By Siobhán McGee and Emerald-jane Turner.
This article is the fourth in a series. To understand the context of this article we advise readers who have not yet read the first three to do so first:
This article focuses on the weeks, months and sometimes years following an incident which constitutes the recovery phase of the human resilience strategy. Because this can be a complex process which can only really be dealt with on a case by case basis, we have aimed in this article to give a wide range of examples that are useful to consider.
It is vital to have a trauma specialist guide your organisation through the recovery process. However, having said that, we believe that resilience is the ability to tap into innate organisational resources and where this process is simply outsourced to an external agency to ‘sort out’, this can prevent the organisational community fully tapping into their own resilience to become an empowered recovering and resilient community. It is for this reason that we stress the importance of developing in-house programmes and working within the organisation to create an organisational culture that is inherently and genuinely supportive.
In her research ‘Reputation & value recovery – a focus on the airline industry’, Dr Deborah Pretty of Oxford Metrica, highlights the importance of such a culture to an organisation’s reputational resilience:
“A successful crisis response strategy relies on strong personal leadership by the chief executive and is driven by the following three elements: action, communication and compassion.” (i)
Like a ‘clean up’ operation, this third phase follows the adrenalin rush of the immediate aftermath, where an organisation will survey the full extent and impact of an incident on its workforce and become aware of the implications of the ripple effect.
A recent article on post trauma in the workplace highlights, that any post incident crisis management should be ‘part of a comprehensive stress management package that enables individuals and groups to receive assessment of individual and group needs, practical support, follow-up which would facilitate the early detection and prompt treatment of psychological conditions such as PTSD’ (ii)
As an organisation, the maintenance of routine and normality as far as possible is helpful for staff, as it provides some familiar structure in a time of unfamiliar feelings and disorientation.
Keeping channels of communication open and providing regular updates on resources, such as in-house stress programmes, other sources of external help e.g. employee assistance providers telephone details etc, as well as distributing information about progress of the business is key at this point. This can be done through using a variety of channels such as leaflets, e-mail, bulletins, text alerts and team meetings and through personal contact with responders, managers and trauma experts.
At this point, initial shock has passed and with the fading of adrenalin comes exhaustion coupled with the very natural emotions of anger and frustration. This is the traumatic anger that we often refer to in our work. Rather than having constructive and reflective discussions what often happens are recriminatory messages in statements such as ‘Why didn’t you...?’ This analysis is a common stage of trauma recovery, re-running events and questioning reactions, often accompanied by feelings of guilt and of wishing that actions were different.
Organisationally during this stage it is important to listen and understand that this is part of the recovery process and provide reassurance that lessons will be learnt and taken forward. This stage, in our experience, is where relationships between employees and managers can be strengthened and mutual respect grown as a result of sensitive and informed management.
After the terrorist attacks on the London Underground a great deal of the work consisted of lots of informal conversations, travelling to sites and listening out for themes, piecing things together and feeding them back to the appropriate parts of the organisation sensitively.
While the business unit is getting back to normal functioning, any staff members who are struggling, particularly those who are off work, can begin to feel more isolated and alienated.
Trained staff responders can continue to carry out their important role, not as counsellor but rather as educator and peer supporter, liaising and advising managers about individuals well being and needs. This can involve calling people regularly, meeting with managers, organising team meetings, where appropriate encouraging attendance at group meetings and counselling appointments, thus generally supporting return to the workplace. These staff should therefore be trained to recognise the normal stages of traumatic stress and be able to reassure others. This is vital as people can sometimes believe they are ‘losing their minds’ when in actuality their nervous system is trying to establish equilibrium.
‘The solidarity of a group provides the strongest protection against terror and despair and the strongest antidote to the traumatic experience’ (iii)
As our approach to human factors focuses mainly on encouraging resilience across the organisation, following major incidents we have found that providing on site group meetings for teams and departments can be immensely helpful in combating isolation and normalizing responses. These can be organised by staff responders, occupational health, or external providers. Groups do not need to focus on the minute details of the incident itself, but can be an effective way of re-establishing connection and supporting coping strategies. These meetings can provide an informal part of assessment to check how people are recovering and to highlight where they are struggling. We have also discovered that this sort of group approach can increase social resilience and cohesion, which promotes the supportive recovery environment where participants look out for each other. This is a vital contributor to organisational resilience.
