Lara Bakes-Denman, Clinical Initiatives Coordinator, Mental Health and Specialised Services at West Moreton Health talks about the Peer support program (the program) designed to support employees who have been directly or indirectly exposed to occupational violence and other types of traumatic incidents while on duty. Even though a significant range of prevention strategies have been put in place, there has been an increasing prevalence of occupational violence in the workplace. The program is a positive approach to meeting the mental health and wellbeing needs of Mental Health and Specialised Services employees working in secure, hospital and community based settings in the West Moreton Health region.
How was the Peer support program developed?
The program was initially implemented at The Park – Centre for Mental Health as part of three-year multi-strategy aggression management program in the late 1990s. The program was specifically developed to provide support to employees that had experienced trauma through patient assault.
Initially, the program was based around critical incident debriefing and underpinned by support for employees from a small number of experienced senior nursing and allied health staff in the various Forensic and Secure Services’ units at The Park – Centre for Mental Health. Training was provided over two to three days in order to support employees.
Lara says, ‘over time and with the benefit of a sound evidence-based approach, the program has evolved and now uses Psychological First Aid as a framework.’ The program was expanded and now supports employees in the Prison Health Service, the Community and Acute Services, and operates across all three streams in Mental Health and Specialised Services.
What are the key elements of the Peer support program?
The program is confidential and available to all Mental Health and Specialised Services’ employees, students on placement and volunteers. It is supported by a network of:
- responders (employees trained and available to respond to referrals of those employees in need)
- supervisors (senior level nursing and allied health employees) who provide support to the responders.
The program is managed by two coordinators – one at Forensic and Secure and Prison Health Service and one at Community and Acute Services.
No details of support through the program are recorded on an individual employee’s personnel file. To maintain confidentiality, support to employees through the program is supplied by a provider from outside of the employees’ immediate work unit. Lara commented, ‘we know and understand some employees may feel vulnerable talking to their line manager about the issue; are likely to have doubts about their ability to work in the role; or feel they have a lack of experience compared to other team members. Talking through the issues and concerns with a colleague external to the work unit helps to break down some of the barriers about seeking assistance, supports and helps to maintain the mental health and wellbeing of the employee.’
Following an incident of occupational violence or trauma, employees can voluntarily access the program, although most times employees are referred by a line manager, rather than self-referral. Employees are able to access up to three sessions of Psychological First Aid and these sessions can be delivered in person, by email or by phone from the program provider. With the roll-out of new technology, further access is currently being trialled through web-based delivery. Where possible there is a preference to provide the sessions face-to-face, however given the geographical spread of employees and settings, other modes are necessary.
The first session, within the first 24–48 hrs following the incident, includes direct contact and discussion with a program provider, the provision of a range of Psychological First Aid resources for the employee and resources for the employees’ family. This session can be anywhere from one half hour to three hours in duration. Lara says, ‘it is important we connect as quickly as possible with the employee to talk about the likely impacts and how to manage these, in addition to offering practical support. Likewise, it is important we provide resources for family members on ways to support each other and how they might also access support.’
To monitor and map the employee’s progress following the incident, a revised version of the Impact of Events scale is used by the employee to document the profile and severity of the symptoms experienced. The scale is not used as a diagnostic tool, rather as a way to provide a meaningful tool to monitor progress. If after the three Psychological First Aid sessions are completed, there is no appreciable progress and decline in the symptoms for the employee then referral and support to more specialised resources is provided.
For the second session, this is a follow-up using the Impact of Events scale as a means of identifying progress and decline of the symptoms, and generally is three days following the incident.
For the third session, this is provided 10 days following the incident. Lara commented, ‘some employees, who have made progress (e.g. they experience a decline or absence of symptoms), engage with either one to two sessions. For employees more deeply affected, the third session provides the opportunity to discuss a personal care plan or possible referral to the employee assistance program.’
Coordinators provide a report based on aggregated (de-identified) data to the executive team on a quarterly basis. This broad evidence base is used to monitor the effectiveness of the program and also to ensure sufficient resources and processes are in place to support employees.
What have you learned and where to from here?
Research has been undertaken on the perceptions of employees, providers, supervisors and coordinators of the program and follow-up research is planned in the next 12 months. Research findings show the provider network and the suitability and recruitment of employees is important.
Lara says, ‘not every employee is suitable to be a provider. It is clear from the research available that employees for the provider role need to demonstrate attributes including empathy, respect, good listening, have current experience on the job, be non-judgemental and seen as credible by their peers.’ One key lesson learned is that it is important to use a sound approach to recruiting potential providers in order to get the right fit for the role.
A further learning has been the need to manage a program that is totally voluntarily based. It is crucial the executive team acknowledge that employees go above and beyond their day-to-day roles and provide reward and recognition for this important work. The sustainability of the program over time is a key consideration.
Lara says, ‘the success of the program is a lot about the enthusiasm and commitment of employees to help to support colleagues. The provision of contemporary resources, including real life stories and refresher training is a cornerstone to maintaining the mental health and wellbeing of all those involved in the program. We need to look out for those employees so they can look out for others.’
Email Lara.Bakes-Denman@health.qld.gov.au to learn more about the Peer support program at West Moreton Health.