Transcript No Slide Title

Compassion, Common Sense &
Continuity:
a partnership model in crisis response
Mandy Rutter
Clinical Manager,
FIRSTcall/CRISIScall
ICAS UK
PROGRAMME OF SESSION
• Introductions & plan of workshop
• Drivers for change
• Organisational issues
• Interventions
- Psychological First Aid,
- Trauma Focussed Interpersonal
Psychotherapy
• Activity
• Future directions
• Feedback & discussion
DEBRIEFING – OUR MODEL
•
Apparently sound clinical intervention
•
Modular approach - easily operationalised
•
Affiliates understood it - paid to be trained in it
•
Applied to both group and individual settings
•
Internationally available
•
Enhanced credibility and reputation of ICAS
INTERNAL CRITICISMS OF OUR
MODEL
•
No empirical evidence demonstrating
effectiveness
•
One outcome study was inconclusive
•
Clinical staff increasingly split on views of its
effectiveness/appropriateness
•
Many “follow-up” onsite groups were not
authorised by organisations.
EXTERNAL FACTORS
•
Many National, International Disasters
•
Further studies on criticisms of debriefing
•
Psychological First Aid
•
Concept of Resilience
•
“Treatment” modality inappropriate
INITIAL RESPONSE TO TRAUMA
“Debriefing is inert at its best and
possibly detrimental to some”
(Rose, Bisson and Wessely, 2004)
“For individuals who have experienced a
traumatic event, the systematic provision to
that individual alone of brief, single session
interventions (often referred to as debriefing)
that focus on the traumatic incident, should
not be routine practice when delivering
services.”
National Institute for Clinical Excellence, 2005
So what should we do?
“Efforts should be made to
enhance the capacity of existing
networks, both formal and
informal, to support recovery
and resilience.”
(Bulletin of World Health Organisation, 2005)
“assistance should be offered to
promote the objective of improving
the quality of the recovery
environment in support of the aim of
helping survivors make phased
adaptations and eventual
adjustment to what has happened”
(Orner, King et al, 2003)
Trauma is………..
“sudden uncontrollable
disruption of affiliate
bonds”
SURVEY OF HIGH RISK OCCUPATIONAL
GROUPS (ORNER ET AL 2003):
• 80% of employees wanted to talk to someone about the
incident
• 71% prefer to talk to colleague
• 72% prefer to talk to someone close to them
• 9% prefer to talk to independent professional
• 85% prefer to talk in free and flexible manner
IS EARLY INTERVENTION STILL VIABLE?
• Requested by Employers
• Appreciated by Employees, customers, passengers.
• Dealing with disequilibrium
• Evidence of increased complexity of symptoms
over time
• Research on Early Intervention
• White paper criminal compensation
WORKPLACE INCIDENT – THE CONTEXT
Employers want:
• employees to know they care
• to provide resources for affected staff
• to understand the impact of the trauma on the staff
• to regain workgroup cohesion
• to return the workplace to effective performance and productivity
• to prevent absenteeism
• to reduce the potential for compensation claim
SHAREHOLDER VALUE
REACTION TO
DISASTERS
RECOVERS -
Initial loss 5% capitalisation.
After 50 days, gained 5% over
the pre-crisis value.
NON-RECOVERS -
Initial loss 11% capitalisation
continued to fall over period
of 12 months.
