STAGE-28 promotes scientific thinking in decision-making for mental health. The acronym refers to:
S |
T |
A |
G |
E |
– |
28 |
|---|---|---|---|---|---|---|
| stress | trauma | assessment | growth | evaluation | in | 28 days |
STAGE-28 was created for non-scientists to generate psychological data by translating experience into the type of evidence that psychologists and psychiatrists rely on. It emerged from 20 years of crisis intervention and trauma resolution work in numerous countries and contexts. The theoretical and statistical work has been coded into the STAGE-28 portal for anyone to use, with its results presented simply and clearly.
Workers can use the portal to meet their Duty of Care to themselves and others by completing the questionnaires online and reading the resulting e-mail with their personal risk level, links to further information and signposts to support, guidance and treatment.
Managers can use the portal to meet their Duty of Care to all workers by sending a web-link and awaiting a deidentified summary that indicates ‘hot-spots’ in their organisations demanding attention.
All data is stored on STAGE-28’s portals in Europe and encrypted to the highest level available [1].
[1] For organisations requiring technical information on encryption standards please contact us. The website passed a Metropolitan Police Service (MPS – ‘the Met’) penetration test before being implemented. Jim Foley, a senior police officer at the Met, acknowledged its importance in the paper ‘Holding onto trauma’ (2024, The Police Journal) stating: ‘The author would like to personally thank Dr. John Durkin for his support in developing the portal, which allowed officers to respond to this survey knowing that their answers would remain confidential
Stress – Trauma – Assessment – Growth – Evaluation – in 28 days
Any scientific processes depend upon the correct use of the terms used so the STAGE-28 model defines:
Stress as necessary, in the way that ‘gravity’, ‘weather’ and ‘resistance’ are necessary. Whether we have inherited or learned problem solving abilities stress calls us to respond to the obstacles, challenges and difficulties in life. Stress might be helpful and sought out (called eustress), or unwanted and troubling (distress). Exercise in a gym might be a useful metaphor. Activities can be difficult, painful and even embarrassing but enduring them and overcoming their challenge seems to build strength, confidence and other resources, especially in the long term.
Stress in the STAGE-28 model, is NOT trauma.
Trauma as disruption, notably when a situation or threat cannot be resisted. Trauma is evident in referral to ‘breakdown’, ‘collapse’ and ‘shock’. Unlike stress, which can be manipulated by re-examining thoughts, beliefs and allowing time to pass, trauma defies manipulation. In trauma the component of unawareness or the failure to remember a key reaction has to be identified for recovery, and growth, to begin.
Correctly handled, recall leads to recovery, which leads to growth – posttraumatic growth.
Assessment as the steps towards the ‘when, where and what’ decisions for directing resources towards someone’s perceived problem, or an organisation’s blindspots for psychological hazards. Whether informally, (e.g., asking ‘What happened?’, ‘What did they do?’) or formally (e.g., completing the portal) a realistic assessment can be made. The informal approach may show how to tackle someone’s problem. The formal approach will show where threats exist and strengths too. It embeds responses in the theory, statistics and logic demanded of scientific enquiry. Both produce a practical and realistic way forward with a decision on which intervention to apply.
Assessment concludes when a decision to act is indicated, and where to apply it.
Growth as both normal development towards maturity, and positive personality changes following traumatic experience. Posttraumatic growth is described as a sense of a stronger self, stable relationships and a renewed life philosophy. To confirm a positive outcome from the intervention, the STAGE-28 portal includes at least one measure of growth.
Posttraumatic growth implies a stronger self, enhanced relationships and a renewed life philosophy.
Evaluation as the summary judgement of i) correctly identifying the psychological hazard, ii) selecting a suitable intervention and iii) measuring the change in symptom scores on standardised questionnaires.
Results of before-and-after testing should confirm the personal changes evident since the intervention.
28 relates to the number of days needed for a posttraumatic stress disorder (PTSD) diagnosis to be valid. If an intervention reduces symptoms (e.g., from 45 to 25 on the PCL-5) within 28 days of a traumatic experience, it has, by definition, prevented PTSD. All STAGE-28 programs are designed to conclude within 28 days.
Evidence-base, experience and initiatives:
Ty Gwyn Military Hospital (2004) – Hospitalised PTSD veterans
PhD thesis: University of Nottingham – operational firefighters
Andy Pike (2008): Former firefighter with PTSD, now
TIR specialist – UK veterans with PTSD and suicide risk.
Go to: https://www.andypikecounselling.co.uk/services/
NICE PTSD Update committee (2013) – RCT evidence presented, and ignored
SAMHSA (USA): Traumatic Incident Reduction (TIR) listed as evidence based [2]
NICE PTSD Triage Panel (2015) – RCT evidence presented, and ignored
NICE PTSD Recommendation Group (2016) – application refused, seat denied
SAMHSA (USA): Critical Incident Stress Debriefing (CISD) listed as evidence based [3]
Westminster Attack, London (2017) – Metropolitan Police and Forensics officers (N=13)
London Bridge/Borough Market attacks – Metropolitan Police officers (N=40+)
Grenfell Tower fire (2017) – Metropolitan Police officers (N=37)
[2] John made the case for Traumatic Incident Reduction (TIR) to be granted ‘evidence-based’ status at the Substance Abuse and Mental Health Services Administration (SAMHSA) at the US Government’s mental health arm at the Department of Health and Human Services. It succeeded in 2013. The evidence-base was removed with the dissolution of the National Registry of Evidence-based Programs and Practices (NREPP) in 2018.
[3] John made the case for critical incident stress debriefing (CISD) to be granted ‘evidence-based’ status at the Substance Abuse and Mental Health Services Administration (SAMHSA) at the US Government’s mental health arm at the Department of Health and Human Services. It succeeded in 2017. The listing was removed with the dissolution of the National Registry of Evidence-based Programs and Practices (NREPP) in 2018.