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Critical Incident Stress Management

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Title: Critical Incident Stress Management


1
Critical IncidentStress Management CISM
UpdateLearning from the Past, . . . Progressing
into the Future Civil Air Patrol Annual
Conference National Board Meeting Friday,
September 4, 2009 Developed by Lt. Col. Sam D.
Bernard, Ph.D.CAP CISM National Team
Leader Partial content from Chevron Publishing
2
Welcome Thank you for attending this
session concerning CAP CISM Updates
3
Goals
  • To provide information concerning various CISM
    topics concerning
  • ICISF
  • CISM information
  • CAP CISM Program

4
ICISF
  • 10th World Congress Jan-Feb 2009
  • Corporate downsizing
  • Staff reductions
  • Still viable and hosting regional conferences
    nationwide

5
Other ICISF Courses
  • Group Basic CISM
  • Peer Individual Crisis Intervention
  • Building Skills in CISM
  • Responding to School Crisis
  • Suicide Prevention, Intervention Postvention
  • Advanced Group CISM
  • Strategic Response to Crisis
  • Emotional Spiritual Care in Disaster
  • Pastoral Crisis Intervention I II
  • Stress Management for the Trauma Service Provider
  • Team Evaluation and Management (TEAM)
  • Grief Following Trauma
  • Psychological Response to Terrorism Impact and
    Implications
  • The Changing Face of Crisis Response and Disaster
    Mental Health Intervention

New Course! Psychological First Aid
6
Certificate of Specialized Training
  • Emergency Services
  • Mass Disaster Terrorism
  • Workplace Industrial Applications
  • Schools Children Crisis Response
  • Spiritual Care in Crisis Intervention
  • Substance Abuse Crisis Response

7
InternationalCritical Incident Stress
Foundation 3290 Pine Orchard LaneSuite
106Ellicott City, MD 21042(410) 750-9600Fax
(410) 750-9601Emergency (410)
313-2473www.icisf.org
8
CISMInformationRefresher / Review
9
The Terrible 10 for CAP
1. 6. 2. 7. 3. 8. 4. 9. 5.
10.
. . . not limited to missions!
Take Home Message
10
Resistance If the stressor continues, the body
mobilizes to withstand the stress and return to
normal.
Exhaustion Ongoing, extreme stressors
eventually deplete the bodys resources so
we function at less than normal.
Alarm The body initially responds to a stressor
with changes that lower resistance.
Return to homeostasis
Homeostasis The body systems maintain a
stable and consistent (balanced) state.
Stressor The stressor may be threatening or
exhilarating.
Illness
Illness and Death The bodys resources are
not replenished and/or additional stressors
occur the body suffers breakdowns.
Death
11
The brain becomes more alert.
Stress can contribute to headaches, anxiety, and
depression.
Sleep can be disrupted.
Stress hormones can damage the brains ability
to remember and cause neurons to atrophy and die.
Baseline anxiety level can increase.
Heart rate increases.
Persistently increased blood pressure and heart
rate can lead to potential for blood clotting and
increase the risk of stroke and heart attack.
Adrenal glands produce stress hormones.
Cortisol and other stress hormones can increase
appetite and thus body fat.
Stress can contribute to menstrual disorders in
women.
Stress can contribute to impotence and premature
ejaculation in men.
Red immediate response to stress
Muscles tense.
Blue effects of chronic of
prolonged stress
Muscular twitches or nervous tics can result.
12
Mouth ulcers or cold sores can crop up.
Breathing quickens.
The lungs can become more susceptible to colds
and infections.
Immune system is suppressed.
Skin problems such as eczema and psoriasis can
appear.
Cortisol increases glucose production in the
liver, causing renal hypertension.
Digestive system slows down.
Stress can cause upset stomachs.
Red immediate response to stress
Blue effects of chronic of prolonged stress
13
(No Transcript)
14
Stress Reactions
Physiological Based not Characteriologically
Flawed
Take Home Message
15
IndicatorsofCritical Incident
Stressvs.Disciplinary ProblemsorCharacter
Disorders
Take Home Message
16
Critical Incident Stress
  • Identifiable traumatic event
  • Reactions begin with an event
  • Reactions worsen after event
  • Reactions follow expected patterns
  • Sudden changes are common in CIS
  • CIS reactions usually reduce with
  • Peer assistance and,
  • With the passage of time

Take Home Message
17
Characteriological Disciplinary Problems -
continued
  • Disciplinary problems have a long and diffuse
    history
  • Problems may have preexisted entry into the CAP
    job
  • Identifiable traumatic event(s) missing
  • Problems may exist in several other important
    areas of the persons life.
  • Problems do not easily resolve over time even
    with help.