SHAREHOLDER VALUE REACTION
TO DISASTERS
ValueReaction (%)
50
40
30
20
10
0
-10
-20
-30
Recoverers
Non-recoverers
Event Trading Days
WHAT REALLY MATTERS
“In crises, the key determinant of whether a company’s reputation
and share value will recover depends on the ability of the:
• senior management to demonstrate strong
leadership and communicate with honesty and
transparency”
• CEO to respond with sensitivity and compassion
to victims families
“Those companies which prepare and react appropriately at the right
time have a higher chance of recovery than those which do not”
“Companies that use an outside disaster management service
provider performed 40% better than those that did not”
(Knight, 2005)
JOHNSON AND JOHNSON:
TYLENOL TAMPERING
•
managed the current situation
•
planned for the future
Refer to the ‘Credo’
•
stopped the production
•
stopped advertising
•
recalled all capsules (31 million)
•
continuous relationship with other authorities
•
reward for information
•
Gave 2500 press interviews (125,000 news clippings)
AIR FRANCE CONCORDE AIR DISASTER
“Germany and France are united in their
horror over the accident, in mourning for
the victims and in sympathy for their
families”
“Disasters focus the glare of
attention on top management, if the
company communicates well and
shareholders and investors view
the event as well-managed, the
impact on stock values is generally
positive”
(Knight & Petty 1997 “the impact of
catastrophes on shareholder value”)
“One of the great shortcomings in most managers
is that they appear cold, arrogant, unfeeling, and
corporately driven when bad things happen and
there are victims. These behaviours are the source
of employee anger and frustration; litigation; angry
neighbours; and bad, embarrassing media
coverage.
Say you are sorry. Help the victims no matter what.
Treat everyone as thought they were a member of
your family”
Lukaszewski (1999)
Opportunities for educating staff on trauma
response
•
Directors
•
Managers
•
Employees
Seminars, training, education
Coaching, briefings, communication
INTENSE STRESS REACTION
(FIGHT OR FLIGHT RESPONSE)
Parts of brain active/inactive
(event feels disjointed some
parts clear others lost)
Only parts of brain needed for
survival active (think and behave
logically and rationally)
Increased flow of blood to brain,
quickens speed of brain activity
(incident in slow motion)
Brain goes into overdrive - absorbs
detailed information (vivid visual
impressions)
Breathing becomes shallow and
fast (hyperventilation)
Pupils dilate allowing extra
peripheral vision (means of escape)
Muscles of jaw, mouth and
forehead tense (headaches)
Increased heart rate (palpitations
/heart attack)
Shut down of feelings (auto
pilot/emotional numbness)
Digestion stops (dry mouth)
Unusual blood flow patterns
(hot or cold)
Colon starved of blood
(constipation)
or
Bowels suddenly emptied to
lighten body (defecation)
Excessive amounts of adrenaline
unless able to burn off through
intense activity (shaking)
Muscles tense - shoulders, arms,
back and legs (muscular pain)
Freeze/immobile body appears
limp/motionless (not feel pain
/analgesia)
IMMEDIATE EFFECTS
PHYSICAL
symptoms of shock
FEELINGS
fear
denial
anxiety
BEHAVIOURAL
crying
hysterical
automatic pilot
wandering around
COGNITIVE
Why me?
I must tell …
What if ….
ICAS “BEST PRACTICE
APPROACH”
Stabilisation
Psychological first aid
Assessment
‘watchful waiting’,
assessment tools
Treatment
Trauma focused IPT
Trauma focused CBT
onsite / individual
SKILLS & ATTRIBUTES REQUIRED FOR
IMMEDIATE RESPONSE
•
Offer a reassuring and confident approach
•
Ability to stay calm under pressure
•
Ability to give “space”
•
Ability to judge when to enter that “space”
•
Be able to listen
•
Show empathy without sympathy
•
Think practically and take action
•
Be able to respond to difficult questions
•
Be able to handle the “not knowing”
PSYCHOLOGICAL FIRST AID
A
ttend to
B
asic needs, with
C
ompassion
Psychological First Aid – use of pragmatic-orientated
interventions delivered during the immediate – impact phase of
a trauma to people who are at risk of being unable to regain
sufficient functional equilibrium by themselves
THE ESSENTIAL PRINCIPLES OF
PSYCHOLOGICAL FIRST AID
1.
To console distress and offer comfort
2.
To offer practical help
3.
To recognise the abnormality of the experience of the
trauma
4.
To recognise and respect the normality of the post
trauma reaction, whatever that might be
5.
Not to medicalise of pathologise the reaction
6.
Not to overwhelm with information
7.
To speak in a language and with a familiarity that the
individual will recognise
8.
To use other professional support networks
TRAUMA FOCUSSED
INTERPERSONAL THERAPY
Aims to fill the gap between immediate
post-trauma and any requirement for
Intervention and formal psychological
/psychiatric treatment for PTSD or other
disorders
Evidence:
Brewin and Lennard (1999) demonstrated that
risk factors operating during trauma, such as
trauma severity, lack of social support,
additional life stress have somewhat stronger
effects that pre-trauma factors.
