What is CISM?(Critical Incident Stress Management)

July 31, 2014

Vince Rodriguez (Ph: 631-4793)◦ CISM Coordinator◦ IDOC Southern Region Team

Debi Jessen (Ph: 890-8643)◦ Assistant CISM Coordinator◦ IDOC Southern Region Team

**All information contained in this presentation has been obtained from the Jeffrey T. Mitchell/George Everly Critical Incident Basic Course Manual, 3rd Edition

What is CISM?Critical Incident Stress

Management◦ A Comprehensive , integrated multi-

component crisis intervention system (Everly and Mitchell, 1999). CISM Consists of Core Interventions useful for public safety applications, schools, businesses, industry, and communities.

CISM Call-Out Situations1. Pre-crisis planning/education2. Individual Crisis Intervention (one-on-one)3. Small Group Crisis Intervention-Defusing4. Small Group Crisis Intervention-CISD5. Large Group Crisis Intervention-

Demobilization (for public safety, rescue, disaster personnel)

6. Large Group Crisis Intervention-Crisis Management Briefing(CMB) for civilian populations, schools, businesses, communities, etc...

Situations Continued….7. Organizational Consultation8. Family Crisis Intervention9. Pastoral Crisis Intervention10. Mechanisms for follow-up and referral

Primary Responses/Functions of the IDOC CISM Teams:

1. Pre-Crisis planning/education2. Small Group Crisis Intervention-

Defusing3. Small Group Crisis Intervention-

CISD4. Large Group Crisis Intervention-

Demobilization (For Public Safety, rescue,…)

5. Mechanisms for follow-up/referral

A Debriefing is Not…psychotherapy or substitute for

P.T.a substitute for traditional EAP

services.a substitute for psychological or

physical rehabilitation.a solve all.an operational critique.a stand alone intervention.

CISD What the Debriefing “Is”

A structured discussion of traumatic event

Lead by a CISD© trained M.H. professional

In combination with trained Peer support

A team approachFor all Emergency Response PersonnelVoluntary participationAccelerates the normal recovery

process

Self Awareness of your own mental state during a process:

◦COUNTERTRANSFERRENCE: Do not allow your personal values to

affect your ability to deal with the crisis, perceive the crisis, or judge the person in crisis.

Likewise, do not allow your previous experiences or other personal opinions to filter or otherwise influence the perception of the person in crisis or the nature of the actual crisis situation (Everly/Mitchell)

Self-awareness cont’d….TRANSFERRENCE:

◦Listen to yourself at the same time so you do not cross the line and make the victim’s crisis your crisis. Do not take responsibility for the victims.

◦This is also the natural tendency of individuals in crisis to ascribe to the crisis worker parental-like qualities, or other such qualities of authority or desirability that may not be reasonable or realistic. (Everly/Mitchell)

Self-Awareness Cont’d….

VICARIOUS TRAUMATIZATION:◦Indirectly experiencing the crisis

through the phases of the process.

How The Process Starts:Setting up the room:

◦ No distractions: TV’s, loudspeakers, radios, windows accessible to outside persons…

◦ Chairs in a circle

◦ White Board/Flip Chart/Pens to write rules on

◦ Comfortable climate (temperature, atmosphere)

◦ Supplies: Kleenex, Water, Have local EAP numbers available.

Assignment of Individual Team Member duties:

This is to be done BEFORE the Process Starts◦ Assign someone to read rules◦ Assign someone to be the “door catcher”◦ Assign the Mental Health professional◦ Assign someone to read/disseminate

symptom information◦ Assign someone to do the Teaching Phase

The Actual Process:Introduction of Team MembersExplanation of RulesFact PhaseThought PhaseReaction PhaseSymptom PhaseTeaching PhaseWrap Up/Re-entry

Introduction of Team Members:

Mental Health Professional to introduce themselves, explain to the participants why they are there (Salmon Fire Issues)

Each Team Member to introduce themselves, no title, just name and that you are a member of the team and how long you have been with the team (some exceptions apply)

Explanation Of Rules: This meeting is confidential, what is said

here remains here.There should not be anyone here that was

not directly involved in the incident.We encourage you to discuss the event that

brought you here, you are not required to speak but what you have to say or your perspective may help others during the processing of the incident.

No breaks.Please speak only for yourself.

Rules Cont’dThis is not a critique or an investigation. There

is no need to get into detail which could jeopardize an investigation or cause any person in the debriefing difficulties on the job.

This is a group discussion to help you deal with and make a quick recovery from the effects of this incident.

There is no rank. In this debriefing we are all equal and here for

the same purpose.No pagers, cell phones, hand-held radios or

anything else that might be distracting.

Rules Cont’d◦ Outline the process, emphasize that at any

point during the process the group can go back to a previous phase.

◦ ******(Write the basic rules and the process on a white board or flip chart)

FACT PHASE:Who are you?

What was your job during the incident?

Tell us some of what happened from your perspective.

THOUGHT PHASE:What were you thinking as all this was

happening?◦ (This brings out the more personal aspects

of the situation)

REACTION PHASE:What was the worst thing about the

incident for you?

What about this incident is sticking with you?◦ (This phase deals with the emotional level

as opposed to the cognitive level)

SYMPTOM PHASE:Tell me about any thoughts, feelings,

physical reactions or behaviors that you have had that you think are unusual for you, on scene and since the incident.◦ Examples of physical, behavioral,

cognitive, and emotional signals of a stress reaction (see handout)

TEACHING PHASE: Once the signs and signals of distress have been

discussed, team member relays information to participants regarding stress reactions and what can be done to alleviate them.

The participants are told that their symptoms are normal reactions to an abnormal situation and that they will subside over time.

Handouts on self-care are given (see handouts)

If symptoms do not subside within about three weeks or if symptoms get worse, contact your local EAP Professional.

Relate to what was discussed during the process and address concerns.

RE-ENTRY: Q&A

Summarize

Tie up loose ends

Help establish a plan of action

Remind about confidentiality

Final Statements from the team (Convey what impressed you about the group, thank them…)

Make sure phone numbers are available for the local EAP provider.

Encourage participants to put their names and phone numbers on a list so team can contact them for follow-up.

Post Process Team Debriefing:

After the process is complete and participants have left, team needs to debrief themselves.

◦ Preferably in an off-site, private location for dinner, re-fueling, etc….

◦ Team critique: What worked, what did not work, what can be learned from the experience.

◦ Assignments of call-backs within one week.

◦ Each debriefing gives the team the ability to improve upon the process.

Questions:Content ReviewFinal thoughts Questions

Who are CISM services available to?IDOCState AgenciesOther agencies (i.e. First

Responders: firefighters, medical/EMT personnel, etc.)

What is the process for requesting services?State communications

statecom@dhw.idaho.govPh: 208-846-7610

Or call Vince RodriguezCISM Coordinator, IDOC Southern Region Team Ph: 208-631-4793

How long does it take to deploy the team?Our goal is within a few hours to

3 days.We have gone as long as a week

away when asked if that’s what is necessary to ensure that everyone who needs to is able to attend.

Are there teams in other areas of the state?Northern team in OrofinoEastern team in Idaho FallsCall me 1st , I can forward to the

closest one. (Vince Rodriguez, 631-4793)

What is the cost?Depends on the situation. The

costs may be covered.Would ultimately need IDOC

approval in advance in order to respond.