Take Home Message
18
Crisis
Noun vs Verb
Both
Take Home Message
An acute reaction to a critical incident. A name
of a particular critical incident.
19
Recall thatPsychological Distress/Discord in
response to critical incidents is called a
Psychological Crisis(Everly Mitchell, 1999,
Critical Incident Stress Management)
20
Psychological Crisis
An acute RESPONSE to a trauma, disaster, or
other critical incident wherein there is evidence
of clinically significant 1. Distress, 2.
Impairment, 3. Dysfunction adapted from Caplan,
1964, Preventive Psychiatry
21
Eustress vs Distress vs Dysfunction
  • Eustress positive, motivating stress May be
    associated with posttraumatic growth. No reliable
    estimations on prevalence post disaster.
  • Distressdyphoria post disaster60-90 of those
    directly affected experience acute distress (Rx
    Identify Monitor)
  • Dysfunctionimpairment of function post
    disaster20-49 of those directly affected may
    experience more lasting or impairing dysfunction
    (Rx Identify, Assess, Intervene)Assessment
    of dysfunction may be the sine qua non of
    disaster mental health

22
Prioritizing the Intervention
  • Initially, given limited resources and the
    potential to interfere with natural coping
    mechanisms, intervention should be targeted to
    issues that are URGENT and IMPORTANT.
  • DISTRESSurgent, but unimportant
  • DISTRESSimportant but not urgent
  • DYSFUNCTIONurgent AND important

23
EUSTRESS vs. DISTRESS vs. DYSFUNCTION
Eustress (Positive, motivating)
No Action Needed
Distress (benign, mild)
Identify, Assess, Monitor
Dysfunction (severe, impairment, incapacitating)
Identify, Assess, Take action
24
Functionalitymay be defined as the ability of
an individual to recognize and successfully
attend to his/her current responsibilities.
25
Signs and Symptomsof Distress and Dysfunction
  • Cognitive
  • Emotional
  • Behavioral
  • Physical
  • Spiritual

26
I. Cognitive Distress
  • Inability to Concentrate
  • Difficulty in Decision Making
  • Preoccupation (obsessions) with Event
  • Confusion (dumbing down)

27
I. Severe Cognitive Dysfunction
  • Suicidal/ Homicidal Ideation
  • Inability to Understand Consequences of Behavior
  • Delusions
  • Hallucinations
  • Persistent Hopelessness/ Helplessness

28
II. Emotional Distress
  • Anxiety
  • Irritability
  • Anger
  • Sadness
  • Fear
  • Phobia
  • Grief

29
II. Severe Emotional Dysfunction
  • Panic Attacks
  • Chronic Immobilizing Depression
  • Depression Guilt
  • Posttraumatic Stress Disorder (PTSD)

30
  • After traumatic events, DEPRESSION is most
    commonly associated with LOSS.
  • ANXIETY, on the other hand, is commonly
    associated with FEAR and life-threatening
    exposure.

31
Posttraumatic stress (PTS) is a normal survival
response Posttraumatic Stress Disorder (PTSD) is
a pathologic variant of that normal survival
reaction.
32
PTSD
A. Traumatic event B. Intrusive memories C.
Avoidance, numbing, depression D. Stress
arousal E. Symptoms last gt 30 days F.
Impaired functioning (This is the most important
aspect of PTSD for the crisis interventionist)
33
Crisis Intervention
Goals The Goal of Crisis Intervention is to
foster Resilience via 1. Stabilization 2.
Symptom reduction 3. Return to adaptive
functioning, or 4. Facilitation of access to
continued care (adapted from Caplan, 1964,
Preventive Psychiatry)
34
Crisis Characteristics
  • The relative balance between thought processes
    and emotional processes is disturbed,
  • The usual coping methods do not work effectively,
  • There is evidence of mild to severe impairment in
    individuals or groups exposed to the critical
    incident,

Chevron Publishing, 2002
35
Post CRISIS
Pre-CRISIS
FEELINGS
THOUGHTS
FEELINGS
THOUGHTS
CRISIS
36
Crisis CharacteristicsImprint of Horror
  • Visual
  • Auditory
  • Olfactory
  • Kinesthetic
  • Gustatory
  • Temporal

Psychological / Perceptual Contaminants
37
Assessing the Need forCrisis Intervention (CISM)
  • Is this one of the CAP Terrible 10?
  • Are coping mechanisms working effectively for
    EVERYONE?
  • Is there evidence of mild to severe impairment in
    individuals or groups exposed to the critical
    incident?

