Introduction
A heightened recognition of self-care has come about as a result of the devastating mental health impacts of the Covid19 pandemic and of the racial justice uprising following the murder of George Floyd (Kamp Dush et al., 2022). These tragic and traumatic societal events led to a global recognition of a mental health crisis that threatened numerous communities and populations (Torales et al., 2020). New York City (NYC) college students were among those most impacted by the pandemic, most of whom reported increased depression and anxiety symptoms due to life disruptions, losses of friends and family members, and profound decline in work-life balance (López-Castro et al., 2021).
Burnout among helping professionals in the human services is well documented (Lizano, 2015), and has increased recently due to growing service complexity, disruptions, and political uprisings (Holmes et al., 2021). Human services professionals were on the frontlines of these crises, especially in NYC (the “epicenter of the Covid19 Pandemic”), providing services in person, remotely, and through tele-health modalities. As a result, in NYC, frontline workers were acutely vulnerable to “burnout” because of the high emotional toll of the work environment (Feingold et al., 2021). Escalating challenges require a concerted effort on the part of educators to reckon with the ethical imperative of preparing students to prioritize their own well-being unlike in years prior (DeMarchis et al., 2022). According to the NOHS Ethical Standard 35: “Human service professionals strive to develop and maintain healthy personal growth to ensure that they are capable of giving optimal services to clients. When they find that they are physically, emotionally, psychologically, or otherwise not able to offer such services, they identify alternative services for clients” (NOHS, 2024). Therefore, students who are at once providing services in their field placements, and studying to become ethical practitioners, must be provided with instruction and opportunities to develop self-care practices of their own. Since faculty and students who are in field, providing direct services as human services workers-in training, are bound by the NOHS Ethical Standards, it is incumbent upon faculty to reinforce, through practical application, the practices necessary to support self-care and wellness.
Burnout leads to poor mental (O’Connor et al., 2018) and physical health (Kim et al., 2011), reduced ability to provide quality services to clients (Wilson, 2016), poor work performance (Paris & Hoge, 2010), and ultimately high turnover (Campbell et al., 2013; Yanchus et al., 2017). For workers providing social and psychological care on the frontlines, practicing self-care and prioritizing wellness has been shown empirically to mitigate the damaging effects of burnout and compassion fatigue (Cuartero & Campos-Vidal, 2019).
Burnout manifests in several ways: compassion fatigue, countertransference, vicarious and secondary trauma, and moral distress (Smullens, 2015). These phenomena may be experienced by students in the field placement, workplace, or through exposure to sensitive themes in academic coursework (Butler et al., 2017; Knight, 2011). Students are particularly vulnerable in their field placements because, usually they lack professional experience and possess insufficient coping strategies and an inability to establish boundaries between the personal and professional (Newell & Nelson-Gardell, 2014).
The Council for Standards in Human Services Education (CSHSE) specifies in educational Standard 19, that students ought to develop “strategies for self-care” and “self-awareness”(Council for Standards in Human Service Education, 2020) signifying the importance of incorporating self-care pedagogy as a core feature of the curriculum. A growing body of literature offers self-care practices and strategies for graduate students (Lewis & King, 2019; Moore et al., 2011; Napoli & Bonifas, 2011). Some have offered suggestions on how to integrate self-care for undergraduate students online (McCarthy, 2020) and in-person by using Photovoice, a research methodology that relies on analyzing students’ photographs (Micsky & John-Danzell, 2021). Despite its acknowledged importance, there is a paucity of research on faculty practices teaching self-care to undergraduate students who are entering the human services workforce. This exploratory study aims to shed light on the perspectives and practices of undergraduate faculty who are supporting students navigating human services careers in a post pandemic environment.
Study Setting
This study was conducted online at the largest public city university system in the United States. Undergraduate students and community college students in this system often come from underserved populations (Office of Institutional Research and Assessment, 2018) and are disproportionately impacted by financial hardship (Sandoval-Lucero et al., 2014). Among all students, 30.2% identify as Hispanic, 21.2% as Asian/Pacific Islander, 25.2% as Black or African American, and 23.1% as white and 45% of the student population represents first-generation college students (Office of Institutional Research and Assessment, 2020).
