Missoula Valley Critical Incident Stress Management Team

COMX 460 & 461 Spring 2016

By: Sophie Biechler, Maille Cavalier, Amanda Foley, Jane Metcalf, and Jacob Reed,

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Introduction

Missoula Critical Incident Stress Management Team, referred to as CISM for short, is an

organization that contracts with local emergency response teams in Missoula County. It is a local

volunteer group of carefully selected and trained members with experience in one of the

emergency services (peer members) or licensed mental health professionals (clinical members)

(Hodgetts, 2014). Founded in 1988, CISM more specifically provides debriefings and diffusing

with individuals and teams who are affected after critical incidents. Debriefings are coordinated

events that are planned as group settings to air feelings and thoughts about a critical incident in a

judgement free and non-hostile environment. Defusings are immediately following a critical

incident, the purpose being to address immediate concerns and needs of the emergency

responders. “The team responds upon request, 24/7, to any local entity with emergency personnel

within Missoula County where a critical incident has occurred” (Hodgetts, 2014). CISM teams

are often made up of twelve active members who utilize pre-established, nationally used and

proven techniques help manage emergency responders’ psychological and physiological health in

the wake of critical incidents. The entirety of the current CISM team expressed desire to assess

awareness, perceptions and opinions of their program among local emergency services.

Rationale

In order for CISM teams to better serve local emergency response groups, it is important

to gauge the awareness, perceptions, and opinions based on experience with the CISM program

among local emergency response teams, such as the volunteer fire departments, sheriff's office,

police and highway patrol, as well as other emergency services and/or dispatchers in Missoula.

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Moreover, as part of this project the research team sought to find out just how local emergency

teams are currently using CISM or would be willing to incorporate CISM into their work. Given

this, local response teams mentioned above were given a survey to discover these aspects.

The research was focused to gauge:

● The level of awareness of CISM services

● Current opinions by those who have taken part in services offered through CISM

● Current perceptions of those who are aware of CISM

● The belief that CISM is a useful asset

● The likelihood of use by those made aware of CISM

Methods

A written survey was conducted among volunteer fire departments, Missoula Rural Fire

Department, Missoula County Sheriff’s Department and the Missoula County Emergency

Communication Department. Surveys were distributed to members of the Missoula County

Sheriff’s Office at morning and evening briefings on both sides of the week to insure coverage of

all patrol deputies. There were surveys left with a lieutenant at the sheriff’s office that were

meant to be distributed to administrative members, however these surveys were not completed.

Surveys were given to the top line supervisor of Missoula City Fire Department and distributed

through their chain of command. There was no way to determine the response rate of these as the

surveys were combined with Missoula Rural Fire Department’s surveys prior to their return to

the research team. The Emergency Communication Department had surveys provided to a

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supervisor who was also a member of the CISM team, after which the surveys were disseminated

amongst dispatchers and returned to the research team after completion.

The survey was completely anonymous and voluntary. There were respondents who made

their identity known by signing and placing their contact information on the survey, for the

purpose of safeguarding the integrity of our promise of anonymity we redacted such information

prior to processing the data. All attempts were made to have a research team member present

with a CISM member at all survey locations, however due to scheduling constraints this was not

always possible. As an incentive to participate, each survey had an attached cover page that, once

completed, was entered into a lottery for a $75.00 prize. Once the survey was completed, and we

analyzed the results and outlined them in this report.

The written questionnaire was split into these categories: awareness, perceptions,

opinions based on experience, and demographics. In the awareness category, questions were

asked that assessed an individual's knowledge of existing CISM programs, functions, and

services. Questions in the perceptions category measured current views of the program either

positive or negative. The opinions based on experience category consisted of contingency

questions that were completed by those who have used the program before. The final section,

demographics, asked whether an individual was male or female, their tenure, age, department in

which they were employed, education level, whether they were married, and if they had children.

These questions were completed at the end of the survey in order to avoid any bias due to the

assumption that a masculine gender type would be dismissive of perceived stress. The survey

was designed to minimize harm to the participants, there was no place to recount incidents that

could cause emotional distress among participants. The survey offered each individual member

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the opportunity to abstain from participating. If an individual believed that the survey started to

bring up emotional distress, they could have declined further participation. Now that the study is

complete, CISM will be provided with the written results.

