Critical Incident Stress Management (CISM)

1. Northeast Region Civil Air Patrol/USAF-Auxiliary Critical Incident StressManagement (CISM)

2. Objectives of this Presentation To provide the participants with • An introduction to NER CISM • An overview of critical incident stress, crisis management and critical incident stress management (CISM) • An orientation to CAP’s CISM program

3. Part IEverything you ever wantedto know aboutCritical Incident Stressand CISM

4. A Crisis A response to an event wherein • One’s normal psychological balance (homeostasis) has been disrupted, • One’s usual coping mechanisms have failed to reestablish the needed homeostasis, or • There is evidence of functional impairment.

5. Critical Incident Stress “Any event in which there is a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.” (Everly & Mitchell, 1999)

6. Examples of Critical Incidents • Line of duty death or death at workplace • Serious line of duty injury or workplace injury • Suicide of coworker, friend, family member • Multiple casualty incidents (MCI’s), disasters • Significant events involving children • Prolonged events especially with loss • Any powerful event which overwhelms a person’s normal coping mechanisms

7. Crisis Intervention The provision of timely “emotional first aid” • An exercise in psychological damage control…stopping the bleeding! • Not a cure • An opportunity for assessment and for follow-up • Guided by a mental health professional (MHP)

8. Crisis Intervention Is one aspect of a continuum of care It requires specialized &uniquetraining

9. B I S E P Crisis InterventionPrinciples Spell B -I -S -E -P • Brevity- few minutes up to 1 hour • Immediacy – Rapid Intervention • Simplicity – KIS – Keep it Simple • Expectancy – A reasonable positive outcome • Proximity – Close to operational zone is most effective

10. Post-Traumatic Stress Post-Traumatic Stress Disorder A normal reaction in a normal person to an abnormal event It is a survival mechanism (PTSD) is a pathogenic (unhealthy) variation of that normal survival mechanism

11. Stress Response Timelines • Immediate – up to 24 hours post event. • Delayed – 24 to 72 hours post event. • Cumulative – buildup of stress over time.

12. Critical Incident Stress Management (CISM)is One type of crisis intervention It is a comprehensive, systematic program for the mitigation of critical- incident related stress.

13. The goals of CISM • Preventtraumatic stress • Mitigate traumatic stress • Intervene to assist recovery from traumatic stress • Accelerate recovery • Restore function • Maintain worker health and welfare

14. CISM involves many facets • Pre-crisis preparation and education • Demobilization (for large groups) • Crisis management briefings (large groups also) • Defusings • Critical incident stress debriefing (CISD)

15. CISM also involves • One-on-one, individual crisis intervention • Pastoral crisis intervention • Family CISM • Organizational crisis intervention/consultations • Follow-up and referral mechanisms

16. CISMdeals with the current circumstancesthe current event or crisis NOT personal histories It is First Aid, not definitive care.

17. Some Key ElementsofCISM

18. Pre-Incident Education“PEP Talks” • General information: stress, trauma, etc. • Set expectations for actual experiences • Teach stress management and coping skills • Appropriate for ALL members

19. Demobilizations • Provide decompression • Transition workers from disaster work (large-scale incident) to routine duties or home • Used with large numbers of people • A 10- to 30-minute session • An opportunity for assessment of group needs • Alert workers to possible stress effects • Always followed by a CISD (debriefing, usually within one week

20. Defusing • A small group intervention conducted within hours of the incident, usually within 12 hours • Shortened version (20-45 mins) of the CIS- Debriefing • May eliminate the need for, or increase effectiveness of, CISD – opportunity to assess the need for CISD • Seeks to reduce intense reactions to a trauma • Seeks to “normalize” the effects of the event

21. The Defusing 3-Step *Introduction *Exploration *Information

22. C I S D The Critical IncidentStress Debriefing (CISD) • A group discussion of a traumatic event • Peer driven • Clinician (MHP) guided • Lasts 1-3 hours • Closed circle format • Held 1-10 days post event • NOT psychotherapy!

23. Objectives of the CISD • Education • Ventilation • Reassurance and forewarning • Positive contact with an MHP • Improvement of interagency cooperation • Increase group cohesiveness • Restore self-confidence • Facilitation of follow-up

24. Referral • Is made for those requiring a more thorough process of assessment and evaluation • The mental health provider should understand the “culture” of the agency in which the person is employed, and • Should have specialized training/experience in post-traumatic stress.

25. Family Support • An essential component of a comprehensive CISM program • Consists of - Educational programs - CISD for significant others - Bereavement support/grief & crisis counseling • Provided by peers, MHP, clergy, trained spouses • Includes children and elderly as well

26. Follow-up • Essential element in all CISM interventions • Can be made by - Phone calls - Station/workplace visits - Home visits

27. Part TwoEverything you always wantedto know aboutthe CAP CISM Program

28. CISMa comprehensive,systematic maintenance program for the overall well-beingof our most valuable assets our members

29. A CAP CIST The CIS Team consists of: • Mental Health Professionals (MHP) • Peer Representatives CAPR 60-5 (3)a 2

30. CAP’s CISM Program “The use of qualified, local, non-CAP teams to respond to incident stress-affected CAP members is highly encouraged … The use of local non-CAP teams will somewhat limit the need to dispatch a trained CAP CIS [Team]” --CAPR 60-5 (2)e

31. CISM is a MandatedOperations Program!

32. CAP’s CISM Program • Mandated by CAPR 60-5 • Not optional • Specifically an operations program • Implementation is assigned to Region Commanders by CAPR 60-5 • Wings are to “assess the need for a CIST” • All personnel are encouraged to receive CIS training.

33. Funding CISM • CISM is not, presently, a specifically USAF funded mission (by itself). • CAP CISM may be funded through an existing mission’s funding.

34. Funding CISM • CAP National HQ has approved limited funding to support CISM missions. • Housing and feeding of a team will normally NOT be reimbursed. • The “use of host families” is encouraged to mitigate housing costs.

35. Compare these... According to the Wing Aircraft Maintenance Officer, HQ-TX Wing expects to spend approximately $187,000.00 this year to maintain our fleet of airplanes. But … How much are we spending to maintain our most valuable asset OUR PEOPLE?

36. Everythingyou ever wanted to know about CAP CISMin Northeast Region

37. Request & Deployment • After a SAR or DR mission “… a review of the need for CIS intervention should be made for all personnel ...” • The Incident Commander or Unit Commander will pass a request to Wing Commander. • In consultation with staff, the Wing CC will coordinate use of a local non-CAP team or request one of the Region Teams.

38. For More Information ... • Visit the website of the International Critical Incident Stress Foundation (ICISF) at http://www.icisf.org. • Join the ICISF. • Review CAPR 60-5.

39. For More Information Contact the NER CIS Staff - Jack Arena, NER CIS 631-645-7912 (cell), mission 442002@yahoo.com - Paul Mondoux, NER Deputy CIS 603-424-3019 (home) or 603-759-0178 (cell), paul@nhplm.org • www.icisf.org • www.capcism.com • www.ner.cap.gov/cism/ops_cism.htm • http://cism.nhplm.org/index.php

40. All CISM InterventionsAre Strictly Confidential!

41. Any Questions?