Take Home Message
38
1/3 Rule - Theoretical
1
2
3
8
39
Peritraumatic Stress
  • Dissociation
  • Depersonalization, derealization, fugue states,
    amnesia
  • Intrusive Re-Experiencing
  • Flashbacks, terrifying memories or night mares,
    repetitive automatic re-enactments
  • Avoidance
  • Agoraphobic-like social withdrawal
  • Hyperarousal
  • Panic episodes, startle reactions, fighting or
    temper problems
  • Anxiety
  • Debilitating worry, nervousness, vulnerability or
    powerlessness
  • Depression
  • Anhedonia, worthlessness, loss of interest in
    most activities, awakening early, persistent
    fatigue, and lack of motivation
  • Problematic Substance Use
  • Abuse or dependency, self-medication
  • Psychotic Symptoms
  • Delusions, hallucinations, bizarre thoughts or
    images, catatonia

Disaster Mental Health Services-A guidebook for
Clinicians Administrators Dept of Veterans
Affairs, 1998
40
Highest Risk forExtreme Peritraumatic Stress
  • Life-Threatening danger, extreme violence, or
    sudden death of others
  • Extreme loss or destruction of their homes,
    normal lives, and communities
  • Intense emotional demands from distraught
    survivors (rescue workers, counselors,
    caregivers)
  • Prior psychiatric or marital/family problems
  • Prior significant loss (death of a loved one in
    the past year)
  • Cardena Spiegel, 1993 Joseph et.al, 1994
    Kooperman, et.al., 19945 La Greca et.al.,1996
    Lonigan, et.al., 1994 Schwarz Kowalski, 1991
    Shalev, et.al., 1993

Disaster Mental Health Services-A guidebook for
Clinicians Administrators Dept of Veterans
Affairs, 1998
41
Effects of Hyper-Arousal
  • Being more emotional
  • Panicking
  • Intensified alertness
  • Reminders of the trauma leading to physical
    reactions
  • Rapid heart beat
  • Sweating
  • etc
  • Increased anxiety
  • Trouble sleeping
  • Difficulty concentrating
  • Heightened vigilance
  • Being easily startled
  • Being wary
  • Sudden crying
  • Becoming suddenly angry

42
Hyper-ArousalSleep Disturbances
  • Longer to fall asleep
  • Unable to fall asleep
  • More sensitive to noise
  • Awaken more often during the night
  • Have dreams and/or nightmares about the trauma
  • Repetitive trauma dreams may awaken and leave
    frightened and exhausted

43
CISM as Mitigation
  • Efforts attempt to prevent hazards from
    developing into disasters altogether, or to
    reduce the effects of disasters when they occur.
  • Differs from the other phases because it focuses
    on long-term measures for reducing or eliminating
    risk.
  • Implementation of mitigation strategies can be
    considered a part of the recovery process if
    applied after a disaster occurs.

44
CISM as Mitigation
  • Structural or non-structural,
  • Is the most cost-efficient method for reducing
    the impact of hazards.
  • Does include providing regulations . . . and
    sanctions against those who refuse to obey the
    regulations . . . potential risks to the public
    fema.gov

A natural mesh with Public Affairs
45
Mitigating C I S
Even with all the right programs, briefings,
teams, personnel, etc lined up available
there can still be CIS. We dont know our
membersbaggage. (Pre-existing
conditions) Pre-Exposure Training can helpID
potential psych/perceptualcontaminants
Take Home Message
46
Mitigating Operational Stress (OpStress)
  • Frequent information / feedback to staff
  • Frequent rest breaks
  • Cold or hot environments might require more
    frequent rest breaks
  • Rest areas away from stimuli
  • 12 hour limit for same scene stimuli
  • Assure proper rehabilitation sector
  • Provide lavatory facilities continued...

