Critical Incident Response: Evolving Best Practices in the Workplace - PowerPoint PPT Presentation

1 / 44
About This Presentation

Critical Incident Response: Evolving Best Practices in the Workplace


Critical Incident Response: Evolving Best Practices in the Workplace Do It Well It is the willingness and capacity to develop their skills that distinguishes ... – PowerPoint PPT presentation

Number of Views:621
Avg rating:3.0/5.0
Slides: 45
Provided by: Amy8197


Transcript and Presenter's Notes

Title: Critical Incident Response: Evolving Best Practices in the Workplace

Critical Incident Response Evolving Best
Practices in the Workplace
(No Transcript)
(No Transcript)
Do It Well
  • It is the willingness and capacity to develop
    their skills that distinguishes leaders from
  • Warren Bennus and Bert Nanus

Presentation Outline
  • R2P CIR History and Mile-High View of Recent
  • CIR Workplace-Specific Objectives
  • Questions and Discussion
  • Paradigm Shift toward Psychological First Aid
  • Questions and Discussion
  • Leadership in Time of Crisis ACT

History of Critical Incident Response
  • American Revolutionary War (1770s) Rail Road
  • Civil War (1860s) Soldiers Heart
  • WW I (Early 1900s) -- Shell Shocked
  • WWII (1940s) -- Applying the Tools of Newly
    Emerging Field of Psychiatry Combat Fatigue
  • Viet Nam (1960s) -- Dx of PTSD Comes to National
  • First Responders (1980s) -- 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

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

Evolution in Critical Incident Response
  • Evidence-informed best practices (R2P)
  • Support for psychological first aid
  • Continuum of care multi-component and
  • Selectively drawing from existent models and
  • 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

Evolution in Critical Incident Response
  • Positions the organizations 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
  • Normalizes symptoms to reduce anxiety regarding
    them without prescribing them.
  • Provides strategies for self-care and re-entry to
    life and work.

Business Continuity and Recovery
  • There is no business recovery without people who
  • Are healthy enough to return to work and be
  • 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

Understanding the Corporate Client
  • Employers Concerns
  • Communicating the employers 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

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

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
  • Irritability with fellow workers and customers.
  • Absenteeism and presenteeism.
  • Decreased productivity.
  • Ongoing corporate financial concerns.
  • Adapted from Veteran's Administration National
    Center for PTSD

(No Transcript)
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 associates 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

Paradigm Shift in Healthcare (Ray, 2004)
Components of Health Care Models Past Future
Focus Fighting sickness Building health
Emphasis Environmental factors Behavioral factors
Cause of disease Pathogen Host-pathogen interaction
Patient role Passive recipient of tx Active in tx and health
Belief system of patient Irrelevant Critically important
Physician role Determiner of tx and healing process Collaborator in tx and healing process
Paradigm shift Pathology to Resiliency
  • 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
  • Extensive sampling of Manhattan residents
    following the September 11th 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,

Psychosocial Impact of Disasters
  • Sources Ursano, 2002 Institute of Medicine, 2003

Fear and Distress Response
Behavior Change
Psychiatric Illness
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)

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.

(No Transcript)
Facilitating Resiliency
  • People are more resilient than they feel.
  • Education can provide inoculation.
  • Utilize strengths.
  • Reduce likelihood of making it worse.

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)

(No Transcript)
(No Transcript)
Functional Denial
  • Reported by Dr. Edna Foa as affective and
    cognitive avoidance previously looked at as
  • Rather than a sign of pathology, researchers are
    now looking at this reaction as one of
  • 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

Psychological First Aid (PFA) Overview
  • Is an evidence-informed approach to providing
    immediate support after exposure to a traumatic
  • 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
  • Embraces a wide range of techniques and
    anticipates that methods will change as evidence
  • Still needs further research.

Organizations Endorsing Use of PFA
  • US Dept of Veteran's Affairs
  • National Center for PTSD
  • Substance Abuse and Mental Health Services and
  • International Society for Traumatic Stress
  • National Child Traumatic Stress Network
  • Center for Disaster Medicine
  • American Psychological Association
  • John Hopkins Center for Public Health
  • American Psychiatric Association Disaster

Psychological First Aid Field Operations
Guide(National Child Traumatic Stress Network
and National Center for PTSD)
  • Core Activities of PFA
  • Contact and Engagement of those in need of
  • Comfort and Safety for those affected
  • Stabilization of situations and reactions
  • Information Gathering to assess impact
  • Practical Assistance
  • Connection with Social Supports
  • Information about Coping
  • Linkage with Collaborative Services
  • (NCCTS National Center for Traumatic Stress,


Crisis Leadership
  • Vision (Understanding Corporate Needs)
  • Action (Plan to Facilitate Resiliency)
  • Leadership in Times of Crisis
  • From Michael Useems,
  • The Leadership Moment

(No Transcript)
(No Transcript)
(No Transcript)
Leadership in Time of Crisis
Leadership Vision Action
  • Deprivation Basic resources
  • Isolation Connectivity
  • Chaos Structure
  • Helplessness Efficacy
  • Victim Survivor

ACT Process
  • A- Acknowledge and name the incident and its
  • C- Communicate pertinent information with
    competence and compassion.
  • T- Transition to next steps adaptive
    functioning or an appropriate level of care.

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

  • 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

  • Communicate
  • Communicate competence and compassion
  • 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.

  • 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/

(No Transcript)
  • Bonanno, G.A. (2004). Loss, trauma, and human
    resilience. American Psychologist, 59, (1),
  • 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.,, (2005) Social, Psychological,
    and Psychiatric Interventions Following Terrorist
    Attacks Recommendations for Practice and
    Research. Neurospsychopharmacology 30, 1806-1817.
  • Frankl, V.E. (2005). Mans 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
  • 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,
  • World Health Organization. Mental Health in
    Emergencies Mental and Social Aspects of Health
    of Populations Exposed to Extreme Stressors.,

(No Transcript)
Write a Comment
User Comments (0)