Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance

Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.

Officer Trust Towards Community Members and Critical Incidents: a Comparison of Factors

Current scholarship suggests attention should be focused on differences in specific job-related conditions to understand help-seeking behavior among police officers. This project examines how officers' feelings of department satisfaction and on-the-job emotions may be associated with trust in members of the community they police. Specifically, officers were asked to report trust levels both in a general sense and in the context of a potential officer-involved shooting (OIS) incident. Print and electronic surveys were completed by 169 police officers across 9 agencies located in 5 New Jersey counties between September 2019 and March 2020. Survey questions covered frequency of on-the-job emotions, satisfaction with department administration, and knowledge of local culture. Bivariate comparisons show officers' levels of both general and post-OIS community trust significantly differ based on reported frequency of emotion, assessment of job satisfaction and department administration, and wider cultural context. Furthermore, multivariate analyses indicate significant factors associated with trust levels include frequency of both positive (fulfillment) and negative (frustration) emotions, satisfaction with training, and attitudes towards the importance of understanding local culture. Findings suggest the complexity of police-community relationships should be more fully explored in relation to supporting aspects of job-related mental wellness in police officers.

A review of workplace mental health interventions and their implementation in public safety organizations

OBJECTIVE

Workplace mental health is relevant to public safety organizations due to the exposure that many public safety personnel (PSP) have to psychological trauma in the course of their daily work. While the importance of attending to PSP mental health has been established, the implementation of workplace mental health interventions is not as well understood. This scoping review describes workplace mental health interventions and their implementation in public safety organizations.

METHODS

English published primary studies with any publication date up to July 3, 2020 were considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed.

RESULTS

89 citations met inclusion criteria out of the 62,299 found. Articles and reports found were largely published within the last decade, most frequently from Western nations, and most often applied to police, followed by firefighters. The focus of interventions was commonly stress management and resilience, and a frequent implementation strategy was multi-session group training. Comprehensive quality improvement initiatives, a focus on supervisors and managers, and interventions across primary, secondary, and tertiary prevention, were infrequent.

CONCLUSION

Public safety organizations are frequently reporting on stress management and resilience interventions for police and firefighters, implemented through multi-session group training. A focus across a range of PSP, including paramedics, corrections officers, and emergency dispatchers, using implementation strategies beyond group training, is suggested. This area of research is currently expanding, with many studies published within the past decade; ongoing evaluation of the quality of interventions and implementation strategies is recommended.

Trauma and Coping Strategies in Police Officers: A Quantitative-Qualitative Pilot Study

Background. Because of their work, emergency workers, such as police officers (POs), are exposed to traumatic events on a daily basis. These experiences can have consequences in terms of physical and emotional stress. Primary attachment relationships affect the development of coping strategies for dealing with stressful events (primarily hyperactivating strategies in entangled adults and hypo-activating strategies in dismissing adults). In this study, we explored how POs describe the experience of traumatic accidents, the effects they reported and their coping strategies related to their attachment style. Methods. We used a quantitative-qualitative method. Thirty-nine POs were administered the Beck Depression Inventory, the Maslach Burnout Inventory and a semi-structured interview about traumatic events and reactions. Interviews were analyzed using Interpretative Phenomenological Analysis. Results. Traumatic events at work predominantly concerned aggressions, witnessing deaths, forced hospitalizations, and domestic violence involving children. POs with a responsible role were more likely than POs to use security-based strategies. Most POs narrated overactivation and deactivation strategies, which were associated with depressive symptoms, emotional exhaustion, and depersonalization. Conclusions. These results can be useful to improve trauma-informed interventions for POs based on their different attachment styles and coping strategies.

Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review

Public safety personnel (PSP) and frontline healthcare professionals (FHP) are frequently exposed to potentially psychologically traumatic events (PPTEs), and report increased rates of post-traumatic stress injuries (PTSIs). Despite widespread implementation and repeated calls for research, effectiveness evidence for organizational post-exposure PTSI mitigation services remains lacking. The current systematic review synthesized and appraised recent (2008-December 2019) empirical research from 22 electronic databases following a population-intervention-comparison-outcome framework. Eligible studies investigated the effectiveness of organizational peer support and crisis-focused psychological interventions designed to mitigate PTSIs among PSP, FHP, and other PPTE-exposed workers. The review included 14 eligible studies (n = 18,849 participants) that were synthesized with qualitative narrative analyses. The absence of pre-post-evaluations and the use of inconsistent outcome measures precluded quantitative meta-analysis. Thematic services included diverse programming for critical incident stress debriefing, critical incident stress management, peer support, psychological first aid, and trauma risk management. Designs included randomized control trials, retrospective cohort studies, and cross-sectional studies. Outcome measures included PPTE impacts, absenteeism, substance use, suicide rates, psychiatric symptoms, risk assessments, stigma, and global assessments of functioning. Quality assessment indicated limited strength of evidence and failures to control for pre-existing PTSIs, which would significantly bias program effectiveness evaluations for reducing PTSIs post-PPTE.