Public Risk March/April 2022 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION MARCH/APRIL 2022

CRITICAL INCIDENT STRESS MANAGEMENT FOR FIRST RESPONDERS SUPPORTING THOSE WHO WORK TO HELP OTHERS PAGE 12

ALSO IN THIS ISSUE

THE IMO SUCCESS STORY: THIRTY YEARS OF HEALTHCARE EXCELLENCE PAGE 7

THE POWER OF PERCEPTION: IMPLEMENTING RISK PERCEPTION SURVEYS AS PART OF YOUR ERM PROGRAM PAGE 16

FREE TO MEMBERS

I Thought I Was an Additional Insured APRIL 20 | 12:00 PM – 1:00 PM EST David Parker, ARM-P, CPM, IPMA-SCP, Director, Enterprise Risk Management and Compliance, Pima Community College The day a large claim arrives and you discover you didn’t have the coverage or status you thought you had will not qualify as one of your better days. Don’t be surprised at one of those critical moments! Develop a process to ensure appropriate insurance requirements are included and you receive what parties agreed to. You also can’t do it all by yourself, which means training a team and managing COIs, not just filing them. Ensure that the words, “but I thought . . .” never apply to this topic. ATTENDEE TAKEAWAYS: 1. Develop contract language that leaves no doubt as to what is required and how it must be documented 2. Identify higher risk agreements and activities that require extra attention 3. Review options for actively managing COIs instead of just filing them

JANUARY/FEBRUARY 2022 | Volume 38, No. 1 | www.primacentral.org

CONTENTS

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Melissa R. Steger, MPA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX PAST PRESIDENT Sheri D. Swain Director, Enterprise Risk Management Maricopa Community Colleges Tempe, AZ PRESIDENT-ELECT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL DIRECTORS Dana S. Henderson, CWCP Risk Manager Town of Mount Pleasant Mount of Pleasant, SC Steve M. LePock, II Risk Manager Virginia Beach City Public Schools Virginia Beach, VA

Critical Incident Stress Management for First Responders By Lisa Hammond

Ann-Marie A. Sharpe, ARM, RMPE Director, Risk Management City of Miami Miami, FL Laurie T. Olson Sr. Risk Management Consultant City/County Insurance Services Salem, OR Adam F. Maxwell, CLRP Director, Administrative Services City of Westerville Westerville, OH Michael S. Payne, ARM, HEM Risk Manager City of Reno Reno, NV NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org ADVERTISING Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org

The IMO Success Story: Thirty Years of Healthcare Excellence By D.C. Campbell

IN EVERY ISSUE

The Power of Perception: Implementing Risk Perception Surveys as Part of Your ERM Program By Christina Childs, MS, ARM

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Public Risk is published 6 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2022 Public Risk Management Association

MARCH/APRIL 2022 | PUBLIC RISK

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MESSAGE FROM PRIMA PRESIDENT MELISSA STEGER

Diversity serves well on teams

or the last eight years, I’ve held an annual retreat for the University of Texas System Workers’ Compensation Program. The invitation list consists of our third-party administrator (TPA), cost containment / network, and UT System team members who handle our claims. Our goal is to reinvigorate, address issues, and continue to build our program on a foundation of innovation. Our retreat is led by a facilitator, Susan Franzen. She has been with our program since the inception of our hybrid model when the program partnered with a TPA. Each year, in preparation, Susan and I pick topics that are relevant to where we are in the growth of the program. Last year’s retreat was virtual due to the pandemic. My team, despite the pandemic, thrived with exceptional outcomes; and I know this is the result of them going above and beyond. In response, I asked Susan to focus the last morning on psychological resilience emphasizing the importance of allowing yourself to take a much-needed break. I commonly leave our retreats with a nugget of information that sticks with me. One year it was, “there’s always enough time in the day.” I still repeat this to myself in a mirror when I’m feeling a bit overwhelmed. I’ve also learned to breathe under pressure. Four counts in, four counts out. This year, Susan spoke from the 2021 Women in the Workplace Report where I learned about burnout. As she described the symptoms of burnout, I realized some of what she was describing was in me. I was experiencing these symptoms and didn’t have a clue! The pandemic led everyone into unventured territory filled with panic, confusion, frustration, and loss. During this time, public risk professionals have sustained work in an emergent state challenging our endurance. I’m sure this is where my burnout symptoms stem, and I’d bet I’m not alone. The survival mode was a necessity, but at what cost to the workforce?

