How School Communities Can Address Compassion Fatigue & Promote Wellbeing
A Q&A with Dr. Shashank V. Joshi
Last month, Dr. Shashank V. Joshi joined us for a virtual meeting of the California Learning Collaborative on Alternative Education. In the conversation that follows, Dr. Kristin Geiser prompts Dr. Joshi to unpack the concept of compassion fatigue and offer his thoughts on how school communities can address secondary traumatic stress and promote wellbeing. Participants from 12 school districts across the state convened to hear his insights.
GEISER: What a pleasure to introduce you, Dr. Joshi, to this community and this community to you.
JOSHI: I am delighted to be with you, and I am happy to share some of what I have learned through my work as a school mental health team lead, a child psychiatrist, and most importantly, as a little league coach and a dad.
GEISER: As we begin the process of returning to school this fall, we are hearing quite a bit about compassion fatigue, both in school communities and in the press. What is compassion fatigue? What might we notice as symptoms or signs of compassion fatigue?
JOSHI: Compassion fatigue essentially describes a level of physical and mental exhaustion that one experiences while providing care for others. It might develop because the needs are complex, as is the case when trauma is involved, or because the duration of the caregiving is so long, or both, but it leaves one depleted and struggling to cope. In many cases, it’s a combination of secondary traumatic stress and burnout.
We can think of it in contrast to compassion satisfaction and wellbeing. As the school year starts, you may be feeling compassion satisfaction: some anticipation, some uncertainty, and a lot of hopefulness that we’ll continue our path to reopening. When compassion fatigue sets in, you start getting tired and you start avoiding some of the activities you would normally lean into, the ones that used to bring you positive emotion, engagement, and meaning. This is where you want to notice the signs and attend to self-care.
GEISER: Do you have any suggestions for how one should respond if they begin to notice these symptoms in themselves, their colleagues, or their staff?
JOSHI: There are individual wellbeing strategies that are helpful. We can increase our self-awareness of compassion fatigue and compassion satisfaction through education. We can develop our own resiliency, relationships, and sense of belonging. We can nurture practices of self-care and self-compassion and, if necessary, seek therapy or medical help.
But we can’t only rely on ourselves. We know from the literature in medicine that palliative care specialists have the most longevity of any physicians in the field. Why might that be? They’re engaging with patients and families at the end of their lives in incredible situations, with incredible stories.
When I give talks, I ask the audience: Do you think the palliative care specialists stay in it for the long haul because of the intellectual stimulation? Or is it because of the patients and their stories? Or is it because of the colleagues who they work with? Or is it something deep inside that maybe they can’t put their finger on but it just pulls them in? Most people pick the last one — it’s their calling — or they pick something about their patients’ stories.
In reality, the answer is: it’s the colleagues. The patients will come and go. They will cross over to the other side. The colleagues will continue to sustain you. The same is true for educators and students. Some students get back to us, some write us letters, some make gratitude visits, but most don’t. Hopefully they think of us at some point, but we remain here for each other.
Colleagues are shown to be the most important contributor for a great deal of compassion satisfaction.
GEISER: Conversations about compassion fatigue or burnout tend to frame it as something an individual experiences, and, in turn, something that an individual needs to address on their own. But your story of palliative care physicians highlights that there is a collective dimension to compassion satisfaction. What can a district or site leader do, at an organizational level, to effectively address compassion fatigue and promote wellbeing?
JOSHI: We really need organizational strategies that attend to our shared sense of wellbeing. As a site leader, one thing you can do is offer framing. The goal isn’t to eliminate stress or fatigue. These are part of life. What you want to do is build capacity for resilience. And this doesn’t just happen by navigating challenges.
There are things we can proactively do to cultivate wellbeing — individually, but also collectively, as a school staff or as a school community.
There are things that we do with one another — with our peers and our students — to build and maintain positive psychosocial supports. So, what are some ways that we can do this?
One way is through education and check-ins. School district and site leaders could provide education to help teachers and staff understand how to identify signs of fatigue in themselves or in a colleague, and to create space in staff meetings, department meetings, or grade-level meetings to check in with our peers on a regular basis. It’s important to have that feeling of being understood and contained by leadership. And, when someone experiences symptoms, it would be helpful for leaders to provide them with access to trauma-informed therapists and compassion-fatigue specialists.
The field of positive psychology provides us with a great framework for understanding and improving wellbeing, and we can bring in research-based exercises for supporting wellbeing into staff meetings. We can ask teachers and staff how they are engaging with things that they like to do, whether it’s interests or hobbies or maybe it’s relationships that bring joy and meaning. As school leaders, we can regularly ask people about how they cultivate their own wellbeing. Taking time to nurture these mindful practices and our relationships with each other can actually help us physiologically. It can reduce our stress hormone output and improve our health, and of course we all need that, especially now with the new school year having started.
