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IN A CRISIS, FIRST STOP, LOOK, AND LISTEN

August 1, 2006
by TONYA TEAL SLAWINSKI, PhD
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An effective crisis response doesn't necessarily entail immediate clinical interventions

We all have been conditioned to believe that when someone is hurt we need to take action. A scraped knee, a broken arm, or chest pain all warrant attention along a continuum of care. Hot chocolate, a hug, and gentle cleaning generally will soothe a scraped knee. Chest pain usually requires more advanced care.

Traumatic events evoke a similar response in us as caregivers. When someone is in pain, we take action. However, we have fewer guidelines than our physical medicine counterparts when responding to emotional/psychological pain. When you break your arm, it gets set, you wear a cast for six weeks, and then it's over. Not so with traumatic reactions, which are unique to the individual, can be difficult to recognize, might become hidden or buried (only to surface later), or might dissipate on their own during a natural recovery process. It's no surprise that we bring out our complete arsenal of skills to cover the full range of possibilities.

Our eagerness to help in a crisis, however, has led us to abandon some of the basic principles of good practice. This is partially because of our reliance on models of intervention that make assumptions that are contrary to our everyday practice—that is, that one type of intervention addresses all reactions, that recovery requires expert intervention, and that the faster the intervention, the better. Throwing caution to the wind, we jump in to provide a response when we have not fully established the need or the potential benefit of an intervention. We basically leap before we look.

Nowhere is this practice more evident than when crisis responders are called upon to provide interventions within the first few hours after an incident in the workplace. Employees generally are unable to verbalize their thoughts or feelings early on and, in fact, would probably benefit most from some basic human kindness and connection with important people in their lives. Support systems are there for the long haul—crisis-response professionals aren’t. To provide a traditional critical incident stress debriefing at this stage actually could exacerbate some individuals’ emotional reaction to the event. But the goal is to do no harm.

Crisis-response services that are artificially inserted into the natural recovery process too early can actually impede, rather than help, recovery. The 2005 hurricanes are a prime example: The initial response had to focus on basic human needs and lifesaving measures, supportive listening, connection with resources, and competence building (psychological first aid). Services focusing on psychological and emotional reactions were premature.

The artificial 24-72 hour time frame for crisis response is no longer the rule of thumb. Providing interventions for psychological or emotional reactions should be assessed routinely for appropriateness, rather than provided as a broad-brush application. In the case of the hurricanes, many crisis responders were just starting to provide more traditional crisis-response services in the early winter (e.g. groups, individual contacts, phone support, etc.). The idea is that affected individuals can address some of these issues, now that life-threatening situations have subsided.

There is no doubt that crisis-response services are important in the aftermath of a tragedy. However, to provide an effective intervention, we need to return to some basic principles that have served us well in other settings. Although crisis response isn’t treatment, there are treatment guidelines that make sense when considering our options for support:

Don’t treat until you know whether a problem exists. Offering an intervention immediately following a crisis is unwise. Most folks don’t quite know what has hit them in a traumatic event's early stages. Imposing a structured intervention is unnecessary when simple human kindness will suffice. Sometimes just a cup of coffee, kind words, and a call to the family is the recommended course of action.

Provide a titrated response. If the best crisis response is one that fits into the natural progression of recovery, then starting with the least intrusive or invasive procedure is wise. Connect people with their natural resources—friends, family, and community. Surgery generally is not the first choice for many ailments, so why should expert intervention supersede family support? The expert's role initially might just entail helping people consider the resources they have available for support. This might even be able to be done via a brief phone conversation.

Offer interventions as an option and on a continuum. Timing is everything. Individuals benefit most from an organized, educational crisis-support session after the initial shock has worn off and they are able to verbalize their reactions. When it comes time to offer expert assistance, include the affected individuals in the decision-making process. Not everyone benefits from a structured format; in fact, for some it might enhance their traumatic reactions. Asking some individuals to talk about their experiences prematurely may remove defenses that provide protection. Provide supportive options that can be offered over time and can be individualized to fit everyone's needs.

Provide the right response at the right time. This can maximize the services while maintaining respect for the individual's unique reaction to the crisis. The first step in a good crisis response is evaluating the need, developing a plan of action that reflects an assessment, and developing flexible services designed to enhance the natural recovery process. A good response is timely, is cost-effective, and provides the maximum benefit to your clients or employees.

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