Following our retreat, I spent some time reviewing the 2021 Women in the Workplace study by LeanIn.Org and McKinsey & Company. The study, first published in 2015, supplies companies with knowledge and resources with the intent of advancing gender diversity in the workplace. The COVID-19 pandemic added another layer to the 2021 study although diversity, equity, and inclusion remains the focus. The findings of the study reveal an improvement in women’s representation across all levels of the corporate pipeline, but women lose the most ground at the first step into management. This broken rung stalls a company’s ability to address the inequity at the senior leadership level. Additionally, the 2021 Women in the Workplace study reveals the pandemic took a toll on employees both at work and at home. Children were homeschooling while parents were telecommuting, and responsibilities grew exponentially outside of the norm promoting the importance of work life balance and employee well-being. The analysis revealed that women are more supportive of their employees than men by helping team members navigate work-life challenges, ensuring manageable workloads, and checking on employee overall well-being.

unheard-of solution making your organization a trailblazer of sorts. Diversity also serves well on teams. Women, with their strong ability to read non-verbal cues and openness to hear opinions from everyone involved, stimulate inclusion and consequential innovativeness. Public entities have a broad spectrum of people served. The makeup of the organization should mirror the population served to improve trust and communication to our customers. An inclusive workplace can improve recruitment and increase the available talent pool. Additionally, the diverse culture can improve morale and show opportunity to staff, ultimately reducing turnover. Yes, there is still some work to do. Organizations seeking to embrace inclusion need ownership from the top. The practices, language, norms, and processes that support these inclusionary goals need to effectively move throughout the organization. In closing, I challenge each of you in the workforce to standup and support each other, regardless of gender. Recognize the hard work we each pour into the job and understand the additional time given and sacrifices made to keep our public entities flourishing during trying times. I proudly celebrate those of you who carried the burdens of the pandemic for your employees, spouse, children, parents, and employer.

The COVID-19 pandemic escalated employee burnout, but at a much faster rate among women. Forty percent of women in the workforce have considered leaving their company or switching jobs according to the study which is probably associated with the high employee turnover in recent months. Companies should be concerned about their staff considering women were the backbone supporting their team throughout the pandemic.

As for me, Susan left me and my team with some tools. We are developing some control over our work and know to communicate clear boundaries when we have too much on our plates. We also vowed to take frequent micro-breaks (my biggest issue) to protect ourselves, and we will respect our time away from the office. Following our time together as a team, I feel rejuvenated and am excited about the coming year.

The good news is the Women in the Workplace study demonstrates progress with equity in the workplace. To promote continued progress, let’s highlight some of the benefits of diversity.

Sincerely,

First, diversity in the workplace promotes varying points of view and problem solving covering the gamut of life experiences. These varied experiences may stimulate an

Melissa R. Steger, MPA, CRM PRIMA President 2021–2022 University of Texas System Austin, TX

MARCH/APRIL 2022 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

FOUR RISK MANAGEMENT LESSONS LEARNED FROM THE PANDEMIC March 8, 2022 | Richard Chambers |Forbes

As we prepare to enter the third year of the pandemic, it’s time to reflect on what we have learned. The World Economic Forum’s recent Global Risks Report 2022 (download required) conveyed just how pervasive the pandemic’s impact has been over the past two years on global risks. According to the WEF, the five non-climate related risks that have deteriorated the most during the crisis globally were: • Social cohesion. • Livelihood crises. • Mental health. • Debt crises. • Cybersecurity failures. The chaotic nature of the pandemic has also challenged senior business leaders’ ability to make forward-looking decisions. Right when we think we have our arms around the risk environment, something new comes along. Organizations depend on input and insights from their audit, risk and compliance leadership so executive management can make informed decisions that fit within their risk appetite. With new Covid-19 variants, border closures, supply chain disruptions, the Great Resignation and many other pandemic-related emerging risks, organizations have been repeatedly schooled on risk management. Lesson 1: Adopt new risk metrics. One of the first lessons learned was about the metrics management uses to assess risks. Traditionally, the main exercise included rating a risk’s impact (how bad will it be) and likelihood (how probable it is to happen). The pandemic has forced business leaders to consider other variables in their assessments—such as velocity and volatility—to understand additional risk dimensions. Read More: https://www.forbes.com/sites/forbesbusinesscouncil/2022/03/08/four-riskmanagement-lessons-learned-from-the-pandemic/?sh=2dac50073f67

PUBLIC RISK | MARCH/APRIL 2022

RISK MANAGEMENT AND THE PREVENTION OF HUMAN TRAFFICKING March 4, 2022 | Glen O'Connor and Christine Sullivan | HotelManagement.net

