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Dr.
Raymond D. Shelton has been a member of the
Emergency Services community for 36 years, having
served as a fire fighter and paramedic. Dr.
Shelton has been with the Nassau County, N.Y.
Police Department for 26 years serving as Director
of Emergency Medical Training at the police
academy. He holds certification from the New
York State Health Department as an EMS Instructor
Coordinator and from the New York State Bureau
for Municipal Police as a Master Police Instructor.
Dr. Shelton developed the Critical Incident
Stress Management Peer Support program for both
the Police and Fire Service in Nassau County.
He currently serves as the Clinical Director
for the Nassau and Suffolk County N.Y. Critical
Incident Stress Programs. Following the Avianca
plane crash in New York, Dr. Shelton was responsible
for the Trauma Debriefing Program utilized to
debrief over 1000 rescue and police personnel,
and provided consultation to the mental health
community for trauma management provided to
the civilian population. Dr. Shelton is the
author of the book EMS Stress, An Emergency
Responders Handbook for Living Well (Mosby Publications,
1994). Moreover, he maintains a private counseling
practice.
In addition to his work with the emergency
service population, Dr. Shelton spends a significant
amount of time consulting with the corporate
community and industry on the subjects of stress
management, crisis response, and workplace violence.
He responds to corporate and industrial accidents
by providing psychological trauma services.
He also helps corporations and industries develop
Crisis Response Teams and Trauma Response Programs.
The Academy is privileged to have Dr. Shelton
serve on the Board of Scientific & Professional
Advisors.
JSV: I know that you maintain numerous roles
as an emergency medical specialist, psychotherapist,
lecturer, author and consultant with many projects
underway. Can you tell me about your present
positions?
RDS: I have been with the Nassau County, New
York Police Department for 28 years. I owe my
current interest in psychological trauma to
the work that I have done with the Department.
Currently, I am assigned to the Police Academy
and have maintained this assignment since 1980.
My work is highly diversified. At the Academy,
I am responsible for all Emergency Medical Training
for police officers, including basic recruit
medical training. In addition to the medical
training, I have developed a county-wide Stress
Management Program and serve as the Clinical
Director for the Police and Fire Service Peer
Support Critical Incident Response Team. I also
provide various lecture programs for a host
of additional topics. My work beyond the Police
Department involves a variety of mental health
areas. I maintain a private counseling practice
with a focus on couples/marital issues. This
area of focus came about while I was working
with police and emergency service families following
critical incidents. It quickly became evident
to me a number of years ago that there was a
significant need to assist the families of our
emergency workers. From this work I have developed
a large practice working with this population.
I believe that what works best for me is my
personal experience of over 35 years in the
emergency service field. I am able to make a
connection with my clients that I believe comes
from their view of me as "one of them,"
not an outsider. The experience that I have
gained through out many years of counseling
work with couples has prepared me well for an
additional area of my work, marriage preparation.
I work as a consultant with the Roman Catholic
Diocese of Rockville Center, NY. In this position,
I have had the opportunity to spend time working
with couples who are preparing for marriage.
It is my hope that in some way, some day, with
education and preparation, we may alter the
divorce rate. We spend more time training for
our careers then we do preparing for our role
as partners and parents. An additional focus
of my practice involves lecturing and workshop
presentations. A large portion of my time is
spent presenting programs to various groups
regarding the subject of Stress, Wellness, Communication,
Anger Management, Parenting and Marriage Enrichment.
My consulting work brings me into the corporate/industrial
world where many of the above presentations
are provided in staff development training.
In addition to staff development, my most recent
consulting work has centered around the topic
of "workplace trauma." More specifically,
I have focused on recognition and management
of workplace trauma from what I call the "total
corporate perspective." This is a departure
from pure crisis management. It is work done
long before crises occurs, continues through
middle ground involvement, and is followed by
many healing stages. It has become most gratifying
to work with a corporation, hospital, or industry
in the planning, training and implementation
of an "in-house" Trauma Response Team.
These Teams, once formed, respond to crises
and can have a positive impact on many employees
following an incident.
JSV: Tell me more about your work with the corporate
and industrial communities in several ground-breaking
areas including workplace trauma, violence and
crisis response.
RDS: Unfortunately, in recent years, our society
has pointed out the fact that being human means
experiencing traumatic events over the course
of our lives. We most often choose not to dwell
on this fact as evident in our "closeting
of death" - don't think about it and it
won't become an issue. However, at some point
in time, it will affect all of us. Work related
crisis/trauma resulting from either violence
or other naturally occurring events has shown
us that no place can be considered a "safe
haven." Unfortunately, we are learning
that "bad" things can affect us at
any place and any time. With greater understanding
about "workplace violence" that has
emerged through many well-publicized incidents,
many have begun to address this problem. We
see many excellent programs being offered by
members of the American Academy of Experts in
Traumatic Stress as attempts are made to gain
control of what is a growing concern. My approach
to this issue departs from traditional "crisis
response" and involves crisis preparation,
crisis management and finally, crisis healing.
