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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • Resources Raphael, B. (1986). When Disaster Strikes…NY: Basic Books. NIMH. (2002). Mental Health and Mass Violence. NIH Pub. # 02-5138. Wash.DC: US Govt Printing Office. Everly, G.S., Jr. & Castellano, C. (2005) Psychological Counterterrorism & World War IV. Ellicott City, MD: Chevron Pub. Everly, G.S., Jr. & Parker, C.I. (Eds) (2005). Mental Health Aspects of Mass Disasters: Public Health Preparedness and Response. Balto: Johns Hopkins Center for Public Health Preparedness. 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Customize for National CISM Staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Customize for Region CISM Staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Customize for Wing CISM staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
  • This slide should be customized for the presenter to provide specific contact information for participants. 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
  • 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update

Critical incident-stress-managment-update386 Critical incident-stress-managment-update386 Presentation Transcript

  • Critical Incident Stress 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
  • WelcomeThank you for attending this session concerning CAP CISM Updates
  • GoalsTo provide information concerning various CISM topics concerning: ICISF CISM information CAP CISM Program View slide
  • ICISF 10th World Congress Jan-Feb 2009 Corporate downsizing Staff reductions Still viable and hosting regional conferences nationwide View slide
  • 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 Ps N Strategic Response to Crisis ych ew C olo ou Emotional & Spiritual Care in Disaster gic rse al F ! Pastoral Crisis Intervention I & II irs tA Stress Management for the Trauma Service Provider id 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
  • 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
  • InternationalCritical Incident Stress Foundation 3290 Pine Orchard Lane Suite 106 Ellicott City, MD 21042 (410) 750-9600 Fax: (410) 750-9601Emergency: (410) 313-2473 www.icisf.org
  • CISM InformationRefresher / Review
  • Take Home Message The Terrible 10 for CAP 1. 6. ... not 2. l imi 7. ted to mis 3. 8. sio ns ! 4. 9. 5. 10.
  • Resistance If the stressor continues, the body mobilizes to Exhaustion withstand the stress and Ongoing, extreme return to normal. stressors eventually deplete the body’s resources so weAlarm function at lessThe body initially than normal.responds to astressor withchanges that lowerresistance. Return to homeostasis HomeostasisStressor The body systemsThe stressor maintain a stablemay be threatening and consistentor exhilarating. (balanced) state. Illness Illness and Death The body’s resources are not replenished and/or additional stressors occur; the body Death suffers breakdowns.
  • The brain becomes more alert. Stress can contribute to headaches, anxiety, and depression. Sleep can be disrupted. Stress hormones can damage the brain’s 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 andRed = immediate response premature ejaculation in men. to stress Muscles tense.Blue = effects of chronic Muscular twitches or “nervous tics” can of prolonged stress result.
  • Mouth ulcers or “cold sores” can crop up.Breathing quickens.The lungs can become moresusceptible to colds and infections.Immune system is suppressed.Skin problems such as eczema andpsoriasis can appear.Cortisol increases glucose productionin 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
  • Take Home Message Stress Reactions Physiological Based not Characteriologically Flawed
  • IndicatorsTake Home Message of Critical Incident Stress vs. Disciplinary Problems or Character Disorders
  • Critical Incident StressTake Home Message  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
  • Characteriological & Disciplinary Problems - continuedTake Home Message  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 person’s life.  Problems do not easily resolve over time even with help.
  • Take Home Message Crisis Noun Bo vs th Verb An acute reaction to a critical incident. A name of a particular critical incident.
  • Recall that…Psychological Distress/Discordin response to critical incidents is called a Psychological Crisis (Everly & Mitchell, 1999, Critical Incident Stress Management)
  • Psychological CrisisAn 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
  • Eustress vs Distress vs Dysfunction Eustress …positive, motivating stress… May be associated with posttraumatic growth. No reliable estimations on prevalence post disaster. Distress…dyphoria post disaster…60-90% of those directly affected experience acute distress (Rx = Identify & Monitor) Dysfunction…impairment of function post disaster…20-49% 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]
  • 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. DISTRESS…urgent, but unimportant DISTRESS…important but not urgent DYSFUNCTION…urgent AND important
  • EUSTRESS vs. DISTRESS vs. DYSFUNCTION Eustress No Action Needed(Positive, motivating) Distress Identify, Assess, (benign, mild) & Monitor Dysfunction Identify, Assess,(severe, impairment, & Take action incapacitating)
  • Functionality…may be defined as the ability ofan individual to recognize andsuccessfully attend to his/her current responsibilities.
