Preventing Second Injury

The Trauma Intervention Program provides emotional support during sudden tragedies

In August 2008, Linda Wall returned from a brief trip out of town to find her husband dead in their home in Gresham, Oregon. 

Wall called 911, and the police arrived at her house. As they stood outside talking, she saw two women approaching from a distance. She assumed they were trying to sell her something. But the policemen went over to talk to the pair, and after a moment, returned to Wall and introduced them as volunteers with the Trauma Intervention Program (TIP). 

“Many people find out about TIP on the worst day of their lives,” Wall says. “And that was my experience.”

The police left the two women with Wall, and they listened as she talked about her husband. They brought her water and a jacket. They watered the hanging plants that had been neglected in her absence. They provided her with information about next steps, and gave her a resource guide that she referred to in the future, which included details on funeral homes in the area. They stayed with her until her own family and friends began to arrive. It was later determined that her husband’s death was the result of a diabetic reaction and subsequent coma.

Wall refers to the volunteers that were with her that day as angels in disguise.

“The memory of those ladies there really stuck with me, that they would care enough to stop what they were doing and come and be with somebody they didn’t know, but just be there in that time,” Wall says. “It had a huge impact on me.”

Thirteen and a half years later, Wall is a TIP volunteer herself, and has responded to hundreds of calls from first responders on the scenes of crises much like her own. 

TIP is a nonprofit program that is deployed by first responders after a traumatic incident such as a sudden death. TIP National is the overarching organization, and there are 14 affiliates nationwide that have citizen volunteers available 24/7 who are trained in providing emotional and practical support to victims. This aid includes making telephone calls, referring clients to additional services, providing a listening ear and following up after the incident to check in.

 “We try to alleviate what we call a second injury,” says TIP National CEO Mandy Atkission. “And that second injury is basically people feeling like nobody paid attention to them. Nobody took care of what they were feeling at that moment.” 

Due to the historical isolation of mental health providers from law enforcement, first responders are the first professionals to interact with victims and witnesses, often long before hospital emergency personnel, victim advocates and mental health professionals. According to emergency manager Alice Busch, who has worked alongside TIP for decades in Multnomah County, first responders are well-meaning but don’t always have the training necessary to be supportive in a traumatizing situation. 

“There is no response activity that doesn’t involve our human emotions,” Busch says. “There’s no incident that should be responded to without emotional and mental health, psychological first aid-type considerations.” 

Dan Isaacson is president of the National Alliance on Mental Illness (NAMI) Lane County, an area that doesn’t have a TIP chapter, and he is working on getting an affiliate launched. He says that without an emotional and mental health framework, the process following a tragic incident can often be very cold and clinical, which can leave the families of victims feeling isolated and without the tools necessary to carve a path forward. This can result in that additional trauma, or the “second injury,” that TIP tries to alleviate. 

Lane County has CAHOOTS, a crisis response program that responds to mental health crises as an alternative to police action. TIP would fulfill a different role in the community, as it is deployed after a crisis with a focus on victims or survivors of an incident such as a sudden death. 

Isaacson says that in Lane County, when a local woman’s son committed suicide in his car, she received a phone call from law enforcement informing her that her son was dead and that she needed to collect his remains and make arrangements. She was not provided with any tools or services available to help her through the process. When she wanted to retrieve his baby book, which was in the car where her son had taken his life, she had to get it herself. The book was in the front seat, covered in gore from the incident, and the ordeal left her in the hospital. 

“This is needless trauma that doesn’t need to exist,” Isaacson says. 

Wayne Fortin, the founder and former CEO of TIP, was working in a mental health center in Oceanside, California, when he noticed what a big issue the second injury could become following traumatic incidents. He saw the need for a program that could prevent this, and worked with Oceanside police to create the model for TIP. It was established in San Diego County in 1985. 

Five years later, TIP competed in and won a major national competition called Innovations in State and Local Government sponsored by the Ford Foundation and Harvard University. TIP received $100,000 for the purpose of replicating the program, which led to the founding of the other 14 affiliates that have been established nationwide over time. 

Fortin says that TIP’s success is based on its ability to live up to the promise it makes — to be there 24/7 for first responders and for victims of tragedy. It accomplishes this by modeling itself in a crisis-oriented way and based on the operations of police and fire stations, making TIP volunteers first responders in their own right. 

“If you claim to be a crisis intervention organization, you have to be serious about it,” Fortin says. “You’ve got to take it all on to really be embraced by the emergency system.” 

When a tragedy strikes, first responders can call on TIP to provide emotional support to the victims. At TIPNW, the Portland/Vancouver affiliate, the team uses an app called Spoke. When a first responder needs TIP, they key that into the CAD (Computer Aided Dispatch) system, and about 25 people are notified via the app. A pair of volunteers are then activated, told where they are going, and TIP will notify the first responder of how long it will take for them to arrive, usually under 20 minutes. 

TIP volunteers go through a 55-hour academy and are trained in “emotional first aid,” which includes practical knowledge like learning what to say and what not to say during a tragedy, what family members need most after a death and how to work effectively in an emergency situation.

Included in this training are the five basic emotional first aid skills, a series of practices which June Vining, CEO of TIPNW, likens to dancing, because all five may not be used or may not occur in the same order when on a scene. 

