Contingency Plan of Major Incident. --Psychological Services for HA Staff

Transcription

1 Contingency Plan of Major Incident --Psychological Services for HA Staff Prepared by Oasis Center for Personal Growth & Crisis Intervention Corporate Clinical Psychology Services Hospital Authority (May 06)

2 Contingency Plan of Major Incident --Psychological Services for Staff Introduction A. Background World Health Organization (WHO) and influenza experts worldwide are concerned that the recent appearance and widespread distribution of an avian influenza virus, Influenza A/H5N1, has the potential to ignite the next pandemic. Given the current threat, developing preparedness plan for managing the psychological consequences that would result from having large numbers of casualties should assume a high priority. Besides, psychological services have a vital role to play in the coordinated response to disaster or major incident in HA community. This document offers a framework of the Hospital Authority s (HA) contingency plan for preparing and managing the psychological consequences of major incidents on staff member of HA. B. Goals To mitigate or prevent adverse consequences of major incident on staff members To increase staff member s positive adaptive behaviors in face of disaster or major incident To facilitate post-traumatic growth and empowerment of staff members C. Intervention strategies Management of the psychological consequences of disaster or major incident requires a range of intervention strategies at multiple levels involving a variety of service providers. The intervention strategies include 3 phrases respectively: Pre-event phrase Event phrase Post-event phrase 2

3 Contingency Plan of Major Incident --Psychological Services for Staff Content Page No. A. Pre-event Stage I. Pre-incident Training 4 7 II. Pre-incident Educational Information and Materials 8 III. Resource Folder for Managers and Supervisors 9 IV. Coordination of Services and Network with Various Community Agencies, Professional Bodies and Religious Organizations 10 B Event Stage I. Critical Incident Stress Management (CISM) Services II. Hotline Service 14 III. Psycho-Spiritual Support 15 IV. Services for Staff Directly Affected by the Major Incident V. Consultation Service 18 VI. Psycho-Educational and Therapeutic Materials E- resources 2. Printed materials/audio-materials VII. Specialized Trainings C. Post-Event Stage I. Crisis Intervention Individual crisis intervention 2. Critical Incident Stress Debriefing (CISD) II. Therapeutic Groups Psychotherapeutic Groups for Injured Staff 2. Psychotherapeutic Groups for Non-Injured Staff III. Rebuilding Programs Nurturing Our Heart - Retreat Camp for Healthcare Workers 2. Psycho-Spiritual Talks 3. Training Programs on Rebuilding Resilience for First Respondents IV. Reintegrating Service for Recovered Staff 28 D Implementation mechanism E Appendixes Appendix Appendix 2 35 Appendix 3 36 Appendix

4 Contingency Plan of Major Incident --Psychological Services for Staff A. Pre-event Stage I. Pre-incident Training 1. Rationale Critical incidents come unexpectedly. As noted from the SARS experience, some of our staff members were not prepared psychologically. They were distressed by the crisis. This in turn might affect their work performance and their compliance to different policies including the infection control measures. The pre-incident training which is part of the Contingency Plan of Major Incidents (Psychological Services for HA Staff) includes 4 training programs that provide psychological immunization for staff members. These series of programs not only aims at enhancing the resilience and coping strategies of staff members but guide them to reflect on the core values of their lives and work. 2. Key objectives 2.1 To enhance staff members inner strength and skills to cope with the major incident 2.2 To bolster the psychological resilience of staff members 2.3 To equip staff members to provide psychological support to other staff members when major incident occurs 2.4 To provide tailor-made programs to assist managerial staff preparing and supporting their subordinates to cope with the major incident 3. Content of service 3.1 Resilience to Crisis Training Programs Objectives: To teach staff members about the concept of resilience and vulnerabilities to psychological crisis / trauma To assist staff members to strengthen their resilience and stress coping abilities before crisis Trainers: Service Target: Corporate Clinical Psychologists Managerial Staff & Frontline clinical staff Program format: 2 day workshop 4

5 Content: Day 1 Principles of stress resilience related to improved health outcomes Skills in enhancing resilience Learned optimism (Part 1) Connectedness Gratitude Day 2 Advanced skills in enhancing resilience Learned optimism (Part 2) Emotion intelligence 3.2 Self Coping Strategies in face of Crisis Objectives: To introduce the concept of psychoneuroimmunology To provide psychological education regarding the stress impact on mental and physical health To learn relaxation skills and effective coping strategies during crisis To guide the staff members to design personal and family contingency plan for the management of crisis Trainers: Service Target: Corporate Clinical Psychologists Managerial Staff & Frontline Clinical Staff of high risk units Program format: 1 day workshop Content: Crisis/Stress impact on mental and physical health Enhancing the sense of control Devising personal and family contingency plan Understanding psychoneuroimmunology Relaxation/visualization techniques Managing emotion in times of crisis Support among team members Support to subordinates* * for managers only 5