The U.S. Department of State estimates more than 24.9 million adults and children are subjected to human trafficking around the world today. Increasing awareness and educating staff on human trafficking (also known as modern slavery) is key to identifying this activity and understanding best practices. As defined by the Department of Defense, human trafficking is a crime in which force, fraud or coercion is used to compel a person to perform labor, services or commercial sex. It affects all populations: adults, children, men, women, foreign nationals and U.S. citizens, and all economic classes. Human trafficking occurs every day and across every industry and geography, but the hospitality industry, with its unique combination of privacy and anonymity, is a frequent target. Hotels and motels can be especially attractive locations for trafficking, though human trafficking also occurs in all forms across all areas for the tourism industry—at sporting events and theme parks, on cruise ships and public transportation. Because of the elevated risk in these locations, it is imperative that staff members are taught how to recognize the signs and trained on appropriate next steps. Potential Human Trafficking Indicators As risk-management specialists, we’re frequently asked by our client partners to help with education and training materials about this issue. We’re pleased to help our insureds develop targeted programs and would urge all hospitality organizations to similarly prioritize human trafficking as a key area of risk-management focus. If your organization doesn’t currently have a human trafficking awareness program, it’s important that one is implemented. Read More: https://www.hotelmanagement.net/operate/risk-management-andprevention-human-trafficking

IT ALL STARTS WITH A QUALITY RISK ASSESSMENT March 7, 2022 | Jeffrey A. Slotnick CPP, PSP | Security Info Watch

While security threats evolve and challenges to managing organizational risk become more seemingly every year, the foundation of securing the business is knowing and understanding its vulnerabilities and how those vulnerabilities impact the Enterprise mission and strategy. We determine vulnerability by conducting an all-hazards risk assessment. Before we get into an in-depth conversation on this issue, let me first demonstrate the importance of quality risk, threat, and vulnerability assessment by asking you a question; what do the following activities have in common? Enterprise Risk Management, Risk Management, Enterprise Security Risk Management, Business Impact Analysis, Business Continuity, Emergency Management, Global Supply Chain, and Cyber Security. If you answered risk assessment, you are correct. Each of these critical areas of business competence requires a risk assessment. Risk, Threat, and Vulnerability Assessments are core functions of any quality security program. A risk assessment identifies, analyzes, and evaluates uncertainties to objectives and outcomes. It provides a comparison between the desired/undesired outcomes and expected rewards/losses of organizational objectives. The risk assessment analyzes whether the uncertainty is within acceptable boundaries and within the organization’s capacity to manage risk. The risk assessment results inform the responsible and accountable decision-makers(s) of choices available to manage risk and achieve the organization’s objectives effectively. In short, you cannot develop solutions until you understand the problem. A comprehensive risk assessment includes a detailed review of all physical security systems, people, processes, plans, policies and procedures. Read More: https://www.securityinfowatch.com/ security-executives/security-industry-services/ article/21257204/it-all-starts-with-a-qualityrisk-assessment

TOP 10 OP RISKS 2022: GEOPOLITICAL RISK TAKES CENTRE STAGE March 9, 2022 | James Ryder | Risk.Net

The chief risk officer at a large European asset manager sums up the impact of Russia’s devastating war in Ukraine on his firm’s operational risk profile succinctly: “We have war in Europe. Not just small blips: things that move our business entirely.” And although the votes in Risk.net’s annual Top 10 operational risk survey were cast in the advent – within a climate of deteriorating relations and Russian troops massing on Ukraine’s borders – the war and its aftermath cast a horrible shadow over this year’s results. As banks brace for an escalation in hacking attempts from Russia-linked groups, op risk managers have never been more aware of the hazards posed to their institutional infrastructure by malevolent actors. The head of cyber risk at a European bank says he also fears IT disruption from extreme cyber attacks or outages beyond his control. Small wonder, then, that IT disruption tops this year’s poll again – a phenomenon that

has never been far from top of mind, with the heads of the largest US banks in May voicing their fears to Congress. Last year also marked the first anniversary of the Russian hack of SolarWinds, which is thought to have compromised US government servers as well as banks and other financial institutions. Theft and fraud jumps several places this year, to second – perhaps owing as much to the bulk of last year’s largest op risk losses emanating from mega frauds as a nod to the current state of roiling markets, and their propensity to drive episodes of internal fraud. Meanwhile, the FBI has warned of a rise in ransomware attacks emanating from Russian state-sponsored cyber criminals targeting US infrastructure. Read More: https://www.risk.net/risk-management/7936031/ top-10-op-risks-2022-geopolitical-risktakes-centre-stage

MARCH/APRIL 2022 | PUBLIC RISK

PRIMA Presents...

Let’s Talk Tuesday A VIRTUAL EVENT

*Member Benefit Only

Join MEC Senior Claims Attorney GEOFF JONES for an informative look at Current Trends in Workers’ Compensation. Some of the topics for discussion include the market environment, evolving workforce, ramifications of the opioid crisis, and changes in the workers’ compensation Medicare set-aside reference guide.

APRIL 12 TH AT 2:30 PM ET

THE IMO SUCCESS STORY

THIRTY YEARS OF HEALTHCARE EXCELLENCE

BY D.C. CAMPBELL

HE WORKERS’ COMPENSATION NETWORK, INJURY

MANAGEMENT ORGANIZATION (IMO), is well-known in Texas for its exemplary medical and outcome performance

results for the past thirty years, particularly with caring for public-sector injured employees, private and nonsubscribers, in the State of Texas.

