Critical Incident Stress Managment 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
  • 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
  • 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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  • 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
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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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  • 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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  • 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 Update

    1. 1. Critical Incident Stress Management CISM Update Learning 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. 2. Welcome Thank you for attending this session concerning CAP CISM Updates
    3. 3. Goals <ul><li>To provide information concerning various CISM topics concerning: </li></ul><ul><li>ICISF </li></ul><ul><li>CISM information </li></ul><ul><li>CAP CISM Program </li></ul>
    4. 4. ICISF <ul><li>10 th World Congress Jan-Feb 2009 </li></ul><ul><li>Corporate downsizing </li></ul><ul><li>Staff reductions </li></ul><ul><li>Still viable and hosting regional conferences nationwide </li></ul>
    5. 5. Other ICISF Courses <ul><li>Group Basic CISM </li></ul><ul><li>Peer & Individual Crisis Intervention </li></ul><ul><li>Building Skills in CISM </li></ul><ul><li>Responding to School Crisis </li></ul><ul><li>Suicide: Prevention, Intervention & Postvention </li></ul><ul><li>Advanced Group CISM </li></ul><ul><li>Strategic Response to Crisis </li></ul><ul><li>Emotional & Spiritual Care in Disaster </li></ul><ul><li>Pastoral Crisis Intervention I & II </li></ul><ul><li>Stress Management for the Trauma Service Provider </li></ul><ul><li>Team Evaluation and Management (TEAM) </li></ul><ul><li>Grief Following Trauma </li></ul><ul><li>Psychological Response to Terrorism: Impact and Implications </li></ul><ul><li>The Changing Face of Crisis Response and Disaster Mental Health Intervention </li></ul>New Course! Psychological First Aid
    6. 6. Certificate of Specialized Training <ul><li>Emergency Services </li></ul><ul><li>Mass Disaster & Terrorism </li></ul><ul><li>Workplace & Industrial Applications </li></ul><ul><li>Schools & Children Crisis Response </li></ul><ul><li>Spiritual Care in Crisis Intervention </li></ul><ul><li>Substance Abuse Crisis Response </li></ul>
    7. 7. International Critical Incident Stress Foundation 3290 Pine Orchard Lane Suite 106 Ellicott City, MD 21042 (410) 750-9600 Fax: (410) 750-9601 Emergency: (410) 313-2473 www.icisf.org
    8. 8. CISM Information Refresher / Review
    9. 9. The Terrible 10 for CAP 1. 6. 2. 7. 3. 8. 4. 9. 5. 10. Take Home Message . . . not limited to missions!
    10. 10. Resistance If the stressor continues, the body mobilizes to withstand the stress and return to normal. Exhaustion Ongoing, extreme stressors eventually deplete the body’s resources so we function at less than normal. Alarm The body initially responds to a stressor with changes that lower resistance. Stressor The stressor may be threatening or exhilarating. Homeostasis The body systems maintain a stable and consistent (balanced) state. Illness and Death The body’s resources are not replenished and/or additional stressors occur; the body suffers breakdowns. Return to homeostasis Illness Death
    11. 11. 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 and premature ejaculation in men. Muscles tense. Muscular twitches or “nervous tics” can result. Red = immediate response to stress Blue = effects of chronic of prolonged stress
    12. 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. 14. Stress Reactions Physiological Based not Characteriologically Flawed Take Home Message
    14. 15. Indicators of Critical Incident Stress vs. Disciplinary Problems or Character Disorders Take Home Message
    15. 16. <ul><li>Identifiable traumatic event </li></ul><ul><li>Reactions begin with an event </li></ul><ul><li>Reactions worsen after event </li></ul><ul><li>Reactions follow expected patterns </li></ul><ul><li>Sudden changes are common in CIS </li></ul><ul><li>CIS reactions usually reduce with: </li></ul><ul><ul><li>Peer assistance and, </li></ul></ul><ul><ul><li>With the passage of time </li></ul></ul>Critical Incident Stress Take Home Message
    16. 17. Characteriological & Disciplinary Problems - continued <ul><li>Disciplinary problems have a long and diffuse history </li></ul><ul><li>Problems may have preexisted entry into the CAP job </li></ul><ul><li>Identifiable traumatic event(s) missing </li></ul><ul><li>Problems may exist in several other important areas of the person’s life. </li></ul><ul><li>Problems do not easily resolve over time even with help. </li></ul>Take Home Message
    17. 18. Crisis An acute reaction to a critical incident. A name of a particular critical incident. Noun vs Verb Take Home Message Both
    18. 19. Recall that… P sychological Distress/Discord in response to critical incidents is called a Psychological Crisis (Everly & Mitchell, 1999, Critical Incident Stress Management)
    19. 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
    20. 21. Eustress vs Distress vs Dysfunction <ul><li>Eustress … positive, motivating stress… May be associated with posttraumatic growth. No reliable estimations on prevalence post disaster. </li></ul><ul><li>Distress … dyphoria post disaster…60-90% of those directly affected experience acute distress (Rx = Identify & Monitor) </li></ul><ul><li>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] </li></ul>
    21. 22. Prioritizing the Intervention <ul><li>Initially, given limited resources and the potential to interfere with natural coping mechanisms, intervention should be targeted to issues that are URGENT and IMPORTANT. </li></ul><ul><li>DISTRESS… urgent, but unimportant </li></ul><ul><li>DISTRESS …important but not urgent </li></ul><ul><li>DYSFUNCTION …urgent AND important </li></ul>
    22. 23. EUSTRESS vs. DISTRESS vs. DYSFUNCTION Eustress (Positive, motivating) Distress (benign, mild) Dysfunction (severe, impairment, incapacitating) Identify, Assess, & Monitor Identify, Assess, & Take action No Action Needed
    23. 24. Functionality… may be defined as the ability of an individual to recognize and successfully attend to his/her current responsibilities.
