1. Presenters: Bernie McCann & Keith Crochiere
 
MA/RI Chapter of EAPA Annual Symposium
Waltham, MA May 10, 2012

2. Presenter Bios
 Bernie McCann, Ph.D., CEAP is an experienced Employee Assistance consultant,
workplace trainer, university instructor and behavioral health researcher. His prior
work experience includes Research Associate at Brandeis University, Policy Analyst at
the White House Office of National Drug Control Policy, Member Assistance
Specialist for the Laborers' Health & Safety Fund of North America; Employee
Assistance Counselor at Baltimore Gas & Electric, and Project Manager on workplace
wellness programs funded by NIH, CDC, SAMHSA and the Robert Woods Johnson
Foundation.
 Keith Crochiere, CEO of Employee Assistance Network, is a psychologist with 20+
years of EAP experience. A published expert on employee performance and
behavior issues and is frequently asked to speak on a variety of human resource
topics such as: Working with Difficult People, Conflict Negotiation, The Art of Giving
and Receiving Criticism, and Listening Skills, Keith has held graduate faculty
positions at University of Massachusetts, Bridgewater State College, and Western
New England College, lecturing on Chemical Dependency, Organizational
Management and Organizational Behavior. EAP Network provides counseling and
consultation services to 100 New England organizations.

3. Presentation Agenda
 Background/Introduction to the issue
 Responding to initial notification of the traumatic event
 Assessing the nature & extent of the incident
 Addressing concerns of employer representatives regarding affected
employees
 Providing EA services to affected employees
 On-site response, psychoeducation, triage for acute stress
 Follow-up support & referrals to higher levels of care
 Training curriculum for bank branch managers
 Request for assistance in reducing post-robbery stress & resignations
 Development & implementation of presentation in providing
psychological first aid to bank line employees.

4. Critical Incidents by Industry
Incident Type
Workplace Accidental Downsizing/
Industry Type Death Injury Layoffs Robbery Suicide
Manufacturing 51.5% 12.1% 25.8% 2.0% 8.6%
Transportation/
Communication
s/ 70.6% 15.8% 4.5% 3.2% 5.9%
Utilities
Services 66.7% 16.7% 3.7% 0% 13.0%
Financial 26.9% 3.8% 7.7% 61.5% 0%

5. Bank Crimes & Worker Impact
Surveyed employees in one large banking company who
experienced one or more robbery provided these reactions:
 80% reported concentration/productivity negatively affected
 67% reported experiencing anger or stress
 63% reported experiencing hypervigilance
 60% reported feeling not safe
 60% reported feeling suspicious of those resembling the
perpetrator
 1/3 reported other symptoms (insomnia, headaches,
stomachaches, nightmares, etc.)
Source: Burke et al. (1999)

6. CSID, PFA, or CISM?
Definitions
Critical Incident Stress Debriefing (CISD) – A technique, originally
developed for use in one-on-one interventions with first responders (the Mitchell
Model) and later expanded to wider application for virtually any type of group post-
trauma response.
Psychological First Aid (PFA) – A more recent technique, primarily a public
health approach to disaster response employing a holistic view of victim safety,
attention to basic needs, and psychological triage.
Critical Incident Stress Management (CISM) – A comprehensive,
integrated, systematic and multicomponent crisis intervention approach. Components
may include pre-incident preparedness, acute crisis support & defusing, referral
mechanisms, post-incident follow up, etc.
*For all the above, the existing research on effectiveness and outcomes can
be characterized as having both gaps and contradictory findings.

7. Critical Incident Stress Research
 Most individuals who received critical incident stress debriefings endorsed
it as helpful (Carlier et al, 2000; Small et al., 2000)
 Rose et al., (2001) concluded “there is no current evidence that
psychological debriefing is useful for prevention of PTSD after traumatic
events and compulsory debriefings should cease.”
 Boscarino (2005) followed 1681 NY adults after 9/11 in a 2 year follow up,
PFA/crisis intervention resulted in lowered binge drinking, alcohol
dependence, PTSD symptoms, major depression and anxiety.
 Comparing two groups of employees who received a single group
intervention (CISD) and an integrated approach (CISM); the CISM group
had significantly less post-trauma morbidity at 3-12 mo. follow-ups
compared to CISD alone (Richards, 2001).

8. A Comprehensive Approach
1. Professional Competency (Knowledge of current best practice)
2. Worksite Needs Assessment (Organizational/Client Knowledge)
3. Capacity for Crisis Response (Adequate Infrastructure & Staffing)
4. Clinical Resources (On-site response & Referral network)
5. Psychoeducation (Employees, Supervisors & Management)

9. Initial Response to Critical Incidents
 Timing is important - A key element is when to do the
debriefing. Too soon and people are still in shock/denial and too
preoccupied with providing information to police and following
internal security protocols.
 Proper coordination with management and onsite leadership is
essential. Having a protocol to follow, a code word to share the
information with others, who is to contact whom, scheduling the
on-site session -- and not leaving the decision to the onsite contact
(who may be emotionally unable to make a good decision regarding
staff needs), are all crucial considerations.
 Obtain as much information as possible (from all contacts) before
arriving to conduct an on-site session.

