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Evaluation of a trauma therapy programme within emergency service organizations

  • Noreen Tehrani Associates

Abstract and Figures

Background: Occupational health practitioners working in emergency services, where employees are exposed to a higher level of physical or psychological trauma, need to be able to access trauma therapy programmes which are economically viable and effective in reducing post-traumatic stress disorder and associated symptoms of anxiety and depression. Aims: The aim of this review is to provide evidence on benefits of a short-term organizational programme of trauma therapy using NICE (2018) [1] recommended interventions. Methods: The review examined the pre- and post-therapy clinical scores from 429 emergency service professionals (ESPs) who were employed in five police forces, two fire and two ambulance services. The ESPs in higher risk roles were in a psychological surveillance programme, with those found to be experiencing clinically significant levels of trauma-related symptoms being referred to a psychologist for an assessment which identified the ESPs requiring trauma therapy. At the end of the therapy, the symptoms of the ESPs were re-assessed, and the scores before and after the therapy were compared. Results: The results showed a significant improvement in the level of symptoms, with 81% of ESPs no longer exhibiting clinically significant trauma symptoms and 6% showing an increase in symptoms. In addition, the clinical results also showed improvements in ESPs' perceived work capacity and quality of social relationships. Conclusions: The findings indicate that there are clinical and personal benefits to using an organizationally based short-term model of trauma therapy in an emergency service setting.
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Occupational Medicine 2019;69:559–565
Advance Access publication 3 August 2019 doi:10.1093/occmed/kqz111
© The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
All rights reserved. For Permissions, please email:
Evaluation of a trauma therapy programme within
emergency service organizations
N. Tehrani
Noreen Tehrani Associates Limited, Twickenham TW1 2QU, UK.
Correspondence to: N.Tehrani, Noreen Tehrani Associates Limited, 12 Baronseld Road, Twickenham TW1 2QU, UK. E-mail:
Background Occupational health practitioners working in emergency services, where employees are exposed to
a higher level of physical or psychological trauma, need to be able to access trauma therapy pro-
grammes which are economically viable and effective in reducing post-traumatic stress disorder and
associated symptoms of anxiety and depression.
Aims The aim of this review is to provide evidence on benets of a short-term organizational programme
of trauma therapy using NICE (2018) [1] recommended interventions.
Methods The review examined the pre- and post-therapy clinical scores from 429 emergency service profes-
sionals (ESPs) who were employed in ve police forces, two re and two ambulance services. The
ESPs in higher risk roles were in a psychological surveillance programme, with those found to be
experiencing clinically signicant levels of trauma-related symptoms being referred to a psychologist
for an assessment which identied the ESPs requiring trauma therapy. At the end of the therapy, the
symptoms of theESPs were re-assessed, and the scores before and after the therapy were compared.
Results The results showed a signicant improvement in the level of symptoms, with 81% of ESPs no longer
exhibiting clinically signicant trauma symptoms and 6% showing an increase in symptoms. In add-
ition, the clinical results also showed improvements in ESPs’ perceived work capacity and quality of
social relationships.
Conclusions The ndings indicate that there are clinical and personal benets to using an organizationally based
short-term model of trauma therapy in an emergency ser vice setting.
Key words Emergency services; trauma; trauma therapy.
There are many organizations where workers face phys-
ical and psychological danger. The Health and Safety
Executive [2] produce data on the number of workplace
fatalities and serious accidents, with construction, agri-
culture, waste and recycling at the top of the table. Other
groups of workers are exposed to psychological trauma,
including train drivers, social workers, medical staff, re
ghters, police ofcers and ambulance personnel [3].
For occupational health practitioners (OHPs), working
for these industries, it is important to have means of
dealing with the psychological as well as the physical im-
pact of traumatic events.
Generally, workers in emergency services cope, but
occasionally they require a therapeutic intervention to
reduce their psychological symptoms [4]. Several emer-
gency service providers have introduced programmes of
trauma support for their emergency service professionals
(ESPs), and these programmes include early interven-
tions such as debrieng [5,6] and psychological rst aid
[7]. OHPs have also developed training for ESP super-
visors and debriefers to help them recognize and refer
members of their teams to occupational health (OH)
when they are showing signs of distress following a trau-
matic exposure [8].
Despite OH support, some ESPs develop serious clin-
ical conditions including generalized anxiety, major de-
pression and post-traumatic stress disorder (PTSD) [9].
