Critical Incident Debriefing Research Articles

Exploring the experiences and perceptions of trainees undertaking a critical incident debrief training programme: A qualitative study.

Critical incident debriefing is an occupational health tool for supporting healthcare workers following critical incidents. Demand for debriefing has increased following the Covid-19 pandemic. There is now a need for more trained debrief facilitators to meet demand, but there is a dearth of literature regarding how best to train facilitators. This study addressed this by exploring participant experiences of an online critical incident debrief training programme. We conducted semi-structured interviews with 14 individuals who received a 5-day training programme based on the Critical Incident Stress Management model. Participants were recruited from a range of professional disciplines including psychology, nursing and human resources within one British healthcare system. Data were analysed using thematic analysis. The analysis produced three themes. Managing trainee experiences and expectations suggested that disciplinary heterogeneity in training groups supported inter-participant knowledge exchange. However, this variation also meant that training materials did not meet the learning needs of all participants. Modality of training suggested that while online learning was acceptable for some, others experienced screen fatigue and found it hard to build rapport with other participants. Systematic and organisational obstacles to training access and delivery suggested that lack of managerial support and organisational mental health stigma may be barriers to accessing training. A 5-day online CISM-based training programme was acceptable to participants. Organisations implementing critical incident debrief training may benefit from (1) offering both in-person and online training options, and (2) tailoring course materials according to the disciplinary make-up of groups.

Critical incident debriefing of registered nurses working in Emergency Medical Communication Centres

Organised debriefing is not part of the regular routine. Instead, registered nurses process their reactions on their own by acquiring more knowledge or talking to colleagues and Emergency Medical Communication Centre physicians.

Supporting staff: The role of health care chaplains

The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020–2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10–30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains’ specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.

Clinical Pearls

Compassion fatigue occurs in response to repeated exposure to emotional and interpersonal stressors. Nurses who experience compassion fatigue have symptoms of depression and anxiety, and they are at higher risk for suicide than other health care workers. Critical incident debriefing is effective at reducing distress; however, the focus has been on clinical feedback and management after a critical situation.Arbios and colleagues examined the effectiveness of cumulative stress debriefings (CSDs)—debriefings offered on a regular basis and not just after a critical event—on reducing compassion fatigue and improving job satisfaction among pediatric intensive care unit (PICU) nurses. They found that those who attended CSDs: The use of CSDs in the PICU was successful in reducing symptoms of compassion fatigue. Most participants stated they would attend a future CSD session.See Article, pp 111-118. Proactive, interprofessional family meetings are held to inform and support patients’ families even when no immediate decisions need to be made. Although such family meetings have been a part of professional organizations’ best practice guidelines since 2007, adherence to them has been low.Seaman et al interviewed members of the intensive care unit team to understand their perceptions of implementing family meetings. They found The authors suggest various types of interventions to shift the thinking from reactive family meetings where a decision needs to be made to proactive meetings where consistent communication and support can be offered.See Article, pp 129-136. Approximately 50% to 70% of intensive care unit (ICU) survivors develop post–intensive care syndrome (PICS), a complication that leads to worsening cognitive, physical, and mental health functioning Self-report tools, such as the Healthy Aging Brain Care Monitor (HABC-M) Self-Report, were developed to detect PICS in the primary care setting, but they may not be appropriate for ICU survivors with significant cognitive deficits.Wang and colleagues used the HABC-M Caregiver version of the tool with informal caregivers of ICU patients to establish its validity for rapid detection of PICS. They found The HABC-M Caregiver tool was validated for use in early detection of PICS symptoms. The tool is user friendly, requires little training, and can be administered in person, on the phone, or through telehealth visits.See Article, pp 137-144. Prepandemic levels of moral distress, burnout, and posttraumatic stress symptoms were higher in intensive care unit (ICU) nurses than in other health care workers (HCWs). Although it is assumed that the additional stress the pandemic placed on front-line HCWs negatively impacted their mental health, no study has described US ICU nurses’ experience.Guttormson and colleagues conducted a national survey with ICU nurses and found 4 major themes: Although some nurses reported positive experiences during the pandemic, most reported a negative impact including high levels of anxiety and depression. The authors recommend continued study of ICU nurses to help build and sustain the nursing workforce.See Article, pp 96-103.

First Responder Resiliency ECHO: Innovative Telementoring during the COVID-19 Pandemic.

