International Society for Traumatic Stress Studies

Outcome of Workplace Interventions Evaluated in Long-Term, Large-Scale Study

Posted 1 October 2001 in StressPoints by Stephen Flamer, British Columbia, Canada

A three-year project evaluating the impact of workplace critical incident intervention (CII) services is now being conducted by the Workers' Compensation Board (WCB) of British Columbia, Canada. As part of its mandate to provide "no fault" preventive treatment and rehabilitation services to workers in 450,000 provincial work sites, the WCB has been coordinating CII services delivered by qualified external third-party providers following a critical incident in the workplace. At the end of the second year of the project's evaluation phase, more than 400 interventions involving approximately 1,900 workers have been arranged.

The main evaluation questions relate to the efficacy of workplace interventions, mainly critical incident stress debriefing (CISD) to prevent or attenuate workplace-induced trauma symptoms-posttraumatic stress disorder (PTSD) in particular.

There has been debate as to whether CISD, or more generally, critical incident stress management, can prevent or attenuate the symptoms of PTSD or related trauma symptoms-and if so, under what conditions. For example, perceived effects of CISD have ranged from having a positive and preventive impact, having no impact and having harmful or deleterious effects, therefore meriting discontinuation (e.g., Mitchell and Everly, 1995; Carlier et al., 1998; Rose & Bisson, 1998).

The results of this project should contribute valuable data that speaks to this debate, which has shifted to the perception of the need for evidence-based practice (e.g., Bisson, 1997; Avery et al., 1999), and the need to develop a spectrum of workplace intervention services.

In addition to focusing on the worker, this project will provide information about the perceived impact of CII on organizational and workplace variables, a topic about which relatively little is known.

Brief Overview
For a three-year period, within a sequential-longitudinal design with an epidemiological focus, workers who receive voluntary debriefing and related interventions are asked initially to provide feedback via questionnaire about the impact of the intervention. Items tracked per workplace incident: the number of workers referred for additional individual counseling services; the number of such hours used per worker; whether a formal compensation claim is filed; treatment costs; return-to-work outcomes; and psychological diagnoses. Time away from work, treatment costs and job outcomes among workers who received the intervention services, those who did not, and those who established WCB claims will be evaluated. This information will be compared with available WCB claims information from past years where no CII services followed a critical workplace incident.

In addition, each "affected employer" is asked three months after the incident to rate the perceived value and organizational impact of the intervention, allowing for cross-referencing of worker and employer information per incident.

The following major questions are of interest in the study:
How are workplace interventions perceived by debriefing participants?

Following CII, what proportion of workers require individual follow-up sessions? How many establish a formal WCB claim? How many claims for PTSD or related diagnoses are filed? How does this compare to situations where there has been no intervention?

Following CII and/or individual intervention, what proportion of workers return to same job, or modified or different jobs? What is the cost benefit of offering CII services, in terms of both clinical and monetary outcome?

What is the impact of a critical incident and CISD on the affected organization? What perceptions do employers have? What, if any, follow-up organizational or safety practices and procedures take place?

What "best practices" can be recommended following a review of the impact of CII on workers and organizations?

This project represents a large-scale and ongoing evaluation of the consequences of CII services in the workplace, with a wide range of workers, employers, work sites and triggering incidents.

This project was described in a poster presentation at the ISTSS annual meeting in San Antonio in November 2000. An e-mail document attachment of the poster is available at: sflamer@wcb.bc.ca.

References
Avery, A., King, S., Bretherton, R., & Orner, R. (1999). Deconstructing psychological debriefing and the emergence of calls for evidence-based practice. Traumatic StressPoints, Spring 1999, 6-8.
Bisson, J.I. (1997). Is post-traumatic stress disorder preventable? Journal of Mental Health 6 (2), 109-111.
Carlier, I.V.E., Lamberts, R.D., van Uchelen, A.J. & Gersons, B.P.R. (1998). Disaster-related posttraumatic stress in police officers: A field study of the impact of debriefing. Stress Medicine, 14 (3), 143-148.
Mitchell, J.T. & Everly, G.S. (1998). Critical Incident Stress Debriefing (CISD) and the prevention of work-related traumatic stress among high risk occupational groups. In G.S. Everly and J.M. Lating (Eds.), Psychotraumatology: Key Papers and Core Concepts in Post Traumatic Stress, 267-280, New York: Plenum Press.
Rose, S., & Bisson, J. (1998). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11 (4), 697-710.
Stephen Flamer, PhD, is a senior psychologist with the Workers' Compensation Board of British Columbia.