Promoting Professional Resilience...working therapeutically with sex offenders (Clarke, 2004) not one study prior to 2000 considered positive aspects of the work. Because of the invidious

C H A P T E R 9

Promoting Professional ResilienceJo Clarke

He is quick, thinking in clear images;I am slow, thinking in broken images.

He becomes dull, trusting to his clear images;I become sharp, mistrusting my broken images.

Trusting his images, he assumes theirrelevance;

Mistrusting my images, I question theirrelevance.

Assuming their relevance, he assumes the fact;Questioning their relevance, I question the fact.

When the fact fails him, he questions his senses;When the fact fails me, I approve my senses.

He continues quick and dull in his clearimages;

I continue slow and sharp in my brokenimages-

He in a new confusion of his understanding;I in a new understanding of my confusion.

(In Broken Images Robert Graves 1914–1946)

Introduction

Some occupations are unique with respect towhich members risk exposure to traumaticevents. Paton and Violanti (1996) describe theseas ‘critical occupations’, a term coined toencapsulate the critical role played by suchindividuals in protecting communities, as well asthe fact that ‘in the course of acting in thiscapacity, these professionals can encountertraumatic events which may, under certaincircumstances, exert critical impact on theirpsychological well-being’ (Paton and Violanti,1996: vii). Emergency service personnel anddisaster responders are two clear examples wherefront-line workers face acute risk owing to thenature of their work. Body recovery after naturaldisasters, removal of victims from vehiclecrashes, attending scenes of terrorist activity canall be readily identified as situations likely tochallenge any individual’s psychologicalequilibrium.

However, more recently it has been recognisedthat some jobs involve considerably more chronicexposure to potential psychological risk, andalthough different from the demands ofemergency work, should also be included underthe umbrella term ‘critical occupation’. Workingin child protection is one such area. The potentialfor almost daily encounters with child victims ofabuse, damaged families, hostile abusers,interrogative and blaming media, not to mentionthe complexities of inter-agency working can attimes conspire to impact on the well-being ofeven the most hardy individuals.

Drawing up an inclusive list of non-emergency‘critical occupations’ would be a considerablechallenge, but therapists working withperpetrators of sexual abuse, and prison andprobation staff managing incarcerated andcommunity-based offenders would be otherindisputable examples. Much of the workpresented here is based on the author’s researchand experience in these two areas, and as such,regular reference is made to the associatedliterature.

The purpose of this chapter is to present anorganisational strategy that has been designedspecifically to enhance the well-being of staffworking with the most difficult, disruptive anddamaged prisoners held in High Security prisondiscrete units. The chapter starts by consideringthe concept of ‘risk’ in non-emergency criticaloccupations, particularly in relation to well-being,psychological harm, resilience and post-traumaticgrowth. The development of the strategy isexplained, including the rationale for the five keydomains. Case examples of differentinterventions in action are then provided.Although designed specifically for HM PrisonService staff, it becomes clear that the principlesunderpinning the strategy’s construction areequally applicable to staff working in anyoccupation where chronic exposure to potentiallytraumatic events is high.

The chapter concludes with a discussionaround implementation of elements of thestrategy across diverse organisations.

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Risk in non-emergency criticaloccupations

The word ‘risk’ has become so overused inmodern vocabulary as to have almost lost itssignificance. For example, the terms riskassessment, risk management, risk reduction andrisk aversion are terms so regularly incorporatedinto organisational parlance, that people seldomseem to question anymore, ‘risk of what?’However, it is argued that without explication,any efforts to reduce risk are at best ad hoc and atworst potentially damaging.

In the context of critical occupations there are anumber of areas where the concept of riskrequires specific consideration. The first, and theone on which the premise of critical occupationsis based, is risk of exposure to events that arepotentially traumatic. DSM IV (AmericanPsychiatric Association, 1994) defines a traumaticevent as one that is outside of the range of usualhuman experience and that would be markedlydistressing to almost anyone. Examples given ofsuch events include threat to life or physicalintegrity, sudden destruction of ones home, orseeing another person who has recently been or isbeing seriously injured or killed. Clearly, frontline emergency responders face such eventsfrequently. And so do social service and criminaljustice professionals. Working with victims ofabuse or being threatened with assault bysomeone already known to be capable of murdercan be daily occurrences, not in the context of anemergency callout, but as part of the daily workroutine. Indeed, studies comparing emergencyresponders with social services personnel, foundthe latter group reported higher levels oftraumatic symptoms despite similar levels ofexposure to traumatic stimuli (Paton, Cacioppeand Smith, 1992; Paton and du Preez, 1993).

However, if the event itself caused traumaticsymptoms, the shelf-life of members of criticaloccupations would be dramatically short. Sowhat other risks should be considered? Paton andViolanti (1996) refer to the ‘potential’ for an eventto be traumatic, suggesting that a second area ofrisk is that of traumatic responding by anindividual worker. As will be discussed later inthe chapter, just because risk of exposure is high,it does not follow that distress is inevitable. Thelevel of risk of such a response is embedded notjust in events, but also in complex psychologicaland demographic individual differences. Age,

gender, length of service, previous trauma historyand family history are all examples of factorsassociated with risk of stressful responding (e.g.Burke, 2007; Clarke, 2004; Clarke and Roger, 2007;Ellerby, 1998; McFarlane, 1987).

