Risk Assesment

The following is a guide to assist in the detection of practitioners at risk of developing PTSD as a result of exposure to job related trauma. It provides a basis for anticipating the intensity of reactions, and likely support requirements (see Occasional Paper No. 2 for evidence to support this guide).

Generally, the more 'more risk' factors, the higher the support needs of practitioners are likely to be if long-term psychological harm is to be avoided. Intervention strategies should be mapped onto risk status.

 

High Risk Events

  • Was there warning and time to prepare? (Less Risk: Yes; More Risk: No)
  • Was the practitioner exposed to grotesque images? (Less Risk: No; More Risk: Yes)
  • Did the practitioner know the victim? (Less Risk: No; More Risk: Yes)
  • Was the practitioner related to, or a friend of the victim? (Less Risk: No; More Risk: Yes)
  • Does the practitioner feel OK about his or her role in the event? (Less Risk: Yes; More Risk: No)
  • Was the traumatic event a result of malevolence? (Less Risk: No; More Risk: Yes)
  • Was the practitioner alone during the event? (Less Risk: No; More Risk: Yes)
  • Did the practitioner have a high level of exposure to the event? (Less Risk: No; More Risk: Yes)
  • Was the exposure prolonged? (Less Risk: No; More Risk: Yes)

 

High Risk Reactions

During event:

  • Did the practitioner experience feelings of fear, horror and / or helplessness? (Less Risk: No; More Risk: Yes)
  • Was time distorted during event? (Less Risk: No; More Risk: Yes)
  • Did the practitioner experience feelings of being unreal, numb, in a daze, outside of self, looking on? (Less Risk: No; More Risk: Yes)
  • Are there parts of the event the practitioner cannot remember? (Less Risk: No; More Risk: Yes)

If yes to any of the above high risk reactions the practitioner should be referred for psychological support/debriefing.

After event:

  • Is the practitioner experiencing strong feelings of distress? (Less Risk: No; More Risk: Yes)
  • Are they able to sleep OK? (Less Risk: Yes; More Risk: No)
  • Are they having nightmares? (Less Risk: No; More Risk: Yes)
  • Are they experiencing flashbacks? (Less Risk: No; More Risk: Yes)
  • Do they feel emotionally numb? (Less Risk: No; More Risk: Yes)
  • Do they keep thinking about the event? (Less Risk: No; More Risk: Yes)
  • Are they extremely reluctant to talk about the event? (Less Risk: No; More Risk: Yes)

If yes to more than one question refer to employee assistance services for one to one counselling (Indigenous counsellor if Indigenous Health Practitioner).

Are they able to function effectively in work role? (Less Risk: Yes; More Risk: No)

If no, the practitioner should be taken off line as soon as possible and referred to employee assistance services for face to face psychological support.

 

High Risk Individuals

  • High levels of ongoing stress (personal or work related)? (Less Risk: No; More Risk: Yes)
  • Exposure to other traumatic events in previous 4 months? (Less Risk: No; More Risk: Yes)
  • Recent loss of loved one? (Less Risk: No; More Risk: Yes)
  • Has difficulty in admitting personal vulnerability? (Less Risk: No; More Risk: Yes)
  • Previous unresolved trauma issues? (Less Risk: No; More Risk: Yes)

 

Recovery Environment

  • On twenty-four hour call? (Less Risk: No; More Risk: Yes)
  • Relieving in community? (Less Risk: No; More Risk: Yes)
  • Successfully adapted to community? (Less Risk: Yes; More Risk: No)
  • Socially isolated? (Less Risk: No; More Risk: Yes)
  • In conflict with team members or the community? (Less Risk: No; More Risk: Yes)
  • Has someone in whom to confide about experience? (Less Risk: Yes; More Risk: No)
  • Networks of social support (peers, friends, family)? (Less Risk: Yes; More Risk: No)
  • Community exposed to several traumatic events in past few months? (Less Risk: No; More Risk: Yes)

If situation is judged to be high risk to the psychological health of the practitioner: within one week and up to one month after the event, the employer or manager should refer the practitioner for individual psychological support by a mental health practitioner, either on-site or in a regional centre. The manager should aim to maximise recovery of practitioner on or off-the-job in collaboration with treating mental health practitioner.

If situation is assessed as low risk to the psychological health of the practitioner: the employer or manager should provide information (eg pamphlets or booklets) about traumatic stress reactions, adaptive coping strategies, and when and where to seek psychological support if they need it. The practitioner should be encouraged to activate social support networks. Manager should aim to maximise recovery of practitioner while still on-the-job.