6 3.3 Psychological First Aid Training Programs Objectives: To equip managers to provide psychological support to other staff in times of major incident Trainers: Service Target: Corporate Clinical Psychologists Managers/Unit heads of high risk units Program format: 1 day workshop Content: Phases of crisis and psychological disorders Components of psychological first aid Supportive communication and crisis intervention skills Caring skills for people with loss and grief Warning signals of burnout and self care skills 3.4 Training Programs on Life Education Objectives: To facilitate staff to reflect the meaning of life and to appreciate the value of life To facilitate staff to understand life and live with uncertainty and fear To guide staff to reflect their meaning and mission of work To learn ways to cope with life difficulties Trainers: Service Target: Experienced Spiritual Directors or Counselors/ Corporate Clinical Psychologists/ Staff who are working or preparing to work in high risk units (e.g. Medical Ward, A&E, ICU, Isolation Ward) Program format: 3 day workshop Content: Purpose and meaning of life and work Understanding the unlimited possibilities of life Ways to deal with uncertainties, fear and chaos Coping with suffering and loss in life Ways to create favorable conditions in life Exploration of death Appreciation of life 6

7 3.5 Other Tailor-Made Training Programs Objective: To tailor training programs to different units, departments or high-risk teams so as to meet the special needs of staff Trainers: Service Target: Corporate Clinical Psychologists Staff in need Program format: Depending on the service needs of the units or departments Oasis can tailor training programs to different units, departments or high-risk teams to meet the special needs of staff. Unit managers or supervisors are welcomed to contact Oasis at to discuss their service needs. 7

8 II. Pre-incident Educational Information and Materials 1. Rationale Education about possible psychological impacts of major incident in the self and others are helpful. This will increase the staff and the HA community s capacity to respond appropriately, to recognize and deal with stress effects and will lessen the likelihood for adverse outcomes from the major incident. Provision of educational information and materials can also avoid stigmatization and strengthen staff s self-help coping strategies in face of the major incident. 2. Key objectives 2.1 To provide relevant information regarding the psychological reactions to stress, crisis and disaster 2.2 To help staff members developing effective personal and family contingency plan prior to the outbreak of major incident 2.3 To assist staff members in learning how to apply effective coping strategies in face of major incident 3. Content of service 3.1 A set of psychotherapeutic and psycho-educational materials with the following themes will be developed. Themes: Ways to build psychological resilience Ways to devise family and personal contingency plan Stress coping strategies in face of major incident Techniques on stress management Ways to break bad news Ways to handle grief 4. Access to the above information The E-version of the above-listed psychotherapeutic and psycho-educational materials will be uploaded on the webpage of Oasis ( when they are ready. Staff are welcome to download the information from the webpage of Oasis. 5. Remarks: For other previously developed psychotherapeutic and psycho-educational materials, please refer to Appendix 1. Psychotherapeutic and psycho-educational materials will be updated according to the needs of staff members and uploaded on the webpage of Oasis continuously. 8

9 III. Resource Folder for Managers and Supervisors 1. Rationale Managers and supervisors play a key leadership role during the outbreak of major incident. They are also important bridge for frontline staff to access services and resources within HA and the community. Partnering with managerial staff and providing them with information on how services and resources can be utilized is helpful for them to provide support to their subordinates through uncertainty or crisis. 2. Key objectives 2.1 To enhance managers / supervisors understanding of the services and facilities provided by Oasis 2.2 To provide information to facilitate managers/ supervisors to make use of the services of Oasis in times of major incident 3. Content of service 3.1 Packaged Resource Folder will be distributed to managerial staff. Content: General introduction of Oasis Overview of clinical psychology services of Oasis Introduction of individual psychological service Introduction of crisis intervention Introduction of other consultation services Consultation services for HA Staff ( 會心談 ) Consultation services for HA sick Staff & their significant others ( 關懷患病員工及其至親諮詢服務 ) Introduction of facilities of Oasis Introduction of Oasis webpage Ways to contact Oasis Service Target: Managers and supervisors 4. Access to Resource Folder The E-version of the above-listed psychotherapeutic and psycho-educational materials will be uploaded on the webpage of Oasis ( Unit managers or supervisors are welcome to download the information from Oasis s webpage. 9

