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HomeMy WebLinkAbout1987-09-08; City Council; 9159; Trauma Intervention ProgramCIT OF CARLSBAD — AGENT BILL ARtf J/3-1 MTG 9/8/87 DEPT. CM TITLE: TRAUMA INTERVENTION PROGRAM DEPT. HD. CITY ATTY\/EA CITY MGfSsi— RECOMMENDED ACTION: If Council so desires, direct staff to review the Trauma Intervention Program (TIP) and return to Council with a recommendation on whether or not the City should participate in TIP. ITEM EXPLANATION; On August 24, 1987, the Acting City Manager received a request from Mr. Dennis Meehan to place the Trauma Intervention Program (TIP) on the Council agenda for consideration. TIP is a County created program which utilizes the services of volunteers to provide immediate assistance to both primary and secondary victims of crimes and other traumatic events. Volunteers are called to the scene of the incident by police officers, firefighters, and/or paramedics through their dispatch center. There are obvious benefits of this program. There is also potential risk to the City in terms of exposure to liability. Staff would like to research all aspects of this program before the City becomes involved with the Trauma Intervention Program. EXHIBITS; 1. TIP Program Outline 2. Letter from Supervisor John MacDonald supporting TIP, July 22, 1987. 3. "Victim Volunteers Mobilize to Minister", Steve Scarano, Emergency Magazine, March 1987. 4. Letter from Dennis Meehan, dated August 24, 1987. zo o oo EXHIBIT^" The Trauma Intervention Program The Trauma Intervention Program (TIP) is a program which utilizes volunteers t assist victims of crime and other traumatic events at the scene on a 24 hr basis Volunteers are called to the scene of the incident by police officers, firefighter-, or paramedics through their dispatch center. The TIP program is jointly sponsor-:, and operated by two police agencies, two fire departments, and San Diego County Mental Health. While existing programs at the local level provide crisis services to special victim populations (rape victims, for example) and to victims a day or two after the incident (victim / witness program) this program provides immediate personal help to aJJ_ victims of traumatic events. The TIP program is comprehensive and encourages police officers and firefighters to call a volunteer no matter how "little" the crime appears and to call a volunteer to assist "secondary victims" i.e. family members, neighbors, bystanders etc. The program therefore serves victims who are suffering greatly but who are not usually identified by emergency first responders or other crisis services as potential clients. The TIP program is also unique in its utilization of volunteers to provide emotional support and practical help to victims and their families. These volunteers are not restricted by a professional role and can communi- cate to victims that "your neighbors care for you" much more effectively than profes- sional helpers. Also by training citizens to help others in crisis, the program is providing the community an ongoing pool of "natural helpers" who utilize their skills beyond the limits of the TIP program. The TIP program is a special partnership between police, fire, and mental he^lt organizations and between two city governments and a county government. All agencies are equal partners and not simply user agencies and share the burden of liability as well as operational costs. The TIP program is unusual in its inclusion of fir« departments into the program and can serve as a model in that regard. Tlie prcgru has a well defined feedback system which insures that emergency personne1 ob•:..-.". feedback from volunteers on how the volunteer was able to provide assir»tan;e at the scene. This feedback process enables emergency personnel to get "closure" OP calls which might otherwise be difficult for them to "shake." The TIP program has gotten wide recognition from the local print media (Includirj the L.A. Times) and has been featured on the local television news. The Febn,1^;- 1987 issue of Emergency Magazine will contain an article in the program. In Ji;Ij 1986 the program received a County Achievement Award from the National Association of Counties. The TIP program can Indeed serve as a model program in that it brings together ele- ments of volunteer involvement, immediacy, agency cooperation, and comprehensive^ - for the purpose of helping victims. HERE'S A HELPFUL TIP THE TRAUMA INTERVENTION PROGRAM Mhat is TIP? 28 trained OFD citizen volunteers available 24 hours a day to help you help citizens in crisis. Volunteers can be called to the scene, to the station, or to Tri City Hospital. Mhy call TIP? The recovery of a person from a crisis event is largely