Crisis Debriefing Following a Child Fatality – Restoring Resiliency Response NCCAN 2009

1. Crisis Debriefing Following a Child Fatality – Restoring Resiliency ResponseNCCAN 2009 Mary L. Pulido, Ph.D. Executive Director The New York Society for the Prevention of Cruelty to Children mpulido@nyspcc.org April 2009

2. Care for the CaregiversThe need to debrief CPS staff • Debriefings, defusings, CISD • Stabilization and support • Not just for disasters and emergency personnel • Critical Incidents: child fatalities, serious on-the-job injuries, suicides, and events that attract considerable media interest

3. Focus Group Questions for NYC ACS • Situations that warrant crisis debriefing • Impact of exposure to traumatic events on staff • Personal coping techniques • How can ACS support staff following traumatic events? • How could Child Fatality Review Process be more supportive? • Structure of Crisis Debriefing to optimize participation

4. Method • 13 groups, 90 minutes, 10 questions • Confidentiality • Tape-recorded, transcribed, qualitative analysis • ProQOL R-IV • SPSS • 59 management, 46 front-line staff

5. Situations that Warrant Crisis Debriefing • Child Fatality • Severe physical abuse, sexual abuse and all cases involving homicide due to DV • Violence against staff member • Bereavement due to death of staff member.

6. Impact of Exposure to Traumatic Events on CPS Staff • Three main categories • PTSD symptoms and Secondary Traumatic Stress symptoms • Decline in physical health • Impact of job on their family life • ProQOL scores • STS high, BO high, concerning

7. How can CFR be made more supportive of staff? • Immediate needs regarding investigation, I.E. management support, streamlined communication, special support team, timely feedback • Staff training on child fatality protocol, special module • Crisis debriefing and emotional support

8. Structuring Crisis Debriefing to Optimize Participation • Make it part of the standard procedure • Have management “full” support • Trust and security issues • Regular stress management support for CPS staff

9. Barriers to Attending Crisis Debriefing • Time • Lack of Trust • Low comfort level with disclosure • Being perceived as weak or incompetent • Should it be mandatory? • Front-line and management together?

10. Didactic vs. CISD • Teaching approach • Education about symptoms • Fact Phase, Thought Phase, Reaction Phase, Symptom Phase, Teaching Phase • Debate over “retelling”

11. Providing a Safety Zone • Many staff do not want to discuss event in detail • Allows staff to participate in sessions without worry about disclosing information that could be incriminating or under investigation at the current time. • Union concern

12. Restoring Resiliency Response • Discussion focused on current stress level • Validation and normalization • Identification of support systems • Practice of coping/relaxation skills • CBT techniques for stress management

13. Steps in Debriefing Process#1 • Explain process and reassure group about symptoms • Semi-structured education and support group • Share feelings • Identify current stress reactions • Learn new or identify past ways to manage stress • Strengthen workgroup

14. Restoring Resiliency ResponseStep #2 • Rules are discussed • Confidentiality • Please speak for yourself only • 75-90 minutes, no breaks, no pagers, no cell phones • Try to forget “rank” • Clinicians available afterwards

15. Step #3 • Reference reason why session is being conducted • Ask participants to share how they are managing the impact • Focus on their present state, particularly if time has passed

16. Stages of Grief and Loss

17. Step #4 • Normalize and validate reactions • Complete stress reactions checklist • Discuss domains • Share current reactions • Stress tolerance of differences • Discuss “Getting Back on Track” • Draw on past experiences

18. Step #5 • Discuss self-care • Professional and personal options • Prideful Moment • “One thing I will do for myself to relax today” • Grounded breathing exercise • Clinicians available after session

19. Participant Satisfaction Survey • Identify stress reactions? • Did you feel safe? If not ….. • Future use of techniques learned • Recommend to co-worker • Effectiveness of facilitators. • Fax, mail or gathered by a group member at the end of the session

20. Utilization • 83 requests in between 11/06 and 12/08 • 78 accepted, 528 people attended • Some boroughs had higher utilization (Bronx, Manhattan, ECS) • Outreach continues

21. Crisis Type • 32 debriefings for child fatalities • 25 for violence against staff in the field • 15 bereavement groups • 13 intense workplace stress • 6 for 9/11 staff reactions • 6 threats in ACS workplace/violence against staff in Family Court • 1 severe physical abuse • 1 bereavement due to client homicide

22. Child Fatality • Drowning • Stabbing • Roll-overs • Adolescent on caseload shot (gang-related) • Miscarriage (seven months) due to domestic violence • Severe neglect • Baby died in a fire started by sibling

23. Violence Against Staff While in the Field • Shot at by family members • Worker assaulted in court • Worker attacked by intoxicated parent • Worker robbed while in the field alone • Worker mobbed by neighbors in building who threatened to kill her during removal • Workers cornered and attacked by parent’s dogs

24. Participant Satisfaction Survey Results387 of 528 • How helpful was the session in helping you identify your stress reactions? • 73% Very helpful • 26% Somewhat helpful • 1% Not helpful

25. How safe did you feel talking about your feelings in the session? • 74% Very safe • 24% Somewhat safe • 2% Not safe

26. If somewhat safe or not safe, what could help? • Only have workers at same level • No upper management • Staff gossip • More support from supervisors to attend • Felt that info from the session could be used to “judge” my effectiveness

27. How likely are you to use stress reduction techniques learned in this session in the future? • 65% Very likely • 33% Somewhat likely • 2% Not likely

28. How likely would you be to encourage a co-worker to attend a debriefing following a crisis? • 84% Very likely • 15% Somewhat likely • 1% Not likely

29. How effective were the facilitators in addressing your concerns? • 82% Very effective • 17% Somewhat effective • 1% Not effective

30. Comments by ACS Staff • Administrators should attend to learn about how staff feels. • Keep staff/supervisors separate • Validating staff when is crisis is critical for morale, keep it up! • Wish bigger issues could be resolved here…

31. Comments by ACS staff • This should be offered every month or even week as a routine. • We need this support from an independent source, very helpful • I got a lot off my chest and my mind. • More breathing exercises, useful…