    24. 25. Signs and Symptoms of Distress and Dysfunction <ul><li>Cognitive </li></ul><ul><li>Emotional </li></ul><ul><li>Behavioral </li></ul><ul><li>Physical </li></ul><ul><li>Spiritual </li></ul>
    25. 26. I. Cognitive Distress <ul><li>Inability to Concentrate </li></ul><ul><li>Difficulty in Decision Making </li></ul><ul><li>Preoccupation (obsessions) with Event </li></ul><ul><li>Confusion (“dumbing down”) </li></ul>
    26. 27. I. Severe Cognitive Dysfunction <ul><li>Suicidal/ Homicidal Ideation </li></ul><ul><li>Inability to Understand Consequences of Behavior </li></ul><ul><li>Delusions </li></ul><ul><li>Hallucinations </li></ul><ul><li>Persistent Hopelessness/ Helplessness </li></ul>
    27. 28. II. Emotional Distress <ul><li>Anxiety </li></ul><ul><li>Irritability </li></ul><ul><li>Anger </li></ul><ul><li>Sadness </li></ul><ul><li>Fear </li></ul><ul><li>Phobia </li></ul><ul><li>Grief </li></ul>
    28. 29. II. Severe Emotional Dysfunction <ul><li>Panic Attacks </li></ul><ul><li>Chronic Immobilizing Depression </li></ul><ul><li>Depression & Guilt </li></ul><ul><li>Posttraumatic Stress Disorder (PTSD) </li></ul>
    29. 30. <ul><li>After traumatic events, DEPRESSION is most commonly associated with LOSS . </li></ul><ul><li>ANXIETY , on the other hand, is commonly associated with FEAR and life-threatening exposure. </li></ul>
    30. 31. Posttraumatic stress (PTS) is a normal survival response; Posttraumatic Stress Disorder (PTSD) is a pathologic variant of that normal survival reaction.
    31. 32. PTSD A. Traumatic event B. Intrusive memories C. Avoidance, numbing, depression D. Stress arousal E. Symptoms last > 30 days F. Impaired functioning (This is the most important aspect of PTSD for the crisis interventionist)
    32. 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 )
    33. 34. Chevron Publishing, 2002 Crisis Characteristics <ul><li>The relative balance between thought processes and emotional processes is disturbed, </li></ul><ul><li>The usual coping methods do not work effectively, </li></ul><ul><li>There is evidence of mild to severe impairment in individuals or groups exposed to the critical incident, </li></ul>
    34. 35. Pre-CRISIS Post CRISIS THOUGHTS FEELINGS THOUGHTS FEELINGS CRISIS
    35. 36. Crisis Characteristics Imprint of Horror <ul><li>Visual </li></ul><ul><li>Auditory </li></ul><ul><li>Olfactory </li></ul><ul><li>Kinesthetic </li></ul><ul><li>Gustatory </li></ul><ul><li>Temporal </li></ul>Psychological / Perceptual Contaminants
    36. 37. Assessing the Need for Crisis Intervention (CISM) <ul><li>Is this one of the CAP “Terrible 10”? </li></ul><ul><li>Are coping mechanisms working effectively for EVERYONE? </li></ul><ul><li>Is there evidence of mild to severe impairment in individuals or groups exposed to the critical incident? </li></ul>Take Home Message
    37. 38. “ 1/3 Rule” - Theoretical 1 2 3 8%
    38. 39. Peritraumatic Stress <ul><li>Dissociation </li></ul><ul><ul><li>Depersonalization, derealization, fugue states, amnesia </li></ul></ul><ul><li>Intrusive Re-Experiencing </li></ul><ul><ul><li>Flashbacks, terrifying memories or night mares, repetitive automatic re-enactments </li></ul></ul><ul><li>Avoidance </li></ul><ul><ul><li>Agoraphobic-like social withdrawal </li></ul></ul><ul><li>Hyperarousal </li></ul><ul><ul><li>Panic episodes, startle reactions, fighting or temper problems </li></ul></ul><ul><li>Anxiety </li></ul><ul><ul><li>Debilitating worry, nervousness, vulnerability or powerlessness </li></ul></ul><ul><li>Depression </li></ul><ul><ul><li>Anhedonia, worthlessness, loss of interest in most activities, awakening early, persistent fatigue, and lack of motivation </li></ul></ul><ul><li>Problematic Substance Use </li></ul><ul><ul><li>Abuse or dependency, self-medication </li></ul></ul><ul><li>Psychotic Symptoms </li></ul><ul><ul><li>Delusions, hallucinations, bizarre thoughts or images, catatonia </li></ul></ul>Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans Affairs, 1998
    39. 40. Highest Risk for Extreme Peritraumatic Stress <ul><li>Life-Threatening danger, extreme violence, or sudden death of others; </li></ul><ul><li>Extreme loss or destruction of their homes, normal lives, and communities; </li></ul><ul><li>Intense emotional demands from distraught survivors (rescue workers, counselors, caregivers); </li></ul><ul><li>Prior psychiatric or marital/family problems; </li></ul><ul><li>Prior significant loss (death of a loved one in the past year) </li></ul><ul><li>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 </li></ul>Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans Affairs, 1998
    40. 41. Effects of Hyper-Arousal <ul><li>Trouble sleeping </li></ul><ul><li>Difficulty concentrating </li></ul><ul><li>Heightened vigilance </li></ul><ul><li>Being easily startled </li></ul><ul><li>Being wary </li></ul><ul><li>Sudden crying </li></ul><ul><li>Becoming suddenly angry </li></ul><ul><li>Being more emotional </li></ul><ul><li>Panicking </li></ul><ul><li>Intensified alertness </li></ul><ul><li>Reminders of the trauma leading to physical reactions </li></ul><ul><ul><li>Rapid heart beat </li></ul></ul><ul><ul><li>Sweating </li></ul></ul><ul><ul><li>etc </li></ul></ul><ul><li>Increased anxiety </li></ul>