I further believe that while "workplace
violence" is a topic that commands the
world's attention, the problem is greater then
violence alone. It is understood how violence
will disrupt the work environment, however,
by no means is it the sole producer of "workplace
trauma and crisis." There are many causes
of traumatic crises in the workplace. They involve
on-the-job injury or death from work-related
accidents, death of a long-term colleague and
friend, serious illness, death or suicide of
a co-worker to name only a few. The list can
be endless of the things that can negatively
affect the work force. Imagine arriving at work
on Monday morning and God knows Mondays are
tough enough and while having your first cup
of coffee with staff, you are informed that
over the weekend a long time colleague and friend
has died suddenly. You have no warning, no expectation
and no preparation for this news. For you and
anyone else in the office, this negative news
will have an impact; productivity will be down.
A crisis has occurred. This personal crisis
will definitely become an issue for the company.
Will crisis management be in order here? Yes.
Will the company see the need? This is questionable.
Will management understand the ramifications
of this crisis event or understand the human
reaction and the effect it will have on those
involved? This is doubtful. What management
will see is a negative change in employee performance.
In their mind, this is going to affect the "bottom
line." Unfortunately, if you are not in
the person's shoes, you may not understand the
pain. You simply barge forward and want business
as usual. The difference between crisis management
and crisis preparation is understanding the
needs of those in crisis. It is not merely intervention
in the hours or days following the incident
- but immediately. Proper intervention requires
training and information long before events
occur. It requires a commitment to the health
and safety of the employee, not just physically
but emotionally and mentally. It asks that those
responsible for worker productivity not only
be good technical managers but that they possess
good people skills, understand the ramifications
of crisis, develop a management style that allows
for direction and control of those they supervise
regarding job performance, with the added ability
to provide empathy during a time of emotional
crisis. In reality this approach is designed
to achieve a balance in the management of crises.
It allows for those responsible for work production
to sense the need, begin the intervention immediately
and most importantly, get the professional assistance
on-board quickly. If you think about this, it
is not far from the old expression – "where's
the cop or firefighter when you need them?"
Well, they are not there when you need them
simply because someone must see the need and
call them. Do you see the point? In this model,
we train the in-house people to see the need
and begin the "emotional first aid."
We do not allow time to go by. We begin to stem
the "hemorrhage," which in effect
will allow for a more successful intervention
by professional staff at a later time be it
hours or in the days that follow the incident.
JSV: When did your interest in workplace violence
and trauma begin?
RDS: I believe my first interest in this area
began when violent events in the work environment
started to command the attention of the news
media. I remember hearing a report on the evening
news of a shooting in a rather small insurance
office. As the report unfolded, I saw visual
images of the co-workers in a high degree of
distress as they were interviewed. This left
a distinct impact on me. I thought about the
similarity between their traumatic experience
and how this was really no different than the
distress that our emergency workers experienced.
What struck me as well was that there was no
discussion about any crisis management assistance
being provided. I wondered "what would
be done for these people?" I believe this
event made me give serious thought to the need
for some type of program to address this area
of trauma. Another example is the shooting incident
on the Long Island Rail Road. It was the holiday
season. People were on their way home. Some
were sleeping in their seats. Suddenly, a gunman
starts shooting people on the train. Instantly,
a tremendous amount of trauma occurs for all
of these people. Let's go one step further.
How many of these people had to go back to work
the next day? Every company who had an employee
on this train was affected. Their families were
affected. Emergency workers and police were
affected as were employees of the railroad.
It is like a mushroom-shaped cloud that gets
bigger and bigger. We must realize that events
are occurring all of the time that affect our
lives. The company or industry that acknowledges
this fact can truly help its employees.
JSV: Was there a specific turning point that
caused you to shift your focus from emergency
service trauma to the issue of work-related
trauma?
RDS: Absolutely and I remember it as clearly
as we are sitting here. As I had mentioned,
my interest began with the event in the insurance
office. However, that incident only sparked
a desire to investigate possibilities. The main
thrust of my work continued to be the emergency
service population until I received a call from
a hospital emergency department supervisor.
She had attended one of my seminars on stress
and suddenly found that she and her staff were
in acute crisis following an incident in their
Emergency Room (ER). The story is powerful.
At about 2:00AM, a call was received from Medical
Control informing the ER staff that two ambulances
were in route with four victims of an assault.
Routine event was the initial thought of the
staff - they prepared to receive the victims.
However, they were not at all prepared for what
was about to arrive. The first victim brought
into the ER was a young male. The nurse who
received this patient thought she had recognized
him but passed this off, thinking "it couldn't
be," or as it turned out - "she did
not want it to be." The second victim to
arrive was a female in her forties. She had
been seriously beaten and was initially not
recognizable. The third victim was a female
in her twenties. She had been beaten and initially
was not recognizable as well. Her clothing had
been torn off - she had been raped. The final
victim, a male in his forties, was rolled in.