The development of these trauma-related responses may
be delayed and go unrecognized, leading to increased
sickness absence and lower levels of productivity. The
need to maintain a healthy workforce has led to the intro-
duction of psychological screening and surveillance [10]
by some occupational health departments as a way of
identifying ESPs requiring a psychological assessment
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and referral for trauma therapy. In addition to measuring
clinical symptoms, some screening programmes also
measure resilience factors, with one of the better-known
resilience measures being the Sense of Coherence (SOC)
scale which assesses the extent to which people nd their
lives and work to be meaningful, comprehensible and
manageable [11]; these attitudes have been shown to be
psychologically protective.
This review examines the outcomes of ESPs assessed
as requiring trauma therapy through a trauma surveil-
lance programme and referred to a therapist trained
in one or both NICE-recommended trauma therapy
programmes (trauma-focussed cognitive behavioural
therapy [TF-CBT] [12] or eye movement desensitiza-
tion and reprocessing [EMDR] [13]). At the end of the
therapy, the ESP is re-screened and the changes in their
clinical symptoms, coping capacity and resilience were
This review is designed to assess the effectiveness of
the trauma therapy programme in reducing the symp-
toms of anxiety, depression and traumatic stress among
ESPs exposed to trauma, and to assess the impact of the
trauma therapy on productivity, satisfaction and lifestyle
of theESPs.
This review used data gathered as part of the regular
monitoring and evaluation of a trauma screening and
therapy programme for ESPs. The review is on the sur-
veillance results rather than research [14]. The screening
and surveillance programme is undertaken under
Health and Safety legislation and therefore does not re-
quire ethics approval; however, the review met the eth-
ical standards of the British Psychological Society [15].
The trauma screening and therapy programme was em-
bedded within the ESP OH service, with the services
reporting into the emergency service’s heads of OH. In
January 2019, the programme had been running 6years;
429 ESPs had completed the trauma therapy programme.
Afurther 66 ESPs were engaged in the therapeutic pro-
cess, with slightly more female (55%) than male (45%)
referrals. Most ESPs involved in the review were from po-
lice services (86%), but it also included 12% ambulance
and 2% re and rescue service personnel. Each ESP had
completed an online screening questionnaire [16], which
had identied clinically signicant levels of psychological
trauma, anxiety and depression. ESPs with clinically sig-
nicant scores were referred for a structured psychological
assessment [17] with the Health and Care Professions
Council (HCPC)-registered counselling psychologist.
The psychologist reviewed physical, psychological and
social well-being, and took a personal history, including
educational achievements, employment and an account
of the traumatic exposure. At the end of the assessment,
the psychologist shared the screening results with the
ESP. The psychologist’s assessment was used to formu-
late clinical opinions on the ESP’s psychological state,
reasons for the state and whether trauma therapy or other
intervention was appropriate. The psychologist provided
recommendations to the responsible OH practitioner on
how the ESP should be supported by OH and line man-
agement during and following the trauma therapy. The
trauma therapy programme was for work-related trauma
and, if the traumatic exposure was not work-related, the
ESP was referred for support from the NHS or to the
organization’s employee assistance programme.
Key learning points
What is already known about this subject:
It is widely recognized [1] that trauma-focused cognitive behavioural therapy and eye movement desensitization
and reprocessing are effective forms of therapy for treating the post-trauma responses of anxiety, depression and
traumatic stress.
Employees of emergency services are frequently exposed to traumatic events in the course of their work and
seek support from their occupational health department.
What this studyadds:
The study has shown that the use of short-term trauma therapy provided within an occupational health frame-
work is associated with signicantly reduced levels of traumatic stress, anxiety and depression on completion of
The study supports the development of a practitioner-led business case for a trauma intervention involving ob-
jective and perceptual factors in support of the Society of Occupational Medicine’s value proposition [30].
What impact this may have on practice or policy:
Organizationally focused short-term trauma therapy can be effective in reducing symptoms of anxiety, depres-
sion and traumatic stress in emergency service professionals.
The role of occupational health is central to the management of emergency service professional trauma
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To assess the effectiveness of the programme, pre-
and post-therpay measures were taken, which included
three clinical questionnaires: the Goldberg Anxiety/
Depression Scale [18], which measures anxiety and de-
pression using a simple yes/no endorsement of symp-
toms with a score range of 0–9; the Impact of Events
Scale-E (IES-E) [19], which measures arousal, avoid-
ance and re-experience using a ve-point scale ranging
from never to most of the time, with a range of 0–92;
and resilience was measured using the SOC scale [20]
using a seven-point scale ranging from never to all the
time (score range 13–91). On completion of the therapy,
the ESPs completed the Goldberg Anxiety/Depression
Scale, IES-E and SOC questionnaires a second time
and the results were compared. The ESPs also provided
satisfaction feedback on the trauma therapy programme
and on any changes they observed in their capacity to
work, understanding of their symptoms, ability to cope
with their job, relationship with colleagues and man-
ager, satisfaction with personal life and ability to deal
with problems.