Take Home Message
47
Mitigating OpStress - continued
  • Provide hand washing facilities
  • Provide medical support to staff
  • Monitor hyper- or hypo-thermia
  • Proper food
  • Limit fat, sugar and salt
  • Fluid replacement
  • Provide drinking water
  • Provide fruit juices
  • Limit use of caffeine products
  • CISM on scene support services continued...

Take Home Message
48
Mitigating OpStress - continued
  • Monitor signs of emotional distress
  • Limit overall stimuli at incident
  • Give clear orders to personnel
  • Avoid conflicting orders to staff
  • Delegate authority
  • Frequent rest breaks for all
  • Back up leaders
  • Sectorization of the incident
  • Delegation of authority
  • Credit people for proper actions continued...

Take Home Message
49
Mitigating OpStress - continued
  • Limit criticism to absolute minimum
  • Utilize a staging area for uninvolved personnel
  • Limit exposure to event sights, sounds and smells
    (reminders)
  • Announce time periodically
  • Rotate crews to alternate duties
  • Others ?

Take Home Message
50
After Action Support
  • Thank personnel for their work
  • Consult with CISM team
  • Provide demobilization services on large scale
    incident
  • Utilize services of CISM teams
  • Arrange defusing for unusual events
  • Consider debriefing for personnel if it appears
    necessary continued...

Take Home Message
51
After Action Support - continued
  • Allow follow up services by CISM team members
  • Critique incident operationally
  • Teach new procedures from lessons learned
  • Consider the need for family support
  • Other ?

Take Home Message
52
Addressing C I S
  • Acknowledge the existence of CIS
  • Pre-incident education
  • Planning
  • Drills / practice
  • Pre-deployment briefings
  • Avoid avoidance of CIS

Take Home Message
53
Summary of Commonly Used Crisis/ Disaster
Interventions (adapted from Raphael, 1986
Everly Langlieb, 2003 NIMH, 2002 Sheehan, et
al., 2004 DHHS, 2004 Everly Castellano, 2005
Everly Parker, 2005 NOVA, 2002)
  • INTERVENTION TIMING
    TARGET GROUP POTENTIAL GOALS
  • 1. Pre-event Planning/ Pre-event
    Anticipated target/victim
    Anticipatory guidance. Preparation.

    population. Foster resistance,
    resilience.
  • 2. Assessment. Pre-intervention.
    Those directly indirectly
    Determination of need for


  • exposed.
    intervention.
  • 3. Indv. Crisis Intervention. As needed.
    Individuals as needed. Assessment.
    Screening.
  • (including "psyc first aid")
    Education. Normalization.
    Reduction of acute distress.
  • Triage.
    Facilitation of continued
    support.
  • 4. Demobilization. Shift disengagement.
    Emergency personnel.
    Decompression.
  • Screening.
    Triage.
  • Education.
    Ease transition.
  • 5. Respite Sector. On-going
    Emergency personnel.
    Respite.

  • large-scale events.
    Refreshment. Screening.
    Triage. Support.
  • 6. Large Group CMB As needed.
    Heterogeneous large
    Inform
  • Large group
    groups.
    Control rumors.
  • psyc first aid

    Inc. cohesion.

54
  • INTERVENTION TIMING
    TARGET GROUP POTENTIAL
    GOALS
  • 7. Group Debriefing Post event...
    Small homogeneous groups c/ Ventilation.
    Information.
  • (CISD, 1-10 days acute
    equal trauma exposure. Often Normalization
  • PD, GCI, incidents workgroups,
    emergency Reduce acute distress.
  • MSD,
    3-4 wks post services, military.
    Inc. cohesion, resilience.
  • CED, mass disaster
    Screening
  • HERD) recovery phase.
    Triage. Follow-up
    essential.
  • 8. Defusing On-going events Small
    homogeneous groups. Stabilization.
    Ventilation (and small group
    Post event May be similar to HERD in
    Reduce acute distress.
  • "psychological first aid.") (lt 12 Hrs)
    process.
    Screening.

  • May be repeated.
    Information.


  • Inc. cohesion, resilience.
  • 9. Small Group On-going events Small groups
    seeking info. Information.
  • Crisis Management Post event. c/o
    delving into affect. Control
    rumors.
  • Briefing (sCMB) May be repeated,
    Reduce acute distress

  • as needed. Inc.
    cohesion, resilience.