Results

Sample Demographics:

Our sample group consisted of 191 members from emergency response teams in

Missoula Valley. These emergency response teams were from the volunteer fire departments

(49.2%), sheriff’s office (10.2%), police (1.7%), emergency services (8.5%), and/or dispatchers

(30.5%) and 0% of the respondents were from highway patrol in the Missoula community. Of

those who worked in more than one field, 91.7% also worked in Emergency Medical Services

and 8.3% also worked with the sheriff’s office.

Of the 191 respondents, 74.6% of respondents were men and 25.4% were female. 60.7%

of the respondents were married, 1% was widowed, 9.9% were divorced/separated and 23.6%

had never been married. 64.3% of the respondents had children, whereas 34.6% did not have

Fire 65.5%

Sheriff’s office 21.8%

Police 5.5%

Highway patrol 0%

Emergency dispatcher .9%

EMS 6.4%

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any children. The educational levels varied from primary school to a graduate degree. 1.1%

completed primary school, 19.1% completed high school, 36.1% had some college, 11.5% had a

two-year degree, 26.8% had a four-year degree, and 5.5% had a graduate degree.

As illustrated in the table below, a significant number of respondents had more than ten

years of experience in emergency services.

Perceptions of Job Stress

Not surprisingly, a majority of the respondents indicated that their job was stressful at

82.9%, whereas only 7.5% disagreed with the statement that their job was stressful. In addition

to this, 60.8% of the responses indicated that the stress in their jobs affected their personal lives

and 44.9% said it affected their work performance. Though a majority agreed that their jobs

were stressful, when responding to the statement: “I have thought about resigning due to stressful

incidents at work” only 2.7% strongly agreed, 13.3% somewhat agreed, 12.2% neither disagreed

or agreed, 16.5% somewhat disagreed, and 55.3% disagreed. Despite the fact that most view

their occupation as stressful, they wish to remain in their field.

Less than one year 11.1%

1-5 years 20.1%

5-10 years 19.6%

More than 10 years 49.2%

Strongly disagree

Somewhat disagree

Neither agree or disagree

Somewhat agree

Strongly agree

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As the graph below demonstrates, only 9.5% indicated that they did not respond to any stressful

calls in a month, while everyone else had at least one per month.

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My job is stressful .5% 7% 9.6% 55.6% 27.3%

Stress levels affect my personal life

7% 10.8% 21.5% 45.2% 15.6%

Stress levels affect my work performance

9.6% 14.4% 31% 39% 5.9%

I have thought about resigning due to stressful incidents at work

55.3% 16.5% 12.2% 13.3% 2.7%

Frequency of Stressful Calls

0.00%

12.50%

25.00%

37.50%

50.00%

None 1-2 per month 5 or more per month

None 9.4%

Less than 1 per month but periodically 46.2%

1-2 per month 24.8%

3-5 per month 10.3%

5 or more per month 9.4%

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In response to stressful work situations, respondents used many different avenues to deal with

their stress. Of the respondents that answered “Other” a majority gave some sort of outdoor

recreation activity such as fishing, golfing, rock climbing, and hiking.

Awareness

When asking respondents whether or not they are familiar with the CISM team, we found that just under

half of the respondents were unaware of CISM.

Extremely Unlikely

Somewhat unlikely

Neither likely nor unlikely

Somewhat likely

Extremely likely

Physical Activity

0% 9% 16.9% 38.1% 36%

Communicate with Family

7% 15% 12.3% 36.9% 28.9%

Communicate with Friends

6.5% 15.1% 17.7% 46.8% 14%

Partake in the use of alcohol

35.5% 15.8% 20.2% 23% 5.5%

Other 6.9% 6.9% 0% 31% 55.2%

Yes 57.5%

No 41.3%

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Of the 57.5% of respondents that said they are familiar with the CISM team, we found that most of the

respondents were slightly or moderately familiar with the CISM team, while only 1.4% of the respondents

said they were extremely familiar.

When asked to indicate which services were offered by CISM, those who stated that they were familiar

with CISM startling tendencies arose. On items that are offered by CISM, only slight majorities answered

correctly, with exception to “debriefing specific calls” (86.6%). Most were unsure of services and a third

of respondents believed that CISM offered therapy and debriefings for spouses.

