As burnout, compassion fatigue, and moral distress continue to affect the health center workforce, the third season of the STAR² Center Talks Workforce Success Podcast presents insights, lessons learned, and first-hand experience in navigating and overcoming the challenges of these issues from those working in the field. In this episode, ACU’s Helen Rhea Vernier interviews Deirdre Hoey, LCSW-C, RYT200, Behavioral Health Therapist of Health Care for the Homeless in Baltimore, MD about creating, innovating, and sustaining programming for employee and client self-care.

Transcript by Rev.com

Helen Rhea Vernier: Welcome to the second episode of the third season of the STAR² Center Talks Workforce Success podcast series. I’m your host, Helen Rhea Vernier, Training Specialist at Association of Clinicians for the Underserved or ACU.

Helen Rhea Vernier: This season we’re focusing on employee self care and exploring how those in the field are engaging in successful, sustainable, organizationally supported self care and the impact that has on retention and recruitment. Today I’m talking to Deirdre Hoey, a Behavioral Health Therapist at Healthcare for the Homeless in Baltimore, Maryland. Thank you so much for being here.

Deirdre Hoey: Absolutely. Thank you for having me.

Helen Rhea Vernier: Could you introduce yourself and tell us a little bit about your organization?

Deirdre Hoey: Definitely. I’m a licensed clinical social worker and I provide direct care through individual therapy sessions and group therapy to people experiencing homelessness. I’m also a mom to three daughters, I’m a long distance runner, a registered trauma informed yoga teacher.

Deirdre Hoey: I started at Healthcare for the Homeless in the year 2000 when there were maybe 65 employees. I got the job over the phone by a conference call from Seattle where I was living at the time. I had experience as an outreach worker and counselor with people who struggled with severe mental illness and homelessness. I was a big fan of motivational interviewing and harm reduction philosophies, still am, which aligned with the agency’s mission at HCH. And I worked at Healthcare for the Homeless as a case manager and a therapist. I took some time off when my kids were little and I came back in 2012. I’m technically still part-time at 36 hours a week and now HCH has over 250 employees.

Deirdre Hoey: So Healthcare for the Homeless is a free standing nonprofit, privately qualified health center that works with people who are homeless or marginally housed. We strive to provide quality integrative healthcare to the whole person.

Deirdre Hoey: We were founded in 1985 as a three year demonstration project and it still exists today 36 years later. The National Healthcare for the Homeless Council has over 200 organizational members across the country. Though most are not as big as Baltimore HCH, we definitely are part of an extended family of people trying to combat homelessness.

Deirdre Hoey: Healthcare for the Homeless in Baltimore offers comprehensive services. A lot of these things were added over the years. I’m going to list them, there’s a lot: medical, behavioral health, psychiatry, outpatient addiction treatment, medication assistant therapy (which is Suboxone here), occupational therapy, pediatrics, outreach, benefits, convalescent care, and supportive housing. Whole slew of services and we try to also support clients through advocacy in the community and in state and federal levels of government through our engagement team on a more macro level of change.

Deirdre Hoey: So I’m not a manager myself, I’m sort of at the bottom of the hierarchy of supervisory flowcharts, but I have supervised graduate level social workers and I’ve had social work students in the past.

Helen Rhea Vernier: Great, thank you so much. So we met when you gave a presentation about the yoga program you lead at HCH. Can you give us a quick introduction to that program?

Deirdre Hoey: Oh definitely. So six years ago, a new yoga teacher approached HCH and offered to teach here as a volunteer but she needed someone on staff who was willing to organize the logistics. And I raised my hand, I raised it really high, I really wanted to do it, nobody else wanted to do it. So it was a good fit for me at the time I was leading meditation groups at HCH. I did that for like six years. And once upon a time I coordinated a yoga class at my kids’ elementary school so I knew that there was a potential to use yoga as a group in this population, but I wasn’t sure exactly how it would be done.

Deirdre Hoey: I figured out the stuff like room reservations and we collected gently used mats and the yoga teacher coordinated a GoFundMe for the props. We decided on a weekly afternoon practice. The yoga teacher led the practice and I assisted, so I helped the clients individually. So maybe someone needed something dry to wear, or they had a question, or maybe they needed a little extra emotional space to process things as rooms get quiet and thoughts get loud.

Deirdre Hoey: It was incredibly valuable to see the yoga teacher work with people as is. So people experiencing homelessness arrive in all states of being. We had acute intoxication, we had active psychosis, low frustration tolerance, physical limitations, extreme fatigue, everything, the whole spectrum of potential problems and issues, yet no one was turned away and everyone was welcomed.