THE IMO SUCCESS STORY

However, until now, little was known about the brains and passion behind IMO’s success: owner and CEO, Catherine Benavidez-Anderson. Catherine inherited her drive, business skills, and personal management habits from her parents, who raised her along with seven siblings. After years of being a plant manager, her father started his own trucking company, while her mother taught herself to be a seamstress. Catherine describes the traits she inherited from her parents. “Thanks to their love, focus, and work-ethic example, we lacked little in the small town of El Campo, Texas. We were blessed with true

PUBLIC RISK | MARCH/APRIL 2022

family values, strong faith, and passion. We all are independent thinkers like my parents. I feel like this ‘stay in the game with grit’ attitude was already ingrained within me when I started my business thirty years ago.” Focus. Passion. Work-ethic. Anyone who followed Catherine’s path during the past 30 years would have seen these building blocks of success displayed in everything she did.

A FAMILY LEGACY OF PASSION, SERVICE, AND LEADERSHIP

Amazingly, the seeds of Catherine’s passion to serve and lead might have been planted in her family even before she was born. Six

generations ago, in the late 1800’s, one of her ancestors was a Texas Ranger. Those were years when it took solid men of grit and wisdom to tame the Wild West. Her grandfather was a deputy sheriff, her father was an auxiliary deputy for more than ten years, and her brother is a lieutenant with the Houston Police Department. And who could ever forget the superman heroics of her late uncle, Roy Benavidez, U.S. Army, Special Forces veteran. For his bravery in the Vietnam war, he was awarded the Congressional Medal of Honor by President Ronald Reagan in 1981. Catherine tells in her own words how the stories of these legends influenced her. “Reflecting now on my family’s history of

service, leadership, and entrepreneurship, their example surely influenced me to create and lead my own company.” Also underpinning her success was the high value her parents placed on education. Catherine earned a degree in Occupational Therapy and, upon graduation, worked with musculoskeletal and work-related injuries. She soon found her niche working directly with employers, traveling cross-country to build and manage rehabilitation clinics. After eight years in clinical rehabilitation, Catherine, then a young wife and mother, felt the need to reduce her travel in favor of a balanced life with more time for home and family. Her decision led her first to consulting and then to the launch of IMO. During those early years, she managed IMO’s growth, adjusted to a new life as a divorcée, and raised two daughters as a single mother.

into the unknown, following her dream. “It was all so overwhelming at times, but my daughters kept me motivated. I am so happy I focused the right priorities on them, while establishing the early growth of IMO.”

THE IMO JOURNEY

What truly inspired Catherine was connecting health care providers and employers with the common purpose of helping injured employees recover medically and return to safe and productive employment. One major step forward came in 2005, when the Texas

legislature allowed the creation of health care networks (HCNs) to help control rising medical costs and improve lackluster outcomes. She recalls that “building an HCN in 2005 felt like the obvious and logical next step in IMO’s business evolution. We immediately began to build an IMO provider panel.” Catherine firmly believes that using a network like IMO, individually owned, organically grown, and managed cohesively without any outsourcing or unbundling, provides the best

Catherine never looked back. She surrounded herself with wise mentors and forged forward

Catherine firmly believes that using a network like IMO, individually owned, organically grown, and managed cohesively without any outsourcing or unbundling, provides the best cost-effective results. Not surprisingly, public, and private industry entities soon joined IMO. The first being the City of Dallas, a major public-sector employer, and a network partner now for more than ten years.

MARCH/APRIL 2022 | PUBLIC RISK

THE IMO SUCCESS STORY

IMO’s success story would be incomplete without recognizing the value Catherine places on client feedback for much of the business strides and innovations. She credits their input and intervention for almost every infrastructural improvement or new service that IMO organically developed and implemented.

cost-effective results. Not surprisingly, public, and private industry entities soon joined IMO. The first being the City of Dallas, a major public-sector employer, and a network partner now for more than ten years. Another significant government agency previously partnered with IMO is the Texas State Office of Risk Management (SORM), which administers the State of Texas risk management services, including workers’ compensation. Says SORM’s Executive Director, Stephen Vollbrecht, “IMO is a uniquely-focused organization that focuses on collaborative approaches between all parties. In every interaction, IMO leadership and staff have been available, adept, and adaptable. They are experts in their field and produce unparalleled results.” Results in the Texas Department of Insurance Report Card shows IMO as consistently one of the top three performing networks. To Catherine, it has been rewarding to see IMO’s hard work result in partnerships with public employers that take care of their employees, especially first responders. “It’s now a reality,” she observed. “The vision, the difficult work, and the long hours paid off. We now have an efficient health care network that delivers its promises of medical cost reduction and quality care at the same time.”

PUBLIC RISK | MARCH/APRIL 2022

Catherine’s early vision started with Texas, but IMO is gearing up to bring its reputation for cost-effectiveness and quality medical care to additional states such as Colorado, Arizona, Florida, Arkansas, Oklahoma, Louisiana, and Illinois.

