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Staff Support

A Practical Guide for staff working in HSE Contact Tracing Centres (CTCs)

“ASSIST ME”

A Model of Staff Support

HeHealthcare Worker Helpline: 1850 420 420

25th

March 2020

V1.0

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Reader Information

Acknowledgments: With thanks to all the staff who contributed to the development of this staff

support booklet and to those who provided resources to support the development of the document.

Developed by: The HSE Quality Improvement Team

Title: COVID-19 CTC Staff Support Booklet

Document Number:

National QI Team

Version Number: V1.1

Approved Date:

03/07/2020

Published Date:

03/07/2020

Subject: This document provides guidance, support and resources for people working in Covid-19 Contact Tracing Centres on how to self-care and how to care for colleagues.

Associated document

Overall CMP programme plan CMP Architecture and data information OOCIO CMP Education and Resources Governance

Revision Date: This document will be reviewed and updated on an ongoing basis

Access: Maintained on the CMP Overall Programme Management shared file

Version control

Date

Version Created By Reviewed By Final Document approved by

15.03.2020 V1.0 National QI Team CMP Management Oversight Group

CMP Management Oversight Group

03/07/2020 V1.1 National QI Team CMP Management Oversight Group

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Table of contents

Page

Content

3 Introduction - How your mental health might be affected (pg. 3) - Psychological First Aid (pg. 4)

5 The “ASSIST ME” model of staff support

8 Practical Guidance on Self-Care in your work as a Contact Tracer

11 The benefits of talking to a manager or colleague

11 Remote Working

11 Available Resources

12 Seeking Medical Assistance

13 Appendix 1: “Minding your mental health” – list of useful contacts

1. Healthcare worker COVID-19 helpline (pg. 13)

2. Link to the HSE Policy for Preventing and Managing Critical Incident Stress 2012 available (pg. 13)

3. Link to the HSE Coronavirus Website (pg. 13)

4. List of staff resources available through the HSE (pg. 13)

5. Tips for healthcare workers on how to manage our emotional response to unprecedented circumstances (video link) (pg. 13)

6. Employee Assistance Program (pg. 13)

7. Health & Safety Helpdesk Team (pg. 14)

8. Workplace Health & Wellbeing Unit (pg. 14)

9. Occupational Health Contacts (pg. 14)

10. WorkWell Covid-19 Signposting Poster for Healthcare Workers (pg. 18)

11. The National Bereavement Support Line

12. Silvercloud Programmes on managing stress, resilience and sleep and managing your mental health during Covid-19

20 Appendix 2: Bibliography

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Introduction:

This document has been developed to provide practical guidance for the HSE Contact Tracing Team

on how to mind themselves and how to provide the best support to colleagues while working in the

Covid- 19 Contact Tracing Service. Staff will be contacting persons who have been confirmed as

positive with Covid-19 or who have been identified as a contact of a person who has been

confirmed positive with Covid-19. These calls must be conducted in a professional, courteous,

empathic and effective manner. Contact Tracing Staff will be involved in dealing with persons who

are experiencing great stress and difficulty at this time.

Infectious disease outbreaks like coronavirus (COVID-19) can be worrying. The spread of

coronavirus is a new and challenging event. Some people might find it more worrying than others.

Try to remember that medical, scientific and public health experts are working hard to contain the

virus. Most people’s lives will change in some way over a period of days, weeks or months. But in

time, it will pass.

This can affect your mental health. But there are many things you can do to mind your mental

health during times like this.

