Primary – Prevention at source

The key elements of primary interventions to manage critical incident stress include the following:

1)       A policy on workplace stress, incorporating critical incident stress, and development of practical protocols from a risk assessment system;

2)       A strategic plan in relation to how staff can be prepared for possible/probable exposure to critical incidents with a view to minimising potential adverse stress reactions;

3)       Stress management programmes for staff who are at risk of exposure to critical incidents, focusing on stress management and  resilience, to facilitate their coping skills and to enhance their ability to deal with difficult emotions and stresses;

 4)  Development and training of Peer Support teams;

• Research indicates that Peer support from colleagues provides feelings of security and belonging that can reduce mental and emotional strain at the scene (ACPMH, 2011). It is recommended that Occupational groups who have a high likelihood of being exposed to critical incidents in the course of their work should have a robust peer support system in place.
• Ensure staff are aware of and have access to supports (e.g. Peer Support, EAP, Occupational Health, Staff Counselling).

5)   Policy/Guidelines on how to respond to conflict amongst service users;

• Polices for managing work-related violence and aggression;
• Operational planning protocols to manage risk of violence and aggression;
• Consensus on what behaviour is acceptable from service users, and how to take steps to restrict unacceptable behaviour;
• Appropriate policy/guidelines for working alone

Secondary Post Incident Support

There are a number of secondary interventions that should be applied in the case of exposure to critical incident to minimise their impact on employees by responding to warning signs and intervening early.

• The availability of managerial support is crucial at such times. Management need to be committed to supporting the development and implementation of a psychosocial support system.
• In addition, the psychosocial support system should include the following components:

1. An incident-specific response, in line with the strategic plan of the service;
2. Assessment/monitoring of the impact of stress on employees;  
3. A support programmes for employees exposed to a potential critical incident to identify need and provide appropriate support to reduce the severity of its psychological impact on them.

Depending on the nature and scale of the incident, these programmes may involve individual or small/large group interventions. This includes:

• One-on-one (crisis) intervention or psychological support: This is an important component of a staff psychosocial model and involves the provision of psychological support throughout the full range of the crisis spectrum (including peer support).  
• Immediate Small Group Support: A structured small group discussion should be provided within hours of an incident led by a mental health professional and a Peer Support Worker, where available, to those employees who require such immediate support for purposes of assessment, triaging, and acute symptom mitigation. Group discussions of the crisis event are designed to reduce acute stress and tension levels for first responders.
• Post Incident Group Support: Structured group discussion/meeting, led by a mental health professional and where available, a Peer Support Worker, should be provided 1   to 10 days post-incident, and aims to mitigate acute symptoms, assess the need for follow-up, and if possible, provide  a sense of post-crisis psychological closure. The provision of information about the normal responses to critical incidents is important so that those affected can better understand their own reaction to it. It is crucial that this is never undertaken as a stand-alone process, nor should it be provided outside of an integrated package of interventions provided for staff. Attendance of staff at such sessions should always be on a voluntary basis.

Tertiary – Incident follow up

• Ongoing managerial support. Management need to ensure the necessary measures are put in place to allow for safe, effective rehabilitation and return to work.
• Monitor employees reactions. Management should be vigilant of employee reactions/wellbeing on return to work.
• Ensure appropriate professional counselling from a mental health professional is available where required.
• Investigation and analysis of incident with focus on prevention. Refer to your local incident reporting policy for information on incident reporting and investigation.
• Incidents reported to relevant authorities such as the State Claims Agency, the Health and Safety Authority, insurers etc. This should be carried out as per your organisation’s incident reporting policy.

NOTE:

It is imperative that the use of trained Peer Support workers to deliver group interventions or individual support is in conjunction with the organisation’s mental health professionals. The most important aspect is to ensure that a ‘safety net’ of peer support and assistance is in place. A range of factors can modify recovery or escalate distress in the aftermath of an event, such as continued exposure to the distress of the victims or legal processes relating to the circumstances of the event.  All elements of a staff psychosocial support/CISM programme should be interrelated and applied systematically to ensure their logical and appropriate use.

One of the most important advantages of an integrated staff support programme is that it serves as a feeder system for the Employee Assistance Programmes and other mental health assessment and treatment services. This enables follow-up and referral to the Occupational Health services which can if required, facilitate rehabilitation and return to work, in partnership with the employee and manager.