Member care in crisesDr Debbie Hawkerwww.resilientexpat.co.uk

After a trauma: Psychological First Aid (PFA)Ensure safety (including from rumours/ excessive media)Help contact family membersProvide drinks, food, shelter, practical helpComfort & reassuranceListeningProvide information FREE MANUALS: see resource list

Reducing arousalA key aim is to help reduce the arousal level of people who have been through traumaThis reduces risk of PTSDBe a calming presenceOK to be with them in silenceAppropriate use of touchCan be good not to sleep in the 6 hours after traumaActivities like cross-stitch, knitting or video games can help after trauma

Reducing arousalDeep, slow breathing might helpGrounding techniques: Describe where you are in detail. Be in the present moment (reduces flashbacks & panic)Remind them of time & date & that this is a safe placeSome people sniff a smell associated with happy memories when thoughts of the trauma are triggered (e.g. a nice perfume; lavender; coffee)

Psychological First AidWoman in her 70s fell over.Pedestrians stopped and:Phoned ambulanceHelp her contact her husbandComfort, reassurance, calmed herProvided waterDignity & warmth (offered a coat)Passed on a messageListened

ChildrenChildren need routine, reassurance and to be with people they know and trustShould be protected from mediaInform school of the situationSpecialists can help children, when necessaryHelp re-establish sense of hope and controlSee handout for more information on helping children

The steps of Critical Incident DebriefingIntroFactsCognitionsEmotionsPsy.ed.CopingEnding

Case example: You have just heard that a young woman in your team has died. Her family have not yet been informed.

What needs to happen now? Who breaks the news? How?

RipplesWho needs member care?FamilyFriendsTeamOthers who knew this personMessages to other members of the organisation, Board, supporters etc

Breaking bad newsE.g. death, abduction or missing personNews travels fast. Want to avoid family/ friends hearing about it on media/ social media before you have told themSomeone needs to break the news

Breaking bad newsShould be done with great careBooklet available at http://www.dartcenter.org/content/breaking-bad-news

Breaking bad newsHearing the news might be the worst event in this persons lifeHow the news is conveyed can impact how they will deal with the traumaIt is best to break the news in person wherever possible (especially if death or missing person)If it has to be by phone, introduce yourself and ensure you are speaking to the right person

Breaking bad newsWhere possible, get someone from their culture & language to offer supportRespect their customs Some are not used to talking about personal matters to strangers, especially at a distanceSome dislike phone / internetIts OK if they dont say muchPass on info and say you are sorry

Breaking bad news

Liaise with police / embassy to see what they are doingYou might be the one to break the news, or be with family immediately afterwards with additional details

Prepare beforehand:Find out what exactly happened and when (as many details as you can people often want every detail)Where exactly is the body/ injured person? (Loved ones might want to go to them)What name did relatives know the person by?Prepare what you will say Breaking bad news

Breaking bad newsTake a colleague with you (for emotional support and practical reasons e.g. to look after children or to take over if you become emotional)Dont phone in advance to say you are coming. Try to find out discretely where family are likely to beIdentify yourself and ask if you can come inMake sure you are giving the news to the right person.Dont tell children first

Breaking bad newsThe loved one might faint. Ask them to sit downAsk where you can sit (so you dont upset them by sitting where the deceased always sat)Try to appear as calm as possible, to help reduce their arousal as this will help them cope.

Breaking bad newsDont delay with small-talkBe clear, short and simple e.g. Im afraid I have very bad news. . has died/ been killed/ is missing Dont rush. Be truthfulBe prepared for raw emotion (anger, tears, uncontrollable grief, shock). Allow time for response, questions or silence. They may be unable to speak.

Breaking bad news Your presence is more important than wordsStay as long as they want youBe prepared for many questionsAsk would you like me to tell you what we know so far? and be guided by them about how much detail they wantOffer pen and paper and suggest they might want to write things down (as later they might fail to remember details)Say please stop me at any time, or ask me to repeat detailsSay what you know and be honest about what you dont know.

Breaking bad news Dont promise anything you cant deliverRespond to questions, but dont overwhelm them with more information than they can take inDont ask them to fill in forms at this point those can wait.Be prepared to repeat yourself as they might not be able to take it all in at once.

Breaking bad news Write down their questions if you dont know answer, and offer to try to find out and let them knowExplain that you wanted to tell them as soon as possible and all the facts are not yet known. Helpful phrases include I am so sorry about this newsDont say I know how you feel

Breaking bad news If children are in the house, they may also need to hear the news. Parents might be best to tell them themselves, perhaps with you still present.Avoid terms such as hes gone to sleep or she is in the arms of Jesus about someone who has died.If children then leave the room, one of you may need to look after them

Breaking bad newsSay that you will be the point of contact (or name who will be)Ask who in the family you should contact when you have more information and check best phone number(s)

Breaking bad newsBe prepared for this to take hours, with comfort breaksAsk if there is anyone else they want to contact or to be with them now Who else needs to be told? The family should generally tell people themselves but they might need help with transport/ a phone say dont drive after this news