  • Screening/ Triage

55
  • INTERVENTION TIMING TARGET
    GROUP POTENTIAL GOALS
  • 10. Family Crisis Pre-event
    Families. Consists of a wide array
  • Intervention. As needed. of interventions
    incl.


  • Pre-event
    prep., individ. intv.,
    sCMB, debriefing, etc.
  • 11. Organizational/ Leadership Pre-event
    Organizations affected Improve
    organizational
  • Consultation As needed. by trauma or
    disaster. preparedness
    response.
  • 12. Pastoral Crisis As needed. Those who
    desire faith-based Faith-based support, eg,
  • Intervention presence/ crisis
    intervention, eg, Info., advocacy, liaison.

    Individs., small groups,
    Ministry of presence.
    large groups,
    congregations,
    Religious intervention,

    communities.
    if
    desired.
  • 13. Follow-up, Referral. As needed.
    Intv. recipients those exposed. Assure
    continuity of care.
  • 14. Strategic planning. Pre-event
    Anticipated exposed/victim Improve
    overall
    during. populations.
    disaster MH
    response.

56
Objectives ofCrisis Intervention
  • Stabilize situation
  • Mitigate impact
  • Mobilize resources
  • Normalize reactions
  • Restore to adaptive function

Chevron Publishing, 2002
57
Crisis InterventionKey Principles
  • Simplicity
  • Brevity
  • Innovation
  • Pragmatism
  • Proximity
  • Immediacy
  • Positive outcome expectancy

Chevron Publishing, 2002
58
Dose Response
59
Basic Crisis Guidelines
  • Never go beyond ones level of training
  • Do not open discussions unless there is
    sufficient time to process
  • The end of every crisis intervention occurs when
    either the person is showing signs of recovery or
    it becomes evident that a referral is necessary

Chevron Publishing, 2002
60
Critical IncidentStress Management
Comprehensive Integrated System utilizing a
Multi-Tactical Crisis Intervention Approach
to Managing Traumatic Stress
61
  • Pre-Crisis Preparation /Education
  • On-scene Support / Consultation
  • Group Intervention
  • Demobilization
  • Crisis Management Briefing
  • Defusing
  • Critical Incident Stress Debriefing
  • Individual Crisis Intervention
  • Pastoral Crisis Intervention
  • Family / Sig. Other Support
  • Organizational Consultation
  • Follow-up and / or Referral
  • Post -event Education Lessons Learned

Tactics
CISM Menu of Services
62
Core Competencies in CISM
  • The ability to properly assess both the situation
    and the severity of impact on individuals and
    groups
  • Ability to develop a strategic plan
  • Individual crisis intervention skills
  • Large group crisis intervention skills
  • Small group crisis intervention skills
  • Referral skills

Chevron Publishing, 2002
63
Essential CISM Courses(2 Days Each)
  • Assisting Individuals in Crisis
  • Basic Critical Incident Stress Management Group
    Crisis Interventions
  • Suicide
  • Grief Following Trauma
  • Advanced Critical Incident Stress Management
    Group Crisis Interventions
  • T.E.A.M.
  • Emotional Spiritual Care in Disasters

Chevron Publishing, 2002
64
In addition to the essential courses,CISM
providers are encouraged to participate in a
variety of other training opportunities to
enhance their skills.
Chevron Publishing, 2002
65
Strategic Planning

Resources
Resources
66
  • Pre-Crisis Preparation /Education
  • On-scene Support / Consultation
  • Group Intervention
  • Demobilization
  • Crisis Management Briefing
  • Defusing
  • Critical Incident Stress Debriefing
  • Individual Crisis Intervention
  • Pastoral Crisis Intervention
  • Family / Sig. Other Support
  • Organizational Consultation
  • Follow-up and / or Referral
  • Post -event Education Lessons Learned

Tactics
CISM Menu of Services
67
Strategic Planning
AKA Tactics
Target Type Timing Theme Team
Resources
Target
Type On-Scene CMB Demob. Defuse CISD 11 Family Ad
min Consult IC/CC F/U
Timing NOW! After Shift Tomorrow AM Before Going
Home After Been Home 1-2 Day
Theme Victim Grief Loss Survivor Survivor
Guilt Boss IC CC Violated World View
Team Peers Flight Crew Ground Team Admin Commo Cad
et Mental Health Outside Tm
Resources Peers Friends Neighbors Family Faith
Community Work EAP PCP Support Groups Outside Tm


