1. Debriefing Activities A Tertiary Prevention Tool Caroline McGrath Executive Director UMass Adolescent Treatment Programs Clinical Instructor Dept. of Psychiatry-UMass Medical School

2. 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. 3 Steps of Debriefing Immediate Post Acute Event Analysis Witnessing / Elevating Oversight Formal Rigorous Event Analysis

4. 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

5. 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 ?

6. 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

7. 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 ?

8. 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 ?

9. 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?

10. 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.”

11. 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

12. 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

13. 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

14. 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

15. Thank You