Weitzman ECHO COVID-19 August 12, 2020; 12 Noon – 1:00 pm (ET) A Journey Towards Resiliency: Resources for Now, Later, & Long-Term from NYC Health + Hospitals Faculty presenters for this session include: Jeremy Segall, MA, RDT, LCAT; Sr. Director, Chief Wellness Officer, NYC Health + Hospitals Eric Wei, MD, MBA; Sr. Vice President, Chief Quality Officer, NYC Health + Hospitals

1. A Journey Towards Resiliency:
Resources for Now, Later, and Long-Term
August 12, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State Medical Society to
sponsor continuing medical education for physicians. The Bridgeport Hospital Yale New Haven Health
designates this live activity for a maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians
should claim only credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential Areas and policies
of the Accreditation Council for Continuing Medical Education through the joint sponsorship of
Bridgeport Hospital Yale New Haven Health and the Weitzman Institute. Bridgeport Hospital Yale
New Haven Health is accredited by the Connecticut State Medical Society to provide continuing
medical education for physicians.
• The content of this activity is not related to products or services of an ACCME-defined commercial
interest; therefore, no one in control of content has a relevant financial relationship to disclose and
there is no potential for conflicts of interest.
2

3. A Journey Towards Resiliency:
Resources for Now, Later, and Long-Term
from NYC Health + Hospitals
www.insidehr.com.au

4. 5,141,208 cases on 8/11/20 up from 4,771,080 cases on 8/5/20
164,531 deaths https://coronavirus.jhu.edu/map.html
COVID-19 by population, U.S.A.

5. 5,141,208 cases on 8/11/20 up from 4,771,080 cases on 8/5/20
164,531 deaths https://coronavirus.jhu.edu/map.html
COVID-19 by population, U.S.A.

6. Johns Hopkins Daily Video Update

7. Johns Hopkins Daily Video Update
• 60 second daily update – every morning
– USA: New cases; deaths; tested; positivity ratio
– USA: New cases (hot spots); hot States
– World: New cases (perspective)
• https://coronavirus.jhu.edu/covid-19-daily-video

8. News updates
• Mask efficiency: Number of droplets that emerged by type
– Least effective:
• bandana
• neck fleece or neck gaiter – created 10% more droplets than NOT wearing a
mask
• Russian vaccine now approved, despite not completing Phase 3
tests
– Putin: “It works effectively enough”

9. News updates
• No college football 😔
– “too much uncertainty regarding potential
medical risks to allow our student-athletes to
compete this fall.” - Kevin Warren, the Big Ten
commissioner
• Europe has problems:
– Cases double in France in 24 hrs
– Spain still struggling – ‘worst infection rate in
Europe’
– UK - 1,148 new cases 8/10 - highest since 6/21

10. Need to stay sane!
• Important Self care behaviors:
– Don't let work encroach on your time off...
– Make time for your family...
– Make sure you get enough sleep...
– Exercise...
– Eat a healthy diet

11. Resources
• Nuvance health:
https://spark.adobe.com/page/LPYqVcgQFwqqh/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

12. Our Journey Towards Resiliency
Resources for Now, Later, & Long-Term

13. Talk The Talk
To Walk the Walk

14. DEFINITIONS OF COMMON TERMS
Stress
A sense that
something is not right
and something needs
to change.
Distress
When the overwhelm
overwhelms.
Burnout
When stress,
distress, or disorder
leads to not being
able to cope at work.
Disorder
When you need
outside help.
Compassion
Fatigue
When burnout leads to a loss
of caring feelings for patients
and loved ones.
Trauma
Psychological and physical overwhelm from
stress.
Vicarious Trauma
The emotional residue of repeated exposure
to hearing trauma stories, witnessing pain, or
fear, terror, and trauma, leading to
psychological overwhelm.
Complex Trauma
Cumulative trauma often over
long periods of time (previous
+ current = too much).

15. DEFINITIONS OF COMMON TERMS
Coping
Mechanisms/Skills
Tools we can use to carry ourselves
through (positive or negative).
Resilience
A combination of support and care from
outside and within, plus positive coping
skills that allow us to heal after the crisis
has passed.