From Circles
68
CISM TacticsMust be Available for
  • Individuals
  • Groups
  • Organizations
  • Families
  • Significant others

Chevron Publishing, 2002
69
CISM ComponentsBefore an Incident
  • Education (PEP)
  • Team training
  • Planning
  • Administrative support
  • Protocol development
  • Guideline development
  • Networking with other teams resources

70
CISM ComponentsDuring an Incident
  • On-scene support services
  • One-on-one crisis intervention
  • Advice to supervisors/IC
  • Support to primary victims (CAP)
  • Provision of food, fluids, rest and other
    services to operations personnel
  • Organizational Consultation (CC)

71
CISM ComponentsAfter an Incident
  • One-on-one crisis intervention
  • Demobilization (post-disaster, large group)
  • Crisis Management Briefing (CMB, large group)
  • Defusing (small group)
  • Critical Incident Stress Debriefing (CISD, small
    group)
  • Significant other support services
  • . . . more . . .

72
CISM ComponentsAfter an Incidentcontinued
  • Post-incident education
  • Follow-up services
  • Referrals according to needs

73
CISM
  • Typically 3-5 contacts
  • After that,
  • Recovery is evident
  • Referral is indicated

74
Maslows Need Hierarchy(1943)
SELF-ACTUALIZATION Personal growth and
fulfillment
SELF-ESTEEM Self-efficacy, empowerment
Psychotherapy
AFFILIATION, SUPPORT Interpersonal family
relationships
CrisisIntervention
SAFTEY Physical and psychological security, law
order
PHYSIOLOGICAL NEEDS Basic life needs - air,
food, water, shelter
Start here
75
Spectrum of Care
Critical Incident
Family Support EAP Chaplain Human
Resources Family Advocate Legal Mental
Health Psychotherapy Hospitalization Rehabilitatio
n Other resources
Crisis Intervention
r
CISM
Refer as needed to any
76
Treatment Referral Options
  • Medical Care Professional
  • MD / DO
  • PA / NP
  • Mental Health Care Professional
  • Psychologist
  • Counselor
  • Social Worker
  • Psychiatrist / NP / PA
  • Spiritual Care Professional
  • Faith Leader
  • Chaplain

77
CISM
  • Is not psychotherapy
  • Is not a substitute for psychotherapy
  • Is not a stand-alone
  • Is not a cure for PTSD, Depression, Anxiety, etc

78
CISM has far more to do withgroup
supportandassessment (triage)than it does
withtreatment and cure.
79
Follow-Up
  • Must be provided after every CISM service
  • Assess impact of intervention
  • Assess for uncovering prior issues
  • Assess trajectory of reactions
  • Decreasing
  • Same
  • Increasing
  • Assess for possible referral
  • Health Care Professional
  • Mental Health Care Professional
  • Spiritual Care Professional

1 week post CISM service 1 month post CISM service
80
P. A. S. S.Post Action Staff SupportDennis
Potter, LCSW
81
Goals For PASS
  • Increase longevity of team members
  • Increase learning from the experience
  • Increase stress management skills
  • Decrease the chance for personal reactions
  • To take care of ourselves (too)
  • Increase effectiveness of team members
  • Monitor team for any adverse reactions

82
Why Do It?
  • To Prevent
  • Vicarious Traumatization
  • Cumulative Stress
  • Critical Self Judgment
  • To Teach
  • To Practice What We Teach
  • The same professionalism we provide to others,
    we deserve ourselves SDB

83
When Should It Be Done?
  • Should be a normal part of the teams standard
    operating guidelines,
  • Should be done prior to the team going home (at
    least a defusing),
  • At the earliest next opportunity,
  • Soon,
  • Its never too late!

84
Where Should It Be Done?
  • Away from the site and participants,
  • Neutral site if possible,
  • Somewhere you will not be interrupted,
  • If the Critical Incident is particularly
    difficult you may want to consider more time or
    bringing in someone else,
  • Somewhere private if you are concerned about the
    difficulty of the CISM response.

85
How Long Does It Take?
  • For normal events usually 10-15 minutes is
    adequate,
  • For abnormal events 30-60 minutes may be
    required,
  • If you always do it, you will discover the
    difference between a normal and abnormal event.

