A Clinical Scoping Model for Assessing Critical Incident Response in EAP

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1 A Clinical Scoping Model for Assessing Critical Incident Response in EAP Speakers: Chris Santalucia Clinical Manager NCC, PPC Worldwide Irene Brumen Senior Clinician / Psychologist, PPC Worldwide

2 Background PPC Worldwide is an International provider of Employee Assistance Services PPC is a leader in the area of Critical Incident (CI) Management Critical Incident Scoping (CIS) introduced to improve the initial assessment and appropriate delivery of services at a more clinical level Previously managed by a call centre administrator or coordinator 3 month pilot program introduced in April 2012 Rolled out nationally in July Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2

3 Acronyms CI CIS NCC SC EAP Critical Incident Critical Incident Scoping National Contact Centre Scoping Clinician Employee Assistance Programs Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3

4 About PPC Worldwide PPC Worldwide currently supports over 750 regional, national and international organisations A rapidly expanding coverage and client base in the Asia Pacific region Owned by Optum Health as the largest health care provider in the USA (international arm of United Health Group) Over 2700 critical incident requests managed over past 12 months Nearly 1000 consultants are utilised in Australia for both EAP and CI delivery Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4

5 Breakdown of CI categories attended Aug 2012 to Aug % - Workplace Restructuring and Redundancies 18% - Fatalities and Deaths due to natural causes 16% - Violence and Assaults/Robbery 11% - Mental Health Issues 10% - Suicide/Threat of Suicide 10% - Grief and Loss 15% - Other, e.g., workplace injuries Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5

6 What is Scoping? A clinical discussion with the referring Manager around deciding the best response to a critical incident situation Experienced senior clinician responds from the outset, and advises and directs the most appropriate steps to manage the incident using best clinical practice Confirms specific details around logistics and circumstances Accurately assesses the questions of Who?, What?, Where?, When? and How? Clarifies and confirms details impacting the number of employees directly and indirectly affected, and who should be included in the CI response Assesses the number of counsellors required Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6

7 Scenario 1: HR advised staff member had allegedly taken their own life overnight Family don t want people to know it is a suicide Employee was a LT member of staff Supervisory role in organisation Deceased employee recently separated Requested a counsellor on-site Counsellor arrives on-site and reports chaos Rumour mill active Lots of people congregating around work area crying Employee from another department best friends with deceased s brother,and was present when family informed of hanging Management affected (Correct scoping ensures a full clinical intake is taken, including initial advice to management re. communication & handling of news) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7

8 Who Scopes? National Clinical Manager Rostered Senior Clinician for both day and after hours shifts National (dispatched locally) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8

9 Scoping Guidelines Balance between referrers request and clinical assessment of response required Refer to a set of clear guidelines to direct appropriate timing for delivery A common sense approach is often best however emphasizing what is considered to be clinical best practice can help to avoid excessive demands in terms of wanting immediate delivery Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9

10 Critical Incident Management Further Intervention When appropriate Psychological First-Aid 2-24 hours 2 week Follow-up Defusing hours Debrief >72 hours Follow-up Management Phone contact Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10

11 Critical Incident Scoping Guidelines (in addition to PFA) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11

12 Guidelines A delay in providing onsite attendance may be appropriate for a variety of reasons In such cases the scoping clinician can offer immediate advice or telephone support (to defuse emotionality and ascertain safety) to both the manager and any employees contactable by telephone, either in the proximity of the manager or as otherwise directed Can be directed: triage urgent phone counselling or manager hotline Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12

13 Scenario 2: Background HR rang to request an immediate home visit for an employee Manager concerned as employee hadn t presented to work today Employee not answering phone Management aware of personal issues Last night employee made a joke about not wanting to be around for Xmas Scoping Saying Yes to a home visit is NOT best clinical practice Issues boundaries, privacy, safety, knee-jerk reaction Refer to Manager Hotline for advice Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13

14 Challenges for effective Scoping Information required to effectively scope/ assess a CI attendance and allocate an appropriate counsellor would include, but is not limited to: The nature of the incident:( death, armed holdup, violence etc) How many staff are directly/indirectly impacted: This refers to staff who were in the direct vicinity of the incident (i.e.. witnessed it), or directly involved (provided first-aid or resuscitation etc) The location(s) of the incident: Onsite support may be required at multiple sites requiring coordination locally, regionally or nationally Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14