16. It Starts With The “Why”
The Platform is On Fire

17. COVID-19 PSYCHOLOGICAL STRESSORS
This leads to a new level of:
Anxiety
Depression
Burnout
Compassion fatigue
Helplessness/Hopelessness
Stress
Guilt
Healthcare teams
overwhelmed with
patients seeking
care & changing
guidelines
A new disease with
unclear treatment
Possible
transmissions of
disease to loved
ones
Potential “2nd Wave”
where staff could
be called back into
“battle”
Worries about PPE

18. URGENCY TO ADDRESS MENTAL HEALTH & WELLBEING

19. Dr. Lorna Breen
“I don’t know what
to do…”
“I can’t get out of
the chair…”
“She had something that was a
little bit different,” said her
colleague and friend Dr. Barbara
Lock, “and that was this optimism
that her persistent efforts will
save lives.”
“Tried to do a few very small things (like
unload the dishwasher) yesterday and
wondering if that was too much…”
“Just baffled and overwhelmed…”
“I’m drowning right now — May be AWOL
for a while…”
“She always had this glimmer in the
eye that was so welcoming and
always had so much energy and
enthusiasm,” Dr. Mills said.
“I couldn’t help anyone. I couldn’t do anything. I just
wanted to help people, and I couldn’t do anything.”
Dr. Lorna Breen
https://www.nytimes.com/2020/07/11/nyregion/lorna-breen-suicide-coronavirus.html?action=click&module=Top%20Stories&pgtype=Homepage

20. EXAMPLE OF STRESSORS
• Witnessing intense pain, isolation,
and loss on a daily basis
• Few opportunities for rest and
breaks
• Surge in care demands
• PPE (Lack of personal physical
safety, emotionally/psychologically
draining and disconnect from
patients/barrier, not feeling seen,
abandonment, physical
discomfort)
• Psychological stress in the
outbreak settings
Workplace (Pandemic)
• Remote learning is hard
• 24-hour childcare responsibilities
on top of work
• Can’t unwind with friends, go to
the movies, or any of the things
that typically relieve stress
• Having to be “on” all the time for
my family and friends
• Hard to stop my brain when my
head hits the pillow
Home
• Keeping my family safe
• Getting enough food and
medication
• Fear of dying
• Going back too soon
• Emotional fallout (can happen
after we recover physically)
• Constantly reading the news and
social media
• Lack of answers about the illness
and recovery
Quarantine

21. THE STRESS CONTINUUM
Distress
 Sometimes life is harder than
we expected
 We experience deep loss
(death of a parent or friend) or
a life change (divorce, health)
 Requires additional support
(some people seek counseling
or spiritual guidance to learn
additional coping skills, or
medication
Disorder
 Mental disorders are also
known as mental illness or
psychiatric disorders: PTSD,
Depression, Substance Use
Disorder
 Mental disorders are brain
disorders
 Assessed and treated by
behavioral health clinicians
with a variety of medications as
needed
Stress
 Happens to everyone, every
day
 General response to stressful
situations (tough commute,
work problems, moving, etc.)
 Most people develop coping
mechanisms (tools to get us
through the experience)

22. UNDERSTANDING CRISIS RESPONSE
Creating a program to address holistic needs
Thoughts
Behaviors Emotions
Situation
• Thoughts: What am I thinking
about during this situation?
• Emotions: What am I feeling?
• Behaviors: What did I do/not do?
• Physical: What do I feel in my
body? Where do I feel it?
• Spiritual: What do I believe? Did
my beliefs change after this
situation?
Source: https://www.massgeneral.org/assets/MGH/pdf/psychiatry/HSPH-COVID-19-mental-health-tips-3-11-20_kk.pdf