10 IV. Coordination of Services and Network with Various Community Agencies and Religious Organizations 1. Rationale Staff may have variety of needs ranging from basic tangible needs to emotional, psychological, social or spiritual needs during the outbreak of major incident. Increasing variety of service is vital to address different needs of staff and to facilitate their early recovery after the major incident. Building supportive networks both within HA and with other organizations in the community can widen the scope of service available so as to address staff s and family members psychosocial or spiritual needs during the outbreak of major incident. 2. Key objectives 2.1 To identify appropriate community agencies and professional bodies and elicit their assistance in providing social service or counseling service to staff and relatives during the outbreak of major incident 2.2 To identify appropriate religious organization and elicit their assistance in providing spiritual support to staff and relatives 2.3 To assist staff and relatives in need to make use of the community or spiritual resources during the outbreak of major incident 3. Content of service 3.1 Oasis will establish networks with social service non-governmental organizations to provide counseling or social services to the staff in need and their family members. 3.2 Oasis will also establish new network and communication channels with various religious organizations to provide religious hotline service and other religious supportive service to the staff in need. 4. Access to Services Provided by Community Agencies and Religious Organizations Telephone hotline will be activated during the outbreak of major incident. Staff are welcomed to contact the hotline service of Oasis to get access to the services provided by community agencies and religious organizations. Please refer to Part B (II) (P.15) for details of the hotline service of Oasis. 10

11 B. Event Stage I. Critical Incident Stress Management Services (CISM) 1. Rationale Crisis intervention should be multi-component in nature. Recent recommendations for early intervention include the use of a variety of interventions matched to the needs of the situation and the recipient populations. Critical Incident Stress Management (CISM) is an integrative and multi-component crisis intervention system, spanning from the pre-crisis phase through the acute crisis phase, and into the post-crisis phase. It is a comprehensive crisis intervention programme which can be applied to individuals, small functional groups, large groups, families, organizations and even communities. Substantial body of literature has supported the efficacy of multi-componential intervention. Based on the CISM model, Oasis will provide a variety of crisis intervention to staff, departments/ hospitals in need of such services. 2. Key objectives 2.1 To stabilize the impacts of major incident 2.2 To reduce or ameliorate symptoms or distress 2.3 To facilitate staff to return to adaptive functioning 2.4 To refer staff to appropriate services, if needed. 3. Content of service 3.1 Core crisis interventions include: Pre-crisis planning and preparation Strategic planning Individual acute crisis intervention Small group crisis intervention a). Defusing b). Critical Incident Stress Debriefing Service (CISD) Large scale crisis intervention a). Demobilization (for rescue, disaster personnel) b). Crisis Management Briefing (CMB) Organizational consultation Mechanisms for follow-up and referrals 11

12 3.2 Details of the core crisis interventions are summarized below: Intervention Timing Activation Goal Format 1 Pre-crisis preparation Pre-crisis phase Crisis anticipation Set expectations Improve coping Groups/Units/ Departments 2 Strategic planning Immediately after crisis 3 Individual crisis intervention (1:1) Anytime, Anywhere 4 Defusing Post-crisis (within 12 hours) 5 Critical Incident Stress Debriefing (CISD) 6 Demobilization & staff consultation (rescuers) 7 Crisis Management Briefing (CMB) 8 Organizational consultation Post-crisis (1 to 10 days; 3-4 weeks for mass disasters) Shift disengagement Anytime Anytime Event driven Symptoms driven Usually symptoms driven Usually symptoms driven; can be event driven Event driven Event driven Stress management Assess service needs Psychological triage Set expectations Advise and plan suitable CISM services Symptoms mitigation Return to function, if possible Referral, if needed Symptoms mitigation, if possible Closure Triage Facilitate psychological closure Symptom mitigation Triage To inform and consult Allow psychological decompression Stress management Either Foster support & symptoms communications driven or Symptoms mitigation event driven Closure, if possible Referral, if needed Phone consultation/ Meeting Individuals Small groups Small groups Large groups/ organizations Organizations 9 Follow-up/Referral Anytime Usually symptoms driven Assess mental status Access higher level of care, if needed Individuals/ Family 4. Access to CISM Services 4.1 Oasis - Center for Personal Growth & Crisis Intervention Unit managers or supervisors may encounter various issues or concerns in specific staff or in their unit during the outbreak of major incident. Interventions or support services that are carefully utilized via a strategic plan can maximize the effectiveness of services provided. 12