Evidence:
Schnyder and Moergeli (2003) report that
recent life events, stress attributable to daily
life and hassles correlate significantly with
PTSD
Evidence:
Pilgrim (1999) if steps are taken to mitigate
the development of beliefs about being
“vulnerable and flawed” or “out of control”,
a positive influence may be exerted on
trauma related reactions.
Evidence:
Trauma focussed IPT is a series of individually
tailored, practical, collaborative suggestions
designed to supplement, enhance and
operationalise the potential support available
from within existing social support networks
and thereby optimise successful adaptation.
TRAUMA FOCUSSED IPT
INTERVENTION
Session 1:
Assessment
Description of symptoms
Description of event
What has caused need for treatment
History of distress
Session 2:
Psycho-education
Normalisation of responses
Session 3
Session 4
Who, how often, what activities shared, expectations changes
Session 5
Role transition
Session 6
Grief Strategies
“If invited to give assistance, providers
will do well to approach the challenge of
delivering quality services with and open
minded flexibility that recognises the need
to draw upon a broad repertoire of skills
to be delivered in a phased manner over
time”
(Bonanno, 2004)
“When specific interventions are
undertaken they must occur without
supplanting or replacing natural contacts
and supports which promote autonomy
and resilience, with artificial structures
that reinforce vulnerability or encourage
reliance on inappropriate ineffective, or
ill-times strategies of coping and
resolution”
(Oxford Handbook on Disaster and
Terrorism Psychology, 2005)
PROGRESS SUMMARY
• Reviewed evidence
• Considered clinical opinion
• Identified appropriate intervention
• Obtained feedback
• Finalised model
FUTURE DIRECTIONS
• Research and establish standards
• Briefing & training internally and externally
• To reorientate and develop best practice
• Educate client organisations
• Enhance credibility and reputation of our
organisation
Thank you
What are your views?
[email protected]
REFERENCES
•
Bonanno, G (2004) Loss, Trauma & Human Resilience Columbia:
American Psychological Ass Inc
•
Delongis, A, Lazarus, R.S and Folkman, S. (1988). The impact of
daily stress on health and mood: psychological and social
resources as mediators. Journal of Personality and Social
Psychology 54 (3): 486-496.
•
Knight & Petty (1996). The impact of castrophes on share holder
value” A research report sponsored by Sedgwick group, from the Oxford
Executive Research Briefings series from Oxford University
•
Mayo R.A, Ehlers A, Hobbs M (2000), Psychological debriefing for
road traffic accident victims. Three year follow-up of a randomised
controlled trial. British Journal of Psychiatry 176:589-93
•
Mitchell, J. (1983) Guidelines for Psychological debriefing,
emergency management course manual. Emmitsburg, MD: Federal
Emergency Management Agency, Emergency Management Institute.
•
Orner R.J, King S, Avery A, Bretherton R, Stolz P, Ormerod J. (2003)
Coping and Adjustment Strategies used by Emergency Services Staff
after Traumatic Incidents. New Zealand: Massey University.
REFERENCES
•
Rose S, Bisson J, Wessely S. Psychological debriefing for preventing
post traumatic stress disorder (PTSD). In: The Cochrane Library,
Issue 1, 2004. Chicester, UK: John Wiley & Sons Ltd.
•
Schnyder U, Moergeli H et al (2002) “Who develops acute stress disorder after
accidental injuries” Psychotherapy and Psychosomatrics 71 Pages 214 - 221
•
Shaler AY (2002) “Acute Stress reactions in adults” Biol Psych 51 532 - 543
•
Watson P (2004) Behavioural health interventions following mass
violence.Traumatic Stress Points, 18, 8-9
•
(2005) Bulletin of World Health Organisation Switzerland: World
Health Organisation
•
(2005) N.I.C.E Guidelines UK: National Institute for Health & Clinical
Excellence
•
Oxford Handbook on Disaster & Terrorism Psychology, (2005)