23. If You Build It They Will Come
The Road to Recovery

24. Tier 3
Helping Healers Heal H3
Providing Support To Your Staff
PROGRAM OVERVIEW
Helping Healers Heal (H3) is an employee wellness program
based on peer-support and expedited referral to critical resources.
It is designed to support your staff as they encounter challenges
due to working in a healthcare environment. H3 helps both
individuals and teams across all departments and disciplines,
both clinical and nonclinical. The program addresses a variety of
emotional and psychological needs that emerge when working in
a patient care setting.
1. Second Victims
Staff who are involved in an unanticipated adverse
patient event, in a medical error and/or a patient
related injury and become victimized in the sense that
the provider is traumatized by the event.
2. Compassion Fatigue
The condition of emotional and physical fatigue that
results when helpers feel compassion for those they
help but do not have adequate time away from caring
for others to refuel and care for themselves.
3. Vicarious Traumatization
The emotional residue that helpers accrue from
exposure to stories of trauma and witnessing the pain,
fear, and terror that trauma survivors have endured.
PROGRAM MODEL
The H3 model is composed of three tiers of support that, together, address the
varying needs of staff as they encounter challenging experiences in the
workplace. The model is both flexible and comprehensive, enabling staff to get
the support they need in the way that they find most helpful and comfortable.
WHAT WE BRING TO YOU
Our experienced trainers lead a cohort of peer support champions through an
interactive four-hour training. These champions will be equipped to address a
variety of H3 activations throughout your organization.
ADDRESSES THREE KEY CONCEPTS
TRAINING OUTCOMES
By the end of the training, participants will:
+ Understand how a healthcare
environment may negatively affect staff
and patients
+ Identify H3 activation opportunities
+ Conduct peer support H3 encounters
with individuals and groups
+ Apply H3 best practices
+ Identify when to escalate H3
encounters to the referral network
+ Understand the logistics and
infrastructure that support the H3
program
Want to learn more and bring H3 to your department?
Email us at HelpingHealersHeal@nychhc.org
T3
T2
T1
EXPEDITED REFERRAL NETWORK
+ Employee Assistance Program
+ Social Work
+ Clinical Psychiatry, Psychology
+ Spiritual Support
+ Community-based Resources
TRAINED PEER SUPPORT CHAMPIONS
Provide one-on-one and group
interventions, team debriefing,
empathetic support, and referral to
Tier 3 as needed
CULTURE OF SUPPORT
All staff has knowledge of second
victimization, compassion fatigue, and
vicarious traumatization, normalization
of discussing difficult experiences,
and supporting each other

25. EMOTIONAL & PSYCHOLOGICAL RESPONSE MODEL
Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K., Phillips, E., and Hall, L.W. (2010) Caring for our Own:
Deployment of a Second Victim Rapid Response System. The Joint Commission Journal on Quality and Patient Safety. 36(5):233-240.
TIER 1
TIER 2
TIER 3
Expedited Referral Network
• Employee Assistance Program
• Chaplain, Social Work
• Clinical Psychiatry, Psychology
• Domestic Violence Support
• The Wellness Center
Trained Peer Supporters
Provide 1:1 crisis intervention, group
debriefing, support, and referral to Tier
3 as needed.
Local (Unit/Department) Support
Everyone having knowledge of
crisis response, normalization of
discussing difficult events, and
supporting each other.

26. BENEFITS OF EMOTIONAL DEBRIEFING
CRISIS RESPONSE REFLECTION
WHY? HOW?
WHAT?
Emotional Debriefing
 Creates a space for reflective learning and helps us
understand how we have all been impacted
 Allows for an improved opportunity to make needed
changes, to engage all levels of staff, and to tend to
emotional and psychological needs of the workforce
 Supports the needs of staff to positively impact staff
burnout, attrition, dropout and engagement
 Improves environments and morale
 Establishes a structure for feedback from frontline staff
 Institutes a cohesive and standardized culture of
communication; enhances up-and-down/lateral
communication
 Assists with recognition of emotional commonalities
and shared experience
 Corrects cognitive distortions