The COVID-19 pandemic has exacerbated a mental health crisis among students nationwide (Salimi et al., 2021), and college students mental health diminished dramatically (Pinkney, 2021). The majority of undergraduate students in NYC reported significant financial hardship as result of the pandemic, food and housing insecurity, half reported symptoms of anxiety/depression and half reported needing mental health services (Jones et al., 2021). Student support services have been emphasized through investment in counseling staff, social media, and promotion of campus wellness activities. The literature on student self-care has proliferated (Liu et al., 2020). Understandably, overburdened, stressed, students report that self-care is another “chore” that they are unable to accommodate in their schedules (Diebold et al., 2018).
Undergraduate students are required to complete an intensive year-long internship (otherwise known as “field placement” or “practicum”) in a human services agency. This internship provides a rich platform for acquiring job skills, competencies, and for professional identity development (Spector, 2022; Wayne et al., 2010); however, it also exposes students to burnout, stress, and vicarious trauma (Collins et al., 2010) which can lead to academic disengagement and exhaustion (Benner & Curl, 2018). There has been a call to action for advancing self-care with students in general (Kahm, 2019) and students in field placements specifically (Griffiths et al., 2019). Thus far, the literature has focused primarily on graduate students (Bamonti et al., 2014; Zahniser et al., 2017). This study offers insight on undergraduate faculty practices, perspectives, and needs in integrating student self-care.
Methods
The study sample included faculty (adjunct and full-time) who teach undergraduate students completing human services agency field placements, from human services, social work, counseling, and community psychology, departments across five community colleges and seven four-year colleges within one university system. Human services are broadly represented by the aforementioned departments by virtue of their curricula which share the key feature of requiring students to work in a human services agency for two semesters, under the close supervision of a senior level human services practitioner. Courses taught across the human services, social work, community psychology, and counseling departments equip students with foundational counseling, case management, assessment, and treatment planning skills that entry level human services careers require. A list of potential participants was generated by contacting department chairs by email and requesting the email addresses of faculty who teach students in field placements, which included all faculty who teach practice classes. Faculty who are on sabbatical or not teaching in the current semester were excluded. The study was approved by the University Institutional Review Board.
Procedures
Faculty were invited by the PI, by email, to complete a survey through a SurveyMonkey link sent to their institutional email. The email explained the purpose of the survey and stated that the source of funding was an internal University grant. Faculty participants were informed that the survey would take approximately ten minutes to complete and that they would receive a fifteen-dollar Amazon gift card by email. Faculty participants were provided with the PI’s email address if additional information was needed. Participants received a bi-weekly email reminder to respond to the survey until data collection closed. A total of five emails were sent out over the course of three months.
Survey
The cross-sectional quantitative survey contained Likert style questions on a six-point scale, multiple choice questions, and yes/no. The scale was deliberately established so as not to include a neutral response, eliminating the possibility of an ambiguous answer. The nature of the questionnaire was such that a faculty member who teaches students participating in field placement internships, would be able to provide an informed view on each item. (See Appendix A).
Questions included perspectives on self-care needs of students, current pedagogical/teaching practices, resource needs for professional development, and potential barriers to teaching self-care. Specific areas/types of self-care referenced in the survey come from the Health Promoting Lifestyle II validated (Walker et al., 1987) questionnaire. Questions for the survey were adapted from the aforementioned questionnaire and modified through an iterative process as follows. The survey was read by a team of human services faculty and a graduate student trained in survey research by the PI, who graduated from the University’s human services program. After careful reading, the team held a series of focused discussions where questions were adapted to a faculty audience. The survey was pilot tested with two faculty members who had not previously seen the survey. Focused discussions and pilot testing confirmed that faculty would be able to answer the questionnaire, and particularly the Likert-style questions, which did not offer a “neutral” option. Questions were subsequently edited for clarity. Redundancies were eliminated and questions that had multiple parts or contained conjunctions were separated into individual items.
Analysis
Quantitative survey data were analyzed using SPSS. Descriptive analyses formed the basis of the analytic strategy. As this is an exploratory study, findings were reported by tabulating results. Some Likert scale findings were collapsed into two categories: Affirm (strongly agree, agree, somewhat agree) and Deny (Strongly disagree, somewhat disagree, disagree).
Results
The survey was sent to 140 faculty. Forty-nine faculty completed the survey. The response rate was 35%. Twenty-seven respondents identified as white, eight as Black/African American, eight as Hispanic/Latino/a, three as Asian/Pacific Islander, one as American Indian/Alaska Native, and two as another race. Thirty-eight identified as female, eight as male, and three did not state their gender. Below, are the results by domain of inquiry.
