AN EXCERPT FROM THE ARTICLE PUBLISHED IN THE LEADERSHIP MAGAZINE
As the disruption and devastation caused by Hurricane Harvey and Hurricane Irma have recently been featured in the news, the grand scale of certain disasters is fresh in many people’s minds. This pair of natural disasters is a valuable reminder that one of the best tools available to employers in a time of crisis is their Employee Assistance Programme which provides the tools for employers to lead a workforce through a crisis and to assist their employees’ in building resilience and facing the aftermath of the disaster
One way or another, the workplace is a setting where human beings spend much of their time in the course of their lives. And so, the contract an employee concludes with their employer is underpinned by a number of expectations, not least of which is the fact that workers have an expectation of safety in the workplace, and employers have a legal responsibility to keep the workplace safe.
When traumatic events occur these can adversely affect employees at all levels. This includes Management who have the multiple-roles of managing the safe-functioning of the workplace, ensuring support is offered, and also accessing the necessary support for themselves, when appropriate.
Critical Incident Stress Management
Management is expected to lead in times of crisis, and if a disaster occurs that causes evidence of distress or dysfunction among a workforce, a formal critical incident intervention can effectively help address concerns. The EAP is an important workplace resource and a tool in management’s ability to strike a balance in managing the workforce while assisting in preparation and recovery, before, during and after workplace trauma. 1
While general EAP services are designed to address personal employee challenges on a day-to-day basis, the acute needs of employees and organisations after a critical incident such as violence, an accident, natural disaster or employee death are better addressed by a specialised EAP-driven Critical Incident Stress Management (CISM) programme.
Critical incidents can cause physical, emotional and behavioural stress symptoms within the workforce which have the potential to create significant human distress, and can overwhelm the usual coping mechanisms of individual employees or an organisation. Employees may experience reactions ranging from deterioration of their job performance, personality changes, anxiety, inability to concentrate, co-worker conflicts, to grief reactions and depression. When an unexpected critical incident or tragedy occurs at work, it is important to rapidly and effectively manage the fallout of the incident, and its emotional impact, through facilitating the recovery of employees and of the group. The goal of a CISM program is to minimise the potential damage caused by an incident, while speeding the recovery process for employees and the organisation.
EAP professionals are trained to assess risk, then develop and deliver effective critical incident response services that deal with the psychological consequences of unforeseen workplace incidents. EAP’s CISM protocols comprise a range of crisis intervention services, a continuum that typically include pre-crisis training, individual crisis counselling, group debriefing, and post-incident referral for both primary and secondary victims.
The CISM continuum includes EAP involvement with an organisation’s pre-incident planning in the areas of assessing risk, working with human resources staff to develop CISM policy and educating managers and employees on critical incident response and disaster preparedness. Before a critical incident in the workplace occurs, EAP professionals provide upfront critical incident orientation and training to employees, managers, supervisors and union representatives, which includes offering Stress Inoculation Training in terms of resilience and being prepared for responding to workplace critical incidents.
EAP professionals are also in a unique position to be able to plan and develop relationships with other providers in the critical incident community, such as emergency response personnel and local hospitals. These relationships can prove vital during a critical incident, but the task of nurturing such relationships needs to occur before a critical incident occurs, when the workplace is functioning as usual.
Support during an incident
EAP professionals have a minimal role to play during a critical incident as the first responders are often building security or risk and safety personnel or even law enforcement or fire fighters. After first responders have restored a safe environment and employees’ basic physical needs have been met, the EAP professional’s role is mostly one of providing coordination and guidance, including working collaboratively with management to help ensure the most appropriate response. The role of management in the containment of a crisis or critical incident should not be under-estimated as the visible sign of a caring environment and EAP professionals play a critical role in working as partners or consultants with management as they strive toward workforce stabilisation and recovery. 2
Support in the aftermath on an incident
Following a workplace critical incident, the EAP professional often takes on a more visible role in the workplace as s/he works with management to assess the needs of the workforce and identify the appropriate services to provide, such as defusing and debriefing, and/or educational sessions that explain normal responses to workplace critical incidents. The EAP firmly grounds its response in management protocols and includes an educational debriefing if appropriate. It does not frame the overall response in medical or psychological terms. 2
Defusing should be provided as soon as possible, typically no longer than the first 24 to 72 hours after the initial impact of the critical event. Defusing allows for the airing of emotions and thoughts associated with the incident and is designed to assure the person, or people, involved that their feelings are normal, to tell them what symptoms to watch for over the short term, and to offer them a lifeline in the form of a telephone number where they can reach someone whom they can talk to. Defusings are limited only to individuals directly involved in the incident and are often done informally, sometimes at the scene. They are designed to assist individuals in coping in the short term and address immediate needs.3
Phases in a Critical Incident Stress Debriefing (CISD)
The most recognized element of CISM is the debriefing, which is a structured on-site individual or group intervention that occurs shortly after the incident. Debriefings, led by experienced counsellors, provide individuals an opportunity to discuss their feelings and thoughts about a distressing event in a controlled and rational manner. Employees learn about stress reactions and symptoms, and acquire additional skills and resources that can help them with the healing process. 4
Within the context of CISM debriefing is not psychotherapy, but is rather a method for alleviating common stress reactions triggered by critical events. It is a precise, 7-phase, small group, supportive crisis intervention process.
