Do It Well “It is the willingness and capacity to develop their skills that distinguishes leaders from followers.” Warren Bennus and Bert Nanus
Restoring Calm in Times of Crisis Presentation Outline R2P – CIR History and Mile-High View of Recent Changes CIR: Workplace-Specific Objectives Questions and Discussion Paradigm Shift toward Psychological First Aid Questions and Discussion Leadership in Time of Crisis – ACT
Restoring Calm in Times of Crisis History of Critical Incident Response American Revolutionary War (1770’s) – “Rail Road Spine” Civil War (1860’s) – “Soldiers’ Heart” WW I (Early 1900’s) -- “Shell Shocked” WWII (1940’s) -- Applying the Tools of Newly Emerging Field of Psychiatry – “Combat Fatigue” Viet Nam (1960’s) -- Dx of PTSD Comes to National Awareness First Responders (1980’s) -- Recognition of Need, Development of Models Sept. 11, 2001 -- Widest Application of CIRS to General Population 2002 to Present -- Research, Evaluation, Validation of Best Practices
Restoring Calm in Times of Crisis Disaster Response Literature and the experience of experts advise a phase sensitive multi-component response for populations exposed to extreme stressors. World Health Organization, 2003
Restoring Calm in Times of Crisis Evolution in Critical Incident Response Evidence-informed best practices (R2P) Support for psychological first aid Continuum of care: multi-component and phase- sensitive Selectively drawing from existent models and approaches Continued valuing of group interventions Minimizing risk of harm. Assessment of who benefits and who might be at risk. Provides additional safeguards against the possibility of doing harm by limiting likelihood of additional stripping of defenses in the intervention. Interventions specifically designed for the work setting
Restoring Calm in Times of Crisis Evolution in Critical Incident Response Positions the organization’s leadership as competent and compassionate. Provider serves more as “consultant” and “psycho-educator” than “counselor” and the intervention as more educational than cathartic. Assumes recovery and defines that recovery in terms of return to work and function. Promotes a flexible approach that allows for unique response and taps into the strengths and resources of the individual to return to adaptive functioning. Normalizes symptoms to reduce anxiety regarding them without “prescribing” them. Provides strategies for self-care and re-entry to life and work.
Restoring Calm in Times of Crisis Business Continuity and Recovery There is no business recovery without people who: Are healthy enough to return to work and be productive Are assured enough of their safety to not feel afraid to return to work Have had their trust in the leadership established so that they desire to return to work Have had their loyalty rewarded so they remain employees over the short haul and the long haul Marsh Crisis Academy 2003
Restoring Calm in Times of Crisis Understanding the Corporate Client Employer’s Concerns Communicating the employer’s compassion and support for employees Fulfilling duty to provide a safe workplace Protecting Assets Protecting Brand Assuring Public that they are safe Responding to Regulatory Agencies Resuming Operation ASAP Controlling Losses
Restoring Calm in Times of Crisis Corporate Impact: Immediate Stressors Displaced employees Death of employees Destruction of property: Unable to return to work until safe Communication barriers Increased media scrutiny of procedures Disruption in usual procedures Veteran's Administration & National Center for PTSD
Restoring Calm in Times of Crisis Corporate Impact: Ongoing Stressors Actual or perceived decreased safety. Pursuit of medical and psychiatric opinions. Employees coping with issues related to grief/loss, increased financial strain, traumatic stress, family concerns, physical needs. Harsh judgments if emergency decisions were handled poorly Tolerance among departments and personnel often decrease as stress, role conflict, and extreme fatigue set in. Difficulty concentrating at work/increased mistakes. Irritability with fellow workers and customers. Absenteeism and presenteeism. Decreased productivity. Ongoing corporate financial concerns. Adapted from: Veteran's Administration & National Center for PTSD
CIR from the Corporate Perspective “For us, this service is about having available immediately (KEY) the specialized, trained (KEY) care our associates need. Our robberies happen late at night and on weekends. The workers compensation system is not set up to address the associate’s needs in this situation. Untrained doctors and counselors think it is best to keep associates out of work whereas these Specialists know the best option for the associate in most cases is to continue working. Once an associate is put out of work by WC doctors, it takes months to years to get the claim resolved.” Director of Risk Management Retailer
Restoring Calm in Times of Crisis Paradigm Shift in Healthcare (Ray, 2004) Components of Health Care Models PastFuture FocusFighting sicknessBuilding health EmphasisEnvironmental factorsBehavioral factors Cause of diseasePathogenHost-pathogen interaction Patient rolePassive recipient of txActive in tx and health Belief system of patient IrrelevantCritically important Physician roleDeterminer of tx and healing process Collaborator in tx and healing process
Restoring Calm in Times of Crisis Much attention in critical incident response has been focused on the avoidance of pathology, most specifically on the prevention of PTSD. In the days immediately following September 11, 2001, many concerned voices proclaimed that psychiatric casualties might number in the millions. Experts estimated that as many as 1 in 4 New Yorkers would need treatment. Extensive sampling of Manhattan residents following the September 11 th attacks found that only 7.5% showed probable PTSD 4 weeks after the event; at 4-6 months, the level had declined to slightly more than one-half of one percent. (Galea, 2003) Research indicates that efforts should be directed towards fostering natural resiliency rather than abating symptoms associated with PTSD. (Bonnano, 2004) Effective critical incident response allows individuals to find their own levels of recovery and does not programmatically apply trauma remembrance and emotional processing in the early phases following critical incident. (NCCTS & NCPTSD, 2005) Paradigm shift: Pathology to Resiliency
Restoring Calm in Times of Crisis Psychosocial Impact of Disasters Sources: Ursano, 2002; Institute of Medicine, 2003 Fear and Distress Response Behavior Change Psychiatric Illness
Restoring Calm in Times of Crisis Resiliency vs. Recovery Resiliency to loss and Trauma: Refers to the ability to maintain relatively stable, healthy levels of psychological an physical functioning after exposure to an isolated and potentially highly disruptive event. Recovery: Represents a “trajectory in which normal functioning temporarily gives way to threshold or sub threshold of psychopathology.” (Bonnano, 2004)
Restoring Calm in Times of Crisis Individual Stress Response Existing research on resiliency and recovery indicates that most everyone experiences some level of distress when a significant crisis strikes a community or workplace. The individual reactions and the course they take will turn out to be highly varied between persons and will represent a wide range.
