| Dr.
Raymond D. Shelton has been a member of the Emergency
Services community for 36 years, having served as
a fire fighter and paramedic. Dr. Shelton has been
with the Nassau County, N.Y. Police Department for
26 years serving as Director of Emergency Medical
Training at the police academy. He holds certification
from the New York State Health Department as an
EMS Instructor Coordinator and from the New York
State Bureau for Municipal Police as a Master Police
Instructor. Dr. Shelton developed the Critical Incident
Stress Management Peer Support program for both
the Police and Fire Service in Nassau County. He
currently serves as the Clinical Director for the
Nassau and Suffolk County N.Y. Critical Incident
Stress Programs. Following the Avianca plane crash
in New York, Dr. Shelton was responsible for the
Trauma Debriefing Program utilized to debrief over
1000 rescue and police personnel, and provided consultation
to the mental health community for trauma management
provided to the civilian population. Dr. Shelton
is the author of the book EMS Stress, An Emergency
Responders Handbook for Living Well (Mosby Publications,
1994). Moreover, he maintains a private counseling
practice.
In addition to his work with the emergency service
population, Dr. Shelton spends a significant amount
of time consulting with the corporate community
and industry on the subjects of stress management,
crisis response, and workplace violence. He responds
to corporate and industrial accidents by providing
psychological trauma services. He also helps corporations
and industries develop Crisis Response Teams and
Trauma Response Programs. The Academy is privileged
to have Dr. Shelton serve on the Board of Scientific
& Professional Advisors.
JSV: I know that you maintain numerous roles as
an emergency medical specialist, psychotherapist,
lecturer, author and consultant with many projects
underway. Can you tell me about your present positions?
RDS: I have been with the Nassau County, New York
Police Department for 28 years. I owe my current
interest in psychological trauma to the work that
I have done with the Department. Currently, I am
assigned to the Police Academy and have maintained
this assignment since 1980. My work is highly diversified.
At the Academy, I am responsible for all Emergency
Medical Training for police officers, including
basic recruit medical training. In addition to the
medical training, I have developed a county-wide
Stress Management Program and serve as the Clinical
Director for the Police and Fire Service Peer Support
Critical Incident Response Team. I also provide
various lecture programs for a host of additional
topics. My work beyond the Police Department involves
a variety of mental health areas. I maintain a private
counseling practice with a focus on couples/marital
issues. This area of focus came about while I was
working with police and emergency service families
following critical incidents. It quickly became
evident to me a number of years ago that there was
a significant need to assist the families of our
emergency workers. From this work I have developed
a large practice working with this population. I
believe that what works best for me is my personal
experience of over 35 years in the emergency service
field. I am able to make a connection with my clients
that I believe comes from their view of me as "one
of them," not an outsider. The experience that
I have gained through out many years of counseling
work with couples has prepared me well for an additional
area of my work, marriage preparation. I work as
a consultant with the Roman Catholic Diocese of
Rockville Center, NY. In this position, I have had
the opportunity to spend time working with couples
who are preparing for marriage. It is my hope that
in some way, some day, with education and preparation,
we may alter the divorce rate. We spend more time
training for our careers then we do preparing for
our role as partners and parents. An additional
focus of my practice involves lecturing and workshop
presentations. A large portion of my time is spent
presenting programs to various groups regarding
the subject of Stress, Wellness, Communication,
Anger Management, Parenting and Marriage Enrichment.
My consulting work brings me into the corporate/industrial
world where many of the above presentations are
provided in staff development training. In addition
to staff development, my most recent consulting
work has centered around the topic of "workplace
trauma." More specifically, I have focused
on recognition and management of workplace trauma
from what I call the "total corporate perspective."
This is a departure from pure crisis management.
It is work done long before crises occurs, continues
through middle ground involvement, and is followed
by many healing stages. It has become most gratifying
to work with a corporation, hospital, or industry
in the planning, training and implementation of
an "in-house" Trauma Response Team. These
Teams, once formed, respond to crises and can have
a positive impact on many employees following an
incident.
JSV: Tell me more about your work with the corporate
and industrial communities in several ground-breaking
areas including workplace trauma, violence and crisis
response.
RDS: Unfortunately, in recent years, our society
has pointed out the fact that being human means
experiencing traumatic events over the course of
our lives. We most often choose not to dwell on
this fact as evident in our "closeting of death"
- don't think about it and it won't become an issue.
However, at some point in time, it will affect all
of us. Work related crisis/trauma resulting from
either violence or other naturally occurring events
has shown us that no place can be considered a "safe
haven." Unfortunately, we are learning that
"bad" things can affect us at any place
and any time. With greater understanding about "workplace
violence" that has emerged through many well-publicized
incidents, many have begun to address this problem.