27. HOW TO BUILD A
WELLNESS PROGRAM
GAP ANALYSIS
What is needed to build out all three tiers
of the program; what needs to be created
from scratch that’s not already there?
COMMUNICATION
PLAN
Determine multi-tiered plan to communicate
awareness of program and culture change to
leadership, general workforce, and
managers/supervisors, as well as to internal and
external partners
FIRST TRAIN-THE-
TRAINER
Identify participants, seeking wide
representation of departments, disciplines,
service-lines, shifts, etc. (including both
clinical and non-clinical)
IT INFRASTRUCTURE
Establish necessary IT support (e.g. intranet,
public internet page, electronic tools for tracking
and monitoring, feedback loop, referral resource
links)
GROW MORE
TRAINEES/PEERS
Establish a consistent facility-
based communication and
training plan, recruitment
strategy, and crowdsourcing
mechanism
GROW RESOURCES
Ensure equity and accessibility of
internal and external resources,
utilize feedback to fill gaps as they
emerge, expand anonymous outside
supports and internal expedited
referrals
SUSTAINABILITY
PLAN
Establish goals for all departments,
disciplines, shifts, etc.
SUPPORT THE
SUPPORTERS
Refresher courses, supervision
groups, wellness events, recognition
and celebration
BUILD A COALITION
Who are your innovators who can help
you implement? Cast a broad net to
include champions across disciplines,
departments, etc.
GOVERNANCE
STRUCTURE
Who should be on your steering
committee? Executive sponsor? H3
leads?
INVENTORY
RESOURCES
Which disciplines and departments have the
human capital to support the program?
What internal supports do you have for
referrals?
IDENTIFY
RISK AREAS
Where do you anticipate the program will
have the greatest impact and/or easiest
deployment? (e.g. ED, ICU, L&D, BH) Identify
crucial conversations.
QUALITY IMPROVEMENT
PLAN
Collect and utilize data to grow and improve
the program. Leverage data to identify trends
of risks, clinical outcomes, etc. to enable
proactive address
BURNING
PLATFORM
Build platform to activate and
engage; what info do you need to
gather to build the business case
and attain executive buy-in?

28. Time Is Of The Essence
Meeting the Immediate Needs of the Workforce

29. MANAGING TRAUMA-RELATED RESPONSES
 To offer consistently organized forums to validate emotions, thoughts, and
experiences – including the challenges associated
 To provide a structured way to effectively assess levels of post-traumatic stress
 To encourage continuous attention to emotional needs and vulnerabilities, as
well as highlight coping abilities and resources
 To ensure that effective strategies are promoted to maintain equilibrium and
healthy states of functioning

30. LEVERAGING H3 INFRASTRUCTURE
Office of Quality & Safety
System Chief
Wellness Officer
Acute H3 Leads
Post-Acute H3
Leads
Ambulatory H3
Leads
Emergency Clinical Affairs & Quality
Community Care H3
Lead
Service-Line H3
Steering Team
QCO Directors of Psychiatry
Patient Safety
Office of Emergency ManagementOffice of Behavioral Health
System Patient Safety
WEEKLY CENTRALIZED COMMAND CENTER CONFERENCE CALLS
Communications / Govt. Affairs
Executive Team
Incident Command
Enterprise IT Services
Facility-Based H3
Steering Team
Executive Team
Incident Command
Facility-Based H3
Steering Team
Executive Team
Incident Command
Service-Line H3
Steering Team
Executive Team
Incident Command
BHS Administrators
BHS Nursing DirectorsH3 Peer Champions
Volunteer Clinical Support Staff
QCO/Quality Lead Directors of Psychiatry
Patient Safety BHS Administrators
BHS Nursing DirectorsH3 Peer Champions
QCO/Quality Lead BH Champions
Patient Safety
Nursing DirectorsH3 Peer Champions
Volunteer Clinical
Support Staff
QCO BH Champions
Nursing DirectorsH3 Peer Champions
Volunteer Clinical Support Staff
Pastoral Care Patient Experience Patient Experience Patient Experience
Volunteer Clinical Support StaffPatient Experience
Workforce Development
Care Experience
Patient Centered Care / Nursing
Performance Improvement