    41. 42. Hyper-Arousal Sleep Disturbances <ul><li>Longer to fall asleep </li></ul><ul><li>Unable to fall asleep </li></ul><ul><li>More sensitive to noise </li></ul><ul><li>Awaken more often during the night </li></ul><ul><li>Have dreams and/or nightmares about the trauma </li></ul><ul><li>Repetitive trauma dreams may awaken and leave frightened and exhausted </li></ul>
    42. 43. CISM as Mitigation <ul><li>Efforts attempt to prevent hazards from developing into disasters altogether, or to reduce the effects of disasters when they occur. </li></ul><ul><li>Differs from the other phases because it focuses on long-term measures for reducing or eliminating risk. </li></ul><ul><li>Implementation of mitigation strategies can be considered a part of the recovery process if applied after a disaster occurs. </li></ul>
    43. 44. CISM as Mitigation <ul><li>Structural or non-structural, </li></ul><ul><li>Is the most cost-efficient method for reducing the impact of hazards . </li></ul><ul><li>Does include providing regulations . . . and sanctions against those who refuse to obey the regulations . . . potential risks to the public fema.gov </li></ul>A natural mesh with Public Affairs
    44. 45. Mitigating C I S 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 Take Home Message
    45. 46. Mitigating Operational Stress (OpStress) <ul><li>Frequent information / feedback to staff </li></ul><ul><li>Frequent rest breaks </li></ul><ul><li>Cold or hot environments might require more frequent rest breaks </li></ul><ul><li>Rest areas away from stimuli </li></ul><ul><li>12 hour limit for same scene stimuli </li></ul><ul><li>Assure proper rehabilitation sector </li></ul><ul><li>Provide lavatory facilities continued... </li></ul>Take Home Message
    46. 47. Mitigating OpStress - continued <ul><li>Provide hand washing facilities </li></ul><ul><li>Provide medical support to staff </li></ul><ul><li>Monitor hyper- or hypo-thermia </li></ul><ul><li>Proper food </li></ul><ul><li>Limit fat, sugar and salt </li></ul><ul><li>Fluid replacement </li></ul><ul><li>Provide drinking water </li></ul><ul><li>Provide fruit juices </li></ul><ul><li>Limit use of caffeine products </li></ul><ul><li>CISM on scene support services continued... </li></ul>Take Home Message
    47. 48. <ul><li>Monitor signs of emotional distress </li></ul><ul><li>Limit overall stimuli at incident </li></ul><ul><li>Give clear orders to personnel </li></ul><ul><li>Avoid conflicting orders to staff </li></ul><ul><li>Delegate authority </li></ul><ul><li>Frequent rest breaks for all </li></ul><ul><li>Back up leaders </li></ul><ul><li>Sectorization of the incident </li></ul><ul><li>Delegation of authority </li></ul><ul><li>Credit people for proper actions continued... </li></ul>Mitigating OpStress - continued Take Home Message
    48. 49. Mitigating OpStress - continued <ul><li>Limit criticism to absolute minimum </li></ul><ul><li>Utilize a staging area for uninvolved personnel </li></ul><ul><li>Limit exposure to event sights, sounds and smells (reminders) </li></ul><ul><li>Announce time periodically </li></ul><ul><li>Rotate crews to alternate duties </li></ul><ul><li>Others ? </li></ul>Take Home Message
    49. 50. After Action Support <ul><li>Thank personnel for their work </li></ul><ul><li>Consult with CISM team </li></ul><ul><li>Provide demobilization services on large scale incident </li></ul><ul><li>Utilize services of CISM teams </li></ul><ul><li>Arrange defusing for unusual events </li></ul><ul><li>Consider debriefing for personnel if it appears necessary* continued... </li></ul>Take Home Message
    50. 51. After Action Support - continued <ul><li>Allow follow up services by CISM team members </li></ul><ul><li>Critique incident operationally </li></ul><ul><li>Teach new procedures from lessons learned </li></ul><ul><li>Consider the need for family support </li></ul><ul><li>Other ? </li></ul>Take Home Message
    51. 52. Addressing C I S <ul><li>Acknowledge the existence of CIS </li></ul><ul><li>Pre-incident education </li></ul><ul><li>Planning </li></ul><ul><li>Drills / practice </li></ul><ul><li>Pre-deployment briefings </li></ul><ul><li>Avoid avoidance of CIS </li></ul>Take Home Message
    52. 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) <ul><li>INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS </li></ul><ul><li>1. Pre-event Planning/ Pre-event Anticipated target/victim Anticipatory guidance. Preparation. population. Foster resistance, resilience. </li></ul><ul><li>2. Assessment. Pre-intervention. Those directly & indirectly Determination of need for </li></ul><ul><li>exposed. intervention. </li></ul><ul><li>3. Indv. Crisis Intervention. As needed. Individuals as needed. Assessment. Screening. </li></ul><ul><li>(including &quot;psyc first aid&quot;) Education. Normalization. Reduction of acute distress. </li></ul><ul><li> Triage. Facilitation of continued support. </li></ul><ul><li>4. Demobilization. Shift disengagement. Emergency personnel. Decompression. </li></ul><ul><li> Screening. Triage. </li></ul><ul><li> Education. Ease transition. </li></ul><ul><li>5. Respite Sector. On-going Emergency personnel. Respite. </li></ul><ul><li>large-scale events. Refreshment. Screening. Triage. Support. </li></ul><ul><li>6. Large Group CMB As needed. Heterogeneous large Inform </li></ul><ul><li>& Large group groups. Control rumors. </li></ul><ul><li>psyc first aid Inc. cohesion. </li></ul>