The 24 trauma therapists working on the programme
were all in private practice. This number of therapists
was necessary to ensure that ESPs did not have to travel
a long distance for their therapy and to ensure that there
was a good supply of sessions. The therapists had been
selected for their qualications and skills in undertaking
trauma therapy and their willingness to work within an
organizational setting. The therapists were accredited
by their professional body and all had been trained in
TF-CBT [21] by the author. Some therapists were also
accredited EMDR [22] practitioners. Thirty-nine per
cent of the therapy involved EMDR, 37% TF-CBT and
24% a mixture of TF-CBT and EMDR. ESPs were as-
signed to the nearest available therapist within a week
of their assessment. The programme provided for six
90-min sessions with the opportunity for the therapist
to split sessions into 60-min sessions where this suited
the needs of the therapy or the ESP. At the mid-therapy
point, the therapist provided a report giving information
to the OHP on how the case was progressing, together
with suggestions designed to assist in rehabilitation and
recovery. If in the view of the therapist there was a need
for additional sessions, the therapist could request up
to two additional 90-min sessions. The average number
of sessions provided by the programme was 6.53 (SD
1.25). During the last session of the therapy, the partici-
pants completed the closing questionnaires and provided
feedback on their experience of the therapy. The ther-
apists wrote a closing report providing information on
the lifelong traumatic exposures experienced by the ESP
together with recommendations on any organizational
or OH support that would be helpful in aiding their re-
covery. The data collected were input into and analysed
by GNU PSPP Statistical Analysis Software version
Fifty-two of the ESPs failed to fully complete the
screening questionnaires at the end of the therapy; there-
fore, the analysis involved the results from 377 ESPs. The
analysis of lifelong exposures to trauma showed that ESPs
had experienced a range of traumatic events, including
traumas in childhood, personal life and working life.
The results showed that in childhood, 33% had experi-
enced a childhood trauma, e.g. involved in an accident
or other traumatic incident; 22% had been exposed to
childhood abuse, e.g. physical and sexual abuse; and
17% experienced the loss of a parent through bereave-
ment or separation. In their personal life, 35% experi-
enced at least one traumatic event, e.g. military action
or accidents; 28% had a traumatic relationship, e.g. do-
mestic violence or stalking; and 7% experienced personal
abuse including rape or harassment. In work, 58% had
been exposed to primary trauma as a victim or by being
involved in rescuing or dealing with a primary victim;
51% had experienced secondary trauma relating to their
work, e.g. dealing with child abuse, interviewing victims
or offenders of domestic violence, sexual abuse or other
personal crime; and 18% had been exposed to bullying
or other aversive behaviours at the hands of work col-
leagues or managers (Table 1). The results show that in
most areas women record higher levels of traumatic ex-
posure than men. Asignicantly higher level of primary
traumatic exposures was reported by men but there was
no signicant difference in the level of secondary trauma
by gender. The results showed that women had a higher
number of lifelong traumatic exposures, although this
was at a lower level of signicance.
Table 2 shows the mean clinical scores before and
after the therapy together with the clinical cut-off levels
for those ESPs completing the closing reports. The
average levels of anxiety had fallen by 3.5 points, depres-
sion by 3.1 points and total trauma by 30.6 points. The
improvement in each of these three symptoms was found
to be statistically signicant. When considering clinical
signicance, the results showed, at the beginning of the
therapy, the percentage of people with clinically signi-
cant scores were: 84% trauma, 80% anxiety and 81%
depression; however, by the end of the therapy, it was
found that the number of ESPs with clinically signicant
scores had fallen to 19% trauma, 24% anxiety and 30%
depression. Asmall number of ESPs were found to have
higher clinical scores following the therapy—the percent-
ages of higher scores were 6% trauma, 4% anxiety and
8% depression.
The feedback of ESPs on their perceptions of the
trauma therapy programme were measured on a ve-point
scale with the range of 1–5. The results showed that the
level of satisfaction was within the range 4–5. The highest
score was for ease of access (4.9) and the lowest score was
for the therapist’s understanding of their problems(4.3).