Deirdre Hoey: The teacher plans adjusted a lot. There were trying to meet the needs of the people in the room, but the practice always seemed to help people re-regulate to a calm state. So I requested a second day for yoga group using some research as a treatment modality for depression and trauma. That was granted.

Deirdre Hoey: And then I had several HCH staff members who would come up to me and say, “Well what about us? What about staff?” Like, “Deirdre, I’m really stressed out. I could use some yoga too.” So we started a weekly lunch hour staff class on Fridays and we were recruited more yoga teacher volunteers at HCH. We had seven over the years.

Deirdre Hoey: In 2018 I completed my own yoga teacher training through the University of Maryland School of Integrative Health and I did 50 hours of trauma informed yoga teacher training in February of 2020.

Deirdre Hoey: So then in March of 2020 the pandemic hit. First the volunteers were not allowed in the building for safety. I taught the groups on my own and then they closed the schools and I realized, “Oo, they’re probably going to stop our yoga group really soon.” And I remember that last day of yoga, which was a Friday, and we had eight people on the mats and I told them, “You know, I think we’re going to be canceled on Monday. We don’t know yet, but I had a feeling.”

Deirdre Hoey: And at the end of the class, we usually agree to be this force of good in the world because we practiced yoga today and not a lot of people might have practiced yoga. But this time it was of an assignment and I asked the people to go forth and collect the stories of when they use their yoga practice as a force of good as we move through this pandemic. I had no idea how long this pause would be but they were in it to win it. These guys were like, “Yeah, sure let’s do it.”

Deirdre Hoey: The pandemic was incredibly hard on homeless people, especially those first days when agencies were closing their doors to people for in-person activities. HCH doors remained open, but there was limited services. And one client yogi, Maggie, saw me and said, “I got your story.”

Deirdre Hoey: Maggie said there was a client at HCH who was not able to be seen. He was a really large, intimidating kind of guy who was very angry, and agitated, and distraught and he didn’t know what to do next.

Deirdre Hoey: Maggie asked him to come and sit down next to her and just to breathe for a moment. And she told him that this was a good place and to come back tomorrow, and the man started to unload his troubles and just weep, and Maggie was able to console him. He released his tension, resettled, he thanked her profusely. She told him that she didn’t need the thanks, it was part of her mission and that she was connected to yoga. And she said this was her story and she wanted to make sure that I knew. Even if we weren’t having in-person classes, she was carrying forth that idea.

Deirdre Hoey: So after a month of no groups, we started back to staff yoga on the Zoom, not in person. And then in June of this year, after 15 months without groups, we started a client class again. Yoga was the first HCH support group to return to be safe in pandemic. It’s taught in a chair, and we keep six foot distance, and we limit to nine in the room, we wear masks.

Deirdre Hoey: People are also given a virtual option if they have the technology to join on a Zoom link. And so we have this big monitor in the room where people come in, and we come over, and we wave to each other through the cameras and they feel like they’re part of the community still even if they can’t come in person. So I’m really happy that we’re still able to offer this type of service to the folks here at Healthcare for the Homeless.

Helen Rhea Vernier: That’s so amazing. I love hearing about the program’s inception and how you were able to find ways to be flexible in the pandemic. And I especially love the story about Maggie and carrying the positivity of yoga forward and sharing it with the rest of the world. So how did leadership play into the creation and sustaining of that program, both your leadership as an individual staff person and the organizational leadership’s response?

Deirdre Hoey: I appreciate the leadership here. The leadership of my supervisors especially who gave me the opportunity to plant this yoga seed and to grow it into the community that it is. I don’t own it, but they allowed it to grow so we were allowed to do things that worked.

Deirdre Hoey: For yoga to work here, we had to kind of take it out of that westernized for-profit studio idea that’s commonly thought of for yoga for certain groups of people and expand it to everybody’s welcome. Clients who experience yoga here have an inclusive, accessible practice and we welcome marginalized communities. So people that say, “Hey, I used to …” And there was one guy who used to say, “I always wondered what they did in there.” As he looked from outside on the sidewalk not thinking he could ever go in and check it out himself.

Deirdre Hoey: HCH allowed me to use my tuition remission and professional development monies to obtain my own certification, which was extremely helpful and it helps me to lead the group safely. They also paid my liability insurance. There was a lot of encouragement and support from leadership which is invaluable to me. They’re kind of like cheerleaders.

Deirdre Hoey: As an individual staff member, I want to be that cheerleader to other people to grow into whatever they want to do that brings meaning and purpose to their lives. Whether it’s a colleague or a client to make meaning out of this experience of homelessness, which is often the greatest challenge of their life, is incredibly healing therapeutically in my experience.