Thirdly, organisational practices evidenced toaffect risk also require attention. Conclusionsfrom research undertaken with emergencyprofessions suggest that organisational variablesrepresent stronger predictors of post-traumaoutcomes than the incidents themselves(Dunning, 2003; Gist and Woodall, 2000; Hart,Wearing and Headey, Paton et al., 2000; Paton etal., 2003; Paton, Violant and Smith, 2003; Paton,2006). For example, organisations characterisedby high levels of bureaucracy, internal conflictsregarding responsibility, persistent use ofestablished procedures (even in novel situations),and a strong motivation to protect theorganisation from blame or criticism, have allbeen found to increase the risk of poorpost-trauma outcome (Alexander and Wells,1991; Gist and Woodall, 2000; Paton, 1997).Conversely, positive organisational practices,such as adoption of autonomous responsesystems, consultative leadership styles, trainingto develop adaptive capacity, and tolerance ofprocedural flexibility, can all enhance thelikelihood of positive outcomes (Dunning, 2003;Gist and Woodall, 2000; Hart et al., 1994; Paton,1994).

Finally, the extent to which risk levels might becompounded by events removed from the workcontext, but significant to the individual, alsoneeds to be understood if risk potential is to becomprehensively managed. For example, in astudy of prison and community-based sexoffender treatment providers, respondents whohad experienced a non-work related adverseevent in the previous six months, also reportedsignificantly higher levels of dissatisfaction withtheir organisations (Clarke, 2004). Such eventsincluded illness, relationship breakdown, housemoves and so on. Although similar researchfailed to find an impact of traumatic life events 12to 24 months after the event (Creamer et al., 1990)recent occurrence does appear to impactnegatively on well-being.

An approach to managing risk incorporatingthese areas can underpin the development of acomprehensive strategy to enhance well-being forstaff in critical occupations.

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Psychological well-being andresilience in critical occupations

Until recently, research into the psychologicalimpact of traumatic events, whether in anoccupational or personal context, has focusedalmost exclusively on the potential for deleteriousoutcome. In a review of the literature concernedwith the impact on treatment providers ofworking therapeutically with sex offenders(Clarke, 2004) not one study prior to 2000considered positive aspects of the work. Becauseof the invidious nature of sexual violence againstchildren and adults and the consequent exposureof therapists to detailed accounts of sexual abuse,the pervasive acceptance of detrimental effects isperhaps not surprising. This has been reflected inthe nature of the psychometric instruments andsurveys employed to assess impact. Measures ofburnout (e.g. Maslach Burnout Inventory,Maslach and Jackson, 1986), vicarious trauma(Traumatic Stress Institute Belief Scale – RevisionL, Pearlman, 1996) secondary traumatic stressand compassion fatigue (Compassion FatigueSelf-Test, Figley, 1995) prevail. Consequently, itshould be expected that symptoms indicative oftrauma, including intrusive imagery, avoidance,cognitive disturbance, mood changes anddisruption of core beliefs, have been identified. Ina similar review of the trauma literature, Stamm(1997: 5) concluded, ‘the great controversy abouthelping-induced trauma is not, can it happen, butwhat shall we call it?’

It is somewhat surprising then that consistentlyacross studies, from the UK to North Americaand Canada, prevalence of symptoms has beenmoderately low, ranging between 20 per cent and25 per cent (Ellerby, 1998; Farrenkopf, 1992;Jackson, Holzman, Barnard and Paradis, 1997;Rich, 1997; Turner, 1992). The reliability of thesefigures is also brought into question by theretrospective, snapshot research methodology bywhich they were derived. Failure to incorporatelongitudinal components into impact researchmeans no conclusions can be drawn about whysome people are affected and not others, howlong symptoms persist, what the long termprognosis is or whether or not deleteriousoutcome is caused directly by work-relatedexposure to trauma.

The cost of the focus on measurement ofpsychological harm has also meant that anotherconsistently occurring statistic has, until recently,been overlooked; that which reflects that

anywhere between 75 per cent and 96 per cent oftreatment providers experience their work asimmensely satisfying and rewarding (Edmunds,1997; Ellerby, 1998; Kadambi, 2001; Kadambi andTruscott, 2003; Myers, 1995; Rich, 1997; Turner,1992). In the critical occupations literaturegenerally, there is a growing body of evidencethat positive outcomes are not only possible, butthat they often outweigh the negatives (Gist andWoodall, 2000; North et al., 2002; Paton, Violantiand Smith, 2003;Tedeschi and Calhoun, 2003).Being able to exercise professional skills toachieve highly meaningful outcomes, a strongsense of personal and professional development,a sense of control over significant adverse events,protection of the public and connection tocolleagues have all been cited as enhancingwell-being (Kadambi and Truscott, 2001; Paton,2006).

In an organisational context the term‘well-being’ refers to establishing the rightconditions for generating high levels of employeeengagement. It emphasises the social andpsychological dimensions of the workplace,workforce and the work people do, and is relatedto both physical and mental health. An engagedworkforce is identified by high levels ofresilience, characterised in turn by the ability tobounce back from negative emotional experiencesdespite threats to the individual, flexibleadaptation to the changing demands of stressfulexperiences and high positive emotionality (Blockand Kremen, 1996; Lazarus, 1993; Masten, 2001).This is illustrated by staff who are competent,autonomous, understand the difference they canmake to their work place and have personalvalues and beliefs that fit the needs of the rolethey undertake. Consequently, an engaged andresilient workforce is one that has low rates ofturnover, low levels of sick absence and highlevels of performance. The development andmaintenance of such should arguably then be thenumber one priority for both individuals andorganisations in the critical occupations business.