13 4.1.2 Strategic planning is characterized by an assessment of the circumstances, the development of clear goals and objectives, the selection of the most skillful people to provide the services and the development of a plan of action. Interventions including a comprehensive strategic planning typically has the best chance of assisting individual through the crisis experience. Unit managers or supervisors are welcome to contact Oasis at to discuss their service need. 4.2 Critical Incident Support Team (CIST) For those clusters that have established Critical Incident Support Team (CIST), staff can also seek assistance from the CIST. Team members of CIST have received training in CISM. They will provide services including: Organizing pre-incident education Providing individual crisis intervention Assisting in small group/large group crisis intervention Referral service Oasis provides all the necessary clinical consultation and backup to CISTs and works with the coordinators of CISTs to assess the service needs of different units/departments after a critical incident. Please refer to Appendix 2 for the list of hospitals with CIST and other related information about individual CIST. 13

14 II. Hotline Service 1. Rationale Telephone hotline is a mean of offering immediate, easily accessible and ongoing emotional support, general information and referral services for all staff and their families who are in need of timely crisis intervention during the outbreak of a major incident. This is especially important if the critical incident is infectious in nature and human contact is discouraged. 2. Key objectives 2.1 To provide timely psychological and emotional support to all staff and their family members without the constraints of time and location 2.2 To provide information and referral service (e.g. counseling, psychological, social or religious services) 2.3 To provide a channel through which staff s and family members concerns and needs can be expressed 3. Content of service 3.1 A hotline will be activated after the outbreak of the major incident 3.2 Oasis will prepare operational guidelines of the hotline service before the major incident occur 3.3 Oasis will also help in recruiting trained volunteers such as nurses, social workers, chaplains, psychologist, or psychiatrists to provide the hotline service 3.4 Training programs will be offered to volunteers to equip them of the skills and knowledge in providing the hotline service. 4. Access to Hotline Service The number of hotline service of Oasis ( ) will be activated after the outbreak of major incident. 14

15 III. Psycho-spiritual Support 1. Rationale Major incident or crisis may challenge individual s core worldviews and even spiritual and religious foundations. There is increasing evidence showing the effectiveness of religion or spiritual faith in coping with trauma or crisis. Utilization of specially trained faith-orientated personnel in the provision of spiritual support during or after major incident is helpful for facilitating staff to adapt to major incident. 2. Key objectives 2.1 To provide timely individual spiritual consultation or support to staff in times of major incident 3. Content of service Religious Hotline Service Description: Please refer to Part A (IV): 3.2 (P.10). 15

16 IV. Services for Staff Directly Affected by the Major Incident 1. Rationale Staff who are directly affected by the major incident (e.g. infected/ hospitalized staff) may experience acute physical and psychological discomfort or even significant psychological distress during the major incident. Besides medical care, emotional and psychological support to the affected staff is important for alleviating their psychological discomfort and assisting them to go through the major incident. 2. Key objectives 2.1 To provide timely psychological and emotional support to the staff who are directly affected by the major incident 3. Content of service 3.1 Food for the Soul for Hospitalized Staff Food for the Soul includes: Psychotherapeutic/ educational materials on spiritual and psychological wellness For instance: "Observing the Torrent in Peace Booklet" (" 靜看急流 ") - To provide practical advice and tips to help infected staff and their relatives understand and cope with the negative emotions arising from the illness Audio psychotherapeutic materials a). Visualization Technique (" 意象自療技巧 ") - Relaxation and revitalization skills b). Stories for the Soul (" 心靈故事 ( 一 )") - Inspiring stories interleaved with soothing music Pamphlets of Oasis Service Information of community hotline service and Oasis hotline service 3.2 Psychological and Emotional Support Service to Hospitalized Staff Clinical psychologists of Oasis will collaborate with hospital clinical psychologists to provide individual psychological service to staff in need CIST members of different hospitals can provide care and emotional support to staff in need through various means available in different settings. 16

17 4. Arrangement of Services for Hospitalized Staff Food for the Soul will be distributed to hospitalized staff after the major incident through the caring teams of different hospitals. Responsible staff are welcome to contact Oasis at to discuss their needs and concerns. 17

18 V. Consultation Service for Managers and Supervisors 1. Rationale Individual staff or certain units/teams may encounter specific and immediate issues or concerns after the outbreak of major incident. Consultation service is crucial for enhancing managers or supervisors understanding to how to support their subordinates in major incident particularly those which involve mass casualties. Consultation on strategic planning and other psychological-related matters will therefore be offered to managers or supervisors to facilitate them to provide support to their subordinates effectively. 2. Key objectives 2.1 To provide consultation to managers or supervisors to facilitate them to provide appropriate support to their subordinates 3. Content of service 3.1 Psychological consultation will be offered through telephone or face-to-face contact. Areas for consultation may include: Psychological-related matter of specific staff Psychological-related issue in specific unit/team/ward 4. Contact Number of Clinical Psychologists of Oasis Unit managers or supervisors are welcomed to contact corporate clinical psychologists of Oasis at for psychological consultation service. Please refer to Appendix 3 for the list of corporate clinical psychologists of different clusters. 18