We see many excellent programs being offered by
members of the American Academy of Experts in Traumatic
Stress as attempts are made to gain control of what
is a growing concern. My approach to this issue
departs from traditional "crisis response"
and involves crisis preparation, crisis management
and finally, crisis healing. I further believe that
while "workplace violence" is a topic
that commands the world's attention, the problem
is greater then violence alone. It is understood
how violence will disrupt the work environment,
however, by no means is it the sole producer of
"workplace trauma and crisis." There are
many causes of traumatic crises in the workplace.
They involve on-the-job injury or death from work-related
accidents, death of a long-term colleague and friend,
serious illness, death or suicide of a co-worker
to name only a few. The list can be endless of the
things that can negatively affect the work force.
Imagine arriving at work on Monday morning and God
knows Mondays are tough enough and while having
your first cup of coffee with staff, you are informed
that over the weekend a long time colleague and
friend has died suddenly. You have no warning, no
expectation and no preparation for this news. For
you and anyone else in the office, this negative
news will have an impact; productivity will be down.
A crisis has occurred. This personal crisis will
definitely become an issue for the company. Will
crisis management be in order here? Yes. Will the
company see the need? This is questionable. Will
management understand the ramifications of this
crisis event or understand the human reaction and
the effect it will have on those involved? This
is doubtful. What management will see is a negative
change in employee performance. In their mind, this
is going to affect the "bottom line."
Unfortunately, if you are not in the person's shoes,
you may not understand the pain. You simply barge
forward and want business as usual. The difference
between crisis management and crisis preparation
is understanding the needs of those in crisis. It
is not merely intervention in the hours or days
following the incident - but immediately. Proper
intervention requires training and information long
before events occur. It requires a commitment to
the health and safety of the employee, not just
physically but emotionally and mentally. It asks
that those responsible for worker productivity not
only be good technical managers but that they possess
good people skills, understand the ramifications
of crisis, develop a management style that allows
for direction and control of those they supervise
regarding job performance, with the added ability
to provide empathy during a time of emotional crisis.
In reality this approach is designed to achieve
a balance in the management of crises. It allows
for those responsible for work production to sense
the need, begin the intervention immediately and
most importantly, get the professional assistance
on-board quickly. If you think about this, it is
not far from the old expression – "where's
the cop or firefighter when you need them?"
Well, they are not there when you need them simply
because someone must see the need and call them.
Do you see the point? In this model, we train the
in-house people to see the need and begin the "emotional
first aid." We do not allow time to go by.
We begin to stem the "hemorrhage," which
in effect will allow for a more successful intervention
by professional staff at a later time be it hours
or in the days that follow the incident.
JSV: When did your interest in workplace violence
and trauma begin?
RDS: I believe my first interest in this area began
when violent events in the work environment started
to command the attention of the news media. I remember
hearing a report on the evening news of a shooting
in a rather small insurance office. As the report
unfolded, I saw visual images of the co-workers
in a high degree of distress as they were interviewed.
This left a distinct impact on me. I thought about
the similarity between their traumatic experience
and how this was really no different than the distress
that our emergency workers experienced. What struck
me as well was that there was no discussion about
any crisis management assistance being provided.
I wondered "what would be done for these people?"
I believe this event made me give serious thought
to the need for some type of program to address
this area of trauma. Another example is the shooting
incident on the Long Island Rail Road. It was the
holiday season. People were on their way home. Some
were sleeping in their seats. Suddenly, a gunman
starts shooting people on the train. Instantly,
a tremendous amount of trauma occurs for all of
these people. Let's go one step further. How many
of these people had to go back to work the next
day? Every company who had an employee on this train
was affected. Their families were affected. Emergency
workers and police were affected as were employees
of the railroad. It is like a mushroom-shaped cloud
that gets bigger and bigger. We must realize that
events are occurring all of the time that affect
our lives. The company or industry that acknowledges
this fact can truly help its employees.
JSV: Was there a specific turning point that caused
you to shift your focus from emergency service trauma
to the issue of work-related trauma?
RDS: Absolutely and I remember it as clearly as
we are sitting here. As I had mentioned, my interest
began with the event in the insurance office. However,
that incident only sparked a desire to investigate
possibilities. The main thrust of my work continued
to be the emergency service population until I received
a call from a hospital emergency department supervisor.
She had attended one of my seminars on stress and
suddenly found that she and her staff were in acute
crisis following an incident in their Emergency
Room (ER). The story is powerful. At about 2:00AM,
a call was received from Medical Control informing
the ER staff that two ambulances were in route with
four victims of an assault. Routine event was the
initial thought of the staff - they prepared to
receive the victims. However, they were not at all
prepared for what was about to arrive. The first
victim brought into the ER was a young male. The
nurse who received this patient thought she had
recognized him but passed this off, thinking "it
couldn't be," or as it turned out - "she
did not want it to be." The second victim to
arrive was a female in her forties. She had been
seriously beaten and was initially not recognizable.