He was immediately recognized by the staff –
an Attending Physician, a co-worker, a friend
for many years to this staff. This was his family.
His home had been entered, robbed and his wife
was beaten and raped. His daughter was beaten
and raped. His son was beaten and he was forced
to watch all of this. Finally, he was beaten
himself. Workplace violence? No. Workplace trauma?
Yes. This violence did not fit the picture of
what had begun to be talked about under the
heading of "workplace violence." This
violence had not been directed at the workers,
yet this violence touched the lives of every
one of the staff including house-keeping,
X-ray, lab and security. The incident was personal.
Detachment was lost. The entire staff had to
continue to function. However, they were now
involved in working on "family." They
all became victims. This incident changed my
thinking from the need to address just "workplace
violence" to the need to address "trauma
and violence in the workplace." The picture
was bigger than what was being addressed. This
staff required assistance. We provided debriefing
service and continued counseling as we would
have for emergency responders. I knew that the
model we were using would work in this environment
and it did. But I remember thinking - as quickly
as we were there, we were not there fast enough.
A more immediate action had been needed. Workplace
trauma needed a more complex model than "crisis
response." It needed a more holistic approach.
There was a need to prepare for this crisis
long before it occurred, manage the event during
the crisis and provide healing service. My focus
had shifted to an area that now needed to be
addressed and could take its queues from emergency
service. This incident has stayed with me.
JSV: Your interest in the field of work-related
trauma has its roots in the field of emergency
service. Can you tell me how this interest began,
and what your role over the years has been?
RDS: My current work involving psychological
trauma began in the 1970s. I had begun to see
the difficulty experienced by emergency workers
following serious incidents. On Long Island,
there were no programs available to address
the stress that these incidents created. Another
interesting phenomena began to emerge. Volunteers
were harder to come by and retention of those
in service was slipping. For the first time
in the history of volunteer service on Long
Island, advertising campaigns had begun in order
to attract members. The need for some form of
stress management work was realized and the
program development began. The initial work
for this began with the fire service and much
"selling" had to be done. The "old
guard" did not fully appreciate the need.
Many presentations were provided to those in
command and gradually the sales pitch worked.
An incident occurred and the peer support team
that I had trained responded. They provided
a successful debriefing/education and our mark
was made. The police department followed soon
after. I trained a team and finally we had developed
a complete program to manage critical incident
stress on Long Island. My role over the years
has been program development, trainer, and Clinical
Director. Today, the four emergency service
teams for which I am the Clinical Director,
service approximately 30,000 police, volunteer
fire and ambulance workers. I further provide
clinical direction, training and consultation
to hospitals, industries and corporations where
I have developed "workplace trauma"
programs and trained in-house crisis response
teams.
JSV: You talk about "workplace trauma"
as opposed to "trauma that affects the
workplace." Can you expand on this concept
as it relates to many of the programs that address
workplace violence?
RDS: Workplace violence is the issue that caught
our attention through media reports of incidents
in the work environment. People suddenly became
aware of the fact that no place can be considered
a safe haven. Violence can even occur in your
quiet little "insurance office," a
place that you would have thought was the furthest
from violence. The need to address this issue
was seen and programs were developed to provide
assistance. As far back as 1970, The Occupational
Safety and Health Administration (OSHA), in
its General Duty Clause, required employers
to provide a safe work environment, free of
recognizable hazards. This clause addressed
safety issues, and certainly the issue of violence
is a safety issue. Program development centered
around violence issues such as identification
of the problem, causes and prevention. At a
later point in time, crisis management was introduced
to help employees after a violent incident had
occurred. The problem with this approach is
that it does not address the many additional
forms of traumatic events employees can experience
- events that can affect performance and quite
possibly the "bottom line." Trauma,
in an employee's life, that will have an impact
on performance includes, but is not limited
to, serious illness or injury to self, family
or co-worker, death of a spouse or child, suicide
of a co-worker, sudden death of a co-worker,
job-related injury or the witnessing of job-related
injury/death. When events like these occur in
a person's life, it will not be "business
as usual." A crisis is present and must
be addressed. Workplace violence programs only
address violence, are usually prevention-oriented
and may not address the trauma following the
event.
JSV: Which factors do you think are most important
for corporations to consider with regard to
the management of trauma in the workplace?
RDS: The obvious consideration is that corporations
must realize that this subject is real. It is
a fact of life. Trauma occurs, not just in the
form of violence in the work environment, but
in the lives of the workers, beyond and on-the-job.
They further need to realize that these traumatic
events will affect productivity, attitude and
the harmony necessary to deliver a product or
service. My experience in consulting with the
corporate and industrial world is that, at the
highest levels of management, there is a limited
understanding of this issue. Understanding usually
comes after the fact - when a crisis has occurred.