How your mental health might be affected Although everyone is affected in some way by the current situation with Covid-19, there are a wide

range of reactions and feelings each person can have. Some people may have mild reactions,

whereas others may have more severe reactions. This event is unusual in healthcare as you are also

personally affected by the pandemic for yourself and your own family and life is not normal as we

have previously known it to be. You may notice some of the following:

• increased anxiety, fearful, feeling numb

feeling overwhelmed, confused

• feeling stressed

• finding yourself excessively checking for symptoms, in yourself, or others

• becoming irritable more easily

• feeling insecure or unsettled

• fearing that normal aches and pains might be the virus

• having trouble sleeping

• feeling helpless or a lack of control

• having irrational thoughts

a change in eating habits

How someone reacts depends on many factors, including:

• the nature and severity of the event(s) they experience;

• their experience with previous distressing events;

• the support they have in their life from others;

• their physical health;

• their personal and family history of mental health problems;

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• their cultural background and traditions;

• their age

Staff have identified the following needs in crisis situations:

• they need to feel safe, connected to others, calm and hopeful;

• they need to have access to social, physical and emotional support and

• they need to feel able to help themselves, as individuals and communities.

Psychological First Aid: Psychological first aid (PFA) describes a humane, supportive response to a fellow human being who is suffering and who may need support. PFA involves the following themes:

providing practical care and support, which does not intrude;

assessing needs and concerns;

helping people to address basic needs (for example, food and water, information);

listening to people, but not pressuring them to talk;

comforting people and helping them to feel calm;

helping people connect to information, services and social supports;

protecting people from further harm. PFA involves: Look – Listen and Link approach Look

Check for safety.

Check for people with obvious urgent basic needs.

Check for people with serious distress reactions. Listen

Approach people who may need support.

Ask about people’s needs and concerns.

Listen to people, and help them to feel calm.

Listening properly to people you are helping is essential to understand their situation and needs, to help them to feel calm, and to be able to offer appropriate help. Learn to listen with your: Eyes - giving the person your undivided attention Ears - truly hearing their concerns Heart - with caring and showing respect Link

Help people address basic needs and access services.

Help people cope with problems.

Give information.

Connect people with loved ones and social support.

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The “ASSIST ME” Model of Staff Support. The importance of support for staff from managers, supervisors, colleagues and peers in this emerging situation should not be underestimated. Being available for colleagues and understanding the challenges they are facing is crucial. Staff require a safe and confidential space in which to talk openly about their experiences and feelings if they wish to do so. This can be very therapeutic. The “ASSIST ME” model of staff support has been developed to assist managers and staff during this process. This has been adapted from the Medical Protection Society’s A.S.S.I.S.T model of communicating with service users following adverse events in healthcare. This communication tool can be used to assist staff who are upset, anxious or in a distressed state. Table 1: The “ASSIST ME” model of staff support

Action Example

A Acknowledge with empathy what has happened and the impact on the member of staff. Assess the impact of the event on the

member of staff and on their ability to

continue normal duties.

“I came to see you as soon as I heard that you had a difficult call. This must have been very distressing for you”, “I know you are dealing with some very distressing calls, I want to support you”. “This must be very difficult for you”. “I believe you had a difficult day today and that you are feeling a bit overwhelmed” “How are you doing?” “How are you coping? “How are you feeling?” “Are you ok to remain at work?”

S Sorry - express regret for their experience “I am so sorry that this has happened and for the distress this has caused for you”, “I am so sorry that you had to be in this situation”. “We cannot fix everything despite our best efforts”. “These are unprecedented times and these calls are very difficult for everyone involved”

S Story –Remain calm and demonstrate understanding. Encourage the staff member to talk about it - allow time and space for them to recount what happened using active listening skills. Do not pressure the member of staff to talk if they don’t want to. Share personal experience which may help, if appropriate in the given situation. Feedback that you have heard what they have said.

“You may find it helpful to talk about what happened on the call” “Would you like to talk about your experience/what has happened?” “Can I tell you about an experience of my own, how I felt and what I found helped me at that time?”

I Inquire – encourage questions Information – provide honest, informed answers/information

““What questions do you have at this time that I can help you with?”

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“Is there anything I can help you with at this time”

S Supports Solutions Discuss what might help. Remember that

your solutions may be different to the

solutions for the staff member.

Agree solutions together. Solutions may

be emotional and/or practical.

(a)Informal emotional support: “My door is open

for you at all times. I will be checking in with you

regularly to see how you are doing. In the

meantime if you do wish to talk about this or

discuss anything with me please come and see me

or give me a call at any time”.