  • Signs and Symptoms ofDistress and Dysfunction I. Cognitive II. Emotional III. Behavioral IV. Physical V. Spiritual
  • I. Cognitive Distress Inability to Concentrate Difficulty in Decision Making Preoccupation (obsessions) with Event Confusion (“dumbing down”)
  • I. Severe Cognitive Dysfunction Suicidal/  Delusions Homicidal  Hallucinations Ideation  Persistent Inability to Hopelessness/ Understand Helplessness Consequences of Behavior
  • II. Emotional Distress  Anxiety  Irritability  Anger  Sadness  Fear  Phobia  Grief
  • II. Severe Emotional Dysfunction Panic Attacks Chronic Immobilizing Depression Depression & Guilt Posttraumatic Stress Disorder (PTSD)
  •  After traumatic events, DEPRESSION is most commonly associated with LOSS. ANXIETY, on the other hand, is commonly associated with FEAR and life-threatening exposure.
  • Posttraumatic stress (PTS) is a normal survival response; PosttraumaticStress Disorder (PTSD) is a pathologic variant of that normal survival reaction.
  • PTSDA. Traumatic eventB. Intrusive memoriesC. Avoidance, numbing, depressionD. Stress arousalE. Symptoms last > 30 daysF. Impaired functioning (This is the mostimportant aspect of PTSD for the crisisinterventionist)
  • Crisis InterventionGoals: The Goal of Crisis Intervention is to fosterResilience via:1. Stabilization2. Symptom reduction3. Return to adaptive functioning, or4. Facilitation of access to continued care (adapted from Caplan, 1964, Preventive Psychiatry)
  • 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
  • Pre-CRISIS Post CRISIS FEELINGSTHOUGHTS FEELINGS THOUGHTS CRISIS
  • Crisis Characteristics Imprint of Horror Visual Auditory Olfactory Kinesthetic Gustatory Temporal Psychological / Perceptual Contaminants
  • Assessing the Need for Crisis Intervention (CISM)Take Home Message  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?
  • “1/3 Rule” - Theoretical 1 2 3 8%
  • Peritraumatic Stress Dissociation  Depersonalization, derealization, fugue states, amnesia Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans 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 Affairs, 1998 Psychotic Symptoms  Delusions, hallucinations, bizarre thoughts or images, catatonia
  • Highest Risk for Extreme 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., 1994&5; 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
  • Effects of Hyper-Arousal Trouble sleeping  Being more emotional Difficulty  Panicking concentrating  Intensified alertness Heightened vigilance  Reminders of the Being easily startled trauma leading to Being wary physical reactions  Rapid heart beat Sudden crying  Sweating Becoming suddenly  etc angry  Increased anxiety
  • Hyper-Arousal Sleep 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
  • 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.
  • 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
  • Mitigating C I STake Home Message Even with all the right programs, briefings, teams, personnel, etc lined up & available – there can still be CIS. We don’t know our member’s baggage. (Pre-existing conditions) Pre-Exposure Training can help ID potential psych/perceptual contaminants
  • Mitigating Operational Stress (OpStress)Take Home Message  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...
  • Mitigating OpStress - continued  Provide hand washing facilitiesTake Home Message  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...
  • Mitigating OpStress - continued  Monitor signs of emotional distressTake Home Message  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 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 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 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 ?
  • Addressing C I STake Home Message  Acknowledge the existence of CIS  Pre-incident education  Planning  Drills / practice  Pre-deployment briefings  Avoid avoidance of CIS
  • 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.
  • 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.") (< 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
  • 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.
  • Objectives ofCrisis Intervention Stabilize situation Mitigate impact Mobilize resources Normalize reactions Restore to adaptive function Chevron Publishing, 2002
  • Crisis Intervention Key Principles Simplicity  Proximity Brevity  Immediacy Innovation  Positive outcome expectancy Pragmatism Chevron Publishing, 2002
  • Dose Response
  • Basic Crisis Guidelines Never go beyond one’s 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
  • Critical Incident Stress ManagementComprehensiveIntegratedSystem utilizing aMulti-TacticalCrisis Intervention Approach to Managing Traumatic Stress
  •  Pre-Crisis Preparation /Education  On-scene Support / Consultation Group InterventionCISM: Menu of Services  Demobilization “T  ac  Crisis Management Briefing ti c  Defusing s”  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
  • 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
  • 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
  • In addition to the essential courses, CISM providers areencouraged to participate in a variety of other trainingopportunities to enhance their skills. Chevron Publishing, 2002
  • Strategic PlanningResources
  •  Pre-Crisis Preparation /Education  On-scene Support / Consultation Group InterventionCISM: Menu of Services  Demobilization “T  ac  Crisis Management Briefing ti c  Defusing s”  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
  • Strategic Planning AKA: TacticsTarget Type Timing Theme Team Resources Team Resources On-Scene NOW! Victim Peers Peers From Circles CMB After Shift Grief Flight Friends Demob. Tomorrow Loss Crew Neighbors Defuse AM Survivor Ground Family CISD Before Survivor Team Faith 1:1 Going Guilt Admin Community Family Home Boss Commo Work Admin After IC Cadet EAP Consult Been CC Mental PCP IC/CC Home 1-2 Violated Health Support F/U Day World Outside Groups View Tm Outside Tm
  • CISM TacticsMust be Available for:  Individuals  Groups  Organizations  Families  Significant others Chevron Publishing, 2002
  • CISM ComponentsBefore an Incident Education (PEP) Team training Planning Administrative support Protocol development Guideline development Networking with other teams & resources
  • CISM Components During 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)
  • CISM Components After 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 . . .