The First Responder ECHO (Extension for Community Outcomes) program was established in 2019 to provide education for first responders on self-care techniques and resiliency while establishing a community of practice to alleviate the enormous stress due to trauma and substance misuse in the community. When the SARS-CoV-2 (COVID-19) pandemic hit the United States (US) in March 2020, a tremendous strain was placed on first responders and healthcare workers, resulting in a program expansion to include stress mitigation strategies. From 31 March 2020, through 31 December 2020, 1530 unique first responders and frontline clinicians participated in the newly expanded First Responder Resiliency (FRR) ECHO. The robust curriculum included: psychological first aid, critical incident debriefing, moral distress, crisis management strategies, and self-care skills. Survey and focus group results demonstrated that, while overall stress levels did not decline, participants felt more confident using psychological first aid, managing and recognizing colleagues who needed mental health assistance, and taking time for self-care. Although first responders still face a higher level of stress as a result of their occupation, this FRR ECHO program improves stress management skills while providing weekly learning-listening sessions, social support, and a community of practice for all first responders.

MP31: Debriefing critical incidents in health care: a review of the evidence

Introduction: Emergency health care providers (HCPs) regularly perform difficult medical resuscitations that require complex decision making and action. Critical incident debriefing has been proposed as a mechanism to mitigate the psychological effect of these stressful events and improve both provider and patient outcomes. The purpose of this updated systematic review is to determine if HCPs performing debriefing after critical incidents, compared to no debriefing, improves the outcomes of the HCPs or patients. Methods: We performed a librarian assisted systematic review of OVID Medline, CINAHL, OVID Embase and Google Scholar (January 2006 to February 2017) No restrictions for language were imposed. Two investigators evaluated articles independently for inclusion criteria, quality and data collection. Agreement was measured using the Kappa statistic and quality of the articles were assessed using the Downs and Black evaluation tool. Results: Among the 658 publications identified 16 met inclusion criteria. Participants included physicians, nurses, allied health and learners involved in both adult and pediatric resuscitations. Findings suggest that HCPs view debriefing positively (n=7). One moderate quality study showed that debriefing can enhance medical student and resident knowledge. Several studies (n=8) demonstrated at least some improvement in CPR and intubation related technical skills. Debriefing is also associated with improved short term patient survival but not survival to discharge (n=5). Two studies reported benefits to HCPs mental health as evidenced by improved ability to manage grief and decreased reported symptoms of Post-Traumatic Stress Disorder (PTSD). Conclusion: We found HCPs value debriefing after critical incidents and that debriefing is associated with improved HCP knowledge, skill and well-being. Despite these positive findings, there continues to be limited evidence that debriefing significantly impacts long term patient outcomes. Larger scale higher quality studies are required to further delineate the effect of structured debriefing on patient and provider outcomes.

Sensory strategies in adult mental health: A qualitative exploration of staff perspectives following the introduction of a sensory room on a male adult acute ward.

In recent years, there has been growing interest in the use of sensory techniques to help with emotional regulation in adult mental health populations. This is against a backdrop of international policies aimed at reducing restrictive interventions and improving the effectiveness of de-escalation techniques. A sensory room was designed and implemented on a male adult acute psychiatric ward. Staff perspectives were sought to evaluate the effectiveness of the room in managing emotional distress by exploring staff awareness of a broader range of de-escalation strategies and by exploring what effect the room had on staff behaviours with respect to sensory interventions. A series of semi-structured interviews were carried out, analysed, and grouped into themes. Three themes emerged as follows: enhancing de-escalation, sensory interventions, and impact on staff. Findings showed that increased awareness of sensory processing and use of sensory strategies such as the sensory room were perceived by staff to have a positive impact on reducing distress with male service users. Staff use of the room was also discovered to have benefits that included staff attending to their own emotional needs and the use of the room supporting reflective learning during critical incident debriefing.

Critical Incident Debriefing: Impact of a Teaching Module for OB/GYN Residents

BACKGROUND: Healthcare professionals commonly confront suffering and death as well as other unique sources of stress. The cumulative effects of these experiences can be psychologically taxing, particularly on trainees. Debriefing has been proposed as a way to alleviate work-related stress. Minimal data exist about the role of debriefing during medical training. METHODS: Eligibility included all OBGYN residents at a single academic hospital. Participants completed surveys immediately prior to and following a 2-hour teaching module on critical incidents in medicine. Using a Likert scale, participants responded to statements that evaluated their perceptions of CI debriefing, familiarity with identifying CI, and comfort with post-incident debriefing. Responses were analyzed using a paired samples t test. RESULTS: Twelve participants were enrolled; 46% reported having experienced a CI. Following the teaching module, participants showed increased comfort identifying CI (P=.025), initiating a debriefing (P=.005) and facilitating a debriefing (P=.003). Following the teaching module, participants reported a stronger belief that post-incident debriefing is useful (P=.046), that learning to lead a debriefing is useful to their work (P=.017), and that they could identify situations where team members might require further interventions beyond debriefing (P=.007). DISCUSSION: Incidents experienced as critical by OBGYN residents are common. Our teaching module may positively affect how residents confront and process CI. Future studies are needed to assess the long-term impact of debriefing on resident wellbeing and patient care.