The third victim was a female in her twenties. She
had been beaten and initially was not recognizable
as well. Her clothing had been torn off - she had
been raped. The final victim, a male in his forties,
was rolled in. He was immediately recognized by
the staff – an Attending Physician, a co-worker,
a friend for many years to this staff. This was
his family. His home had been entered, robbed and
his wife was beaten and raped. His daughter was
beaten and raped. His son was beaten and he was
forced to watch all of this. Finally, he was beaten
himself. Workplace violence? No. Workplace trauma?
Yes. This violence did not fit the picture of what
had begun to be talked about under the heading of
"workplace violence." This violence had
not been directed at the workers, yet this violence
touched the lives of every one of the staff including
house-keeping,
X-ray, lab and security. The incident was personal.
Detachment was lost. The entire staff had to continue
to function. However, they were now involved in
working on "family." They all became victims.
This incident changed my thinking from the need
to address just "workplace violence" to
the need to address "trauma and violence in
the workplace." The picture was bigger than
what was being addressed. This staff required assistance.
We provided debriefing service and continued counseling
as we would have for emergency responders. I knew
that the model we were using would work in this
environment and it did. But I remember thinking
- as quickly as we were there, we were not there
fast enough. A more immediate action had been needed.
Workplace trauma needed a more complex model than
"crisis response." It needed a more holistic
approach. There was a need to prepare for this crisis
long before it occurred, manage the event during
the crisis and provide healing service. My focus
had shifted to an area that now needed to be addressed
and could take its queues from emergency service.
This incident has stayed with me.
JSV: Your interest in the field of work-related
trauma has its roots in the field of emergency service.
Can you tell me how this interest began, and what
your role over the years has been?
RDS: My current work involving psychological trauma
began in the 1970s. I had begun to see the difficulty
experienced by emergency workers following serious
incidents. On Long Island, there were no programs
available to address the stress that these incidents
created. Another interesting phenomena began to
emerge. Volunteers were harder to come by and retention
of those in service was slipping. For the first
time in the history of volunteer service on Long
Island, advertising campaigns had begun in order
to attract members. The need for some form of stress
management work was realized and the program development
began. The initial work for this began with the
fire service and much "selling" had to
be done. The "old guard" did not fully
appreciate the need. Many presentations were provided
to those in command and gradually the sales pitch
worked. An incident occurred and the peer support
team that I had trained responded. They provided
a successful debriefing/education and our mark was
made. The police department followed soon after.
I trained a team and finally we had developed a
complete program to manage critical incident stress
on Long Island. My role over the years has been
program development, trainer, and Clinical Director.
Today, the four emergency service teams for which
I am the Clinical Director, service approximately
30,000 police, volunteer fire and ambulance workers.
I further provide clinical direction, training and
consultation to hospitals, industries and corporations
where I have developed "workplace trauma"
programs and trained in-house crisis response teams.
JSV: You talk about "workplace trauma"
as opposed to "trauma that affects the workplace."
Can you expand on this concept as it relates to
many of the programs that address workplace violence?
RDS: Workplace violence is the issue that caught
our attention through media reports of incidents
in the work environment. People suddenly became
aware of the fact that no place can be considered
a safe haven. Violence can even occur in your quiet
little "insurance office," a place that
you would have thought was the furthest from violence.
The need to address this issue was seen and programs
were developed to provide assistance. As far back
as 1970, The Occupational Safety and Health Administration
(OSHA), in its General Duty Clause, required employers
to provide a safe work environment, free of recognizable
hazards. This clause addressed safety issues, and
certainly the issue of violence is a safety issue.
Program development centered around violence issues
such as identification of the problem, causes and
prevention. At a later point in time, crisis management
was introduced to help employees after a violent
incident had occurred. The problem with this approach
is that it does not address the many additional
forms of traumatic events employees can experience
- events that can affect performance and quite possibly
the "bottom line." Trauma, in an employee's
life, that will have an impact on performance includes,
but is not limited to, serious illness or injury
to self, family or co-worker, death of a spouse
or child, suicide of a co-worker, sudden death of
a co-worker, job-related injury or the witnessing
of job-related injury/death. When events like these
occur in a person's life, it will not be "business
as usual." A crisis is present and must be
addressed. Workplace violence programs only address
violence, are usually prevention-oriented and may
not address the trauma following the event.
JSV: Which factors do you think are most important
for corporations to consider with regard to the
management of trauma in the workplace?
RDS: The obvious consideration is that corporations
must realize that this subject is real. It is a
fact of life. Trauma occurs, not just in the form
of violence in the work environment, but in the
lives of the workers, beyond and on-the-job. They
further need to realize that these traumatic events
will affect productivity, attitude and the harmony
necessary to deliver a product or service. My experience
in consulting with the corporate and industrial
world is that, at the highest levels of management,
there is a limited understanding of this issue.
