JEA Q1 2020

Applying the MSRA Approach to Mass Shooting Incidents

By Robert Intveld, LCSW, CEAP

With the increasing frequency of mass shooting incidents, EAPs should consider reviewing the traditional Critical Incident Response (CIR) approach to meet the challenging needs of organizations and employees affected by these horrific events. Today, responding to mass shootings requires interacting with more emergency management operations, fielding more management consultations, coordinating with more onsite professionals, and intervening with more significantly impaired employees and disrupted systems.
EAPs also know that each time there is a mass shooting incident, they are not responding to just an isolated incident. There will be numerous requests for EAP CIR from multiple workplaces within neighboring communities. For instance, while Walmart was the epicenter of the incident in El Paso, Texas, the entire community was impacted as well – in addition to communities across the border into Mexico.
Moreover, each shooting incident leads to a pervasive sense of fear and vulnerability that can ripple across the entire country. As an example, an EA professional who responded to the El Paso shooting reported that their EAP was also getting calls from a client company in Oklahoma who had experienced a shooting incident six months prior. They also wanted onsite support, thus increasing the number of CIR requests per incident.

The Multi-Systemic Resiliency Approach (MSRA)
MSRA, developed by this writer in 2013, recognizes the interconnectedness of the systems involved in recovery from critical incidents and their contribution in fostering a resilient outcome (Intveld, 2015; Walsh 2007). The development of MSRA addressed an ongoing gap in CIR services that other response protocols failed to take into consideration. EAPs require an approach that addresses the needs of multiple stakeholders, balances the demands of a dual-client structure, and offers a response with the flexibility to adapt to a variety of workplace cultures.
To achieve this goal, multiple systems must be mobilized and coordinated in a united effort to address the need for restoring safety and fostering resilience (Intveld 2015). This overarching theme also applies in response to mass shootings. In keeping with the MSRA approach, EAPs need to strengthen their focus on helping restore organizational fortitude and its connection to employees, early on in their response.

Focal Points of MSRA
While a complete review of MSRA is beyond the scope of this article, there are several interventions that are emphasized and enhanced when addressing mass shooting incidents. They include:
* Management Consultation;
* Creating and operating within Safe Zones;
* Deploying appropriate group interventions; and
* A return-to-work process.

* Management Consultation (MC)
Key information to be obtained beyond the typical CIR assessment must include questions to help understand the level of disruption the organization has sustained and its impact (physical and emotional) on employees. Questions about the following areas are critical: proximity of the organization to the shooting incident; damage it may have sustained; accounting for the whereabouts of all employees, including any traumatic loss that may have incurred, and whether a police investigation barrier line has been in place. It is particularly helpful if the management consultation team is cognizant of the kind of emergency management operations that are underway so that they can help deploy EAP response professionals.
Securing onsite providers is a primary task of the MC process. While this may seem routine, there is a race to secure providers by all the EAPs, both regional and national, plus crisis vendors serving their clients in the impacted area. Local providers with acceptable training in CIR (determined by the EAP) are often on multiple EAP networks. The demand for these providers will be high.
While there will be a surge of general “crisis counselors” willing to help, there are only so many providers with CIR training and fewer still with an understanding of EAP. Using untrained providers creates ethical challenges (EAPA Code of Ethics 2009), not to mention potential harm to both clients and counselors.
Local providers are also part of the impacted community and may be going through their own reactions. Since the intervention timeline is expanded during mass shooting incidents, EAPs need flexible providers who can work extra hours and/or days to maintain continuity of care.
In the absence of providers, an ad hoc process to secure temporary, onsite professionals to deliver ethical EAP CIR, must be in place. On-Demand EAP CIR training, along with coaching, may provide that solution as well as serving the greater need of EAP preparedness.

* Creating and Operating within Safe Zones
Immediately following the Response Stage of Emergency Management Plans where law enforcement has secured the area and neutralized the threat, operations within the Recovery Stage involve setting up community resources for victims of the shootings.
These will include Reunification Centers (safe areas where victims can connect with family members, i.e. students with parents), and Family Assistance Centers (safe locations with access to multiple community resources, such as American Red Cross, FBI, transportation, childcare, crisis counselors) with access to law enforcement as they carry on their investigation.
Secondary to these community safe zones, local organizations can set up their own Corporate Safe Zones. These are temporary locations where employees can gather safely and securely in the event the workplace becomes unavailable. They serve an important transitional function, not only for access to EAP services, but to create a space where the natural sources of resilience, (connection with significant others, group cohesion, organizational leadership and communications) can flourish.
Families can be invited to participate as well. During the crisis and its immediate aftermath, in addition to worrying about their own safety, employees worry about each other. A Corporate Safe Zone is a space where, at minimum, they can go for social support and to hug each other! Do not underestimate the power of this seemingly simple intervention (Craig, 2019).
In addition, Corporate Safe Zones allow restoration of contact and communication with leadership, regular corporate briefings, access to EAP services, and other wellness resources. These zones may be located in branches, satellite offices, treatment centers, churches, restaurants, hotels, schools, anywhere that can accommodate employees outside the restricted areas until the workplace is ready to resume operations. Pre-incident preparedness plans may have already determined locations.

* Deploying Appropriate Group Interventions
During the MC and subsequent communication with organizational leadership, it is crucial to identify those who may have been injured, were in the proximity of the shooting incident, or experienced a tragic loss, as they are at higher risk for experiencing trauma (May, 2015).
Medical intervention to those injured is the first priority. Efforts to assist victims in reconnecting with family and/or significant others offers the best path as increasing safety and emotional support. Following these initial courses of recovery, there may be appropriate candidates for one-on-ones and/or group interventions.

When considering group intervention, group selection is critical. If there are natural employee groups or teams who had similar exposure and/or reactions, these may be good candidates for group interventions.

A Psychological First Aid (PFA) Group should be considered for this type of intervention. According to the National Child Traumatic Stress Network, psychological first aid is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping.
When delivered in a group format, it can provide a structure for catharsis, self-learning, group cohesion, symptom management, and universality (the idea that someone’s reactions are shared by others) (Everly, 2006).
There are two essential elements when providing PFA Group interventions: EAP responders must adjust the group process to the cognitive functionality of the employees; and be aware of research that indicates conflicting support for single session debriefing interventions (van Emmerik, 2002), (Bisson, 2003).
PFA groups must integrate some or all of PFA’s 8 Core Actions. Examples can be found through the National Center for PTSD in its PFA for Schools Field Manual. Follow-up activities are also essential (Everly, 2006). This may include outreach services to determine further need of one-on-one support, and/or PFA or resiliency-based support groups.

* A Return-to-Work Process
Returning to the workplace can be difficult. Even if officials have deemed it “safe” to return, employees returning to or near where a shooting took place can trigger stress; including emotional, psychological and physical reactions. Such reactions are normal.
Even if the shooter was apprehended or is deceased, the “perception of fear” rises when thinking of returning to the workplace. Consultation with organizational leadership on how to address this is imperative. Employees will need visual cues and recurring messages that reinforce safety over a period of time, to counter the intense level of fear they may still be experiencing. If not addressed, connection and trust with their organization may erode and return to work delayed.
One intervention that can be extremely helpful, is a mock return to work.  The coordination and logistics of a mock return to work are discussed with organizational leadership and mapped out within the Corporate Safe Zone. Mock returns allow employees to return to the workplace site, and move around freely without having to actually work. These practice runs give employees a chance to see that any damage has been repaired, the site is visibly secure, and that a return to a normal work routine is progressing.  
The first day of the mock return can be very stressful, but it is an important first step of returning to work. Some employees may not feel ready. They may be encouraged by being offered a ride or prefer a buddy to return with. These details can be worked out during the time in the Corporate Safe Zone. EAP will be part of the mock return as well, helping with the onsite adjustment.
This is a good place and time for a resiliency group intervention. The intervention will reinforce the normalcy of their reactions, enhance group cohesiveness, and strengthen resilience both within and outside the workplace. Once the workplace has resumed operations, a short-term, EAP onsite presence can be made available for those who desire additional support.

Traumatic Loss and Grief
Deaths that are untimely, sudden, and/or violent are the most common source of trauma (Norris, 2002).

In MRSA we talk about Collegial Grief as it relates to one’s level of connection to the deceased (Intveld 2015). This connection varies among colleagues and thus the impact and feelings associated with loss will vary. Collegial Grief applies to many of the deaths related to EAP onsite requests.
 In mass shooting incidents, however, employees can experience the impact of traumatic loss no matter the level of connection. The realization that it could have been any one of us, or any one of our family members; can be overwhelming. There will be a pervasive sense of loss within the community.
A request for a grief-focused intervention may seem obvious, even logical. However, an assessment for the clinical readiness and timing such an intervention should be carefully conducted. The first priority of all CIRs is safety. All interventions must be focused on helping restore physical and emotional safety.  While interventions will have a grief element, the impact of the critical incident and on one’s coping skills becomes paramount.
Once safety and stabilization has been achieved, additional grief-focused interventions can be considered. Keep in mind that while the EAP response is initially on safety, additional resources for stress management, the fostering of resilience, and trauma support are being provided by multiple community agencies.
Our role in EAP CIR, consistent with MSRA, is to help employees connect to these powerful resources.  Referrals to the treatment community for working through traumatic loss, at some point, may be appropriate. In the event the EAP is asked to provide some form of grief support group around traumatic loss, EA professionals must remember that we provide crisis intervention, not treatment, and use of a group model must reflect this fact.

Summary
EAP response to mass shootings and/or acts of terrorism are no longer unusual requests. Their presence challenges our foundational, professional training, not to mention our own core, personal beliefs. They tax our own internal EAP resources. We have learned a great deal about what works and what areas need to be emphasized. Incidents of this magnitude highlight our partnerships with organizational clients. Getting it right matters.

Robert Intveld, LCSW, CEAP, is the owner of Robert Douglas and Associates, www.eap-rda.com and author of “EAP CIR: Multi-Systemic Resiliency Approach”. For more information about Robert’s trainings and services contact him at: rintveld@verizon.net


References

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