| 7.24.05 |
| CCN prominently noted in Risk Management Magazine |
The following article was taken from the May 2005 edition of Risk Management Magazine
The Benefits of Post-Crisis Counseling
by Carol Milano
When three Oklahoma City firefighters died in a 1989 flash fire, the entire department was devastated emotionally. Lacking a crisis team, the department gratefully accepted crisis management services donated by counselors from the Shreveport, Louisiana fire department. In 1990, Shreveport helped helped Oklahoma City’s firefighters develop and train their own critical incident stress management (CISM) team, which later became a statewide model. Nearly six years after the 1989 fire, the new CISM squad was on duty when Timothy McVeigh detonated a truck bomb at the Murrah Federal Building. Within the hour, the CISM team, consisting of mental health professionals, chaplains and field providers, was on the scene administering emergency emotional care to first responders.
The CISM operations consisted of six steps: 1) prebriefing emergency crews on conditions at the bombing site; 2) monitoring crews on-site for signs of stress and offering one-to-one counseling when needed; 3) having exiting crews attend mandatory demobilization meetings in which they discussed their experiences, and in which problems were presented to command for administrative involvement; 4) addressing individual issues in one-to-one meetings with chaplains and counselors, and encouraging responders with friends or loved ones in the building to seek reassignment; 5) counseling responders’ families a week after the bombing; and 6) holding scheduled debriefings directly after the conclusion of the Murrah response.
While not perfect, the Oklahoma City CISM’s response to the bombing nevertheless was a success and epitomized the usefulness of crisis counseling services in extreme circumstances. Less frequently, but by no means less importantly, employers may have to cope with industrial accidents, plane crashes, robberies, natural disasters, massive layoffs, threats, assaults on employees, fires and other crises. Emergencies are always unexpected, but advance preparation for crisis counseling makes a major difference in recovery—of employees, commerce, morale, reputation and trust.
What Crisis Counseling Entails
Crisis counseling is a continuum of individual and group interventions, designed to meet specific needs of people experiencing different levels of impact. It is a professional service, requiring specialized training.
“The goal of crisis counseling is to facilitate normal recovery response in normal people having normal reactions to an abnormal event,” says Kathryn Dardeck, Ed.D, co-chair of the Massachusetts Disaster Response Network and president of Neurobehavioral Associates in Hingham, Massachusetts. “Mitigating the impact of an event can reduce the possibility of long-term problems, such as trauma or alcohol abuse.” The bottom line, Dardeck says, is restoring adaptive functioning in employees.
Any kind of crisis evokes extraordinary physical, emotional or cognitive responses. Intervention should begin very soon after an incident—usually within a few days. A frequent mistake is waiting several months, until problems become persistent. Occasionally, immediate intervention is appropriate. However, Dardeck finds it is far more frequent that, when called to respond to a crisis the next day, she has to say that it is too soon. “People may still be in shock, and they have to be ready to hear what’s being said.”
Once those in most immediate need are identified, they might be seen individually. The most effective approach, however, is for a mental health professional or a very experienced HR person to gather a small group—no more than eight people—and assess the needs and strengths of different participants. Some people may need only that first session; others may require additional time and counseling.
In smaller organizations, one counselor can hold several separate sessions in a single workday. With larger employers, a team of counselors will probably lead concurrent sessions over a specific time period. Counselors are particularly alert to any indications of potentially suicidal or violent tendencies, and quickly refer those individuals to further assistance.
A Plan for Crisis Counseling
Crisis management plans often neglect an organization’s human needs by omitting counseling, but crisis counseling services facilitate a return to normal business activities and minimize the negative effects of a crisis on employees. Without use of crisis counseling, those same negative effects, left unattended, can lead to higher absenteeism, lower morale and productivity, loss of concentration and accuracy, increased health benefit costs, greater turnover, work force attrition and recruiting expenses, and more conflict between employees, or with customers.
An emergency can traumatize leadership, too. “Just when you need to be thinking clearly and decisively, you may not be functioning at peak level,” says Bob VandePol, MSW, president of Crisis Care Network in Grandville, Michigan. “It’s best to have the steps set out, then just read the plan and do it. It will help carry you through a crisis.” In struggling to make sense of a terrible event, people may blame co-workers or leaders. To prevent that symptom, predict it. “Anticipating is good defense,” says VandePol.
Dardeck concurs. “Whether bank robbery or building collapse, the gamut of responses runs from shock (no visible reaction) to worker delinquency to potential violence, and emotional problems of every kind. Risk managers should know this is a predictable dynamic, and have the right personnel lined up to assist.”
These include a pre-determined crisis counseling team, usually called in after leadership has acknowledged the trauma (hopefully, with compassion and competence). Besides assisting employees, counseling services afford external benefits, by helping to rebuild the organization’s image and reputation, staving off a decline in demand, and maintaining the ability to recruit desirable employees.
Employee and Community Needs
Effectively handling the first few hours of a crisis can avoid exacerbating a difficult situation. After a traumatic experience, the biggest human needs are the simplest—relocation to a safe place, any required medical assistance, accurate information, reassurance (including “permission” to be very upset) and a chance to talk about their torrent of feelings.
Dardeck often counsels firefighters, who are tough, resilient and aware of the dangers of their profession. “What they are not prepared for is an inability to save children. If they cannot get a child out of a burning building, it haunts them. They do not expect the overwhelming response they feel.”
Individual responses vary with each person’s experience, and the nature of the event. For example, despite the frequency of bank robberies, tellers are often traumatized by such events, says Dardeck. “Depending on their prior history [with robberies], recovering can take anywhere from two days to two years.”