Understanding usually comes after the fact - when
a crisis has occurred. Only then does this idea
have merit and realization occurs that something
must be done. Managers, oftentimes, may not consider
poor performance to be anything other than the result
of a "poor attitude." Consideration is
rarely, if ever, given to the cause for an employee's
change in performance. I have further observed that
supervisory/management training is much better at
"technical" management skill training
than it is at teaching managers and supervisors
about people and performance concerns. Motivational
skill training for managers usually only considers
how to motivate the employee; it does not address
the issue of why this "once good employee"
may now need assistance. I had worked with one company
that had an "at will" policy. This meant
that if performance was bad - "let them go."
Managers did not take the time to find out why the
performance had deteriorated. One case, in particular,
stands out in my memory. There was a situation involving
an employee who had been with the company for 18
years and had excellent service. His performance
had dropped. He was "counseled" but there
was no real improvement. He was terminated. As it
turns out, his son was diagnosed with cancer. This
worker was a private person and had not shared this
at work. His burden, and his inability to talk about
it, led to an issue on the job. The sad part about
this incident was that no one, not even his immediate
supervisor, or the Human Resources department ever
took the time to consider the possibilities of why
this once good employee had crashed. They only identified
the obvious and took action. This is a clear example
of "trauma" affecting the workplace and
not being addressed. Oh yes, the picture is far
greater than "workplace violence." The
true picture requires corporations and industry
to do all in their power to protect the most valuable
asset they have - their people. This is the most
sound business practice that exists. Keep your workers
safe, assist them in a time of need, show them that
you value their contribution to your success. This
represents a winning situation for all.
JSV: How do we justify the need for workplace trauma
response teams?
RDS: Trauma and violence in the work environment
do not bode well for business. The success of any
corporation is dependent on each employees' ability
to do their job well. Protecting employees from
harm and assisting them following traumatic incidents,
whether the incidents are work-related or have occurred
as the result of an outside incident, is sound business
practice. The cost to business for lost productivity,
worker error, sick-time and the potential for job-related
injury due to a loss of concentration that often
accompanies the traumatic stress response can be
staggering. The National Safe Workplace Institute
projects the cost to business at greater than $4.3
billion annually! I also believe that in our litigious
society, every employer runs the risk of finding
themselves on the losing end of a law suit based
on the fact that an employee was "psychologically"
injured as a result of a workplace trauma incident.
If there is an obligation to provide a safe workplace,
free of danger, can we not expect that workers should
be protected from the emotional and mental trauma
that they may experience on the job? Thus, in the
"trauma or violence potential environment,"
each employer needs to ask - "What are the
risks?" and "Where does the greatest threat
come from for my people?" "What can I
do about this?"
JSV: What benefits can be derived from the development
of corporate-based peer crisis response teams who
can respond to incidents ranging from chronic illness
of an employee to a workplace shooting or hostage
situation?
RDS: Benefits include an increased awareness on
the part of management and line supervision of the
nature of the problem and the effect it has on the
employee. The advantage is having many eyes and
ears throughout the workplace that can have their
"finger on the pulse" of traumatic stress.
In effect, they would know when to sound the alarm.
They would have the ability to respond "immediately"
with PEERS, who are respected and trusted members
of the corporate/industrial family who can begin
the process of SUPPORT and are able to continue
the support in the days following the incident.
The nature of the incident really does not matter.
In-house peer teams, in conjunction with trained
management, are able to provide a response at the
time the crisis is unfolding. They are in the best
position to begin the process of mitigating the
effects of traumatic stress on employees. The benefit,
while it may not be "business as usual,"
will be a return to a "normal" environment
much more quickly. This is an example of a positive
action step producing positive outcome. An additional
benefit that has been expressed by both employees
and union personnel following incidents, has been
an entirely new respect for their company. Comments
like - "Its nice to know they are human,"
"It felt good to know they cared enough about
us to provide the support," "It's a great
company to work for, they are there for you when
the chips are down" are readily heard. Another
important benefit is that when your work force has
this view of you, they will perform for you. It
should be obvious that the bottom line will be positively
affected with this "human" approach to
management. A corporation that demonstrates concern
for its workforce builds morale.
JSV: Although many of the causes of workplace violence
are easily understood, there are several hidden
causes. Can you describe how the causes are manifested
across various circumstances?
RDS: This is an area that can be difficult to approach.
We most often think of violence following a somewhat
predictable pattern. We look at such things as the
angry and out-bursting employee, those with poor
impulse control, drug or alcohol use, history of
family violence, grudge holding, and the marginal
performer, etc, etc, etc. Consideration is also
given to the work environment and its potential
for violent events (i.e., late night shift in the
gas station). These examples are common-place and
violence prevention programs do address these concerns.
However, the "violence potential environment"
may be a factor of internal cause. Oftentimes, this
internal cause can be linked directly to management
personnel, company policies or company attitude
toward its workforce. For some managers and supervisors,
there may be only one goal - get the job done at
any cost and, in the process, protect self. This
management style may create a hostile situation
that may conclude in violence. Such things as accusation
without foundation, poor communication skills, lack
of understanding of human needs, poor conflict resolution
skills, self-preservation above all, and inappropriate
pride lead to a lowering of morale and the creation
of mistrust. This approach to people management
creates a "violence potential environment."