Breaking bad newsIs there anything else they want you to do?The family may wish to discuss funeral arrangements (e.g. if body needs to be flown home or they want to fly to body), or these might be left for later after they have got over shock

Guide for bereaved familiesFCO provide a lot of practical information in Guide for bereaved families, http://www.fco.gov.uk/resources

Family might be unable to cope with this so you can talk them through step by step

Breaking bad newsI will leave you shortly, so that you can be by yourselves. Is there anything else you want to ask while I am still here?You might want to write down any questions which come to mind, and ask me next time we speakGive them a contact number and let them know when they can call you

Breaking bad newsIf appropriate book your next visit or phone-call (especially if there is more information you have not been able to give this time, or you have paperwork to complete)Write this down for yourself AND the familyIf appropriate, ask the family what they need to do after you leave (e.g. contact people; collect children; arrange time off work)Suggest they think about who can help them at this time

Common reactionsShockAngerDespair, griefMoving on

Handling the mediaGive the family advice about handling the media

Future meetingsTell them how long you have (e.g. we have about an hour today)Family may go to collect the body will someone accompany them? And provide a translator if necessary?Ask about funeral arrangements and whether someone from the organisation can attend/ whether they would like you to speak

Honouring the deadYou may wish to discuss a memorial service It means a lot to the bereaved if you honour the dead. How can you best do this e.g. through literature or press releases?

Contacting familyHierarchy is important in some culturesCan the International Director write to the family?Write to let family know how much you valued the contribution their loved one made

Dont forget colleagues and friendsWhat support do the team on the ground need?How can they contribute to articles or letters for the family?Will they have a memorial service too?

Longer-termIt is important that the family feel supported Particularly acknowledge special occasions (e.g. the first birthday or Christmas without their loved one; or the first anniversary of the event) perhaps send a card or flowers saying you are praying for them

Longer-termDont let the family become emotionally dependent on you, or they will face a second bereavement when you pull out.Encourage them to accept support from friends, family, church etcYou have an important role to play, in encouraging them to seek further help if you think they would benefit

Further helpDoctor might be able to provide help (e.g. for depression, insomnia, PTSD or alcohol abuse)Or find a local counsellorOr charity e.g. www.crusebereavementcare.org.uk or Support after Murder and Manslaughter (SAMM) Abroad www.SAMMabroad.org

Self-careYou also need support and occasional relief from this roleAfter handling a crisis, take care of yourselfDo you need time off?

Back to case study 1A young woman diedPolice broke news to parents (after waiting for their return) & left after a few minutes while they were still in shock. Police didnt have the details family wanted2 people from the organisation spent a long time with parents comforting, giving details, answering questions

Case study 1 cont.The same 2 people remained in touch with parents and attended the (traumatic!) funeral serviceOngoing support given during the long process of inquestColleagues also needed to be informed and supported by the organisationHousemates supported while they were investigated (Why sudden death?)

Handling the mediaProvide written information about handling the media, e.g. the handout A familys guide to handling the media during and after a kidnapping downloaded from www.hostageuk.org

Handling the media: Info for families In most cases it is NOT advisable to speak to the media as it can be very stressful (and in the case of abduction it may have negative impact on the hostage, making them seem more valuable, which can prolong negotiation and may lead to selling the hostage on)

Handling the media: Info for familiesExplain that they dont have to tell the media anythingIf the family DO want to talk to the media, advise them to think clearly about what they want to achieve, and what they will say.

Handling the media: Info for families Journalists might turn up at the door, phone landline or mobile, or try to speak to neighbours, extended family, friends or colleaguesAsk people not to commentConsider having one person as the point of contact for media, and request that no other family/ friends speak to media. Maintain a consistent message.

Handling the media: Info for families Try to be polite with the media. You might want their help at some point.Note the name, paper and contact details of each journalist you speak to

Handling the media: Info for families If you decide to talk to media, first write down what you want to say. Stick to that and dont say more than you planned.You can email quotes rather than talking to journalistsNote the name, organisation and contact details of each journalist you speak to

Handling the media: Info for families If you speak to 1 journalist, flocks of others might come to your door, each wanting more information/ a better story.To avoid this, set up a single interview to be shared around papers and TV channelsYou can read or issue a prepared statement rather than answering questions

Handling the media: Info for families You can report a journalist to their employer and to the Press Complaints Commission or the police if they trespass on your property or harass youYou can record any conversations with journalists

Social media: Info for familiesIncrease privacy settings on the Facebook/ MySpace etc of the hostage. The media might try to access it for photos and private information. If you dont know how to do this, you can ask the Foreign Office for assistance

How long should family support continue?Depends on the situation and people involvedAfter a month family might start to rebuild their own lives. Encourage them to receive support from friends Let them know how to access professional help if appropriate (e.g. counselling)

How long should family support continue?Unresolved crisis (a missing person) is more difficultAt some point you will need to stop regular supportSay that contact can be resumed by both sides if there is further news

Ending family supportSay that your support role is coming to an endDiscuss what other support is available to them (e.g. friends, church, counsellors)Say good byeLet them know how to get back in touch if a need arises