    53. 54. <ul><li>INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS </li></ul><ul><li> </li></ul><ul><li>7. “Group Debriefing” Post event... Small homogeneous groups c/ Ventilation. Information. </li></ul><ul><li>(CISD, ~1-10 days acute equal trauma exposure. Often Normalization </li></ul><ul><li>PD, GCI, incidents; workgroups, emergency Reduce acute distress. </li></ul><ul><li>MSD, ~3-4 wks post services, military. Inc. cohesion, resilience. </li></ul><ul><li>CED, mass disaster Screening </li></ul><ul><li>HERD) recovery phase. Triage. Follow-up essential. </li></ul><ul><li>8. Defusing On-going events Small homogeneous groups. Stabilization. Ventilation (and small group & Post event May be similar to HERD in Reduce acute distress. </li></ul><ul><li>&quot;psychological first aid.&quot;) ( < 12 Hrs) process. Screening. </li></ul><ul><li>May be repeated. Information. </li></ul><ul><li> Inc. cohesion, resilience. </li></ul><ul><li>9. Small Group On-going events Small groups seeking info. Information. </li></ul><ul><li>Crisis Management & Post event. c/o delving into affect. Control rumors. </li></ul><ul><li>Briefing (sCMB) May be repeated, Reduce acute distress </li></ul><ul><li>as needed. Inc. cohesion, resilience. </li></ul><ul><li> Screening/ Triage </li></ul>
    54. 55. <ul><li>INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS </li></ul><ul><li>10. Family Crisis Pre-event & Families. Consists of a wide array </li></ul><ul><li>Intervention. As needed. of interventions incl. </li></ul><ul><li> Pre-event prep., individ. intv., sCMB, debriefing,” etc. </li></ul><ul><li>11. Organizational/ Leadership Pre-event & Organizations affected Improve organizational </li></ul><ul><li>Consultation As needed. by trauma or disaster. preparedness & response. </li></ul><ul><li>12. Pastoral Crisis As needed. Those who desire faith-based Faith-based support, eg, </li></ul><ul><li>Intervention presence/ crisis intervention, eg, Info., advocacy, liaison. Individs., small groups, Ministry of presence. large groups, congregations, Religious intervention, communities. if desired. </li></ul><ul><li>13. Follow-up, Referral. As needed. Intv. recipients & those exposed. Assure continuity of care. </li></ul><ul><li>14. Strategic planning. Pre-event & Anticipated exposed/victim Improve overall during. populations. disaster MH response. </li></ul>
    55. 56. Chevron Publishing, 2002 Objectives of Crisis Intervention <ul><li>Stabilize situation </li></ul><ul><li>Mitigate impact </li></ul><ul><li>Mobilize resources </li></ul><ul><li>Normalize reactions </li></ul><ul><li>Restore to adaptive function </li></ul>
    56. 57. Chevron Publishing, 2002 Crisis Intervention Key Principles <ul><li>Simplicity </li></ul><ul><li>Brevity </li></ul><ul><li>Innovation </li></ul><ul><li>Pragmatism </li></ul><ul><li>Proximity </li></ul><ul><li>Immediacy </li></ul><ul><li>Positive outcome expectancy </li></ul>
    57. 58. Dose Response
    58. 59. Chevron Publishing, 2002 Basic Crisis Guidelines <ul><li>Never go beyond one’s level of training </li></ul><ul><li>Do not open discussions unless there is sufficient time to process </li></ul><ul><li>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 </li></ul>
    59. 60. Critical Incident Stress Management C omprehensive I ntegrated S ystem utilizing a M ulti-Tactical Crisis Intervention Approach to Managing Traumatic Stress
    60. 61. CISM: Menu of Services <ul><li>Pre-Crisis Preparation /Education </li></ul><ul><li>On-scene Support / Consultation </li></ul><ul><li>Group Intervention </li></ul><ul><ul><li>Demobilization </li></ul></ul><ul><ul><li>Crisis Management Briefing </li></ul></ul><ul><ul><li>Defusing </li></ul></ul><ul><ul><li>Critical Incident Stress Debriefing </li></ul></ul><ul><li>Individual Crisis Intervention </li></ul><ul><li>Pastoral Crisis Intervention </li></ul><ul><li>Family / Sig. Other Support </li></ul><ul><li>Organizational Consultation </li></ul><ul><li>Follow-up and / or Referral </li></ul><ul><li>Post -event Education & Lessons Learned </li></ul>“ Tactics”
    61. 62. Chevron Publishing, 2002 Core Competencies in CISM <ul><li>The ability to properly assess both the situation and the severity of impact on individuals and groups </li></ul><ul><li>Ability to develop a strategic plan </li></ul><ul><li>Individual crisis intervention skills </li></ul><ul><li>Large group crisis intervention skills </li></ul><ul><li>Small group crisis intervention skills </li></ul><ul><li>Referral skills </li></ul>
    62. 63. Chevron Publishing, 2002 Essential CISM Courses (2 Days Each) <ul><li>Assisting Individuals in Crisis </li></ul><ul><li>Basic Critical Incident Stress Management: Group Crisis Interventions </li></ul><ul><li>Suicide </li></ul><ul><li>Grief Following Trauma </li></ul><ul><li>Advanced Critical Incident Stress Management: Group Crisis Interventions </li></ul><ul><li>T.E.A.M. </li></ul><ul><li>Emotional & Spiritual Care in Disasters </li></ul>
    63. 64. Chevron Publishing, 2002 In addition to the essential courses, CISM providers are encouraged to participate in a variety of other training opportunities to enhance their skills.
