Corporate. Supporting Staff following Critical Incidents Policy. Document Control Summary

Corporate Supporting Staff following Critical Incidents Policy Document Control Summary Status: Replacement Version: V2.0 Date: 18 th January 2017 Author/Title: Owner/Title: Gary Firkins De-escalation Management & Intervention Service Lead Liz Lockett - Associate Director of Quality & Risk Approved by: Policy and Procedures Committee Date: 23 March 2017 Ratified: Trust Board Date: 30 March 2017 Related Trust Strategy and/or Strategic Aims Value We Value our Staff Provide high quality recovery focused services. r Adherence to regulatory, financial, performance and quality standards Implementation Date: March 2017 Review Date: December 2019 Key Words: Associated Policy or Standard Operating Procedures Staff, Support, Stress, PTSD, adverse Management of Adverse Events, Serious Incidents and Near Misses Security Management Policy Health & Safety Policy Incident, Near Miss and Serious Incident Policy Page 1 of 15

Content 1.0 Introduction 1.1 Background 1.2 Rationale 1.3 Scope 1.4 Policy Outline 1.5 Definitions of Critical Incidents 2.0 Roles and Responsibilities 2.1 Chief Executive / Trust Board 2.2 Team Prevent Occupational Health Services 2.3 Managers / Heads of Department / Team Leaders / Supervisors 2.4 Trust Employees 3.0 Guidelines and Directions for Staff Support 3.1 Recognition of Potential Barriers to Support 3.2 Requests for Support Service Provision 3.3 Levels of Staff Support Provision (Informal / Formal) 3.4 Competencies 3.5 Serious Incident Investigation 3.6 Human Rights 4.0 Policy Monitoring & Review 4.1 Confidentiality and Record Keeping 4.2 Audit and Evaluation 4.3 Key Performance Indicators 5.0 Consultation 6.0 Dissemination/Implementation 7.0 The other bodies and agencies to be considered. 8.0 Monitoring Compliance 9.0 Related Policy & Procedure 10.0 References & Acknowledgments Appendix 1: Post Incident Support Form Appendix 2: IMPACT OF EVENT SCALE-REVISED 1.0 Introduction 1.1 Background Page 2 of 15

South Staffordshire and Shropshire Healthcare NHS Foundation Trust was subject to an inspection by the Health and Safety Executive (HSE) in March 2008 and following this inspection a number of recommendations were made by the HSE to ensure that the Trust continued to adopt best practice in relation to Health and Safety issues. One of the recommendations made by the HSE related to ensuring that the Trust formulated a formal Post Incident Support Policy and that clear guidance was given on how the Policy should be adopted across the organisation to ensure that a consistent support facility can be afforded to Trust staff. Information contained in this Policy outlines the structure required, specific directions and guidance on issues related to staff support and the roles and responsibilities of nominated persons to ensure that the Policy is effectively implemented. 1.2 Rationale The purpose of this policy is to ensure that the Trust continue to be supportive to all staff who have been involved (directly or indirectly) in an adverse/critical incident (see paragraph 1.5 below for definition) within the workplace and to reduce, where possible and practicable, the impact of a critical incident on the individual s psychological, physical, spiritual and social health. The primary aim of the policy is to provide care and support to Trust staff that have been exposed to incidents that have the potential to have an ongoing impact upon the health and well-being of the individual(s) concerned. 1.3 Scope This Policy applies to all staff employed by the Trust, either directly or as part of a contracted service, whether they are substantive or temporary support staff, (Bank or agency). All staff have a core responsibility to ensure that Trust wide and local support procedures are observed at all times. Do we need to include anything around the incident needing to of happened/taken place in the workplace? 1.4 Policy Outline This policy is in a number of sections as follows; Definitions of a critical incident Outlining procedures to ensure that support and assistance is afforded to members of staff following a critical incident. Outlining the other main bodies or agencies which should be considered in the aftermath of a critical incident. Outlining the Trust and Directorate Policies and practices which should be referred to as part of the post incident supporting process. 1.5 Definitions of a Critical Incident A critical incident is "any event or circumstance arising during NHS care that could have or did lead to unintended or unexpected harm, loss or damage" (NPSA, 2001). Page 3 of 15