Not familiar at all 9.7%

Slightly familiar 41.7%

Moderately familiar 34.7%

Very familiar 12.5%

Extremely familiar 1.4%

Yes No Unsure

Therapy 35.9% 26.5% 37.6%

Defusing 59.7% 16% 24.4%

Training about traumatic stress

53% 17.1% 29.9%

Education about burnout

34.7% 26.3% 39%

Debriefing specific calls

86.6% 6.7% 6.7%

Debriefings for spouses 30.5% 31.4% 38.1%

Assistance in mass causality events

58.8% 18.5% 22.7%

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Although most of the responses were closely grouped, the majority of respondents learned about CISM

through a variety of means, with 36.8% learning about CISM through their supervisor, while only 7.4%

had heard of CISM through some sort of CISM advertisement. This shows that CISM could benefit from

more advertisements to emergency service workers. Of the respondents that answered “Other” the

majority heard of CISM through a parent, training, or had used it in the past.

Of the 191 respondents, 53.5% of them had been a part of a CISM intervention. These results are

surprising because 57.5% knew of CISM before taking the survey. This indicates that most of the

awareness of CISM comes from prior use of their services

Perceptions of past CISM users

Of the 191 respondents, those who had used CISM answered the following questions on their

perceptions of their CISM intervention experience. When asking respondents about which

CISM intervention they had been a part of, the vast majority of them had been involved in

debriefing sessions, whereas a much smaller percentage took part in defusing processes. Of

those that responded “Other” none reported which services they used.

Through a supervisor 36.8%

Through a co-worker 20.6%

Through a CISM member 16.2%

Through CISM handouts / other CISM materials 7.4%

Other 19.1%

Yes 53.5%

No 46.5%

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The respondents that used CISM in the past a majority reported they found it helpful and would use the

services offered by CISM again. These results demonstrate the effectiveness of CISM when emergency

services are actually aware of it.

Defusing 13.4%

Debriefing 85.1%

Other 1.5%

Strongly disagree

Somewhat disagree

Neutral Somewhat agree

Strongly agree

It caused additional

stress

39.7% 23.5% 19.1% 8.8% 8.8%

I found it helpful

8.7% 5.8% 21.7% 30.4% 33.3%

I would use this CISM

service again

8.8% 4.4% 14.7% 30.9% 41.2%

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General perceptions of CISM

After getting a brief description of CISM and the services offered, surprisingly only 49.5% of the

respondents indicated that they would use CISM services in response to stressful incidents.

The respondents that answered “No” gave various reasons on why they wouldn’t use CISM, such

as having a bad experience, or they would rather handle their stress on their own.

Of the 191 respondents, 41.3% were not familiar with CISM and its services and answered the

following questions after a brief description of CISM and the services that are offered.

Respondents were overall open to the idea of a CISM team member coming to a team meeting to

give a short presentation on their services at 76.2% indicating they thought it would be

beneficial, whereas only 5.4% said that was not necessary.

I was caution against

participation in CISM services

55.9% 14.7% 20.6% 4.4% 4.4%

Yes 49.5%

No 42.1%

Maybe 6.8%

Definitely not

Probably not Might or might not

Probably Yes Definitely yes

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Our research indicated that that over 80% of respondents stated that, on some level, services to

help emergency workers cope with stress are needed. As illustrated in the graph above, 100

people (53.2%) said definitely yes and 56 people (29.8%) said probably yes, whereas only 27

people (14.4%) said might or might not and 2 people (1.1%) said probably not and 3 (1.6%) said

definitely not.

Conclusions and Takeaways

Actual finding of the survey was that many emergency respondents lack awareness of

CISM services, with a low number of respondents, only 57.5%, indicated that they were at all

familiar with the CISM team. Of those who were familiar with the team, only 47.9% reported to

be at least moderately familiar and of those, a third of them were misinformed as to the services

that CISM provides. One of the most inaccurate beliefs was that the CISM team offers therapy

for individuals.

It would be beneficial for a CISM team

member to attend a unit briefing or meeting to

give a short presentation on their

services

.5% 4.9% 18.4% 48.1% 28.1%

I would be more likely to use CISM services if

I did NOT know any CISM members

personally

13.3% 27.7% 41.5% 13.8% 3.7%

Services to help emergency workers to cope with stress are

needed

1.6% 1.1% 14.4% 29.8% 53.2%

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The low awareness of the services offered by the CISM team indicate an educational

need. Recommendations to rectify that problem are to increase general awareness by having

CISM team members take a more active role as ambassadors to various emergency service units.