Without managers and supervisors being able to connect
with their staff on a human level, they will never
know that a crisis may be unfolding in a workers'
life, beyond the job. Poor communication, poor conflict
resolution and accusation may place the worker over
the edge and violence can erupt. Consider this.
Only five months ago, I was called into a company,
as an after thought, following a "downsizing"
incident. Ten workers from one work-group upon arrival
in the morning were instructed to meet in the conference
room at 10:30am. No reason for the impromptu meeting
was given. But since they were all actively involved
at a high level on an important project, they believed
that this was the nature of the meeting. Not so.
Upon all of their arrival in the conference room,
security secured the area. Upper management personnel
accompanied by the Human Resource Director entered
the room and proceeded to inform the group that
their service with the company had been terminated.
They were provided no further information other
than security would collect their keys and would
escort them to their work station to collect their
personal effects. They were to be out of the building
by 1:00pm. Common place? I hope not. But let's be
honest, this is happening across corporate America
more than we would like to think. If anyone of these
workers had been in a difficult place outside of
the job (e.g., sick spouse or child, dying parent,
financial issues etc.), the incident could have
been the breaking point and a violent outcome may
have occurred. This is what I address as a "hidden
cause." Those internal events that push the
final launch button. It is violence created by a
company's poor attitude and management that is poor
at what it does. People need to be cared about and
cared about employees will be better workers.
JSV: It seems as though your approach to workplace
violence is somewhat more complex than is generally
seen. Why is this?
RDS: As you recall, my shift from emergency service
critical incident stress programs occurred based
on a workplace violence incident. However, as I
began to work within the violence prevention context,
I felt as though I was missing something important.
I recognized that violence was a serious issue and
that we must begin to address it. I certainly understood
the need for crisis intervention. Prevention programs
work to stop the issue from occurring in the first
place. They have great value in raising awareness
both on the part of management and on the workers.
They generally accomplish the mission of providing
a safer workplace. Additionally, a program should
provide for some level of employee support following
an incident. However, this usually is the extent
of the program. What the programs do not do is address
the issue of "workplace trauma" which
could be a direct result of workplace violence.
However, it is most often the result of more "naturally"
occurring human experiences such as those previously
discussed. No consideration is given to these other
events, yet these events occur far more readily
than violence. The effect that they will have on
job performance is powerful. This was the missing
piece for me. My work with the emergency population
centered around a number of areas that included
stress management and wellness programs, officer/management
training regarding human performance issues (which
included in-depth training regarding the effects
of stress and traumatic stress incidents on responders),
the development of "peer" response teams
with representation from all levels of the organization,
and training for EAP/HR personnel regarding traumatic
stress and its management. I believe that the best
approach to the issue of "workplace trauma"
is holistic in nature. It should increase awareness
on all levels from management to line workforce.
Moreover, there is a need to select and train a
"peer" team with representation from each
area of the corporation and to train line supervision
regarding the nature of the problem. With such pre-incident
training, there is quick recognition and appropriate
response. We need to train management about the
effects that trauma has on humans and allow them
to consider possibilities for poor performance other
than a "poor attitude." We need to develop
a network of mental health providers who are qualified
and desire to respond to traumatic incidents. I
raise this point based on my experience in presenting
programs to various mental health professional groups.
On many occasions, I have encountered clinicians
who have attended one of my conference workshops
and, at its conclusion, have come to me and stated
"this is powerful work - I don't think it is
for me." It should not be assumed that because
a corporation has a network of providers available,
that they will be the best people to respond to
a traumatic event. Many don't want to get the call
and respond to a steelworker who had been vaporized
with molten steel in front of twenty other people.
They don't want to hear that story. It is definitely
my belief that we need to do more than just address
prevention and crisis management. Prevention, by
it's most widely accepted approach, seeks only to
discuss the single issue of violence. We establish
and teach violence prevention policies making them
available to each employee, supervisor and manager.
In other words, we demonstrate that we will not
tolerate violence. However, in this approach, many
companies do simply what has just been described.
They have employees read the policy - job done.
Managers are told to enforce the policy and security
provides what protection it can. No consideration
is provided for the deeper aspects of the issue
of trauma. In most programs, no training is conducted
to train management and supervision to identify
cause, reaction, and management of trauma in their
employees. No provision is given to "pre-plan"
for a traumatic incident through the development
of a Crisis Management Team comprised of Senior
Management, Security Personnel, Peer Support Team,
Medical Personnel, Human Resource Managers, EAP
Professionals, Public Relations, Community Representation,
Investigative Staff and Assessment Experts. A well-developed
Crisis Response Plan consisting of a Chain of Command,
Emergency Notification System, Impact Assessment,
Emergency System and clear guidelines for both internal
and external communication is never considered.