    64. 65. Resources Resources Strategic Planning
    65. 66. CISM: Menu of Services <ul><li>Pre-Crisis Preparation /Education </li></ul><ul><li>On-scene Support / Consultation </li></ul><ul><li>Group Intervention </li></ul><ul><ul><li>Demobilization </li></ul></ul><ul><ul><li>Crisis Management Briefing </li></ul></ul><ul><ul><li>Defusing </li></ul></ul><ul><ul><li>Critical Incident Stress Debriefing </li></ul></ul><ul><li>Individual Crisis Intervention </li></ul><ul><li>Pastoral Crisis Intervention </li></ul><ul><li>Family / Sig. Other Support </li></ul><ul><li>Organizational Consultation </li></ul><ul><li>Follow-up and / or Referral </li></ul><ul><li>Post -event Education & Lessons Learned </li></ul>“ Tactics”
    66. 67. Target Type Timing Theme Team Resources Target Type On-Scene CMB Demob. Defuse CISD 1:1 Family Admin Consult IC/CC F/U Strategic Planning 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 Cadet Mental Health Outside Tm Resources Peers Friends Neighbors Family Faith Community Work EAP PCP Support Groups Outside Tm From Circles AKA: Tactics
    67. 68. Chevron Publishing, 2002 CISM Tactics Must be Available for: <ul><li>Individuals </li></ul><ul><li>Groups </li></ul><ul><li>Organizations </li></ul><ul><li>Families </li></ul><ul><li>Significant others </li></ul>
    68. 69. CISM Components Before an Incident <ul><li>Education (PEP) </li></ul><ul><li>Team training </li></ul><ul><li>Planning </li></ul><ul><li>Administrative support </li></ul><ul><li>Protocol development </li></ul><ul><li>Guideline development </li></ul><ul><li>Networking with other teams & resources </li></ul>
    69. 70. CISM Components During an Incident <ul><li>On-scene support services </li></ul><ul><li>One-on-one crisis intervention </li></ul><ul><li>Advice to supervisors/IC </li></ul><ul><li>Support to primary victims (CAP) </li></ul><ul><li>Provision of food, fluids, rest and other services to operations personnel </li></ul><ul><li>Organizational Consultation (CC) </li></ul>
    70. 71. CISM Components After an Incident <ul><li>One-on-one crisis intervention </li></ul><ul><li>Demobilization (post-disaster, large group) </li></ul><ul><li>Crisis Management Briefing (CMB, large group) </li></ul><ul><li>Defusing (small group) </li></ul><ul><li>Critical Incident Stress Debriefing (CISD, small group) </li></ul><ul><li>Significant other support services </li></ul><ul><li>. . . more . . . </li></ul>
    71. 72. <ul><li>Post-incident education </li></ul><ul><li>Follow-up services </li></ul><ul><li>Referrals according to needs </li></ul>CISM Components After an Incident continued
    72. 73. CISM <ul><li>Typically: 3-5 contacts </li></ul><ul><li>After that, </li></ul><ul><ul><li>Recovery is evident </li></ul></ul><ul><ul><li>Referral is indicated </li></ul></ul>
    73. 74. PHYSIOLOGICAL NEEDS Basic life needs - air, food, water, shelter SAFTEY Physical and psychological security, law & order AFFILIATION, SUPPORT Interpersonal & family relationships SELF-ESTEEM Self-efficacy, empowerment SELF-ACTUALIZATION Personal growth and fulfillment Maslow’s Need Hierarchy (1943) Start here Crisis Intervention Psychotherapy
    74. 75. Spectrum of Care Crisis Intervention CISM r Refer as needed to any Family Support EAP Chaplain Human Resources Family Advocate Legal Mental Health Psychotherapy Hospitalization Rehabilitation Other resources Critical Incident
    75. 76. Treatment Referral Options <ul><li>Medical Care Professional </li></ul><ul><ul><li>MD / DO </li></ul></ul><ul><ul><li>PA / NP </li></ul></ul><ul><li>Mental Health Care Professional </li></ul><ul><ul><li>Psychologist </li></ul></ul><ul><ul><li>Counselor </li></ul></ul><ul><ul><li>Social Worker </li></ul></ul><ul><ul><li>Psychiatrist / NP / PA </li></ul></ul><ul><li>Spiritual Care Professional </li></ul><ul><ul><li>Faith Leader </li></ul></ul><ul><ul><li>“ Chaplain” </li></ul></ul>
    76. 77. CISM <ul><li>Is not psychotherapy </li></ul><ul><li>Is not a substitute for psychotherapy </li></ul><ul><li>Is not a stand-alone </li></ul><ul><li>Is not a cure for PTSD, Depression, Anxiety, etc </li></ul>
    77. 78. CISM has far more to do with group support and assessment (triage) than it does with treatment and cure.