dependent on the support he/she gets immediately after a crisis. Often this support is not immediately available from family or friends - that is where the TIP Volunteer comes in. When to Call In any situation in which you judge that a person could benefit from emotional reassurance or practical support (telephone calls, clean up, etc.) Examples of situation in which officers have called for a volunteer include: domestic violence house fire completed suicide residential burglary threatening suicide confused elderly sudden death problem with adolescents SIDS death auto accidents Remember: A routine call for you may be a big crisis for a citizen involved. Don't wait for "the big call" to call a TIP Volunteer. TIP Volunteers are particularly helpful with "secondary victims" I.e. those who were not directly victimized but who are nevertheless on the scene and suffering because of their association with the victim. How to call Acknowledge the citizens crisis ("this is a tough time for you") and offer to send "one of our volunteers to help you..." Call dispatch and request a TIP Volunteer. When the TIP Volunteer arrives (within 20 minutes of the time called) brief him/her on the situation. The volunteer will seek your initial direction and then will stay with the victim as long as necessary. Mho are the TIP Volunteers Men and Women from-all walks of life between the ages off 30-6^ who are committed to helping others. They are extensively screerotMSnd receive extensive classroom and hands-on training. They attend mandatory continuing education classes and have 24 hour professional backup available to1 them. Trauma Intervention Program i, L Progress Report - Qceanside Fire Dept. July 17,1986 TO November 17,1986 Total Number of Calls 18 Location of Intervention: Client Home 8 Tri City E.R.10 Number of Calls per OFD shift:Shift A 4_ Shift B 5_ Shift C 9 Average Time Spent per Call 2 hrs. Types of Calls T}Support Family - Death 2) Support Family - Sickness / Injury 3) Support injured or ill citizen 4) Support anxious / depressed citizen 5) Support Fire Victims Type of Intervention T)Emotional Support and Practical Help until other support available 2) Follow up calls 3) Other Follow Up Referrals * Tri City Social Workers * Red Cross * Senior Services Team * County Mental Health 18 12 EXHIBIT; a- JOHN MACDONALD SUPERVISOR. FIFTH DISTRICT (619) 734-5669 BOARD OF SUPERVISORS 325 S. MELROSE DRIVE, VISTA. CALIFORNIA 92083-6617 July 22, 1987 Claude Lewis, Mayor City of Carlsbad 1200 Elm Avenue Carlsbad, CA 92008 Dear Ma is: I am writing to register my support for the Trauma Intervention Program now being reviewed by the City of Carlsbad. This program, which has been in effect for two years now, is not only a benefit to the victims contacted but also to the city as a whole. I know of no better way to assist our emergency rescue personnel in doing that "little extra" to help these people who have been violated in some way. The reflection on the City for having loving support available to its citizens in a most great time of need can be nothing but positive. I also realize that there is a liability risk involved, as is in most services provided by cities. Yet, to deny the citizens of Carlsbad this asset of a program because of the "what if's" surrounding it, would be a sad loss to the multitudes standing to benefit. I sincerely hope you take the time to discuss the proposal in its entirety with the people who administer the program. The level of human kindness afforded by the volunteers is a rare yet beautiful sight in our society today. I am comforted to know that these people are waiting and available to come to my aid, at any time of the day, should I need them. I am sure you will agree, after you become more familiar with the Trauma Intervention Program. Should you need further information or clarification with regard to the program, please contact either Gloria Cothran of my office at 236-2293, or Wayne Fortin, Coordinator, at 433-6141. Thank you for taking the time to look into the service offered. Sincerely, ^Au, JOHN MACDONALD Supervisor, Fifth District EXHIBIT^ Victim Volunteers Mobilize to Minister BY STEVE SCARANO In the last decade, the media and health care services have devoted an immense amount of attention to the impact that human-made and natural disaster has upon individuals and groups of people. We've observed the rapid growth of crime-victim advocacy organizations, victim sensitivity guidelines in the operating procedures of helping agencies, and batteries of mental health professionals who can mobilize to minister to survivors of high-drama events like aviation accidents, earthquakes and mass murders. We all applaud those efforts and, indeed, this article