An additional concern of the crisis management/response
plan should include Family Support Service. What
consideration will have to be given to assist family
members in the aftermath of the crisis? We must
consider notification procedures and immediate assistance
for child care or travel to a hospital. What is
oftentimes missed by upper management is the fact
that, through a well-developed Trauma Management
Plan, the company will be able to continue to function
at a high level throughout the hours, days and weeks
following a crisis event. Secondary traumatization
to employees will be minimized and worker down-time
will be greatly lessened. It is too late to think
of the above when the crisis is unfolding. Prevention
should include all that is required to lessen negative
impact during and following the greater significance
of a traumatic incident. While crisis response may
be needed based on "violence," it must
be remembered that it is always about "traumatic
stress" regardless of the cause. The company
should be concerned with one key question - "What
do our people need to assist them through this difficult
time?" "Are we ready to meet the needs
that will present during and following a traumatic
incident?"
JSV: In your opinion, is there any advantage to
addressing traumatic stress reactions in the immediate
aftermath of a stressful event as opposed to waiting
until after a crisis situation has been resolved?
RDS: My first thought when I hear this question
is - "Is there any advantage to waiting to
stop the bleeding from a serious wound until we
reach the hospital?" Obviously not. Treatment
is needed at the moment or the patient may not survive.
I believe that people in the midst of a traumatic
stress incident, require support immediately. They
need to know that someone is there who cares, that
they are not alone and that there may be some very
simple things that they can do to gain some level
of control. At its most basic level, having someone
take some slow deep breaths to calm down and regain
control is a positive step. Things said to the victim
that are comforting and supportive may be the very
things that the victim will remember in the years
following the incident that gave them a sense of
calm in a moment of crisis. People want to help.
I have found that in the early moments of any incident,
peers are best at this. In recruiting peers, you
need to screen through those individuals to find
who would be in the best position to offer support.
Peers are not trained like mental health professionals.
They are trained to provide "psychological
first aid." We can train people to provide
this initial support. The peers start the process
and open the door for professional assistance. I
can't underscore, however, just how important education
and training will be to make this all work. So,
with regard to waiting to provide support until
the incident is over - never wait, they need support
at the moment! This is the essence of what a good
"Trauma Response" program is about - knowing
when support is needed, providing the degree of
support that is needed, and following up in the
days after the incident.
JSV: How can you be reached by a corporation that
would like to have you consult in order to develop
a corporate-based trauma response team?
RDS: I would welcome the opportunity to work with
corporations and industries in the development of
Trauma Response Programs. I can be reached by telephone
at (516) 681-3976, or by EMAIL at r.shelton31@yahoo.com.
JSV: Today we know that there are a growing number
of organizations concerned with preventing workplace
violence. Do you see a time when this issue will
no longer be a concern?
RDS: Unfortunately, I do not believe that the issue
of violence in the workplace will ever cease to
exist. We are, after all, human. Humans have a tendency
to become violent - this we all know. Programs will
work very well at lessening the overall effect of
violent incidents and may, in some limited cases,
be the driving force that prevents a violent event
from occurring. However, I believe that we will
always find ourselves needing to respond to the
after-effect of a violent event. I also believe,
it is a given, that we will continually need to
prepare for and respond to the traumas of life that
our workforce will experience. It would be nice
to believe that a day may come when these kinds
of issues are non-existent. We all know better.
JSV: For a number of years, we have seen very good
things happen in the field of psychological trauma
management, in particular, management and support
of emergency workers following critical incidents.
Do you see a link between what is being done to
assist this population and the corporate/industrial
work force?
RDS: My own experience with exposure to work-related
trauma has its foundation in the emergency services.
The need for management of traumatic stress with
this group of workers has been evident for many
years. Personally, I have had my share of experiences
with powerful incidents over the years as an emergency
provider that have left their mark on me. This was
my work. As such for many years, I had accepted
the fact that I would experience many of life's
worst events as part of my job. As my focus shifted
from provider to educator/psychotherapist, I began
to draw on my own work experience with assisting
the emergency worker in times of emotional distress.
Programs had begun to develop that provided a means
to recognize and manage the stressful reactions
experienced during difficult calls. These programs
definitely addressed the need. I began to build
on these fine concepts and developed programs that
fit a specific need for the groups that I serviced.
I added a pre-incident education program. I approached
the education piece from a Holistic perspective
and decided to present training programs that addressed
the "total person" of the rescue provider.
These programs centered around Wellness, Stress
Management, Traumatic Stress Management, and included
a "family life" component. In conjunction
with the general provider program, I began to offer
an Officer Training component that addressed the
above topics but added a "symptom" recognition
piece. This part of Officer Training presented the
issue of stress in the individual worker with an
emphasis placed on symptoms, the effect on performance
and immediate management. It further developed management
skills in communication and counseling techniques
that could be utilized during the crisis event.