Facilitating Resiliency People are more resilient than they feel. Education can provide inoculation. Utilize strengths. Reduce likelihood of making it worse.
Restoring Calm in Times of Crisis Resiliency – You tend to find what you look for! A powerful finding in resiliency research suggests that internally directed, self- motivated people thrive in conditions of constant change. (Siebert, 2005) Evidence suggests that resiliency is much more common than often believed. (Bonanno, 2004)
Functional Denial Reported by Dr. Edna Foa as affective and cognitive avoidance previously looked at as dissociation. Rather than a sign of pathology, researchers are now looking at this reaction as one of self-preservation. Denial is an adaptive reaction that protects survivors from the full force of the tragedy. This coping mechanism is a gradual and graceful way to deal with the loss of a loved one, allowing families the time that they need to make the transition from shock and denial into the grieving process. Cummock, 1996
Restoring Calm in Times of Crisis Psychological First Aid (PFA) Overview Is an evidence-informed approach to providing immediate support after exposure to a traumatic event. Directs efforts toward enhancing natural resilience rather than preventing PTSD. Assists in reducing initial distress. Fosters short and long-term adaptive functioning. Is used by mental health specialists in diverse settings. Embraces a wide range of techniques and anticipates that methods will change as evidence develops. Still needs further research.
Restoring Calm in Times of Crisis Organizations Endorsing Use of PFA US Dept of Veteran's Affairs National Center for PTSD Substance Abuse and Mental Health Services and Administration International Society for Traumatic Stress Studies National Child Traumatic Stress Network Center for Disaster Medicine American Psychological Association John Hopkins Center for Public Health Preparedness American Psychiatric Association: Disaster medicine
Restoring Calm in Times of Crisis Psychological First Aid Field Operations Guide (National Child Traumatic Stress Network and National Center for PTSD) Core Activities of PFA 1.Contact and Engagement of those in need of assistance 2.Comfort and Safety for those affected 3.Stabilization of situations and reactions 4.Information Gathering to assess impact 5.Practical Assistance 6.Connection with Social Supports 7.Information about Coping 8.Linkage with Collaborative Services (NCCTS & National Center for Traumatic Stress, 2005) www.NCTSN.org
Restoring Calm in Times of Crisis Leadership = Vision + Action Deprivation Basic resources Isolation Connectivity Chaos Structure Helplessness Efficacy Victim Survivor
Restoring Calm in Times of Crisis ACT Process A - Acknowledge and name the incident and its impact. C - Communicate pertinent information with competence and compassion. T - Transition to next steps – adaptive functioning or an appropriate level of care.
Restoring Calm in Times of Crisis ACT Process Identify circles of impact and utilize the continuum of CIR services accordingly. Position corporate leadership favorably by coaching regarding an ACT process. Integrate the elements of PFA into an ACT process.
Restoring Calm in Times of Crisis ACT Acknowledge Acknowledge what has happened. Summarize what has happened using the real words. Present objective and credible information. Deliver information with sensitivity. Serves to: control rumors, reduce anxiety, and return a sense of control to impacted individuals.
Restoring Calm in Times of Crisis ACT Communicate Communicate competence and compassion simultaneously. Visible leadership communicates care and concern for those involved. Transitions to specialist (if utilized). Provide information about common. reactions to critical incidents and what can be done to exercise resiliency.
Restoring Calm in Times of Crisis ACT Transition Information about Coping – Emphasize resiliency. Triage back to adaptive functioning or to an appropriate level of care. Practical Assistance - determine basic and practical needs. Linkage with Collaborative Services - transition individual to appropriate level of support and provide information. (EAP, counseling center, community resources, written communications and web resources, telephonic support via a 1-800 number, to continued personal assistance/ intervention).
References Bonanno, G.A. (2004). Loss, trauma, and human resilience. American Psychologist, 59, (1), 20- 28. Boscarino, J.A., Adams, R.E., and Figley, C.R. (2005) A Prospective Cohort Study of the Effectiveness of Employer-Sponsored Crisis Interventions after a Major Disaster. International Journal of Emergency Mental Health, Vol. 7, No. 1, pp. 9-22. Foa, E.B., et.al., (2005) Social, Psychological, and Psychiatric Interventions Following Terrorist Attacks: Recommendations for Practice and Research. Neurospsychopharmacology 30, 1806-1817. Frankl, V.E. (2005). Man’s search for meaning. Boston, MA: Beacon Press. Maddi, S.R & Khoshaba, D.M. (2005). Resilience at work. New York, NY: AMACOM. National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid : Field Operations Guide, September, 2005. National Institute of Mental Health (2002). Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138, Washington, D.C.: U.S. Government Printing Office. Department of Veteran's Affairs. Disaster Mental Health Services: A Guidebook for Clinicians and Administrators. Ray, O. (2004). How the mind hurts and heals the body. American Psychologist, 59, (1), 29-40. Siebert, A. (2005). The resiliency advantage. San Francisco, CA: Berrett-Kohler Publishers, Inc. World Health Organization. Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors., 2003.