31. COVID-19 Guidance &
Resource Page /
Intranet Wellness Portal
Just-in-Time
Crisis Response
Trainings
Anonymous
Counseling
Hotline
Wellness/
Mourning
Rooms
In-Kind Donation
Management
Proactive Unit-
Based Wellness
Rounds
Standing Debriefs
& Wellness
Events
Visual & Auditory
Management
Enhanced
Community-
Based Resources
NYC H+H WELLNESS PROGRAM COMPONENTS
Evolving the Holistic Health Infrastructure

32. A PUSH & PULL APPROACH
1:1 Debrief
(Telephonically/virtual with
Peer Support Champion)
Anonymous Counseling
(with Licensed Counselor at facility)
1:1 Debrief
(on unit/area or
Wellness area)
Socially Distanced Small
Group Debrief
(on unit/area, virtual, or
Wellness area)
Wellness/Respite Areas
(Rest/Relax/Grab a Snack)
Talk In
person?
BH Hotline (System-Wide)
We Call You! You Call Us!

33. H+H RESOURCES
 The COVID-19 Intranet Webpage is the one-stop-shop, centralized location for all COVID-19 needs including:
 Emotional & psychological support  Training resources  FAQs / Fact sheets
 Policy & procedural guidelines  Feedback / Information sharing  Clinical guidance

34. H+H & NYC RESOURCES
“Sometimes there's comfort in anonymity. Despite living in an era where people readily broadcast their innermost thoughts, not
everyone finds it easy to speak up, and that can especially be the case for some people who live with mental health issues.
While it's important to actively seek professional help, you can take baby steps by reaching out to confidential resources.
Though no one should ever feel ashamed to take care of their mental health, seeking totally anonymous help can be an easy
start for those who prefer to keep things private.” ~ Yohana Desta

35. A Look Ahead
Navigation & Mitigation for the Future

36. Phase 1
• Individualized Facility &
System Tools + Resources
• Training & Information
Sharing
• Optimizing Pre-established
Infrastructure
• Facility-specific Strategic
Planning
Phase 2
• Concrete Needs Assessment
• Macros System, Facility &
Unit-Based Gap Analysis
• Non-Mandatory Individualized
Frontline Workforce
Assessments
• Micro Optional &
Anonymous Individual
Assessments
Phase 3
• Improved Tiered Support &
Treatment
• Non-Clinical Screening
• Clinical Assessment
• Expanded Internal/External
Resources
NYC HEALTH + HOSPITALS RESILIENCE BUILDING

37. BUILDING WELLNESS & RESILIENCE CAPACITY
Peer Support Champion Directory:
Identify on-the-ground support that
is available to conduct standing
debriefs and enhance competencies
Tracking Training Status:
Determine the number of
persons that are trained to
date to facilitate standing
debriefs, wellness rounds, etc.
Staff Engagement: Consistently
engage, re-engage, train and refresh
staff in order to actualize wellness
goals
1
2
3

38. EXPECTATIONS FOR PROVIDING TRAINING & SUPPORT
Master Train-the-Trainers
 Register for all training modules
 Review videos and available toolkits
to reinforce knowledge and
understanding
 Clarify areas of uncertainty and
seek guidance to further develop
hard and soft skills
 Use subject matter expertise to
contribute ideas for expanding
support for program
 Collaborate internally to develop a
format and schedule to train
subsequent groups
 Initiate training in a timely manner
Peer Support ChampionsTrainers
1 2 3
 Accept meeting invitations in a
timely manner
 Participate actively in trainings
and fully engage in learning
 Utilize internal knowledge to
offer ideas for tailoring training
 Ask questions or share ideas for
responding to various situations
 Collaborate with Master Trainers
to initiate teaching for the
identified Peer Support
Champions
 Collaborate with stakeholders to
create streamlined dialogues
centered around responses to
traumatic events
 Communicate information about
wellness events & standing debriefs
 Serve as a facilitator or co-facilitator
for debriefing events
 Document emotional debriefing
interactions on the H3 Post-
Encounter Form

39. It has shown to have a positive effect on confidence,
morale, and commitment
Largely Developed by the US Armed Forces
That can provide informal emotional and psychological
support by acting as an outlet for a staff member to discuss
their experiences, their worries, and their stressors
A peer at work
Shared work environment and similar level of experience
and responsibilities. These shared characteristics help the
BB relate to the staff member and their situation.
Ideally will be matched based on
WHAT IS A BATTLE BUDDY (BB)?

