Trauma Response Profile: Raymond D. Shelton, Ph.D., F.A.A.E.T.S. Member, Board of Scientific & Professional Advisors

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.