The EAP critical incident continuum: using a continuum of services to assist management and employees in responding to a workplace disaster enables EA professionals to support business continuity and employee recovery.

Employee assistance (EA) professionals serve important functions in preparing for, and responding to, workplace critical incidents. Workplace critical incidents are sudden, unexpected events that often are significant enough to overwhelm normal coping responses. They vary in type and severity and can affect employees as well as management.

Jacobson (2004) wrote that EA professionals consider deadly workplace accidents (caused by automobiles, machines, electrocution, and explosions), the September 2001 attacks on the United States and other incidents of terrorism, suicides and homicides at work, workplace fires, the sudden death of a co-worker, robberies, and drownings among the most traumatizing workplace critical incidents. Such incidents can seriously affect the psychological, emotional, and physical well-being of employees, employers, and the entire organization. Negative effects from the unresolved trauma of a critical incident in the workplace can contribute to overall lowered levels of productivity, poor performance, more frequent interpersonal conflict, increased absenteeism, increased use of physical and mental health benefits, increased workers' compensation claims, higher turnover, higher rates of alcohol and other substance misuse and abuse, and lower overall employee satisfaction and morale (Hrebiniak and Alutto 1972; Ivancevich and Matteson 1980; Lewis 1994, 2002).

Workplace critical incidents--both natural occurrences, such as earthquakes and floods, and human-caused incidents, including terrorist attacks and homicides--appear to be increasing. In response, more employers are expressing concern for a need to provide support to employees in the aftermath of a workplace critical incident. Many employers are calling on their EAPs for such assistance and to help develop and implement services related to workplace disaster preparedness and response. The onus is on the EA professional to facilitate or deliver the most appropriate and supportive services to the workplace.

CONTINUUM OF SERVICES

The services rendered by an EA professional will vary depending on the nature of the business, the type of EAP provider, and the specific needs and culture of the workplace. There are several models for delivering workplace critical incident response services, including those advanced by the International Critical Incident Stress Foundation (ICISF), the American Red Cross, and other individual trainers and providers.

In a study of EAPA members who have responded to workplace critical incidents, a sizable majority (83.5 percent; n = 237) reported receiving formal training or education to provide critical incident stress management services (Jacobson 2004). Almost 60 percent of those who received formal training reported completing the Basic Critical Incident Stress Management training course offered by the ICISF. Many EA professionals have been trained in multiple models, which share the common feature of using a psycho-educational group meeting that allows individuals to talk about and process the critical incident, learn about normal reactions and effective coping methods to deal with critical incident stress, and encourage group support (Regehr and Hill 2000).

The practice of providing a single-session debriefing is opposed by some who question its effectiveness and suggest it may even cause harm (Vedantam 2002). The EAP Critical Incident Continuum of Services, a model established in the aftermath of the 2001 terrorist attacks on the World Trade Center and Pentagon, supports EA professionals' use of a range of services to (1) assist management in supporting and managing workers before, during, and after the critical incident, (2) assist employees in working through the impact of the incident, (3) support employers with business continuity and return-to-business operations, and (4) assist in reviewing the response to the incident in anticipation of the next incident.

The continuum includes the familiar practice of critical incident stress debriefings, but only as one component of a much larger system of services. Taking the traditional models of crisis response a step further, the continuum focuses on the role of the EA professional to empower supervisors and business leaders to better manage the workplace following a critical incident and support business continuity and employee recovery. The continuum represents a continuous cycle, allowing for managers, employees, or EA professionals to enter at any point. This cyclical model also allows the EA professional to work with employers and employees to resolve cumulative stress caused by the compounding impact of one or more workplace critical incidents.

THE EAP CRITICAL INCIDENT CONTINUUM

The well-placed and well-functioning EA professional is strategically positioned in the workplace and recognized as an expert on human dynamics. The EA professional does not function as a mental health counselor, but rather as a management consultant for workplace human dynamics and a provider of services to employees and managers affected by a workplace critical incident.

Before a workplace critical incident occurs, the continuum supports EAP involvement with pre-incident planning in the areas of assessing risk, working with human resources staff to develop policy, consulting with managers to help increase resilience, and educating managers and employees on critical incident response and disaster preparedness. EA professionals will often offer "stress hardening" or "stress inoculation" training as preparation for responding to workplace critical incidents.

Finally, the EA professional is in a unique position to formulate and develop relationships with other critical incident community providers and response teams, local hospitals, and emergency response personnel. These relationships can prove invaluable during a critical incident, but they cannot effectively be developed in the midst of responding to a workplace critical incident. The task of fostering such relationships needs to occur in the pre-incident phase of the continuum, when the workplace is functioning in its usual state.

During a workplace critical incident, the EA professional's role is mostly one of providing coordination and guidance. This includes working collaboratively with management to help ensure the most appropriate response. After security personnel and other first responders have verified the safety of the workplace, EA professionals can begin working as partners with, or consultants to, management as they strive for workplace stabilization and recovery.

Following a workplace critical incident, the EA professional often takes on a more visible role in the workplace as s/he works with management to assess the needs of the workforce and identify the appropriate services to provide, such as defusings, debriefings, and/or educational sessions that explain normal responses to workplace critical incidents. The EAP firmly grounds its response in management protocols and includes an educational debriefing if appropriate. It does not frame the overall response in medical or psychological terms.