86
Who Should Do It?
  • Usually the Event Team Leader
  • Probably 90 can be done by the team itself
  • Occasionally, by someone not involved in the
    response itself
  • Particularly difficult or events of long duration

87
Important Notice
  • All CISM services should be provided only by
    people who have been properly trained in Critical
    Incident Stress Management courses,
  • Having attained an advanced academic degree alone
    does NOT indicate knowledge of CISM or related
    protocols.

88
CAPCISMRefresher / Update
89
Where We Are NowWeb-Site
  • cism.cap.gov
  • Staff listings contact information
  • Calendar of events / trainings
  • Forms Handouts
  • Send training certificates / reports to . . .
  • Certificates
  • Wing Reports Region Reports

90
Decentralization of Staff
  • Wings Getr done dudes Providing Frontline
    Service
  • Providing CISM services
  • Networking with other local non-CAP CISM teams
  • Regions Make it happen Administrative
    Support
  • Administrative support and facilitation /
    paperwork
  • Technical assistance if needed
  • Maintains team records
  • Maintains ICISF Registered Team status with ICISF
  • Monthly conference calls with Wings
  • National Lead into the future Overall
    Leadership
  • Develop training based on Wing and Region needs
  • Keep everyone updated on new ideas/issues
  • Monthly conference calls with Region s

91
Staff Structure
  • Wings Doing the CISM Work
  • Officer/Coordinator
  • Clinical Director
  • Region Team Support Administration
  • Officer / Coordinator
  • Clinical Director
  • National Leading into the Future
  • Team Leader
  • Clinical Director

92
Staff Structure
  • Officer / Coordinator
  • Administrator of the program within Wing or
    Region
  • Point person for Wing or Region
  • Coordinates service requests and services
  • Maintains paperwork for Wing or Region
  • Officiates administration portion of
    meetings/trainings
  • Clinical Director
  • Supervises all clinical aspects of program
  • Must be licensed in the state of residence and/or
    Wing of membership
  • Conducts clinical portion of meetings/trainings

93
Required Training
  • Introduction to ICISF (On-line or classroom)
  • Program Orientation (On-line or classroom)
  • CISM Basic Concepts (On-line or classroom)
  • Group Crisis Intervention (Classroom only) AND
  • Peer / Individual Crisis Intervention (Classroom
    Only)
  • NIMS
  • NIMS 100 http//training.fema.gov/IS/NIMS.asp
  • NIMS 700 http//training.fema.gov/IS/NIMS.asp
  • ICS 300 and 400 is not required, but can aid in
    understanding command and general staff issues.

94
Renewal / Refresher
  • Renewal / Refresher
  • Group (2 Classroom days)and
  • Individual (2 Classroom days)or
  • Building Skills in CISM (2 Classroom days)
  • or
  • The Changing Face of CI and DMHI(1 Classroom day
    or internet)
  • CISM Service provision does not qualify for
    renewal/refresher

While other ICISF and other organizations
courses are encouraged, to maintain basic CISM
skill sets and knowledge currency, the above
courses are required on a 3 year rotation.
95
Recruiting
  • Ground team members and support personnel
  • Air crew member and support personnel
  • Administration personnel
  • Communications personnel
  • Physical health personnel (doctors, nurses, etc.)
  • Mental health personnel (psychologist,
    counselors, social workers, etc)
  • Spiritual health personnel (chaplains, character
    development, etc)
  • Cadets (training our replacements)
  • Elders - Recycling . . .

96
Recycling Members
  • Because
  • Physical injury nor disability
  • Normal aging
  • does not eliminate
  • Experience insight,
  • Cognitive abilities strategizing
  • Positive coping skills, abilities, outlooks,
  • The CISM Program welcomes
  • Flight crews members who no longer fly
  • Ground teams who dont ground pound
  • Administration and Communications folks
  • We still need you . . . you arent done yet

97
Cadets CISM
  • Introduction to CISM at technician level
  • Cadet-to-Cadet Peer Support
  • Educate on effective listening communication
    skills
  • Provide awareness of suicide warning signs how
    to summons help
  • How to help a friend
  • Prepare for Senior Member CISM program
  • Will Not
  • Participate in Senior CISM service provision in
    support staff roles only,
  • Be considered peer to any senior member
  • We need you . . . Were Training Our Replacements

98
CISM Specialty Track
  • Technician Learning the program
  • Knowledge Requirement
  • Service Requirement
  • Senior Doing mentoring the program
  • Knowledge Requirement
  • Service Requirement
  • Master Managing the program
  • Knowledge Requirement
  • Service Requirement