Can I arrange for someone to collect you from

work?”

“You are doing a great job”

“The service you are providing is so crucial at this

time and you are so good at what you do”

(b) Formal Supports: Provide information on

formal supports available e.g. Psychology

support, Coaching, Employee Assistance

Programme, Occupational Health or GP, as

appropriate.

Assist with setting up appointments - arrange

urgent referral if necessary.

(c) Practical Support:

Provide an opportunity for the member of staff to

take time out from their duties, if required.

Provide refreshments and suggest a walk in the

fresh air.

Staff should be involved in and have input to any

decision made regarding solutions. Many staff

find it more helpful to remain at work. Allocation

to different duties may benefit initially if it is

practical to do so.

Establish the learning from the type of calls experienced and if there is any need for additional training or support from the learning/experiences identified. Provide information on resources available on HSE website and Staff Helpline 1850420420

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Action Example

T Travel – providing continued support and reassurance going forward.

Providing continued support and reassurance going forward. Check in regularly – ensuring they are ok Examples: “I am here to support you and make sure you get any help that you need”, “I will be with you every step of the way and I will assist you in any way I can”. Check in with staff members at the beginning and end of shift to ensure any concerns can be discussed and supported.

M Maintain contact Monitor progress Moving forward

Ensure that there is continued contact with the staff member to prevent feelings of isolation. Continually monitor and assess the staff member’s response to being involved in the delivery of the contact tracing service and their response to tasks allocated to them. Provide guidance and support to them in this role which is so different to their usual duties. Continually monitor and assess the staff member’s response to the situation and their response to any interventions. Provide guidance and support on their return to

normal duties.

E End – reaching a stage of closure from the event. Evaluate

Establish when the staff member is ready to return to work. Do not keep re-opening the situation with them. Leave your door open to them if they should require any further assistance going forward. Establish when the staff member is comfortable in this role and is gaining confidence in the tasks allocated to them. Review the support provided with the staff member involved. Consider feedback and establish any learning which may benefit other staff.

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Practical Guidance on Self-Care in your work as a Contact Tracer Table 2: The following table outlines some practical things which staff can do to assist them if they are feeling upset or distressed following a call.

Do Why? 1. Talk to a friend/colleague/line manager about your experience and your feelings.

Talking to someone may help to reduce feelings of isolation and stress. Talk is the most healing mechanism.

2. Consider participating in staff de-briefing sessions – this is not mandatory.

Whereas the debriefing process should not be deemed as mandatory for staff it is recognised as a valuable tool for health care organisations to have at their disposal in relation to supporting staff in the aftermath of a difficult and emergency event. Formal debriefing must only be undertaken by a person who is trained to do so.

3. Ensure that you are involved in and kept informed in relation to what is happening in the delivery of this service and the emerging situation with Covid-19

Good support, information and communication

will help staff to cope with the evolving

emergency situation. This also helps the

relationship between staff and in turn helps

them to support the people they are calling.

4. Set limits for news and social media The constant stream of social media updates

and news reports about coronavirus could

cause you to feel worried. Sometimes it can be

difficult to separate facts from rumours. Use

trustworthy and reliable sources to get your

news. Read up-to-date, factual information on

coronavirus in Ireland on the HSE website.

On social media, people may talk about their

own worries or beliefs. You don’t need to make

them your own. Too much time on social media

may increase your worry and levels of anxiety.

Consider limiting how much time you spend on

social media.

If you find the coverage on coronavirus is too

intense for you, talk it through with someone

close or get support.

4. Take time to relax. It’s important to pay attention to your needs and feelings, especially during times of stress. You may still be able to do some of the things you enjoy and find relaxing. Relaxation techniques can be helpful as stress is completely normal at a time like this. Learn some stress management strategies and use

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them frequently. Give yourself time to recover. Try to switch off from work during off duty periods.

5. Get enough sleep. Sleep is always important but especially now. Make sure you allow enough time for a full nights sleep. If you have difficulty sleeping for more than a week you should consult with your GP.