EA professionals are positioned to consult with management regarding employee recovery through information shared by management, such as workplace attendance, performance, and conduct assessments. This information can be used to identify employees or work groups requiring additional assistance following a workplace critical incident. EA professionals are often allowed to provide services and referrals to employees' family members who may have been affected by the incident. In addition, EA professionals can provide follow-up services to supervisors and mangers that include, but are not limited to, management debriefings and consultation.

AFTER THE RESPONSE

After a workplace critical incident response concludes, the EA professional's role involves supporting research and evaluation efforts aimed at determining the overall effectiveness of the response, then consulting with management and human resources to improve the organization's disaster response plan. The EAP Continuum encourages EA professionals to work collaboratively with management and human resources to evaluate policies related to disaster preparedness and response and offer expert guidance to revise the plan. The continuum also encourages EA professionals to support long-term responses to critical incidents and, when appropriate, provide follow-up services for employees who were more severely affected by the incident.

Little information is available regarding the steps (if any) EAPs are taking to support EA professionals who respond to workplace critical incidents. Jacobson (2004) studied how EAPA members responded to workplace critical incidents and found that only a small percentage of EA professionals reported receiving or seeking supportive services. Those who reported receiving support services identified the following:

* EAP sessions offered by another EAP (42.6 percent);

* Individual counseling (20.4 percent);

* Debriefing of debriefers (9.3 percent);

* Consultation services (7.4 percent);

* Stress management services (7.4 percent);

* Access to a fitness center (7.4 percent); and

* A combination of services (16.7 percent).

It is not evident from this study or other studies what type(s) of services may be most effective in supporting EA professionals who respond to workplace critical incidents. The EAP Continuum encourages support services, such as self-care and "debriefing the debriefer" programs (Potter 2000).

FUTURE STEPS

The minimal expense of planning an EAP response to a critical incident in the workplace is far outweighed by the significant costs resulting from failing to plan for or (even worse) ignoring the seriousness of workplace critical incidents. This ignorance can result in poor performance, reduced productivity, lost loyalty and commitment, increased absenteeism, decreased retention, higher healthcare costs, and more workers' compensation claims (Hoffman 2001).

The EAP Continuum introduced in this article represents one model for workplace critical incident preparedness and response. As the EAP field strives to develop best practices, more research on this model is required, including how it functions as a dynamic model and whether it allows for flexibility and modification to meet the needs of the changing workplace.

Future discussion regarding the EAP Continuum will be posted on the EAPA Critical Incident Web page (www.eap-association.org); additional information will appear in the International Journal of Emergency Mental Health in a special edition on EAPs and crisis intervention to be published later this year. The EAPA Workplace Disaster Preparedness Subcommittee will continue to support, through an advisory role to EAPA, EA professionals throughout the world as they prepare and respond to workplace critical incidents. Most recently, the subcommittee was involved in providing support to EA professionals who responded to the Florida hurricanes and is beginning to provide support for EA professionals responding to the recent earthquake and tsunami in Asia.

The subcommittee will also continue to work with EAPA and its members to offer EA professionals the latest information related to workplace critical incident preparedness response. The subcommittee encourages EA professionals to talk with one another and exchange information online to promote learning communities where we can share information about best practices and learn from one another to enhance our knowledge regarding workplace critical incidents.

References

Hoffman, C. 2001. "Responding to workplace trauma." Trauma Response 7 (1): 14-15.

Hrebiniak, L. and J. Alutto. 1972. "Personal and work-related factors in the development of organizational commitment." Administrative Science Quarterly (17) 555-572.

Ivancevich, J. M. and M. T. Matteson. 1980. Stress and work: A managerial perspective. Dallas, Texas: Scott, Foresman and Company.

Jacobson, J. M. 2004. "Compassion fatigue, compassion satisfaction, and burnout among EAP counselors." Unpublished dissertation. University of Maryland, Baltimore: School of Social Work.

Lewis, G. 2002. "Post-crisis stress debriefing: More harm than good?" Behavioral Health Management (July/August) 22-25.

--. 1994. Critical incident stress and trauma in the workplace: Recognition, response, recovery. Levittown, Pa.: Accelerated Development.

Potter, D. 2000. "Debriefing the trauma team: Taking care of your own." Published online at http://www.aaets.org/arts/art89.htm.

Regehr, C. and J. Hill. 2000. Evaluating the efficacy of crisis debriefing groups. Social Work with Groups 23 (2): 69-79.

Vedantam, S. 2002. "Debriefings don't help, and may harm." Washington Post, Sept. 6, page A12.

Jodi Jacobson is a visiting assistant professor at Towson University (Md.) and a senior researcher for MASI Research Consultants. She serves as co-chair of the EAPA Workplace Disaster Preparedness Subcommittee. She can be reached by phone at [phone] or by e-mail at [e-mail].

Jan Paul is the manager of the State of Washington's EAR which serves approximately 100,000 state and other government employees and their family members. She serves as co-chair of the EAPA Workplace Disaster Response Subcommittee.

Dorothy Blum is president and founder of SELECT, Inc. (Services for Employees Looking for Education, Counseling and Treatment), which specializes in the development and operation of EAPs. She is president of EAPA and has served as a member of the association's Workplace Disaster Preparedness Subcommittee.