Broadening the Value of Critical Incident Response

By Jeff Gorter, Jodi Jacobson Frey and Sharon O’Brien


Critical incident response (CIR) has long been one of the main offerings in EAP services, as well as one of the most valued by EAP clients. With its high level of visibility, it has also been, not surprisingly, one of the most controversial and misunderstood.

Highly impactful events in the workplace, such as robberies, natural disasters, and unexpected employee deaths, have the potential to be extremely disruptive to a workplace and leave managers and workers alike with a wide range of emotional reactions.

At this critical juncture, employers turn to their EAPs for assistance. But what exactly are employers looking for?
* Are they looking for help in preventing post-traumatic stress disorder (PTSD) among their staff?
* Are they hoping for a “psychological inoculation” to contain a feared outbreak of mental illness?
* Or are their expectations more specific, related to business and organizational outcomes?

Recent research conducted by the University of Maryland, School of Social Work (UMSSW), supported by Crisis Care Network (CCN), suggests that a successful CIR – as defined by the end user – has as much to do with business objectives as it does with clinical efficacy. 

Five-year Study
In 2013 Crisis Care Network contracted with UMSSW researchers to analyze five years of data on CIR responses throughout the U.S. A total of 120 EAPs who partner with CCN agreed to participate in the study. CCN prepared a database of case management EAP notes for almost 32,000 unique CIR incidents between the years of 2008-2012.
The research team, led by Dr. Frey, reviewed the data for trends in CIR services offered by CCN with regard to industries served, incident types, distribution of cases over time and region of the U.S., and average utilization for service hours, individual and management contacts, group sessions, and number of participants per group. 

Three Most Commonly Requested Incidents
The most common requests for CIR services through the EAP were for: employee death, 45% of all requests; robbery and armed robbery, 31%; and layoff, downsizing, termination, 8%. The following is a brief explanation of each category:

* Employee death. Natural or accidental (i.e. heart attack, automobile accident, etc.). Typically non-work related nor witnessed by co-workers. This does not include industrial accidents resulting in death as those were categorized separately (i.e. machine malfunction, etc.).

* Robbery and armed robbery. Targeted criminal activity, typically in a retail or banking setting although not limited to those industries. 

* Layoff, downsizing, termination. Usually a planned event with predictable, associated disruption.

The largest industry classification requesting services was banking (42% of all cases).  These workplaces requested more than three times the number of CIR services compared to the next closest industry served, manufacturing (12% of all cases).  [1] Industries were classified using the National Association of Industry Classification coding system.

Additional analyses comparing industry type by incident and service utilization were conducted. For a copy of the Final Report Executive Summary, email jfrey@ssw.umaryland.edu

Robbery is the Most Traumatic…
Each of the three incident categories listed previously are disturbing at both individual and organizational levels. But of those three, only one – robbery – has any significant potential of inducing pathological levels of trauma (i.e. a real or perceived threat of loss of life, or a profound loss of personal safety, as identified in the DSM 5).

The remaining two categories – unexpected co-worker death and corporate downsizings – can be emotionally disruptive, but are less likely to lead to PTSD. Again, this is not to say that these types of events are in any way “less serious,” especially for individuals confronted with them. However, in the vast majority of cases, they are far less likely to trigger the criterion necessary to meet the diagnostic threshold for PTSD (i.e. witnessing horrifying visuals, intrusive and repetitive flashbacks, and hypervigilance that lasts more than one month). (DSM 5, 2013)

… Even then Resilience is Common
In fact, research suggests that resilience after critical incidents is the most common trajectory after even the most extreme events (Bonnano, et al, 2004, 2011). Acute life events – such as the unexpected death of a co-worker – are intensely distressing for a relatively short period of time but only rarely lead to diagnosable pathology.

This clarifies our focus then, and shifts our approach from an entirely clinical intervention (designed to address pathology) and toward one that facilitates natural resilience. In the context of the workplace, natural resilience is defined as reducing disruption and a return to pre-incident functioning. This is most clearly seen in the banking industry following robberies.
Many of the nation’s largest banks rely heavily upon Ceridian, one of the largest providers of EAP, Work-Life and Wellness services in the U.S., for the immediate delivery of CIR services following a bank robbery. Ceridian’s crisis assessment consultant team works closely with Crisis Care Network (CCN) to respond to an average of just over two bank robberies every day.

In 2013 Ceridian statistics showed that 818 total shifts for CIR were dispatched following a bank robbery, accounting for 41% of Ceridian’s total CIR shifts. (A “shift” is defined as a discreet unit of service, i.e. each time a consultant went on site).

These are divided into two bank robbery types – “takeovers” (15.14%) where a weapon is brandished or used, where hostages may be taken, or where injuries or fatalities occurred – and “non-takeovers” (26.14%) where the perpetrator passes a demand note to the teller.

