CASE STUDY

Running a service in times of crisis

We talk to Caroline Harroe, CEO of Harmless and The Tomorrow Project, about how to continue in a challenging time, and how to support staff.

Introduction

Caroline Harroe is the CEO of Harmless and the Tomorrow Project, delivering training, consultancy and support services across self-harm, suicide prevention and bereavement. They employ around 40 staff in 4 locations; the head office in Nottingham, one in Derbyshire, Leicester city centre and on the border between Leicestershire and Derbyshire.

While we understand the extreme and uncertain nature of trying to keep services functioning in these unprecedented times, there are many people like Caroline coming up with agile and adaptable ways to keep going.

We asked Caroline about the last few weeks and how she hopes to continue to support staff and clients in the weeks to come.

How did you begin to prepare for a big and sudden change in operation?

We have been preparing for weeks, starting when we saw what was happening worldwide. We researched different country approaches, such as all the paperwork developed in Spain on how they were maintaining services there.

We started off with a worst-case scenario – we have to close down our offices, how can we continue to run our services?

We then worked backwards from that.

At a time like this, people are describing us as their anchor. Everything else around them is in chaos, there are implications on funerals, inquests and that’s before dealing with the trauma of bereavement by suicide. At the minute, even we do not know what will happen locally with inquests. We have to be careful with our clients though. They need us to hold the chaos, and to be sensible in the slow delivery of this complex information.

We have developed a Client Information Template on COVID19

What did you do to prepare staff and clients?

We have developed flow charts and maps of a client’s journey, always asking ‘what if?’ What if we can’t meet face to face, what if we can’t run that training session, what if all of our staff are off sick?

We have developed a simple form for all of our clients (300-400 people) and our staff. We want to collect information from everyone on how we stay in touch with them. We have included this document above, the “Client Information Template on COVID19”, which you are welcome to use.

We found that this approach helped us to effectively mitigate every challenge we might come across, and we were able to put in place different systems and ways of working. Importantly, it has meant that we have stayed open.

And we are having to change our operations almost every day. Our routine is that we take in the government’s daily briefings late afternoon, spend our evenings focused on what that means for us and planning how to respond, and the next day doing what we need to do.

We are using our template form to collect information from clients and staff. We want to collect information from everyone on how we stay in touch with them, what devices they have available (even whether they use Wifi or 4G), their preferred platforms to stay in touch and clients’ very individual preferences on how they want to be in touch with us over these coming weeks and months.

It might be surprising at a time like this, but we have recruited two members of staff to cover for those who cannot work for any reason, and to ensure that we have capacity in our crisis team.

What do I need to think about?

What are the changes in demand for your service(s)?
What are the reasons for any cancellations, and can alternatives be offered?
What is the capacity of clients to access your support remotely? e.g. do they have use of a personal computer at home, or access to one publicly?
How can you stay in touch with them?
What are the financial implications of the crisis?
Consider a ‘cover plan’ for staff being off sick.
Can your community help? For example, could a local company donate mobile working laptops and phones? or provide childcare for staff?

We have used a simple addition to the organisational calendar, where we have added a ‘notes section’ to all appointments. From this we have been able to monitor any changes in demand in all services, cancellations that may be made, times of the day that are busier/less busy than others, and also reasons for cancellations. This has really helped us to plan where we are most needed and to operate effectively.

What are the changes in how people use your service?

We have seen for example that need for self-harm support has dropped off, but as our clients are with us longer term, and possibly more stable because of that, we can direct resources to those services such as bereavement and crisis support that have not seen a drop off. We have audited all of our services; training, self-harm support, bereavement support and crisis support.

Yesterday, our commissioners (the CCG, and Local Authorities) assessed our bereavement service as critical, so for now we are staying open for face to face support for those in crisis. This has mobilised our thinking further, and we have made sure that should we need to close one of our buildings, we can move teams and functions elsewhere. We realise that some services might become remote, and think that our preparation might also be helpful here.

In our buildings, we have hugely reduced footfall in groups and in the waiting areas. We have a rigorous cleaning schedule of all workspaces. We are looking at splitting teams into shifts with a smaller cohort of staff so that any illness will not bring the system to a halt. So, instead of all of the crisis team together, we will split them into thirds so that there is always a part of the service that is operational.

Instead of saying ‘we are not seeing you’, we are allowing people to be part of that decision, understanding that they are at a time of great distress. Also, we will not start to ask bereaved people at our first contact about preferred ways of being in touch as it may be overwhelming. We will work that out with them after offering our support.

Challenges and Risks

To me, it is about the balance of risk. We work with very vulnerable people whose lives might depend on contact with us. In turn, we make consistent, sensible assessments according to the government’s advice.

We are trying to keep one step ahead – understanding demand on our services, evaluating risk and reducing risk on staff, mobilising paperwork.

Usually, we contact people by telephone, and have their physical address. Now, through using Facetime and other platforms we might not have that information about their physical location. If people are moving around and we need to safeguard somebody – that is an additional risk around remote working. We need to assess someone’s location. We have introduced an agreement form about our expectations of each other if we are moving to remote services.

We are lucky that within our training department, we have invested in an e-learning developer. A lot of the technical skills for this period of rapid change has come under their remit, which has helped us to mobilise quickly.

The situation isn’t easy; there are two of us from a senior management team working 15-hour days. We have daily update with teams. At the minute, we are fully open, but with 50% of our self harm support online.

Staff and management in times of crisis

We already have some people in self isolation. If they can work from home, then they are doing that. In our bereavement service too, someone with underlying health conditions will not be available to work. In that case, we have recruited an additional staff member.

Throughout all of our services, we have the same training and induction for all members of staff. They all receive the same training in safeguarding, suicide prevention, mental health. So, if we need to move people to different pathways, they are 80% trained in that pathway anyway.

We are taking each absence on a case by case basis. Can work continue, does it need to be covered, who is in the current team, any additional resources needed, how can we cover that? This is reviewed on a day to day basis.

Final Thoughts

It is very easy to be paralysed by this, where to start and how to cope. We found that planning for the worst, and then using a phased approach, works well for us.

When looking at platforms for remote contact, look to those that are very easy to access and use. It’s so important to make things really accessible when people are deeply traumatised by suicide.

Ask people what they want to use. Facetime is GDPR-compliant, encrypted, and a lot of people are familiar with it. But we have set up on all platforms, Whatsapp, videocalls, Facetime, Zoom.

At times like this, people may need us to hold the chaos in the world to let them deal with their own grief, and to be sensible in the slow delivery of this complex information. If we are not confident about something, we must hold off until we are fully informed.