Only then does this idea have merit and realization
occurs that something must be done. Managers,
oftentimes, may not consider poor performance
to be anything other than the result of a "poor
attitude." Consideration is rarely, if
ever, given to the cause for an employee's change
in performance. I have further observed that
supervisory/management training is much better
at "technical" management skill training
than it is at teaching managers and supervisors
about people and performance concerns. Motivational
skill training for managers usually only considers
how to motivate the employee; it does not address
the issue of why this "once good employee"
may now need assistance. I had worked with one
company that had an "at will" policy.
This meant that if performance was bad - "let
them go." Managers did not take the time
to find out why the performance had deteriorated.
One case, in particular, stands out in my memory.
There was a situation involving an employee
who had been with the company for 18 years and
had excellent service. His performance had dropped.
He was "counseled" but there was no
real improvement. He was terminated. As it turns
out, his son was diagnosed with cancer. This
worker was a private person and had not shared
this at work. His burden, and his inability
to talk about it, led to an issue on the job.
The sad part about this incident was that no
one, not even his immediate supervisor, or the
Human Resources department ever took the time
to consider the possibilities of why this once
good employee had crashed. They only identified
the obvious and took action. This is a clear
example of "trauma" affecting the
workplace and not being addressed. Oh yes, the
picture is far greater than "workplace
violence." The true picture requires corporations
and industry to do all in their power to protect
the most valuable asset they have - their people.
This is the most sound business practice that
exists. Keep your workers safe, assist them
in a time of need, show them that you value
their contribution to your success. This represents
a winning situation for all.
JSV: How do we justify the need for workplace
trauma response teams?
RDS: Trauma and violence in the work environment
do not bode well for business. The success of
any corporation is dependent on each employees'
ability to do their job well. Protecting employees
from harm and assisting them following traumatic
incidents, whether the incidents are work-related
or have occurred as the result of an outside
incident, is sound business practice. The cost
to business for lost productivity, worker error,
sick-time and the potential for job-related
injury due to a loss of concentration that often
accompanies the traumatic stress response can
be staggering. The National Safe Workplace Institute
projects the cost to business at greater than
$4.3 billion annually! I also believe that in
our litigious society, every employer runs the
risk of finding themselves on the losing end
of a law suit based on the fact that an employee
was "psychologically" injured as a
result of a workplace trauma incident. If there
is an obligation to provide a safe workplace,
free of danger, can we not expect that workers
should be protected from the emotional and mental
trauma that they may experience on the job?
Thus, in the "trauma or violence potential
environment," each employer needs to ask
- "What are the risks?" and "Where
does the greatest threat come from for my people?"
"What can I do about this?"
JSV: What benefits can be derived from the development
of corporate-based peer crisis response teams
who can respond to incidents ranging from chronic
illness of an employee to a workplace shooting
or hostage situation?
RDS: Benefits include an increased awareness
on the part of management and line supervision
of the nature of the problem and the effect
it has on the employee. The advantage is having
many eyes and ears throughout the workplace
that can have their "finger on the pulse"
of traumatic stress. In effect, they would know
when to sound the alarm. They would have the
ability to respond "immediately" with
PEERS, who are respected and trusted members
of the corporate/industrial family who can begin
the process of SUPPORT and are able to continue
the support in the days following the incident.
The nature of the incident really does not matter.
In-house peer teams, in conjunction with trained
management, are able to provide a response at
the time the crisis is unfolding. They are in
the best position to begin the process of mitigating
the effects of traumatic stress on employees.
The benefit, while it may not be "business
as usual," will be a return to a "normal"
environment much more quickly. This is an example
of a positive action step producing positive
outcome. An additional benefit that has been
expressed by both employees and union personnel
following incidents, has been an entirely new
respect for their company. Comments like - "Its
nice to know they are human," "It
felt good to know they cared enough about us
to provide the support," "It's a great
company to work for, they are there for you
when the chips are down" are readily heard.
Another important benefit is that when your
work force has this view of you, they will perform
for you. It should be obvious that the bottom
line will be positively affected with this "human"
approach to management. A corporation that demonstrates
concern for its workforce builds morale.
JSV: Although many of the causes of workplace
violence are easily understood, there are several
hidden causes. Can you describe how the causes
are manifested across various circumstances?
RDS: This is an area that can be difficult to
approach. We most often think of violence following
a somewhat predictable pattern. We look at such
things as the angry and out-bursting employee,
those with poor impulse control, drug or alcohol
use, history of family violence, grudge holding,
and the marginal performer, etc, etc, etc. Consideration
is also given to the work environment and its
potential for violent events (i.e., late night
shift in the gas station). These examples are
common-place and violence prevention programs
do address these concerns. However, the "violence
potential environment" may be a factor
of internal cause. Oftentimes, this internal
cause can be linked directly to management personnel,
company policies or company attitude toward
its workforce. For some managers and supervisors,
there may be only one goal - get the job done
at any cost and, in the process, protect self.