describes a very unique, grass- roots approach to crisis response, called the Trauma Intervention Program (TIP). My experience as an emergency services worker, however, prompts me to offer a quick aside: Is it possible that we are losing sight of the primary responder's personal needs? That is, what machinery or organi- zation is in place to rescue the rescuer, to help the helper? My point is two-fold. First, I am keenly aware of the issues involving bearing the burden of occupational stress in the caring professions. Secondly, I believe that models like the Trauma Intervention Program can significantly mitigate the helper's stress by providing an effective and expeditious means of servicing the needy people he or shy is committed to. So this is not just another trade-journal discourse about victims' needs and rights. My viewpoint includes the people who scoop them up, suck blood and vomit o.ut of their throats and package in evidence bags the crime-stained bedding and under- wear of emotionally traumatized people. The public safety industry's broad motive to "save life and protect property" has been brought into sharper focus in recent years. In their own particular and collective "search for excellence," police, fire and pre-hospital care personnel are redefining their roles in working for the common good. This community service ethic is what we're here-for. In fact, the way in which an emergency services organization responds to people in crisis can be held as a yardstick against which the technical skill, leadership and humanness of the agency and its members can be measured. The Trauma Intervention Program is a tested, reliable system which enables a police officer, firefighter or paramedic to access a competent lay counselor through the emergency services dispatcher with a guaranteed 20-minute response time at the scene of the crisis. County Mental Health's co-organizer of TIP acknowledges that often those who are first on the scene to help in an emer- gency aren't "equipped to handle the emo- tional needs of some involved." Wayne Fortin cites the lack of time and sense of urgency that emergency workers feel be- cause they have to be available for other calls or patients; the inability to keep current with changing community resources; and competitive, practical, situational require- ments like traffic control, triage and treat- ment or documentation. Directly after the crisis, the victim is very sensitive, vulnerable and feeling helpless. "What is needed," said Fortin, "is reassur- ance, direction from others (this is NOT the time for crisis responders to mind their own business) and help with concrete tasks like making phone calls to family members and clearing up the mess." Like emergency medicine's "golden hour" of physical trauma care, prompt and effi- cient care of the victim's emotional needs can be critical to recovery. "If we're going to help them, we need to get to them early on," Fortin emphasized. "After the neces- sary practical help is rendered by EMS, police or firefighters, a gap exists until the victim is connected to his or her natural support system —relatives or friends." Absent that, other nurturing help is vital. That's where TlP'comes in. TIP volunteers are area residents who can provide their own transportation to crisis scenes at any hour and who are motivated to help people. No formal experi- ence is required, but they must survive a rigorous basic training program and parti- cipate actively in continuing education (see side bar). During the six-week training program, staff trainers verify that volunteers possess qualities such as a non-judgmental attitude, common sense and an ability to listen, particularly in evaluating role-playing performance. Not every applicant completes the train- ing. Since the program is officially endorsed by the police department, a background check is made to determine if participants have any criminal history or unsafe driving record which might make them mappro priate for membership. TIP members use beepers and are re- quired to work a minimum of two shifts each month as well as attend a monthly training meeting. As it is a 24-hour program, the duties are divided into two shifts —from 7 a.m. to 7 p.m., and on again to 7 a.m. According to Fortin, TIP volunteers "do little that would not be done at some point by either the victim or a professional, but the volunteer does it early in the crisis and takes the burden off the victim at a critical time." People in crisis go through stages, and the TIP counselor may be called in at any stage. "What our training seeks to emphasize," he said, "is the ability to identify that stage and be flexible enough to act accordingly with the appropriate