Perspectives on Student Wellness
Forty-five (92%) faculty respondents affirmed that their students experienced mental health challenges. Thirty-eight (77%) affirmed that their students experienced physical health challenges. Forty-seven (96%) affirmed that since the pandemic, students’ challenges have increased. While it is not possible to make a causal inference, overall faculty perceived that students were impacted in a variety of ways as a result of a changed post-pandemic social and academic landscape.
When asked about students in human services and related fields of study, forty-two (86%) faculty affirmed that students in their departments experience stress related to being in the field. Forty (82%) affirmed that students’ field placements expose students to vicarious or secondary trauma. However, despite experiencing stressors unique to human services work, faculty were mostly optimistic about the support that is available to students. Twenty-six (81.2%) faculty agreed emphatically (“strongly agree” and “agree”) that students receive sufficient support from their field placement supervisors, and while 15 (88.2%) were less certain and responded, “somewhat agree”. In general, most faculty consider field placements to have an adequate level of management and oversight.
Similarly, twenty-four (50%) faculty stated, “somewhat agree” when asked if students receive sufficient support from the University’s counseling services, while thirteen (26%) stated “agree” or “strongly agree”. Forty-six (94%) faculty affirmed that students receive sufficient support from their college professors. Most expressed approval for the level of support available to students, however, approval was least enthusiastic in the areas of field placement supervision and University counseling services. Faculty were most confident in the level of support that students received from their professors.
Self-care in the Curriculum and Course Materials
Forty-three (88%) faculty affirmed that self-care should be integrated into all courses at the University. Nearly all faculty (forty-eight, 98%) affirmed that self-care should be integrated into all courses in their departments. Forty-four (90%) reported advertising campus wellness resources in their syllabi, while only twenty-eight (57%) posted resources on Blackboard, the course management system. No faculty included resources in their electronic signatures. Only sixteen (33%) shared off-campus resources with students. While most faculty believe in including self-care across their courses, many do not provide resources in their materials outside of the course syllabi.
Classroom Practices and Pedagogy
Twenty-two (45%) faculty reported assigning self-care homework as follows. Twenty-five (51%) assigned mindfulness, 18 (36.7%) assigned social connection, 17 (34.7%) assigned listening to music, 14 (28.6%) assigned meditation, nine (18.3%) assigned outdoor recreation/physical fitness, nine (18.3%) assigned nutrition, six (12.2%) assigned volunteering, five (10%) assigned spirituality, and none assigned dancing. Nineteen (39%) faculty asked for evidence of having completed the assignment (e.g. writing, photograph, video). So, while nearly all faculty consider self-care to be important, fewer than half actually include any assignments, and even fewer ask students to provide documentation of having completed the assignment. Students may therefore be encouraged verbally to engage in self-care activities, but we can infer that they are not required to do so, nor that class credit is given for doing so if there is no documentation or evidence to submit.
Faculty were also asked about the topics covered in classroom discussions. All of the faculty reported discussing healthy eating, healthy relationships, sleep hygiene, social connections, spirituality, meditation, finding meaning, physical activity, hobbies, counseling, relaxation, and being connected with a healthcare provider. Classroom discussions may have varied widely in quality, depth, and frequency. The data shows that classroom discussions did not correspond with assignments. Therefore, while students may hear varying messages orally promoting self-care practices, the messages are not, in many cases, reinforced with actual assigned activities.
Professional Development Preferences
Forty-two (85.6%) faculty stated that they would like resources to help them integrate self-care into the curriculum. Thirty-seven (75.5%) faculty stated that they were likely or somewhat likely to attend an in-person workshop. Forty-six (93.9%) were likely or somewhat likely to attend an online synchronous workshop. Forty-three (87.8%) were likely or somewhat likely to watch a recorded webinar. Forty-five (91.8%) were likely or somewhat likely to use prepared lesson plans. Forty-seven (96%) were likely or somewhat likely to use prepared activities for in class and outside of class work. Forty-seven (96%) were likely or somewhat likely to offer referrals to campus wellness. Forty-five (91.8%) were likely or somewhat likely to offer referrals for off campus wellness. In general, faculty expressed openness to any resources that could help them integrate self-care into their courses, with in-person workshops being less favorable than online. Written materials (e.g., lesson plans, homework assignments, referrals) were overwhelmingly of great interest.