This management style may create a hostile situation
that may conclude in violence. Such things as
accusation without foundation, poor communication
skills, lack of understanding of human needs,
poor conflict resolution skills, self-preservation
above all, and inappropriate pride lead to a
lowering of morale and the creation of mistrust.
This approach to people management creates a
"violence potential environment."
Without managers and supervisors being able
to connect with their staff on a human level,
they will never know that a crisis may be unfolding
in a workers' life, beyond the job. Poor communication,
poor conflict resolution and accusation may
place the worker over the edge and violence
can erupt. Consider this. Only five months ago,
I was called into a company, as an after thought,
following a "downsizing" incident.
Ten workers from one work-group upon arrival
in the morning were instructed to meet in the
conference room at 10:30am. No reason for the
impromptu meeting was given. But since they
were all actively involved at a high level on
an important project, they believed that this
was the nature of the meeting. Not so. Upon
all of their arrival in the conference room,
security secured the area. Upper management
personnel accompanied by the Human Resource
Director entered the room and proceeded to inform
the group that their service with the company
had been terminated. They were provided no further
information other than security would collect
their keys and would escort them to their work
station to collect their personal effects. They
were to be out of the building by 1:00pm. Common
place? I hope not. But let's be honest, this
is happening across corporate America more than
we would like to think. If anyone of these workers
had been in a difficult place outside of the
job (e.g., sick spouse or child, dying parent,
financial issues etc.), the incident could have
been the breaking point and a violent outcome
may have occurred. This is what I address as
a "hidden cause." Those internal events
that push the final launch button. It is violence
created by a company's poor attitude and management
that is poor at what it does. People need to
be cared about and cared about employees will
be better workers.
JSV: It seems as though your approach to workplace
violence is somewhat more complex than is generally
seen. Why is this?
RDS: As you recall, my shift from emergency
service critical incident stress programs occurred
based on a workplace violence incident. However,
as I began to work within the violence prevention
context, I felt as though I was missing something
important. I recognized that violence was a
serious issue and that we must begin to address
it. I certainly understood the need for crisis
intervention. Prevention programs work to stop
the issue from occurring in the first place.
They have great value in raising awareness both
on the part of management and on the workers.
They generally accomplish the mission of providing
a safer workplace. Additionally, a program should
provide for some level of employee support following
an incident. However, this usually is the extent
of the program. What the programs do not do
is address the issue of "workplace trauma"
which could be a direct result of workplace
violence. However, it is most often the result
of more "naturally" occurring human
experiences such as those previously discussed.
No consideration is given to these other events,
yet these events occur far more readily than
violence. The effect that they will have on
job performance is powerful. This was the missing
piece for me. My work with the emergency population
centered around a number of areas that included
stress management and wellness programs, officer/management
training regarding human performance issues
(which included in-depth training regarding
the effects of stress and traumatic stress incidents
on responders), the development of "peer"
response teams with representation from all
levels of the organization, and training for
EAP/HR personnel regarding traumatic stress
and its management. I believe that the best
approach to the issue of "workplace trauma"
is holistic in nature. It should increase awareness
on all levels from management to line workforce.
Moreover, there is a need to select and train
a "peer" team with representation
from each area of the corporation and to train
line supervision regarding the nature of the
problem. With such pre-incident training, there
is quick recognition and appropriate response.
We need to train management about the effects
that trauma has on humans and allow them to
consider possibilities for poor performance
other than a "poor attitude." We need
to develop a network of mental health providers
who are qualified and desire to respond to traumatic
incidents. I raise this point based on my experience
in presenting programs to various mental health
professional groups. On many occasions, I have
encountered clinicians who have attended one
of my conference workshops and, at its conclusion,
have come to me and stated "this is powerful
work - I don't think it is for me." It
should not be assumed that because a corporation
has a network of providers available, that they
will be the best people to respond to a traumatic
event. Many don't want to get the call and respond
to a steelworker who had been vaporized with
molten steel in front of twenty other people.
They don't want to hear that story. It is definitely
my belief that we need to do more than just
address prevention and crisis management. Prevention,
by it's most widely accepted approach, seeks
only to discuss the single issue of violence.
We establish and teach violence prevention policies
making them available to each employee, supervisor
and manager. In other words, we demonstrate
that we will not tolerate violence. However,
in this approach, many companies do simply what
has just been described. They have employees
read the policy - job done. Managers are told
to enforce the policy and security provides
what protection it can. No consideration is
provided for the deeper aspects of the issue
of trauma. In most programs, no training is
conducted to train management and supervision
to identify cause, reaction, and management
of trauma in their employees. No provision is
given to "pre-plan" for a traumatic
incident through the development of a Crisis
Management Team comprised of Senior Management,
Security Personnel, Peer Support Team, Medical
Personnel, Human Resource Managers, EAP Professionals,
Public Relations, Community Representation,
Investigative Staff and Assessment Experts.
