A Clinical Scoping Model for Assessing Critical Incident Response in EAP

A Clinical Scoping Model for Assessing Critical Incident Response in EAP

Speakers: Chris Santalucia – Clinical Manager NCC, PPC Worldwide [email protected]

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 2012.

Acronyms

• CI Critical Incident

• CIS Critical Incident Scoping • NCC National Contact Centre • SC Scoping Clinician

• EAP Employee Assistance Programs

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

Breakdown of CI categories attended –

Aug 2012 to Aug 2013

• 20% - 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

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

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)

Who Scopes?

• National Clinical Manager

• Rostered Senior Clinician for both day and after hours shifts

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

Critical Incident Management

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

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

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

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)

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

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

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

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

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 email 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.

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

Scenario 1: Issues to consider

• 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)