Deirdre Hoey: So at yoga, we promote events that connect us like the consumer relations committee or the homeless person’s memorial day, or the HCH Rock Your Socks 5K. All those things are just a few of them but we share those opportunities so that people can use their voice to advocate for positive changes.

Deirdre Hoey: I also invite clients to participate in the National HCH Clinicians Conference, if I’m able to get my own proposal together, just as a way to share the experience and build hope in the other people that are experiencing homelessness.

Deirdre Hoey: One of the most devastating aspects of homelessness is the loss of positive human connections and a healthy support system. The social service delivery systems have oppressive bureaucracies and they’re almost impossible for anyone to navigate alone. Whether you’re a client or a staff, doesn’t matter, we are all better when we are actively willing to share knowledge and resources for the greater good.

Deirdre Hoey: My supervisor, Ellie, often says, “Help me understand how to support you in your work.” And I just love that. I wrote it down and I put it on my computer monitor so that it reminds me to communicate in that way too. We are all on the same team, we’re all supporting the good fight. What can I do to support you and your work? And it helps create this relationship where I can also communicate things that I might need for my work.

Helen Rhea Vernier: All right, so pivoting a little, what does self care mean to you?

Deirdre Hoey: Okay. Yeah, great. So I work a lot in self care. So self care is doing what you need to do to keep yourself in a calm, connected, safe frame of mind. And I’m really interested in Polyvagal Theory, which sounds complicated, but really makes sense when you notice people who encounter stress. So if you don’t mind, I’m going to talk a little bit about it.

Deirdre Hoey: Polyvagal theory can be called the science of connection and it relates to the nervous system. So a person’s nervous system works best when it’s flexible and mostly in a calm, thoughtful space. I think of this as flow. Technically they call it “ventral”.

Deirdre Hoey: In this state people greet each other, problem solving is easy, cooperation is abundant, life feels comfortable. It’s kind of like walking down the hallway saying hi to people and sharing cookies and, “Let’s go get coffee.” It’s real easy to connect.

Deirdre Hoey: Now when the nervous system picks up on stress or a potential threat, that peaceful executive functioning part of my brain shuts down and I start to look for signs of danger. And the body shifts into a way to protect itself rather than to connect to others, so I start getting into that fight, flight, or freeze response and my body reacts that way.

Deirdre Hoey: Yeah and I can logically think like, “Oh no, I’m at work.” But if I’m approached by somebody who’s agitated, I might automatically go into that, I call it “activation”. Sometimes people say, “triggered” but I kind of like activation because it sounds a little more normalized, that response. It’s an exhausting state to live in and it uses a ton of energy. And people that are here, there’s arguments, there’s accusation, fear is common, anger dominates. This is what happens when people are activated.

Deirdre Hoey: If you stay in activated too long, people’s nervous systems start to get in a state of depression or collapse, they often think of it as a shutdown. That’s the way I think of it. It’s also technically called “dorsal”. And in this state, this is where people get very isolated and it’s difficult to move at all.

Deirdre Hoey: All of these states are controlled by the nervous system and they call it polyvagal theory because there’s this vagus nerve that just winds around the different parts of the body to get it to respond in these ways.

Deirdre Hoey: So we at HCH, we meet a lot of clients who spend a lot of their time in activated or shut down states due to their constant exposure to dangerous unsafe environments. Their nervous systems become rigid, or stuck on, or stuck off and so it’s natural to feel activated when people approach you who are activated or shut down. But it’s also wise to learn how to keep your own nervous system healthy and flexible. And so back to self care, I’m not … I’m coming back there. I know it’s a short question but a long answer.

Deirdre Hoey: So self care means doing the activities that promote my own feelings of safety and connection; that flow state. So self care is individualized, it’s often discovered by trial and error about what feels good to people without causing harm to self or others.

Deirdre Hoey: Self care is positive activity that promotes a sense of wellbeing and connection. I’ve heard coworkers sing in their office; that’s self care. I’ve seen coworkers take walks around the building or outside at regular intervals during the day; that’s self care. I know coworkers who watch jellyfish swimming from the national aquarium cam, you know like a live cam; that’s self care. To do that in between clients because they want to get themselves back into that connective state so they can do their work better, whatever their work might be. So that’s a long answer to a short question, but thank you for following along.

Helen Rhea Vernier: Thank you for that explanation. So then recognizing that it’s this very individual thing and if you don’t mind sharing, what are some of your self care activities?