interven- tion techniques that the victim, not the rescuer, needs." Volunteers are insured while traveling to and from, and during, the authorized activity. The Hold Harmless Agreement signed by volunteers purports to refrain them from seeking compensation from the city on account of injury relating to partici- pation in the program. TIP counselors are well-suited to deal not only with the immediate person in crisis,, but also with "secondary victims" who are often ignored, especially by emer- gency services professionals. These are the people who are peripherally impacted by the stress of the crisis —the spouse or boyfriend of the rape victim, the close friend of a family which has been burned out of their home, or an elderly wife whose husband has been assaulted. Secondary victims can even include the cleanup crew — police officers, firefighters and paramedics. Department policy prohibits officers from making referrals to TIP in certain criminal cases which are likely to involve prosecu- tion and follow-up in the court system. In these instances, counselors from another organization, Victim Aid Program, are called. The counselors provide particular emotional, technical and financial support to victims of family violence and sexual assault. Whereas TIP volunteers are limited to a single follow-up call to check on the client's welfare, VAP staff are paid person nel and literally accompany the needy person through hospital, investuj.itory and tMHKMNCr/MAKCHIW 47 court processes. The Victim-Aid Program is actively involved in TIP training and the two services complement each other. The on site police officer or requesting medic is generally responsible for ensuring the safety and stability of the situation before the TIP counselor takes over. Need- less to say, there are no guarantees when it comes to dealing with people. It's possible, for example, lhal a TIP volunteer alone with a beaten wife and her children could encounter the irate husband after the officer has left. Fortunately, the excellent personal safety guidelines presented to the volunteers in their training, coupled with the accurate situational analysis of the on- site officers and medics, have kept these kind of incidents from occurring. Like the mission of other emergency responders, the first requirement for the TIP volunteer is the safe and expeditious delivery of competent talent. Violation of the rules of the road are intolerable— trainees learn that if they're stopped for a violation en route to a call, it will be futile for them to tell the officer that they are "on a police emergency." They're cautioned about the effects of some prescription drugs and the consumption of alcohol while on the duty roster. A curbside look-and-Iisten assessment is encouraged, and the problem of parking too close to emergency vehicles is ex- plained. The advantages of a threshold evaluation, listening at the door for a moment before knocking, are described by a police trainer. Upon entering, the TIP counselor is urged to act upon what his or her senses suggest, and to leave at any time danger is felt. Trainees learn about some of the risks peculiar to certain areas of a residence— bedroom, bathroom and kitchen, and how to tactfully arrange disputants or despon- dent persons to gain a tactical safety advantage. The hazards of underestimating females' fighting ability, is a .lesson the police trainer speaks of from personal experience. When both the requesting officer and the TIP volunteer are in agree- ment that the situation is safe, the latter releases the officer. Since its inception in January, 1985, volunteers have responded to 180 incidents. The average call-out lasts about two hours, and evenings and Sundays seem to be the busiest periods. About half of the calls involve supporting survivors of family death by suicide, accident or natural causes. Roughly 15 percent have to do with some kind of personal assault, and 3d percent of the call-outs deal with despondent people who have called the police,'and family disputes (including problems with adoles cents). The remaining 5 percent of activity includes support to the elderly, fire burn- outs and other problems. Although the program has yet to be formally evaluated, it has received high praise from throughout the user strata — observers from outside agencies, and the print and broadcast media. TIP was designated by the National Association of Counties as a recipient of the 1986 Achievement Award in Las Vegas, which commended its founders for "ingenuity and creativity in establishing a useful program for county government." In this citation, NAC Director John Thomas informed the unit that a file would be kept as a resource for the qut-nca which were