Samantha Langford (pictured) started her career as a crime scene investigator, a job she did for ten years before moving into training investigators and, now, running her own consultancy, Gaia Workplace Wellbeing. She’s become known for two specialities on the back of her experiences, the first being bereavement (her brother died at age 21) and trauma (due to witnessing many traumatic scenes).
While working for the Independent Office for Police Conduct she introduced ‘trauma risk management’, known by its acronym TRiM, which has become the gold standard approach for dealing with trauma at work.
The origins of TRiM
TRiM was born in the military, evolving from observations made following the Falklands conflict. After the war, the Air Force and Army flew back, whereas the Navy took longer due to having to sail. It turned out that the incidents of negative or long-lasting effects were higher in the Air Force and Army than the Marines. This was because the sail gave people time to process the events while being supported by peers who shared the experience.
“That’s where TRiM as a peer support system was born,” says Langford. “People aren’t trained as counsellors; they don’t need to be medically supervised. It’s just someone in your organisation who is trained to identify the risk factors that someone may develop a mental health concern following a traumatic event.”
In this feature, Langford talks us through best practice for implementing TRiM in an employer.
Where do you start to implement TRiM as en employer?
Firstly, really do your research when choosing your TRiM trainer. Ask your trainer if they have been a TRiM practitioner themselves (not all trainers have) because then they will have a much deeper understanding. I’m an associate trainer with the creator of TRiM, psychiatrist Professor Neil Greenberg who is managing director of health consultancy March on Stress.
Usually organisations start with TRiM practitioners, then train TRiM managers who are peers that have volunteered for the role alongside their daily duties; then, (ideally) have someone in a TRiM co-ordinator role; usually someone who works in Health and Safety, or Health and Wellbeing.
How do you select TRiM volunteers?
You’ll need to identify appropriate employees to be TRiM volunteers. There are no hard and fast rules, but ultimately 10% of workforce is the aim, as this allows for appropriate welfare of practitioners. Most organisation start with a small cohort and develop from there.
When you are trying to find volunteers to be TRiM Practitioners in your company be aware that it tends to be people who have been through some sort of past trauma who want to do this work. In order to look after the welfare of that person, we advise that the volunteer shouldn’t have experienced something traumatic within the 12 months previously. We don’t want them to be retraumatised, or affected by the conversations they’ll be having.
TRiM practitioner training equips non-medical staff to manage the response to a potentially traumatic event, so you need to choose employees who have strong soft skills and are good, active listeners. You also need people who won’t talk to anyone else because the process is confidential.
How does the process actually work?
The TRiM process kicks into action after a potentially traumatic event occurs. We say ‘potentially’ because everyone is different and individual in how they respond, and some may not perceive the event as traumatic.
A first step is to work out which employees have been involved in the incident and to what extent. It’s important to remember that they don’t actually need to have been present at the scene to be potentially traumatised. They could be call handlers, or they could have been absent from work that day (but supposed to be in the team that encountered the incident, so they may still experience a response).
Following this, a briefing is provided to all staff, not just those involved, to provide the facts of the incident and education on how people may respond. Usually, too, they’ll be given some literature outlining possible symptoms and signs of traumatic response .
What should you talk about in a TRiM meeting?
TRiM trained employees then reach out to those identified, and invite them for a TRiM assessment. But TRiM meetings are not mandatory and they can say no. The interviewee can leave at any time but it’s worthwhile stressing that the meeting is confidential and beneficial in helping them process the event.
We can never prevent a trauma response but we can identify someone’s risk early and support them as soon as possible.
The TRiM assessment lasts around 45 minutes and is an informal conversation in which the interviewee doesn’t feel like they are being risk assessed.
There are 10 risk factors to consider, some relating to the event but some also relating to what is going on in their life outside work (as more stress could make them a higher risk). It may be they need help with external factors – such as debt management for instance – before they can deal with the trauma effectively.
Risk factors
There are many risk factors that are covered during the informal conversation, such as sleep. If sleep patterns change and the person is having dreams or nightmares about the event, this could be an indication of a traumatic response. Other indications might be struggling with appetite, or symptoms like sweatiness, and dizziness. If they have significant symptoms, the assessment may conclude they need immediate support.
The key characteristic of PTSD is that distressing symptoms last for more than the acute ‘normal’ period and interfere with day to day life. Typically, people will have a strong response to the event – which is a normal reaction to an abnormal event – but if it continues weeks after the event they could be at increased risk of developing not just PTSD but also anxiety/depression, so they need support.
Treatment pathway
If the person is deemed as needing support, they are then referred straight to the company’s chosen pathway of support, which is often Occupational Health or an EAP. When training we always recommend that you check your provision before you begin doing any TRiM work. Ask yourself: can we support someone if we recognise they are at risk? Have we got the right psychological support in place?
It’s important to recognise that trauma requires specialist expertise, not generic counselling for anxiety/depression.
How should you finish the initial assessment?
The assessment finishes with education on what will help them specifically, with examples of how they can get back to their normal routine as soon as possible, as this helps them to normalise what they have been through. We also talk about the importance of social support, and Let them know they are not on their own.
The most important thing to do after this first meeting, and the reason why TRiM is so effective, is to book a second meeting to see them in a month’s time, to further assess how they are getting on. The research shows that in 99% of cases people start to naturally recover over this time. TRiM enables employers to pick up on the 1% who don’t and ensure they get the right support quickly, so impact can be minimal.