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The ESPs also provided feedback on their perceived
capacity before and after the therapy (see Table 3). The
responses were measured on a ve-point scale (range
1–5) apart from the capacity to work which was assessed
as a percentage of their potential working capacity. The
greatest change was seen in the ESPs’ understanding of
their symptoms (2.41) followed by their improved ability
to deal with their problems (2.03). There were small
but signicant improvements in relationships with col-
leagues (0.90) and manager (0.76). The ability to cope
with symptoms (2.41), deal with problems (2.03) and
their satisfaction with life (1.56) had also improved. The
changes in the perceived capacity to work showed the
mean capacity to undertake the work had risen signi-
cantly from 37% to 69% of their potential capacity.
The results from the SOC questionnaire are given
in Table 4—‘before therapy’ scores were taken from
the pre-assessment screening and ‘after therapy’ scores
were taken at the end of the therapy. All the SOC scales
showed a signicant improvement; a correlation be-
tween the trauma scores and the individual SOC scales
showed that there was a signicant relationship between
the changes in trauma symptoms and all the SOC scales
(Table 5).
OHPs providing services in emergency services where
there is a higher risk of workers being exposed to
traumatic events, materials or victims need the evi-
dence to show that there is a benet to introducing a
OH-managed trauma therapy programme. This is par-
ticularly important where there are known psychological
trauma hazards leading to the statutory duty to undertake
screening and surveillance to identify employees experi-
encing signs of PTSD [23]. While employee assistance
programmes can offer general counselling, they rarely
have the specialist trauma therapists available to offer
trauma therapy. Trauma therapy in the UK is available
from the NHS via the Improving Access to Psychological
Therapies (IAPT) [24]; however, this often involves long
delays (6–18 weeks) with services that have not been
tailored to the needs of ESPs or their organizations. The
recovery rate standard for IAPT is 50% of referrals.
The trauma therapy programme was therefore de-
veloped to meet the unmet needs of emergency services
where it is important to be able to return emotionally
t ESPs to duty enabling them to carry out their duties
which frequently expose them to challenging relation-
ships and traumatic situations. This review demonstrated
that the trauma therapy programme reduced the symp-
toms of trauma in >90% of those referred and that over
80% of ESPs were no longer experiencing clinical levels
of symptoms at the end of the therapy, signicantly
higher than the aim of a 50% recovery rate identied
by IAPT [24]. As reported, however, a small number of
ESPs were found to have a higher level of symptoms at
the end of the therapy. This result was unsurprising given
Table 1. Percentage of ESPs affected by childhood, adult and work-related trauma
Gender nChildhood Adult Work Mean number
Type Trauma Abuse Loss Trauma Relationship Abuse Primary Secondary Relationship
Male 194 27% 17% 11% 32% 21% 2% 68% 51% 17% 2.86
Female 235 38% 28% 21% 37% 34% 11% 51% 52% 20% 3.57
Total 429 33% 22% 17% 35% 28% 7% 58% 51% 18% 3.24
t score 2.98 2.88 2.93 1.58 3.38 3.06 −2.97 1.34 1.24 3.84
Signicance 0.000 0.000 0.000 0.016 0.000 0.000 0.000 0.859 0.015 0.028
Table 2. ‘Before therapy’ and ‘after therapy’ scores for anxiety, depression and PTSD
Range Mean nSD SE Mean
tSignicance Clinical
% < Clinical
Lower Upper Before After
Anxiety before therapy 0–9 7.5 377 1.6 0.8 3.5 3.3 3.9 24.6 0.000 5 80 24
Anxiety after therapy 4.0 2.8 0.1
Depression before therapy 0–9 6.2 378 2.0 0.1 3.1 2.8 3.4 21.6 0.000 3 81 30
Depression after therapy 3.1 2.7 0.1
PTSD before therapy 0–92 63.3 377 14.3 0.7 30.8 28.5 32.9 27.0 0.000 50 84 19
PTSD after therapy 32.7 20.7 1.1
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that many of those in the programme returned to work
while they were in therapy and were exposed to trauma
triggers which caused an increase in symptoms; others
with more signicant trauma symptoms had entered the
process of medical retirement which may have affected
their level of engagement in the therapeutic process.