expected. Sometimes it's the yratitude of the loot soldier that counts most. The officers and supervisors of the police n ght shilt said in „ letter of recognition that they "... praise the work done by TIP. We've jwinli-il our selves of your staff innumerable times .md their expertise and professionalism Ikav been outstanding." Signed by the shitt lieutenant, three seryeants and live ciis patchers, the letter lauded TIP's ".. Lljm passion and understanding." Sometimes victims thank the counselors. Wrote a survivor-of -suicide, "Thank you so much for the efficiency and kindness shown to us on the night of my husband's "Size Up"k Upon arrival at the crisis scene, the volunteer interventionist is likely to debrief the investigating police officer or paramedic before actually being intro- duced to the person(s) being called to assist. Typical elements of this dialogue involve obtaining essential information regarding the following: THE NATURE OF THE CALL • How was the call dispatched to the officer? Was it dispatched differently to the volunteer? • What is the nature of the call as the officer or medic actually found it? (It will always be different to emergency services.) • What is the situation now? THE HISTORY OF INCIDENTS AT THAT ADDRESS OR WITH THOSE INVOLVED ("Have you been called here before?") • What is the threat assessment? Are either drugs or alcohol involved? Are there verbal threats, weapons or force being used? Does the victim have the ability to carry out threats of violence? • Has the victim requested specific assistance (from friends, clergy or relatives, etc.)? • Describe the symptoms or behavior of the victim. • Who is inside? Has anyone left? Is there an expectation that anyone will be coming back? • "What do you recommend be done here, officer?" A TIP volunteer's six-week "boot camp" consists of about 40 hours of didactic and role-playing experience, coupled with three ride-alongs in the field with the police department's beat officers. The ride-alongs give the TIP trainee a practical perspective on what officers see and do with people in crisis. The shoulder-to-shoulder ex- posure of the TIP volunteers to the officers elevate the awareness of the police to the availability and usefulness of the program, so the learning oppor- tunity is double-edged. "TIP-ical" basic- academy topics include • the helping relationship • the experience or being trau- matized • working in the hospital emergency room • helping the family of a trauma victim • suicide assessment and interven- tion • helping the survivors of suicide • working with the elderly • personal safety issues • family dispute mediation • spousal assault • getting peer support • working with the police and fire departments Continuing education for the graduate TIP counselor generally emphasizes the types of call-outs being experienced in a given training period, and is likely to include dealing with death, crisis inter- vention at disasters, and adolescent problems. Instructors who participate in both the "rookie" and in-service staff develop- ment have included • police department chaplain • hospital social worker • emergency services dispatcher • coroner's office deputy • Red Cross disaster team worker • emergency room nurse • police counselor • psychiatrist • funeral director 4* 1MWOINCV/MARCH1987 suicide ... the wormin from TIP had the dreadful task of lelling my teenager about her dad. How grateful 1 am that she was there." Is your community ready for volunteer- delivered crisis intervention operated through your police, EMS or fire service? A few cities determined that they were. The Police Crisis Assistance Program of Orange County, Calif., is based at the Irvine PD and serves three other cities as well. During fiscal year 85-86, its 49 volun- teers aided 692 citizens in 475 on-site calls at the request of investigating officers. Participants donate two eight-hour shifts and attend the monthly training meeting, after the completion of their 24-hour basic training. The Pima County, Ariz., Attorney's Victim/Witness Program has been active since its initial Law Enforcement Assistance Administration grant funding in 1976. This program offers relatively long-term support for crime victims through its 55 volunteers and nine paid staff. Sgt. Bill Krunglevich, coordinator for the Oceanside TIP, offers this start-up advice, "In the planning phase, insist on including all levels of your agency, from rank and file, to first-line supervisory and command staff. The development of sound written policy will serve greatly in reducing the vagueness that often arises in the earliest stages of a new program occurring in a traditionally closed business. Finally, allow a year for the program to take—don't