6. Get some exercise. Exercise regularly, especially walking. A brisk walk is good for the body and has a calming effect on the mind as well. Mild exercises can help to combat stress. Don’t over do it or push yourself beyond your limits!

7. Maintain a good diet. Foods can help tame stress in several ways. Comfort foods, like a bowl of warm oatmeal, boost levels of serotonin, a calming brain chemical. Other foods can cut levels of cortisol and adrenaline, stress hormones that take a toll on the body over time. A healthy diet can counter the impact of stress, by shoring up the immune system and lowering blood pressure.

8. Follow a structured schedule. Your routine may be affected by the coronavirus outbreak in different ways. But during difficult times like this, it’s best if you can keep some structure in your day.

Learn to accept that you are not capable of doing all things all the time. Allow some flexibility in case you are unable to follow through on everything. Remember that you will also have concerns about your own health and family. Keep your life as normal as possible. Prioritize your time – write down the things you have to do in the order that they have to be done.

9. Stay connected with family and friends. Don’t isolate yourself. During times of stress, friends and families can be a good source of support. It is important to keep in touch with them and other people in your life.

If you’re advised to limit your social contact to contain coronavirus, try to stay connected to people in other ways. E-mail, social media, video calls or phone calls can help you to stay social during this time.

Remember that talking things through with someone can help lessen worry or anxiety. You don't have to appear to be strong or to try to

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cope with things by yourself.

10. Take time for leisure activities.

Take part in relaxation activities as appropriate within the advice given. Take a walk outside, read a book or watch a movie at home - do something you find enjoyable.

11. Recognise that healthcare is complex and that this emergency situation is changing.

These are unprecedented times and difficult for

everyone.

12. Expect the current healthcare crisis to bother you.

It is understandable to feel vulnerable or overwhelmed reading or hearing news about the outbreak. Remember that your response is a temporary and normal reaction to an abnormal situation. You are having a normal response to an abnormal experience. Making a conscious effort to work through it will ultimately help you to overcome the stress and difficulty. Acknowledge these feelings.

13. Realise that others around you are under stress also.

Be aware of those around you, how they are feeling and coping. Encourage staff to look after their physical and mental health. Share thoughts and feelings.

14. Learn about post traumatic stress This will assist you in recognising the symptoms and feelings you are experiencing which are a normal reaction to the event and to also recognise those feelings and symptoms which you are experiencing which may be worrying in nature and which may require additional intervention from your GP, Employee Assistance Programme(EAP) and/or Occupational Health Department(OH).

15. Contact your GP/EAP/OH department if you are concerned that your response to the event is too intense or lasting too long.

Talk to your line manager who can assist you in this matter and who can organise a referral to EAP/OH for you. Remember that you can self refer to EAP/OH if you prefer. It is also important to talk to your GP about how you are feeling.

16. Look after your own health and wellbeing If you smoke or drink, try to avoid doing this any more than usual. It won’t help in the long-term. Try to keep yourself as fit and well as possible.

Remember: your reactions are the normal reactions of one who is experiencing an abnormal situation.

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The benefits of talking to a manager or colleague:

This will help you to evaluate the emotional and physical impact on yourself and

everyone involved.

Will provide you with support to reduce the isolation.

Relieve your stress at an early stage.

Reinforce team spirit.

Decrease isolation at a time when you may want to withdraw from social contact.

Reduce dysfunctional reactions or health consequences over time.

Identify the need for and provide counselling or support if needed.

Remote working –

Some staff will be required to work remotely during this Contact Tracing period. It is really

important that you remain connected to your team to reduce isolation, feel able to be productive

and remain connected. Please refer to the fact sheet to support staff working remotely which is available in the CTC Staff Resources Brochure. This factsheet provides practical advice and tips on remote working for staff and managers.

Available Resources: Face-to-face interaction may be limited during this period. There are many online mental health resources and phone services that can help.

Support is available from:

o your line manager o senior management staff o staff support person(s) o Occupational Health Department/Employee Assistance Programme o Mental Health Services, Coaching Services and Psychology Services. o Bereavement services

Do not underestimate the importance of discussing your feelings/symptoms with your line

manager and work colleagues.