Future studies should follow up ESPs that have been
through the programme to establish whether the bene-
ts achieved in this review are maintained over time. It
may be possible to look at levels of sickness absence in
the year before trauma therapy and compare them with
the absence levels in the year following the completion
of the rehabilitation of the ESP; this evaluation could
begin to establish some of the nancial benets of the
One of the surprising ndings from the review was that
ESPs could be working at 37% or less of their capacity
without being identied by their manager as requiring
Table 3. ESPs’ perceptions of their capacities and resilience assessed in the nal therapy session
Mean nSD SE Mean difference 95% condence
Lower Upper
Understanding of symptoms before therapy 2.01 375 0.93 0.05 2.41 2.52 2.31 44.95 0.00
Understanding of symptoms after therapy 4.42 0.64 0.03
Coping with symptoms before therapy 1.90 375 0.98 0.05 1.57 1.69 1.44 25.34 0.00
Coping with symptoms after therapy 3.47 1.14 0.06
Relationship with colleagues before therapy 2.95 375 1.17 0.06 0.90 1.00 0.80 17.35 0.00
Relationship with colleagues after therapy 3.85 1.02 0.06
Relationship with manager before therapy 2.91 375 1.29 0.07 0.76 0.87 0.65 13.66 0.00
Relationship with manager after therapy 3.67 1.15 0.06
Satisfaction with life before therapy 2.23 375 1.01 0.05 1.56 1.67 1.45 27.40 0.00
Satisfaction with life after therapy 3.79 0.92 0.05
Ability to deal with problems before therapy 1.76 375 0.80 0.04 2.03 2.14 1.92 36.19 0.00
Ability to deal with problems after therapy 3.79 0.89 0.05
% of capacity working at before therapy 37% 375 25.5 1.35 31.2% 34.15 28.78 28.05 0.00
% of capacity working at after therapy 69% 28.3 1.50
Table 4. SOC scores measured in screening before and after therapy
Mean nSD SE Mean difference 95% condence
Lower Upper
SOC meaningfulness before therapy 16.77 375 5.41 0.28 2.1 2.71 1.49 6.77 0.00
SOC meaningfulness after therapy 18.87 5.43 0.28
SOC comprehensibility before therapy 17.61 375 6.07 0.31 4.6 5.33 3.94 13.17 0.00
SOC comprehensibility after therapy 22.24 6.38 0.33
SOC manageability before therapy 13.49 375 5.33 0.28 3.2 3.74 2.57 10.63 0.00
SOC manageability after therapy 16.65 5.64 0.29
Table 5. Correlation between the change in scores for trauma and SOC measures before and after trauma therapy
Changes in trauma scores before and after trauma
therapy Correlation 0.33 0.38 0.41
0.000 0.000 0.000
n 369 369 369
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a referral to OH. This nding reinforced the benet of
undertaking regular psychological screening of emer-
gency service workers and others in roles where there is a
high risk of psychological trauma. It would be interesting
to see if introducing a proactive programme of education
and resilience skills training reduced the levels of trauma
found in the psychological surveillance results of these
The SOC questionnaire is recognized as a reliable in-
dicator of psychological resilience to trauma [11]; the re-
sults from this review showed that ESPs receiving trauma
therapy signicantly increased their scores on this
measure, suggesting that the trauma therapy programme
may do more than simply reducing the clinical symp-
toms. It is possible that the SOC provides the framework
for enabling emergency services to work with their ESPs
to create more meaningful work, opportunities to under-
stand how their role ts with the objectives of the organ-
ization and to nd ways to manage role demands which
will not only increase job satisfaction but also reduce the
incidence of traumatic stress.
The lifelong traumatic experiences showed that it
was common for ESPs to have been exposed to mul-
tiple traumas including childhood traumas. This mul-
tiple traumatic exposure suggests that some ESPs may
be experiencing complex PTSD (c-PTSD) [25] rather
than simple PTSD. If this is the case, the results may be
even more interesting as the ESP trauma therapy pro-
gramme is short term rather than the long-term c-PTSD
treatment [26]. The diagnosis of c-PTSD was only for-
mally recognized in the International Classication of
Diseases in 2018 [27] but, with the development of the
International Trauma Questionnaire [25], which meas-
ures both PTSD and c-PTSD, it is possible for future
studies to assess ESPs for c-PTSD.
The trauma programme in this review was embedded
within OH and designed to maximize opportunities for
multidiscipline working [28]. It is likely that some of the
benet came from the close working between the trauma
therapy programme and the OHPs who provided the
vital link between the programme, the manager and the
employees, ensuring that a holistic approach was taken
to well-being. It would be interesting for future studies to
look at the relative contribution of each element of this
collaborative support.
There are several limitations for this review: there
were variations in the therapy offered, some ESPs were
treated with TF-CBT, others with EMDR and a third
group with a combination of TF-CBT and EMDR. It
is not therefore possible to say if one model was more
effective. Twenty-four trauma therapists were engaged
in providing the support, and, while each adhered to
the TF-CBT or EMDR protocols, there are inherent
differences in the personal styles and approaches to the
trauma therapy. However, as has been demonstrated,
the most signicant factor in therapeutic effectiveness
is the nature of the relationship rather than the thera-
peutic model [29]. It is also acknowledged that the
review relied on self-report questionnaires; however,
there was some anchoring, with each of the ESPs re-
ferred being seen by a psychologist qualied to under-
take a trauma assessment to increase the reliability of
the formulation.
