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  E.A.R. Model for Field Trauma Response

(© Baranowsky & Watson-Elliott, 2002)

This model has been developed based on the recent research, debates and in recognition of the need to have up-to-date methods of early intervention following trauma. The model pulls the best from the Psychological Debriefing models (i.e., Education, Assessment & Referral) while reducing the potential for harm. As we have seen in recent articles, the debate about the efficacy of the seven-step Mitchel model (CISM/D) continues to raise concerns. Current research does not consistently show evidence to support the use of this model. This is particularly true in circumstances where members of a "debriefing" are not part of a team, are not known to an organization/team/community and/or do not have easy access to follow-up care and ongoing treatment if needed. Nonetheless, it is premature to entirely discard the model based on the basis of uncertain research findings. There appear to be circumstances in which CISM/D continues to offer a useful approach (i.e., emergency response professionals, organizations that continue to work together in teams, situations where follow-up care is readily available). In addition, there may be a utility for this intervention that goes beyond the limited information gleaned from research to date (i.e., reductions in substance abuse and self-harm, early screening and self-screening, psycho-education).

Regardless of the approach used, there continues to be a need for preventative early screening and education following traumatic events. This model is in the early stages of development but we hope it will result in a process to address early intervention needs based on current research and literature. For more information on current issues regarding the use of Psychological Debriefing, CISM/D or other forms of early intervention see the following reference documents:

  • Litz, B., Gray, M., Bryant, R., Adler, A., Reed, W. Early Intervention for Trauma: Current Status and Future Directions. (in press). Clinical Psychology: Science and Practice. Posted with permission [Available on-line].
  • van Emmerik, A., Kamphuis, J., Hulsbosch, A., Emmerik, P. (2002). Single Session Debriefing After Psychological Trauma. The Lancet, 360, 766-771.

Three of the most important aspects of Early Intervention methods are: (1) Education regarding potential psychological symptoms or warning signs that may result following exposure to a traumatic event; (2) Identification of those at risk of developing more severe symptoms and (3) Referral to appropriate services when required. Clearly it would be difficult to assess need or inform trauma survivors of appropriate services if early intervention by skilled professionals were not conducted. This early intervention model aims to reduce stress, to improve adaptive functioning, and to refer individuals to the appropriate resources for follow up.

Meichenbaum (1994) has suggested that responses to traumatic experiences can be divided into four categories: emotional responses, cognitive responses, behavioural responses, and physical or biologically based responses. It is important for us to give victims and survivors information regarding the types of responses they may experience as well as effective coping strategies to employ. This can be done within the framework of EAR.

Early interventions for post trauma events have the potential to identify those at greatest risk and may even save lives. If we remember the elevated suicide statistics among emergency workers following the Oklahoma City bombing it should alert us to the need for skilled Traumatologists to direct those in need to more comprehensive care.

The EAR model stands for Educate, Assess and Refer. These tasks make up the key elements of this early intervention model.

1. EDUCATE

Group Psycho educational Session

  • Approximately 15 – 30 minutes in duration
  • Provide information on “Normal Traumatic Stress Responses” Emotional, Cognitive, Behavioral and Physical.
  • Timeframe common for recovery process (Acute Stress Reactions up to 4 weeks)
  • Expect most to recover within 4 weeks
  • Suggestions for survivors if things worsen after 4 weeks instead of improve
  • What to do to care for self within the first days and weeks after the event. Breath, Anchor, Grounding and Support
  • Early Warning Signs: Breathing, Heart Rate, Confusion, Sweating, Faint, Shaking, Startle, Disrupted Sleep, Panic, etc.
  • Handouts (not included here) for Self-Care; Trauma Symptoms over time; Who to contact for further assistance or referrals

Individual Education Session

  • See above
  • Attempt to address any specific concerns
  • This may include accurate information on what the next steps are for individuals or for loved ones.

 

2. ASSESS

This component of the model is to be conducted on an individual basis. Our first priority is identification of those who may be in greatest need for future care or prevention. Speak with those involved directly or indirectly to assess their current and future requirements. This is a brief assessment and not a clinical interview. It is important to offer an EAR to listen without demanding a full replay of events at this stage. Stay focused on the current situation. Assessment is the key to getting the critical information you need to determine if the clients need immediate or future help. In addition it provides you with information to determine appropriate referral agents.

Degree of Event

  • First-Degree Trauma: Minor or secondary exposure; no previous trauma experience; no personal loss or injury; not personally connected with those most impacted by trauma. Event serious but no loss of life or physical injury.
  • Second-Degree Trauma (Type I & II): Type I: Moderate or secondary exposure; possibly personal history of mental health illness or traumatic experience; personally connected with event either through professional work or as witness to events. Not physically harmed or threatened personally. Event may involve significant injury but no loss of life. Not large scale or mass destruction. Type II: Moderate or secondary exposure; possibly personal history of mental health illness or traumatic experience; personally connected with event either through professional work or as witness to events. May be physically harmed or threatened personally. Event may involve significant but injury no loss of life. Not large scale or mass destruction.
  • Third Degree Trauma: Most serious trauma exposure; possibly personal history of mental health illness or traumatic experience; personally connected with event. Physically harmed or personally threatened. Event involves significant injury and possibly loss of life(s). May be large scale or mass destruction.

Safety / Urgency of the Situation:

  • Is the person danger to themselves or others? Present or future?
  • Is the person at risk of harm from others? Present or Future?

If there are any safety concerns or the person presents in immediate crisis a more comprehensive crisis intervention and suicide risk assessment should take place at this time. Refer to various models of crisis intervention and suicide risk assessments included in the following training courses and manuals (see www.ticlearn.com for online training):

Resources:
  • Internal
  • How is the current situation manifesting itself cognitively, emotionally, behaviorally, and physically?
  • Make a general measure of the survivor’s functioning at a cognitive, emotional, behavioral, and physical level.
  • Does the survivor have a history of dealing with difficult situations, previous trauma? How did they cope last time something happened? How do they cope with stress? Ask them to tell you about this?
  • External
  • Look at the appropriateness and availability of the client’s personal support system. For example family, friends, etc.
  • Who or what is available for the client? Is the client willing to and able to access these supports?

ISSUES TO CONSIDER

  • Degree of closeness to event **
  • Severity of Event
  • Previous Trauma Exposure
  • Previous Mental Health Problems
  • Previous Physical Health Problems
  • Sleep Disturbance **
  • Intrusive thoughts and images **
  • Age
  • Degree of life threat
  • Degree of injury (very high risk factor)
  • Additional victim variables (age, race, lower social economic status, sex)
  • Intentionality
  • Job Demands
  • Years of experience on job (if exposure is work related)
  • Hardiness & Resiliency
  • Suicidality Risk Factors
  • Symptoms (ASD < 4 weeks; PTSD > 4 weeks)
  • Other Stressers (ongoing) Family, Social, Occupational, Educational, Financial, Other?
  • Global Check Set as quick check of symptoms (including suicidality) (visit www.psychink.com for a copy of this scale)
  • Remember that even those with exposure to Third Degree Trauma may never develop symptoms of Post-Traumatic Stress Disorder and may recover very well without further assistance.

3. REFER

  • Identify those in need of further care and make appropriate referrals for short-term Trauma Therapy or Recovery and Resiliency Group work
  • Follow-up (3-6 weeks after initial meeting) with those referred for early intervention services
  • Follow-up (3-6 weeks after initial meeting) with those identified as possible future need but not referred yet. Determine if referral is necessary at this time
  • Use of “Contact Sheet” from 1001 manual (Not included here)