19 VI. Psychological wellness materials and messages of care for all staff Reach for our heart and soul 1. Rationale Major incident may undermine one s psychological well-being and one s perceived ability to cope with the crisis situation. To avoid stigmatization and to equip staff self-help coping strategies, provision of psycho-educational and psycho-therapeutic materials through different means is useful for facilitating staff to understand and cope with their emotions and reactions arising from the crisis. It is also important to provide a platform which can facilitate staff to nurture their heart and soul and to support each other in face of fear or uncertainty. 2. Key objectives 2.1 To introduce ways to handle fear, anxiety, worries and stresses 2.2 To introduce self-help strategies to cope with crisis situation 2.3 To introduce available psychosocial support service 2.4 To provide a channel through which staff can express mutual care and support and nurture their heart and soul 3. Content of service 3.1 E-resources - Webpage of Oasis ( Lighten up our heart ( 匯聚心燈 ) Objectives: To promulgate mutual support and care among staff members To strengthen psychological resilience of staff members by instilling positive messages Content: Words of encouragement and blessings sent in by both staff and the public Spring in Oasis ( 綠洲流泉 ) Objective: To nurture the psychological wellness of staff, especially those who are in social isolation and those who are convalescing at home or in staff quarters after work Content: Collections of positive quotes Touching short stories and articles Inspiring paintings, photos Book reviews Film commentaries 19

20 3.2 Printed materials and audio-visual materials Objective: To enhance staff s understanding to stress and crisis reaction To equip staff of self-help coping strategies in face of stress or crisis situation Content: Practical advice and tips on stress management and anxiety management Introduction of self-help coping skills in face of stress and crisis situation Introduction of available psychological and social support services 4. Access to psycho-educational and psycho-therapeutic materials Staff can obtain the E-resources materials through the webpage of Oasis ( Staff can obtain other psycho-educational and psychotherapeutic materials by completing the request form provided by Oasis. Request form can be downloaded from the webpage of Oasis ( or obtained by contacting Oasis at Remarks: The E-resources and other psychotherapeutic and psycho-educational materials will be updated according to the needs of staff members. All updated materials will be uploaded to the webpage of Oasis continuously. 20

21 VII. Specialized Training 1. Rationale Staff of certain departments or service teams (e.g. ICU, A&E unit) may encounter specific difficulties and issue during the outbreak of major incident. Maintenance of team cohesion and team spirit are crucial for providing them with strength and support to cope with the changes and difficulties arising from the major incident. Therefore, specialized training programs will be offered for those staff who are preparing to work or currently working in wards with high stress level during major incident. 2. Key objectives 2.1 To enhance staff s awareness of the impact of stress on their physical and mental health and the effectiveness of their coping styles 2.2 To facilitate staff to identify their service needs and to protect them from being overwhelmed by acute and cumulative stress 2.3 To enhance the inner strength of the staff and to assist them develop skills for self-revitalization and relaxation 2.4 To enhance team cohesion and team spirit 3. Content of service 3.1 A series of training programs and support group will be offered according to the service needs of staff of various department or unit. Trainings and support groups will include: Self-Coping Strategies in Face of Critical Incident Objectives: To enhance staff s awareness of the impact of stress on their physical and mental health and the effectiveness of their coping styles To facilitate staff to identify their service needs and to provide ways on how their service needs can be addressed To assist staff to develop effective coping strategies Facilitators: Service Target: Program format: Corporate Clinical Psychologists Staff in need Workshop Self-Revitalization and Relaxation Skill Training Objectives: To assist staff to develop skills for mind revitalization and relaxation skills Facilitators: Corporate Clinical Psychologists 21

22 Service Target: Program format: Staff in need Workshop Support Group Objectives: To provide an opportunity for staff to share their concerns and difficulties during the major incident To facilitate access to information and support service To facilitate staff to defuse the negative emotions associated with the major incident Facilitators: Service Target: Program format: Corporate Clinical Psychologists/Advisors of Oasis Staff in needed Group sharing Other Tailor-Made Training Programs Oasis can also tailor training programs to different units, departments or high-risk teams to meet the special needs of staff. Unit managers or supervisors are welcomed to contact Oasis at to discuss their service needs. 22