A well-developed Crisis Response Plan consisting
of a Chain of Command, Emergency Notification
System, Impact Assessment, Emergency System
and clear guidelines for both internal and external
communication is never considered. An additional
concern of the crisis management/response plan
should include Family Support Service. What
consideration will have to be given to assist
family members in the aftermath of the crisis?
We must consider notification procedures and
immediate assistance for child care or travel
to a hospital. What is oftentimes missed by
upper management is the fact that, through a
well-developed Trauma Management Plan, the company
will be able to continue to function at a high
level throughout the hours, days and weeks following
a crisis event. Secondary traumatization to
employees will be minimized and worker down-time
will be greatly lessened. It is too late to
think of the above when the crisis is unfolding.
Prevention should include all that is required
to lessen negative impact during and following
the greater significance of a traumatic incident.
While crisis response may be needed based on
"violence," it must be remembered
that it is always about "traumatic stress"
regardless of the cause. The company should
be concerned with one key question - "What
do our people need to assist them through this
difficult time?" "Are we ready to
meet the needs that will present during and
following a traumatic incident?"
JSV: In your opinion, is there any advantage
to addressing traumatic stress reactions in
the immediate aftermath of a stressful event
as opposed to waiting until after a crisis situation
has been resolved?
RDS: My first thought when I hear this question
is - "Is there any advantage to waiting
to stop the bleeding from a serious wound until
we reach the hospital?" Obviously not.
Treatment is needed at the moment or the patient
may not survive. I believe that people in the
midst of a traumatic stress incident, require
support immediately. They need to know that
someone is there who cares, that they are not
alone and that there may be some very simple
things that they can do to gain some level of
control. At its most basic level, having someone
take some slow deep breaths to calm down and
regain control is a positive step. Things said
to the victim that are comforting and supportive
may be the very things that the victim will
remember in the years following the incident
that gave them a sense of calm in a moment of
crisis. People want to help. I have found that
in the early moments of any incident, peers
are best at this. In recruiting peers, you need
to screen through those individuals to find
who would be in the best position to offer support.
Peers are not trained like mental health professionals.
They are trained to provide "psychological
first aid." We can train people to provide
this initial support. The peers start the process
and open the door for professional assistance.
I can't underscore, however, just how important
education and training will be to make this
all work. So, with regard to waiting to provide
support until the incident is over - never wait,
they need support at the moment! This is the
essence of what a good "Trauma Response"
program is about - knowing when support is needed,
providing the degree of support that is needed,
and following up in the days after the incident.
JSV: How can you be reached by a corporation
that would like to have you consult in order
to develop a corporate-based trauma response
team?
RDS: I would welcome the opportunity to work
with corporations and industries in the development
of Trauma Response Programs. I can be reached
by telephone at (516) 681-3976, or by EMAIL
at r.shelton31@yahoo.com.
JSV: Today we know that there are a growing
number of organizations concerned with preventing
workplace violence. Do you see a time when this
issue will no longer be a concern?
RDS: Unfortunately, I do not believe that the
issue of violence in the workplace will ever
cease to exist. We are, after all, human. Humans
have a tendency to become violent - this we
all know. Programs will work very well at lessening
the overall effect of violent incidents and
may, in some limited cases, be the driving force
that prevents a violent event from occurring.
However, I believe that we will always find
ourselves needing to respond to the after-effect
of a violent event. I also believe, it is a
given, that we will continually need to prepare
for and respond to the traumas of life that
our workforce will experience. It would be nice
to believe that a day may come when these kinds
of issues are non-existent. We all know better.
JSV: For a number of years, we have seen very
good things happen in the field of psychological
trauma management, in particular, management
and support of emergency workers following critical
incidents. Do you see a link between what is
being done to assist this population and the
corporate/industrial work force?
RDS: My own experience with exposure to work-related
trauma has its foundation in the emergency services.
The need for management of traumatic stress
with this group of workers has been evident
for many years. Personally, I have had my share
of experiences with powerful incidents over
the years as an emergency provider that have
left their mark on me. This was my work. As
such for many years, I had accepted the fact
that I would experience many of life's worst
events as part of my job. As my focus shifted
from provider to educator/psychotherapist, I
began to draw on my own work experience with
assisting the emergency worker in times of emotional
distress. Programs had begun to develop that
provided a means to recognize and manage the
stressful reactions experienced during difficult
calls. These programs definitely addressed the
need. I began to build on these fine concepts
and developed programs that fit a specific need
for the groups that I serviced. I added a pre-incident
education program. I approached the education
piece from a Holistic perspective and decided
to present training programs that addressed
the "total person" of the rescue provider.
These programs centered around Wellness, Stress
Management, Traumatic Stress Management, and
included a "family life" component.
In conjunction with the general provider program,
I began to offer an Officer Training component
that addressed the above topics but added a
"symptom" recognition piece. This
part of Officer Training presented the issue
of stress in the individual worker with an emphasis
placed on symptoms, the effect on performance
and immediate management. It further developed
management skills in communication and counseling
techniques that could be utilized during the
crisis event. I believe that this was the first
attempt to move management/supervision into
the realm of "human needs" issues
as opposed to predominantly technical job performance
concerns. The link between this work and the
corporate/industrial work force is a natural
fit. Trauma and crisis in the workplace is no
different from the emergency environment. Trauma
is trauma regardless of cause. In the corporate/industrial
world, crisis events need to be understood.