Despite its limitations, the programme was valued by
ESPs and their organizations for providing timely sup-
port to ESPs experiencing symptoms of trauma. The
trauma therapists found it rewarding to be involved in
providing trauma therapy, particularly the opportunity
to be able to provide suggestions to assist rehabilitation.
OHPs appreciated the additional information and sup-
port provided by the programme’s psychologists and
therapists which they saw as enhancing the services they
were able to provide.
Competing interests
None declared.
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SOM annual photo competition
SOM has launched its photo competition again to cele-
brate what OH looks like. We want to use the photos to
visually show what OH is and to bring to life what our
members and wider OH community do across all of our
comms channels including our website, eNews, LinkedIn,
blogs and Twitter prole. Our ambition is that the photos
will give people working in OH a sense of pride when they
look at them and give others a better understanding of
what OH is. The two winning photos will be displayed on
our annual report, on our website and eNews. Enter by
emailing Judges of senior OH
professionals will agree on a shortlist. Deadline: 30April.
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... The officers had consented to the data to be used to provide management information to monitor and audit the effectiveness of the service and to identify opportunities to improve the well-being of the officers and staff. Following the screening, officers or staff members found to have clinical symptoms to have exceeded the cutoff levels for a referral to an OH professional or to a psychologist were provided with a follow-up assessment and where appropriate a referral for general counselling or trauma therapy (Tehrani, 2019) bv. ...
... Suggestion: Introduce easy access to trauma therapy programmes (Tehrani, 2019). ...
Police officers play an important role in protecting the community. During the COVID-19 pandemic, their role has posed a serious threat to their physical and psychological health and well-being. This study was designed to assess the prevalence of anxiety, depression, PTSD and compassion fatigue in police officers and to identify the factors that predict COVID-19-related physical and mental well-being. As part of a regular health surveillance programme, 3863 police officers recorded their physical exposure to COVID-19 and the extent to which COVID-19 had affected their psychological well-being. The study provides suggestions on developing evidence-based well-being interventions for policing.
... We used clinical data to evaluate the effectiveness of a service providing brief trauma-focused interventions to police officers with PTSD and CPTSD. A recent evaluation of the service programme shows benefits in emergency service workers with PTSD [19]; however, effectiveness for CPTSD has not yet been investigated. ...
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Background Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma. Aims To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups. Methods Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness. Results Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type. Conclusions Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.
... OH practitioners would be encouraged by the good outcomes reported in the use of short-term trauma therapy within an occupational health framework for emergency service organizations; the study supports the development of a practitioner-led business case for a trauma intervention involving objective and perceptual factors (in support of SOM's value proposition) [8]. Indeed, while studies in this issue (including from Brazil, Australia and The Netherlands) focus on negative impact of the uniformed occupations, the majority of their study populations remained healthy; resilience, after all, usually develops from exposure to adversity. ...
... Following traumatic exposure, many workers experience upset and distress that may reduce their productivity, cause absence, and increase accidents and errors (McNally et al., 2003). In a group of traumatized emergency service workers, the perceived capability to perform at work was estimated to be 37% of their normal level of performance (Tehrani, 2020). For most, the psychological impact will reduce over the next few days and weeks. ...
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Background: In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aims: This scoping review was designed to identify research which evaluates the use of early interventions in emergency and other high-risk organizations following exposure to primary or secondary trauma and to report on the effectiveness of the early intervention models in common use. Methods: A scoping review was conducted to examine early interventions for workers exposed to trauma, including emergency response, military, and humanitarian aid. Relevant data were extracted from the included studies and the outcomes were assessed using meta-ethnography. Results: Fifty studies of mixed quality met the inclusion criteria for this review. A synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they are delivered in a manner that (a) respects distinct organizational culture, (b) is supported by organizations and senior management, and (c) harnesses existing social cohesion and peer support systems within teams. Conclusion: This review demonstrates that early interventions support emergency responders following exposure to trauma when these are tailored to the needs of the population, are supported by the host organization, and harness existing social cohesion and peer support processes within a team or unit. A number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organizations were made.
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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.
