Basic Critical Incident Stress Management
Basic Critical IncidentStress ManagementCritical Concepts ConsultingDaniel W. Clark, Ph.D.WSP Department Psychologist
What is Stress?Ø "The nonspecific response of the body toany demand made upon it" (Selye)Ø "Demands on the person which tax orexceed his adjustive resources" (Lazarus)Ø "A particular relationship between theperson and the environment that isappraised by the person as taxing orexceeding his/her resources andendangering his/her well-being"
Components of Stresslnecessary for lifelsubjectivelpositive and negativeanything that threatens uspushes usscares usworries usthrills us
Prolonged Stress Physical EffectsØ muscle tensionØ headachesØ lack of energyØ stomach problemsØimmune systemØ high blood pressureØ strokesØ sexual problems
Prolonged Stress.Psychological onfusionirritabilityimpatiencefearnegativismmemory problemshelpless/hopeless
Prolonged Stress.Behavioral effectsØ Alcohol and drug useØ Change in usualbehaviorØ WithdrawalØ Acting outØ Silence / talkativeØ Under / OvereatingØ HypervigilanceØ Impulsive
StressorAny event acting as a stimulus whichplaces a demand upon a person, agroup, or an organization.
What are your stressors?8Home8Work8Environment8Biogenic8Law Enforcement8Psychosocial8Cadet
Home StressorsØSpouse/SOØChildrenØFamily demandsØFinancesØRole in the homeØFamily illnessØShift changesØRelatives
Work StressorsØSupervisor/subordinatesØTime demandsØPersonal safetyØRole at workØEnvironmentØShift workØWork pace
Environmental StressorsØPollutionØCrowdingØTemperatureØNoise
Biogenic StressorsStimulants which cause stress by virtueof the biochemical actions they exert onthe body.CaffeineNicotineAmphetamines
Law Enforcement Stressors Irregular work schedule Danger of job/injury Human suffering/death Absence of closure Excessive paperwork Inadequate rewards Special assignments Unfavorable courtdecisions Corrections system Distorted media reports Public sentiment
Work Stressors
Military Stressors Irregular work schedule Danger of job/injury Frequent relocations Inadequate rewards Frequent deployments Field time Human suffering/death
Psychosocial StressorThose events that are interpreted orappraised as being challenging,threatening, or otherwise adverse.Like beauty -They lie in the eye of the beholder.
Cadet Stressors
“Real cesNutritionSecurity
Willpower Defeats FirepowerLAPD – 28 Feb 97
Critical Concepts ConsultingCoping Techniquesfor Managing Stress
Steps in stress management accept that you are constantly under stress explore areas causing negative stress practice effective stress management
Time ManagementDecide what's importantand worth worryingaboutGet organizedSchedule time forrelaxation andexerciseWrite it down!
Positive AttitudeHumorCommunicate andexpress yourfeelingsRally your supportsystemAdopt a problemsolving approach
Positive Attitude
Perspective
Problem-solving ApproachCan I change this?YesNoAccept it!Do it!
Think Win/WinI LoseI WinYou WinLose/WinWin/WinYou LoseLose/LoseWin/Lose(from The Seven Habits of Highly Effective People by Covey)
RelaxationDo something you enjoy, whether indoorsor out, alone or with othersDo what is satisfying for youSet aside time for yourself
ExerciseExercise is a great way to relievephysical and mental tensionImproves physical resistance to stressChoose an activity that appeals to you
Don't accept substitutesfor stress management
Perfectionism“Perfectionsts aren’t people who dosomething perfectly. Perfectionists arepeople who fantasize about doingsomething perfectly.”John Perry, professor emeritus ofphilosophy at Stanford University
Self Care
Specific SuggestionsWhen helping othersDon’t take anger/feelings of others personallyListen non-judgmentallySpend time with themReassure themListen carefullyBe patient
Specific SuggestionsTo help selfTalk to peopleMental Health ProfessionalChaplainMedical doctorFamily membersFriendsState EAPSupervisors1800SafeCallNow
Crisis InterventionPeer SupportCritical Incidents
Post-Traumatic StressPost - traumatic stressis a normal reaction,in a normal person,to an abnormal event.
Post-Traumatic StressPost-traumatic stress is asurvival mechanism, PostTraumatic Stress Disorder is apathogenic version of thatsurvival mechanism.
Post Traumatic Stress DisorderBrief History8 FirstNamed in DSM - III, 19808 Militaryawareness8Civil War - nostalgia8WWI - war neurosis, shellshock8WWII - combat fatigue/exhaustion8Post Vietnam - PTSD8 Prevalence8General population: 1-2%8Emergency Services: 16-20%
PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)
Fairchild AFBJune 1994
PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)
LAPD Officer Whitfield – 9L89
PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)
Critical IncidentIn a career where day to day you respondto the abnormal events in other people’slives;A critical incident is the one that, forwhatever reason, is abnormal even forexperienced personnel.
