Magazine article The Journal of Employee Assistance

The Evolution of Psychological First Aid: Evidence-Based Practice Guidance Underscores the Value of Prompt and Practical Workplace Response to Critical Incidents, but Increasingly There Is Compelling Evidence That Traditional Approaches Must Be Reconsidered

Magazine article The Journal of Employee Assistance

The Evolution of Psychological First Aid: Evidence-Based Practice Guidance Underscores the Value of Prompt and Practical Workplace Response to Critical Incidents, but Increasingly There Is Compelling Evidence That Traditional Approaches Must Be Reconsidered

Article excerpt

Evidence-based practice has become increasingly important in all aspects of medical care, including behavioral health. Interventions designed to address psychological trauma, especially preventative interventions of the type typically used in workplaces, have received particular scrutiny as the mobilization of mental health resources in response to disasters and terrorist incidents has gained strong momentum.

There is a clear consensus that the mental health impacts of such incidents can be significant and warrant systematic response efforts, but some widely practiced and promoted approaches--most specifically, debriefing and related techniques have proven, in a growing range of controlled studies, to be ineffective in preventing post-traumatic stress disorder (PTSD) or depression, and a few well-controlled studies have reported adverse outcomes from using these approaches with some traumatized persons (see, for example, Rose et al. 2004 or van Emmerik et al. 2002, for detailed meta-analyses of relevant studies; see also McNally, Bryant, and Ehlers 2003 for an exhaustive review of the issues and arguments). The weight of the evidence has become overwhelming, as bodies ranging from the World Health Organization (2005) to the British National Institute for Clinical Excellence (2005) have issued guidelines that expressly contraindicate exclusive over-reliance upon the continued use of interventions styled after debriefing.

This does not, even remotely, preclude EAP assistance to client organizations following workplace events. Current evidence and best practice emphasize strongly the importance of practical, palliative assistance in the crisis phase and of competent, efficient, and efficacious early screening of those exposed, even where traditional counseling or debriefing services may not be needed or desired (cr. Rubin et al. 2005). The importance of evidence-based treatment for those whose exposure will result in clinically significant impairment over time is also widely accepted (Litz et al. 2002).

But it is the perception of support and responsiveness, regardless of the particular intervention offered, that likely plays the most central role in the reports of help that employees and employers consistently indicate they receive from their involvement in critical incident response interventions (Devilly and Cotton 2003; McNally, Bryant, and Ehlers 2003). Organizational recovery is further facilitated when leadership is positioned, equipped, and supported as competent and compassionate. When this occurs, the organization and its workers experience the desired business and personal objectives of regaining work-life equilibrium. Workers return to a high level of productivity more frequently and more quickly.

The onus that emerging research findings and practice guidelines place upon our profession is not to abandon our efforts but to relinquish our ties to the familiar and the convenient while diligently pursuing the integration of evidence-based best practices into our programs. We can no longer count on a single system to cover all our needs, get the training we need from a single conference, or remain current just by reading trade magazines or proprietary publications. We must instead find ways to keep abreast of the entire breadth and depth of research that affects our practice and profession.

RESHAPING OUR REPERTOIRE

Our most difficult hurdle may arise in repositioning our understanding of what we want to do and what we regard as success. We must revisit who we serve as clients--in most crisis planning and response projects, our clients are organizations rather than individuals. Our customary clinical goals may, therefore, be less pertinent, especially during immediate crisis response.

We need to explore with our organizational clients what they seek as a result of our work on their behalf, helping them define clear outcomes so we can select the most pertinent approaches and clearly calibrate their impact. …

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