Post Trauma Resources has developed innovative approaches to trauma response:

• Trauma Response Interventions
  
• Ventilation-Oriented Debriefing Model
  
• Improved Debriefing Model
  
• Telephone Contact with Employees
  
• Assisting Employees Return to Work
  
• Responding to Retail Robbery

No single intervention is capable of providing the needed assistance to all survivors. The following is a list of intervention strategies most commonly used to assist recovery (link to article in Crime Victims Newsletter, 2000)

• Initial Telephone Consultation
• Immediate On-Site Response
• Telephone Screening
• Telephone Availability
• Humanitarian Assistance
• Initial On-Site Meeting
• Crisis Intervention
• Assessment Meeting
• Psychological Debriefing
• Educational Debriefing
• Final On-Site Meeting
• Post Trauma Counseling
• Case Management
• Follow-up Debriefings
• Telephone Follow-Up
• Return to Work Coordination
• Evaluation
• Memorial/Anniversary Assistance

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A ventilation-oriented debriefing emphasizes the detailed discussion of the potentially traumatic incident and also includes the provision of information, building group cohesion and assessment for further services. Caution should be used when promoting ventilation. Participants whose primary coping skills are avoidance may be negatively impacted by overexposure.

1. Introductions and Agenda
   Introductions of facilitators and the debriefing process occurs.
   
   
2. Telling the Story
   Participants describe their experience in detail while the debriefers ask clarifying questions. Debriefers assess each survivor for the level of distress.
   
   
3. Looking at the Consequences of Survival
   Participants report their post trauma consequences with the debriefers asking questions. Normalcy is emphasized.
   
   
4. Understanding the Consequences of Survival
   Information concerning post trauma consequences and coping skills are presented. Indications for counseling are presented.
   
   
5. Closing and Evaluating
   Debriefing is terminated by the facilitators and a closing statement is made. The debriefers remain after the session to provide additional support and make referrals.

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During the past several years, we have become increasingly concerned about the continued reliance of trauma responders on the debriefing process.

Those concerns are outlined here.

In addition, there is a growing scientific literature indicating that debriefings do not assist in recovery and that there is a small, stable group of participants who experience a worsening of their condition.

As a result of these concerns, we have developed an improved debriefing model.

This approach increases the emphasis on assessment and the provision of information to participants and reduces the amount of disclosure and ventilation. In addition, the process is "salutogenic" in nature emphasizing the building of group cohesion and the likelihood of successful recovery.

Participant response to date has been very good and and we have not noted a change in recovery patterns.

Process

1. Introductions and Agenda
Appropriate opening statement, introduction of facilitators, description of debriefing process, ground rules.

2. Checking In
Description of exposure and consequences by each participant, commonalities noted and information provided as appropriate. Assessment.

3. Understanding Consequences and Recovery
Information provided concerning post trauma consequences and coping skills. Emphasizes probability of successful recovery and availability of support services.

4. Closing and Evaluating
Review and closing statement. Evaluation. Individual contact after session is over.

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Notification of Incident
    Information about the incident assessed
    Information about employee, if available
        Personal information
        Initial reaction to incident
    Support provided to employee

Contact with Employee(s)
    Opening statement – I’m sorry
    Brief description of incident – assess
    Time structuring since incident
    Symptom development
            Three intrusive symptoms
    Plans for return to work
    Other traumatic events
    Plans for face to face, if necessary
    Provision of 24 hour contact

Follow-up Contact
    Check in
    Symptoms developed, worsened or improved
    Assessment of support by employer

Contact with Employer
    Initial and after follow-up
    Coordinate face-to-face services
    Coordinate transition back to work

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Most Common Causes of Work-Related Difficulties:

• Hypervigilence
• Site is a trigger and causes an increase in symptoms
• Secondary injury from employer causing anger and resentment, lack of motivation to return to work
• Questions and other reminders originating from co-workers, customers, others
• Memory difficulties, other trauma related symptoms

Return to Work Process:

1. Assess employee’s desire to return to work
2. Assess manager’s willingness to assist in return to work efforts
3. Help employee create a list of activities in increasing intensity of discomfort
4. Ask client to engage in first activity. Limit discomfort to 6/10
5. Assess and continue to increase difficulty of tasks
6. Provide feedback to employer

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Post Trauma Resources responds to many robberies of retail businesses, each year. Here is a description of the typical activities for support of employees.

1. Immediate Response to Event
   Physical safety insured
   Support by company officials
   Notification of trauma response providers
   
   
2. Trauma Response Services
   Check in with employees, if needed
   Debriefing as soon as possible
   Services at location
   Ventilation
   Skills for return to work
   Assessment for symptoms and safety
   
   
3. Return to Work Efforts
   Increase work load slowly
   Continue supportive atmosphere
   Robbery focused counseling, if necessary
   Malingering checks by provider
   
   
4. Follow-up and Termination
   Communication with supervisor, management
   Check work record, adjustment periodically

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