A critical incident can also be defined as any incident which produces a high emotional reaction that may be immediate or delayed. As a result of such an incident an individual s coping mechanisms may be overwhelmed and their ability to function may be diminished either immediately or later. A critical incident is one which causes a person to pause and contemplate the events that have occurred to try to give them some meaning. This may be a positive experience or a negative one. Using a critical incident as a way of reflecting involves the identification of behaviour deemed to have been particularly helpful or unhelpful in a given situation, (Hannigan, 2001). Examples of critical incidents may include; Serious injury or death of client or colleague Serious injury caused by a member of our client group (including a member of the public) Sexual assault or abuse Physical or non-physical assault Situation involving firearms or other weapons Robbery Major incident or natural disaster Hostage taking Situation which causes high publicity Please note that this list is not exhaustive. 2.0 Roles and Responsibilities 2.1 Chief Executive / Trust Board The Chief Executive and the Trust Board have overall responsibility and accountability for the implementation of all aspects of this Policy and to ensure that the organisational commitment to staff support is fully met and monitored. The Board recognises that a successful healthcare organisation ensures that its expertise in service provision is translated into all aspects of its work and that effective staff support procedures are an integral part of effective working practice. 2.2 Team Prevent Occupational Health Service Team Prevent shall provide an assessment of each individual employees needs, this can either be through a management referral following agreement or a self referral from the employee. They will provide and recommend specific care as required. It shall be the function of Team Prevent to maintain a data base of all staff that are being supported following an incident to ensure that follow up and further support is implemented. This will include the monitoring of Health & Safety issues. Team Prevent will also retain copies of completed Impact of Events Scale - Revised (IES-R) questionnaires. The data base will also include where staff have been offered support and have declined. 2.3 Managers / Heads of Department / Service Leads Page 4 of 15

Each above named staff member is responsible for leading on and promoting safe working practices. In particular they will be responsible for: - Ensuring their own level of competence, when required to support others Ensuring each adverse/critical incident is reported. Ensuring that they and their staff are trained so that they are familiar with the content of this Policy and associated procedures. Implementing effective measures to ensure that safe working practices are promoted and undertaking post incident review to identify where formal/informal support procedures should be implemented. Undertaking risk assessments of their areas of responsibility and acting to remove/reduce (as far as is reasonably practicable) any identified risks related to health & safety. Maintaining a record of all informal diffusion and Post incident support sessions. 2.4 Trust Employees Employees of the Trust must ensure that they comply with the legal duties placed on them under the Health & Safety at Work Act 1974 and other related law and legislation. This includes ensuring that they co-operate with the Trust as an employer with regards to measures put in place to safeguard the health & safety and well being of themselves and others. This will include the following; Abiding to all Trust Policy and local procedures. Not compromising health and safety by their actions. Ensuring that all adverse/critical incidents are reported. Advising their line manager / supervisor / team leader on any occasion where their health or well being has been unduly compromised due to an adverse/critical incident. Staff may want to discuss their feelings with their trade union representatives 3.0 Operational Guidelines and Directions for Staff Support 3.1 Recognition of Potential Barriers to Support A critical incident may be a particularly upsetting experience for those involved, either directly or indirectly, and appropriate post incident help and support should always be considered for all staff involved in such an incident. Immediate and follow up support for individuals from within the Trust and from other sources needs to be considered as a valuable option for the organisation (including relatives and carers). However research into the issues relating to Critical Incident Post incident supporting (CID) and Post Traumatic Stress Disorder (PTSD) have unclear conclusions (Robbins 2003), and therefore it needs to be recognised that Critical Incident post incident support should not be deemed to be mandatory but a valuable tool for the Trust to have at their disposal. Page 5 of 15

It also needs to be considered what constitutes a critical incident is also a perception and that it depends on the perception of the individual s vulnerability at the time of the incident. This needs to be considered when any form of post incident supporting occurs. 3.2 Requests for Support Service Provision Following the reporting of an adverse/critical incident, it shall be the responsibility of line managers, team leaders or service leads to identify if an individual staff member requires specialist support and what level of support is required. The line manager, team leader or service lead has a responsibility to provide the staff member with the options available to them for support, as listed in Section 3.3 of this Policy Levels 1, 2 and 3. Where it has been identified that Levels 1-2 are appropriate then local arrangements should be implemented to provide staff with the relevant support service. 3.3 Levels of Staff Support Provision (Informal/Formal) It should be recognised that positive post incident supporting can be achieved in a number of ways and to ensure that best practice is maintained, staff should be given the opportunity to choose what level of support would be of most benefit to them, dependant on the severity of the critical/adverse incident they were involved in or exposed to. The level of response will be dependant upon the incident, the individuals involved and the consequences of the incident. Managers should support and offer guidance to staff in the appropriate level of support that is available to individuals The aim of support is to provide a framework to reduce the isolation of staff or other individuals, and where appropriate to reinforce team spirit. Post incident supporting is about ventilation of feelings, the aim to reduce dysfunctional reactions or health consequences over time. Any incident which scores 3 or above on the severity scale of the adverse event reporting scale (Refer to Adverse Event Reporting Policy) should be referred by the appropriate clinician and/or healthcare professional to a Level 1 response as highlighted in this Policy. To ensure that clarity of options is maintained this Policy shall outline the different types of support that should be made available to all staff following a critical/adverse incident, as listed below as Levels 1, 2 and 3. Level 1 Appropriate Time scale 3-7 days As an organisation specialising in Mental Health, with staff who are relevantly qualified as Mental Health practitioners in the main, it is recognised that there are many staff will have the required competency and skills to be able to provide support to colleagues following an incident. A staff support session should be held at local level (i.e. within the Ward area) between all those staff, clinical or non-clinical, involved in a critical/adverse Page 6 of 15