40. ADDED RESPONSE MODEL LAYER
Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K., Phillips, E., and Hall, L.W. (2010) Caring for our Own: Deployment of a Second Victim Rapid Response System.
The Joint Commission Journal on Quality and Patient Safety. 36(5):233-240.
BATTLE BUDDY
WORKFORCE
BATTLE BUDDY
PEER SUPPORT
CHAMPION
REFERRAL
Local (Unit/Department) Support
Everyone has basic understanding around crisis response and the
importance of normalizing discussion of difficult events to better
support each other. Peers/colleagues are the first line of defense as
they can help to provide an outlet to share common experiences and
identify those who may benefit from additional support. A Battle Buddy
is part of this tier and lends support, connecting a colleague to a
structured debrief if needed/requested.
H3 Trained Peer Supporters
A Battle Buddy can assist in activating a formal debrief
with a Peer Support Champion that will:
Provide 1:1 crisis intervention, group debriefing, support,
and/or referral to Tier 3 as needed.
Expedited Referral Network
• H3 / Wellness Lead
• Psychiatry, Psychology, Social Work, Licensed Creative Arts Therapy
• Employee Assistance Program
• Chaplain Services
• External resource (i.e. – substance use, domestic violence, etc.)

41. ADDRESSING RACIAL INJUSTICES
The events across the country highlight the institutionalized racism that plagues our country.
There is a need to have a platform to discuss racism, but many don’t know where, or how to start.
 Facilitating these courageous conversations
can be daunting, but it is necessary to raise
awareness and understanding
 We are continuously collaborating with the
Office of Diversity & Inclusion to provide
supportive tools to facilitate these
conversations and encourage people of all
backgrounds to show up for one another
How have current events/racism impacted your
work or you personally?
What would you like your colleagues to know about
you? And about how racism has impacted you?
How can we support each other better? What actions
can we take?
Here are some questions to get the conversation
started:

42. Reminders For Self Care
Take Care of Yourself to Take Care of Others

43. CORE RESILIENCE BUILDING
Source: NYC Department of Health & Mental Hygiene

44. TOOLS FOR SELF CARE
Social Emotional Physical
Now
 Speak with a wellness staff
member
 Talk to your colleagues (we
are in this together)
• Practice grounding techniques
such as deep breathing
• Thought-slowing (observation
and thought attention)
• Take a short walk, even just to
the bathroom
• Stop and look out the window
Later
• Don’t be afraid to express
your feelings
• Reach out to a support
network
• Remind yourself to focus on
what is in your control
• Set boundaries with the news
• Move a muscle, change a
thought
• Prioritize getting enough sleep
• Maintain a healthy diet
LongTerm
• Utilize social support networks
• Engage in activities that you
enjoy
• Take part in counseling
• Take time for yourself
• Stay physically active
• Get enough sleep

45. Helpful Resources
Stay Informed to Inform Others

46. HEALTH SECURITY PUBLICATION
https://www.liebertpub.com/doi/10.1089/hs.2020.0091

47. HERO-NY TRAINING SERIES
https://www.gnyha.org/program/hero-ny https://www.gnyha.org/event/hero-ny-module-5-resilience-
wellness-program-development/

48. Meet the Facilitators
Connect & Become Acquainted

49. CONTACT INFORMATION
Eric K. Wei, MD, MBA
Sr. Vice President
Chief Quality Officer
NYC Health + Hospitals
Eric.Wei@nychhc.org
Jeremy Segall, MA, RDT, LCAT
Sr. Director
Chief Wellness Officer
NYC Health + Hospitals
Jeremy.Segall@nychhc.org

50. 50 * This initiative is supported by 50

51. Thank You!
www.weitzmaninstitute.org/coronavirus
51