See Appendix 1 for a list of resources available for staff.

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Seeking Medical Assistance: You should seek medical advice and assistance if : (a) you are experiencing difficulty with sleeping for more than 1 week. (b) your response to the event is too intense or lasting too long. (c) you are experiencing intense physical reactions to reminders of the event e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating. (d) you are experiencing suicidal feelings or symptoms associated with depression/despair. (e) you feel unable to work because of the event. (f) your response to the event is impacting on your private life outside work and your ability to cope generally with normal day to day activities.

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Appendix 1: “Minding your mental health” – list of useful contacts

1. Healthcare worker COVID-19 helpline - Callsave 1850 420 420. Opening hours: Monday to Friday: 8am - 8pm, Saturday and Sunday: 9am - 5pm

2. The HSE Policy for Preventing and Managing Critical Incident Stress 2012 available here https://www.hse.ie/eng/staff/resources/hrppg/policy%20for%20preventing%20and%20managing%20critical%20incident%20stress.html

3. The HSE Coronavirus Website for regular updates https://www2.hse.ie/coronavirus/

4. List of staff resources available through the HSE https://www2.hse.ie/wellbeing/mental-health/minding-your-mental-health-during-the-coronavirus-outbreak.htm

5. Video link with tips for healthcare workers on how to manage our emotional response to

unprecedented circumstances https://youtu.be/oLSbA-_ehnM

6. Employee Assistance Program Contact Details (16/03/2020)

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7. Health & Safety Helpdesk Team: 1850 420 420 https://www.hse.ie/eng/staff/workplace-health-and-wellbeing-unit/national-health-and-safety-function/ 8. Workplace Health & Wellbeing Unit: https://www.hse.ie/eng/staff/workplace-health-and-wellbeing-unit/

9. Occupational Health Contacts

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10. WorkWell Covid-19 Signposting Poster for Healthcare Workers

11. The National Bereavement Support Line: The Irish Hospice Foundation, in conjunction with the

HSE, has set up a National Bereavement Support Line to provide connection, comfort and support to those

grieving in these exceptional times. It is a freephone service which commenced on 9th June 2020 and which

operates from 10am to 1pm, Monday to Friday. The number to call is 1800 80 70 77. Please find more

information here.

The service provides a confidential space for people to speak about their experience with personnel

specifically trained to provide bereavement support and information. It is staffed by Irish Hospice

Foundation and HSE personnel and volunteer. This is an overwhelming and unsettling time for us all, but for

those facing death and grieving it is particularly difficult.

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12. Silvercloud Health https://hse.silvercloudhealth.com/onboard/hsestaff/programs/

Giving free access to all HSE staff to 4 online programmes dealing with stress, resilience, sleep and managing

your mental health during Covid-19. There is a dedicated phone line provided by the HSE to give

information and advice to staff and managers: 1850 420 420.

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Appendix 2: Bibliography:

Cork Kerry Community Healthcare - “Calm - tips for healthcare workers to manage our emotional response to unprecedented circumstances”, YouTube video prepared by Daniel Flynn, Principal Psychology Manager, Cork Kerry Mental Health Services

Irish Hospice Foundation Bereavement support line https://hospicefoundation.ie/bereavement-2-2/bereavement-support-line/

HSE Supporting staff following an adverse event The “ASSIST ME” Model 2013. https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/opendisclosure/staff-guide-supporting-staff-following-an-adverse-event.pdf

HSE Policy for the Prevention and Management of Stress in the Workplace 2012.

HSE Coronavirus website https://www2.hse.ie/coronavirus/

HSE Workplace Health and Wellbeing https://www.hse.ie/eng/staff/workplace-health-

and-wellbeing-unit/

Psychological first aid: Guide for field workers WHO 2011

Silvercloud Programmes https://hse.silvercloudhealth.com/onboard/hsestaff/programs/

Work Well Covid-19, HR Workplace Health & Wellbeing