Studies on post traumatic stress disorder (PTSD) show that for 85 percent of people, trauma symptoms gradually recede and normality starts to re establish after a period of 5 – 6 weeks.
After this time-frame, people need to be referred on for specialist help if their symptoms are getting worse or there is no change. This is where trained staff supporters can play a vital emotional first aid ‘triage’ role to refer individuals on.
This is also the phase where people such as managers, HR teams, staff responders and counsellors, who have been supporting others throughout the incident, need attention. Finding ways of doing this, either formally or informally is important, perhaps drawing on external resources or organising meetings in groups or 1:1.
Engaging specialist help for trauma assessment is necessary. For large-scale events, it can be helpful to have a standard procedure to contact all staff directly involved by telephone within the first three weeks following the incident. The purpose of this call can be to conduct a triage assessment and can aid recovery and identify individuals who are at risk of PTSD, enabling them to be referred onto appropriate professional help. We train managers and staff supporters to conduct this post incident contact and in our experience have found that employees really value the contact from the organisation.
This contact also gives everyone the chance to have some support without pinpointing individuals and also gives a very strong message that the organisation cares about its workforce
In order to ensure you are sufficiently taking care of your staff it is vital your employee assistance programme (EAP) provider supplies counsellors with training and experience in the area of trauma.
Trauma symptoms are not only experienced by those directly involved in the incident but can also be experienced by others hearing about it; particularly those involved in supporting others in the organisation.
Example: B was a press officer, mediating between the staff and the mainstream media. At a chance meeting we talked about her experience and she broke down in tears. We talked about the effect on her of hearing so many distressing stories. She then organised a group for press officers, looking at symptoms of secondary trauma. They expressed relief at realising that most of what they were experiencing was normal symptoms of prolonged exposure to other people’s trauma. We discussed strategies for modulating arousal and building resilience. Several people opted for counselling sessions to help cope with the effects of secondary trauma.
The ripple effect
It is natural for trauma events to create a ripple effect, affecting many people. For a short time people can become hyper vigilant, protective and preoccupied. Below are some examples that we came across when helping an organisation to manage trauma related to the London 7th July terrorist attacks:
Families needed help and reassurance as they were affected by their partners/parents traumatic reactions, they had a sense of them being unsafe when at work and not knowing how best to help and support.
Admin staff were continuously on the phone listening to people and then creating images, which their body then reacted to. This led to overwhelming feelings for some and needed acknowledgement as well as attention drawing to the part that imaging was unconsciously playing.
After about three months, some managers starting to feel their own symptoms but had difficulty admitting to them, due to their role and the general culture. It helped that there was a continuing counselling presence on sites that enabled relationships and trust to be built. We used the booklet ‘Remaining Resilient’ and explained about secondary trauma. This proved helpful and with careful management secondary symptoms passed quickly.
Assisting people back to work
Some people will need assistance to return to work, while for others returning quickly is a way of reclaiming normality. Each individual is different.
The manager can assist individuals to have some control about their return to work, which is important as trauma removes control. Weekly meetings, allowing staff to set their own goals and finding practical ways of supporting them, are valuable ways of approaching this. Counsellors or other experts can be a valuable source of guidance and support for managers at this time.
D wanted things to be back to normal. Everything had changed, all his life he has been a rock in the family and a strong union member at work. After the bombing he found himself emotional and withdrawn. The manager at work had always been someone to bump up against. The manager’s compassionate and person/driver centred approach simply exacerbated D’s feeling that everything had changed. We asked the manager to set limits and put some pressure on D which helped him feel more normal and stabilised.
When incidents are high profile and involve many people there are further aspects which are important to take into account. Some of these can distress staff and make it difficult for them to move on or to find closure. It is very important to create adequate support or make provisions in your procedures for this. Such aspects include:
Because major incidents are very much in the public eye, the media are normally present in droves and can be very intrusive. They will be on the scene within minutes and may camp outside the sites at all times of day and night, often approaching individuals for stories and details of the incident.
If you have an in-house press office they will negotiate with the mainstream press and try to protect people and give them some control. However, this can prove to be a very difficult job.
Often the lack of accuracy of reporting adds to the distress of those who have been involved, causing angry outbursts and retriggering trauma symptoms.
