The third blog in this series shares a short snip of my presentation at the BACP Conference which focusses on developing a ‘trauma management programme’ part of a critical incident plan.
The Trauma Management Programme should define every stage of a critical incident, from early intervention, trauma-specific treatments, follow-up, right through to recovery. A well thought-through critical incident plan saves lives and helps people recover quicker. Staff need training, guidance, knowledge and clear policies. The reality is that major incidents almost always catch us unaware; therefore, forward planning is essential.
I would recommend that a Trauma Management Programme include the following:
Immediate Crisis Management
The situation is often chaotic in the initial stages of a critical incident. Thus the immediate stage of any crisis is all about practical support, and deescalating and defusing the situation. Five points to consider in the immediate crisis phase: 1.) Safety and Practical support; 2.) Non-judgmental communication; 3.) Offer empathy, not sympathy; 4.) Empower the individual impacted; 5.) Offer information and implement clear administration processes.
Most people will recover from a traumatic event naturally, but having an evidence-based screening process, one that is culturally and ethically appropriate, can monitor individuals who may need further support. Screening should be carried out on a regular basis, ideally within the first week following an incident, then at one month, six months and one year follow ups.
Family liaison support
Family Liaison officers are necessary when a member of staff has died or they are unable to speak for themselves, perhaps through a kidnapping incident or being unconscious. The family liaison officer’s responsibilities include: being the point of contact between the family and the organisation, keeping the family informed, listening to the family’s needs, providing practical guidance, signposting for further support where necessary, and helping the family deal with the reality of the situation. The family liaison officers also need supervision and psychosocial support when necessary.
Peer support programs are a great resource and support to national staff as they are versatile, cost-effective, and can offer support to staff that are harder to reach. Peer supporters are volunteers within the organisation. They will be assessed regarding skills and resilience, before being trained and offered supervision. This training should consist of trauma awareness & Psychological First Aid, management of sexual assault, stress & resilience, and training of the trainer (where necessary). It is often colleagues that notice the first signs of a peer struggling and are well placed to offer early psychosocial support, and by doing so, can improve an individual’s recovery.
Psychological First Aid (PFA)
PFA focuses on understanding trauma symptoms and building coping strategies and resources. PFA is educational, does not explore the incident in detail, and therefore can be offered to individuals who experienced the same event, but had different levels of impact and exposure to the traumatic incident. It can also be offered whilst an incident is still on going, such as working in a war zone etc. PFA offers a chance to triage and assess staff. The advantage of PFA is that peers can be trained to facilitate groups, making it an economical and accessible option.
Debriefing focuses on processing an event in detail and bringing a sense of closure to the traumatic incident. Individuals would be assessed to decide which debrief group they would be best suited depending on the level of exposure to an event. It is important to place individual’s who have had a similar experience and level of exposure together in the same group, so those who were less impacted are not exposed to further traumatic material. Although there is some controversy of using debriefing many organisations such as emergency first responders, Employment Assistant Programs (EAPs), NHS foundation trusts, various NGOs and United Nations departments are continuing to use various forms of psychological debriefing. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) have endorsed psychological debriefing (Tuckey & Scott, 2014).
Initial trauma assessments
Some staff members may choose not to attend a psychosocial group, or it may not be beneficial to them, depending on the nature of the traumatic incident. Therefore an initial individual trauma assessment, which can be carried out remotely, and covers elements of the PFA model, can be helpful.
Specialist trauma counselling
If an individual’s symptoms persist after 4-6 weeks we would recommend trauma specialist treatments. The main two treatments are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behaviour Therapy (TF-CBT), both of these models have been culturally adapted to be effective globally, although many countries do not have access to specialist trained therapists in these approaches. It is therefore useful not to overlook other trauma therapies that are also getting good results globally, such as Narrative Exposure Therapy (NET), and the Tree of Life Model (Denborough, 2008). Additionally, clinicians can offer these services remotely through various software applications and webcam.
It is good practice to offer follow up appointments one month, six months and one year after a traumatic incident, so staff feel that their experience of having been through a distressing situation is acknowledged, and that they are supported and valued by their organisation.
Watch the presentation here: