Complex Incidents

It is a challenge to provide onsite services by yourself. Lets face it, an understaffed intervention forces the counselors to wear many hats. Being everything to everybody will not only accelerate your burnout rate, but run the risk of poorly executed and completed services.

Whether properly staffed or not, a dysfunctional work unit or department will also complicate the process. Consider the closed, dysfunctional department like an onion with layers and layers of skin neatly packed and tightly woven. When an incident occurs, the skin starts to unravel, fast. All the effort to package it back up fails, only further unraveling it. An untrained counselor in the midst of this is likely to repeatedly try to assist in getting the onion together. Furthermore, it seems like the appropriate organizational response as well, for the sake of the business. After all, isn't it our doctrine to make the dysfunctional functional? If you answer this yes, your in a bind. The solution is:

As seen by the statistic, EAP counselors are much more likely to come across failed suicide attempts than completed. The impact on the workplace is often overlooked and/or not addressed. Failed attempts can have a "hush" around them. If, however, the workplace becomes aware that an employee attempted suicide, news is likely to travel fast. It will disrupt the workplace.

Attempted suicide is more likely to occur outside of the workplace. The employee is likely to be placed on a leave of absence status depending on how the attempt was reported and who and how the intervention took place.

This is a scenario that calls for the blending the Onsite Services role and the ongoing EAP role. Some EAPs are faced to manage these event solo, but if you do not have to, don't. You will save yourself and offer a better service to your employees. That being said, consider this scenario:

An employee is reported on the ledge of a high rise building. Work has stopped as employees and colleagues race to witness the event. Negotiations with the employee by police, family and close friends continue on for 2-3 hours. Helicopters and press circle from above and below.

EAP is contacted and placed on an alert status pending the outcome of this event.

The troubled employee is talked back off the ledge and is escorted to the hospital and admitted. The next day front page in the newspaper is the employee on the ledge, he is cited as a disgruntled employee of XXXX. It receives national coverage (this is a true event).

Considerations for the EAP:

Consultation to management, HR, Security
Coordinate services for employee post emergency.
Coordinate leave of absence, and follow-up with mgmt.
Coordinate family resources
Onsite services for employees regarding this event
Monitor progress of employee and work with providers of services
Coordinate return to work and medical clearance
Onsite/return to work meeting with employees
Ongoing follow-up.

Responses to failed suicide attempts and the role of EAPs may vary depending on the type of EAP one operates out of (internal vs. external). Of note in this scenario is the second onsite service. The employees last image of their colleague was when he was on the ledge. Visiting with him afterwards was limited based on the request of the employee and awkwardness of colleagues. As news entered the workforce of the employee returning to work in the near future, the employees anxiety levels raised and the stress reactions to the events of the attempt were being re-experienced. Questions reflected uncertainty of the employee returning.

"Is he stable?" "Can we kid around with him?" "Were we too hard on him in the past?" "Did we contribute to putting him "over the edge"? "What should we say to him?" "Is this job too stressful?" "Is it too stressful for me?"

The anxiety level was high. The meeting (Corporate Debriefing) was a question and answer format after a brief introduction and educational piece on critical incident stress. They needed to know that their reactions were normal, and that a three headed alien wasn't returning to work, just a colleague.

The employee had already worked through these issues and had chosen to return to his position rather than leave. This decision was supported by his doctors, therapist and reviewed by the EAP.

During the pre-return meeting with the employees and management, this was the focal point of the meeting. That in fact, he would not be returning unless he demonstrated wellness and consistency in recovery. Part of the evaluation and treatment is readying for the issues of work and the environment of work. They also needed to know that employees returning from a medical leave of absence are returning in healthier state than when they first entered treatment. They were assured that the employee would continue to have access to supportive resources and it was customary that the EAP stay involved when an employee returns to work for any reason to assist with the transition back.

There was a team of 3 EAP counselors. One provided the contact with the management, HR, and other company officials throughout the event. A second responded to the individual treatment needs of the employee and family, and a third provided the Onsite Services. Separating out the roles made the entire task more manageable and eliminated counselors of the awkward position of managing multiple roles with privileged information. Managing multiple roles is a task that EAP counselors can do well, but in complex scenarios like the above, managing the boundaries can become challenging and risk the success of EAP/Onsite interventions.

As mentioned, failed suicide attempts may not be carried out in such dramatic fashion, but suicide attempts can be powerful workplace disruptors and lead to an environment that reinforces issues of shame that the returned employee may be dealing with.

When a disaster occurs, EAPs can do little for their employees in the EAP capacity, until the site is considered safe by the powers that be. Whether it is man-made or a natural disaster, safety and concrete services are the priority. If a company is physically not affected by the disaster, but in proximity of it, expect that employees have been impacted in varying degrees. Those most impacted may not be at the workplace. If they are handling concretes services they are likely not ready for any psychological interventions. Others may be. Traditional Onsite Services can be applied. A community devastated by a disaster takes a long period of time to recover. Prepare yourself for a lengthy intervention. While initial emergency response concerns fade with time, ongoing stress and exhaustion are likely to creep in. Poor follow-up services will lead to abandonment reactions. EAPs should develop a schedule of contact up to and through several months past the first anniversary date. Employee turnover rate is likely to increase during this time.

If the company has suffered a physical loss in the disaster, i.e. the building is destroyed, the EAP hopefully had some access to, or knowledge of, the company's recovery plan, if they had one. This is the mechanism that is set in motion and EAPs need to integrate themselves into this response. Hopefully this was done beforehand. If not pursue this.

A disaster scene is likely to be under the jurisdiction of the government and/or military. Special permission and clearance need to be achieved before any access inside the scene is granted. The EAP's work can begin in securing safety in there own personal lives before assisting their ongoing caseloads. After, concrete services for their employees and securing safe sites for any debriefing activities are the first steps.

Some employees had to evacuate. When an evacuation is ordered, a family leaves in a stressed state for the event has not happened and my not. Nonetheless they evacuate to somewhere. Any services provided for evacuees are services to promote resilience. It is not a time to reverse the stress response but help them to maintain it in a manner that doesn't create an over fatigue. The evacuee will either experience great relief or a life altering experience upon return to their home. Services at that point may be more relevant.

Communities impacted by disasters come together. While one's personal space may not be impacted, others may be. Outreach efforts are common and stress responses will be activated. The counselor needs to consider the interconnected systems and how their impact relates to each other.

The key to managing large scale events is to have the resources to provide the services. There are many experiences, reactions, perceptions by many people to the same event. There are "subdisasters". We cannot lump all of these employees into one group. They must be separated and run as homogenous as possible. There is great risk of retraumatization in groups in the aftermath of disasters because the experience that are shared may not be universal, but an experience that catches everyone off guard. In Oklahoma City, for example the experience of the employees who were in the building adjacent to the Federal Building, were much different to the employees who were smoking outside, and yet still different from those who were still on route to the office and in a different part of the city. The groups were separated by those at the work site and those outside. To mix them would have been to risk employees hearing disturbing experiences that they were not ready to hear due to their own rawness.

Similar and to a much larger scale was the aftermath of the 9/11 attacks in NYC. where volumes of people were significantly impacted in very dramatic and different ways. The common element however in all was that a stress reaction was activated and was the starting point for the interventions. There were many workplaces that were under resourced in their recovery. Those who attempted to be responders to these agencies worked to exhaustion. Many struggled with secondary traumatization. Some, even today, have not yet returned to ground zero.