    78. 79. Follow-Up <ul><li>Must be provided after every CISM service: </li></ul><ul><li>Assess impact of intervention </li></ul><ul><li>Assess for uncovering prior issues </li></ul><ul><li>Assess trajectory of reactions </li></ul><ul><ul><li>Decreasing </li></ul></ul><ul><ul><li>Same </li></ul></ul><ul><ul><li>Increasing </li></ul></ul><ul><li>Assess for possible referral: </li></ul><ul><ul><li>Health Care Professional </li></ul></ul><ul><ul><li>Mental Health Care Professional </li></ul></ul><ul><ul><li>Spiritual Care Professional </li></ul></ul>1 week post CISM service 1 month post CISM service
    79. 80. P. A. S. S. Post Action Staff Support Dennis Potter, LCSW
    80. 81. Goals For PASS <ul><li>Increase longevity of team members </li></ul><ul><li>Increase learning from the experience </li></ul><ul><li>Increase stress management skills </li></ul><ul><li>Decrease the chance for personal reactions </li></ul><ul><li>To take care of ourselves (too) </li></ul><ul><li>Increase effectiveness of team members </li></ul><ul><li>Monitor team for any adverse reactions </li></ul>
    81. 82. Why Do It? <ul><li>To Prevent: </li></ul><ul><ul><li>Vicarious Traumatization </li></ul></ul><ul><ul><li>Cumulative Stress </li></ul></ul><ul><ul><li>Critical Self Judgment </li></ul></ul><ul><li>To Teach </li></ul><ul><li>To Practice What We Teach </li></ul><ul><li>“ The same professionalism we provide to others, we deserve ourselves” SDB </li></ul>
    82. 83. When Should It Be Done? <ul><li>Should be a normal part of the team’s standard operating guidelines, </li></ul><ul><li>Should be done prior to the team going home (at least a defusing), </li></ul><ul><li>At the earliest next opportunity, </li></ul><ul><li>Soon, </li></ul><ul><li>Its never too late! </li></ul>
    83. 84. Where Should It Be Done? <ul><li>Away from the site and participants, </li></ul><ul><li>Neutral site if possible, </li></ul><ul><li>Somewhere you will not be interrupted, </li></ul><ul><li>If the Critical Incident is particularly difficult you may want to consider more time or bringing in someone else, </li></ul><ul><li>Somewhere private if you are concerned about the difficulty of the CISM response. </li></ul>
    84. 85. How Long Does It Take? <ul><li>For “normal” events usually 10-15 minutes is adequate, </li></ul><ul><li>For “abnormal” events 30-60 minutes may be required, </li></ul><ul><li>If you always do it, you will discover the difference between a normal and abnormal event. </li></ul>
    85. 86. Who Should Do It? <ul><li>Usually the “Event Team Leader” </li></ul><ul><ul><li>Probably 90% can be done by the team itself </li></ul></ul><ul><li>Occasionally, by someone not involved in the response itself </li></ul><ul><ul><li>Particularly difficult or events of long duration </li></ul></ul>
    86. 87. Important Notice: <ul><li>All CISM services should be provided only by people who have been properly trained in Critical Incident Stress Management courses, </li></ul><ul><li>Having attained an advanced academic degree alone does NOT indicate knowledge of CISM or related protocols. </li></ul>
    87. 88. CAP CISM Refresher / Update
    88. 89. Where We Are Now: Web-Site <ul><li>cism.cap.gov </li></ul><ul><li>Staff listings & contact information </li></ul><ul><li>Calendar of events / trainings </li></ul><ul><li>Forms & Handouts </li></ul><ul><li>Send training certificates / reports to . . . </li></ul><ul><ul><li>“ Certificates” </li></ul></ul><ul><ul><li>“ Wing Reports” & “Region Reports” </li></ul></ul>
    89. 90. Decentralization of Staff <ul><li>Wings “Get’r done dudes” – Providing Frontline Service </li></ul><ul><ul><ul><li>Providing CISM services </li></ul></ul></ul><ul><ul><ul><li>Networking with other local non-CAP CISM teams </li></ul></ul></ul><ul><li>Regions “Make it happen” – Administrative Support </li></ul><ul><ul><ul><li>Administrative support and facilitation / paperwork </li></ul></ul></ul><ul><ul><ul><li>Technical assistance if needed </li></ul></ul></ul><ul><ul><ul><li>Maintains team records </li></ul></ul></ul><ul><ul><ul><li>Maintains ICISF Registered Team status with ICISF </li></ul></ul></ul><ul><ul><ul><li>Monthly conference calls with Wings </li></ul></ul></ul><ul><li>National “Lead into the future” – Overall Leadership </li></ul><ul><ul><ul><li>Develop training based on Wing and Region needs </li></ul></ul></ul><ul><ul><ul><li>Keep everyone updated on new ideas/issues </li></ul></ul></ul><ul><ul><ul><li>Monthly conference calls with Region s </li></ul></ul></ul>
    90. 91. Staff Structure <ul><ul><li>Wings – “Doing the CISM Work” </li></ul></ul><ul><ul><ul><li>Officer/Coordinator </li></ul></ul></ul><ul><ul><ul><li>Clinical Director </li></ul></ul></ul><ul><ul><li>Region – “Team Support & Administration” </li></ul></ul><ul><ul><ul><li>Officer / Coordinator </li></ul></ul></ul><ul><ul><ul><li>Clinical Director </li></ul></ul></ul><ul><ul><li>National – “Leading into the Future” </li></ul></ul><ul><ul><ul><li>Team Leader </li></ul></ul></ul><ul><ul><ul><li>Clinical Director </li></ul></ul></ul>