get discour- aged if it starts with somewhat low usage." On a more personal level, veteran volun- teers offer practical, rather than philosophi- cal, advice to neophytes — "Keep your car gassed and wear clean socks." Bev Bowie came into the TIP from considerable ex- perience as a volunteer rape/domestic violence counselor with the local Women's Resource Center. "The single, most needed quality by far is to be non-judgmental," Bowie remarked in profiling the potential volunteer, and "the quality that must accompany this is being a good listener and adjusting to the people and situation." Emergency services professionals know that helping people comes with its own rewards, but there are frustrations. One TIP counselor complained that "the short- term relationship with the client doesn't permit (he volunteer to watch the helped person grow as a professional might." An- other remarked, "We only see the tragedy." Some volunteers get discouraged when they spend their shift "waiting for the big one" and aren't called out. Remarkably, helper stress is dealt with purposefully at the monthly team-building meetings, where case reviews and formal training occur. Also, TIP has built into itself a peer support system — not only for dealing with personal problems —but for second- opinion field consultations. When cases involve multiple victims, the on-site volunteer can call out others if necessary. In other instances, response by the duty volunteer might be inappropriate (if the client is a friend, or the incident occurs in the counselor's neighborhood, for example) and another will substitute. Case reviews by the professional Mental Health Officer coordinators begin with the volunteers' Call-Out Report, which contains a brief statement of the situation and a summary of the action taken. Actual examples are illustrative: Sfafemenf of Situation: Called to assist 68-year-old man who discovered wife had shot herself in the bedroom. He appeared very upset, sad and was sitting with his head in his hands when I arrived. Action Taken: Talked to client for two hours about his feelings and his life with his wife. Assisted him in viewing the body. Helped him call his wife's sister. Left when he expressed feelings of wanting to be alone. The next dayfollow-up call is not always necessary but it may be useful to commu- nicate concern and to encourage the client to pursue the plan made previously with the counselor. A feedback loop between the initiating officer or medic and the volunteer has been engineered into the system, and is proving to be a genuine asset to the program. Within a few days of the incident, the TIP coordinator sends a brief report back to the officer, which summarizes the outcome of the call-out. The Trauma Intervention Program is mentally healthy not only for victims in crisis but for victims of crisis—police, fire and pre-hospital care workers who respond to troubled people and drive away wearing some of their trouble. Public safety officers want to help and volunteer programs like this one allow that. Consequently, they serve as effective instruments in mitigating the burden of occupational stress. TIP coordinators forecast good things for this successful program. Expansion has already occurred in the adjacent city at the request of the fire department's paramedics. Future users may be another bordering community and nearby state-operated campgrounds, where rangers often deal with homeless transients. J0t Steve Scarano is a sergeant and training manager at the Oceanside Police Depart- ment in California. THE BASHAW CID® 'The standard by which all others are measured" 5 MODELS AVAILABLE THE MOST VERSATILE CERVICAL IMMOBILIZER ON THE MARKET DESIGNED TO FIT ALL LITTERS CAN BE USED WITH OR WITHOUT THE CHIN STRAP WASHABLE AND X-RAY PERMEABLE ASK US ABOUT OUR EVALUATION PROGRAM DEALER INQUIRIES INVITED BROCHURES ON REQUEST COMPATIBLE WITH MILITARY STRETCHERS BASHAW MEDICAL INC MFGR'S OF EMERGENCY MEDICAL EQUIPMENT 4909-B MOBILE HWY PENSACOLA, FL. 32506 904-455-7017 U.S. PATENT #4,297,994 Circle No. 15 on Reader Information Card BMEROCNCV/MAnCH 1967 49 EXHIBIT Ocean Pointerealty rei. <ei9) 433-7470 A California Corporation August E4, 1987 Ray Patchett City Manager 1500 Elm Avenue Carlsbad, CA 92008 Dear Mr. Patchett, Please consider this a formal request to put the discussion of the Trauma Intervention Program on the Council agenda hopefully for the September 1 meeting A number of Carlsbad residents have been assisted by this program while in neighboring cities, and other Carlsbad residents are interested in volunteering and would like to have this highly successful program available to all Carlsbad residents and visitors. Sincerely, Dennis M. Meehan DMM/jm