First Responders for Child and Family Trauma
Secondary traumatic stress (STS) is prevalent among professionals who work with victims of violence and crime, and historically has been conceptualized as an issue prevalent for ‘first responders’, such as firefighters, police officers, and emergency medical technicians. More recently, however, the impact of these stressors on individuals that regularly witness child abuse, fatalities, family violence, and dangerous field working conditions, is being increasingly recognized. These ‘first responders’ to cases of severe child abuse and trauma – such as child welfare workers, Internet Crimes Against Children task force employees, and other providers of crisis care – regularly report high levels of PTSD and STS symptoms, experiencing adverse physiological and psychological effects. The stress of such work often manifests in the form of nightmares, anger, sadness, depression, apathy, and physical ailments. These symptoms are detrimental to workers on a personal level, affecting their quality of life and interactions with family and friends, as well as their professional life, resulting in reduced performance and productivity. To combat the effects of the excessive work-related stress resulting from witnessing severe cases of physical and sexual abuse, and experiencing violence against themselves while in the field, employee support services such as crisis debriefing must be incorporated into standard operating procedures.
The Restoring Resiliency Model: Background and Development
Crisis and stress debriefing protocols, such as Critical Incident Stress Debriefing (CISD), have been in existence for several decades and are intended mitigate and prevent the development of posttraumatic syndromes and stress disorders. These models, however, are geared toward use by emergency service personnel (police, fire, EMT), and generally focuses on the specific details of a case at hand. Employees recount events that went right or wrong, and often are required to retell the details of the traumatic event. In contrast, the Restoring Resiliency Response Model (RRR) was created to specifically address the needs of child welfare and protection workers, to support their capacity to manage the unique stressors associated with their work. This model differs from classical critical incident stress debriefing, in that it does not have an investigatory stance that requires staff to retell the incident. The primary goal of RRR is to reduce the impact of the critical incident, to accelerate the recovery process, and provide insight into self-care. Focus is placed on the stress reactions experienced by the workers, understanding individual reactivity to such events, and on the individual’s ability to utilize support systems and past coping techniques. In addition, education about how trauma can affect each person, constructive emotional expression, and cognitive restructuring are introduced. Because the symptoms of STS are so pervasive and detrimental to both the individual, as well as their work performance, RRR also aims to enhance group cohesion and unit performance.
In 2006, the Administration for Children’s Services (ACS) contracted with The New York Society for the Prevention of Cruelty to Children (The NYSPCC) to develop and implement a crisis debriefing program that could effectively respond to the needs of Child Protective Service (CPS) workers in New York City. To do this, The NYSPCC conducted a series of focus groups with managers and front line staff across the five boroughs of New York City, gathering data on the experience of CPS workers, both front-line and management staff, in responding to critical incidents, and determining what type of supports and training would best help the service workers in managing their stress. Based on this research (described below), the RRR model was developed, and has been used by child welfare and crisis response workers both locally and across the country, to alleviate the stress and anxiety associated with STS issues.
The Restoring Resiliency Model: Research and Publications
RRR Development Study: The NYSPCC conducted a mixed methods research study to examine the experience of ACS staff, and develop a strategic debriefing model targeted at child protective and crisis care workers. A total of thirteen focus groups for managers and front line staff were conducted across NYC to inform the development of the RRR protocol. In total, 59 mangers and 4 front line staff members participated in these groups, during which time a series of questions were answered that were designed to gain insight into CPS staff needs after a child fatality and other critical incidents frequently encountered. Both front line and management staff reported that they were willing to attend crisis debriefing sessions if they were offered, and that it would be best if debriefings would be considered a normal part of the procedure following a crisis or critical incident. This would function to help staff feel more comfortable taking time to attend sessions. Participants also completed the Professional Quality of Life Scale (ProQOL), which is the most commonly used measure of the positive and negative effects of working with people who have experienced extremely stressful events. The three scales of the ProQOL measure separate constructs: burnout, secondary traumatic stress, and compassion fatigue. The measure has good construct validity, and satisfactory alpha reliabilities. Data from the ProQOL is included in Figure 1.
Crisis Debriefing Program Evaluation: The NYSPCC provides ongoing debriefing services, using the RRR model, to agencies citywide and across the country. Debriefing sessions are 75minutes in length for individuals and groups, and include integration of education, emotional expression, cognitive restructuring, and healing. Reinforcement of self-care and coping skills are essential. Crisis debriefing services are tailored to address a variety of issues, including child fatalities, bereavement, grief and loss, threats and assaults on employees, and incidents of severe child abuse or neglect and domestic violence. In 2015, The NYSPCC provided a total of 71 crisis debriefing sessions, serving 340 individuals. Since its inception, over 400 sessions have been provided to 2,100 CPS staff. Evaluations received from 1350 participants indicate that the intervention has been very positively received and appreciated.