Perceived Barriers
Twenty-three (47%) faculty stated that students’ lack of interest and thirty-three (67.3%) stated that students’ lack of time could be barriers to integrating self-care in their courses. Notably, 35 (71.4%) stated that students do not already have sufficient self-care opportunities. Fourteen (28.6%) faculty stated that self-care doesn’t fit well with their curriculum. Twenty (40%) faculty affirmed the statement, “I have too much on my plate already”. Nine (18.4%) faculty stated that self-care is out of their area of expertise. While most faculty perceive that barriers arise from student characteristics, a sizeable proportion consider their own limitations as obstacles.
Discussion
Similar to what has been reported nationwide about faltering student mental health, faculty in this study observed students struggling with challenges that eclipsed years prior to the pandemic. This is unsurprising given the location of the study setting, New York City, the epicenter of the pandemic, and the population of students attending this public university, for whom college is already often fraught with economic and social hardships. However, unlike many other academic majors, human services students work directly within communities most impacted by poverty, housing instability, food insecurity, chronic disease, discrimination, pollution, and violence. In their field placements, students may encounter real-world traumatic events, bearing witness to human suffering, and working alongside staff, often in under-resourced organizations, who may be themselves be experiencing burnout. The human services workers who supervise and mentor student interns are navigating the post-pandemic role of “essential” provider in communities that are impacted by high levels of economic, social, and mental health stressors (Suggs et al., 2021). Students may not always have adequate support to cope with the secondary trauma, vicarious trauma, or potential feelings of helplessness that are often a part of direct practice in the field placement (Knight, 2011).
Field placement supervisors are often the students’ main source of support at their internships through formal and informal supervision. About half of faculty respondents agreed that students get sufficient support from field placement supervisors. Establishing strong partnerships and monitoring students in the field through regular check ins and field placement site visits should be prioritized by department faculty and staff. Students and field supervisors should have clear, well-documented agreements, from the outset of an internship, about the type of support that can be expected. For example, field placement contracts should specify the duration, frequency, and modality of clinical supervision meetings. Students may benefit from coaching on how to advocate for themselves and how to ask for support when they are struggling. Self-advocacy, a valuable skill, should be included in teaching self-care to students.
About three quarters of faculty stated “somewhat agree” when asked about students receiving adequate support from university counseling services. Beyond merely mentioning counseling services to students, faculty ought to develop direct relationships with campus counseling services to facilitate referrals, invite counselors to come into the classroom and introduce available services, and develop satisfaction surveys to help counseling offices improve services to students. Strengthening connections between each college’s counseling services and faculty may help augment student support for mental health.
All faculty claim to discuss a plethora of self-care activities in the classroom, however, fewer than half asked students for any evidence (e.g., a reflection, journal entry, visual representation) of having completed an assignment demonstrating students’ active engagement with self-care. Adult learning theory posits that learning is reinforced by integrating hands-on, real-world, practice with theoretical and instructional information (Simons et al., 2012). Therefore, classroom discussion sans reinforcement through practice, may be insufficient. Classroom discussions should be connected to specific learning outcomes outlined in the syllabus to further reinforce the variety of self-care practices and the adaptability of self-care to students’ needs, values, and lifestyles. For example, self-awareness, as a course learning outcome, can be developed through somatic exercises, mindfulness, yoga, creative writing, journaling, and artwork, among other strategies. Tailoring experiences to students’ preferences can be complemented by a universal assignment like a reflection essay, video, photograph, or presentation.
Mindfulness was assigned by half of the faculty sample. Mindfulness has been shown to be effective for reducing stress among graduate students (Gockel et al., 2013). In other areas of self-care, fewer than one third assigned any activities. Without requiring evidence of having completed the activities assigned, and given students’ competing demands, one cannot assume that the students are engaging in the self-care discussed in class or even those that are assigned. Also, when students aren’t required to document self-care, the activity may appear to students, to be of low value. It is recommended that faculty assign self-care activities with corresponding credited documentation to convey to the student that self-care practices are worth prioritizing as a part of their professional education.
Paradoxically, while nearly three quarters of the faculty stated that students do not already have sufficient opportunities for self-care, more than half also believe that students may not have the time or interest in self-care activities assigned in class. To mitigate this challenge, faculty could include brief self-care like meditation, deep breathing, and guided imagery/relaxation as in-class activities. Taking several minutes of class time to integrate a brief exercise may provide motivation or self-efficacy, that can inspire out of class engagement with self-care. Future research should assess satisfaction and impact of both in-class activities, and assigned homework, among students.