Thus, we train from the highest level of management
down to the work force. We recruit and train
trauma/crisis response teams comprised of various
members of the corporate/industry family. We
develop a Crisis Response Plan. We make the
teams visible and available - to respond when
called. We provide on-scene support and continue
to provide support in the days and weeks following
the incident. Finally, we offer a support component
to the families of distressed workers. Every
piece of this program has its roots in the programs
that I have been using to service the emergency
population for years. It is a simple adaptation
to a different population. The beauty of the
design is that it can be easily adapted to any
need.
JSV: In you book EMS Stress, you utilize the
concept of AWARENESS-ATTITUDE-ACTION as a central
theme for the continued management of stress.
In your programs on workplace trauma/violence,
you speak of the "trauma potential environment."
Can you explain how you link this to your concept
of AWARENESS-ATTITUDE-ACTION?
RDS: I believe that, for the most part, we lack
AWARENESS about the effect that stress has on
our lives. This includes, oftentimes, not having
a clear focus on the depth of our stressors
or the physical, emotional, mental, social and
spiritual destruction that stress may be creating.
We often develop a "poor" ATTITUDE
that drags us down as we begin to succumb to
the events in our lives. And, when stress reaches
a high level, as it does in times of crisis,
people feel out of control, not able to make
decisions - they lack the ability to take ACTION.
I believe that with increased awareness, a "survivor
attitude," and a decision to take action
steps, people begin the recovery from powerful
negative stress in their life. As I had mentioned
earlier, the "trauma potential environment"
exists in our workplace. A keen AWARENESS of
this fact must be present at all levels of the
workforce. Management needs to understand clearly
the nature of the problem, where it may come
from within the organization, and the possibility
that crises experienced off the job in the form
of personal tragedy will affect the company.
Awareness comes through the pre-incident training
component for managers, supervisors and the
workforce. Through an increased AWARENESS, a
new ATTITUDE emerges toward the issue of trauma
and crisis. I have found, on many occasions,
that the most difficult "sell" is
possible when people begin to realize the reality
of the problem. Educational examples are powerful
tools that bring the point home. When understanding
is gained - forward movement occurs. Team development
and training are ACTION steps that begin the
process of crisis management. Once a Trauma
Response Team is developed and "on-line,"
it becomes the action force to carry the program
forward. One company's team (that I had the
good fortune to work with) is so successful
with it's crisis response ability, that it plays
a role in education on a regular basis in the
Mill work areas. Its team members are sought
out by employees for advice when their stress
levels are building. The team, through its progressive
action steps, has become a welcomed addition
to the plant. They have made their mark through
a strong commitment to be present and aware
of the problem. They believe that they make
a powerful difference in the lives of the workers
that they serve. They have done this through
AWARENESS-ATTITUDE-ACTION, a proactive response.
JSV: What do you see as the biggest stumbling
block in the management of workforce violence
and trauma?
RDS: The biggest stumbling block is a lack of
understanding of the problem, coupled with the
time old problem "no funds" for this
project. Lack of understanding is present because
no one wants to think about this problem. This
is evident even today regarding violence issues
in so many companies. They simply do what the
law requires - post a policy on a bulletin board
and believe it will "never happen here."
We've met the requirement, now on with business.
The same holds true for trauma/crisis issues
- they won't occur here. This thinking is not
different than what had occurred in the emergency
professions not many years ago. The attitude
was - "we don't have a problem with this,
it's part of our job." Obviously we now
know differently. In the emergency professions
an awareness was raised, a new attitude has
taken place, action steps occur and the issue
of critical incident/traumatic stress reactions
are being addressed successfully. Funding will
always be a stumbling block for progress. Money
must be used for things that are necessary to
the product or service delivery. The question
is always asked - "Why should we allocate
funds to this area?" My best answer to
this question is that these funds are an investment
in your workers who you need to deliver your
product or service in a competent manner. Protect
the most important asset you have. The cost
is minimal compared to the potential losses
that can be experienced following an incident
in your workplace, estimated at an average incident
cost of $250,000. Traumatized workers will be
less productive following a traumatic incident.
As I had said earlier, sick time will increase,
error levels will rise, and the potential for
further injury due to poor concentration is
high. This is the risk taken by not developing
a program to meet this issue head on.
JSV: With regard to the effects of traumatic
stress, what things do you believe are in need
of greater investigation?
RDS: The field of Traumatic Stress Management
is an emerging area. Wonderful strides have
been made in a relatively short time-frame.
I believe that we need to continue to develop
programs that address the varying needs of humans
in crisis across the population. No one program
or approach will fit the bill for all incidents.