    91. 92. Staff Structure <ul><ul><li>Officer / Coordinator </li></ul></ul><ul><ul><ul><li>Administrator of the program within Wing or Region </li></ul></ul></ul><ul><ul><ul><li>Point person for Wing or Region </li></ul></ul></ul><ul><ul><ul><li>Coordinates service requests and services </li></ul></ul></ul><ul><ul><ul><li>Maintains paperwork for Wing or Region </li></ul></ul></ul><ul><ul><ul><li>Officiates “administration” portion of meetings/trainings </li></ul></ul></ul><ul><ul><li>Clinical Director </li></ul></ul><ul><ul><ul><li>Supervises all clinical aspects of program </li></ul></ul></ul><ul><ul><ul><li>Must be licensed in the state of residence and/or Wing of membership </li></ul></ul></ul><ul><ul><ul><li>Conducts “clinical” portion of meetings/trainings </li></ul></ul></ul>
    92. 93. <ul><li>Introduction to ICISF (On-line or classroom) </li></ul><ul><li>Program Orientation (On-line or classroom) </li></ul><ul><li>CISM Basic Concepts (On-line or classroom) </li></ul><ul><li>Group Crisis Intervention (Classroom only) AND </li></ul><ul><li>Peer / Individual Crisis Intervention (Classroom Only) </li></ul><ul><li>NIMS: </li></ul><ul><ul><li>NIMS 100 http://training.fema.gov/IS/NIMS.asp </li></ul></ul><ul><ul><li>NIMS 700 http://training.fema.gov/IS/NIMS.asp </li></ul></ul><ul><li>ICS 300 and 400 is not required, but can aid in understanding command and general staff issues. </li></ul>Required Training
    93. 94. <ul><li>Renewal / Refresher: </li></ul><ul><ul><li>Group (2 Classroom days) and </li></ul></ul><ul><ul><li>Individual (2 Classroom days) or </li></ul></ul><ul><ul><li>Building Skills in CISM (2 Classroom days) </li></ul></ul><ul><ul><li>or </li></ul></ul><ul><ul><li>The Changing Face of CI and DMHI (1 Classroom day or internet) </li></ul></ul><ul><li>* CISM Service provision does not qualify for renewal/refresher </li></ul>Renewal / Refresher While 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.
    94. 95. <ul><li>Ground team members and support personnel </li></ul><ul><li>Air crew member and support personnel </li></ul><ul><li>Administration personnel </li></ul><ul><li>Communications personnel </li></ul><ul><li>Physical health personnel (doctors, nurses, etc.) </li></ul><ul><li>Mental health personnel (psychologist, counselors, social workers, etc) </li></ul><ul><li>Spiritual health personnel (chaplains, character development, etc) </li></ul><ul><li>Cadets (training our replacements) </li></ul><ul><li>Elders - “Recycling” . . . </li></ul>Recruiting
    95. 96. “ Recycling” Members <ul><li>Because: </li></ul><ul><ul><li>Physical injury nor disability </li></ul></ul><ul><ul><li>Normal “aging” </li></ul></ul><ul><li>does not eliminate: </li></ul><ul><ul><li>Experience & insight, </li></ul></ul><ul><ul><li>Cognitive abilities & strategizing </li></ul></ul><ul><ul><li>Positive coping skills, abilities, outlooks, </li></ul></ul><ul><li>The CISM Program welcomes: </li></ul><ul><ul><li>Flight crews members who no longer fly </li></ul></ul><ul><ul><li>Ground teams who don’t “ground pound” </li></ul></ul><ul><ul><li>Administration and Communications folks </li></ul></ul><ul><li>We still need you . . . you aren’t done yet </li></ul>
    96. 97. Cadets & CISM <ul><ul><li>Introduction to CISM at “technician” level </li></ul></ul><ul><ul><li>Cadet-to-Cadet Peer Support: </li></ul></ul><ul><ul><ul><li>Educate on effective listening & communication skills </li></ul></ul></ul><ul><ul><ul><li>Provide awareness of suicide warning signs & how to summons help </li></ul></ul></ul><ul><ul><ul><li>How to help a friend </li></ul></ul></ul><ul><ul><ul><li>Prepare for Senior Member CISM program </li></ul></ul></ul><ul><ul><li>Will Not: </li></ul></ul><ul><ul><ul><li>Participate in “Senior” CISM service provision in support staff roles only, </li></ul></ul></ul><ul><ul><ul><li>Be considered “peer” to any “senior” member </li></ul></ul></ul><ul><li>We need you . . . We’re Training Our Replacements </li></ul>
    97. 98. <ul><ul><ul><li>Technician : “Learning the program” </li></ul></ul></ul><ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul><ul><ul><ul><li>Senior : “Doing & mentoring the program” </li></ul></ul></ul><ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul><ul><ul><ul><li>Master : “Managing the program” </li></ul></ul></ul><ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul>CISM Specialty Track
    98. 99. <ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Introduction to ICISF </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Orientation to CAP CISM Program * NIMS 100 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>CISM Basic Concepts * NIMS 700 </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ICISF’s Group Crisis Intervention </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ICISF’s Individual/Peer Crisis Intervention </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Serve in support role until completion of courses (above) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 6 CISM responses as an observer only </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 4 Debriefings (non leader) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 4 Individual/Peer contacts </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 6 Follow-Up contacts </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively provide 4 Intro to ICISF presentations </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively provide 4 Orientation to CAP CISM Program presentations </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Attend 4 PEP trainings </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Attend 75% of the Wing CISM meetings </li></ul></ul></ul></ul></ul>Technician: Learning the program