There is a tension in people about fascination-versus-overwhelm and where someone is traumatised they may have an almost obsessive need to watch the news, however this can be unhelpful and can cause further trauma. It can be helpful to remind people that the TV can be switched off and newspapers do not need to be read, so controlling their exposure to images and stories.
Shrines and vigils
It has become common for shrines and vigil sites to be set up where human tragedy has occurred and is a natural outpouring of grief and sorrow at the loss incurred. However, these shrines may be something that staff encounter on a daily basis, making work a constant reminder which can mean that they find it hard to move on from the event.
Where members of the public have died, their families may request visits or appear unexpectedly at the scene of the incident to help with their grieving process. This often involves the support of a manager or member of staff and it is essential that the organisation anticipate and plan for this, as staff can become distressed as a result of witnessing the grief of others.
Inquests are often many months after the event; police may interview staff, often several times, in detail. It is supportive to organise someone to be there or to telephone staff members during or after such interviews. During the time that the inquest is taking place anticipate a surge in media interest and all that goes with that.
Large-scale events have many anniversaries, after a week, a month, a year etc. Each anniversary attracts media coverage and often the gathering of people in remembrance. It’s important for staff to have a choice in whether they attend these or take time off and it can be useful to have responders or counsellors on site at these times.
Where members of staff have died or been injured as a result of a large scale incident the impact of the above events may be intensified even more.
Checklist for phase three:
* Ensure you have a team of responders who are regularly trained and updated.
* Include responders when carrying out scenario practice.
* Ensure post incident contact with responders and managers to keep informed of emerging issues and themes.
* Senior management team should remain mindful of the impact upon staff and communicate.
* Group meetings to enhance community resilience.
* Referral of vulnerable individuals onto specialist agencies.
* Ensure your EAP has specialist training in traumatic stress.
* Liaison between responders, managers and individuals for return to work.
* Support for families by leaflets, responders or specialist agencies.
* Supervision for responders, HR/occupational health and other related teams to ensure prevention of secondary traumatisation.
* People who may have been actively involved in an incident but on the periphery can often be forgotten when thinking about support. These may include staff such as maintenance, photographers, press office staff, control centre telephone staff etc.
* Plan for ripple effect e.g. shrines, vigils, inquests, and media etc.
We believe that at the heart of recovery is the community within the organisation. If the community strives to understand and support its members, communicates and is open to listening to their experience then not only can reparation take place in times of adversity, but strengthening and growth can result.
Dr Deborah Pretty’s research measures the vital contribution to value recovery of engaging specialist disaster experts. The research emphasises that, “the humanity with which management responds to a tragedy is an essential part of the recovery process” (iv).
In the words of Malidoma Patrice Some "A true community begins in the heart of the people involved. It is not a place of distraction but a place of being. It is not a place you reform but a place you go home to."(v).
(i) Pretty, Deborah “Reputation and Value Recovery – a focus on the airline industry” Oxford Metrica (http://www.oxfordmetrica.com/research.aspx)
(ii) Regel, Stephen Post-Trauma Support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debrief (PD) within organizations in the UK Occupational Medicine 2007 57(6):411-416; doi:10.1093/occmed/kqm071
(iii) Hermann, Judith Lewis “Trauma and Recovery”1992-214
(iv) Pretty, Deborah “Reputation and Value Recovery – a focus on the airline industry” Oxford Metrica (http://www.oxfordmetrica.com/research.aspx)
(v) Some Malidoma Power, Healing and Community 1993; 69
Authors: As a psychotherapist and occupational therapist, Siobhán McGee and Emerald-jane Turner, share over 30 years experience working with people and have brought their knowledge of the physiological understanding of trauma into many business sectors and organisational settings including working with financial institutions, fire services personnel and providing support and guidance following 7th July bombings. Siobhán and Emerald-jane work for Human Resilience Ltd. The focus of Human Resilience is to help organisations understand the processes of traumatic stress and create a number of in-house strategies for providing support and emotional first aid to their staff in order to ensure a supportive recovery environment and therefore reduce the need for longer term support such as counselling. http://www.humanresilience.com/
Contact the authors:
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© Copyright all rights reserved Human Resilience 2008
•Date: 15th April 2008• Region: UK/World •Type: Article •Topic: BC general
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