Assessing critical incident supports aims to provide a structured approach to examine initiatives for handling psychosocial hazards pertaining to critical incidents and the support available to employees to help them cope if they are exposed to a critical incident (as far as reasonably practicable), through primary, secondary and tertiary interventions. The information obtained from this review, along with information from the Prepare and Measure stages will inform the development of an action plan for risk reduction of critical incident stress.
The interventions below specify key elements for managing critical incident stress and provide a consultative checklist for assessing current practices and resources available within the psychological support system.
What are primary, secondary and tertiary interventions?
These are the main types of stress management interventions used in organisations:
- Primary prevention: Focuses on hazard reduction and stress prevention activity ‘at source’, in order to prevent stressors developing. It usually involves addressing various work-related hazards within systems of work which are known to be potential sources of psychosocial harm (e.g. changes to organisational culture, workload, job redesign)
- Secondary prevention: Focuses on prevention activity and risk reduction for employees by minimising the adverse effects of a hazard. It includes training for the job, training in general aspects of health and safety, training in coping strategies and support offered through the provision of adequate management of the social and technical aspects of an employee’s working life (i.e. identifying and assisting employees exhibiting the early warning signs of stress and providing employee assistance programs). This good management practice has a role both in preventing stress and helping stressed employees to recover
- Tertiary prevention: Focuses on the provision of staff supports such as counselling, Employee Assistance Programmes (EAPs), occupational health or outsourced support services in order to assist employees who feel a need for extra support as a result of psychosocial distress, injury or illness. It includes the treatment of the identified condition, rehabilitation and return to work strategies.
Conducting the assessment
The assessment of all three categories of interventions should be carried out by completing the assessment tables below for your organisation. This assessment will help inform actions within your final action plan and will also prove very useful for ongoing reviews to monitor change. This can be completed per department/division if you have chosen this approach for all elements of the Work Positive CI process.
The key elements of primary interventions to manage critical incident stress include the following:
1) A policy on workplace stress, incorporating critical incident stress, and development of protocols;
2) A strategic plan in relation to how staff can be prepared for possible/probable exposure to critical incidents with a view to minimising potential adverse stress reactions;
3) Stress management programmes for staff who are at risk of exposure to critical incidents, focusing on stress management and resilience, to facilitate their coping skills and to enhance their ability to deal with difficult emotions and stresses;
4) Development and training of Peer Support teams;
- Research indicates that Peer support from colleagues provides feelings of security and belonging that can reduce mental and emotional strain at the scene (ACPMH, 2011). It is recommended that Occupational groups who have a high likelihood of being exposed to critical incidents in the course of their work should have a robust peer support system in place.
- Ensure staff are aware of and have access to supports (e.g. Peer Support, EAP, Occupational Health, Staff Counselling).
5) Policy/Guidelines on how to respond to conflict amongst service users;
- Polices for managing work-related violence and aggression ( e.g. HSE, 2008 )
- Operational planning protocols to manage risk of violence and aggression;
- Consensus on what behaviour is acceptable from service users, and how to take steps to restrict unacceptable behaviour;
- Appropriate policy/guidelines for working alone (HSA, Policy and Guidance for Lone Workers, HSE, 2012);
Primary Intervention Checklist
|Key primary interventions||Present in the organisation? (Y/N)||Action required? Please specify)|
|Stress and Critical Incident Stress policy and protocol|
|Strategic planning for stress management|
|Psychosocial education for at risk groups (i.e. Stress management, Resilience)|
Peer Support teams:
|Ensure staff are aware of and have access to supports (e.g. Peer Support, EAP, Occupational Health, Staff Counselling)|
Policy/Guidelines - responding to conflicts amongst service users
Appropriate policy/guidelines for working alone (HSA, Policy and Guidance for Lone Workers, HSE, 2012)
There are a number of secondary interventions that should be applied in the case of exposure to critical incident to minimise their impact on employees by responding to warning signs and intervening early.
- The availability of managerial support is crucial at such times.
- In addition, the psychosocial support system should include the following components:
- An incident-specific response, in line with the strategic plan of the service;
- Assessment/monitoring of the impact of stress on employees;
- Support programmes for employees exposed to a potential critical incident to identify need and provide appropriate support to reduce the severity of its psychological impact on them.
Depending on the nature and scale of the incident, these programmes may involve individual or small/large group interventions as outlined below:
- One-on-one (crisis) intervention or psychological support: This is an important component of a staff psychosocial model and involves the provision of psychological support throughout the full range of the crisis spectrum (including peer support).
- Immediate Small Group Support: A structured small group discussion should be provided within hours of an incident led by a mental health professional and a Peer Support Worker, where available, to those employees who require such immediate support for purposes of assessment, triaging, and acute symptom mitigation. Group discussions of the crisis event are designed to reduce acute stress and tension levels for first responders.
- Post Incident Group Support: Structured group discussion/meeting, led by a mental health professional and where available, a Peer Support Worker, is usually provided 1 to 10 days post-incident, and aims to mitigate acute symptoms, assess the need for follow-up, and if possible, provide a sense of post-crisis psychological closure. The provision of information about the normal responses to critical incidents is important so that those affected can better understand their own reaction to it. It is crucial that this is never undertaken as a stand-alone process, nor should it be provided outside of an integrated package of interventions provided for staff. Attendance of staff at such sessions should always be on a voluntary basis.
Secondary Intervention Checklist
|Key secondary interventions||Present in the organisation? (Y/N)||Action required? (Please specify)|
Psychosocial support system components:1. Incident-specific strategic planning
|2. Assess/monitor impact on employees|
1. One-to -one intervention or psychological support
|2. Immediate small group support|
3. Post incident group support
- Ongoing managerial support (e.g. measures to ensure safe, effective rehabilitation and return to work)
- Monitor employees reactions;
- Ensure timely referral and access to a mental health professional is available to those who require it;
- Investigation and analysis of incident with focus on learning and prevention;
- Ensure that incidents are reported to the relevant authorities.
Tertiary Intervention Checklist
|Key tertiary interventions||Present in the organisation? (Y/N)||Action required? (Please specify)|
|Ongoing managerial support (e.g. measures to ensure safe, effective rehabilitation and return to work)|
|Monitor employees reactions|
|Ensure professional counselling from a mental health professional is available|
Investigation and analysis of incident with focus on prevention
|Incidents reported to relevant authorities (as per your organisation’s reporting policy)|