Nearly half of faculty stated, “I have too much on my plate already”. Faculty burnout has intensified post pandemic due to increased workloads, shift to online teaching modalities, and declining student enrollment (Daumiller et al., 2021; DeDiego et al., 2023; Schmidt-Crawford et al., 2021).
Adding the component of self-care to the curriculum could mitigate some of the challenges of feeling that there is already too much to do. Teaching students about self-care can serve as an important vehicle for faculty awareness and enactment of best practices in baccalaureate pedagogy (Radis et al., 2020). While about a third of faculty stated that self-care doesn’t fit well with their curriculum and about a fifth stated that self-care is out of their area of expertise, professional development could help overcome these obstacles. Faculty identified professional development needs and preferences that may serve as a platform for overcoming obstacles and successfully integrating self-care pedagogy into their courses. Nearly all the faculty welcomed online modules, webinars, lesson plans, resource referral sources, and a full three quarters were willing to attend an in-person workshop. Therefore, developing low barrier, accessible resources for undergraduate faculty is an important future direction to pursue.
At the undergraduate level, students across departments are relatively new to the profession and are learning similar new skills (e.g., engagement, advocacy, ethical decision-making, and evidence-informed culturally relevant practice) in a changing service landscape. Therefore, recommendations arising from this study may be applicable to various undergraduate programs that focus on providing direct human services in a range of practice and treatment settings (e.g., occupational, nursing, vocational, disability, geriatric/aging).
Limitations
The study has several limitations. The main limitation is the response rate of approximately 35%. While a 35% response rate is not uncommon for surveys sent by email (Wu et al., 2022), we hypothesize the following mitigating factors for the low response rate. Firstly, some of the faculty emailed may not have been actively teaching that semester, especially adjuncts or part-time faculty, and therefore, may not have seen the email. Some may have been on sabbatical or other leave. Relatedly, faculty are often wary of clicking on links that could be “phishing”, and it is possible that seeing a link from SurveyMonkey that promised a gift card incentive caused them to ignore the email for fear of a “phishing” email.
In the survey, we asked faculty to report whether students have sufficient opportunities for self-care. This question is limited in that it relies on faculty perceptions which are grounded in their knowledge of campus and classroom resources and their own relationships with students, formed through teaching courses connected to students’ field placements. Future research should examine students’ own perceptions of their opportunities for self-care, particularly after self-care pedagogy has been implemented in the classroom.
The study relied on self-report. There was no corroborating evidence to determine the veracity of the self-report. However, given the confidential nature of the survey, it is reasonable to consider that faculty would be candid. Finally, the study did not include student perspectives due to feasibility and logistical constraints.
Conclusion
This exploratory study helps shed light on how self-care is currently integrated throughout undergraduate curricula at a large urban public university system in the aftermath of the Covid19 pandemic. The researchers identified gaps in providing resources to students and in providing opportunities to practice self-care, and offered recommendations to strengthen self-care pedagogy in the classroom and beyond.
This study points to the need for lesson plans and training for undergraduate faculty. Lesson plans should include credit-bearing assignments that offer low-stakes rewards to students for completing activities outside of the classroom. Students who are required to submit an assignment for class credit will have the impetus to engage in self-care and may come to recognize the intrinsic value and find themselves able to incorporate small activities into their busy schedules. Lesson plans may also provide brief in-class self-care exercises like deep breathing, meditation, or journaling. For example, brief guided imagery videos or audio recordings, can be used as a technique in the classroom to both, help students relax and establish calmness and to teach students how to use guided imagery as a tool in their human services practice with clients. Chair yoga and stretching can also be both a teaching tool and an intervention for the students themselves in the classroom. Students may be encouraged to engage in these brief activities as a way to inform their practice and add “tools” to their “toolbox”.
Over time, throughout the course of their human services training, students will be able to establish routines that prioritize wellness as they continue to advance in the field.
Future research should seek to examine the feasibility, acceptability, and effectiveness of providing professional development in a variety of modalities (e.g., online, in person, live webinar, etc.). Ultimately, future research should examine students’ engagement with the material and the impact of self-care pedagogy as a feature of their undergraduate training.