By Tammy Bradly, Vice President of Clinical Product Development, Coventry
Last week, we looked at the importance of intervening after a traumatic incident occurs at work. This includes not only attending to the physical injuries but the mental and emotional trauma as well. Doing so can help all workers — not just those who suffered physical injuries or who were present for an incident — to begin healing.
Tammy Bradly, vice president of clinical product development at Coventry, recently asked two of Coventry’s crisis intervention case managers to discuss their work.
Eleanor Armstrong-Head and Michelle Volpe have seen how the proper response after a traumatic worksite incident jumpstarts the recovery process and promotes positive outcomes.
Here is an excerpt from the discussions:
Tammy: Intervening after a traumatic event is challenging work. What skills or tools make a crisis intervention case manager successful?
Michelle: We have our standard protocol for conducting the intervention and I always review that before going in. But the one thing I’ve found to be very true — and I’ve been doing this for 11 years — it’s very important that you be true to yourself. When you’re with a group of people who lost a coworker, for example, you need to be genuine to establish trust and engagement or it won’t work.
When you’re with a group of people who lost a coworker, for example, you need to be genuine to establish trust and engagement or it won’t work.
Tammy: That’s true. I imagine reading from a script or seeming like you’re taking a formulaic approach would make it harder to establish trust with the folks you’re meeting with. And we know building trust and making a connection is critical to helping people recover from an incident and get back to their best performance at work and in life. But making a connection can be easier said than done. Do you find it difficult to get groups of workers to talk after a traumatic incident?
Michelle: I recently did a session where a young man was killed on a job site. The group I met with was mainly young men who were not comfortable sharing their feelings. So I sat there and I talked to them like I was in their living room. I used their terms and used language they would understand, not clinical terminology. The most important piece was being genuine. I said “I don’t know what you’re going through, but I am here to help where I can. I have tools that could help.” It was a difficult discussion from the get-go. These were 20-somethings — big, strong guys — and it took a little longer to hit that spot. But I just kept going until something clicked and someone started to talk. I told them they were having very normal reactions. You are kind of pushing a button with them and then they open up. By the end, half of them hugged me before I left.
Tammy: That’s incredible. It also makes me think you both must have to really think on your feet as you see how a debriefing is unfolding. What do you do to prepare?
Eleanor: Well, before a session begins, I try to observe which groups are hanging out with who, what’s their body language, what’s the energy in the room with the group. Are they nervous? Are they scared? Are they looking at the floor? Who is the leader of the group? Then I begin to react as the discussion unfolds.
Recently, I had a pretty large group of folks. I separated the workers who spoke only Spanish from the English speakers. I also speak Spanish so I met with that group while a colleague met with other group. I brought some snacks to keep it casual. Then I just observed who they were looking at the most. We started talking and they began to open up. I listened to their belief systems. I learned that there was going to be a massive walkout of the Hispanic male community at that employer. I pressed them a little more and realized they had a spiritual belief that they could still see their former coworker in the area around the equipment where the fatality occurred. At work, people often are afraid to speak about religion. Crisis intervention allowed us to get to this space and talk about their faith and their superstitions.
We also had an employer that allowed it. They were willing to be creative and responsive to get to a better outcome. They brought in a chaplain — a Catholic priest — to bless the site. Before that, there had been a lot of absenteeism. It took a lot of listening and observation. Then you take them through the steps of crisis intervention. Active listening and observing body language are key. These workers felt listened to; they felt like someone understood. It’s the ability to shift and meet them at their needs. There was not one walkout. The manager said it was an extraordinary turnaround among the workers.
Active listening and observing body language are key. These workers felt listened to; they felt like someone understood.
Tammy: That’s amazing and, I imagine, not what the employer expected. But expecting the unexpected makes sense because a critical incident can take many forms. What are some of the types of calls you get?
Michelle: I had a client who was working at a convenience store. She was cleaning the bathroom and was dumping the trash when she stepped on a syringe; she was afraid she had contracted HIV. I worked with her for a few sessions to help her through that until her medical tests came back negative. Then I had another case where a frequent guest at a hotel took his own life in his car in the parking lot. I provided counseling for the hotel staff that found him. Another time I worked with a highway crew working overnight that saw an accident involving a two car collision and one driver died immediately. Then another car hit some of the crew members and injured two of the workers very badly. In all of these cases, people often feel like they will never un-see it. But I explain that it won’t always feel as intense as it does right now.
