Compassion, Common Sense

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Compassion, Common Sense Continuitya
partnership model in crisis response
Mandy RutterClinical Manager, FIRSTcall/CRISIScal
l ICAS UK
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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

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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
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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.
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EXTERNAL FACTORS
Many National, International Disasters
Further studies on criticisms of debriefing
Psychological First Aid
Concept of Resilience

• Treatment modality inappropriate

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INITIAL RESPONSE TO TRAUMA
Debriefing is inert at its best and possibly
detrimental to some
(Rose, Bisson and Wessely, 2004)
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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
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So what should we do?
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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)
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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)
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Trauma is.. sudden uncontrollable disruption
of affiliate bonds
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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
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• 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

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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
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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.
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SHAREHOLDER VALUE REACTION TO DISASTERS
50
40
30
20
ValueReaction ()
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0
-10
-20
-30
Non-recoverers
Recoverers
Event Trading Days
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WHAT REALLY MATTERS
In crises, the key determinant of whether a
companys 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)
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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)

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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
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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)
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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)
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Opportunities for educating staff on trauma
response Directors Managers Employees
Seminars, training, education Coaching,
briefings, communication
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INTENSE STRESS REACTION (FIGHT OR FLIGHT
RESPONSE)
Only parts of brain needed for survival active
(think and behave logically and rationally)
Parts of brain active/inactive (event feels
disjointed some parts clear others lost)

Brain goes into overdrive - absorbs detailed
information (vivid visual impressions)
Increased flow of blood to brain, quickens speed
of brain activity (incident in slow motion)
Pupils dilate allowing extra peripheral vision
(means of escape)
Breathing becomes shallow and fast
(hyperventilation)
Increased heart rate (palpitations /heart attack)
Muscles of jaw, mouth and forehead tense
(headaches)
Shut down of feelings (auto pilot/emotional
numbness)
Digestion stops (dry mouth)
Excessive amounts of adrenaline unless able to
burn off through intense activity (shaking)
Unusual blood flow patterns (hot or cold)
Muscles tense - shoulders, arms, back and legs
(muscular pain)
Colon starved of blood (constipation)or Bowels
suddenly emptied to lighten body (defecation)
Freeze/immobile body appears limp/motionless (not
feel pain/analgesia)
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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 .
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ICAS BEST PRACTICE APPROACH
Stabilisation
Psychological first aid
watchful waiting, assessment tools
Assessment
Trauma focused IPT Trauma focused CBT
Treatment
onsite / individual
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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
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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
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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
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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
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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.
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Evidence
Schnyder and Moergeli (2003) report that recent
life events, stress attributable to daily life
and hassles correlate significantly with PTSD
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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.
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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.
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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
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Session 3 Session 4
Who, how often, what activities shared,
expectations changes
Session 5 Session 6
Role transition Grief Strategies
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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)
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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)
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PROGRESS SUMMARY

• Reviewed evidence
• Considered clinical opinion
• Identified appropriate intervention
• Obtained feedback
• Finalised model

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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

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Thank you What are your views?
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mrutter_at_icasgroup.com
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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 176589-93 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.
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• 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)