Trauma Treatment International hosted an Experts’ Day to gather evidence to design and inform our Organisational Trauma Exposure Assessment process.

In 2021 Trauma Treatment International is working with organisations in order to deliver Organisational Trauma-Exposure Assessments (OTEA). These organisations that we are working with are in contact with beneficiaries who have experienced torture, slavery, war, trafficking, and other forms of organised violence. Therefore, the staff of these organisations is at risk from extended trauma exposure as they are recurrently being exposed to the traumatic experiences of others. Without a trauma informed lens on both organisational delivery and workforce functions, organisations face:

• High rates of burnout, stress, mental ill-health, or vicarious trauma amongst staff and volunteers

• Lost days of work due to sickness

• High turnover of frontline workers

• Less effective interventions for trauma victims

• Increased organisational vulnerability to shocks and external stressors

In order to guarantee that the workforce is capable of delivering their best effort to their work, as well as ensuring that beneficiaries are efficiently being taken care of, it is essential that organisations are able to provide suitable wellbeing support to staff. Particularly during this difficult time with Covid-19 and the prevalence of lone working from home, it is more important than ever to check in with everyone’s mental health and wellbeing.

What is involved in an Organisational Trauma Exposure Assessment?

OTEAs usually include the following components:

• Planning: in consultation with the leadership team and Board

• Assessment research: participatory workshops, interviews, documentation reviews, and clinical assessments

• Report: all findings compiled into a report that can be shared with Board, staff, donors, and other stakeholders

• Recommendations: key actions to reduce risk and strengthen the organisation and delivery

• Ongoing support: where clinical intervention and expertise are needed, TTI can provide a range of support services, such as workforce therapy and counselling.

Consultation with expert advisors

TTI’s work has a strong focus on providing evidence-based interventions. The design of TTI’s OTEA process was based on the evidence of what works, as well as feedback and input, provided by a range of experts with a combination of clinical and research backgrounds. Consultation took place on a TTI hosted Experts Day on 11th October 2019.

The following subjects were discussed during the Experts Day:

• ‘Proactive and Preventative Measures’,

• ‘Trauma Informed Practice’, and

• ‘Critical Incident Aftercare’.

Proactive and preventative measures

This aspect of Organisation Assessments is about mitigating the impact of trauma and traumatic stress arising from the working environment, including a possible critical incident in the future. It is intended to flush out key factors that reduce the burden on employees exposed to stressful and/or traumatic events regularly, including vicarious trauma. It is also suspected that these factors will offer some protection in the event of a critical incident. A few examples that were discussed by the experts are:

• Emotionally intelligent line management: tools and capacity to talk to staff.

• Flexible working/good life-work balance.

• Health and safety duty of care framework: not always currently seen as encompassing psychological harm.

Trauma Informed Practice

This factor relates to the hypothesis that being more trauma informed reduces the distress of the staff who work with trauma exposed people. The idea is that there is not only direct benefit to the beneficiaries, but because their needs are better met, they are less stressful to work with, making staff roles easier. It includes the understanding that some staff in organisations will also have a trauma history. Additionally, it was discussed at the event that there are multiple benefits to applying trauma informed practice within the workplace of these organisations, such as the following:

• A more resilient workforce

• Cost-effectiveness increased: retaining staff by building their resilience is cheaper than firing them.

• The staff feels valued by the organisation and, in turn, so do the beneficiaries they serve.

Critical Incident Aftercare

Within this section, it was questioned what an organisation and/or individual can do to mitigate traumatic stress following a critical incident. For example, it was discussed that organisations would need to assess the degree of trauma that an individual may be facing and decide the degree of social support that is required to help them.

The Experts

The following individuals are those who attended the event and provided their input on the significance of organisation assessments.

Dr. Sarah Davidson 

Dr. Sarah Davidson is the Head of Psychosocial and Mental Health for the British Red Cross and a Consultant Clinical Psychologist in a specialist, national service at the Tavistock and Portman NHS Foundation Trust. Sarah is also the Chair of the International Federation of Red Cross and Red Crescent’s European Network of Psychosocial Support, and the professional lead of the Psychosocial Support Team (PST).

Professor Neil Greenberg (BM, BSc, MMedSc, FHEA, MFMLM, DOccMed, MEWI, MInstLM, MFFLM, MD, FRCPsych)

Professor of Defence Mental Health and Managing Director of March on Stress Ltd

Professor Greenberg is a consultant academic and occupational psychiatrist at King’s College London. Neil served in the United Kingdom Armed Forces for more than 23 years and has deployed to a number of hostile environments including Afghanistan and Iraq. He took up the Chair of the Royal College of Psychiatrists’ Special Interest Group in Occupational Psychiatry in October 2018.

Dr. Helen Winter 

Dr. Helen Winter works as a Clinical Psychologist, overseeing the implementation and evaluation of Staff Support work for SLaM. Support is provided across a range of projects (including Critical Incident Staff Support and Schwartz Rounds) from within Corporate Psychology and Psychotherapy, and available to staff of all disciplines across the organization. Helen has a special interest in Trauma Informed Care and the role of Staff Support in trauma-exposed organisations, including the crucial role it can play in supporting the reduction of restraint and restrictive practices.  

Noreen Tehrani

Noreen is the Past Chair of the Crisis, Disaster, and Trauma Section of the British Psychological Society and has worked with various aspects of trauma for a long time. Noreen has written many articles, papers, and book chapters including two books on trauma Workplace Trauma – concepts, assessment and intervention and Managing Trauma in the Workplace

Dr. Richard Amlôt 

Public Health England

Dr. Richard Amlôt is Scientific Programme Leader of the Behavioural Science Team based in the Emergency Response Department at PHE. He leads a programme of research that explores operational, behavioural, and psychological responses to emergencies and disasters, with a particular focus on CBRN incidents.

Professor Stephen Regel

Stephen Regel is Founder and Clinical Lead for the Centre for Trauma, Resilience, and Growth, Nottinghamshire Healthcare NHS Foundation Trust, Hon., Professor, University of Nottingham, and Senior Fellow of the Institute of Mental Health, Nottingham. He trained as a CBT therapist in Sheffield and has over 35 years’ experience working with trauma and Post Traumatic Stress Disorder (PTSD).

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