23 C. Post-Event Stage I. Post-Event Crisis Intervention Service 1. Rationale Major incident may generate significant psychological aftermaths in individuals which may turn into psychopathology if no timely or proper psychological care and attention is given. Therefore, provision of crisis intervention service after the major incident can help lessening the aftermaths of major incident and facilitating early recovery. 2. Key objectives 2.1 To lessen the impact of major incidents on staff 2.2 To accelerate normal recovery 2.3 To assess the service needs of staff and refer them to appropriate services, if needed 3. Content of service 3.1 Individual Crisis Intervention For details, please refer to B1 (3.2) (P.13) 3.2 Critical Incident Stress Debriefing (CISD) For details, please refer to B1(3.2) (P.13) 23

24 II. Therapeutic Groups 1. Rationale Mass causalities usually generate much distress and threaten one s coping ability. Therefore, helping one to work through their residual emotional reactions, restore their former functioning and acquire stress coping strategies early are vital for those who are affected by the major incident. Therapeutic groups focused on stress and trauma mitigation will be offered for staff who are infected/ injured during the major incident and for staff who have involved in the major incident to facilitate early recovery. 2. Key objectives 2.1 To facilitate staff to work through their emotions/inner concerns in response to the major incident 2.2 To facilitate early recovery of both injured and non-injured staff 2.3 To enhance staff s stress coping strategies and resilience to future crisis 3. Content of service 3.1 Psychotherapeutic Groups for Recovered Staff Objectives: To facilitate recovered staff to work through their residual emotional reactions To restore recovered staff s former functioning To strengthen recovered staff s stress coping strategies To facilitate growth experience after critical incident Facilitators: Service Target: Format: Corporate Clinical Psychologists Recovered staff Small group 3.2 Psychotherapeutic Groups for Staff Objectives: To facilitate staff to reflect their emotions/inner concerns in response to the critical incident To assist staff to learn ways to revitalize themselves To strengthen staff s ability in handling future crisis Facilitators: Service Target: Format: Corporate Clinical Psychologists Staff who are affected by major incident Small group 24

25 4. Remarks: For further information on previously developed therapeutic groups for SARS recovered staff and non-infected staff, please refer to Appendix 4. 25

26 III. Rebuilding Programs 1. Rationale Post-event is a time of appraising achievements and losses and repairing dints in morale. A series of rebuilding programs will be offered for staff members to facilitate them to feel continued support by other colleagues and their supervisor and to rebuild their inner strength. 2. Key objectives 2.1 To support staff to cope with the residual effects of the major incident 2.2 To review staff s experiences during the incident 2.3 To reframe staff s experiences and foster their inner strengths to thrive future challenges in their personal and work life 3. Content of service 3.1 Nurturing Our Heart Retreat Camp for Healthcare Worker Objectives: To facilitate the care-taking process of the body, mind and spirit To work through inner difficulties and vulnerabilities To regain inner strength To learn ways to cope with future critical incident Facilitators: Service Target: Format: Corporate Clinical Psychologists, /Experienced spiritual counselors 1). Managers and supervisors 2). Frontline clinical staff 3). Frontline supporting staff Day or overnight camp 3.2 Psycho-Spiritual Talks Objectives: To facilitate staff to transform negative feelings and to regain strength after crisis To enhance staff s inner strength to cope with stress or difficulties in future Facilitators: Advisors of Oasis, Experienced Counselors or Professionals Service Target: All HA staff 26

27 Format: Talk 3.3 Training Programs on Rebuilding Resilience for First Respondents Objective: To facilitate staff to review their experience during the major incident and to strengthen their ability to thrive future challenges in personal and work life Content: Ways to transform negative feelings Ways to rebuild inner resilience after crisis Facilitators: Service Target: Format: Corporate Clinical Psychologists 1). Managers and supervisors 2). Frontline clinical staff 3). Frontline supporting staff Workshop 27

28 IV. Reintegrating Service for Recovered Staff 1. Rationale Helping recovered staff to return to daily work is important to the healing/recovery process. It also reduces the chance of long- term disability and minimizes the associated financial and human costs 2. Key objectives 2.1 To facilitate recovered staff to return to work after recovery 2.2 To facilitate recovered staff s job and interpersonal adjustment after returning to work 2.3 To increase co-workers awareness of the needs and difficulties encountered by the recovered staff during the rehabilitation process. 2.4 To facilitate other colleagues and managers to provide support to recovered staff 3. Content of service Content: Psychological needs and difficulties of recovered staff and appropriate ways of coping Ways to provide psychological support to recovered staff Facilitators: Service Target: Format: Corporate Clinical Psychologists 1). Recovered staff 2). Co-workers 3). Managers/supervisors Training Workshop 28

