against compassion fatigue. Journal of Interpersonal Violence, 27(9), 1699-1715. doi: 10.1177/0886260511430388

Bride, B. (2007). Prevalence of secondary traumatic stress among social workers. Social

Work, 52(1), 63-70. doi: 10.1093/sw/52.1.63 Cacciatore, J., & Flint, M. (2012). Attend: Toward a mindfulness-based bereavement care

model. Death Studies, 36(1), 61-82. doi: 10.1080/07481187.2011.591275

51

Campbell, J., & Christopher, J. (2012). Teaching mindfulness to create effective counselors. 34(3), 213-226.

City of Long Beach Government. (2014). Home page. Retrieved from http://longbeach. gov/citymanager/maprogram/city.asp DeTienne, K., Agle, B., Phillips, J., & Ingerson, M. (2012). The impact of moral stress

compared to other stressors on employee fatigue, job satisfaction, and turnover: An empirical investigation. Journal of Business Ethics, 110(3), 377-391.doi: 10.1007/sl0551-011-1197

Fjorback, L., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124, 102-119. doi: 10.1111/j.1600-0447.2011 .01704.x

Gerber, M., Brand, S., Elliot, C., Holsboer-Trachsler, E., Ptihse, U., & Beck, J. (2013).

Aerobic exercise training and burnout: A pilot study with male participants suffering from burnout. BMC Research Notes, 6(1), 1-9. doi: 10.1186/1756-0500- 6-7849

Gethin, R. (2011). On some definitions of mindfulness. Contemporary Buddhism, 12(1), 263-279. doi: 10.1080/14639947.2011.564843

Granath, J., Ingvarsson, Sara., Thiele, U., & Lundberg, U. (2006). Stress management: A

randomized study of cognitive behavioural therapy and yoga. Cognitive Behaviour Therapy, 35(1), 3-10. doi:10.1080/16506070500401292

Hozel, B., Lazar, S., Gard, T., Shuman-Olivier, Z., Vago, D., & Ott, U. (2011). How does

mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537. doi: 10.1177/1745691611419671

Hulsheger, U., Alberts, H., Feinholdt, A., & Lang, J. (2013). Benefits of mindfulness at

work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. doi: 10.1037 /a0031313

Jenaro, C., Flores, N., & Arias, B. (2007). Burnout and coping in human service

practitioners. Professional Psychology: Research and Practice, 38(1), 80-87. doi: 10.1037/0735-7028.38.1.80

The Jewish Community Foundation of Los Angeles. (2014). Home page. Retrieved

November 30, 2014, from http://mindfulness based stress reduction training.jewishfoundationla.org/

52

Jewish Family and Children’s Service. (2015). Home page. Retrieved from http://www .jfcslongbeach.org/about.htm

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and

future. Clinical Psychology: Science and Practice, 10(2), 144-152. doi: 10.1093 /clipsy/bpg016

Kanter, J. (2007). Compassion fatigue and secondary traumatization: A second look.

Journal of Clinical Social Work, 35, 289-293. doi: 10.1007/s10615-007-0125-1 Keune, P., & Forintos, D. (2010). Mindfulness meditation: A preliminary study on

meditation practice during everyday life activities and its association with well-being. Psychological Topics, 19(2), 373-386.

Kim, H., Ji, J., & Kao, D. (2011). Burnout and physical health among social workers: A

three year longitudinal study. Social Work. 56(3), 258-268. Kim, H., & Lee, S. (2009). Supervisory communication, burnout, and turnover intention

among social workers in health care settings. Social Work in Health Care, 48, 364-385.

Kim, H., & Stoner, M. (2008). Burn out and turnover intention among social workers:

Effects of role stress, job autonomy, and social support. Administration in Social Work. 32(3), 5-25. doi: 10.1080/03643100801922357

Klink, J., Blonk, R., Schene, A., & Dijk, F. (2011). The benefits of interventions for work

related stress. American Journal of Public Health, 91, 270-276. Maslach, C., & Jackson, S. (1981). The measurement of experienced burnout. Journal of

Occupational Behavior, 2, 99-113. Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006). Bumout and risk

of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychological Bulletin, 132, 327-353.