OVERCOMING THE CHALLENGES AND DOUBTS

While IMO’s future looks bright, Catherine is courageously transparent in discussing the doubts and discouragements she faced in the early days. In the regular meetings and conferences that she attended then, she often overheard remarks that cast doubts on her ability to build a company. “I would often say, ‘could I really run a company as a single mom with young girls?’ I was also concerned that the male-dominated workers’ compensation market might not accept a young Hispanic female. But each doubt and challenge I experienced gave me the determination to move forward.” Catherine is quite clear that her faith, family support and positive mentors provided her the strength to keep going. She acknowledges that faith has always been an anchor for the hard times. “Every business owner, single mom or risk taker faces challenges. But those times

make us stronger and wiser. I am not sure how I could have gone through tough times without my faith and prayers.’” IMO has always remained focused on building a solid identity of quality service, rather than on color or minority leverage. “When I reflect, I realize now that diversity inclusion and its challenges always played a part in my business journey experience. Our cornerstone is quality managed-care with guaranteed outcomes.” IMO’s success story would be incomplete without recognizing the value Catherine places on client feedback for much of the business strides and innovations. She credits their input and intervention for almost every infrastructural improvement or new service that IMO organically developed and implemented. As IMO celebrates its Thirtieth Anniversary, Catherine’s vision for the company remains crystal clear. “Servant leadership is our foundation, and it is our goal to represent these characteristics in all areas of business. Our people make it happen!” DC Campbell, Consultant, Injury Management Organization (IMO)

Join us June 5-8 for the leading event for Public Risk Management Professionals

EARLY BIRD PRICING ENDS APRIL 4 Conference.PRIMACentral.org

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CRITICAL INCIDENT STRESS MANAGEMENT FOR FIRST RESPONDERS Supporting Those Who Work to Help Others BY LISA HAMMOND

IRST RESPONDERS PROVIDE CRITICAL AND OFTEN LIFE-SAVING SERVICES TO THE PUBLIC. HOWEVER, THE PACE AT WHICH THEY MUST WORK, AND THE STRESSFUL AND DANGEROUS SITUATIONS THEY FACE ON A REGULAR BASIS PUT THEIR OWN WELL-BEING AT RISK. The inherent nature of their work means first responders witness and directly experience traumatic events such as violence, accidents, disasters, injuries, the deaths of civilians and colleagues, and threats to their personal safety. This exposure to traumatic stress increases first responders’ risk of developing serious problems including anxiety, depression, posttraumatic stress, marital issues, substance abuse, and suicidal behaviors such as ideations and attempts. FIRST TO PROVIDE HELP, LAST TO ASK FOR IT First responders rush into chaotic situations and help those in need. They are hailed as being brave, strong and heroic.

Shame and stigma can be barriers to first responders seeking help for the effects of occupational stress and trauma. They want to appear “tough enough” to do their job. They fear that talking about their problems or admitting any vulnerability may signal a fitness-for-duty concern that could harm their reputation or end their career. First responders often have thoughts such as, “This shouldn’t bother me,” or “I shouldn’t feel this way,” or “I should be able to handle this on my own.” Instead of asking for help, they may turn to unhealthy coping mechanisms such as alcohol abuse, drug use, aggressive behavior, poor eating habits, overspending, or gambling.

MARCH/APRIL 2022 | PUBLIC RISK

CRITICAL INCIDENT STRESS MANAGEMENT FOR FIRST RESPONDERS

HEALTHY STRESS MANAGEMENT PRACTICES FOR FIRST RESPONDERS • Connect with friends and family. • Talk about your thoughts and feelings with someone you trust. • Write in a journal. • Take time off work. • Engage in regular, moderate exercise. • Pursue a hobby. • Get adequate sleep. • Eat well. Prepare healthy meals to eat on night shifts when restaurants are closed. • Participate in activities that promote relaxation and stress management such as meditation, yoga and tai chi. • Seek help in managing finances and budgeting to live within your means and avoid the need to moonlight.

No one, not even a first responder, is immune to the impact of trauma. Having a strong reaction to a critical incident is not a sign of weakness, and neither is needing support to recover and become resilient. As the body needs medical attention to heal from an injury, the mind needs psychological intervention to resolve reactions and feelings brought on by a traumatic event. First responders are critical to ensuring public safety. Municipalities and public safety agency leadership have the responsibility to protect their first responders’ well-being and help them prepare for and cope with trauma. Following a critical event, the earlier the intervention, the better the chance of recovery. First responders can heal if they receive psychological first aid in an environment that promotes safety, empowerment and hope. Supporting first responders builds strong, resilient public service organizations and ensures the availability of prepared emergency teams to serve the community. CRITICAL INCIDENT STRESS MANAGEMENT FOR FIRST RESPONDERS Many municipalities have a Critical Incident Response Plan that addresses training and response to emergency situations. However, oftentimes, these plans do not include Critical Incident Stress Management (CISM) for first responders. CISM is an intervention protocol of education, prevention and mitigation of the effects of exposure to stressful incidents. CISM helps people cope with their experiences, process and share their emotions, understand the reactions to and the symptoms of stress and grief, and if needed, receive referrals for treatment. Handled most effectively by specially trained individuals, CISM can help prevent or alleviate behavioral health issues for first responders and other municipal employees who are exposed to work-related trauma. CISM FACILITATORS A local, licensed mental health professional – especially one with experience in crisis intervention, trauma care and working with