29 D. Implementation Mechanism 1. Rationale Major incident may affect a large number of staff. However, each staff s needs and concerns are unique. In order to meet the unique needs of individual staff, their family members and the special group affected by the major incident and to provide timely and effective response, it is desirable to establish mechanisms or organizational frameworks ready to facilitate the coordination of the response to a wide spectrum of practical, medical, social, emotional and psychological needs of staff and family members throughout different stages of the major incident. 2. Key objectives 2.1 To introduce the contingency plan of major incident to unit mangers or supervisors 2.2 To introduce the services delineated in the contingency plan to staff and unit heads 2.3 To identify the service needs of staff and family members at different stages of the major incident 2.4 To implement the contingency plan through different channels of communication and networks in individual hospital 2.5 To facilitate the coordination of an effective response throughout different stages of the major incident 3. Content of service 3.1 It is suggested that a working group can be established in each hospital or cluster to perform the above-listed objectives The Working Group of each hospital or cluster is suggested to include representatives from: Management (e.g. DOM/WM) Frontline clinical staff (e.g. doctors, nurses) Allied health (e.g. medical social workers) Religious groups Caring groups CIST Administrative unit (e.g. SHM, HRM) Corporate clinical psychologists from Oasis 3.2 Functions of the Working Group : The Working Group will help to plan and implement the following tasks during the pre-event phrase: (a) Explore and develop effective ways/communication channels in each hospital through which information (e.g. psycho-educational materials) can be disseminated to the staff 29

30 (b) (c) (d) (e) (f) (g) members Help coordinate information exchange after the communication channels have been identified Identify and establish the roles and responsibilities of each representatives during different phrases of the major incident (e.g. pre-event phrase, event phrase, post-event phrase) Arrange and organize promotion briefing about the psychological service contingency plan to all staff members of each hospital Coordinate the training activities provided for staff members of each hospital (e.g. psychological first aid training) Provide the necessary resources to the team Corporate clinical psychologist of Oasis will provide all professional support and consultation to the team The Working Group will help to plan and implement the following tasks during the event phrase: (a) Monitor and coordinate the information exchange (e.g. the delivery of the psycho-educational materials) to staff members of each hospital (b) Keep update information of the impacts of the major incident on staff members and update the team members of the progress (c) Arrange and coordinate appropriate services for staff members and their family members when needed (e.g. making referral, applying for religious support service) (d) Provide the necessary resources to the team (e) Corporate clinical psychologist will provide psychological service, individual and group crisis intervention to staff in need. They will also work closely with the team members and provide ongoing consultation to the team members The Working Group will help to plan and implement the following tasks during the post-event phrase: (a) Continue service in the Event phrase (b) Arrange and coordinate appropriate services to promote healing in respective hospital (c) Corporate clinical psychologist will continue providing psychological service and ongoing consultation to the team members 30

31 (d) Evaluate the contingency plan 3.3. Proposed selection criteria of working group representatives: Have good understanding of the culture and service needs of staff members of their hospitals 31

32 Appendix 1 Pre-incident Educational Information and Materials Previously developed educational information and materials: For SARS Infected Staff and Relatives: 1. " 靜看急流 " ("Observing the Torrent in Peace Booklet") Content: To provide practical advice and tips to help infected staff and their relatives understand and cope with the negative emotions arising from the illness For Emergency Workers/Professional Bodies and the Public: 1. " 危機自助法 " ("Self-Coping Strategies in Face of Crisis Booklet") Content: To provide education on stress and crisis response To introduce effective ways to cope with crisis To introduce available psychological support services 2. " Food for the Soul" Content: a. " 意象自療技巧 " (Visualization techniques) - Relaxation and revitalization skills b. " 心靈故事 ( 一 )" (Stories for the Soul ) (for Adult) - Inspiring stories interleaved with soothing music c. " 心靈故事 ( 二 )" (Stories for the Soul ) (for Children and Family) - Inspiring stories for children 3. 逆旅中的蛻變 VCD (Audio psychotherapeutic materials) - Inspiring sharing of SARS recovered staff and staff who have worked in SARS ward 32