A model of well-being

The number and complexity of factors implicatedin risk to individual well-being outlined at thestart of this chapter, highlights the need for astructured, systematic and integrated approach totheir identification and management. The Modelof Dynamic Adaptation (MDA) (Figure 9.1)

166 Contemporary Risk Assessment in Safeguarding Children

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Figure 9.1 The model of dynamic adaptation

generated from research into the well-being of staffworking therapeutically with sex offenders (Clarkeand Roger, 2002; Clarke, 2004) provides a usefulframework for this process. So named in an attemptto encapsulate the fluid risk status of an individualat any given time, it is based on the principlesemanating from the risk prediction field (Groveand Meehl, 1996). In this, Here there is an emergingview that there are categories into which factors canbe grouped that contribute to the prediction of risk(e.g. Hanson and Bussiere, 1998; Thornton, 2001).Although not yet empirically tested as a predictivemodel, a large number of variables incorporated inthe MDA have been identified as significant, eitherin terms of heightening vulnerability to risk orincreasing resilience to it. The organisation ofvariables in the way described allows for futuredevelopment of the MDA as a reliable and validrisk prediction tool.

Variables are categorised according to thefollowing definitions: Static Factors are anyvariables from an individual’s history that areeither fixed or unchanging, or change in a highlypredictable way. Age and gender are examples ofthese. Stable Factors are those that are potentiallychangeable but relatively stable. Under normalcircumstances they would change only slowly,usually as a result of intervention or experience.Personality variables such as emotionalsensitivity, coping styles and ability to takeperspective are examples. Dynamic factors arethose that can change rapidly, unpredictably andmay well be outside the sphere of influence of the

individual. Examples might include winning thelottery, a spouse losing a job, a new colleaguejoining the team, or having an accident.

The Critical Occupation category incorporatesall those variables relevant to the work thatpeople and the work do. It includes risk ofexposure to critical incidents, team cohesiveness,the physical environment in which the worktakes place, policies and procedures,organisational support practices and so on.

The two outcome boxes refer to positive ornegative psychological consequences, but are notmutually exclusive. As the figures from the sexoffender treatment provider literature suggest,both rewarding and deleterious outcomes arepossible simultaneously. The aim of any strategyto enhance well-being should be to tip the balancein favour of positive outcome for a majority ofworkers for a majority of the time.

The MDA is intended as a functional model forapplication to any critical occupation. However,identification of static, stable and dynamicvariables, as well as rewards and cost of thework, needs to be specific to the occupationunder consideration. Ideally, organisations willconduct their own longitudinal research, workingwith new, experienced and former practitioners,to establish the relative importance of themultitude of potential variables. The very natureof critical occupations though, means that somevariables are likely to be common to all.

For example, within the static domain, age,gender, length of time in the role, family status


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and previous history of trauma repeatedlyemerge as significant to well-being (e.g. Clarke,2004; Clarke and Roger, 2007; Clarke and Blythe,in preparation; Ellerby, 1998; McFarlane, 1987;Murphy, 1991). Within the stable category,dispositional optimism, emotional response style,coping strategies, perspective taking skills andempathy have all been identified as significant(e.g. Clarke, 2004; Clarke and Roger, 2007; Moranand Massam, 1997; Myers, 1995; Roger, Guarinoand Olason, 2000). Dynamic factors, althoughlittle researched, include exposure to an eventperceived to be traumatic within the previous sixmonths, and quality of social support networkpost-event (Clarke, 2004; Pearlman andSaakvitne, 1995; Rich, 1997). Job andorganisational characteristics include training,on-the-job support, preparedness and culturalissues (blame versus learning) (Alexander andWells, 1991; Eisenberger et al., 2002; Gist andWoodall, 2000; Paton, 1997).

It is important to note that the extent to which aparticular variable might influence either positiveor negative outcome has not been elaboratedupon here, and would need to be established inthe context of other variables and the role towhich it was being applied. For example, in areview of the literature on humour and coping inemergency work, Moran and Mossam (1997)concluded there is scope for some but not allhumour to act as a positive coping strategy. Othervariables may well be double edged swords. Forexample, high levels of emotional inhibition havebeen demonstrated to be detrimental topsychological and physical health (Roger, 2002).However, emotional expressiveness needs to takeaccount of time and place. It is unlikely to beconducive to high performance or well-being inthe face managing of a critical incident.

Understanding the rewards of working in aparticular critical profession is also essential ifwell-being is to be enhanced. In a conceptmapping exercise with sex offender treatmentproviders, Kadambi and Truscott (2003)identified seven key areas in which providersfound reward and meaning in their work. Thesewere labelled: protection of the public, sociallymeaningful curiosity, enjoyment of counselling,professional benefits, connection to colleagues,offender wellness and change and offendingspecific change. Knowing such specifics affordsorganisations the opportunity to maximiseworkers’ development in these domains.

A strategy to enhance well-being ofdirectorate of High Security DiscreteUnit staff

HMPS Discrete Units

In 2005, HM Prison Service’s Director of HighSecurity (DHS) Prisons appointed a well-beingadvisor to consider the psychological supportneeds of staff working in DHS Discrete units(DUs). Discrete Units comprise Close SupervisionCentres (CSCs) and segregation, special secure,detainee and protected witness units. All suchunits are self-contained within their parentestablishment, in that they are run and managedby dedicated staff teams who in most instanceshave been especially selected for the role. Amajority of DUs accommodate the mostdisruptive, dangerous and often damagedindividuals in the prison system. These includemen who have a history of institutional violence(that may include murder) who exhibit aggressiveand unpredictable behaviour and who may wellhave a diagnosis of personality disorder. Morerecently, extremist prisoners charged with, orheld on suspicion of, terrorist activity havepresented a new and somewhat differentpsychological and emotional challenge to staff.

The types of challenges faced by staff on analmost daily basis include managing long-termprisoners with a history of serious hostage-taking(of both staff and other prisoners) and receivingconstant personalised abuse from particularprisoners. The following incidents serve toillustrate other challenges: A previously quiet andreclusive prisoner mounting an unprovokedassault resulting in a member of staff being stabbedin the eye; a highly disturbed prisoner deliberatelyself-inflicting serious injury and excavating his ownflesh to ‘flick’ at staff; prisoners uniting to go on‘dirty protest’ whereby they urinated and defecatedover their cells over a prolonged period of time.

