RCASA Saturday with Case Management: Impact of Iatrogenic Harm….Is ignoranace an excuse for inadequate service?

In Sexual Assault Awareness on November 19, 2011 at 6:00 am

So Thursday and Friday I attended the Virginia Network for Victims and Witnesses of Crime’s 29th Annual Training on Crime Victims’s Issues.  All it all it was a pretty good training.  I attended three trainings:  Human Trafficking with Kathleen Davis of Polaris Project, Providing Ethical Treatment for Traumatized Populations Part 1 and 2 with Mary Beth Williams, Ph.D., and Responding to Survivors of Interpersonal Crime: Techniques for Victim Witness, Law Enforcement, and Other Community Providers Carol Olson, LPC.  All of the segments were very interesting and relevant.  I want to highlight the later two.  Basically at the root of both presenters topics with the foundation of competency when working with victims of crime and violence.  The first presenter focused on the ethical responsibility of the service providers and the second focusing on safe and proper techniques that service providers with out counseling and other certifications and credentials can use to effectively respond to the needs of traumatized victims. 

Mary Beth Williams Ph.D., introduced the term Iatrogenic Harm.  She asked “what does it mean, in the context of your position as victim advocate, clinician, prosecutor, educator, or other profession, to do harm?  Iatrogenic harm is damage induced as a by-product of an intervention by a caregiver of any type or from a procedure or technique.”  So it is extremely possible to cause harm even if we do not intend to do so.  Some examples she gives include, failing to listen, no putting clients needs first, observing through a biased lenses, failing to be prepared, allowing personal beliefs and agendas to get in the way, and not practicing in the limits of competence.  Those are just a couple from a long list of examples.

She also provides guidelines to limit Iatrogenic Harm.  “Everly (2002) believes that there are specific core competencies for those who provide disaster/emergency mental interventions.  She goes on to reference, in a guess editorial featured in Volume 5 of the International Journal of Emergency Mental Health, Everly (2004) suggests that providers of services to victims help them to:

a.  meet basic needs for food, water, shelter, alleviation of pain, reunification with family members, and provision of a sense of safety and security first, prior to utilization of psychologically oriented interventions;

b. Allow voluntary participation in any psychologically-oriented crisis intervention activity accompanied by a form of relevant informed consent if the intervention activity accompanied by  a form of relevant informed consent if the intervention goes beyond simple information or educational briefing;

c. not introduce traumatic material to person who would not otherwise be exposed to such material; one way to limit this source of iatrogenic harm is to utilize naturally occurring cohorts and/or homogeneous groups in regard to trauma exposure and toxicity; watch how you talk with people about the trauma they have experienced;

d. present health education about signs and symptoms of potential distress as basic health information designed to empower recipients, encouraging them to assume more control of their manner of responding to adversity;

e. conduct ongoing assessment and triage to remove or exclude persons who are psychologically vulnerable or brittle (over aroused, morbidly depressed. highly shamed or guilt-ridden, intensely bereaved, dissociating, psychotic, physically injured) from group interventions;

f.  utilize individual interventions with those who are more psychologically vulnerable or brittle;

g. Know when to refer and have a panel or available referral sources that are sensitive to issues and situations with whom you work;

h.  Do not operate outside of you areas of competence and mission;

i.  Provide ongoing specialized training for that practicing psychological crisis intervention.

These are excellent guidelines to consider when working with victims of crime.  Often service providers without and often out of the goodness of their hearts might inadvertently cause harm, however, ignorance is not an excuse.

We must be competent in all that we do and if we don’t know what to do we must be competent enough to acknowledge that it is time to call in someone who does know….


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