Critical IncidentsThe Terrible 101)Line of Duty Death2)Serious Line of DutyInjury3)Suicide of a Co-Worker4)Disaster / MultiCasualty Incident5)Law EnforcementShootingOKC, 19 APR 1995
Critical IncidentsThe Terrible 10Baby Jessica Rescue - 16 OCT 19876)Events Involving7)ChildrenRelatives of KnownVictims8)Prolonged Incident Especially with loss9)Excessive Media Interest10)Any Significant Event
Intensity of ImpactPersonal Relevance *DurationSense of LossPrevious HistoryGuiltSocial SupportCoping Skills
Types of InterventionsqPre-Incident EducationqOn Scene Support ServicesqPeer Support (Individual Consults)qDefusingqDemobilizationqCritical Incident Stress Debriefing
Types of InterventionsqSpecialty DebriefingsqSignificant Other Debriefings andSupportqFollow Up ServicesqMental Health Referral ServicesqCommunity Assistance
Pre-Incident Education§ Heart of Successful CISM Program§ Discuss Stress/Human StressResponse§ Describe CISM Services§ Explain What CISM Is Not§ Provides Outline for CISM Access§ Generates Positive Contacts
Peer Support/Individual Crisis Intervention
Individual Crisis InterventionPositivesØØØNegatives‘Been there, done – May be too closethat’– Very vulnerable toCredibilitycountertransferenceRapport– May over-identify
1:1 Crisis Intervention§Communication Skills§Awareness of Acute Stress Symptoms§Intervention Protocol§Referral Options
Demobilization24 MAY 2001, Jerusalem Wedding Collapse
Demobilization4 Providedby trained CISM personnel.4 10 minute informational talk.Describe stress reactions.List signs and symptoms.Outline stress survival strategies.4 20minute rest after talk is completed.Low fat, low sugar, low salt foodsNon-caffeinated drinks
Crisis Management Briefing
Crisis Management Briefing“ a group psychological crisis interventiondesigned to mitigate the levels of felt crisisand traumatic stress in the wake ofterrorism, mass disasters, violence, andother “large scale” crises.”IJEMH v2(1) p. 53-57 (2000)
Crisis Management BriefingGoalsInform and consultAllow psychological decompressionStress managementSimilar to Demobilization but fornon-operational personnel
Defusing
DefusingDefusing means to render somethingharmless before it can do damage.
DefusingA small group intervention applied withinhours of a critical incident.
Defusing1)Introduction2) Exploration3) Information
Critical IncidentStress Debriefing
Critical Incident StressDebriefingThe goal of aCritical Incident Stress Debriefingis psychological closure.
DebriefingConsiderations8Large scale incident.8Prolonged incident.8Circumstances out of the ordinary.8CISD is not therapy8CISD is not a substitute for therapy.
ghtReactionSymptomTeachingRe-Entry
Mental Health ServicesPsychotherapy for employeesand family members:IndividualMarital/couplesGroupTrooper applicant screeningTraining/Academy instructionCommand consultation
Referrals & AppointmentsØ Referrals: Directed VoluntaryØ Appointments Days off Medical leave Supervisor’s discretion
Confidentiality/Privileged Communication Privacy: a personal right which limits theaccess of others to certain information aboutone’s self, body, mind, etc. Confidentiality: a professional duty to refrainfrom speaking about certain matters Privilege: a legal decision which provides relieffrom the duty to speak in court proceedingsabout certain matters
Limits of Confidentiality RCW 71.05 RCW 26.44 RCW 74.34 Danger to self orothers Abuse of children orDD adults Abuse of vulnerableadults Case review
Questions?
Daniel W. Clark, Ph.D.Washington State Patrol1405 Harrison Avenue NWSuite 205Olympia, WA 98502(360)-586-8492wsp-psych@att.net
What is Stress? Ø"The nonspecific response of the body to any demand made upon it" (Selye) Ø"Demands on the person which tax or exceed his adjustive resources" (Lazarus) Ø"A particular relationship between the person and the environment that is appraised by the person as taxing or
Incident Management Process Map 1. Incident Management Process Map 1. Incident Management Description and Goals 9. Incident Management Description and Goals 9. Description 9. Description 9. Goals 9. Goals 9. Incident Management RACI Information 10. Incident Management RACI Information 10. Incident Management Associated Artifacts Information 24
A. BLM Critical Incident Stress Management Q. What is the Critical Incident stress Management Program? A. CISM program is comprehensive, in that it: promotes pre-event stress and crisis management education, planning and policy development, as well as training and preparation for the management of traumatic stress through
in a critical incident. Some of these are presented in Critical and Traumatic Incident. (2) There are various possible responses to a critical incident. These are presented in Critical Incident Information. (3) There are many things that police agencies can do to minimize the possible undesirable effects of a critical incident.
1.4 importance of human resource management 1.5 stress management 1.6 what is stress? 1.7 history of stress 1.8 stressors 1.9 causes of stress 1.10 four major types of stress 1.11 symptoms of stress 1.12 coping with stress at work place 1.13 role of human resource manager with regard to stress management 1.14 stress in the garment sector
wrote a comprehensive review of Critical Incident Stress Management (CISM) (Everly & Mitchell, 1999). This volume represents the latest available review of the core concepts, intervention tactics, and research on Critical Incident Stress Management (CISM), albeit in digest form. Since the last review of CISM was written, many
Critical Incident Stress Management: Perspectives on its History, Frequency of Use, Efficacy, and Success Jenifer Swab jarswab@gmail.com Abstract; The process of Critical Incident Stress Management (CISM) was examined by surveying 153 respondents in Western Pennsylvania. At the writing of this article, CISM had been in existence for nearly five .
critical incident stress management services first responder confidentiality law enforcement & criminal justice interim committee june 21, 2017 41 states have critical incident stress management team listings* 22 states have confidentiality ** idaho illinois indiana iowa kansas kentucky louisiana maryland massachussettes michigan minnesota .
after an incident happened, they are normal reactions of normal people to an abnormal event. A critical incident is any situation that causes a person to experience unusual strong stress reactions that the person perceives as disturbing or disabling. Besides accidents, also minor events may be experienced as a critical incident specific to this .
