By Jean Brajuha, MHS, CRC, CCM – VP, Field Case Management, Paradigm Complex Care Solutions
A little-known case management service makes a huge difference for employers whose employees have experienced a traumatic incident in the workplace. Case managers with specialized education and certifications in critical incident stress management can be deployed to the workplace after an armed robbery, catastrophic accident, or other disaster. This expert counseling supports employees experiencing trauma and stress and helps them return to work.
Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) are two intervention methods designed to reduce the impact of a traumatic event in the workplace and to accelerate recovery. These methods are not to be confused with psychiatric or psychological treatment, but can be used in conjunction with them. CISM or CISD intervention has been useful in all types of professions and is most frequently used with first responders to devastating situations.
CISM and CISD counselors can go directly to affected employees as opposed to only meeting with individuals who visit the service provider’s office. For example, a grocery store employee shot and killed three coworkers before turning the gun on himself. The shooting happened after the store was closed, while workers were restocking the shelves. The quick-thinking employer and its third-party administrator called Restore Rehabilitation (now Paradigm Complex Care Solutions) for assistance. Gregory Macera, MS, CRC, CISM, CRP, MSCRP, rushed to the scene and held a debriefing session that night.
Words of respect and encouragement
Debriefing involves a group or individual meeting about the incident during which the counselor provides words of respect, encouragement, support, gratefulness, and direction. The counselor reassures workers that what they may be experiencing – feelings of fear, anxiety, and shock – are normal symptoms of trauma. The individuals are encouraged to avoid alcohol, caffeine, watching the news, and/or viewing violent movies and TV programs. In addition, the counselor will suggest appropriate activities to do as soon as possible after the incident, including light exercise, relaxation techniques, eating balanced meals, talking to people in their support system, and creating a routine.
After the store shooting, Macera stayed in the area for six days, holding group sessions with all the employees, including those not present during the shooting, and offering private sessions for individualized support in a hotel room the employer arranged.
Recovery periods differ for everyone and some people may return to work shortly after the incident. For those who do not feel comfortable returning to the workplace immediately, it is important for them to try to tend to normal day-to-day activities. It’s common for people who experience trauma to want to stay in their homes and avoid places that bear similarities to the site of the incident.
Early intervention is important
Psychiatrists and psychologists recognize that early intervention (within 24 to 72 hours of the event) is important because the longer a traumatized person retreats physically and emotionally, the harder it is for them to return to a sense of normalcy. Things like loud noises, being around groups of people, certain clothing, and even certain types of behaviors can incite fear and cause their anticipation of danger to increase. With desensitization, the person is encouraged to go with the counselor to locations near the incident site or to places that closely resemble it.
Here’s how it worked in one case. Sarah was at work in a gas station that was robbed at gunpoint one night. She received a debriefing within 24 hours, and then began CISD intervention.
The idea is to help the traumatized people talk about their feelings and fears and help redirect their thoughts. Debriefing gets people to talk about their feelings and fears, and the counselors offer positive scenarios for them to focus on.
Sarah’s sessions progressed from meeting with Macera in her home to sitting in a car at the gas station shopping center and then to entering a store a few shops down from the gas station. Later, she said that she believed she could work in that store, which was owned by the same company that owned the gas station.
At first, Sarah experienced anxiety and sleep issues and couldn’t complete her shifts. CISD helped reduce her anxiety levels and focused her on moving forward. CISD services lasted for six weeks and when they concluded, she had returned to work at the very gas station that had been robbed. After three months a follow-up was completed and due to a positive end-assessment, the file closed.
While no industry-wide studies exist, Paradigm Complex Care Solutions has seen an 88 percent success rate. Success is defined as the employee returning to work, settling the claim, or transferring to a vocational rehabilitation program.
Not only for violent events
Plus, CISM and CISD are not confined to violent events. If a delivery truck driver has trouble driving after a major accident, the counselor may simulate work conditions by having the driver spend a few sessions sitting in a vehicle, and then driving the vehicle in closed course. The goal is for the driver to become comfortable driving on the road with other cars and eventually become recertified and able to return to a driving position either with the original employer or a new one.
These services can also help workers who have developed a fear of re-injury. A worker who injured an elbow may be terrified the arm would get bumped and might struggle to verbalize that fear. Regular sessions with a CISD counselor could encourage him to express his fears while helping get him out of the house and into crowded places.
CISM and CISD interventions can be applied to most traumatic incident cases, but not all individuals will experience the same recovery timelines. The key to this aspect of case management is to customize the services to the traumatized individual, give them support, and encourage them to reenter society as a functioning member.
About Jean Brajuha
Jean Brajuha, MHS, CRC, CCM, is Vice President of Field Case Management for Paradigm Complex Care Solutions, formerly Restore Rehabilitation. She has more than 12 years of case management experience in workers’ compensation and currently oversees case management operations, clinical oversight, and program development/implementation for the firm with more than 180 case managers. Previously, Brajuha provided Vocational Counseling services and Expert Witness vocational services.
About Paradigm
For almost 30 years, Paradigm has been the industry leader in solving complex health care challenges and improving lives. With the most connected and experienced team in health care, we define and deliver outcomes that exceed financial and health expectations for our clients, as well as for individuals and their families.
Paradigm delivers its solutions through three divisions: Catastrophic Care Management, Complex Care Solutions and Specialty Networks. The Paradigm divisions are built on expertise from five best-in-class businesses: Paradigm Outcomes, The ALARIS Group, Encore Unlimited, ForeSight Medical, Restore Rehabilitation, and Adva-Net. Founded in 1991, Paradigm is headquartered in Walnut Creek, California with offices across the U.S. For more information, please visit https://www.paradigmcorp.com/.
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