In the late 1990s, as the development of CSCswas in progress, it was suggested that the singlemost difficult management issue confronting thePrison Service was creating secure and orderedconditions for long-term and difficult prisoners,while also establishing a realistic opportunity forthem to progress, ultimately to less secureconditions (Morgan, 1997). Achieving suchconditions without resorting to physical barriers,surveillance technology or regime deprivationwas, and still is, considered to lie in theprofessional integrity of staff (King, 1985). The


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skills needed to respond to the intenselydemanding nature of the work are multiple, andover the past six years, considerable effort hasbeen put into equipping DU staff with theprofessional competencies to fulfil their role.However, although an integral aspect ofwell-being (as will be discussed later),competence is only one of a multitude ofelements that requires attention if a holisticsolution is to be operationalised. As Liebling(1999: 161) highlighted: ‘the question of how staffcope with the fluctuating possibility of abuse andviolence, while maintaining a relationship withprisoners, has never been adequately addressed’.

Wilson (2001) highlighted that one of the coreprinciples in setting up CSCs, in recognition ofthe demands placed on staff, was that routinesand staffing arrangements should be organised toensure effective staff support. This is particularlypertinent given the physical environmentassociated with most DUs. Although far removedfrom the austerity described above, DUs arenecessarily managed with security and control asthe highest priorities. For example, electronicdoors operated externally prevent free entry orexit to staff, barred windows limit natural light,furnishing and decoration is kept to a minimumto reduce the potential for weapon construction,rest rooms for staff may be difficult to access(owing to electronic doors) or, if located centrally,overlooked by prisoners. The paradox thenbecomes clear that the very measures designed toincrease physical safety may simultaneously havea negative impact on psychological well-being.

In an attempt to support staff, operatingstandards evolved which included a requirementfor team members to receive individual sessionswith a qualified psychologist. In addition toaddressing well-being issues, sessions wereintended to counteract regime ‘drift’ and theeffects of attempted conditioning by prisoners.Some units also contracted-in EmployeeAssistance Programmes to provided access toexternal counselling.

Individual support sessions, while laudable interms of responding to potential individual need,failed to encapsulate the wider spirit of Wilson’srecommendations. Consequently, they came torepresent the totality of the supportinfrastructure, whilst neglecting a multitude ofother practices, strategies and techniquesevidenced to enhance well-being. Furthermore,the inflexible nature of this approach met withconsiderable resistance. Specifically, the

mandatory requirement for attendance atindividual support sessions resulted in staffperceiving that their ability to cope with highpsychological demand was being undermined.This in itself resulted in distress, often exhibitedas hostility, suspicion and outright anger,supporting empirical evidence that such anapproach may result in greater severity andchronicity of symptoms (Bisson and Deahl, 1994;Carlier, Uchelen, van Lamberts and Gerson, 1998).

A second intuitive response designed to reducethe potential risk to staff was to limit the length oftime individual officers stayed in DUs to twoyears. This was based on concerns surroundingcapacity to cope and the potential for individualsto encounter numerous critical incidents in thattime. Such a policy fails to account for individualdifferences in exposure, coping strategies,support networks or job satisfaction, the impacton teams of regular rotation or the financialimplications of continually training new staff andinducting them to different ways of working, toname just a few. Further, there is a growing bodyof evidence to suggest that levels of distress mayactually increase on leaving a critical occupation.For example, ex-sex offender treatment providersreported significantly higher levels of negativereactivity than practicing providers. Violanti(1996) points to the depressed, bored, tired andpsychologically deadened state experienced bysome police officers on leaving their role. Hesuggests it indicates a type of ‘addiction totrauma’, withdrawal, from which can beextremely difficult without intervention.Therefore, any decision to impose a maximumlength of service in a critical occupation shouldalso accommodate the potential costs to theorganisation of relocating staff to less demandingroles, the potential requirement for ongoingsupport interventions and the personal cost to theindividual of a possibly unwanted transfer.

Despite these efforts to address perceivedneeds of DU staff, it became evident they werenot combating reported distress. Evidence for thiswas mostly anecdotal, although on one particularunit hard evidence was available in the form ofhigh sick absence and turnover figures.*

* Sick absence among DU staff is generally lower than theService population as a whole (Clarke and Blythe, inpreparation). This might well attest the earlier observationsregarding high levels of job satisfaction in COs, despitepotential for distress, and cautions against over-reliance onsick absence figures as a measure of well-being.


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Clarke and Lloyd (2004) in research intended todetermine support preferences of DU staff,identified 35 separate items endorsed asbeneficial to well-being. Using a critical itemscore methodology pioneered in earlier research(Clarke, McDougall and Harris, 2003) and theprinciples of factor analysis, the items werebroadly categorised into two key areas;Operational Support and Personal Care/Emotional Well-Being. Items falling in the formergroup included ‘A staff rotation plan that alwaysleaves some experienced staff on the unit’,‘Minimising the use of non-regular staff’ and‘Senior managers acknowledging a job welldone’. In the latter group ‘Training in how to lookafter myself emotionally’, ‘Training in mentalhealth issues’ and ‘Mandatory recovery timeimmediately after incidents and before debriefsor paperwork’ were all considered supportive.Not only were many of the items far removedfrom previous organisational responses tominimising apparent distress, many of them werevery straightforward to implement and far morein keeping with Wilson’s (2002) originalrecommendation.

In an attempt to comprehensively address thesupport needs of DU staff, a long-term strategicapproach has been adopted, incorporating manyof the measures generated by staff in an effort toenhance well-being.