    99. 100. <ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ICISF’s Advanced Group </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ICISF’s Suicide </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ICISF’s Grief Following Trauma </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Achieve Technician rating </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mentor 4 upcoming Technicians </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 6 more CISM Mission/Training responses </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in 4 more debriefings (as leader) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively provide 4 more Individual/Peer contacts </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively provide 6 more Follow-Up contacts </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Meet with 1-2 local CISM teams 3 times minimum </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Provide 3 CISM Basic Concepts presentations </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Assist a Wing CISM Officer/Coordinator for 1 year (Team Coordinator, Clinical Director, etc) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Attend 75% of the Wing CISM meetings/trainings </li></ul></ul></ul></ul></ul>Senior: Doing & mentoring the program
    100. 101. <ul><ul><ul><ul><li>Knowledge Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Strategic Response to Crisis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Team Evolution and Management </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Emotional & Spiritual Care in Disasters </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Service Requirement: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Achieve Senior rating </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mentor 4 upcoming Seniors </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Actively participate in planning CISM involvement in 4 CAP Exercises/Drills </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Develop MOUs with 2 local non-CAP CISM teams </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Participate in 4 meeting/trainings with non-CAP CISM teams, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Serve as a co-instructor (maximum of 10%) for a Group and Individual/Peer course </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Assist a Region CISM Officer for 1 year (Team Coordinator, Clinical Director, etc.) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Attend 75% of the Wing and Region CISM meetings </li></ul></ul></ul></ul></ul>Master: Managing the program
    101. 102. Where to from here? <ul><li>Satisfied with the knowledge & awareness </li></ul><ul><li>How to do more: </li></ul><ul><ul><li>Join a team </li></ul></ul><ul><ul><li>Attain further CISM education </li></ul></ul><ul><ul><li>Provide further CISM education & awareness </li></ul></ul><ul><ul><li>Advocate for appropriate CISM services </li></ul></ul><ul><ul><li>Provide more: </li></ul></ul><ul><ul><ul><li>Within your Squadron, Group, Wing, Region </li></ul></ul></ul><ul><ul><ul><li>With your family </li></ul></ul></ul><ul><ul><ul><li>At your place of work </li></ul></ul></ul><ul><ul><ul><li>In your community </li></ul></ul></ul><ul><ul><ul><li>For yourself </li></ul></ul></ul>
    102. 103. How To Become a Member <ul><li>Complete basic trainings (technician) </li></ul><ul><li>Complete application & be accepted to a team </li></ul><ul><li>Participate in quarterly Team trainings </li></ul><ul><li>Participate in CAP CISM functions </li></ul><ul><li>Maintain currency </li></ul><ul><li>Participate in non-CAP CISM teams & functions </li></ul><ul><li>CISM Team membership is a privilege not a right. </li></ul>
    103. 104. “ Knowledge itself is power” Sir Francis Bacon “ Action is the proper fruit of knowledge” Thomas Fuller
    104. 105. Feedback Thoughts Comments Reactions
    105. 106. Lt Col Sam D. Bernard, PhD National CISM Team Leader (423) 322-3297 [email_address] Maj Chris Latocki Administrative Officer ( 813) 412-9231 [email_address] National Staff
    106. 107. ________ Name ____________ Region CISM Officer Telephone / e-mail ________ Name ____________ Region Clinical Director Telephone / e-mail Region Staff
    107. 108. ________ Name ____________ Wing CISM Officer / Coordinator Telephone / e-mail ________ Name ____________ Wing Clinical Director Telephone / e-mail Wing Staff
    108. 109. Thank You! . . .and just one more thing. . .
    109. 110. Critical Incident Stress Management Lt. Col. Sam D. Bernard, Ph.D. National CAP CISM Team Leader (423) 322-3297 Cell [email_address] www.sambernard.info cism.cap.gov
    110. 111. Critical Incident Stress Management CISM Update Learning 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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