In another case, I had one young woman working at a convenience store who was robbed on her shift. The attacker was caught and then released. I conducted telephonic counseling with her. She returned to work and at the end of her first day back she called me at 4 a.m. to say she’d gotten through her shift and was doing better.
Tammy: That’s quite a variety. What are some of the techniques you use to gently encourage individuals or groups into sharing what they might be feeling?
Michelle: I just say to each person, “Tell me from your perspective what happened. How did you feel after? How did you react? What’s been going on with you since then?” The most common answer is “I should have, I could have done something to help or to change it.” I try to do a reality check with them to say, “Realistically, what could you really have done given the situation?” It helps. I try and give people tools to unpack their feelings. They can use them at home on their own to deal with the trauma. These are normal feelings and there are tools you can use. At 3 a.m., when you’re in the dark by yourself, that’s when you’re going to feel these things. And that’s when you need to have a reality check with yourself. It’s about support, education, and teaching them to manage on their own.
Tammy: What are some of the signs you see that someone might be struggling more than he or she lets on?
Eleanor: Many times you’ll see people who are self-medicating — drinking, taking medication, whatever is handy. Some will go to a doctor to say they aren’t sleeping but not tell the doctor about this tragic incident at work so it’s not diagnosed properly. We educate the employer to look for signs and also identify those that would be at risk for developing more issues. These might include witnesses to an incident or those that didn’t engage in our initial session.
We educate the employer to look for signs and also identify those that would be at risk for developing more issues.
Tammy: How do you know your efforts are working?
Michelle: I focus on active listening and empathetic responding. The best scenario is where the group starts talking to each other. That happened in a session with a group of managers not too long ago. They took the ball from me and were communicating with each other. That was a great sign that they would be able to support each other and their crew after I was gone. I told them when we started that these are techniques you can use when dealing with your crew. So it’s education for the management team as well. It’s imparting them with the tools they need.
Tammy: What are some of the mistakes you see employers make following an incident?
Eleanor: Employers do make mistakes. They’re human, too. Sometimes their reaction is, “Get out of here and go back to work.” They just want keep everyone else out of the area where an incident occurred. They’re meaning well and want to take their employees away from a bad situation. Better preparedness can help employers know what to do when something happens rather than just reacting without a plan.
Michelle: Things happen. And you can’t assume that you’re going to be safe in any workplace whether it be somebody attacking you or simply an accident. This is something employers have to prepare for just as much as they do the physical injuries.
Tammy: Have you seen employers miscalculate how widespread the fallout is from an incident?
Eleanor: Yes, I would say probably on every crisis intervention I’ve had. In one case, we had a projection for a maximum 10 people participating and it turned out to be almost double what the management thought. I had 100 percent participation. Honestly, we got so many letters and calls from that employer and so much praise for how much help our solution provided. The manager was literally searching to see what he could do. He was actually a nurse; he just had no idea that this kind of crisis intervention existed. I always do a follow-up call the employer to get their feedback. I had one manager say he didn’t know so much could be done in one afternoon. They’re just surprised by how much can come from this and how much people can be helped by debriefing. They’re seeing people smile again. It’s one of the things that I love about my job. I love being able to help who I can help for as long as I can help them and get them going in the right direction.
I had one manager say he didn’t know so much could be done in one afternoon.
Tammy: That’s fantastic. It must feel great to help traumatized workers though I imagine it’s also difficult to interact with workers so soon after a workplace incident. Is that the case?
Michelle: Yes. I hate the reasons for these cases but I love working on them. It’s something where you know within a very short amount of time you’ve made an impact. As a counselor, you take away something from every case that you have and you learn how to do something a little better and you learn different approaches for reaching people. Everybody comes out of it a little changed. The one thing I would say from a case-management perspective is don’t go into this lightly. It does take a lot out of you but it can give you some of the most satisfying moments of your work. It’s one the hardest things I’ve ever done but it’s one of the best things I’ve ever done. I truly believe it’s a great service.
Tammy: Thank you both for the great work you do.
Eleanor Armstrong-Head is a nurse, a clinical research coordinator, a bilingual case manager, and a field case manager.
Michelle Volpe is a certified rehabilitation counselor, a vocational case manager, a forensic specialist, a disability specialist, and a crisis response specialist.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry. Bradly is a certified case manager with more than 25 years of comprehensive industry experience through service delivery, operations management, and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC) and certified program disability manager (CPDM).
Coventry offers workers’ compensation cost- and care-management solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 30 years of industry experience, knowledge, and data analytics.
Coventry is a WorkCompWire ad partner.
This is not a paid placement.