Strategy development andunderpinning principles

The aim of any strategy is to help an organisationthink through what it wants to achieve and howit will go about achieving it. Putting a strategyinto practice and acting strategically ensures theorganisation focuses on what needs to be done, isable to allocate resources accordingly and is notbuffeted by events or distractions. The StrategySurvival Guide (2004) issued by the CabinetOffice, states that good public service strategiesneed to be; clear about objectives; informed by arich understanding of causes, opportunities,trends, threats and possible futures; based on arealistic understanding of effectiveness; creative;adaptable; and, developed with, andcommunicated effectively to, all stakeholders. Indeveloping the DU Well-Being strategy, anumber of underpinning assumptions weremade, including:

� Working in the Directorate of High SecurityDU is a critical occupation and presents uniquepsychological challenges to staff.

� Staff are in a constant process of adaptation totheir work, influenced by a range of differentfactors.

� Allied to the point above, different staff havedifferent needs at different times in relation towell-being.

� The Model of Dynamic Adaptation is anappropriate one on which to base anunderstanding of causes, threats and possiblefutures, given the points above.

� Pro-active, preventative strategies are morecost-effective than reactive, post-eventstrategies.

� The principles of evidence-based practice arehighly relevant to interventions to enhancewell-being. Intuitive interventions should onlybe implemented when theoretically supportedand reinforced by thorough evaluation.

Fundamental to the success of the strategy isflexible, dynamic and holistic application inwhich the individual and employer havecomplementary responsibilities for sustainingwell-being. Flexible in that elements of thestrategy can be applied to the need of each unitand every individual at different times; dynamicin that it can accommodate change in the light offeedback or in response to new research evidence;and holistic in that it encompasses thepreparation of staff from the point of expressionsof interest to join a critical occupation through tocomprehensive planning and support fordeparture and beyond.

To help achieve this, wider organisational andgovernmental considerations needed to beincorporated. In particular, the Health and SafetyExecutive (HSE) management standards forreducing workplace stress, and the Departmentof Health principles for primary, secondary andtertiary prevention were consulted.

The six HSE management standards cover theprimary sources of stress at work, considered tobe:

� Demands – such as workload, work patternsand the work environment.

� Control – such as how much say the person hasin the way they do their work.

� Support – such as the encouragement,sponsorship and resources provided by theorganisation, line management and colleagues.


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Figure 9.2 The model of dynamic adaptation with potential intervention points

� Relationships – such as promoting positiveworking to avoid conflict and dealing withunacceptable behaviour.

� Role – such as whether people understand theirrole within the organisation and whether theorganisation ensures that they do not haveconflicting roles.

� Change – such as how organisational change(large or small) is managed and communicatedin the organisation.

Staff reporting positively about their working lifein each of these domains is thought to reflect highlevels of health, well-being and organisationalperformance. The DU Well-Being strategy is thusinformed by these standards. However, the HSEacknowledges that while the organisation cantake steps to reduce the potential for stressfulresponding, such emotional reactivity is largely afunction of individual differences. Therefore,organisational measures for stress reduction needto be accompanied by protocols for addressingindividual, psychological need.

To derive a framework for the strategy theorganisation needs to first consider where itwants to be (its vision), and then how it might getthere, through defining aims and short, mediumand long-term objectives. By considering pointson the MDA where intervention is possible, acoherent framework begins to emerge.

The points of intervention may be consideredprimary, secondary and tertiary in nature (DoH,

2007). In the context of the well-being model,primary intervention aims to promote goodpsychological health and requires action on itsdeterminants to prevent dysfunctional outcomes;secondary intervention involves the earlydetection of dysfunctional outcome, followed byappropriate intervention; and tertiaryintervention aims to reduce the impact of thedysfunctional outcome and promote quality oflife through active rehabilitation.

Intervention One is concerned with theindividual. It covers issues of selection, trainingand preparation of the individual to undertake acritical role. In addition to skills andcompetencies to do the job, self-care skills alsoneed to be considered (psychologicalself-maintenance). The aim here is not necessarilyto deselect staff who have yet to acquire therequisite skills, competencies or values to staypsychologically well and perform highly, but togenerate a profile that enables the individual andorganisation to work together to achieve such aposition if potential is shown to do the job. PointOne is thus considered a primary intervention.

Intervention Two concerns the job itself, andrelates to the workplace, the work force and thework people do. Here, consideration needs to begiven to the environment, organisational policiesand procedures, on-the-job support, frequency ofexposure to traumatic events, recognition ofdistress and so on. Essentially a primaryintervention, elements of secondary intervention


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would be applicable, if, for example, detrimentalorganisational practices were identified.

Opportunities to intervene at point Three areminimal. However, recognition andunderstanding of the impact that dynamic factorscan have on well-being enables appropriateresponses at both the individual andorganisational level. Disclosure by a worker ofdifficult family circumstances, for example, canenable a manager to initiate different supportoptions; understanding the impact on the team ofa new manager can allow apposite preparationand so on. Intervention here would be anexample of secondary prevention.

Intervention Four concerns action to be taken inthe event of deleterious outcome, whether theresult of a critical incident, other events related toorganisational practices or individualcircumstances. Generally tertiary in nature,responses might include referral to a mentalhealth professional, adjustment of workdemands, retraining and so on.

Table 1 illustrates the strategic framework forenhancing the well-being of staff working in DHSDiscrete Units, derived from the MDA.