99
Technician Learning the program
  • Knowledge Requirement
  • Introduction to ICISF
  • Orientation to CAP CISM Program NIMS 100
  • CISM Basic Concepts NIMS 700
  • ICISFs Group Crisis Intervention
  • ICISFs Individual/Peer Crisis Intervention
  • Service Requirement
  • Serve in support role until completion of courses
    (above)
  • Actively participate in 6 CISM responses as an
    observer only
  • Actively participate in 4 Debriefings (non
    leader)
  • Actively participate in 4 Individual/Peer
    contacts
  • Actively participate in 6 Follow-Up contacts
  • Actively provide 4 Intro to ICISF presentations
  • Actively provide 4 Orientation to CAP CISM
    Program presentations
  • Attend 4 PEP trainings
  • Attend 75 of the Wing CISM meetings

100
Senior Doing mentoring the program
  • Knowledge Requirement
  • ICISFs Advanced Group
  • ICISFs Suicide
  • ICISFs Grief Following Trauma
  • Service Requirement
  • Achieve Technician rating
  • Mentor 4 upcoming Technicians
  • Actively participate in 6 more CISM
    Mission/Training responses
  • Actively participate in 4 more debriefings (as
    leader)
  • Actively provide 4 more Individual/Peer contacts
  • Actively provide 6 more Follow-Up contacts
  • Meet with 1-2 local CISM teams 3 times minimum
  • Provide 3 CISM Basic Concepts presentations
  • Assist a Wing CISM Officer/Coordinator for 1 year
    (Team Coordinator, Clinical Director, etc)
  • Attend 75 of the Wing CISM meetings/trainings

101
Master Managing the program
  • Knowledge Requirement
  • Strategic Response to Crisis
  • Team Evolution and Management
  • Emotional Spiritual Care in Disasters
  • Service Requirement
  • Achieve Senior rating
  • Mentor 4 upcoming Seniors
  • Actively participate in planning CISM involvement
    in 4 CAP Exercises/Drills
  • Develop MOUs with 2 local non-CAP CISM teams
  • Participate in 4 meeting/trainings with non-CAP
    CISM teams,
  • Serve as a co-instructor (maximum of 10) for a
    Group and Individual/Peer course
  • Assist a Region CISM Officer for 1 year (Team
    Coordinator, Clinical Director, etc.)
  • Attend 75 of the Wing and Region CISM meetings

102
Where to from here?
  • Satisfied with the knowledge awareness
  • How to do more
  • Join a team
  • Attain further CISM education
  • Provide further CISM education awareness
  • Advocate for appropriate CISM services
  • Provide more
  • Within your Squadron, Group, Wing, Region
  • With your family
  • At your place of work
  • In your community
  • For yourself

103
How To Become a Member
  • Complete basic trainings (technician)
  • Complete application be accepted to a team
  • Participate in quarterly Team trainings
  • Participate in CAP CISM functions
  • Maintain currency
  • Participate in non-CAP CISM teams functions
  • CISM Team membership is a privilege not a right.

104
Knowledge itself is powerSir Francis Bacon
Action is the proper fruit of knowledgeThomas
Fuller
105
Feedback
Thoughts Comments Reactions
106
National Staff
Lt Col Sam D. Bernard, PhD National CISM Team
Leader (423) 322-3297 sam_at_sambernard.info Maj
Chris Latocki Administrative Officer ( 813)
412-9231 clatocki_at_cism.cap.gov
107
Region Staff
________Name____________ Region CISM
Officer Telephone / e-mail ________Name_________
___ Region Clinical Director Telephone / e-mail
108
Wing Staff
________Name____________ Wing CISM Officer /
Coordinator Telephone / e-mail ________Name_____
_______ Wing Clinical Director Telephone / e-mail
109
. . .and just one more thing. . .
Thank You!
110
Critical Incident Stress Management
Lt. Col. Sam D. Bernard, Ph.D. National CAP CISM
Team Leader (423) 322-3297Cell sam_at_sambernard.info
www.sambernard.info cism.cap.gov
111
Critical IncidentStress Management CISM
UpdateLearning from the Past, . . . Progressing
into the Future Developed by Lt. Col. Sam D.
Bernard, Ph.D.CAP CISM National Team
Leader Partial content from Chevron Publishing
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