We further need to continually investigate the
work that we are doing to determine its effectiveness.
We need to see why it works and if it does not,
why not? We need to develop studies that will
assist in showing the efficacy of the work we
are doing. There is a need to prepare people
to manage the stress that life will create.
We spend a considerable time in the education
of humans on subjects that fall short of what
we might well call "life survival"
skills. I believe programs in stress management
should be developed and implemented at the earliest
point possible in the schooling process. At
this point, we do not even do a good job helping
students to handle "test anxiety."
With this being the case, how will they ever
learn to respond in a healthy manner to a serious
life crisis? Train for the crisis and when it
occurs you will respond appropriately.
JSV: As you are aware, The American Academy
of Experts in Traumatic Stress recognizes that
traumatic events are an unfortunate part of
the human experience that professionals and
workers from many fields work with on a regular
basis. What do you see as a major advantage
of an organization such as the Academy that
is dedicated to increasing awareness and ultimately,
improving the quality of intervention with survivors
of such events across such an eclectic group?
RDS: Trauma, be it physical or psychological,
is a fact of human existence. The American Academy
of Experts in Traumatic Stress represents all
aspects of human life. The diversity of its
membership allows the Academy to provide the
most complete understanding of the nature and
effect of traumatic stress across the population.
I believe the Academy is in the best position
to provide a forum for research and education
on traumatic stress. It swells with a knowledge
base unparalleled in the field of trauma survival.
The Academy further provides a means to legitimize
those who choose to work within this area. The
Certification Programs provide a framework that
begins the task of standardization in this powerful
work. Finally, working with victims following
crisis can be a lonely journey. There are many
human service workers who choose not to be a
part of this difficult work. The Academy lets
us know that we are not alone in our efforts.
It provides support and encouragement.
JSV: You have become a Fellow of The American
Academy of Experts in Traumatic Stress as well
as Board Certified by the Academy in Emergency
Crisis Response and Stress Management. What
made you pursue these credentials offered through
the Academy's Board Certification Programs in
traumatic stress specialties?
RDS: As I have discussed, I have been involved
in traumatic stress management for many years.
I clearly remember, on many occasions in the
early days of this work, wondering - "Am
I doing this the right way?" The knowledge
base was limited and I often felt, as I am sure
many of our colleagues have felt, that I was
flying by the seat of my pants. As the years
went by, and this subject received more attention,
research was conducted and management models
began to emerge. Trial-and-error gave way to
more pointed management with measurable results.
Through the Academy's Certification Programs,
I was finally able to realize a comfort level,
not experienced in the beginning of my work.
I was able to realize that the work I had been
doing had merit. It was finally recognized as
valuable.
JSV: As an active member of the Board of Academic
& Professional Advisors of the American
Academy of Experts in Traumatic Stress, are
there any suggestions or concluding comments
that you could offer with regard to helping
survivors of traumatic stress?
RDS: Working with victims of crisis is powerful
work. It can be exhausting to the crisis worker
in each of the five realms of human life - Physical,
Mental, Emotional, Social and Spiritual. With
each crisis intervention we do, we take a piece
of the victims' incident with us. We experience
their incident through their story. Over the
course of time, we can become weighted down
by the pain of those we help. To stay effective
in this work, each crisis worker must always
care for self, protecting the balance of the
five realms. I further encourage crisis workers
to know and respect their limitations, to respect
the place you may be in at any given time. It
is most important to be able to say NO to involvement
in the intervention if there is danger that
you will be "hurt" in the process.
I further believe that each person who provides
this service must develop a strong and varied
support network for self. In my years in this
field, I have met far too many human service
workers who have become "islands"
of isolation. Doing this work continually requires
support from colleagues, friends and family.
It is important to develop and maintain a network
of people who will be there for you. Learn to
practice what you teach. Take time for you.
Talk about your reactions to the work you do.
Remember to find the time to play and laugh.
Stay abreast of change. The field of traumatic
stress is changing almost every day. Take the
time to learn what you can - attend the conferences,
talk to colleagues, be willing to consider new
approaches to management. Investigate their
merit and apply it to the work you are doing.
Remember always - our mission is to "do
no harm." Finally, I would like to offer
a comment to those who may read this article
who are not from the disciplines of mental health,
but rather are interested in helping survivors
of trauma in the "peer" role. A great
proportion of our work in crisis management
is the provision of support in a safe place.
It is a time to help survivors realize that
they are not alone and that they are cared for
and protected. It is a time for you to demonstrate
a high degree of empathy and understanding.
Consider this - sympathy and empathy are often
confused, if understood at all. Simply stated
- sympathy is feeling sorry for someone's difficulty.
Empathy requires you to enter their world and
connect with the survivor and help them to know
that you are present and concerned about them.
In crisis work, as it should be in all counseling
- it is always about the survivor, never about
you. Finally Joe, I would like to thank the
Academy for allowing me to be an active part
of its mission. I look forward to a long, productive
relationship.
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