The level of workplace disruption is always high in bank robberies because the employees feel more victimized, as they may believe they were specifically targeted by the criminal. The resulting distress and trauma experienced by the victims creates a potential increase for PTSD, especially after a “takeover” robbery, but PTSD is not the dominant outcome. 

Bank Robberies are Distinct
After bank robbery the second-highest category for CIR services at Ceridian was employee deaths outside of the workplace (27.5% of all CIR cases). As indicated, an employee death consistently and significantly disrupts the workplace. However, while the death of an employee and bank robbery are both events that cause distress and disruption, bank robbery has its own distinctive characteristics and response needs. Bank robbery is a targeted criminal activity, which requires a different kind of CIR that is unique to the incident and to the industry. It is a specific CIR response demanded by banking industry customers due to the nature of their business continuity requirements and expectations. Banks are built on trust, and a branch that remains closed for an extended period after a robbery may risk losing the trust of its customers. Even the perception of diminished access, uncertain stability, or impaired customer service can have a debilitating effect on customer retention and the bank’s reputation.

Ceridian’s EAP worked with one of its most tenured bank customers to develop an immediate CIR model (defined as responding within two hours of being notified of the event) that has been used to respond effectively in terms of employee support and business continuity over the past 20 years.

Banks have done a good job training and preparing their employees for the inevitable robbery. They have established clear policies and procedures that guide managers and employees through these situations and CIR is woven into their corporate culture and risk management plans. Bank tellers understand that robbery is a risk of the job and they also know it is not a “once in a lifetime event” – it may even happen twice in one day!

Flexible Response is Necessary
Although thousands of bank employees are exposed to the effects and possibility of a robbery every day, the primary impact of an actual robbery is more emotional than physical. Few employees who have experienced a bank robbery sustain physical or life-threatening injuries. Affected employees may be at different phases of their lives, in terms of emotional health and maturity, so responding clinicians need to be flexible in their response to the crisis. The real focus is on applying psychological first aid to decrease the arousal of strong emotions – thus the need for crisis counselors to offer an immediate supportive, calming, positive presence so that employees can return to the job as soon as possible.

Emotional and Business Concerns
Given this dynamic, it can easily be assumed that employers are not primarily concerned with preventing PTSD (a relatively rare outcome), but rather their expectations are more focused on the common thread that runs through all critical incidents – that is, the level of disruption to the workplace.

Again, to be clear, this is not to minimize the emotional impact on employees, but instead recognize that employer concerns are also focused on organizational and operational objectives. They include:

* Communicating a reassuring corporate message following the incident;
* Facilitating a swift return to work and productivity;
* Reducing absenteeism and workers’ compensation claims;
* Improving morale; and
* Positively influencing perception of leadership. 

These goals are more closely related to business continuity factors rather than mental health, but this does not reduce the value of CIR. Indeed, attending to both humanitarian concerns and organizational objectives, enhance the effectiveness of the intervention for all stakeholders, at multiple levels. 

Research supports that a return to predictable levels of functioning in which the individual feels competent and effective at work is an essential element following a traumatic event (Hobfoll, et al, 2007). Interventions that support the integrity of a business also help encourage individual recovery and vice versa. In fact, research by Bonanno, Brewin, Kaniasty, and LaGreca (2010) found that access to economic resources (i.e. a stable paycheck) and cohesive social connections (i.e. established co-workers) are some of the most potent factors in resilience following events of great psychological distress. 

Summary
As demonstrated in this article, even the highest-impact events (robbery) demand an understanding of both clinical approaches and customer objectives in order to be successful. Customers require and depend upon EAPs to deliver clinically sound interventions in CIR and related services, but these employers rely even more heavily on EAPs for the promotion and support of business goals.

It is clear that part of the value of CIR to the workplace is that it is specifically tailored to the customers’ industry and types of events. Practical and operational implications requires a balance between responding in a humanitarian way to employees who have experienced a traumatic event while also facilitating a swift return to normal business functioning. Employee assistance programs are perfectly situated to promote resilience at both the individual and operational levels.

Jeff Gorter, LMSW, is the VP of EAP/Corporate Relations with the Crisis Care Network in Wyoming, Mich. 

Jodi Jacobson Frey, Ph.D., is an Associate Professor at the University of Maryland, Baltimore. 

Sharon O’Brien, MSW, LSW, is the VP of EAP/Worklife Operations US, with Ceridian LifeWorks.



References
Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? GA Bonanno - American psychologist, 2004

Five essential elements of immediate and mid–term mass trauma intervention: empirical evidence
SE Hobfoll, P Watson, CC Bell, RA Bryant, MJ Brymer, et.al. - Psychiatry, 2007

Weighing the costs of disaster consequences, risks, and resilience in individuals, families, and communities
GA Bonanno, CR Brewin, K Kaniasty, AM La Greca - Psychological Science in the Public Interest, 2010

Resilience to loss and potential trauma GA Bonanno, M Westphal, AD Mancini - Annual Review of Clinical Psychology, 2011

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) American Psychiatric Association [APA], 2013