3-CISM_TRAINING_publichealth

CISM Critical Incident Stress Management: 

CISM Critical Incident Stress Management Cynthia Thomae, Ph.D.(C)., M.S., L.P.C., N.C.C., Az.C.S.C, B.C.E.T.S., R.T.C. Diplomat, American Academy of Experts in Traumatic Stress Northwest Fire and Rescue

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JEFF MITCHELL ACUTE DELAYED CUMULATIVE HANS SELYE ALARM RESISTANCE EXHAUSTION

Hypothalamus-Adrenal Medulla: 

Hypothalamus-Adrenal Medulla Fight or Flight 1. Adrenaline 2. Noradrenalin More ongoing stress leads to…

Hypothalamus-Pituitary-Adrenal Cortex Stress Pathway: 

Hypothalamus-Pituitary-Adrenal Cortex Stress Pathway Secretes… Gluccorticoids…95% Cortisol Protein Exercise Mineralcorticoids… 95% Aldosterone

Hypothalamus-Pituitary-Thyroid: 

Hypothalamus-Pituitary-Thyroid Secretes Thyroxin T3 T4 Called the Thyroxin Axis, which is slower to activate, but the lasting effects create disease!

STRESSOR: 

STRESSOR Defense Mechanism (i.e. Denial & Repression) TARGET ORGAN STRESS RELATED DISEASE

TRIGGERS/Flashbacks: 

TRIGGERS/Flashbacks Sights Sounds Smells Touch

MODELS: 

MODELS Acute Traumatic Stress Management On Scene Support SAFER-R Demobilization Crisis Management Briefing Defusing Debriefing/ Formal, Disaster, LODD, Children Individual/ One on One Consult Follow-up Services

Trauma Listening: 

Trauma Listening Psychological alignment (Cognitive and/or Emotional). Mirroring or reflective listening. Listen for cognitive, emotional, behavioral, and spiritual symptoms. Assess how they are coping. Ask questions to obtain more facts and to obtain a better understanding.

On Scene Support/CISM: 

On Scene Support/CISM Have CISM Team Member on scene to assess 1. Scene Safety/ Cold/Warm/Hot Zone (know for triage) 2. Observe/ Body Language 55%, Tone of Voice 38%, Words Spoken 7% 3. Offer Support/Identify Future/Systemic Interventions/Here and Now/Follow-up Services (Cognitive Restructuring) 4. District Crisis Team/ NWFD CISM Team/ Victim Witness/ARC

SAFER-R: 

SAFER-R S- Stabilize the situation/ Remove victim A-Acknowledge/ Find out what happened F-Facilitate Understanding/ Normalize E-Encouragement of Adaptive Coping R-Recovery/Restoration of Independence R-Referral of other resources

Slide 12: 

Appraisal of the Event Make a Critical Incident Primary Appraisal Secondary Appraisal Reappraisal 1. Challenge 2. Threat 3. Loss 4. Benefit

Slide 13: 

8 Ways of Coping Lazarus and Folkman Distancing Self Controlling Confrontative Coping Seeking Social Support Positive Reappraisal Accepting Responsibility Escape/Avoidance Planful Problem Solving

Slide 14: 

Practice the SAFER-R Model A student comes to you first thing in the morning to tell you that they saw… Groups of 3 1 st person is the student 2 nd person the school counselor 3 rd person the observer… give feedback on… a. Did they psychologically align themselves with the student (cognitive/emotionally)? b. Did they use trauma listening (cognitive symptoms, emotional symptoms, physical symptoms, & spiritual symptoms)? c. Did they assess how they were coping ?

Slide 15: 

8 Ways of Coping Lazarus and Folkman Distancing Self Controlling Confrontative Coping Seeking Social Support Positive Reappraisal Accepting Responsibility Escape/Avoidance Planful Problem Solving

Organization: The Key: 

Organization: The Key Idea presented to administration and command Authorization of administration Cooperation of administration and command S.O.P’s for administration and command Pre-designated sites Pre- Incident arrangements for food Pre-printed handouts

Organization: The Key continued: 

Organization: The Key continued Continued training of all CISM members Written Plan Agreements with all jurisdictions Development of brief 10 minute presentation Practice of demobilization at drills A list of resources and emergency numbers for center managers Pre-Incident briefings to the media

Crisis Management Briefing: 

Crisis Management Briefing Four Phases/ For Large Groups (20 to 300) Assembly- Groups can be brought together sequentially and mental health team members do triage. Information- Level of anxiety reduced by giving facts. Helps with rumor control. Reactions- Psychological and behavioral reactions are discussed and normalized. Coping Strategies and Resources- Discuss stress management techniques and give a handout.