incident. This type of support should usually be facilitated by a Ward Manager, Team Leader or nominated Healthcare Professional, who meet the GEN 42 criteria for competencies to facilitate Post Incident Support. The support should take place as soon as is reasonably practicable following the incident occurring and should allow all those involved in the process to be able to vent their feelings and discuss the events as a group, or on a 1:1 basis, in an open and non-judgmental environment. All staff should be aware that following a critical incident there will be a period of time where staff may well experience a range of emotions and consequent changes in behaviour. Staff must be reassured that this is a normal reaction to what maybe an abnormal incident and that most people start on a process of self repair. This period of time may well start up to and including approximately 72 hours. The member of staff facilitating the support meeting must fill in the Trust Post Incident Support Form (Appendix 1) Level 2 Appropriate Timescale 1-4 weeks A line manager should pay attention to the behaviour and well being of all staff following a critical incident and if concerned may make a referral to Occupational Health at any time. Where a manager has concerns and feels a follow up meeting is required or would be beneficial the line manager can request support from a suitable/competent practitioner e.g. Senior Nurse, Ward Manager, Psychologist, DMI Service Lead, Security Management lead to carry out a post incident review meeting. The Line manager should not be facilitating this meeting, especially if they were involved or witnessed the incident.this should involve all staff members affected by the incident, and allow all involved to consider how they are feeling about and coping with the after effects and to consider whether additional support may be helpful. In line with current practice and research the follow up meeting would normally happen three to four weeks following the incident. This can be bought forward if assessed as being necessary; however evidence (Robbins, 2003) suggests that the follow up meeting should not take place within seven days of the incident. The practitioner/s facilitating the review meeting will administer an Impact of Events Scale - Revised (IES-R) tool 9 (Appendix 2) to be completed by all involved, and ensure this is returned to the Team Prevent Health & Well Being Service at sssft@teamprevent.co.uk. This form must not be completed until seven days have elapsed from the event. Any individual scoring above 33 on the IES-R tool will also be referred to Team Prevent and offered additional support. One copy goes to the ward/team manager. Team manager to next line manager findings considered and actions agreed; All completed IES-R tools to be filed in occupational health records. The member of staff facilitating the support meeting must fill in the Trust Post Incident Support Form. Level 3 Appropriate Timescale 4 weeks to Ongoing Page 7 of 15

Where more formal support is required (i.e. score of 33 on IESR self rating form) the manager should refer the individual to the Team Prevent Health and Well Being Service (H&WBS). Following receipt of the referral the individual will be triaged and an appropriate course of intervention will be put in place for example: Counselling Psychological Interventions Physiotherapy Nursing support Access to the Listening Ear Service 3.4 Competencies The competencies of the member of staff carrying out the support should include the following: 1. How to highlight team member s abilities and experiences in a positive way 2. Methods of counselling and interpretive skills 3. How to obtain full and accurate information about team members 4. How to separate psychological support from other aspects of a relationship with a colleague 5. How to approach others problems without intruding ones own 6. How to maintain a support stance that is not judgmental 7. How to reduce people s dependence on your support 8. Methods of interviewing 9. Models of psychological functioning and need 10. Work relationship issues, and how to identify them 11. How to balance needs of others while prioritising the patients needs and wishes 12. Methods of dealing with conflict 13. How to respect others privacy, dignity, wishes and beliefs, and do so 14. Principles of confidentiality, disclosure and recording of information (e.g. What should/should not be recorded, how to agree the boundaries of confidentiality without ambiguity) 15. Methods of helping other members of the multi-disciplinary team to develop skills of psychological support 16. Evidence of team member s emotional and psychological responses to long term patients and the care they need 17. Evidence of successful approaches to providing psychological support 18. History of pressures occurring in the workplace 19. The communication skills required in complicated and sensitive situations 20. The importance of providing team members with opportunities to ask questions and increase their understanding 21. The importance of treating people fairly, and how to do so 22. The effects of culture, religious beliefs, age and disability on individual Communication styles Performance Criteria; Managers must be able to do the following: Page 8 of 15

