The United Kingdom: practical support and expert assessment.

In 2005, Britain's leading authority on best medical practice issued general guidelines on the most effective approaches to treating post-traumatic stress disorder. The guidelines were released in the wake of research that had been less than positive toward a widely used debriefing model.

The National Institute of Clinical Excellence (NICE) now recommends "watchful waiting" where symptoms are mild and have been present for less than four weeks and warns that systematic provision of brief, single-session interventions (often referred to as debriefing) focusing on the traumatic incident should not be routine practice. Trauma-focused psychological treatment (e.g., cognitive behavioral therapy) and eye movement desensitization and reprocessing (EMDR) are recommended for those with severe post-traumatic symptoms or PTSD; for those at risk of developing PTSD, there should be routine use of a brief screening instrument.

These clinical guidelines have influenced current practice in the management of EAP trauma services throughout the United Kingdom. Managing workplace trauma is a central and pivotal component of the employee assistance product, whether the trauma is of an individual nature (as in the case of a sudden death, suicide, or traffic accident), affects a team (such as in a bank robbery, assault, or fire), or has implications for the larger company (via terrorist attacks or natural disasters).

As a result of the guidelines, EAPs in the United Kingdom no longer typically offer a single-session debriefing immediately after an event; instead, they combine various approaches that might include "defusing" or "psychological first aid" as an initial intervention. Practical support and a calm, expert assessment of the situation are seen as the proper initial responses and reflect the "watchful waiting" recommended by NICE.

Rather than rushing to a site within hours of an incident, EAPs today will probably e-mail their clients to remind them of the 24-hour telephone line. Human resources managers, health and safety personnel, and business continuity departments will be encouraged to use telephone support in the first hours after an incident. Both individuals and groups affected by the incident will be treated by skilled professionals in cases where protocols have been negotiated with the company Fact sheets or CDs often will be distributed as a matter of course. Onsite visits and face-to-face counseling will be offered as needed, and other psychological treatments of choice (EMDR and CBT) will be made available at a later date.

EAP providers use terms such as "education," "normalization," "stabilization," and "psychological inoculation" when describing aspects of their trauma services. The variations between the services appear slight, so perhaps the differences are a matter of semantics. Although the term "debriefing" is still commonplace, different interpretations can confuse organizations unless their meanings are clearly spelled out.

Some EAPs present a clear trauma management model to companies, with a step-by-step approach and a formal critical stress debriefing intervention with specific timelines (e.g., assessment within 48-72 hours after an incident). Others prefer a more client-led positioning, modeling their response to the nature of the crisis.

There is widespread consensus that best practice does not mean offering a group debriefing at a very early stage, but it can be helpful to have a specialist onsite during the first few days to help develop an appropriate program of support. Follow-up visits and assessments are recommended, with ongoing monitoring, evaluation, and feedback.

Some EAPs offer specific training and consultancy programs to key managers and staff to help prepare them for crises and complement their overall business continuity strategy.. This service has become of greater interest to companies since the London Underground bombings of July 2005. Having people inside a company who are trained to respond appropriately in a time of emergency can make a significant contribution to the ongoing stability of a business, helping avert the high levels of absenteeism and low morale and productivity that so often are the legacies of a traumatic event.

The challenge facing an EAP in a time of crisis is to be alert both to the needs of the organization (which may have become very dysfunctional) and of individual employees and their family members (who may have urgent and overwhelming personal demands weighing upon them). EAP providers in the United Kingdom are clear that their task is to support their clients by offering proactive and expert consultancy designed to help contain anxiety and uncertainty in situations where normal coping strategies do not apply.

Kate Nowlan is chief executive of CiC, a leading EAP provider in the United Kingdom, and has a particular interest in the provision of trauma services in the workplace and the effect of prolonged exposure on groups and individuals. She has worked as a trainer and therapist on trauma programs in several countries and serves on the advisory panel of Darteurope, an organization dedicated to supporting journalists facing trauma in their working fives. She can be reached by e-mail at [e-mail].