Deirdre Hoey: Okay, so I work in self care, I’m a big fan of it in my sessions with clients. So my own self care is daily, consistent, and ongoing. I am a work in progress always. You can ask my family, they’re most aware. I am on my own quest to live an examined life and I’ve noticed my self care activities have shifted over time.

Deirdre Hoey: So for example I said in the beginning, I’m a runner and I used to run alone, but I’ve discovered that it’s much more rewarding to run with people. So I try to run with people these days and it’s more connecting and more taking care of myself in those ways.

Deirdre Hoey: Another example is I would try to force myself to write a journal back in the day and I’d have like two pages done. Well I didn’t need to continue, I can just let that go. But nowadays I have a journal, I just love it. I filled out like a couple of them over pandemic, I’ve really spurred that on. So that’s become something for self care too that I’ve discovered.

Deirdre Hoey: I’m involved in a faith community in spiritual practices that keep my days on a path of peace, which is good for me. I have support groups and therapy of my own. I avoid sugar because I notice my mood crashes if I have a colossal donut. I laugh a lot, I’ve learned how to really enjoy those awkward moments of shared humanity; they make the best stories.

Deirdre Hoey: One of the things that I think has really helped me in my self care is … And gosh, I’ve done it for like five years, but I do “three good things” every day. So “three good things” is you write down three things that happened during the day, no matter how bad the day was, three good things that happened during the day and the reason that it was positive. Like it was tender, or maybe it was something that surprised you, or something that just made you feel purposeful. So you put the good thing, the word it made you feel, and you do that each day.

Deirdre Hoey: And I read this study once that said it helps with burnout. They did some doctors and they did this for a year and they discovered that the people who did it for a year, even after they stopped the practice, were still less likely to feel burnt out. And I think that that practice itself, of all my self care activities, that’s my favorite because it shifts my perspective so I’m always looking for something positive even in the midst of the negativity. And we see a lot of negativity so I got to really keep my mind sharp to what’s going on that’s good in this situation to not get my own heart kind of dragged down into whatever is worrying somebody or getting somebody activated themselves.

Helen Rhea Vernier: Thank you so much for sharing that. So again this is kind of a pivot, but what do you think is the relationship between trauma informed management and self care?

Deirdre Hoey: If you decide that you want to work in a place that serves people experiencing trauma, somewhere like HCH, I think, I feel, I believe in that it’s mandatory that you practice self care. And the reason that I’m really firm on that and I promote it for people is because a lot of people that I’ve known have come and gone from the field or they’re here, but they’re not really here. Their heart is not really well taken care of and it kind of shows because people might be getting into the overwhelming stress that they encounter from the clients and sort of taking it in.

Deirdre Hoey: I’m not trying to tell you how to do it but just that you do do it, that you have some way of taking care of yourself. So I believe that there is a responsibility in trauma informed organizations to let’s talk about it because if you don’t talk about it, it won’t get done and there’s a potential harm that you could be causing in your interactions.

Deirdre Hoey: I’ve seen interactions get explosive because there’s that activated meets activated and nobody’s backing down. So the ability for management to be able to promote self care and to consistently offer that as something as both a model and a cheerleader.

Deirdre Hoey: So I can tell you what to do but if I am, myself, never taking time for self care, then you’re not going to really believe me. You’re going to think you need to work tons of hours and never take a break and never take a day off because that’s the way that the manager’s doing it.

Deirdre Hoey: So humans like that mirror kind of behavior where we notice what people are doing themselves and we kind of take it in, that’s a very powerful way to change behavior. So both in as a model and then as that cheerleader who’s like, “What are you doing for your self care? That sounds great. Have you ever tried this?” Those kind of sharing of resources.

Helen Rhea Vernier: So beyond the yoga program that they support, what are some other ways that HCH, as an organization, supports employee self care?

Deirdre Hoey: I’ll speak to my own experience as an employee here in that regard. HCH has supported my self care by literally giving me time. They permit me to hold onto this part-time status that I have that helps me keep my life in balance. It’s 36 hours, but those four hours are really important to me right now for school pick up and all those kind of things.

Deirdre Hoey: As a direct care provider on my team, as in lots of different other parts of healthcare, we have an inordinate amount of paperwork that we have to do. And one example is during pandemic, our behavioral health team had a great increase in productivity. So there weren’t these gaps and no-shows, we had telehealth so we could get ahold of all of our clients and they all wanted to talk because everybody was feeling anxiety and stressed out.