This can take the form of preparing and presenting information to units while at meetings or

briefings. Our research indicated strong support for that practice, as 76.2% of respondents

believed that it would be beneficial if a CISM team member were to give a short presentation

about services.

A majority of workers say their occupation is stressful and stress affects their personal

life to some degree. This validates a need for CISM services, but without knowledge of the

services, members of the emergency responder community may turn to other avenues for relief.

The importance of this cannot be overstated in terms of the CISM mission. The next step

for the CISM team should be a concentrated effort to inform all responders of their services and

availability.

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Appendix A

Hello,

The Missoula Valley Critical Incident Stress Management Team has partnered with a

research team from the University of Montana in the development of this survey. The survey is

designed to assist the CISM team in their future operations. We would like to have you complete

this survey to provide information to benefit all emergency service organizations in the Missoula

Valley. There are a few things we should tell you first.

This survey is completely voluntary, if at any time you feel that you do not wish to

answer a question, or find a question to be too intrusive please just leave the question blank.

The survey is completely anonymous, so please respond openly and honestly to the

following questions. On top of the cover sheet you will find a raffle ticket attached. This raffle

ticket is to be removed and turned in separately to the CISM team, ensuring that your responses

will remain anonymous. This ticket will enter you into a raffle for a prize that is to be determined

by the CISM supervisors.

Thank you for assisting the Missoula Valley CISM Team by performing this short survey,

it should not take more than a few minutes. Again, we greatly value and appreciate your help

with this project. Please take a moment and answer the following questions:

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Let’s get started!

Q1 How many years have you been involved with emergency response?

m Less than 1 year (1)

m 1-2 years (2)

m 3-5 years (3)

m 5 or more years (4)

Q2 Stressful calls may be those calls where you have experienced some form of post incident physical, emotional, or

mental effect. Examples of these effects may be fatigue, restlessness, trouble concentrating, irritability or anxiousness. It is not

necessary to experience any one or all of these, they are mere examples. On average, how many stressful calls do you respond to

in a month?

m None (1)

m Less than 1 per month but periodically (2)

m 1-2 (3)

m 3-5 (4)

m 5 or more (5)

Q3 Are you familiar with the Missoula County Critical Incident Stress Management Team? If no, proceed to question

10.

m Yes (1)

m No (2)

Q4 How familiar are you with CISM and their services?

m Extremely familiar (1)

m Very familiar (2)

m Moderately familiar (3)

m Slightly familiar (4)

m Not familiar at all (5)

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Q5 Which of the following services are available through the CISM team? Check all that apply.

q One-on-one clinical counseling (1)

q Defusing (2)

q Training about traumatic stress (3)

q Education about burnout (4)

q Debriefing (5)

q Debriefings for spouses (6)

q Assistance in mass casualty events (7)

Q6 How did you learn of the CISM team?

q Through a supervisor (1)

q Through a co-worker (2)

q Through a CISM member (3)

q Through CISM handouts or other CISM materials (4)

q Other: (5) ____________________

Q7 Have you ever been a part of a CISM intervention? If no please proceed to question 10.

m Yes (1)

m No (2)

Q8 If yes, which CISM intervention were you a part of?

m Diffusing (1)

m Debriefing (2)

m Other: (3) ____________________

Q9 Thinking of your most recent experience with a CISM service, what are your levels of agreement with these

statements:

Strongly

disagree (1)

Somewh

at disagree (2)

Neutral

(3)

Somewh

at agree (4)

Strongly

agree (5)

It was

helpful. (1)

m m m m m

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Q10 On a scale of 1-10, 1 being not stressful at all and 10 being extremely stressful, how stressful is your job?

_________

Q11 Please select which answer best describes your level of agreement with each statement.

It caused

additional stress

(2)

m m m m m

I found it

neither helpful nor

stressfull (3)

m m m m m

I would

use this CISM

service again. (4)

m m m m m

I would

hesitate to use

CISM service

again. (5)

m m m m m

I would

not use CISM

services again. (6)

m m m m m

I would

recommend CISM

services. (7)

m m m m m

Strongl

y Disagree (1)

Somew

hat disagree (2)

Neither

agree nor

disagree (3)

Somew

hat agree (4)

Agree

(5)

My

agency has

turnover due to

stress. (1)

m m m m m

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Q12 How likely are you to use the following avenues to decompress from stressful work situations?

