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Debriefing Activities
A Tertiary Prevention Tool
Caroline McGrath
Executive Director
UMass Adolescent Treatment Programs
Clinical Instructor
Dept. of Psychiatry-UMass Medical School
The use of seclusion and restraint are high risk, problem prone interventions & are to be avoided whenever possible.
The use of S/R may cause trauma and re-traumatization in an already vulnerable group of persons and may cause trauma, stress and injury for staff persons.
Debriefing : Why do we debrief ?
3 Steps of Debriefing
Immediate Post Acute Event Analysis
Witnessing / Elevating Oversight
Formal Rigorous Event Analysis
Immediate Post Acute Analysis
Is anyone hurt ? On site leadership apologizes to the
staff Gather facts , talk to on-site witnesses Restore safety and calmness to the
milieu
Witnessing/Elevating Oversight
What is the leadership paying attention to ?
What are they called about 24/7 ? Leadership can allocate additional
resources, help to problem solve How does leadership take the
patterns they hear about and use this to change practice and policy ?
Formal Rigorous Event Analysis
Opportunity to make amends, to decrease shame and humiliation
Opportunity to learn about triggers, did the coping skills / soothers work ? If not why ? Opportunity to update their treatment plan
Opportunity to improve relationships and prevent future violence
How Can We Improve Our Debriefing Process ? What are the values you want to bring
to life in your treatment culture and in the debriefing process ?
How do you align your process to reflect your trauma-informed care
philosophy ? What information do you need to improve
your debriefing process and to prevent future episodes of S/R ?
Organizational Problems Identified by the Debriefing Process What information do you glean from the
debriefing process that informs….
your staff orientation, on going supervision and training.
How does the information impact how you allocate your resources ?
How does it help you to decide that a peer mentor would add tremendous value ?
What do you do with the information identified by the debriefing process ? How does the information inform how
you adapt your programming ? How does the info help you
understand if your organization is living it’s values and treatment philosophy ?
Is the info used to make sustainable changes in your policies and practices?
Saying Sorry- A Natural Response
The use of apology has become an
important ritual at the start of every
debriefing meeting. We begin with the program leaders
saying a sincere and direct apology to
the youth-e.g.,”I am sorry that we
restrained you last night.”
Saying sorry evolved as a natural response to our deep desire to enhance our relationships with the youth we serve and to decrease our use of coercion
In our programs we serve youth who have suffered trauma and maltreatment.
We must ensure that we do no harm and avoid interactions that are shameful or humiliating
We want the youth to learn from an environment that demonstrates dignity, respect, collaboration and healing. When violence has occurred the entire group has failed to prevent it not just the staff involved
The Use of Apology
Observations We’ve Made Along the Way
We began to look at restraint as a part of the cycle of violence
We recognized that our use of restraint and the debriefing process could leave everyone with feelings of shame
We recognized the suffering that transpired when restraint was used for both the youth and the staff
We recognized that the negative consequences of restraint can be invisible and are often unspoken
We noticed that a lot of energy and effort was spent focusing on what the child had done wrong and the youths feelings or complaints were minimized
We noticed that the child was often expected to say sorry
Observations We’ve Made Along the Way
We became aware that the adults involved did not usually share responsibility for what had transpired
We observed that staff actions may have triggered past shameful deeds and acts from the child’s past
We realized that the youth’s voice was not heard or supported as staff tried to remain “correct” in the actions that had taken place
We realized that the debriefing process should serve a function other than the staff “setting the record straight”
We observed that the debriefing process was not helping to repair the child/staff relationship, but rather the two parties remained angry at one another
We recognized there was a great need for staff debriefing to help address physical or psychological injury to staff
To break patterns of violence youth need to have a voice and the ability to question restraints
We need to encourage youth to question what has occurred and help them talk about violent outbursts
By saying sorry we are being mindful about our communication and are leading the way towards resolution and growth
This moment of apology is a sacred moment and it helps the people heal
Saying sorry validates the pain incurred by the youth – past and present
Closing Remarks
Thank You