  • CISM Components After an Incident continued Post-incident education Follow-up services Referrals according to needs
  • CISM Typically: 3-5 contacts After that,  Recovery is evident  Referral is indicated
  • Maslow’s Need Hierarchy (1943) SELF-ACTUALIZATION Personal growth and fulfillmentPsychotherapy SELF-ESTEEM Self-efficacy, empowerment AFFILIATION, SUPPORT Crisis Interpersonal & family relationshipsIntervention SAFTEY Physical and psychological security, law & orderStart here PHYSIOLOGICAL NEEDS Basic life needs - air, food, water, shelter
  • Spectrum of Care Critical Incident Family Support EAPCrisis Intervention r Chaplain Human Resources CISM Refer as Family Advocate needed Legal to any Mental Health Psychotherapy Hospitalization Rehabilitation Other resources
  • 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”
  • CISM Is not psychotherapy Is not a substitute for psychotherapy Is not a stand-alone Is not a cure for PTSD, Depression, Anxiety, etc
  • CISM has far more to do withgroup supportandassessment (triage)than it does withtreatment and cure.
  • Follow-UpMust be provided after every CISM service: Assess impact of intervention Assess for uncovering prior issues Assess trajectory of reactions • Decreasing 1w • Same 1 m eek p ont ost • Increasing hp CIS ost Ms Assess for possible referral: CIS erv Ms ice  Health Care Professional erv i ce  Mental Health Care Professional  Spiritual Care Professional
  • P. A. S. S.Post Action Staff Support Dennis Potter, LCSW
  • 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
  • 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
  • When Should It Be Done? Should be a normal part of the team’s 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!
  • 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.
  • 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.
  • 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
  • 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.
  • CAP CISMRefresher / Update
  • Where We Are Now: Web-Site cism.cap.gov Staff listings & contact information Calendar of events / trainings Forms & Handouts Send training certificates / reports to . . .  “Certificates”  “Wing Reports” & “Region Reports”
  • Decentralization of StaffWings “Get’r done dudes” – Providing Frontline Service  Providing CISM services  Networking with other local non-CAP CISM teamsRegions “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 WingsNational “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
  • 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
  • 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
  • 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.aspICS 300 and 400 is not required, but can aid in understanding command and general staff issues.
  • 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/refresherWhile other ICISF and other organization’s courses are encouraged, to maintain basic CISM skill sets and knowledge currency, the above courses are required on a 3 year rotation.
  • 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” . . .
  • “Recycling” MembersBecause: •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 don’t “ground pound” •Administration and Communications folksWe still need you . . . you aren’t done yet
  • 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” membere need you . . . We’re Training Our Replacements
  • 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:
  • Technician: Learning the program Knowledge Requirement:  Introduction to ICISF  Orientation to CAP CISM Program * NIMS 100  CISM Basic Concepts * NIMS 700  ICISF’s Group Crisis Intervention  ICISF’s 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
  • Senior: Doing & mentoring the program Knowledge Requirement:  ICISF’s Advanced Group  ICISF’s Suicide  ICISF’s 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
  • 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
  • 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
  • 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.
  • “Knowledge itself is power” Sir Francis Bacon “Action is the proper fruit of knowledge” Thomas Fuller
  • FeedbackThoughtsCommentsReactions
  • National StaffLt Col Sam D. Bernard, PhD National CISM Team Leader(423) 322-3297 sam@sambernard.info Maj Chris Latocki Administrative Officer( 813) 412-9231 clatocki@cism.cap.gov
  • Region Staff________Name____________ Region CISM Officer Telephone / e-mail________Name____________ Region Clinical Director Telephone / e-mail
  • Wing Staff________Name____________ Wing CISM Officer / Coordinator Telephone / e-mail________Name____________ Wing Clinical Director Telephone / e-mail
  • . . .and just one more thing. . .Thank You!
  • Critical Incident Stress ManagementLt. Col. Sam D. Bernard, Ph.D. National CAP CISM Team Leader (423) 322-3297Cell sam@sambernard.info www.sambernard.info cism.cap.gov
  • Critical Incident Stress 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