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 Dr. Sarah Koerner, Director of Behavioral Health Services at Village Health Center at Father Joe’s Villages in San Diego, CA about the wide variety of what “self-care” means in practice and how she models that for her team. Additionally, Dr. Koerner underscores the importance linking efforts to increase diversity, equity, and inclusion with an organizational emphasis on supporting self-care.

Transcript by Rev.com

Helen Rhea Vernier: Welcome to the fourth 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 are 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.

Helen Rhea Vernier: Today, I’m talking to Dr. Sarah Koerner, Director of Behavioral Health Services at Village Health Center at Father Joe’s Villages in San Diego, California. Thank you so much for being here.

Dr. Sarah Koerner: Thank you so much for having me.

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

Dr. Sarah Koerner: Sure. So I’m Dr. Sarah Koerner. I’m a psychologist. I’ve been the Behavioral Health Director at Father Joe’s now for about three years. I work within the Village Health Center, which is a subset of Father Joe’s. Father Joe’s provides a wide range of services to people experiencing homelessness, everywhere from short to long term housing, lunches for anybody who needs it, education and employment services. They have a really neat job training program. They have a bike repair part of it. They have a gardening section. It’s fascinating. I could go on for days, but there’s also a full medical clinic, which includes behavioral health, alcohol and other drug services, psychiatry, and a full dental clinic, which is the little portion that I work in.

Helen Rhea Vernier: Great. What does self-care mean to you?

Dr. Sarah Koerner: I think most simply put, it’s doing the things that bring us joy and doing things to reduce our stress, our sort of general negative feeling states. The World Health Organization in their definition of it, add in taking care of our physical selves, which I also think is important. I don’t have a good crisp way to put all those together, but it’s some mix of increase joy, reduce stress, and take care of our physical bodies, because I think we forget that one with self-care.

Helen Rhea Vernier: If you don’t mind sharing, what are some of your self-care activities?

Dr. Sarah Koerner: Honestly, the biggest one is not as interesting in some ways, but I am the champion of not working off the clock. My staff and other managers and bosses will all tell you that I’m not up in my emails in the evenings. And a part of that is, I set boundaries around my time. As much as I can at work, I try to not triple book myself. Try not to because I do 50% client care and 50% admin, so it can get a little chaotic in my Outlook calendar, but I work very hard to keep it manageable chaos. Again, not three meetings and I’m trying to dip between all of them while also writing a note and none of it gets done. Luckily for me I have a good team where I trust my team, the managers cover, I provide coverage when I’m on, it all kind of flows.

Dr. Sarah Koerner: The more interesting answer I think you’re probably actually asking is, “What do I do to blow off steam?” And that is a wide range of very nerdy activities. If you think, “Man, what nerd activity?” It’s all of them. I read, I play video games, I paint, I have a monthly Dungeons and Dragons campaign with my friends. I travel when that is, and or was, possible. I spend time with my cats and my husband. I like things that are a little fantasy oriented, kind of let you dip out of the current reality for a bit, like a video game or like a Dungeons and Dragons.

Helen Rhea Vernier: Nice. Thank you for sharing. I love that answer. One of the things I’m trying to get out with this podcast is to show people the extremely wide variety of what self-care can be. So thank you so much for sharing that.

Dr. Sarah Koerner: It’s always my favorite question because I do our self-care presentations at work and my favorite piece of it is asking people what they do, how they take care of themselves. You learn so many interesting things and get some good ideas. Like, “I’m going to steal that one. I’m going to steal that one.”

Helen Rhea Vernier: Yes, absolutely. How can we talk about self-care without just putting another thing on the never ending to-do list and overburdening already busy employees/frontline workers?

Dr. Sarah Koerner: Because there’s nothing quite like telling people who don’t have extra time, “Hey, squeeze in this hour of yoga a week.” I think the answer to that is, there’s a couple pieces. One is by framing burnout not as a personal failing, which is often how, at least in upper class white American culture, everything is a personal failing. It’s all on you. “You didn’t do something so now you’ve ended up here.” I think the other is widening the definition of self-care. And honestly I think the piece for long standing stuff is pushing for some systemic changes that need to happen in order for people to be able to take care of themselves. Acknowledging those systems with people, I also find helpful. Stuff like improving access to healthcare, and a living wage, and championing for people to get better access to childcare, and all of these things.

Dr. Sarah Koerner: Issues surrounding DEI, all of these things impact our ability to feel okay and take care of ourselves. And so there’s systemic level stuff that I think as managers, as bosses, as organizations, we need to do and really show staff that we’re doing, because it’s important. And then, I think reframing self-care is another big one for folks. It often gets that kind of hashtag self-care, which in my head is the Instagram post of the thin white lady with a face mask and cucumbers on her eyes. And she looks just so calm. And that is what it is for some folks, for sure. Although I’ll be honest, the cucumbers I’ve never fully understood, but that’s an aside. Does it do something? Maybe. TV would have me believe it does, but self-care isn’t just that, it’s also working with staff to find ways to set boundaries at work or improve their communication in a way that works better for them so they can talk to coworkers, they can bring up things that are happening. They’re not just bottling everything up in a volcanic rage.