33 Appendix 1(cont) For Disaster / Trauma Victims: 1. " 天有不測之風雲 " ("You Can Never Tell") Content: Disaster/ trauma can have a varying degree of psychological impact on the survivors. As the event is so sudden and outside the normal experiences of most people, it is common for the survivors to exhibit a number of reactions. The pamphlet introduces the reader to the common reactions of adult disaster/ trauma victims. There are a number of approaches that survivors can adopt to assist their recovery. 2. " 天有不測之風雲 -- 孩子的世界 " ("Accidents Will Happen -- In The Children s World") Content: Not only adults, children are also vulnerable to disaster/ trauma. Children of different ages exhibit different reactions after trauma. The booklet lists out psychological reactions of preschool children, school age children and adolescents after experiencing a traumatic event. It also offers suggestions for adults how to help children victims. For Bereaved Relatives: 1. " 造物弄人 " ("In Distress") Content: There is no easy way to face the death of the beloved, especially when the death is sudden. The pamphlet helps the bereaved to recognize their normal grief reactions and identify ways to work through their grief. 2. " 孩子的哀傷 " ("The Anguish of Children") Content: Adults always find it difficult to talk about death with children or they may be too protective of grieving children. The pamphlet highlights the possible grief reactions of children and how the adults can help children dealing with his/her grief. 3. " 又見笑臉 " ("Smiles Again") 33

34 Appendix 1(cont) Content: Children should not be excluded from the grieving process. It is important to help them to understand the death of a loved one. The pamphlet is especially written for children. As the message is illustrated by cartoons and simple words, even young children can read it. Common grief reactions of children are listed and ways to cope with their grief reactions are offered. For Emergency Workers: 1. " 助人以外 " Content: Not only the victims and their bereaved relatives, staff helping these people may also experience post trauma or grief reactions after the disaster/trauma. The booklet introduces the common critical incident stress symptoms and warning signals of posttraumatic stress. Recommendations for staff/supervisors on effective stress management before, during and after an operation are included. 2. 以心療心 -- 哀傷支援服務 Content: Immense emotions used to be aroused when a person has to face the sudden death of his/her beloved. Appropriate support from the health care professionals involved can have very positive impact in facilitating the whole grief process. Practical guidelines on supporting the bereaved are described in the pamphlet. 34

35 Appendix 2 Contact Number and Contact Persons of Critical Incident Support Team (CIST) of Different Hospitals: 緊急事故支援小組友心人 聯網醫院聯絡專員聯絡電話 HKE 東區尤德夫人那打素醫院 陳玉兒小姐 (Ms Anne Chan) 聽語 律敦治醫院鄧肇堅醫院 郭慧嫻小姐 (Ms Kwok Wai Han) 心聆之友 KWC 瑪嘉烈醫院 陳貴芳小姐 (Ms Pamela Chan) 同路人 廣華醫院東華三院黃大仙醫院 劉洪漪小姐 (Ms Liu Hung-yee) 網址 : 心聆夥伴 聖母醫院明愛醫院 Ms Florena Yau - 同仁共濟 仁濟醫院 Ms Grace Wan - 聆心薈 KEC 靈實醫院 朱懿芬小姐 (Ms Josephine Chu) 支心友 NTW 青山醫院博愛醫院小欖醫院屯門醫院 何鈺瑩小姐 (Ms Maicy Ho) 陽光行動 NTE 雅麗氏何妙齡那打素醫院大埔醫院 談德榮先生 (Mr Victor Tam) 緊急事故支援小組 威爾斯親王醫院 何沛儀小姐 (Ms Becky Ho) 晴心苗圃 沙田醫院沙田慈氏護養院白普理寧養中心 ' 張少瑛小姐 (Ms Christine Cheung)

36 Appendix 3 List of Corporate Clinical Psychologists of Different Cluster: Cluster Name of Clinical Psychologist Telephone Number HKE HKW KCC KEC KWC NTEC NTWC Miss Wacy Lui Mr Daniel Ngan Miss Christine Mak Miss Yon Ip Miss Patricia Chan or

37 Appendix 4 Previously Organized Therapeutic Groups during the Outbreak of SARS: 1 Therapeutic Groups for SARS Recovered Staff - Positive Growth After Crisis Objectives: To help recovered staff to work through residual emotional reactions To assist recovered staff to restore their former functioning and acquire stress coping strategies To facilitate growth experience and mutual support among recovered staff Facilitators: Service Target: Format: Corporate clinical psychologists SARS recovered staff Small group training workshop 2. Therapeutic Group for Non-Infected Staff - Handling Your Emotions after SARS Objectives: To review and reflect upon personal experience during SARS To facilitate expression of emotions associated with the SARS experience To identify approaches to manage SARS-related emotions Facilitators: Corporate clinical psychologists, lecturer of Nursing Department (University of Polytechnic), Nurse specialist Service Target: Format: Frontline clinical staff who have worked for SARS patients Small group training workshop 37