In addition to the central domains ofpreparation, practice and post-event recovery, thestrategic framework incorporates two additionalstrands; evaluation and expert advice.Evidence-based practice is essential if thewell-being of staff in critical occupations is to beenhanced. Even though empirical evidence forthe efficacy of interventions in the non-emergencycritical occupations is sparse, there isconsiderable evidence emerging from relatedfields that supports the testing of specifictechniques in this context. Backed up bythorough evaluation, the intention is to developan array of evidenced-based techniques forapplication in non-emergency settings. To thisend, the advice of a number of experts in relatedfields has guided and will continue to guide thedevelopment and implementation of the strategy.The fields include critical occupations, stress andemotion, statistics and experimental design,supervision, and training methodology.

Implementation of the strategy

HM Prison Service’s Directorate of High SecurityWell-being Strategy is in the early stages ofimplementation. The number and range ofinterventions mean that it will be a number of

years before all elements are in place, and evenlonger before empirical evidence of efficacy isavailable. The full version of the strategy includesjustification and supporting empirical evidencefor the inclusion of each element in the fourcentral domains, and will not be elaborated uponhere. However, to illustrate the strategy in action,three case examples are provided, in which twointerventions from the Practice domain and onefrom Preparation 2: Training domain, aredescribed.

Practice: Develop and implement aplan of Environmental Resilience

In 2005, concern was raised regarding the moraleand subsequent performance of a staff teammanaging a small but highly disruptive group ofprisoners held under conditions of closesupervision. Reasons for the malaise were variedand plentiful, ranging from the implementationof new policies and procedures with little or noconsultation, the long term placement of anextremely challenging prisoner, to a difficult teammember perceived to be working beyondpersonal competencies and at high risk of beingmanipulated by prisoners. Many staff reportedwanting to leave the unit, sick absence was highand when staff were on duty they spent as littletime as possible interacting with prisoners. Theconsequence was that the prisoners became moredisruptive and difficult to manage, perpetuatingthe disquiet. The development of environmentalresilience with this team was considered by theauthor the most appropriate way to change theprevailing conditions.

Environmental Resilience (ER) essentiallyrefers to how an organisation can developpeople’s resilience to deal with adversity (for adetailed description see, for example, Paton,Violanti and Smith, 2003). Two key componentsare how it can facilitate a capacity for adaptabilityprior to exposure and how it can supportindividuals to sustain resilience post-incident(Johnston and Paton, 2003). Central to the ERconstruct is the concept of empowerment.Empowerment ‘enables’ people to deal withenvironmental demands (Conger and Konungo,1988), with empowered people having enhancedbeliefs about their ability to achieve a desiredlevel of performance, no matter what thehoped-for outcomes. An organisation canfacilitate this capacity by focusing on what are


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considered the four cognitive components ofempowerment; Competence, Meaningfulness,Choice and Impact.

Competence describes an individual’s beliefthat they possess the skills and abilities necessaryto perform the job. Clearly related to preparationin terms of training, it also incorporates morepersonal skills useful for looking after oneself.The more competent staff feel, the moreproductive and adaptable they are and the moreeffort they put into their work.

Meaningfulness refers to the ‘fit’ between theneeds of the role and the values, beliefs andbehaviours of the individual. This is likely to bereflected ultimately in how much an individualcares about their work (Thomas and Velthouse,1990). Individuals who find their workmeaningful are likely to perceive problems anddemands as welcome challenges (Antonovsky,1990). In the social services and criminal justiceprofessions, meaningfulness is likely to be high,and reflected in the large proportion of workerswho report their jobs to be highly satisfying andrewarding, despite the adversity faced.

Choice, according to Spreitzer (1997) refers tothe extent to which an individual perceives theirbehaviour as self-determined. It is likely to beevident in an individual’s predisposition to actpositively under adverse conditions (Dunning,1994). Choice for staff can be difficult to facilitatein a highly structured, necessarily disciplinedenvironment, where strict application of rules isconsidered to enhance equity and fairness forprisoners. However, there are opportunities formanagers to exercise discretion, thus allowingstaff some freedom in how units are operated.

Impact refers to the extent to which anindividual perceives they can influence strategy,administration or operating outcomes at work tomake a difference. Spreitzer (1997) points out thatwhere choice concerns control over oneself,impact concerns the notion of control overorganisational outcomes.

Johnston and Paton (2003) argue thatidentification of organisational conditions thatcultivate powerlessness is the first step todeveloping an empowered workforce. Removalof those conditions, together with encouragementof self-reliance, leads to the experience ofempowerment, resulting in behaviourscharacterised by initiative and perseverance.

Putting these principles into practice with theteam described above required input with boththe frontline staff and unit managers. With the

support of the prison’s senior managers (essentialto the perception of meaningful intervention), afive stage process was initiated in line withJohnston and Paton’s recommendations. Thisincluded:

1. Focus groups with frontline staff to identifytheir perceptions of barriers to well-being andhigh performance.

2. Examination of which of these (if any) could beremoved or changed.

3. Use of training in how to manage the demandsof work that cannot be adjusted.

4. Consideration of best methods to supportmanagers.

5. Consideration of new ways of working toencourage resilience.

Focus groups with frontline staff resulted in theidentification of a range of issues that concernedteam members. For example, officers expressedanxiety at not feeling confident to manageprisoners’ mental health issues in the absence of aspecialised mental health provider. The resultwas staff finishing their shift concerned they hadat best, not dealt with the prisoner well, and atworst made things more problematic for theircolleagues coming on duty. Clearly an issue ofcompetence, staff had found this issue verydifficult to voice outside the ER forum, partly forfear of being judged, but also simply because thequestion had not previously been asked. Thematter was addressed through additional on-sitetraining, and more frequently scheduled visitsfrom the mental health nurse.