Objectives: The purpose of this study is to provide basic data for the development of effective post-traumatic stress disorder (PTSD) intervention programs for firefighters.Methods: Four domestic and four abroad databases were used, and 7 domestic and 4 abroad studies that met the criteria of this study were selected for systematic review and meta-analysis.Results: The overall effect size of the PTSD intervention program was 0.40 (95% confidence interval, CI: 0.17-0.64, p<0.05) in domestic and 0.37 (95% CI: 0.02-0.71, p<0.05) in abroad.Conclusions: Various domestic and abroad intervention methods for PTSD of firefighters have low effects. Therefore, based on the results of this study, it is necessary to develop and apply a post-traumatic stress disorder intervention program for firefighters.
Background: Prior to COVID-19 there had been a renewed policy focus in the National Health Service on the health and well-being of the healthcare workforce, with the ambulance sector identified as a priority area. This focus is more important than ever as the sector deals with the acute and longer-term consequences of a pandemic. Aim: To systematically identify, summarise and map the evidence regarding mental health, well-being and support interventions for United Kingdom ambulance services staff and to identify evidence gaps. Method: Evidence mapping methodology of published and grey original research published in English from 1 January 2000 to 23 May 2020 describing the health risk, mental health and/or well-being of UK ambulance services staff including retired staff, volunteers and students. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases, plus EThOS, Zetoc, OpenGrey and Google, were searched, alongside hand-searching of grey literature and bibliographies. Information was extracted on study aims, sample, design and methodology, funding source, country and key findings. Included studies were categorised into seven a priori theme areas. Results: Of 1862 identified articles, 45 peer-reviewed studies are included as well as 24 grey literature documents. Peer-reviewed research was largely observational and focused on prevalence studies, post-traumatic stress disorder or organisational and individual social factors related to health and well-being. Most grey literature reported the development and testing of interventions. Across all study types, underpinning theory was often not cited. Conclusion: To date, intervention research has largely been funded by charities and published in the grey literature. Few studies were identified on self-harm, bullying, sleep and fatigue or alcohol and substance use. Theoretically informed intervention development and testing, including adaptation of innovations from other countries and 24-hour workforces, is needed. This evidence map provides important context for planning of staff well-being provision and research as the sector responds to and recovers from the pandemic. Prospero registration number: CRD42018104659.
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Purpose The purpose of this paper is to examine the role that psychological screening and surveillance can take in improving the delivery of psychological support to emergency service responders (ESRs) at a time of increasing demands and complexity. Design/methodology/approach The study aims to present and discuss the use of psychological screening and surveillance of trauma exposed emergency service workers. Findings The evidence supports the use of psychological screening and surveillance using appropriate validated questionnaires and surveys. Research limitations/implications The findings suggest that emergency services should be using psychological screening and surveillance of ESRs in roles where there is high exposure to traumatic stress. Originality/value These findings will help emergency service organisations to recognise how psychological screening and surveillance can be used as part of a wider programme of well-being support. This approach can also help them meet their legal health and safety obligations to protect the psychological health and well-being of their ESRs.
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Occupational health specialists enhance employee health, workforce productivity, business performance and the economy " This report provides a comprehensive analysis and evidence review of the value of occupational health. It comes at a critical time for the policy agenda for work and health, and the challenge of the productivity gap. It is essential reading for managers, clinicians and policy makers. "
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Psychological Screening and Surveillance in the Workplace Noreen Tehrani Health surveillance and screening are a familiar part of an occupational health advisor’s role involving a systematic approach to the identification of early signs of work-related ill-health or injury. The Management of Health and Safety at Work (1999) legislation provides the framework with a specific reference to the need for surveillance “Every employer shall ensure that his employees are provided with such health surveillance as is appropriate having regard to the risks to their health and safety which are identified by the assessment.” Surveillance falls within the wider Risk Control and Management Cycle in which organisations are required to undertake key five activities: 1. Identify the risks in the workplace: What hazards exist and how could these hazards affect the health and wellbeing of employees? 2. Find out who might be harmed and how this might occur: Who might be exposed? Which groups are particularly vulnerable? How could they become exposed? Which roles or tasks are particularly hazardous? 3. Analyse and evaluate the level of risk: What is the likelihood of an injury occurring? What could be the magnitude of harm caused? How can the risk be measured? 4. Establish ways to reduce the risks: What are the control measures? Are they proportionate? How should they be implemented? Who would be responsible? 5. Record, monitor, review and improve: How is the surveillance programme working? How do we compare with other organisations? What can we do to improve? Whilst occupational surveillance shares some of the features and tools of clinical research it is not designed to generate or create new scientific knowledge but rather it uses existing knowledge and research to prevent disease or injury, enhance resilience and increase wellbeing in employees who may become exposed to an identified health hazard (Otto et al. 2014). A review of the risks inherent in organisations (European Agency for Safety and Health at Work, 2011) identified a number of hazards inherent in emergency services these included physical exposures including: musculoskeletal hazards, radioactive substances, chemical substances, biological substances; however in addition to these physical hazards the agency also identified psychological hazards including exposure to disasters, dealing with multiple deaths, body recovery, transport accidents, terrorism, fires, shootings and other threats to life. The HSE has also identified a number of psychosocial workplace hazards that are less extreme including bullying, harassment and workplace stress (Rick et al. 2001). This article is concerned with the need for OH providers to engage in undertaking surveillance in relationship to known psychosocial workplace hazards which have been shown to cause harm to workers. The surveillance of psychosocial hazards should be treated with the same importance and urgency as physical surveillance in order to support organisations to meet their duty of care to their workforce (ACAS, 2012).