Another thing we can do is engage our staff in a gratitude practice. I’ll give you an example. My nine-year-old son got a gift card for a new bubble tea restaurant. He rode his bike there with his friend, and he brought my favorite bubble tea home. I didn’t even ask him for it. He bought his friend a bubble tea, bought me a bubble tea — got my order right too — lychee black tea with extra boba and lychee jelly. I mean, how wonderful and beautiful, right? Why did that happen? What went well and why? Amidst my very stressful, deadline-infused week, I had this moment to say: I have a nine-year-old son who thinks about others. He loves me and I love him and what an important thing to remember. Reflecting on gratitude is a great way to start a staff meeting. Or to start or end the day with our students. The Greater Good Science Center at UC Berkeley has a wealth of resources related to gratitude available for those who are interested in learning more.
A technique called cognitive reappraisal will be familiar for anyone who has been in treatment for PTSD or secondary traumatic stress. This is the practice of not only learning how to feel emotions — but naming them. When you name the negative thought cycle, you are engaging the prefrontal cortex. It’s a very important neurological task. You can then override the amygdala where you’re stressed or you have anticipatory dread like “here we go all over again.” Simply naming the emotion is an important cognitive task that can help to mitigate the downstream effects of distress.
GEISER: We have been focusing on the importance of attending to compassion fatigue because doing so serves and supports our teachers and staff. I want to shift this just a bit to ask how this connects to students. When we support the wellbeing of our teachers and staff, in what ways are we also supporting our students? Can you tell us more about this and help us understand the connection?
JOSHI: In the days of the previous administration in Washington, we worked with a lot of students who were worried that their parents might be deported or their relatives might not be safe. These were everyday struggles that students were bringing to class. What students told us was: ‘School is my haven. School is a place where my teachers care. That’s my place of connection.’ For many students, their wellbeing is linked to their teacher’s ability to be present. So teacher wellbeing matters. It matters a lot.
When teachers have support — through individual wellbeing practices as well as an organizational culture that promotes wellbeing — they can be present for their students.
The social part is a great benefit to students, too. Hopefully now they’re going to get the everyday doses of wellbeing by being in school in person, engaging with their teachers the way they are most used to, and seeing their friends. The doses of wellbeing they get from coming to school every day — having the little conversations in the hall, eating lunch together even if they’re masked or indoors — will be so important for their mental health — but they will still be looking to the teachers and staff for that sense of belonging and safety.
GEISER: Any last thoughts for us as we head into the fall?
JOSHI: Dr. Amy Heneghan, a pediatrician, and I do talks together about primary care’s role in mental health. One of the strategies she talks about is “embracing the roller coaster.” We are getting news about increasing numbers everywhere from delta variant, but most places in California are still doing alright. We’ve learned so much and we just have to be ready for what’s happening next. There are numerous mitigation strategies now. Even before we had the vaccine, we were doing extraordinarily well in California school communities because of the guidance our public health officers provided and district leaders’ capacity to put that guidance into practice. I’m confident with the vaccination rates we have now — even with delta variant — yes, it’s going be a roller coaster — but we can embrace that, we can be ready.
GEISER: And, as you said, we can be there for each other. That’s a big part of being ready. John W. Gardner often spoke about cultivating a sense of “collective responsibility.” We know this approach serves young people well, but I appreciate how you reminded us today that this also serves and sustains the adults. Thank you for being our friend and colleague in this work.
JOSHI: Thank you for the intro to this wonderful group and I’m already hoping I get invited to another gathering because I really feel like, you know, these are my people!
Shashank V. Joshi, MD, FAAP, DFAACAP, is Professor of Psychiatry, Pediatrics and Education at the Stanford University School of Medicine and Graduate School of Education (by courtesy), and the Director of School Mental Health at Lucile Packard Children’s Hospital. Professor Joshi is a Faculty Advisor at the Center for Comparative Studies in Race and Ethnicity (CCSRE), the John Gardner Center for Youth & their Communities in the Graduate School of Education, and the Stanford Center for Asian Health Research and Education (CARE).
For more information on the Gardner Center’s work in the field of alternative education, please contact Dr. Jorge Ruiz de Velasco at jorge@stanford.edu. For more information on our work in the area of mental health and wellbeing, please contact Dr. Kristin Geiser at kgeiser@stanford.edu.