10. Onsite Critical Incident Response
Following notice of a workplace critical incident and after receiving a
request for onsite EAP response, some logistical suggestions are:
 Bring sufficient educational materials, EAP brochures, etc.
 Arrive early, introduce yourself to and talk casually with staff if
possible
 Provide each employee with an EAP brochure & any handouts used
 Provide managers additional materials & extra copies of brochures
 Notify participants that you will remain after session to speak
individually/privately to anyone who desires, be visible during this
time period

11. Conducting Onsite Critical
Incident Sessions
When conducting the onsite session:
 Personally invite all employees to join session to encourage
attendance, even those who may not have been present during the
incident – the goal is to create a sense of shared support for the
work group and those affected, that “we are all in this together”
 During the session, provide information to participants on:
 Purpose of the session, why EAP is responding
 Typical responses to traumatic events
 Any additional psychoeducational details
 How the EAP works, confidentiality, etc.
 Take this opportunity to describe the many other types of
support/assistance available from the EAP (i.e., normalizing the idea
of contacting the EAP)

12. Post-Session Follow up
 After providing an on-site session, EAP critical incident
follow up services may include:
1. Employees identified as suffering particularly severe acute
stress symptoms - for these individuals it may be appropriate
to recommend continuing EAP involvement via phone or in-
person counseling, individually or in group sessions.
2. Management/HR/on-site supervisors – to ascertain staff
recovery from the incident; their satisfaction with on-site
sessions; additional training or organizational development
needs

13. Psychoeducation & Stress Response
 Psychoeducation can provide important information for individuals with
psychological concerns. A primary goal is to assist individuals to better
understand conditions and to better deal with symptoms. The individual's own
strengths, resources and coping skills are reinforced, in order to encourage
improved functioning/wellness, feel less helpless and avoid relapse.
 As an element of Psychological First Aid and Critical Incident Response to bank
crimes, psychoeducation content may include:
 Common symptoms & duration of stress reactions
 Self-care following traumatic incidents
 The benefit of support from co-workers, supervisors, families, etc.
 Data on the likelihood of injuries or fatalities during bank crimes
 Additionally, psychoeducation also has the function of contributing to the de-
stigmatization of psychological concerns and diminish resistance to treatment.

14. Presenting OD Issue & EA Response
 Situation: Multiple requests to provide post-robbery EA
services to a number of local banks in the Boston area
 Additional data: Subsequent discussion with HR Manager at
one of the largest credit unions in Massachusetts revealed that
often after robberies, a percentage of line employees
(particularly novice staff members) would resign/miss work
 From exit interviews and other discussions, HR Manager
ascertained these resignations and absences were due to:
 Novice employees being frightened of “unsafe work environment”
 Family pressure on employees to resign or stay home

15. Branch Manager Training
 Based on the HR Manager’s concerns about bank line
employee absences and retention following robberies; we
suggested and developed a 90 minute training presentation
for a quarterly bank branch managers meeting.
 This training focused on the following:
• Data about bank crimes & likely employee responses to
robberies
• An orientation to Psychological First Aid
• Encouraging use of services
• Helping families/friends cope to reduce employee stress

16. The Critical Incident Stress Response
When a robbery occurs, employees are likely to
feel a variety of emotions; these include shock,
fear, anxiety, disconnectedness, and even anger.
 The time span of these emotions may continue for
days, weeks, months -- although typically these
feelings become less intense in frequency, duration
and intensity.
 Given that bank employees typically return to the same
environment where the robbery occurred, some may
experience a ‘triggering effect’ when they encounter
certain stimuli.

17. ‘Psychological First Aid’
 Psychological first aid is an application of early
critical incident/crisis response suitable for use
by non-mental health professionals.
 Relying on a strengths-based perspective, it
involves providing a basic level of support and
information to victims immediately following a
critical incident/emergency/disaster.
 It is designed to reduce the initial distress of
traumatic events and foster coping abilities.

18. Providing ‘Psychological First Aid’
 When victims want to talk, be prepared to listen.
When listening, focus on patiently hearing what
speakers are trying to say.
 Respond in ways that address immediate goals
and how you can be of assistance. Speak slowly,
clearly and calmly. Clarify answers repeatedly as
necessary.
 Update victims and others as new information
becomes available. Inform them of available
resources and how they can access them easily.

19. Encouraging the use of services
 Inform employees that a EAP representative/mental
health professional will be conducting an initial
debriefing session (and provide date and time if
available).
 Strongly encourage all employees (not just those
present during the incident) to attend.
 For those unable or unwilling to attend the initial
debriefing service, make certain they understand that
additional counseling services are available now and
will continue to be provided through the EAP.
 Furnish EAP contact information to employees (and
family members as appropriate).

20. Ways to help employees cope
 First priority: Make sure everyone is safe – visual
staff inspections are just part of a complete picture.
 Expressing your concern by engaging/inquiring
directly of each employee as to how they are doing
will help gauge their state of mind and the level of
their stress reaction.
 Keep in mind the potential variety of individual
responses and range of emotions in such events –
avoid judgmental language or labeling of anyone’s
particular responses, the initial focus should be on
checking in with each individual and reassurance.

21. Branch Manager Training Results
 Comments from branch managers during the training were
remarkably similar to those often heard from supervisors and
managers during workplace substance abuse and EAP
orientations – they expressed an uneasiness when entering
into areas considered “psychological” or commenting on
employee’s family life, etc.
 Post-training feedback from HR Manager was positive, she
felt the training had given branch managers an understanding
of the principles of PFA and how they might apply them with
employees after a robbery.
 Additionally, a slight increase in requests for post-robbery
EAP response did occur following the training.

22. Concluding Remarks
 While not all EAPs will be confronted with the task of
responding to bank crimes, we believe this aspect of EA
services provides a good illustration of how to develop and
apply a comprehensive approach to workplace critical
incident stress management.
 Research on the evolving best practices for supporting
employees (and others) during crises/traumatic events
indicates that an approach which fosters resistance to stress
and resilience through appropriate levels of support,
psychoeducation, and referral to higher levels of care when
indicated, can be an effective EAP approach.