PUBLIC RISK | MARCH/APRIL 2022

first responders – can be instrumental in developing and facilitating CISM. This professional may be provided by or accessible through the municipality’s Employee Assistance Program provider. If not, a separate contract with a qualified provider may be required. In addition to a mental health provider, Peer Support Members (PSMs) can help provide CISM interventions. PSMs are people trained to assist first responders by listening and providing confidential and non-judgmental support. PSMs can be fellow first responders, medical professionals, clergy or community leaders who receive training in CISM and the basic techniques of crisis intervention from a recognized, accredited institution or mental health professional. PSMs, however, cannot provide “fit for duty” evaluations as these should be handled only by a licensed mental health professional. CISM INTERVENTIONS CISM promotes resiliency and recovery for first responders by creating support systems. There are several types of CISM interventions that can be provided in group or one-on-one sessions and are executed during the pre-crisis, crisis response and post-crisis phases of an incident: Pre-Crisis Preparation – Education on stress management, relaxation techniques, and developing and strengthening coping skills Defusing Sessions – Structured small group discussions provided within hours of a crisis for the purposes of assessment and acute symptom mitigation Critical Incident Stress Debriefings – Sessions in structured group settings within the first three days of a crisis to mitigate acute stress symptoms and assess the need for follow-up assistance Grief and Loss Sessions – Structured group or individual sessions for open dialogue around the circumstances of a death and to assist people in understanding their grief and loss One-on-One Crisis Intervention/Psycho-

logical Support – Provided throughout the full range of the crisis spectrum by a licensed mental health professional Family Crisis Intervention – Techniques used when a first responder’s family is involved Follow-up and Referral Mechanisms – Specifically designed processes for assessment and treatment purposes following initial interventions In addition to providing CISM, public safety leaders can support their teams by taking a personal interest in their lives and demonstrating that their wellness is a priority: • Be available and supportive – on a day-to-day basis and after critical incidents. • Share personal experiences and reactions to trauma. • Show reports that they value their work with recognition and open communication. • Build team unity by organizing events such as family picnics or a sports league which provide opportunities for their reports to socialize with and support one another.

IMPACTS OF TRAUMATIC STRESS ON PUBLIC SERVICE ORGANIZATIONS Communication breakdowns Decreased morale Deteriorating group cohesiveness Increased absenteeism Decreased ability to retain effective personnel Decreased employee efficiency and productivity Increased healthcare costs including increased worker’s compensation and disability claims Source: Used with permission from FireRescue1, Dr. Chuck Russo, Program Director, Criminal Justice at American Military University, and Carrie Kahn Courtney firerescue1.com/fire-products/education/articles/how-critical-incident-stressmanagement-interventions-help-heal-responders-HHmB9TmVGvZP3nui

• Set an example by demonstrating positive physical and mental health practices such as taking time off when needed and talking about something they do to stay in shape. Municipalities need to support their first responders before, during and after incidents. Providing mental health support, including CISM, helps first responders deal with the effects of occupational traumatic stress, which can prevent and mitigate long-term behavioral health conditions. This builds stronger public service organizations and safer communities. RESOURCES First Responder Support Network frsn.org International Critical Incident Stress Foundation icisf.org Substance Abuse and Mental Health Services Administration samhsa.gov

OSHA-Critical Incident Stress Guide osha.gov/emergency-preparedness/guides/ critical-incident-stress

National Suicide Prevention Lifeline 800-273-TALK (8255) 800-799-4889 (TDD)

National Institute of Mental Health, National Institutes of Health nimh.nih.gov

Disaster Distress Hotline 800-985-5990

National Center for PTSD, U.S. Department of Veteran Affairs ptsd.va.gov

Veterans Crisis Line 800-273-8255 Lisa Hammond, Risk Control and Business Development Manager, Tokio Marine HCC – Public Risk Group

MARCH/APRIL 2022 | PUBLIC RISK

THE POWER OF PERCEPTION: Implementing Risk Perception Surveys as Part of Your ERM Program

O YOU HAVE A RISK REGISTER? THAT’S GREAT! Now it’s time to rank the identified risks… but how? Get a group together to offer

their opinions or hash it out? Leave it to a few key members of senior leadership? Leave it to one person? There is a multitude of methods for ranking risks, and ultimately, it’s an organizational decision as to

how you do it. While this can be a difficult choice, another solution to consider is risk perception surveys.