Deirdre Hoey: Well in response to that high productivity, HCH gave us an hour of admin time every day just to help us balance the paperwork burden that we had to address and to give us a little wiggle room. And that made a big difference because we felt we were handling a lot more and then they were able to actually recognize it and shift our schedules to allow that to happen, so that made a big difference in my own personal self care.

Deirdre Hoey: Also my supervisor encourages me to take mental health days and she often reminds me if she knows something stressful’s going on at home like, “You go if you need to and we can cover this and do that.” It’s not that I often use it, but it makes a big difference when she encourages it, so I think that’s important.

Deirdre Hoey: Just the encouragement of career development and education makes me feel purposeful, and worthy, and invested in my agency. I think that makes a big difference so that people can see that the agency, the managers, are interested in the development of the humans that are working here.

Deirdre Hoey: We also have a staff wellness day, and an all staff holiday party, and smaller team gatherings that promote just that idea of team building so that you don’t feel alone when you’re tackling some of the oppressive systems and things and situations that we regularly encounter on a daily basis.

Helen Rhea Vernier: Wonderful. So my final question for you is while conversations around burnout, compassion, fatigue, and moral distress have become more commonplace throughout the pandemic, we know that this has been a growing issue in the healthcare workforce for a long time. So what can leaders and staff do to keep staff wellness at the forefront of their organizations, mission, and values?

Deirdre Hoey: That’s a great conversation to have. Okay, so healthcare workforce is only as good as the wellbeing of its staff and providers, period. I’m referring to everyone. I’m thinking about the screeners at the front door, to the security, to the IT folks, and the maintenance people, and the direct care providers all the way to the executive team.

Deirdre Hoey: There may be new technologies and state-of-the-art healthcare that people have, but if a client or a colleague feels unwelcome, mistreated, or ignored at this start, that healthcare will not be utilized at all. So relationships and communications are tremendously important especially for traumatized and marginalized populations and those who dedicate their lives, their work, their days to serving these communities.

Deirdre Hoey: So there’s depressive systems outside of HCH, there’s intense suffering, there’s injustice. And to say it feels like a war to live in extreme poverty, violence, and homelessness is not an over exaggeration in my view. So can we be a place of calm in the storm? Can we be a place of refuge? I think that we can but only if we’re staying in that safe flow state ourselves and keeping that as the way that we communicate with each other.

Deirdre Hoey: So if leaders want to prioritize staff wellness, their effort to communicate needs to be consistently welcoming, open, and intentional. The feeling of being seen and heard costs nothing, yet it makes an enormous difference to the state of the human condition.

Deirdre Hoey: So I can do many hard things if I understand the reasoning for the change or the shift and that it makes sense. And so that communication between managers and staff is just crucially important. Here at HCH we have six stated core values. I love them, they’re to guide our work here. But I love to read them or to look at them.

Deirdre Hoey: Here they are: dignity, authenticity, hope, justice, passion, and balance. And so on our website, it says, “We are centered on what’s good, right, and true.” And these are high standards, I get that. And it might be complicated, it might seem complicated, like how do you operationalize that? But I don’t think it’s really that complicated, I think it’s intentional and it keeps us on that path towards a greater good. That united sense of purpose is incredibly powerful as a team builder. And for this work, for this group of people, you need a team.

Deirdre Hoey: So it’s something … Whenever I notice people, we kind of get divided at times or we think like, “Why are they saying that and why doesn’t it match what I think?” And when I get into that … Because I’m human too, right? So we all get into that frame sometimes. Sometimes I’ll say to myself, “Unity, unity, unity.” Just to myself, just a little thing that I say to myself, “Unity, unity, unity.” To remind myself, “You got a team here, there must be a reason, it must make sense. Let’s just communicate and get to that clarity and that understanding.”

Deirdre Hoey: So when we think about how can leadership support this, I just think of that. That’s the core, that’s the foundation. And if we get that right, if we get the heart right, we can do all the other things, we can do all the other things. We’ll take care of each other, we’ll communicate better with the clients, we’ll be more effective, things will move more efficiently through the clinic. It’s a win-win situation as far as I’m concerned. So thanks for asking that question.

Helen Rhea Vernier: Yeah, of course. Thank you so much, that’s really beautiful. I love that. I want to thank you, Deirdre, for joining me today and sharing your wisdom on this topic. Thank you also for all the work you do at HCH.

Helen Rhea Vernier: To our listeners, thank you very much for joining us today for this episode of the STAR² Center Talks Workforce Success podcast series. We hope today’s conversation provided you with ideas, suggestions, and insight into ways you can approach, encourage, and organizationally support employee self care, wellness, and resilience at your organization. Be sure to check out all of our free workforce tools and resources found at chcworkforce.org.