THE ROLE OF EAP IN DISASTER MANAGEMENT

Workplaces are often the arenas where human beings spend much of their time in the course of their lifetime. The contract an employee concludes with their employer is, thus, 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.

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When traumatic events occur, these can adversely affect employees at all levels, including management who have multiple roles of managing the safe-functioning of the workplace, ensuring support is offered and also accessing the necessary support for themselves, where it is appropriate.

Critical Incident Stress Management

Response programmes for workplace critical and traumatic events are becoming an acknowledged and sought-after standard of care. The EAP is an important workplace resource and tool in management’s ability to strike a balance in managing the workforce while assisting in the preparation and recovery, before, during and after a 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 programme 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 includes pre-crisis training, individual crisis counselling, group debriefing and post-incident referral for both primary and secondary victims.

Pre-incident support

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 underestimated 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

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 recognised 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 with 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 the intervention team members, explain the process and 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 the 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 realised 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 a 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 listens 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 normalises the symptoms brought up by the 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 summarises what has been discussed in the CISD. Final explanations, information, action directives, guidance, and thoughts are presented to the group. Handouts may be distributed.4

4 http://www.info-trauma.org/flash/media-f/mitchellCriticalIncidentStressDebriefing.pdf

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
  • Post incident evaluation

After a workplace critical incident response is over, the EAP professional’s role involves supporting research and evaluation efforts aimed at determining the overall effectiveness of the response, then consulting with management and human resources to improve the organisation’s disaster response plan.

The EAP Continuum encourages EAP professionals to work collaboratively with management and human resources to evaluate policies related to disaster preparedness and response, determine how it was incorporated in the business continuity processes and review key aspects of how the disaster was managed; involving all stakeholders, to determine what changes need to be made to the existing policy or work practice. In some instances, it may be useful for an external facilitator to carry out such a review along with expert guidance to revise the plan.2

The EAP professional needs to work continuously to establish and maintain norms and standards of best practice for crisis management consultations, defusings, debriefings, follow-up and all other services provided within the continuum of workplace critical incident response.

EAP should encourage management to incorporate disaster response training into employee and management training. 

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