Dr. Sarah Koerner: It’s also incorporating 10 minutes. It doesn’t have to be this multi-hour thing a week where you take yourself to the spa, which sounds delightful and I’m really not trying to denigrate that, but do you have 10 minutes on your commute to work? Do you have 10 minutes in the shower to turn off a little bit? I have some people who, the 10 minute commute, they’ll do a podcast. I have some that just sit in silence. I find that personally horrifying, but it’s different for everybody and it really can just be stealing those moments when you have them because we don’t all have the same 24 hour day. We don’t all have that additional hour, but most folks have a few minutes here or there or again, framing the things they’re already doing. Taking themselves to the doctor, that counts.

Helen Rhea Vernier: Awesome. Thank you. So how does Village Health Center at Father Joe’s Villages as an organization, support employee self-care?

Dr. Sarah Koerner: They’ve got a couple of routes. One is general encouraging and building some systems in place for work life balance. Another is trying to highlight successes and another is helping people feel fulfilled by the work that they’re doing. So we’ll start with that one. So the thing with Father Joe’s is it’s a nonprofit, the folks are all there, the staff is all there because they want to make a difference. They want to work with people and help people. They can get a job elsewhere. They may pay better in the non nonprofit sector, but they’re here because they want to help and they’re giving people. So trying to find part of it is things like paying for trainings or providing space for trainings so people can feel like they’re bettering their clinical skills.

Dr. Sarah Koerner: I say clinical, my folks are clinical. True for nonclinical folks too. I don’t know what their trainings look like. I assume it’s a lot of billing codes, but anything that makes you feel like you’re improving and growing and being able to do the best job you can. Some of the helping people feel fulfilled is also actively listening to staff concerns and having an open door policy so you can make changes within the organization where you can, when needs grow. When people are feeling really stuck, maybe you need to create career pathways, you need to do something else because it’s not working. The highlighting successes, within the clinic, we have a kudo board, which is just where staff can highlight other staff and it gets a ton of traffic. And it’s just being able to call out, “Thank you so much for this. That was super useful.”

Dr. Sarah Koerner: Then all of those end up going back to the supervisor who then puts it in your yearly eval so it has a real concrete benefit to it. We also do multiple staff appreciation events and try to get staff feedback on what they care about. Sometimes it’s T-shirts, we did a scavenger hunt a few months ago outdoors. Trying to do staff appreciation events in COVID times has been a challenge. Personally, I have a relatively small team. It’s about 10 people. I like cards. I tend to, especially when we were all separated, writing cards or, “Thank you for this.” Or “You did this really well” and I’ll mail them to folks so people can get their feedback privately. The work life balance is the bigger one. That’s the big buzzword, I feel like, for a lot of the self-care stuff. It gets thrown around a lot without concrete things attached to it, I think, but for us, Father Joe’s has a lot of PTO that they offer, a lot of PTO, you’re accruing PTO almost immediately.

Dr. Sarah Koerner: There’s not a blackout period at the beginning. They just added, last year, 10 additional PTO days to cover holiday days. And that’s on top of the other stuff you’ve already got. We also, at least within our departments, work really hard to have the lowest barrier to using your PTO. There’s some places where you have all this PTO, you can’t take it or everyone gets mad. That’s not helpful so we try to have the lowest possible barrier to using your PTO. We recently started doing alternate work schedules so that folks could work nine hour days and take a day off to get stuff done during the week, every other week, trying to model the work life balance. Again, you can give all the PTO in the world, but if you as the boss never take it, your staff’s not going to take it either.

Dr. Sarah Koerner: And we do self-care presentations throughout the year, just so that folks know what they’re even supposed to be looking for. What is self-care? What is burnout? If you don’t know what you’re looking for, then it just sort of sneaks up and smacks you in the face, which is not helpful.

Helen Rhea Vernier: That all sounds amazing. It sounds like your organization is really focused on this, which is super cool.

Dr. Sarah Koerner: I am certainly very focused on it. So you are talking, I’m sort of champion to it, but the organization really is, again, we’re a nonprofit, we have limits to how much we can pay in a lot of ways so we have to make up for another arenas. I think this is one of the ways we do well or at least try to do well.

Helen Rhea Vernier: Yeah. Awesome. So this next question kind of leads off from that. Speaking of both you as a champion and then the organization finding ways to highlight this, but what role do you believe leadership plays in supporting and protecting the wellbeing and mental health of their workforce?