The first is reaching out, which concerns establishing rapport with a victim. The second is protecting, which can include making sure they have a coat or have taken their medication. The third is reassuring, which is all about giving them information to understand what is happening and why it is happening. The fourth is organizing, which usually involves helping someone make a literal list of what they need to do after a tragedy, rather than let them ramble and lose track. 

And the fifth skill is reinforcing. Often after an incident, a client will be searching for a reason to live, and TIP volunteers verbally reinforce the existence of something, whether it be faith or a pet, that will keep a person going after a tragedy.

Vining says that TIP volunteers also have to know how and when to “shut up.”

“Society has taught us that we have to have the words,” she says. “When you’re standing in front of a mom whose child has just died, there are no words to make it OK. So we have to be comfortable with silence and then just the power of one human being coming alongside another.”

In order to collect feedback, TIPNW sends a letter 30 to 45 days after an incident to their clients, ensuring that the client felt taken care of and received the resources that they needed. They also request feedback from first responders. Vining says she has “file drawers full” of cards people send in.

“We rely on the feedback from our emergency response agencies. We rely on the feedback from our clients,” Atkission says. “We get beautiful letters all the time. ‘I would have been all alone. I don’t know what I would have done. Your volunteer was there for me.’ Those types of things.”

Busch, who has worked in emergency management for years, first became introduced to TIP in 1994 when she was working in the fire service and responded to a lightning strike death. While on scene, she saw a TIP volunteer hugging the wife of the casualty. Busch says first responders can get defensive of their patients, and she didn’t understand this mysterious person hugging someone she was responsible for. 

“I didn’t trust them,” Busch says, “So I went through the Trauma Intervention Program training.”

Busch says she was impressed by TIP’s strict adherence to its guidelines and the way it took care of its volunteers. She has continued to work in tandem with TIP ever since, and sees their emotional response work as key for the wellbeing of both victims and other first responders. 

But TIP cannot address every facet of a crisis. It responds to the immediate aftermath of an emergency, and is not a long-term response.

“We provide a caring, knowledgeable best friend, someone who’s been trained to kind of help someone maneuver through those first few hours,” Atkission says. “We are not counselors. We do not provide counseling services.”

When necessary, Vining says TIPNW volunteers refer clients to additional mental health services after an incident. But when mental health services in an area are already lacking or understaffed, TIP can only do so much.

“In Clackamas County, they have an unbelievably great suicide prevention/postvention/intervention program, so every time we respond to a suicide under the age of 25, they will reach out afterwards to anybody that was connected,” Vining says. “It’s not as active in Multnomah County, I think it’s just a staffing thing. I think they want to, but they haven’t been able to.”

While the organization itself is ready to go, TIP is still waiting in the wings to be launched in Lane County. Funding has proven to be the major roadblock, as the county budget as well as the Eugene and Springfield city budgets could not fold in the $60,000 cost of a local TIP affiliate for the 2021-2022 cycle. 

Absent private funding, TIP will have to wait until the next budget evaluation process, which begins in May, and if all goes well, Isaacson would hope to see Lane County benefitting from TIP’s services in the winter of 2023. 

“This is really a no-brainer when it comes to a program that is needed here,” Isaacson says. “And there’s definitely a voice for it.”

Devon Ashbridge, Lane County public information officer, says that there is no guarantee at this point of what will be possible in the next budget cycle, but that the budget-building process is dedicated in part to providing and expanding services to the community. 

In the communities that it does serve, TIP promises to be there 24/7 for first responders and for victims of tragedy, and it lives up to that promise. Between June 2019 and February 2020, TIPNW alone responded to 213 calls with 100 percent reliability. 

Laurie Christensen, a TIP volunteer of 11 years, benefitted from one of these calls. 

One evening in September 2019, Christensen was on call when her daughter-in-law called because her father had unexpectedly passed away. Christensen felt like she had it under control and left her shift to go to Portland to be with her daughter-in-law. But when she arrived and saw the police lights, she was immediately overcome with anxiety. When her grandkids asked to see her and talk to her, Christensen started crying. 

Fortunately, TIP was on the scene. A TIP volunteer placed her hand gently on her arm and said, “Would you like me to go with you?” And Christensen said yes. 

Being on the other side of a TIP interaction was very personal, Christensen says. Now, every time she hears about a new TIP affiliate being launched in a community, she feels thankful, because she knows how powerful it can be to have a companion during a tragedy. 

“I wish every community had TIP,” Christensen says. “Because I don’t think I’ve ever had a call where somebody said ‘I don’t need you here.’”

For information on Trauma Intervention Programs nationally go to, and for TIP in the Pacific Northwest check out Adult Mental Health, Trauma and Care. Dan Isaacson will be one of the speakers at City Club of Eugene noon March 4 at First United Methodist Church, 1376 Olive Street, discussing TIP and adult mental health.

This story was developed as part of the Catalyst Journalism Project at the University of Oregon School of Journalism and Communication. Catalyst brings together investigative reporting and solutions journalism to spark action and response to Oregon’s most perplexing issues. To learn more visit or follow the project on Twitter @UO_catalyst.

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