1. Agree your own role, responsibilities, accountability and scope of practice in discussing the distress experienced by the team member(s) 2. Agree a contract for the support, including frequency, duration and boundaries of confidentiality 3. Identify if there is a preference, or a need, for issues to be discussed with someone external to the team 4. Encourage the team member(s) to articulate their perceptions and feelings by active listening and creating enough time and privacy 5. Offer no judgment on the feelings expressed 6. Offer evidence and examples to help the team member(s) normalise their response to the situation 7. Offer explanation to help the team member(s) recognise and understand what they are experiencing and what they may experience in future 8. Identify models, evidence, strategies and techniques that are applicable to the team member s work with patients 9. Encourage the team member(s) to explore the range of actions they could take, and to identify the advantages and disadvantages of those actions in improving their feelings regarding their work 10. Encourage the team member(s) to consider when they should draw back or engage more closely with the source of distress 11. Agree the next stages in the provision of psychological support and the actions to be taken. (Skills for Health, GEN42 Provide psychological support for team members) 3.5 Serious Incident Investigation During an investigation into a serious incident or near miss, it would be expected that if the investigating officer observed a member of staff experiencing changes in their behaviour or reporting psychological trauma, that this would be reported to the appropriate line manager. The Trust will then ensure that it liaises immediately with Team Prevent when a serious critical incident occurs to ensure timely intervention. 3.6 Human Rights Whilst providing this service the Trust needs to make reference to the Human Rights Act. Specifically Article 3, which gives all staff and patients an absolute right not to be treated in an inhumane, degrading or torturous way. Any post incident support provided by the organisation must ensure that the trust observes this 4.0 Policy Monitoring and Review 4.1 Confidentiality and Record Keeping The IESR Scale will be made available to Team Prevent subject to the consent of the member of staff being referred. E-mail address for Team Prevent is sssft@teamprevent.co.uk The Post Incident Support records are strictly confidential and are not noted in any personal or personnel files. Page 9 of 15

Notes are only made to aid the post incident supporter s memory. All records are maintained within the Trust policy on record keeping and with the highest standard of confidentiality and record keeping. The purpose of records is to monitor service uptake and for evaluation and identification of common themes of occupational stress. Information about individual staff is not available to other managers not involved in the Post Incident Support. Prior negotiation with both parties may be requested to discuss parameters of any feedback to management that is seen as essential. With prior agreement of the member of staff, liaison work may be undertaken on their behalf and may include communication with union representatives, GP s and Occupational Health. Any concerns or complaints about their service can be raised in the first instance with Occupational Health or the member of staffs Line Manager. 4.2 Audit and Evaluation An annual report will be made available to the Trust Health & Safety Committee, via Team Prevent to the Trust summarising number of attendances, types and lengths of interventions offered. Qualitative information will also be available about the themes or trends of problem areas, highlighting any specific area where remedial action by the Trust could prevent future problems. No information will be supplied that would compromise confidentiality. 4.3 Key Performance Indicators Evidence of action taken in response to themes identified by Team Prevent and the Risk Management team. Reduction in the number of staff taking sick leave as a result of traumatic / stressful incidents, complaints or claims. Number of Serious Incidents (SI s) reported where staff required formal support. 5.0 Consultation This policy was developed in consultation with key stakeholders: a) Learning and Development Team members. b) Team Prevent. c) Staff Representatives d) Members of the Workforce & Development Directorate e.) Workforce & Development Committee f.) Members of JSP Page 10 of 15