Dr. Sarah Koerner: I think we are responsible for decreasing the barriers to self-care as much as we can. So some of that, I can’t fix a staff member having depression. But I can make it as easy as possible, and again, without having any consequences to using the EAP or to taking the time off when you need to, or trying to shift around coverage in a way that is helpful. I think that’s a lot of it. A lot of it is people fix their own problems, but I can at least make that road easier. I think the other big one is, and I know I talked about it a few minutes ago, is modeling self-care. Again, if we’re not doing it, no one’s going to do it. And that’s that’s how you get the workplaces where again, everybody is always up in their email because that’s the expectation that gets set.

Dr. Sarah Koerner: So certainly for me, for us, it’s not working off the clock. It’s trying to have very good up front communication about things so that staff doesn’t feel like they’re out of the loop or like I’m hiding stuff, which then encourages them to do that with themselves and me, and the open communication helps. Less things fester that way. And yeah, actually taking my PTO, setting up good coverage when I’m gone, doing all of these things so the staff knows they can, they know it’s okay. It’s not like Mad Men where everybody feels like they have to be on the grind all the time.

Helen Rhea Vernier: Absolutely. Yeah. Thank you for sharing. So you mentioned this briefly earlier, but how are diversity equity, and inclusion, or DEI, and staff wellness or employee self-care linked? Can you tell us a little bit about that?

Dr. Sarah Koerner: It is linked in the way that the flip side of self-care is stressors and burnout. Inequality, lack of inclusion and diversity, all of the racism, ableism, homophobia, add the other 300 that are on that one, all of those are constant and chronic stressors for folks, which impact different people differently and at different times because they are such a complicated set of issues. So basically because the problems are individual level, like lack of seeing people who look like you in the management space, direct slurs from a client or staff member or coworker at work, and on a systemic level, communities having less access to healthcare opportunities, educational opportunities, decent paying jobs, safety where they live, that kind of stuff. So because you’ve got both of those, these aren’t things that staff are going to fix on their own or they’re not going to fix with self-care.

Dr. Sarah Koerner: I feel like sometimes self-care gets talked about like, “Well, you’re tired. Have you considered not using your cell phone for half an hour before bed?” And that will, again, it goes back to that thing of like, if you burn out, it’s your fault. I think this is a really good example of one of those things where this is a constant chronic stressor. This is a trauma informed care type situation. It needs to be thought of in that way, that it’s chronic, it’s longstanding, it’s multi-generational. I mean, there’s all of these things. And so what this brings up for me is the staff being able to come in and have these conversations when they need to, correcting you and your organization when things are wrong, hiring consultants to come in and figure out what’s not working so that all of the onus isn’t on staff, there’s all these steps that we can start to take.

Dr. Sarah Koerner: But what it can’t be is a staff member comes to you, a client has called them a slur and you go, “God, that sounds stressful. Have you considered yoga for an hour a week?” Which is, I think sometimes when we don’t quite know what to say is what’ll happen, which again, shows you’re not listening. And I think that’s a big piece of this. The only way to fix it is to listen. Short version is it’s a constant chronic stressor, which there is no nice, easy, clear solution for, and I’ll be honest, but I am fully of the opinion that in a system that is so entrenched in capitalism and inequality that taking care of yourself is a form of protest. Honestly, it’s a form of activism, which is much easier for folks that have resources and have a job that can give you PTO. Much easier for some folks to do than others. And even just still in those five minutes, to take care of yourself is huge.

Helen Rhea Vernier: I love that. Thank you so much.

Dr. Sarah Koerner: You can’t work with the homeless population and not come out of it seeing the inequality that is everywhere. You simply can’t. It’s such a fine line between, how can we help you take care of yourself in a way that still honors the fact that this isn’t your fault. And that’s hard. That language is hard. Because on the one hand, it’s not your fault. On the other hand, the system’s not going to make you feel less bad. You’re the only person that can do some of that on the micro level. There’s activism, there’s larger change, but it’s not immediate. It’s like, if I’m feeling anxious right now, the system’s not going to help me feel less anxious. It’s such a funky balance, I think.

Helen Rhea Vernier: Awesome. Well, that’s great. Yeah. That’s awesome. All right. Before we wrap up, is there anything else you would like to tell our audience?

Dr. Sarah Koerner: No, I’ve just enjoyed having the opportunity to get to brag on Father Joe’s and brag on some of our self-care practices.

Helen Rhea Vernier: Yeah, absolutely. Thank you so much for sharing and for being a leader in this space. I think it’s really one of the things I’m really enjoying about this podcast is, like I said, hearing the variety of answers and wisdom that people come with. And it gives me a lot of hope to know that there’s creativity and innovation in this space and that leaders like you are being thoughtful about how we encourage self-care and maintain the wellbeing of health center staff. So thank you so much.

Dr. Sarah Koerner: Absolutely.

Helen Rhea Vernier: Dr. Koerner, thank you very much for joining us today and listeners thank you for tuning in. We hope today’s conversation provided you with ideas, suggestions, and insights 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.