I believe that this was the first attempt to move
management/supervision into the realm of "human
needs" issues as opposed to predominantly technical
job performance concerns. The link between this
work and the corporate/industrial work force is
a natural fit. Trauma and crisis in the workplace
is no different from the emergency environment.
Trauma is trauma regardless of cause. In the corporate/industrial
world, crisis events need to be understood. Thus,
we train from the highest level of management down
to the work force. We recruit and train trauma/crisis
response teams comprised of various members of the
corporate/industry family. We develop a Crisis Response
Plan. We make the teams visible and available -
to respond when called. We provide on-scene support
and continue to provide support in the days and
weeks following the incident. Finally, we offer
a support component to the families of distressed
workers. Every piece of this program has its roots
in the programs that I have been using to service
the emergency population for years. It is a simple
adaptation to a different population. The beauty
of the design is that it can be easily adapted to
any need.
JSV: In you book EMS Stress, you utilize the concept
of AWARENESS-ATTITUDE-ACTION as a central theme
for the continued management of stress. In your
programs on workplace trauma/violence, you speak
of the "trauma potential environment."
Can you explain how you link this to your concept
of AWARENESS-ATTITUDE-ACTION?
RDS: I believe that, for the most part, we lack
AWARENESS about the effect that stress has on our
lives. This includes, oftentimes, not having a clear
focus on the depth of our stressors or the physical,
emotional, mental, social and spiritual destruction
that stress may be creating. We often develop a
"poor" ATTITUDE that drags us down as
we begin to succumb to the events in our lives.
And, when stress reaches a high level, as it does
in times of crisis, people feel out of control,
not able to make decisions - they lack the ability
to take ACTION. I believe that with increased awareness,
a "survivor attitude," and a decision
to take action steps, people begin the recovery
from powerful negative stress in their life. As
I had mentioned earlier, the "trauma potential
environment" exists in our workplace. A keen
AWARENESS of this fact must be present at all levels
of the workforce. Management needs to understand
clearly the nature of the problem, where it may
come from within the organization, and the possibility
that crises experienced off the job in the form
of personal tragedy will affect the company. Awareness
comes through the pre-incident training component
for managers, supervisors and the workforce. Through
an increased AWARENESS, a new ATTITUDE emerges toward
the issue of trauma and crisis. I have found, on
many occasions, that the most difficult "sell"
is possible when people begin to realize the reality
of the problem. Educational examples are powerful
tools that bring the point home. When understanding
is gained - forward movement occurs. Team development
and training are ACTION steps that begin the process
of crisis management. Once a Trauma Response Team
is developed and "on-line," it becomes
the action force to carry the program forward. One
company's team (that I had the good fortune to work
with) is so successful with it's crisis response
ability, that it plays a role in education on a
regular basis in the Mill work areas. Its team members
are sought out by employees for advice when their
stress levels are building. The team, through its
progressive action steps, has become a welcomed
addition to the plant. They have made their mark
through a strong commitment to be present and aware
of the problem. They believe that they make a powerful
difference in the lives of the workers that they
serve. They have done this through AWARENESS-ATTITUDE-ACTION,
a proactive response.
JSV: What do you see as the biggest stumbling block
in the management of workforce violence and trauma?
RDS: The biggest stumbling block is a lack of understanding
of the problem, coupled with the time old problem
"no funds" for this project. Lack of understanding
is present because no one wants to think about this
problem. This is evident even today regarding violence
issues in so many companies. They simply do what
the law requires - post a policy on a bulletin board
and believe it will "never happen here."
We've met the requirement, now on with business.
The same holds true for trauma/crisis issues - they
won't occur here. This thinking is not different
than what had occurred in the emergency professions
not many years ago. The attitude was - "we
don't have a problem with this, it's part of our
job." Obviously we now know differently. In
the emergency professions an awareness was raised,
a new attitude has taken place, action steps occur
and the issue of critical incident/traumatic stress
reactions are being addressed successfully. Funding
will always be a stumbling block for progress. Money
must be used for things that are necessary to the
product or service delivery. The question is always
asked - "Why should we allocate funds to this
area?" My best answer to this question is that
these funds are an investment in your workers who
you need to deliver your product or service in a
competent manner. Protect the most important asset
you have. The cost is minimal compared to the potential
losses that can be experienced following an incident
in your workplace, estimated at an average incident
cost of $250,000. Traumatized workers will be less
productive following a traumatic incident. As I
had said earlier, sick time will increase, error
levels will rise, and the potential for further
injury due to poor concentration is high. This is
the risk taken by not developing a program to meet
this issue head on.
JSV: With regard to the effects of traumatic stress,
what things do you believe are in need of greater
investigation?