A second, less clear cut, issue was a perceptionthat prisoners had their requests and applicationsexpedited more efficiently than staff. Oneparticular incident surrounded the purchase of amusical instrument for a particularly demandingprisoner that some staff felt was not deserved.They felt vexed that goods seemed to have beenpurchased quickly and without question. Bycomparison, when staff had asked for theinstallation of lockers for storage of their personalbelongings, very little seemed to happen. Theconsequence was staff feeling angry, resentfuland undervalued. The ER focus group not onlyallowed this issue to be aired, it also provided anopportunity for a number of differentperspectives to be heard. It transpired that theprisoner’s order had taken many months to beprocessed, but since it had arrived the prisonerhad been far calmer and less demanding of staff.


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The unit manager was also able to take up thematter of the lockers and agreed to keep the teamregularly updated about progress.

A third and highly emotive issue for the teamconcerned the working environment. Ashighlighted earlier in this chapter, often the verymeasures put in place to enhance physicalsecurity can compromise emotional well-being. Acentrally located general office with 360° views ofthe unit and lack of rest facilities meant noprivacy for staff during the core day. With aminimum of four centrally operated electronicdoors, entry and egress from the unit was alsoproblematic. It is hard to imagine the demandplaced on individuals of being permanentlyobserved. Although it took time to address,adjustments were made as a consequence of theconcerns raised. The central office windows werecovered with one-way reflective sheets, allowingobservation of prisoners but not prisonerobservation of staff, and a small office, away fromthe central area but within the unit, wasconverted into a rest room.

These examples illustrate stages one to three ofthe process in action. Most actions wereundertaken with minimal cost implications,which in any case were likely to have beendisproportionately low compared with theincreased well-being of the team.

Additional focus groups were held with thefirst-line managers, including one PrincipalOfficer (PO) and four Senior Officers (SOs) andtwo psychologists having input to both prisonerand staff well-being. First-line managers arecentral to the development of ER in teams for amultitude of reasons. They act as role models totheir team and provide feedback to staff(Johnston and Paton, 2003). They also have theauthority to introduce ER related initiatives, suchas structuring team briefings (affordingopportunities for impact); setting progressivelymore challenging targets (developingcompetence); increasing variety of tasks (choice)and matching skills of staff to roles within theteam (meaningfulness). They also need to havetheir own support needs met.

The managers identified additional issues thatthey perceived may have been hindering thedevelopment of resilience in the team, andamongst themselves. For example, with two SOson duty, it was not always clear who wasresponsible for what. SO tasks could be broadlysplit into either operational or administrative innature. New practice meant the roles were clearly

defined, the managers were clear about theirresponsibilities, and staff knew who to go to overwhat issue. The managers also discussed the needto enhance competence and choice by providing asupporting role to staff managing highlydemanding prisoners, rather than the hands-onapproach they had been adopting. It is easy forthe often overwhelming operational demands onprison staff to overshadow the very solutions thatcan reduce or remove them. The opportunity,time and space afforded to the managers and staffby the ER process resulted in the implementationof a range of simple, straightforward and costeffective solutions that may not have otherwisebeen identified.

Eighteen months on from the initialintervention, the team hold ER meetings on amonthly basis. Although not yet empiricallytested, morale in this well-functioning andintegrated team is high. Visitors to the unitcomment on the calm and ordered atmosphereand staff present as relaxed and competent intheir roles.

Practice: Identify and implementadaptive working practices

Some high risk jobs involve undertakingrepetitive and painstaking tasks that most of thetime, do not demand high levels of emotionalenergy to perform well. They do, however,require vigilance and can at times become criticalin nature. An example of one such job is that ofmonitoring the correspondence, both verbal andwritten, of prisoners subject to SafeguardingChildren measures.

In 2006, new procedures were introduced toundertake this task, and, in one prison, a smallteam of ancillary grades was appointed toadminister them. Despite the newness of the role,the then Director of High Security prisons raisedconcerns regarding the potential for the work toexert critical pressure on well-being. He asked fora review of that potential and for interventions tobe considered that would reduce the risk ofpsychological harm to the team.

The prison concerned had 180 prisoners subjectto the measures. The team was required tomonitor communications and make anassessment about the nature and level of risk inrelation to public protection. The gathered datamay be used in a number of ways, includingpreventing a known sex offender gaining access


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to children, foiling an escape attempt, orimposing conditions on a licence prior to release.Accordingly, team members are required toremain highly vigilant in the face of potentiallyemotionally upsetting material, in the knowledgethat their assessment is likely to have a significantimpact on public safety. It is a highly responsibleand high profile role.

In order to establish the nature of the riskposed to psychological well-being, a focus groupcomprising representatives of the team and theteam leader was held. This group identified thefollowing challenges: anticipation of the contentof material they may encounter – generally foundto be worse than the content itself (issues ofpreparation); reading security files containinggraphic offence information and occasionallyphotographs; managing strong emotionalreactions to the content of phone calls monitored(compounded by wearing headphones whichgive the sensation of personal involvement in theconversation); the amount of time spentmonitoring conversations, which could be foreight hour stretches; and singleton working,particularly at weekends, with no opportunity todebrief.

The team identified the following areas asparticularly rewarding:

� Knowing that actions taken have a far reachingeffect on public safety.

� New, novel and interesting work.� Systematic gathering of information.� Able to use initiative.� Able to operate independently.� Close knit team.� Attendance at Safeguarding children meetings.� Greater involvement in prison life.� Potential to have a big impact.

The components of ER were already evident inthe team (impact and meaning especially). Thepriority therefore was to develop healthyworking practices to enhance the existingrewards of the work and reduce the risk of workcontent impacting negatively. To achieve this, theprinciples of ‘Full Engagement’ explicated byLoehr and Schwartz (2003) were consulted ascomplimentary to other practices evidenced toenhance well-being.