Stress

levels affect my

personal life. (2)

m m m m m

Stress

levels affect my

work performance.

(3)

m m m m m

I have

thought about

resigning due to

stressful incidents

at work. (4)

m m m m m

Extrem

ely likely (1)

Somew

hat likely (2)

Neithe

r likely nor

unlikely (3)

Somew

hat unlikely (4)

Extrem

ely unlikely (5)

Physical

Activity (1)

m m m m m

Commu

nicate with Family

(2)

m m m m m

Commu

nicate with Friends

(3)

m m m m m

Partake

in the use of

alcohol (4)

m m m m m

Other:

(5)

m m m m m

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Q13 The Missoula Valley Critical Incident Stress Management Team consists of volunteer members who are on call to

assist emergency personnel as they cope with job stress. They have trained people from various emergency agencies, such as

police officers, ER nurses, firefighters, and ambulance personnel, plus mental health professionals who have had special training

in traumatic stress and are sensitive to the challenges of emergency service work.

Given this description, please indicate your responses to the following statements.

Definit

ely yes (1)

Probab

ly yes (2)

Might

or might not (3)

Probably

not (4)

Definitely not

(5)

It

would be

beneficial for a

CISM team

member to attend

a unit briefing or

meeting to give a

short presentation

on their services.

(1)

m m m m m

I would

be more likely to

use CISM

services if I did

NOT know any

CISM members

personally. (2)

m m m m m

There

are other

resources I use

that are similar to

the CISM Team.

(3)

m m m m m

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You are almost done, just a couple more questions and you’ll be done!

Q14 What is your gender?

m Male (1)

m Female (2)

m Prefer to not say. (3)

Q15 What month and year were you born?___/_____

Q16 Which agency do you work for?

m Fire (1)

m Sheriff's Office (2)

m Police (3)

m Highway Patrol (4)

m Emergency Dispatcher (5)

m Other Emergency Services (6)

Q17 How long have you been employed at an emergency service organization?

m Less than 1 year (1)

m 1-3 years (2)

m 4-6 years (3)

m More than 6 years (4)

Q18 What is your marital status?

m Married (1)

m Widowed (2)

m Divorced (3)

m Separated (4)

m Never married (5)

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Q19 Do you have children?

m Yes (1)

m No (2)

Q20 Highest level of education?

m High School (1)

m Some College (2)

m 2 year Degree (3)

m 4 year Degree (4)

m Professional or Doctorate (5)

You’re all done! Thank you very much for your participation in the survey. Your answers will be used in

assisting the CISM Team in refining their services, benefiting all who work in emergency services in Missoula!

Don’t forget, fill out and detach the cover sheet to be entered to win a prize for your participation!

Appendix B

Script for CISM Member to Approach Prospective Agencies

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The following may assist you in fostering cooperation with prospective agencies that you wish to

partake in our survey. If they have any additional questions or concerns about the survey that you

are unable to answer, please direct them to email Jacob Reed at jacob.reed@umontana.edu.

The Missoula Valley Critical Incident Stress Management, or CISM, Team consists of volunteer

members who are on call to assist emergency personnel as the cope with job stress. In order to

better serve emergency personnel, we have partnered with a small research team from the

University of Montana in order to assess the knowledge, perceptions and opinions about the

CISM program. We would ask for your cooperation in the administration of a short survey to

your unit’s members. The data obtained from this survey will be compiled with others of the

same kind from across the CISM service area to generate information to aid in the performance

of our services.

With your help, and permission, we would like to attend a meeting/briefing or series of meetings/

briefings with a member from our CISM team and a member of the research team. At that/those

meeting(s) we will introduce ourselves and the survey briefly, administer the survey, collect them

and answer any questions afterward in a short brief of CISM functions. The survey should be

complete in no more than 10 minutes, and participation is completely voluntary. The surveys are

considered anonymous and any possible identifying information will be keep strictly

confidential. There will also be an incentive for those who complete the survey, in the form of a

lottery drawing for a prize.

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