Mosby, C.V. (2008). Mosby’s dictionary of medicine, nursing & health professions. New York, NY: Mosby/Elsevier.

Malathi, A., Damodaran, A., Shah, N., Patil, N., & Martha, S. (2000). Effect of yogic

practices on subjective wellbeing. Indian Journal of Physiology and Pharmacology, 44(2), 202-206.

Murugesan, R., Govindarajulu, N., & Bera, K. (2000). Effect of selected yogic practices on the management of hypertension. Indian Journal of Physiology and Pharmacology, 44(2), 207-210.

53

National Institute of Mental Health. (2013). Home page. Retrieved from http://nimh.nih .gov/about/index.shtml

Pasupuleti, S., Allen, R., Lambert, E., & Cluse-Tolar, T. (2009). The impact of work

stressors on the life satisfaction of social service workers: A preliminary study. Administration in Social Work. 33(3), 319-339. doi: 10.1080/036431009029 88141

Piet, J., Wiirtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on

symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80(6), 1007-1020. doi: 10.1037/a0028329

Ray, S., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology 19(4), 255-267. doi: 10.1177/1534765 612471144

Rossi, A., Cetrano, G., Pertile, R., Rabbi, L., Donisi, V., Grigoletti, L., & Amaddeo, F.

(2012). Bumout, compassion fatigue and compassion satisfaction among staff in community-based mental health services. Psychiatry Research, 200(2-3), 933-938. doi: 10.1016/j.psychres.2012.07.029

Roth, B., & Robbins, D. (2004). Psychosomatic medicine mindfulness-based stress reduction and health-related quality of life: Findings from a bilingual inner-city patient population. Journal of Biobehavioral Medicine, 66(1), 113-123. doi: 10.1097-01.psy.0000097337.00754.09

Schaufeli, W.B., Leiter, M.P., & Maslach, C. (2009). Burnout: 35 years of research and

practice. Career Development International, 14(3), 204-229. doi: 10.108/136204 30966406

Schwartz, H., Tiamiyu, M., & Dwyer, D. (2007). Social worker hope and perceived

burnout: The effects of age, years in practice, and setting. Administration in Social Work, 31(4), 103-119.

Shapiro, S., Astin, J., Bishop, S. & Cordova, M. (2005). Mindfulness-based stress

reduction for healthcare professionals: Results from a randomized trial. International Journal of Stress Reduction 12(2), 164-176. doi: 10.1037/1072-5245.12.2.164

Shapiro, S., Brown, K. & Biegel, G. (2007). Teaching self-care to caregivers: Effects of

mindfulness-based stress reduction on the mental health of therapist in training. Training and Education in Professional Psychology, 1(2), 105-115. doi: 10.1037 /1931-3918.1.2.105

54

Sharma, M., & Rush, S. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: A systematic review. Journal of Evidence-Based Complementary and Alternative Medicine, 19(4), 271-286. doi: 10.1177/2156587214543143

Showalter, S. E., (2010). Compassion fatigue: What is it? Why does it matter?

Recognizing the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue and strengthen the professional already suffering from the effects. American Journal of Hospice and Palliative Medicine, 27, 239-242. doi: 10.1080/15325020701238093

Sprang, G., Clark, J., & Whitt-Woosley, A. (2007). Compassion fatigue, compassion

satisfaction, and burnout: Factors impacting a professional’s quality of life. Journal of Loss and Trauma, 12(3), 259-280. doi: 10.1080/15325020701238093

United States Census Bureau. (2014). State and county quickfacts: Long Beach (city),

California. Retrieved from http://quickfacts.census.gov/qfd/states/06 /0643000.html

Weingart Foundation. (2014). Home page. Retrieved November 30, 2014, from

http://mindfulness based stress reduction training.weingartfnd.org/ home Wilmar, B., Schaufeli,P., & Maslach, C. (2009). Burnout: 35 years of research and

practice. Career Development International, 14(3), 204-220. doi: org/10.1108 /13620430910966406

55