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Resilience may mean different things to different researchers and practitioners in psychology and public health: A process, an outcome, a dynamic steady state in the face of adversity, and defiance of risk/vulnerability are among the variety of understandings of the concept that are extant. This article summarizes the results of a systematic review of the literature on definitions and measurements of resilience. It is evident that resilience is more than the absence of “posttraumatic stress disorder,” just as health (and indeed mental health) is more than the absence of disease (or mental/behavioral disorder). A multidimensional construct, resilience a requires a multimethod and multilevel study design that combines both qualitative and quantitative techniques to be examined satisfactorily. Seven selected studies are discussed in detail, highlighting examples that offer a fuller understanding of resilience in its sociocultural and ecological context.
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Employers are becoming increasingly aware of the risks to employee wellbeing associated with the traumatic incidents that occur in the workplace. Despite this increased organizational awareness of the need to protect employees from the damaging effects of traumatic events, there has been little provision to help organizations to evaluate their management systems and post trauma interventions. This problem of a lack of evaluation has become more important as a growing body of evidence has provided evidence that suggests that trauma debriefing, the widely used approach to traumatic stress may be ineffective or damaging. The problem for an organization is to have a means of assessing the impact of a traumatic incident on exposed employees soon after the event and at regular intervals as a way of tracking the effectiveness of the treatment and rehabilitation programme. This paper examines the development and validation of a traumatic stress questionnaire designed to be used by trained practitioners working with traumatized employees. The extended impact of events scale (IES-E), took the 15 items from the impact of events scale (IES) and added eight new items which had been chosen on the basis of existing theory and clinical experience to represent the traumatic stress symptom of hyperarousal. Two studies are reported which examine the structure and reliability, and then the discriminant validity of the extended scale when used with a working population. The first study involved a factor analysis of the IES-E items using data collected from 105 subjects who had formally reported exposure to stressful work events to their employing organization. The second study then used the IES-E to compare employees self-reporting of the impact of either a major positive or a major negative life event. The results of the first study confirmed the presence of the re-experience and avoidance symptoms as a response to a traumatic event (as in the IES) but, in addition, identified a new factor, arousal and a new measurement model based on a single general factor. The reliability coefficients for all three scales and the general factor were found to be good. The second study showed that IES-E scores on re-experience, avoidance, arousal and the general factor could be used to discriminate between the subjects reporting major positive and negative life events. Two measurement models can therefore describe the impact of stressful events, the first based on three orthogonal factors, and the second based on a single general factor. The theoretical implications of these findings are explored.
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Abstract Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.
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Background: Work-related post-traumatic stress disorder (PTSD) is an important condition encountered by many occupational health practitioners. Aims: To carry out an in-depth review of the research on occupational groups that are at particular risk of developing work-related PTSD. Methods: A literature search was conducted in the databases OVID MEDLINE, OVID Embase, Ovid PsycINFO, ISI Web of Science and CSA Health and Safety Science Abstracts. Results: Professionals such as police officers, firefighters and ambulance personnel often experience incidents that satisfy the stressor criterion for the PTSD diagnosis. Other professional groups such as health care professionals, train drivers, divers, journalists, sailors and employees in bank, post offices or in stores may also be subjected to work-related traumatic events. Work-related PTSD usually diminishes with time. Conclusions: Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD. Prevention of work-related PTSD includes a sound organizational and psychosocial work environment, systematic training of employees, social support from colleagues and managers and a proper follow-up of employees after a critical event.
The following values have no corresponding Zotero field: ID - 47
SUMMARY This paper provides a critical look at the challenges facing the field of health promotion. Pointing to the persistence of the disease orientation and the limits of risk factor approaches for conceptualizing and conduct- ing research on health, the salutogenic orientation is presented as a more viable paradigm for health promo- tion research and practice. The Sense of Coherence framework is offered as a useful theory for taking a salutogenic approach to health research.