15 Effective Scoping cont. Are police or ambulance involved: Consideration for staff being unavailable due to police attendance, emergency services or other investigations taking place Are any staff at particular risk: Managers may be aware of staff with mental health issues, or recent bereavement issues, or previous exposure to the same or similar incident How many counsellors will we send onsite: How many staff are we supporting in one location? And what is the sense of reaction from those staff? (as a general rule it is 1 counsellor to 15 staff). Confirm numbers with referring manager at time of intake) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15

16 Dealing with Manager Expectations What is the managers/organization s expectation of our services? Are they realistic about what we can do and when? Most important part of our role is to educate and placate any knee jerk expectations from the referring manager and to advise of best practice in managing the CI. However, if they are insistent on contractual timeframes (versus best clinical practice) we will oblige given that: (i) there is a contractual obligation (ii) employees are available (iii) the counselor can access the site (iv) the counselor is not at any personal risk and (v) the counselor would not be compromising any other official service(police, ambulance, coroner etc.) in delivering the support Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16

17 Scenario 3: HR request urgent CI onsite to meet with team who witnessed an angry outburst by employee Also request separate session for worker stood down from higher duties for anger management issues Want an assessment of risk and whether employee satisfies requirements to return to higher duties Manager aware of mental health issues and wants an assessment of employees insight and prospects for rehabilitation Pressure to respond to urgent request Best clinical practice assess needs and outcome Further scoping learn that the team have declined a group session as they just want HR to manage the employee Outcome - Manager Hotline, referral for management coaching & Workplace Support Service Team support Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17

18 Sourcing a counsellor Once all relevant material is gathered, refer to the Critical Incident Coordinator (CIC) CIC will: source the appropriate counsellor/s liaise further with the referring manager confirm details for delivery. The Coordinating role is based at 3 key locations in Australia. Melbourne manage CIs in Victoria, Queensland, South Australia, Tasmania and Northern Territory Sydney manage CIs in NSW Perth manage CIs in WA Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18

19 Role of Scoping Clinician Assess and triage from a clinical, not administrative, viewpoint Educate referrer as to the best clinical response Confirm details Dispatch to CIC to organise and manage the logistics of the CI response (e.g., sourcing counsellors, confirm timing) Brief responding counsellor(s) regarding background information (prior to on-site attendance) Debrief counsellor(s) following CI response Phone call to referring personnel to provide feedback and assess and further needs for follow-up Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 19

20 Briefing and Debriefing Once a counselor/s is sourced by the CIC, they are to be contacted by the SC for briefing via either phone or particularly if there are complex dynamics in play. Debriefing the counsellor will occur at the conclusion of the counselling service and contact made with the original referring manager to gauge client satisfaction and determine any further needs. This concludes the Scoping process. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 20

21 Clinical Best Practice Our primary role is that of a CONSULTANT: support, direct, recommend, and impart our professional, organizational and clinical expertise. Crisis Intervention is an urgent and acute emotional first-aid designed to stabilise and reduce symptoms of distress, while assisting the person in crisis to return to a state of adaptive functioning (Robinson, 2006). However, timing is important too much too soon can be ineffective or destabilizing. Scenario 1: 4pm PPC Worldwide notified of workplace fatality at the Docks HR request a counsellor to attend on-site immediately 3 people witnessed the incident Shift just ended, next shift postponed attend 6am tomorrow Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 21

22 Scenario 1: Issues to consider Questions: Is there clearance to enter the site? Are emergency services on-site? When will witness statements be taken? Is Work Safe and/or Coroner in attendance? Have employees and management left for the day? Scoping coordinated and managed by Senior Scoping Clinician: Assessment of immediate response and next day follow-up Initial management support & coaching Initial phone calls to witnesses given unavailability for face-to-face Follow-up support tomorrow (witnesses, team, organisation) On-site attendance at 6am with staggered support across shifts Advice and management of support to the family (as required) Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 22

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