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Complete Guide to Building Resilience, Reducing Stress, and Avoiding Burnout.

Every health-care worker knows about burnout—the state of mental and physical exhaustion that results from overwork and emotional wear and tear. Even before the pandemic, providers across the health-care workforce spectrum have been at significant risk for the development of burnout, compassion fatigue, and isolation, not to mention substance use/abuse, post-traumatic stress disorder, depression, and suicide. As work demands have grown and the face of health care has changed, burnout has only increased among health-care providers. This has not only had a tragic effect on the lives of providers, it has also eroded patient trust, satisfaction, and health outcomes, and it has cost health-care organizations millions of dollars as they lose providers and are forced to recruit new people to fill the gaps.

Introduction to Resilience: Building Our Internal Resources is designed by health-care professionals for health-care professionals to help them ward off burnout, reduce their stress levels, and rejuvenate their passion for the profession they love. Resilience allows individuals to work with and transcend adverse conditions and events, often leading to personal growth and enhanced self-care. The field-tested contents of this workbook stem from Project ECHO’s multifactorial program on building resilience. This program entails webinar-like presentations, consultations to workplace programs in development, and workgroups in which health-care providers are presented with relevant material and given the opportunity to talk about their experiences in breakout rooms with matched peers. Introduction to Resilience: Building Our Internal Resources has been developed by analyzing the output of these workgroups—it captures the critical concepts presented during each week of the workgroup process, with links to videos of the actual presentations. These concepts can be used to help oneself build resilience skills or to teach these skills to others, either clients or peers, in an organization.

PLEASE give a copy of this workbook to a colleague in need!

Contributing Authors:

JEFF KATZMAN, MD; Medical Director of the Behavioral Health Professional Workforce Resiliency ECHO; Medical Director, Project ECHO Resilience Programs Emeritus Professor University of New Mexico Dept of Psychiatry; Director of Education, Silver Hill Hospital; Adjunct Professor, Yale Dept of Psychiatry Jeff is currently the Director of the Fellowship Programs at Silver Hill Hospital in Connecticut and holds leadership positions in the American Association of Dynamic Psychiatry and Psychoanalysis. He has recently retired as a professor of psychiatry at the University of New Mexico School of Medicine Health Sciences Center, where he also served as vice chair for Education. He has served as the medical director for the Project ECHO First Responder Program, a novel teleECHO program that shared best practices between clinicals and traditional and nontraditional first responders (NTFRs). He received his BA at Stanford University and went to medical school at the University of California, San Diego, before going to UCLA for his psychiatry residency. Jeff has studied improvisational theater for 30 years. He has used the techniques of improvisational theater to teach collaboration, spontaneity, access to the imagination, and the importance of play and a good time to patients, scientists, psychiatry residents, psychotherapists, and interdisciplinary leadership teams. His novel The Storymaker was a quarterfinalist in the Amazon Breakthrough Novel Competition. He lectures at conferences across the country each year on psychodynamic psychotherapy, attachment, and applied improvisation.

MATT DEBERNARDIS, MA, Community Resilience Campaign (CRC) coach at Silver Hill Hospital in New Canaan, Connecticut Matt brings a unique background to the campaign as well as a passion and energy for personal and professional development. In conjunction with the University of Pennsylvania and the Department of Defense, Matt’s experience includes training US Army soldiers and their families in resilience and psychological skill-building in Fort Hood, Texas. While there, he was responsible for developing curriculum and executing high-impact training for company-sized elements, which led to enhanced performance outcomes and fewer behavioral incidents. As a degree holder in psychology and sport psychology, Matt supports the CRC at Silver Hill Hospital as a subject matter expert in resilience coaching and performance psychology. Matt is a certified Police Officer Standards and Training Council (POST) instructor and has had the honor of consulting with business leaders, professional athletes, and Division I student-athletes and coaches.

