Prepared by Nancy Crawford, Psy.D.
AIM Care at Tumaini Counselling Centre
Nairobi, Kenya
Background readings:
1. Critical Incident Stress Debriefings for Cross-Cultural Workers: Harmful or Helpful? (2003) by Karen Carr, Mobile Member Care Team (MMCT), Accra, Ghana http://www.mmct.org/critical_incident_stress.php
2. The Post-Trauma guidelines of the National Institute for Clinical Excellent (NICE) of the National Health Service of the UK (2005.) http://www.nice.org.uk/nicemedia/pdf/CG026NICEguideline.pdf
3. Trauma and Critical Incident Care for Humanitarian Workers; a continuing education module of the Headington Institute (2004)
http://www.headington-institute.org/Default.aspx?tabid=2079
From a review of these sources along with other literature, three important principles stand out:
1. Debriefings should be voluntary, not-required.
• To quote from Karen Carr, “if a person feels forced to talk about something that they are not ready to talk about, this can be harmful and detrimental to them. And given that the evidence has not proven that CISD is a beneficial thing, it does make sense that this intervention should be a person’s choice rather than a medicine that is given to them because it’s good for them whether they like it or not.”
2. Debriefings should be need-specific, and not a routine part of post-trauma care.
• To quote from the NICE guidelines, “For individuals who have experienced a traumatic event, the systematic provision to that individual alone of brief, single-session interventions (often referred to as debriefing) that focus on the traumatic incident, should not be routine when delivering services.” (emphasis theirs)
3. Educating leaders and members about the effects of trauma and when to contact a mental health professional is a crucial piece of pre-and post-trauma care.
• To quote from the Headington Institute, “All humanitarian workers should understand the dynamics of trauma and know how to help manage or alleviate trauma reactions. This knowledge decreases their risk of experiencing enduring trauma reactions and increases their resilience – their ability to ‘bounce back’ – more effectively after traumatic events.” (emphasis theirs)
Based on this data, we would recommend a policy of post-trauma care be developed by mission organizations that include the following components:
1. An emphasis on building resilience throughout the membership.
2. An emphasis on pre-and post-trauma care training for mission leadership. This training to include Resilience Building, First Responses, Watching Waiting, and guidance of when to refer for more help.
3. The facilitation of voluntary debriefings/post-trauma care by mental health professionals (such as AIM Care) when either the individual requests such care or his/her leader recommends such care.
Referenced above is a sample of Headington Institutes on-line self-study program for Trauma and Critical Incident Care as an example of a quality training program for mission leaders. This free, on-line resource is in addition to the good training that Mobile Member Care Team offers (see www.mmct.org )