CMB Continues: 

CMB Continues Participants who are traumatized may receive a debriefing, a one on one, and follow-up. CMB in schools/agencies should not be used if there was a violent issue on campus/site.

CMB Progression: 

CMB Progression Cognitive Emotional Cognitive Cognitive Restructuring is important in reducing Psychotraumatization

Defusing Defined: 

Defusing Defined A shortened version of a Critical Incident Stress Debriefing. Intervene within the first 24 hours and preferably within hours after the incident. Lasts about 20 minutes to 1 hour. Keeps people from isolating themselves. A normalization experience of all stress reactions. To help workers return to their routine as quickly as possible.

Slide 22: 

Defusing Phases Introduction of Team- State ground rules of confidentiality, no rank, encourage mutual support, not a critique, no note taking, and no one who was not at the scene Exploration- Participants are asked to discuss what they experienced (fact, thought, reaction, symptom combination) Information- Combination of teaching and re-entry phases. Normalize all experiences Follow-up

Critical Incidents Defined: 

Critical Incidents Defined Line of Duty Death/ Faculty on Duty Death Suicide of Emergency Worker Suicide of a Student/ Faculty Member Multi-casualty incident/disaster Significant event involving children Knowing the victim of the event Serious line of duty injury Police Shooting Excessive media interest Prolonged incident with loss Any significant event

CISM Team Organization: 

CISM Team Organization Clinical Director Team Coordinators Management Liaison Chaplains Mental Health Professionals

Call Out Procedures: 

Call Out Procedures Team members use a phone tree. Dispatch pages NWFD CISM Director/Team Coordinators at the request of a school/agency official. Alpha pager requesting team members to respond.

Debriefing Children Model 5 Phases: 

Debriefing Children Model 5 Phases Introduction- Explain who you are and why you are there Facts- Give children the facts (fact sheet provided by school) Reaction- Discuss the worst part for them Teaching- Teach about “good” thoughts Re-Entry- Question and Answers. They make cards for the family or ribbon pins.

Slide 27: 

Critical Incident Stress Debriefing (CISD) Truths 1.The most complex of all of the CISM interventions 2. Is not designed to be applied to routine cases 3. Is not psychotherapy/ Always have a mental health person present 4. Never combine groups- civilians with L.E., F.F., etc. 5. Triage and hold separate debriefings for a variety first responders that have been traumatized (disaster etc.)

Slide 28: 

Formal Debriefing Pre-debriefing meeting of team members Debriefing Phases 1. Introduction/ Cognitive 2. Facts/ Cognitive 3. Thoughts/ Cognitive 4. Reactions/ Emotions 5. Symptoms/ Physical, Emotional, Cognitive, Behavioral 6. Teaching/ Cognitive 7. Re-Entry/ Cognitive

Slide 29: 

Follow-up After a day. Not to exceed 3 days Know your resources If symptoms exceed 1 month, refer to a Mental Health provider

One on One Consults: 

One on One Consults May take through one of the debriefing models Follow-up necessary Referral to a Mental Health Professional trained in trauma may be needed

Follow-up: 

Follow-up After a day. Not to exceed 3 days. Know your resources! If symptoms exceed 1 month, refer to a Mental Health provider! May have PTSD.

Administrators Trained in CISM: 

Administrators Trained in CISM They can support other administrators. Better able to work systemically for school/agency recovery. They will be more likely to include CISM Team member in the Unified Command.

Do’s and Don’ts: 

Do’s and Don’ts Do not hover Do not stand in a group (us against them?) Do not over use silence Help return to routine and optimum levels of learning, functioning, and performance

Questions and Answers: 

Questions and Answers Future training NWFD THANKS YOU FOR WHAT YOU DO!