PTSD in Psychiatric Nurses and Other Mental Health Providers: A Review of the Literature

Psychiatric nurses are subject to a high rate of assault by patients. The stress of exposure to assault and the potential for assault appear to impact nurses’ emotional states in the form of post-traumatic stress and post-traumatic stress disorder (PTSD). Most studies report a prevalence rate of PTSD in this population of between 9–10%. Training in the management of aggressive patients, participating in Critical Incident Debriefing, and having routine structured debriefing meetings may play a role in facilitating the development of resilience in nurses with respect to the risk of PTSD. Knowledge about the state of the science regarding aggression and PTSD is necessary for clinicians and researchers to develop and test effective strategies. This article presents a review of the current literature on this topic.

Abstract 252: Critical Incident Debriefing After Cardiopulmonary Resuscitation in Pediatric Cardiac ICU: Effect on Patient Safety, Performance Improvement and Survey

Background: Critical incident debriefing has been established in many industries, including healthcare. To our knowledge, there have not been any published data about debriefing in the pediatric cardiac ICU (PCICU) setting. Objective: The goal of this initiative was to test the feasibility of debriefing and to establish a multidisciplinary team process after CPR for the purpose of improvements. Methods: This qualitative process as part of rapid cycle improvement was initiated as a method to improve patient management, and included assimilation of pertinent information, provision of immediate team feedback, safety and system improvement. After every CPR, we involved frontline staff in an informative, non-punitive, continuous quality improvement process. Debriefings lasting 10 to 15 minutes were led by the attending physicians. Issues related to communication, response time, effectiveness of the resuscitation, and support of family members was included. Participants were encouraged to express concerns and questions related to pre-code and code events to improve patient management and enhance unit safety culture. A survey of team members assessed effectiveness of the debriefing process using REDCap web application. Results: From 2008 to 2011, 68/71 consecutive debriefings were performed. As a result, there have been several rapid cycle improvements in patient care, including preventative and anticipatory patient management, timely notification of team members, comprehensive team training via simulation training, restructuring of supply availability, family support during acute events and hospital-wide revision of the code record. One hundred twenty-three PCICU personnel were invited to complete the survey. Sixty [49%] responses were received: 100% from patient care nurse managers, 36%bedside nurses, 50% APNs, 63%physicians and 100%respiratory therapists. The beneficial aspects of the debriefing included the examination of opportunities to improve (88%), asking questions, reviewing performance (85%), and receiving education (80%). Conclusion: Clinical debriefing in a PCICU is feasible. It positively affected the quality of patient care, enhanced the safety culture, improved occurrence reporting, and staff felt empowered.

Occupational stress, paramedic informal coping strategies: a review of the literature

Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.

Mental Health Service Use and Outcomes After the Enschede Fireworks Disaster: A Naturalistic Follow-Up Study

This study documented the number of people seeking help for mental health problems after a fireworks disaster in Enschede, the Netherlands. It describes their diagnostic characteristics, interventions provided, and their results. Researchers coded data from intakes and medical charts of all patients who sought help (N=1,659) and entered treatment (N=663) at a disaster relief service between May 13, 2000 (day of the disaster), and June 1, 2004. Patients who received more than eight treatment sessions (N=394) and were in treatment one year after the disaster were interviewed with the Composite International Diagnostic Interview (CIDI) (N=228, response rate, 58%) and other questionnaires (N=271, response rate, 69%). In the population probably exposed, the cumulative referral-incidence for disaster-related mental health problems over four years was approximately 10%; in terms of referrals to the mental health facility over five years, the proportion of disaster-related referrals was 5.7%. Among adults, posttraumatic stress disorder (PTSD) was the most common clinical diagnosis (53%, chart sample). However, depression was the most common CIDI diagnosis (58%, CIDI interview sample). The recovery rate was about 50% on the basis of clinical judgment (chart sample), between 69% and 76% on the basis of "healthy" scores on symptoms, and between 39% and 60% in social and physical functioning (interview sample). Apart from persons seeking support during the first weeks postdisaster, the largest influx occurred after about one year and was limited in size. Clinicians in specialized services should be aware that conditions other than PTSD, such as depression, anxiety, substance abuse, and somatoform disorders, are also quite common after disasters.

Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand

Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0-12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed.

Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips

Medical teams are commonly called on to perform complex tasks, and when those tasks involve saving the lives of critically injured patients, it is imperative that teams perform optimally. Yet, medical care settings do not always lend themselves to efficient teamwork. The human factors and occupational sciences literatures concerning the optimization of team performance suggest the usefulness of a debriefing process--either for critical incidents or recurring events. Although the debrief meeting is often used in the context of training medical teams, it is also useful as a continuous learning tool throughout the life of the team. WHAT ARE GOOD DEBRIEFS? The debriefing process allows individuals to discuss individual and team-level performance, identify errors made, and develop a plan to improve their next performance. THE DEBRIEF PROCESS: The list of 12 best practices and tips--4 for hospital leaders and the remainder for debrief facilitators or team leaders--should be useful for teams performing in various high-risk areas, including operating rooms, intensive care units, and emergency departments. The best practices and tips should help teams to identify weak areas of teamwork and develop new strategies to improve teamwork competencies. Moreover, they include practices that support both regular, recurring debriefs and critical-incident debriefings. Team members should follow these main guidelines--also provided in checklist form--which include ensuring that the organization creates a supportive learning environment for debriefs (concentrating on a few critical performance issues), providing feedback to all team members, and recording conclusions made and goals set during the debrief to facilitate future feedback.

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Occupational Therapists’ Role on U.S. Army and U.S. Public Health Service Commissioned Corps Disaster Mental Health Response Teams

Training lay-people to use automatic external defibrillators: Are all of their needs being met?

We explored the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED? Fifty-three semi-structured, qualitative interviews were conducted, some with those who had been trained and others with trainers. Locations included airports, railway stations, private companies and first responder schemes. Geographically, we covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK. Our analysis of the data indicates that most people believe scenarios based within their place of work were most useful in preparing for 'real life'. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal. Training scenarios should be conducted outside the classroom. There should be more focus on critical incident debriefing during training and a clear identification of who should provide support after an incident. Other issues which were of interest included: (1) people's views on do not attempt resuscitation (DNAR); (2) perceived boundaries of responsibility when using an AED; (3) when is someone no longer 'qualified' to use an AED?

Suicide by Cop: Committing Suicide by Provoking Police to Shoot You

Back to table of contents Previous article Next article Book ReviewsFull AccessSuicide by Cop: Committing Suicide by Provoking Police to Shoot YouDebra A. Pinals, M.D.Debra A. PinalsSearch for more papers by this author, M.D.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ps.56.11.1470AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Who would have thought Suicide by Cop: Committing Suicide by Provoking Police to Shoot You, by Mark Lindsay and David Lester, would include mention of Antigone and Socrates? These ancient Greek figures seem far removed from what the reader would expect from the book's title. Nevertheless, the book's authors, who have law enforcement and social and political scientific backgrounds, include these figures as part of vignettes of persons who are seeking death at the hands of the state through execution. Also included is a review of the life and death of Gary Gilmore, the first person to be executed in the United States after a hiatus in state executions of approximately one decade. State executions would not meet any formal definition of suicide by cop, a situation wherein a suicidal individual intentionally engages in specific behavior to provoke a law enforcement officer to use lethal force so that the individual will be killed.In fact, the authors of this compact text cover a variety of areas not commonly seen in existing literature on suicide by cop, including suicide following the murder of police officers or other individuals. A broader title for this book might have helped me understand the direction the book would take. Nevertheless, reading the book in its entirety provides a spectrum of situations that, through extrapolation, share related themes.Within this context, the authors do a decent job of describing the phenomenon of suicide by cop, looking at its epidemiology as well as providing suggested directions for reducing its incidence. They describe situations in which suicide by cop may take place, including those involving barricades or hostages. Although the book does not fully address the rigor of the existing research on these topics—which is often a major critique of papers on this topic—it does reference many important articles. Also, the section about helping police officers provides a balanced commentary on the issues of critical incident debriefing, which has generated some controversy among clinicians as to its effectiveness in preventing anxiety disorders. The bibliography at the end of the book will be useful for anyone who is interested in pursuing further reading in this area.Probably one of the more unique chapters is Chapter 5, which addresses victim-precipitated homicide in other cultures. For example, the authors describe "crazy dog wishing to die," a phenomenon of the Plains Indians, such as the Crow, wherein a man who is tired of living deliberately seeks death in battle and is accorded special status if he persists in his plan. According to the authors, rituals before the battle include singing special songs and using a special rattle. In addition, the book devotes an entire chapter to suicide by cop among African Americans. However, in this chapter, the authors come close to using racial stereotypes. They tell the stories of the Black Panthers and the MOVE confrontations in the 1970s, which, again, seem somewhat removed from the book's topic.Given the growing interest in encounters between law enforcement officers and persons with mental disorders, Suicide by Cop is a useful reference. The book's casual, unscientific style in many ways makes it more geared toward law enforcement than mental health professionals. However, the book's contents provide some interesting perspectives for anyone who is interested in the phenomenon of suicide by cop and of seeking suicide by proxy.Dr. Pinals is affiliated with the department of psychiatry of Worcester State Hospital in Massachusetts.by Mark Lindsay and David Lester; Amityville, New York, Baywood Publishing, 2004, 128 pages, $32.95 FiguresReferencesCited byDetailsCited byNone Volume 56Issue 11 November 2005Pages 1470-1470 Metrics History Published online 1 November 2005 Published in print 1 November 2005