BY CHRISTINA CHILDS, MS, ARM

Risk perception surveys are an effective, often low-cost (or in some cases, even free) method for ranking your organization’s risks, inclusive of all operating divisions. Even if your risks are ranked, seeking opinions from key stakeholders can promote ERM buy-in, justify which risks are given priority (and resources), and can serve as an internal benchmark to address changes in risk perception over time as better practices are implemented. By asking respondents to risk rank ALL risks on your register – even for other divisions – you end up with a prioritized risk register to guide your ERM efforts. Plus, you get a pulse for risk perceptions across the entire enterprise rather than the opinions of a few people.

THE TROUBLE WITH RISK RANKINGS

There is no one-size-fits-all approach to ranking risks. Some organizations may choose a workshop-style method where executives sit in a room and discuss risk rankings. Others may choose to assign a risk owner who ranks the risks. These risk rankings are often very narrowly representative

MARCH/APRIL 2022 | PUBLIC RISK

THE POWER OF PERCEPTION

of a few people instead of inclusive of the organization. If risk owners feel that they didn’t have input on the risk rankings, they may be more resistant to addressing actions to mitigate these risks.

STAKEHOLDER BUY-IN TO ERM PROGRAMS

It is important to note that enterprise risk management programs are not projects. They are an integrated business process and have no end date. Implementing an ERM program often follows many of the characteristics of project management, including executive sponsor, a team, a timeline, communication, budget, etc. An ERM program cannot be implemented, managed and executed by a single person. You will undoubtedly need input from everyone in your organization at various points. This assistance may be necessary for adding risks to the risk register, appointing individuals or departments to provide risk treatment plans, or communicating your program’s action plans to various levels of the organization. That’s why just like in project management, stakeholder buy-in is critical. You wouldn’t launch a project without an executive sponsor, plan or communications strategy, and ERM programs are no different. Additionally, bringing in a third party to help manage your program is a helpful way to establish a sense of objectivity among your staff and ensure that there is no internal bias when it comes to the decision-making process.

A NEW APPROACH

This is where risk perception surveys come in. These surveys are an online tool made to help identify stakeholder perceptions of an organization’s identified risks (the risks on your register). In a typical risk perception survey, respondents are asked to rank each risk based on potential impact if it were to occur and the likelihood of it happening. These two scores are then multiplied to arrive at the risk ranking. Scores are presented on an aggregate basis but can be presented further by respondent role (senior leadership, directors, managers, etc.) to identify aggregate opinions and find the points

PUBLIC RISK | MARCH/APRIL 2022

where key stakeholders agree or disagree. This process allows risks to be reviewed within a structured context considering strategic, reputational, technology, compliance, operational, and/or financial impacts and benefits. This data provides a platform for strategic discussions with leadership regarding organizational priorities to best assess, adjust, manage, control and/or monitor enterprise risks.

THE POWER OF RISK PERCEPTIONS

This process can (and should) be repeated every three to five years to address emerging risks, changes in perception, and how perceptions are aligned or disparate among the organization.

HOW TO IMPLEMENT ON A DIME

Convinced? Good! Now it’s time to implement. But how? Well, to start, there’s a good chance your organization subscribes to an online survey tool, so the costs may be little to none.

By allowing risk owners and employees to provide insights into your ERM program and risks, you will enable them to weigh in and drive risk prioritization. You’ll find this especially helpful when requesting assistance with risk ownership, mitigating actions, reporting and more. This data can also help create useful risk heat maps to present the data.

Grouping risks (if not already done so) by operational domain (i.e., sheriff’s office, parks & rec, finance, human resources, etc.) for ease of organization is a good rule of thumb. Although we understand that most risks are not wholly-owned or managed by a single department or division, it’s still helpful to organize them this way.

THE RUNDOWN: BENEFITS OF RISK PERCEPTION SURVEYS

Results can be easily inputted into Excel. Formulas can then be used to determine the average impact and average likelihood, and finally, to multiply impact and probability to arrive at your risk score.

• Stakeholders feel included and valued in overall ERM efforts.

Having a third-party partner in place to help you analyze your results is a great strategy to prevent any notion of biases being present within your program. SISCO is experienced in the risk assessment process and can help you with the “what’s next” behind the results of your risk perception survey.

In short, here are some of the benefits you’ll enjoy by implementing risk perception surveys into your risk ranking process:

• Gives stakeholders the opportunity to comment on existing risks, emerging risks, risks they feel are missing from the risk register and provide qualitative input to provide context for certain risk rankings. • Helps to justify which risks and/or operational domains are given initial priority. • Stakeholders from each department must rank the risks from other departments/divisions, too – even if they are not as familiar. This gives an unbiased, big picture view. • Survey is deployed anonymously, allowing respondents to comment freely. This ultimately provides better input without fear of retaliation. Respondents also tend to provide a level of detail on issues occurring that may not otherwise be gleaned. • Most importantly, the aggregate data provides a prioritized guide for where to focus efforts first.