- Phase 1 – Introduction
Objective: To introduce intervention team members, explain process, set expectations.
In this phase, the CISM intervention professionals introduce themselves and describe the process. They present guidelines for the conduct of the debriefing and they motivate the participants to engage actively in the process. Participation in the discussion is voluntary and the team keeps the information discussed in the session confidential. A carefully presented introduction sets the tone of the session, anticipates problem areas and encourages active participation from the group members.
- Phase 2 – Facts
Objective: To describe traumatic event from each participant’s perspective on a cognitive, or thinking, level.
In this fact phase only a brief overview of the facts is requested from each participant. Excessive detail is discouraged. This phase helps the participants to begin talking. It is easier to speak of what happened before they describe how the event impacted them. However, the fact phase is not the crux of the debriefing. More important elements are yet to come, but giving the group an opportunity to contribute in a small way to the discussion is significant in lowering anxiety and letting the group know that they have control of the discussion.
- Phase 3 – Thoughts
Objective: To allow participants to describe cognitive reactions and to transition to emotional reactions.
It is easier to speak of one’s thoughts than to focus immediately on the most painful aspects of the event. The typical question addressed in this phase is “What was your first thought or your most prominent thought once you realized you were thinking? Again we will go around the room to give everybody a chance to speak if they wish. If you do not wish to contribute something, you may remain silent. This will be the last time we go around the group.”
- Phase 4 – Reactions
Objective: To identify the most traumatic aspect of the event for the participants and identify emotional reactions
The reaction phase is the heart of a Critical Incident Stress Debriefing. It focuses on the impact of the incident on each of the participants. Anger, frustration, sadness, loss, confusion, and other emotions may emerge. The trigger question is “What is the very worst thing about this event for you personally?” The support team listens carefully and gently encourages group members to add something if they wish. When the group runs out of issues or concerns that they wish to express the team moves the discussion into the next transition phase, the symptoms phase, which will lead the group from the affective domain toward the cognitive domain.
- Phase 5 – Symptoms
Objective: To identify personal symptoms of distress and transition back to cognitive level.
The CISD team will ask, “How has this tragic experience shown up in your life?” or “What cognitive, physical, emotional, or behavioural symptoms have you been dealing with since this event?” The CISD team listen carefully for common symptoms associated with exposure to traumatic events. The team will then use these signs and symptoms of distress presented by the participants as a kicking off point for the teaching phase.
- Phase 6 – Teaching
Objective: To educate the participants regarding normal reactions and provide adaptive coping mechanisms such as stress management, providing a cognitive anchor.
The team conducting the Critical Incident Stress Debriefing normalizes the symptoms brought up by participants. They provide explanations of the participants’ reactions and provide stress management information. Other pertinent topics may be addressed during the teaching phase as required. For instance, if the CISD was conducted because of a suicide of a colleague, the topic of suicide should be covered in the teaching phase.
- Phase 7 – Re-entry
Objective: To clarify any ambiguities, prepare for termination and facilitate “psychological closure.”
The participants may ask questions or make final statements. The CISD team summarizes what has been discussed in the CISD. Final explanations, information, action directives, guidance, and thoughts are presented to the group. Handouts maybe distributed.4
Long-term follow up
The CISM continuum encourages EAP professionals to provide follow-up services for employees who were more severely affected by the incident including one-on-one crisis counselling, crisis interventions for families, and aftercare follow up and referral procedures. However, CISM is not a type of psychotherapy; rather it is to be seen as a system of support that is meant to do the following:
- Lessen the impact of the critical incident
- Normalise instinctive reactions to the incident
- Encourage the natural recovery process
- Restore the adaptive functioning skills of the person and/or group
- Determine the need for further supportive services or therapy 5
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Contributor: Dr. Marion Borcherds
EAPA-SA Board Member: STAKE HOLDER RELATIONS AND SPONSORSHIP
Dr. Marion Borcherds has worked within the field of Employee Assistance for the last 20 years in both a senior manager and executive position.
She is currently employed at Transnet as the Group Employee Wellness and Transformation Manager, managing the components of EAP, Absenteeism management, Medical schemes, Incapacity and disability management, the HIV/AIDS Workplace programme as well as the Transformation portfolio. She is a thought leader in the employee wellness space, having designed, implemented and managed EWP programmes for both government and para-statals over the years.
She has also worked in academia and private and her expertise in mental health and gender and reproductive health is worthy of noting. Dr. Borcherds is a regular speaker at local conferences on various Employee Wellness related topics. She has also has participated at a number of international conferences such as the international Nursing summit, the International Health conference and the International Employee Assistance conference at which she has delivered papers on Integration within employee wellness, the strategic positioning of Employee wellness within HR, EAP as a behavioural risk assessment tool as well the Management of violence in the workplace, amongst others.
Within South Africa she has plowed back to the EAP profession by being actively involved in the EAPA-Egoli Chapter both as a Committee member and as the Chairperson from 2010 to 2012.She has served two previous terms of office on the EAPA-SA Board and previously occupied the portfolio of “Education” which includes research and publications. Dr. Borcherds doctoral thesis was on the Management of Violence in the workplace and she has done extensive work on this topic, assisting with policy formulation and the protection of dignity and respect for employees.