6.0 Dissemination/Implementation The policy will be available to all staff on the Trust intranet/website and in paper format for those without intranet access. 7.0 The other bodies and agencies to be considered. As well as appropriately trained professionals from within the Trust other parties and agencies can be considered. Individual s General practitioner or practice nurse/counsellor. Occupational Health & Wellbeing Service who can arrange staff counselling from within or outside the Trust Voluntary sector services.e.g. Victim support Chaplaincy Services It should also be noted that in many instances the police and ambulance departments are very supportive in incidents where they are directly or indirectly involved. 8.0 Monitoring Compliance In order to ensure compliance with the document, the following monitoring will be undertaken: Aspect of compliance or effectiveness being monitored Monitoring method Individual or department responsible for the monitoring Frequency of the monitoring activity Group / committee/ forum which will receive the findings /monitoring report Committee / individual responsible for ensuring that the actions are completed NHSLA Standard 3.9 Supporting staff involved in an incident, complaint or claim. includes: All Organisations must have an approved documented process for making sure that all staff involved in traumatic or stressful incidents, complaints or claims are adequately supported. Immediate support is offered to staff Team Prevent Annually Ongoing support is offered to staff Review of records held Review of records held Team Prevent Annually Health and Safety Committee Health and Safety Committee Health and Safety Committee Health and Safety Committee 9.0 Related Policies and Procedure. Please refer to the following policies Management of Adverse Events, Serious Incidents and Near Misses Security Management Policy Health & Safety Policy Incident, Near Miss and Serious Incident Policy Page 11 of 15

References A document Help is at Hand is available from Department of Health website www.doh.gov.uk British Association of Counselling & Psychotherapy (2002) Ethical Framework for Good Practice in Counselling & Psychotherapy Leicestershire: British Association of Counselling & Psychotherapy. Available: http://www.bacp.co.uk/admin/structure/files/pdf/ethical_framework_web.pdf Creamer, Bell & Failla (2003) Behaviour Research & Therapy, 41(12) (December): 1489-96 GEN42 Provide psychological support for team members Final version approved June 2010 copyright Skills for Health Department of Health (2000) Provision of Counselling Services for Staff within the NHS London: Department of Health. Available http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyand Guidance/DH_4007087 Department of Health (2001) Effective Management of Occupational Health & Safety Services within the NHS London: Department of Health. Available: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyand Guidance/DH_4009674 Health and Safety Executive (1974). Health and Safety at Work Act United Kingdom Available: http://www.hse.gov.uk/legislation/hswa.htm Human Rights Act 1998 http://www.opsi.gov.uk/acts/acts1998/ukpga_19980042_en_5 Robbins SP (2003) The rush to counsel Lessons of caution in the aftermath of disaster http;//www.srobbins.com/cv/rushtocounsel.html Page 12 of 15

Appendix 1 Post Incident Support Form To be completed by senior manager following a Critical or Serious Incident (notification of suicide, homicide, Vulnerable Adult or Safeguarding children) or near misses if deemed by the team to be of value Team and location of Post Incident Support Staff present Names of staff that have declined Post Incident Support Meeting led by Issues discussed Page 13 of 15

Immediate actions if needed following incident (pending report) Actions needed following meeting (i.e. Occupational Health/further Post Incident Support session) Requests for further information /support /action Date Page 14 of 15

IMPACT OF EVENT SCALE-REVISED Appendix 2 Instructions: The following is a list of difficulties people sometimes have after stressful life events. Please read each item, and then indicate how distressing each difficulty has been for you during the past 7 days with respect to the incident in question. How much were you distressed or bothered by these difficulties? Not at all A little bit Mod erate -ly Quite a bit I1 Any reminder brought back feelings about it. 0 1 2 3 4 I2 I had trouble staying asleep. 0 1 2 3 4 I3 Other things kept making me think about it. 0 1 2 3 4 H4 I felt irritable and angry. 0 1 2 3 4 Extreme -ly A5 I avoided letting myself get upset when I thought about it or was reminded of it. 0 1 2 3 4 I6 I thought about it when I didn t mean to. 0 1 2 3 4 A7 I felt as if it hadn t happened or wasn t real. 0 1 2 3 4 A8 I stayed away from reminders about it. 0 1 2 3 4 I9 Pictures about it popped into my mind. 0 1 2 3 4 H10 I was jumpy and easily startled. 0 1 2 3 4 A11 I tried not to think about it. 0 1 2 3 4 A12 I was aware that I still had a lot of feelings about it, but I didn t deal with them. 0 1 2 3 4 A13 My feelings about it were kind of numb. 0 1 2 3 4 I14 I found myself acting or feeling like I was back at that time. 0 1 2 3 4 H15 I had trouble falling asleep. 0 1 2 3 4 I16 I had waves of strong feelings about it. 0 1 2 3 4 A17 I tried to remove it from my memory. 0 1 2 3 4 H18 I had trouble concentrating. 0 1 2 3 4 H19 Reminders of it caused me to have physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart. 0 1 2 3 4 I20 I had dreams about it. 0 1 2 3 4 H21 I felt watchful and on guard. 0 1 2 3 4 A22 I tried not to talk about it. 0 1 2 3 4 Creamer, Bell & Failla (2003) Behaviour Research & Therapy, 41(12) (December): 1489-96 Page 15 of 15