While productivity typically decreases by about 80% for two weeks after a crisis, people want a return to normalcy and a chance to feel involved and useful again. That is why, after a robbery, bank departments are soon running fairly well, if they have had a plan in place.
Crises can even shake organizations providing aid. Susan E. Hamilton, Ph.D., senior associate, disaster mental health at the American Red Cross, recalls a colleague who had a cerebral hemorrhage at work. Well-trained staff members calmly assisted her until emergency medics arrived. However, after learning that she had died in the hospital, many co-workers became upset; some came to see Hamilton individually. “We held a memorial service at the Red Cross. It was a good place for people who knew her at work and considered her a friend or a colleague, to come and talk,” says Hamilton. The woman’s family attended, too.
In fact, family members and community residents may also need reassurance and support after a crisis. Designated representatives should reach out with compassion and diplomacy to comfort those outside your organization who are also affected. Offering assistance, while expressing sympathy and concern, is greatly appreciated.
Sometimes even customers, suppliers, distributors or shareholders need straightforward information about crisis impact, and how soon your business can return to regular operations. A pre-assigned spokesperson can talk with them once the situation becomes clear.
Developing the Counseling Plan
“Don’t wait until a crisis happens to figure out the steps,” says Mary P. Hannon, licensed clinical professional counselor at Mercy Medical Center’s Pastoral Care Department, in Baltimore. To prepare an effective crisis counseling plan, Hannon suggests the following steps:
Define a “critical incident” for your organization. Would the death of an employee’s spouse qualify, for instance?
Evaluate your own resources. Are any staff members experienced in trauma response, first aid or counseling?
Establish a first responder team. This should include at least one manager and one HR person. Who is authorized to call for assistance, or make referrals? Create a written agreement as to just who will do each task.
Arrange training sessions for first responders. They should cover common reactions to enormous stress, and longer-term effects—such as disturbed sleep or ongoing depression—indicating a need for referral to medical or mental health professionals. (Typically, about 8% of people require additional ongoing care.) If possible, include the entire staff.
Identify and train representative(s) who will work with family and community members, if necessary. Reaching out promptly in a crisis is a pivotal point, when a company’s reputation can soar or plummet.
Develop channels for crisis information and communication. Once a list of procedures and resources is compiled, distribute it to the entire staff to use during or after any emergency. Include sources of assistance for anyone having ongoing problems months afterward, to avoid having the employee feel embarrassed about needing further help.
Hold a detailed annual role-play, simulating responses to an actual disaster. An untested plan could prove too weak or ineffective to meet its aims. Establish the place where everyone will be taken initially, and who will bring them. Have top management participate in order to simulate giving accurate, unfiltered information immediately after a crisis.
Be redundant. Identify an alternate for each role, to avoid adding confusion to disaster if someone is unavailable for an assigned responsibility.
Apply critical incident stress debriefing (CISD) with care. CISD was introduced in 1974 for military personnel and emergency workers, but it is often applied inappropriately in the business sector to individuals, for whom the methodology was not intended.
Arranging for Skilled Providers
After developing a crisis counseling plan, the final step is pinpointing its providers. Even if your own human resources or employee assistance program (EAP) staff is qualified to deliver professional crisis counseling services, they may be very shaken by a catastrophe and not ready to lead a group. Pre-arrange for outside assistance, even if you never need it.
Case in point: Hannon recalls one Monday morning she reported to an urban high school after a sophomore’s weekend suicide. After the principal addressed all the tenth graders, he introduced first responder team members. Then students were divided into small groups, and led to different classrooms. “The counselors on staff were available and led some groups, but many were upset themselves. The outside team, including the pastor of a local church, was called in to expand in-house resources.”
To select professional counselors who can give training sessions and be on-call for an emergency, develop a list of nearby mental health providers. Try the psychology or counseling department at a medical center, or pastoral counseling program of a religiously-affiliated hospital. (The American Psychological Association, National Association of Social Workers, and American Counseling Association can direct you to local chapters.) EAP departments, insurance companies or employment lawyers can also make recommendations.
Establish links to nearby resources that help in crises. The nationwide Disaster Response Network (overseen by the American Psychological Association) provides volunteer assistance through its state chapters. Hamilton, who oversees American Red Cross disaster mental health, recommends contacting local law enforcement agencies, fire department, and the nearest Red Cross chapter. Be sure to ask what information they will need in order to respond appropriately.
Pre-arrangement with a private critical incident response firm will ensure prompt attention to your staff in a catastrophe. One such service is Crisis Care Network (CCN). CCN sometimes contracts directly with risk management departments and works with each client to develop its plan and assist employees impacted by an incident. CCN’s specially trained mental health professionals consult with employee groups at the worksite, and then strategize ways to facilitate recovery. CCN also works through insurers—“third party administrators who link with us as a means to help an employer control workers compensation costs,” says VandePol.
Some companies contact CCN for the first time immediately after a disaster. The opportunity to plan ahead of time, though, “makes us more confident that we can deliver our services in accordance with the specific protocols and objectives of the particular company, instead of just responding,” he says.
The best way to manage the risks in a crisis is to “address its psychological undercurrent,” says VandePol. “Violence, a catastrophic manufacturing or industrial accident, robbery, or even an employee fatality can actually lead to a new sense of loyalty, community, and commitment to excellence—versus a negative image, conflict and distrust of the leadership.” Planning ahead for crisis counseling, in case the need ever arises, is the surest step towards a positive recovery.
Carol Milano is a freelance writer based in New York. |
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