Alcohol and Tobacco Consumption among Police Officers

Police occupy an important position within the community as both enforcers of the law and as role models for appropriate behavior. Despite this interesting juxtaposition, research has shown that they may consume alcohol and tobacco at rates higher than the general population. A significant causal factor is occupational stress, and the fact that police are regularly exposed to stressors beyond the range of normal human experiences. Given this ongoing and unavoidable relationship, the recognition and control of stress is paramount within law enforcement. Because police stressors are usually multi-faceted, health promotion interventions should focus on stress-reduction at both the institutional and individual level. Examples of health promotion strategies may include reducing overtime, carefully organizing shift rosters, streamlining administrative processes and allowing rest breaks for those on the night-shift. Interventions which focus on the individual are also important, because excess alcohol and tobacco consumption levels often relate to individual stress-coping mechanisms. Programs to help recognize and prevent excess alcohol and tobacco consumption may be worthwhile, as too, counseling, interpersonal support and critical incident debriefing. Promoting non-drinking and non-smoking stress-reduction activities where police can socialize and de-brief with their colleagues may be beneficial. Encouraging social events at sports clubs and gymnasiums has also been suggested. In order to achieve these goals however, governments will need to place a greater emphasis on the occupational health of police officers and the law enforcement agencies in which they work.

Critical Incident Debriefing and Social Work

ABSTRACTA debriefing is a structured group process that responds to the cognitive, emotional, physical and social reactions resulting from disasters and other traumatic events. This article describes debriefings and reviews research critically examining their effectiveness. The author proposes ways that social workers can contribute to theoretical frameworks, expand debriefing models, contribute to skill development and advance debriefing research and scholarship.

Employee Assistance Program Utilization

Abstract In the EAP field, utilization rates are an important concept routinely used as a descriptor of EAP success, yet there has been little formal research conducted in this area. In a study of 154 Canadian EAPs, 102 organizations reported their utilization rates along with how they defined both utilization and a case. Mean utilization rate was 9.2% with utilization being greater in organizations with a union where labor was involved in establishing the program, providing assistance in accessing the program and in managing the program through participation on a joint labor-management committee. Utilization rates were also found to be greater where there was an EAP policy in place and where ongoing program promotion occurred. However, what was also discovered was that most of these statistical conclusions were questionable as there was a lack of consistency in how utilization rates were calculated by various organizations, nor was there any agreement on what even constituted a case. This brings into question the utility of EAP utilization rates in any comparative program monitoring or evaluation. A comprehensive EAP Utilization Scorecard is offered as a response to this situation. The scorecard counts the actual number of employees, retirees and family members who use the EAP, either face-to-face, through telephone counselling or via e-counselling. Also presented is the idea of a new calculation, penetration rate. This value would include counselling offered by the EAP along with the other services, including group counselling, critical incident debriefings, consultations and mediations, workshops and seminars, peer referral contacts and telephone inquiries. This approach would provide a more comprehensive understanding of what EAPs do and would also allow for longitudinal program comparison as well as comparisons between programs.