CONCLUSION

Whether you are in the conceptual stages of ERM or have a mature program, risk perceptions can make a significant difference. If your ERM program is in its infancy stage, check out this helpful checklist to ensure your organization is on the right track. Risk perception surveys provide key stakeholders with an anonymous method to rank ALL risks, provide areas of emerging risk that they feel are missing from your risk register and provide you with prioritized risk rankings to focus your risk management efforts. Christina Childs, MS, ARM, ERM Consultant, SISCO

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PRIMA'S AWARDS LUNCHEON MONDAY JUNE 6, 2022 | 12:15 PM-1:15 PM | STARS AT NIGHT BALLROOM Join us as we celebrate the top risk managers within the profession, including the 2022 Public Risk Manager of the Year. Dessert reception in the Business Exchange to follow. PRMY Sponsored by AON

DESSERT RECEPTION MONDAY JUNE 6, 2022 | 1:15 PM-2:15 PM | HALL 1 Let's Eat Cake as we toast to our industry's top influencers.

PRIMA SIGNATURE SOCIAL EVENT TUESDAY, JUNE 7 | 7:00 PM-10:00 PM | SOUTHBANK RIVER WALK The Southbank River Walk has something for everyone. From pulling up a barstool, to dancing the night away or just lounging by the riverwalk. PRIMA's signature event is one you can't miss. Sponsored by Euclid Public Sector | Genesis *Shuttle Service Available

PRIMA'S KEYNOTE LUNCH & LEARN WEDNESDAY, JUNE 8 | 11:30 AM-1:30 PM | STARS AT NIGHT BALLROOM Join PRIMA and a host of industry experts as we discuss top industry topics that are affecting risk management professionals everywhere! Sponsored by Alliant

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month, Public Risk features articles from practitioners like you. Share your successes with your colleagues by writing for Public Risk magazine! For more information, or to submit an article,

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PRIMA ANNUAL CONFERENCES June 5–8, 2022 PRIMA 2022 ANNUAL CONFERENCE San Antonio, Texas Henry B. Gonzalez Convention Center June 4–7, 2023 PRIMA 2023 ANNUAL CONFERENCE Long Beach, California Long Beach Convention Center June 16–19, 2024 PRIMA 2024 ANNUAL CONFERENCE Nashville, Tennessee Gaylord Opryland Hotel

PRIMA WEBINARS April 20 I Thought I Was an Additional Insured May 18 The Change Cycle: Building Resilience & Success in a World of Change June 29 You Have Insurance but Do You Have Coverage?: Emphasis on Exclusions and Coverage Gaps July 27 Risk Management’s Role in Addressing the Insider Threat Security Risk

PRIMA INSTITUTE October 17-21, 2022 Old Town Alexandria, VA The Westin Alexandria Old Town

Keep up with what’s happening at PRIMA and connect with your risk management peers! Visit us at linkedin.com/company/prima-central/.

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The Change Cycle: Building Resilience & Success in a World of Change MAY 18 | 12:00 PM – 1:00 PM EST SPEAKER: Jackie Martin, CEO & Founder, A Matter of Motivation Feeling overwhelmed or exhausted by recent change but desire to feel more positive, flexible and hopeful? Learn what change really is and why we think, feel and behave the way we do in changing times. Discover how to use change as a catalyst to build your own resilience as a leader and improve your ability to guide your team through uncertain times. ATTENDEE TAKEAWAYS: 1. Discover the predictable and unpredictable elements of how we deal with change 2. Recognize the specific skills each person needs to move through the next stage of change 3. Create a plan for yourself and others to move through change more smoothly and positively

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October 17–21 // Old Town Alexandria, VA

SPONSORSHIP OPPORTUNITIES AVAILABLE NOW FOR PRIMA INSTITUTE 2022 PRIMA Institute (PI22) is the premier educational program for new and seasoned public risk management professionals who seek to learn more about emerging trends and best practices. This hands-on learning environment affords attendees the opportunity to participate in case studies and network with leaders in the field of public risk management.

2 complimentary registrations will be given when a GOLD or PLATINUM sponsorship is purchased. PLATINUM $10,000+

GOLD $9,999–$7,000

SILVER $6,999–$4,000

BRONZE $3,999-$2,500

Signage Recognition at PI and PRIMA’s Annual Conference

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Listing on PRIMA Institute Web site with Link to Your Company’s Web Site

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*Scholarship recipients will receive complimentary registration.

For additional information regarding sponsoring PRIMA Institute 2022, please contact PRIMA ’s education and training director, Shaunda Ragland, at sragland@primacentral.org.