| 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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