CIR Summit Explores Expanded Value

By Jeff Gorter, MSW


Questions around critical incident response have long challenged the EAP industry. While it is reported to be one of the most requested and valued services to corporate customers, EAPs have struggled to reach a consensus on what CIR is, how it should be delivered, and perhaps most importantly, why critical incident response is offered. It was in the hope of answering these questions that the first EAP Critical Incident Response Summit was held on September 29, 2015 in San Diego, Calif. The event was held in conjunction with EAPA’s 2015 World EAP Conference. Hosted by Crisis Care Network, the summit included 57 attendees, representing:

* Executive leaders at 26 separate EAP organizations;
* Industry-related professional groups, including EAPA, EASNA, National Behavioral Consortium (NBC), the Employee Assistance Roundtable (EAR), the Asia Pacific Employee Assistance Roundtable (APEAR), and the European Employee Assistance Forum (EAEF);
* Published researchers in the fields of trauma and EAP; and
* Other affiliated stakeholders.

The goal was to begin a dialogue around the question “What does the corporate customer really want when they ask for CIR?” Through a number of keynote presentations, customer panels, and roundtable discussions, participants explored CIR delivery from this organization-centric perspective, seeking consistent themes and emerging consensus points.

Opening Keynote
The first keynote, “Out of the Ashes: Implications of Individual and Organizational Resilience” was presented by Les Kertay, PhD, Chief Medical Officer of Crisis Care Network (CCN). Building on both internal CCN data and external academic research, Dr. Kertay highlighted that most CIR events in an EAP setting are not likely to induce PTSD, and in fact, resilience among employees is by far the dominant trajectory. The majority of EAP events, while undoubtedly distressing, are not traumatizing in a clinical sense. They are, however, emotionally disruptive and have potential to have a negative impact from a business continuity perspective.

He described the high organizational cost associated with one specific productivity metric, workplace absence, which can clearly be driven by an emotional component. Internal data from Liberty Mutual estimates these costs in excess of $59 billion.

Dr. Kertay also connected workplace absence (or prolonged “worklessness”) to recent studies showing the significant negative health effects on the individual, with medical issues and mortality rates similar to chronic tobacco use. EAP CIR services that support a swift return to work and minimize absence would have great value for both the employer and the employee.

Customer Panel
A customer panel presentation followed with representatives from three organizations. They provided insight into their respective industry concerns regarding response to disruptive workplace events. The panelists were: Michele Neptune of Wells Fargo; Nicole Stelter, PhD, LMFT of Kaiser Permanente; and Jim O’Hair of Northrop Grumman.

I served as moderator, as each panelist was asked to operationalize resilience, not as an abstract psychological concept, but in terms of organizational objectives and productivity outcomes.

Michele Neptune spoke to the needs of the Banking and Financial industry, particularly in response to bank robberies and other targeted criminal activity. Michele specifically identified the importance of CIR in public perceptions of strength/security engendered by a swift return to operations at a banking location.  

Nicole discussed the CIR challenges her organization faces as the largest nonprofit health plan in the U.S. (over 180,000 employees). She explained that in the Health Care industry, exposure to upsetting or distressing events is unavoidable – and most disruptive workplace events occur in areas specially designed for trauma, such as emergency departments or the NICU/PICU. Nicole remarked on CIR as a way to minimize burnout and build team unity in high-stress medical settings.

Jim O’Hair described the complexity in delivering service to a large, multi-national corporation involved in a highly diversified business and product line (e.g. Security, Manufacturing, Aerospace). For Northrup Grumman, minimizing lost productivity following disruptive workplace events is a central business goal.  Jim emphasized that CIR services, as well as other essential EAP offerings, are fully integrated into the business continuity, risk management and organizational resilience plans of NG, while recognizing that business recovery is based on people recovery.

A common theme expressed by all panelists was the critical importance of employee perception of leadership following a critical incident. Regardless of the event, employees will look to the response and make judgments about leadership commitment, corporate responsibility, and whether they as employees are truly valued – all of which have implications for morale, presenteeism, liability, and even shareholder/customer reputation in the marketplace.

Second Keynote
The afternoon keynote was presented by Gary DeFraia, PhD, titled “EAP-Based CIR: Organizational Outcomes Following Disruptive Events.” Drawing on his decades of experience with Magellan EAP, Dr. DeFraia further reinforced the assertion that individuals tend to be resilient in response to disruptive or traumatic events – and so, he contends, are organizations. By integrating business continuity planning with human continuity planning, an overarching focus on Organizational Continuity begins to emerge as being very helpful to corporate customers

Workgroups
The final segment of the summit involved breaking into workgroups to discuss the following four topic areas:

* What is the definition and best practice of CIR as offered by EAPs?
* What is the value of CIR services in an EAP context?
* Do CIR services improve specific business/productivity outcomes?
* How can we track data and reliably measure outcomes? 

As each group wrestled with these questions, certain common themes emerged that perhaps reflected the beginning of a loose industry consensus: 

* Redefine terminology. There was broad agreement that CIR terminology should be reevaluated and redefined for an EAP context. For instance, the term “critical incident” is itself potentially confusing or misleading given that most EAP requests for service are related to events that are disruptive but not necessarily traumatic (i.e. normal grief).

* Recognize overall resilience. Strong support was expressed for efforts that facilitate both individual and organizational resilience since they are interrelated. Workplace resilience is best defined in functional and operational terms, such as a swift return to normal levels of productivity, lowering absenteeism, minimizing Workers’ Comp claims, etc. These business-related metrics mark a return of personal self-efficacy, reflecting an often expressed and understandable desire of impacted employees to “just get back to normal, and get back to work” following a disruptive event.

* Avoid a pathological approach. All EAP CIR assistance should avoid pathologizing the event or interfering with the natural course of resilience. Assistance need to be cautious, measured, and cognizant of both the context of the disruptive event and culture of the organization.

Real-time Technology
Using real-time polling technology throughout the day and in a follow up survey, Summit attendees were able to directly offer insights and experience regarding the future of CIR services. This representational feedback from industry leaders will inform next steps in building and researching CIR that is evidence-based, oriented to enhance human capacity for resilience, and tailored to the organizations and settings in which CIR is delivered. The authors noted three key themes that emerged:

* There is a polarity of views as to shaping new developments in CIR. At one extreme are those who see little need to modify CIR as currently delivered, and who believe that the clinical value of services offers sufficient justification for keeping the status quo. On the other extreme are those who believe that CIR needs to be entirely re-conceptualized. In between, there is a broader range of sentiment that notes the value of CIR, but also cites a need to tailor interventions to the circumstances that matter most to employers who ultimately are the consumers.

* There needs to be a standardized an approach to gathering information on the front end. This would enable CIR specialists to better understand both the nature of the incident, and the characteristics of the organization in which services are requested. There is reasonable consensus that better information at intake/case shaping will lead to CIR services that are specifically targeted, more readily received, and with enhanced outcomes.

* A key aspect of CIR services in any employer organization is to maintain and improve the productivity of the impacted employees. To better understand what this means for employers, we need to involve and solicit feedback from employers to help aid in discussions in order to avoid, in the words of one participant, “our tendency to keep talking only to ourselves.”

Summary
The summit was well received, with great participation and the sharing of important insights for the continual development of CIR services in an EAP context. This dialogue points the way for further research, highlights the need for validated measurement tools to define efficacy, encourages the ongoing refinement of delivery models, and lays out a challenge on how to use CIR to deliver even greater value to employers and their workers.

Jeff Gorter is the Vice President of EAP and Corporate Relations with the Crisis Care Network. He may be reached at jeff.gorter@crisiscare.com.