LINDA GRABBE, PHD, APRN-BC, Family and psychiatric/mental-health nurse practitioner and professor emeritus at the Nell Hodgson Woodruff School of Nursing at Emory University Professor Grabbe is a board-certified Family and Psychiatric-Mental Health Nurse Practitioner, with expertise in mental health care for persons who have experienced trauma. Her focus is on teaching skills to promote mental well-being among persons with secondary traumatic stress or post-traumatic stress disorder. She currently serves as a health-care provider at Community Advanced Practice Nurses Clinic (CAPN), which provides services to medically underserved women, children, and young adults in Atlanta, and is certified to teach Dialectical Behavior Therapy (DBT) skills training and the Community Resiliency Model (CRM) with the goal of increasing resilience and mental wellness in at-risk individuals. During her 20 years as a clinical assistant professor at Nell Hodgson Woodruff School of Nursing, she trained hundreds of nursing students in traumainformed and resiliency-focused care. She works with Resilient Georgia to reach cross-sector human services providers in Georgia with CRM. Dr. Grabbe has brought CRM to over 6,000 persons in Georgia. As California’s Trauma Resource Institute’s Georgia Regional Consultant, she has built a cadre of over 100 CRM teachers who work to get CRM training to those who most need it: health-care workers, police, community groups, clinical and incarcerated populations, and underserved/marginalized groups. Professor Grabbe has published extensive research (including two randomized controlled trials) on the effectiveness of CRM’s somatically based skills for emotional self-regulation.

JOANNA KATZMAN, MD, MSPH; pain specialist in neurology at UNM Department of Neurology & director of Public Health Initiatives, the ECHO Institute Dr. Katzman is a Professor of Neurology at the UNM School of Medicine and has worked on ECHO programs since 2005. In 2008, Dr. Katzman began the ECHO Pain and Opioid Management teleECHO program at the ECHO Institute. This program has been replicated by the Department of Defense, the Department of Veterans Affairs, the Indian Health Service and over 30 academic medical centers and the province of Ontario in Canada. Dr. Katzman is an FDA special governmental employee and has served on two Institute of Medicine (IOM) Committees related to the Gulf War and Health. She is a past president of the Academy of Integrative Pain Management (formerly American Academy of Pain Management). In 2019, she founded the First Responders Resiliency ECHO Program. Currently, Dr. Katzman oversees the public health initiatives for the ECHO Institute. She has experience in programs focusing on resilience, substance abuse, behavioral health, climate change and human health, as well as community safety as it is affected by gun violence. Joanna. serves on the BHPWR hub team to provide expert guidance, mentorship, and support to providers working in rural and underserved communities.

ELIZABETH LAWRENCE, MD; professor, Department of Internal Medicine, assistant dean for Professional Wellbeing, chief wellness officer UNM School of Medicine Office of Professional Wellbeing Dr. Elizabeth Lawrence is a graduate of Yale College and Stanford University School of Medicine. She has lived and worked in New Mexico since 1995, when she moved there to begin her three-year internal medicine residency. She currently practices general internal medicine at UNM SOM, where she is also the chief wellness officer and assistant dean for Professional Wellbeing. Liz became a general internist because she cherishes the long-term relationships built with patients from age 16 to 103. Since 2013, her area of academic interest has been on clinician well-being. At that time, while in private practice caring for a large number of physician-patients, she became disheartened to see the toll clinical work took on doctors. She believes that we need to change the culture of medicine to one in which clinicians can thrive and experience joy in their practice. This change will only come about when we build a health-care system that puts primacy on patient welfare and relationships and not on productivity and paperwork.

SHANNON MCCOY-HAYES; MA, ABD, University of New Mexico, Albuquerque, New Mexico. Shannon has over 35 years of experience with primary and higher education, vocational training and academic research and support. She has worked with the California Conservation Corps, the California Department of Forestry, and for the last 20 years with the University of New Mexico (UNM) at the Department of Biology, the Department of Computer Sciences and now at Project ECHO for the last several years. Her areas of special interest are in student and trainee mentoring, resilience and success, community  cultural wealth, and cultural, scientific, and medical literacy within communities. Shannon has a BA in cultural anthropology, an MA in American Studies, and is currently all but dissertation in Education Leadership within the College of Education and Human Services at UNM. Her dissertation topic focuses on the lived experiences and persistence of female doctoral students in computer science.

