This article was originally published in the Project Optimist newsletter on Oct. 26, 2022.

ST. CLOUD - Tracy Schreifels started her career as a preschool teacher for Head Start — a federal program that supports the health and development of vulnerable young children. Then she moved into the mental health field and experienced the crush of a big caseload that left little time for reflection.

"It was exhausting. People were burning out," Schreifels said.

Now she's executive director at the Ellison Center in St. Cloud, a nonprofit agency focused on early childhood mental health. Staff at the center provide therapy and support to young kids and families.

They also offer a service called reflective consultation, or reflective supervision, which supports the frontline workers who support children and families. Last year, Ellison Center staff provided reflective consultation to 150 professionals in public health, early care and education, mental health and child protection. Ellison Center staff are on the receiving end of reflective consultation too.

It's different from talk therapy, Schreifels said. In reflective consultation, providers identify some of the challenges they face at work and determine how to move forward in the work despite those challenges.

Burnout is an occupational phenomenon, not a medical condition, according to the World Health Organization. The WHO definition of burnout reflects the work of psychology researchers Christine Maslach and Michael Leiter:

"Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment. The significance of this three‐dimensional model is that it clearly places the individual stress experience within a social context and involves the person's conception of both self and others." -Maslach and Leiter

An April 2021 Kaiser Family Foundation/Washington Post  survey of frontline healthcare workers reported that 55% felt "burned out." And yet, within that same sample, 76% reported feeling "hopeful" when going to work.

Caring for children as a therapist, social worker, teacher or in any other capacity requires emotional energy. Think about how it feels to hear a crying baby that no one is tending to.

"We're biologically wired to be emotionally aroused by the needs of young children," Schreifels said.

How does it work? What does it do?

People who provide reflective consultation report decreases in burnout and turnover as well as improvements in work skills and self-efficacy, according to an  e-book on the practice from the University of Minnesota Center for Early Education and Development's Reflective Practice Center.

To be considered "reflective" the consultations need to be regular, collaborative and involve stepping back to sort through feelings and thoughts, according to the e-book. The sessions give providers a place for stress release, reframing (including unpacking biases) and refocusing on where providers can make an impact. And they help providers become more responsive to families' needs rather than their own agendas.

There's research underway to explore reflective consultation as a tool to challenge and interrogate bias, Schreifels said. It's suited to that, because the process is open and non-judgmental. It encourages providers to examine their assumptions, be curious and ask "according to whom," Schreifels said. "How do I know that my way is the right way?"

There is growing evidence to support reflective consultation, but there's a need to document how it affects children and families. Reflective consultation is promoted by infant mental health associations in the majority of U.S. states. But there are limitations to quick expansion — it requires time, money and buy-in.

The Ellison Center plans to expand from six clinicians to 12 with half trained to provide reflective consultation. But there aren't enough providers to serve everyone who could benefit.

Schreifels is looking to offer reflective consultation to child care providers, public health nurses, child protection workers, people in leadership roles in the field and even clergy and first responders.

When reflective consultation meets self-care

Rebecca Schroeder is a licensed psychologist in Sartell, just north of St. Cloud, where she provides assessments and therapy to young people with autism spectrum disorder.

She has worked with adults, too, but now she serves children and adolescents.

"The complexity is, kids don't come as a single person. They're in the context of their family," Schroeder said.

She has seen burnout increase in her profession during the pandemic in part because the percentage of patients in crisis increased. The stressors that strained clients also impacted providers — financial strains, health concerns and having children at home when schools closed.

"I think people are leaving the field. People are questioning if they want to leave the field. Questioning if it's sustainable," Schroeder said.

Schroeder doesn't participate in one-on-one reflective consultations, but she is in a consultation group with her colleagues. It allows them to check in, check their boundaries and review what they can help and what they can't help, Schroeder said.

She doesn't hear many in the field speak directly about reflective consultation. She does hear a lot of talk about self-care, including specific practices like making time for family, exercising and eating well.

Self-care and reflective consultation pair well together. A  January 2022 study reported in the "Infant Mental Health Journal" found that people who received reflective consultation were more likely to practice self-care despite COVID stressors, and they internalized less than providers who didn't participate in reflective consultation.

The Ellison Center's Schreifels says self-care and reflective consultation together help providers slow down and maintain the capacity to manage challenges at work.

Self-care doesn't necessarily look like a professional massage or a weekend away, Schreifels said. It could mean taking 30 seconds to appreciate a gesture of kindness.

It is, she said, "building a life you don't have to escape from."