The Business Case for Workplace Critical Incident Stress Response: A Literature Review of Clinical and Cost-Effectiveness Research
Critical incidents are sudden, unexpected, often life-threatening time-limited events that can inhibit an individual’s capacity to respond adaptively. The impact of critical incidents may be debilitating and stems from recurrent intrusive images, persistent fear, displaced anger, guilt, and isolation. Extreme critical incident stressors can even result in personal crises, traumatic stress, and Post-traumatic Stress Disorder (PTSD). Critical Incident Stress Response (CISR) refers to an integrated comprehensive, multicomponent, crisis intervention approach for addressing the psychological aftermath of critical incidents.
Over the past 25 years a general model of CISR group debriefing has been developed and which can be used to accelerate recovery from traumatic workplace events. CISR can accomplish psychological closure, prevention, and mitigation of traumatic stress, and promote return to normalcy, benefiting the individual, organization, and the community at large.
CISR services have become popular in the United States (Burton, Gorter, & Paul, 2009), the United Kingdom (Regel, 2007) and in many other countries around the world (Mitchell, 2004). CISR services have been provided in a wide variety of occupational contexts, including firefighters (Mulligan, 2001), medical staff (Flannery, 2001), bank personnel (Miller-Burke, Attridge, & Fass, 1999), and for natural disasters (Attridge, Bergmark & Parker, 2002; Vineburgh et al., 2006). CISR services are often included as part of employee assistance programs (EAPs; VandePol, Gist, Braverman, & Labardee, 2006; VandePol & Gilmour, 2008). EAP services are now widely available to over 90% of large size companies in the US and the majority of all employers in the US and Canada (SHRM, 2008; Csiernik, 2002) and thus CISR services are now available, if needed, to millions of workers.
This paper reviews the research literature on the business value that can be achieved when employers and organizations offer critical incident stress response (CISR) services. CISR services are frequently provided as a specialty service from an employee assistance program (EAP). There is a significant body of applied research conducted over the past 20 years worldwide that offers considerable empirical evidence to support the clinical effectiveness of CISR and related “psychological first aid” kinds of workplace services. There are far fewer research studies available to examine the business case for CISR. The literature obtained features a small number of employer case studies conducted in the 1990s and newer investigations of CISR services that are integrated with other behavioral health and benefit management programs.
The research available indicates that CISR services can offer financial savings and business value, primarily from reducing disability and workers’ compensation claims and improving the rate and success of employee return to work after a critical event. The rare event nature of the conditions that create the need for CISR services and their delivery model in applied organizational and workplace settings combine to offer significant challenges to conducting more scientific investigations of the business impact of these services. Nonetheless, additional high quality research is needed before firm conclusions can be drawn about the nature of workplace and claims cost outcomes in this area.
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Emotional Continuity Management, pioneered by Vali Hawkins Mitchell, Ph.D. LMHC, is a valuable tool in the face of workplace disruption. Vali is the author of Emotional Crises in the Workplace: Protecting Your Business’ Bottom Line – Emotional Continuity Management in the Workplace.
Tags: CISR, Critical Incident Stress Response, EAP, emotional continuity management, PTSD