RDS: The field of Traumatic Stress Management is
an emerging area. Wonderful strides have been made
in a relatively short time-frame. I believe that
we need to continue to develop programs that address
the varying needs of humans in crisis across the
population. No one program or approach will fit
the bill for all incidents. We further need to continually
investigate the work that we are doing to determine
its effectiveness. We need to see why it works and
if it does not, why not? We need to develop studies
that will assist in showing the efficacy of the
work we are doing. There is a need to prepare people
to manage the stress that life will create. We spend
a considerable time in the education of humans on
subjects that fall short of what we might well call
"life survival" skills. I believe programs
in stress management should be developed and implemented
at the earliest point possible in the schooling
process. At this point, we do not even do a good
job helping students to handle "test anxiety."
With this being the case, how will they ever learn
to respond in a healthy manner to a serious life
crisis? Train for the crisis and when it occurs
you will respond appropriately.
JSV: As you are aware, The American Academy of Experts
in Traumatic Stress recognizes that traumatic events
are an unfortunate part of the human experience
that professionals and workers from many fields
work with on a regular basis. What do you see as
a major advantage of an organization such as the
Academy that is dedicated to increasing awareness
and ultimately, improving the quality of intervention
with survivors of such events across such an eclectic
group?
RDS: Trauma, be it physical or psychological, is
a fact of human existence. The American Academy
of Experts in Traumatic Stress represents all aspects
of human life. The diversity of its membership allows
the Academy to provide the most complete understanding
of the nature and effect of traumatic stress across
the population. I believe the Academy is in the
best position to provide a forum for research and
education on traumatic stress. It swells with a
knowledge base unparalleled in the field of trauma
survival. The Academy further provides a means to
legitimize those who choose to work within this
area. The Certification Programs provide a framework
that begins the task of standardization in this
powerful work. Finally, working with victims following
crisis can be a lonely journey. There are many human
service workers who choose not to be a part of this
difficult work. The Academy lets us know that we
are not alone in our efforts. It provides support
and encouragement.
JSV: You have become a Fellow of The American Academy
of Experts in Traumatic Stress as well as Board
Certified by the Academy in Emergency Crisis Response
and Stress Management. What made you pursue these
credentials offered through the Academy's Board
Certification Programs in traumatic stress specialties?
RDS: As I have discussed, I have been involved in
traumatic stress management for many years. I clearly
remember, on many occasions in the early days of
this work, wondering - "Am I doing this the
right way?" The knowledge base was limited
and I often felt, as I am sure many of our colleagues
have felt, that I was flying by the seat of my pants.
As the years went by, and this subject received
more attention, research was conducted and management
models began to emerge. Trial-and-error gave way
to more pointed management with measurable results.
Through the Academy's Certification Programs, I
was finally able to realize a comfort level, not
experienced in the beginning of my work. I was able
to realize that the work I had been doing had merit.
It was finally recognized as valuable.
JSV: As an active member of the Board of Academic
& Professional Advisors of the American Academy
of Experts in Traumatic Stress, are there any suggestions
or concluding comments that you could offer with
regard to helping survivors of traumatic stress?
RDS: Working with victims of crisis is powerful
work. It can be exhausting to the crisis worker
in each of the five realms of human life - Physical,
Mental, Emotional, Social and Spiritual. With each
crisis intervention we do, we take a piece of the
victims' incident with us. We experience their incident
through their story. Over the course of time, we
can become weighted down by the pain of those we
help. To stay effective in this work, each crisis
worker must always care for self, protecting the
balance of the five realms. I further encourage
crisis workers to know and respect their limitations,
to respect the place you may be in at any given
time. It is most important to be able to say NO
to involvement in the intervention if there is danger
that you will be "hurt" in the process.
I further believe that each person who provides
this service must develop a strong and varied support
network for self. In my years in this field, I have
met far too many human service workers who have
become "islands" of isolation. Doing this
work continually requires support from colleagues,
friends and family. It is important to develop and
maintain a network of people who will be there for
you. Learn to practice what you teach. Take time
for you. Talk about your reactions to the work you
do. Remember to find the time to play and laugh.
Stay abreast of change. The field of traumatic stress
is changing almost every day. Take the time to learn
what you can - attend the conferences, talk to colleagues,
be willing to consider new approaches to management.
Investigate their merit and apply it to the work
you are doing. Remember always - our mission is
to "do no harm." Finally, I would like
to offer a comment to those who may read this article
who are not from the disciplines of mental health,
but rather are interested in helping survivors of
trauma in the "peer" role. A great proportion
of our work in crisis management is the provision
of support in a safe place. It is a time to help
survivors realize that they are not alone and that
they are cared for and protected. It is a time for
you to demonstrate a high degree of empathy and
understanding. Consider this - sympathy and empathy
are often confused, if understood at all. Simply
stated - sympathy is feeling sorry for someone's
difficulty. Empathy requires you to enter their
world and connect with the survivor and help them
to know that you are present and concerned about
them. In crisis work, as it should be in all counseling
- it is always about the survivor, never about you.
Finally Joe, I would like to thank the Academy for
allowing me to be an active part of its mission.
I look forward to a long, productive relationship.
Return to The
American Academy of Experts in Traumatic Stress
Homepage |