Loehr and Schwartz propose that‘performance, health and happiness aregrounded in the skilful management of energy’(p. 5) resulting in greater empowerment and

productivity. Full engagement requires anindividual to be physically energised,emotionally connected, mentally focused andspiritually aligned. It involves not just theexpenditure, but also the recovery of energy inthese domains. In a job involving the monitoringof high risk prisoners, being disengaged in any ofthe domains could have disastrous consequences.Therefore practices such as monitoring phonecalls continuously for eight hours for example,needed addressing.

Four interventions were proposed. To aid themanagement of physical energy, regularformalised breaks were introduced. Five to 10minutes in every 90 was recommended, withteam members physically leaving their workstations for that period of time. Some teammembers additionally opted to undertake alunchtime exercise programme to augment theirphysical energy. To assist with the renewal ofemotional energy, formal debriefs wererecommended to provide team members with anopportunity to off-load the issues at the end ofeach day. Voluntary sessions with a mentalhealth professional were also offered on an ‘asneeded’ basis. To help staff remain mentallyengaged, a rotation system was recommended,whereby team members moved between the tasksneeding to be undertaken.

In addition to the above, preparedness trainingwas also advised. Training in psychologicalself-maintenance skills, emotion managementand the nature of psychological distress canenable staff to feel equipped and empowered tomanage their emotional reactivity as it arises,rather than feel overwhelmed or baffled by it.

A recent review of the monitoring team founda psychologically and physically healthy staffgroup, fully engaged with their work andthriving in the face of some considerableadversity.

Preparation 2: Training

Within the Preparation 2 domain of the strategy,training, a number of initiatives have beenimplemented that will be summarised here byway of illustration.

An evaluation of a related but separatestrategy, to reduce violence in prisons (Fylan andClarke, 2006), identified a deficiency in theexisting training for staff working withchallenging prisoners. Although staff indicated


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they enjoyed and appreciated the training, theylacked confidence and competence to apply thenew skills they had learned. Research findingsfrom the disaster and emergency literature haveidentified a clear link between competence,well-being and resilience (e.g. Spreitzer et al.,1997), suggesting a priority need to address theapparent shortfall between training aims andoutcome.

Two steps were taken. The first was to identifythose skills based training modules consideredcritical, and develop them into morecomprehensive packages. This aim was toprovide more practice opportunities with a viewto building confidence in the use of specific skills.The second step was to consider ways of makingthe training more engaging and relevant to theworkplace. It was recognised by trainers andtrainees alike that the abstract nature of theclassroom is not conducive to engagement withskills that are likely to be needed in highlyemotionally charged and volatile situations. Forexample, applying the skills of a motivationalinterview to encourage a prisoner to progress isfar less challenging in the training room that it isin a cell with a prisoner refusing to go to work.

To address this problem an expert in the use ofdramatic techniques was bought in to advise ondeveloping the training modules. A variety oftechniques have now been incorporated thatencourage far greater interactive practice of skillsin much more realistic settings.

In addition to enhancing existing training,additional training was established, focusinguniquely on the development of psychologicalself-maintenance skills. As most practitioners inhigh risk jobs would probably affirm, training inthe skills to do ones job is often comprehensive,but in the skills to look after oneself, non-existent.The training of choice for incorporation into thewell-being strategy is that devised by Roger(2002). Based on the principles of emotionaldetachment, and developed from a series ofexperimental studies on the role of emotionalinhibition and rumination in prolongingphysiological recovery from stress, theprogramme describes the behavioural andpsychological process of stressful responding andthe physical correlates. Attendees generate theirown risk profile, through use of establishedpsychometric instruments and then practicemethods for managing risky elements andenhancing protective ones. An empiricalevaluation of the programme when used with

police officers demonstrated significant increasesin job satisfaction and reduced absenteeism(Roger and Hudson, 1995).

A number of research projects have beeninitiated in support the strategy’s development,including the construction of an early distresswarning system and exit support plans. Theproof of efficacy will come from long-termevaluation of projects and the ongoing feedbackof frontline staff and managers.

Well-being in critical occupations

Critical occupations are unique with respect towhich members risk exposure to potentiallytraumatic events. However, what should beevident from the review provided here is thateven if risk of exposure is high, risk of deleteriousoutcome for individual workers need not be.Indeed, contrary to previous assumptionsregarding pathological outcome in the face oftrauma, an increasing body of evidence isemerging supporting what has been described aspost-traumatic growth (PTG) (Tedeschi andCalhoun, 2003). PTG is defined as ‘significantbeneficial changes in cognitive and emotional lifebeyond levels of adaptation, psychologicalfunctioning, or life awareness that occur in theaftermath of psychological traumas that challengepreviously held assumptions about self, othersand the future’ (Paton, 2005: 226).

Understanding the processes and factorsinvolved in both positive and negative outcomesfor workers in critical occupations enablesorganisations and individuals to respondaccordingly. Establishing and maintainingappropriate preparation, practice and post eventrecovery environments should ensure the risk ofpsychological harm is kept to a minimum and theopportunities for psychological growthsubstantially enhanced.

Clearly, organisations have a duty of care totheir employees to generate workingenvironments that are as safe as possible.Individuals also have a duty of care to themselvesto ensure they avail themselves of allopportunities to stay psychological well in thework context. These complimentaryresponsibilities are likely to be most effectivelyexecuted in environments where there is agenuine desire to enhance performance andwell-being through consultation andcollaboration. Organisations that impose support


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structures from the top down are unlikely to reapthe benefits of their intentions. It should not besurprising that many of the interventionsincluded in the DHS Well-being strategy,supported empirically in the relevant literature,were also recommended by frontline staff –testament to staff’s wisdom, experience andintuition for what works in enhancing theirwell-being.

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Promoting Professional Resilience...working therapeutically with sex offenders (Clarke, 2004) not one study prior to 2000 considered positive aspects of the work. Because of the invidious