ANKIT MEHTA, MD, FACP, SFHM Affiliation; Hospitalist, HealthPartners associate professor, Department of Internal Medicine, University of Minnesota Ankit Mehta is a hospitalist with HealthPartners and an associate professor at the University of Minnesota (UMN). He has a keen interest in the intersection of arts, humanities, and medicine. He co-created a one-day communication and empathy course, “CRAVE” (Communication, Resilience, Authenticity, Vulnerability, and Empathy) at HealthPartners for practicing clinicians. Dr. Mehta also directs a “medical improv” course, an adaptation of improvisational theater principles in a medical context to enhance skills including communication, empathy, and teamwork. He currently chairs the research committee for the National Medical Improv Collaborative group. He has presented at various regional, national, and international conferences. Dr. Mehta’s research is focused on the impact of improv training on communication, empathy, emotional intelligence, and uncertainty tolerance. Dr. Mehta is a member of the Editorial Review Board for the Journal of Patient Experience. He has been a part of the planning committee as creative arts/narrative medicine chair for the International Conference on Communication in Healthcare (ICCH) in 2021 and 2023. He has served on the Medical Executive Committee at Regions Hospital (St. Paul, MN) and the Patient Experience Council. Dr Mehta is passionate about graphic medicine as a powerful tool in medical education to teach self-reflection and empathy with easy accessibility and poignancy. His graphic works have been published in various journals (including JAMA and Annals of Internal Medicine) and magazines. His graphic story (in collaboration with Twin Cities PBS and UMN Medical School) was part of an Emmy-winning documentary, Speaking About Race.

KIMBLE RICHARDSON, M.S., LMHC, LCSW, LMFT, LCAC, is manager of business development and referrals with Community Health Network-Behavioral Health in Indianapolis, Indiana Kimble has a master’s degree in Counseling and Counselor Education from Indiana University and over 35 years of experience in health care. He is licensed in Indiana as a mental health counselor, clinical social worker, marriage and family therapist, and clinical addiction counselor, and currently serves as the board chair of the Indiana Behavioral Health and Human Services Licensing Board. He is a faculty member for the Community Health Network Psychiatry Residency Program and the APIC-approved Psychology Internship Program. He has provided training and consultation for the United States Postal Service Office of Inspector General, the FBI, the NCAA, and various state agencies and organizations. His work experience has been in emergency departments, crisis centers, partial hospitalization, intensive outpatient programs, and in leadership and business development, currently at Community Health Network. Kimble is a former Indiana “Mental Health Counselor of the Year,” “Distinguished Counselor of the Year,” and “Outstanding Faculty Member of the Year” at the University of Indianapolis. He has served as the clinical coordinator for several Critical Incident Stress Management (CISM) teams and is an Approved Instructor for four CISM courses. He coordinates Indiana’s District 5 Resilience and Emotional Support Team and is a member of the Indiana Mortuary Emergency Response Team and several crisis intervention teams. Kimble has given presentations at the World Congress on Stress, Trauma, and Resilience; the National Healthcare Coalition Preparedness Conference; the National Nursing Management Congress; the National Neonatal Association; and the Global First Responder Summit.

STEVE XENAKIS, M.D., Brigadier General (Ret), U.S. Army, Community Resilience Campaign (CRC) coach at Silver Hill Hospital in New Canaan, Connecticut Dr. Xenakis is an adult, child, and adolescent psychiatrist with many years of clinical, academic, and management experience. He retired from the U.S. Army in 1998 at the rank of brigadier general and entered an active career in start-up medical technologies and clinical practice. He has advised the chairman of the Joint Chiefs of Staff and other senior Department of Defense officials on psychological health, the effects of blast concussion, and suicide. During his career in the Army, he pioneered the introduction of telemedicine applications including the development of a device for electronic house call services. He has an active clinical and research interest in promising medical technology, including quantitative electroencephalography (qEEG). He founded the Center for Translational Medicine to develop treatments and conducts tests on brain-related conditions affecting soldiers and veterans. Dr. Xenakis has numerous medical publications and is an adjunct professor at the Uniformed Services of Health Sciences of the military medical department. He has served on the Executive Board of the Center for Ethics and Rule of Law (CERL) at the University of Pennsylvania since 2014. Dr. Xenakis is a graduate of Princeton University and the University of Maryland School of Medicine.