1. Managing A CISM Team & Program Ron Quinsey, FF/PM, Peer Debriefer CISM Program Manager King County CISM Program Ron Quinsey, FF/PM, Peer Debriefer CISM Program Manager King County CISM Program

2. Objective of this class: Discuss the make-up of a CISM program Administration and funding Recruiting and Selecting a quality CISM Team Team Building and Incentives Pre-Incident Training - Increasing your effectiveness Networking

3. Basic CISM Team Elements Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours)

4. Basic CISM Team Elements Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone # Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone #

5. Basic CISM Team Elements Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone # Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone #Training: Initial Initial Continuing Education Continuing Education Motivation MotivationTraining: Initial Initial Continuing Education Continuing Education Motivation Motivation

6. Basic CISM Team Elements Team: Mental Health Mental Health Peers Peers Chaplain ChaplainTeam: Mental Health Mental Health Peers Peers Chaplain Chaplain Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Policies & Procedures Organizational Organizational Administrative Administrative Activation (24 Hours) Activation (24 Hours) Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone # Sponsorship Agency Administrator/Coordinator Administrator/Coordinator Point of Contact Phone # Point of Contact Phone #Training: Initial Initial Continuing Education Continuing Education Motivation MotivationTraining: Initial Initial Continuing Education Continuing Education Motivation Motivation

7. Starting a CISM Team Identify the need: What is the need or reason for a Team Is there a pattern of incidents or effects for lack of CISM To whom will it serve How much will it cost How many times will the Team be needed Is there any other way of providing the service without having to start the team? Identify the need: What is the need or reason for a Team Is there a pattern of incidents or effects for lack of CISM To whom will it serve How much will it cost How many times will the Team be needed Is there any other way of providing the service without having to start the team?

8. Starting a CISM Team Identify a Lead Agency Government (EMS, Police, Emergency Mgmt, Other) Private (non-profit) Organization (Mental Health Svc, Church) Business/Corporation (EPA, Industry) Identify a Lead Agency Government (EMS, Police, Emergency Mgmt, Other) Private (non-profit) Organization (Mental Health Svc, Church) Business/Corporation (EPA, Industry)

9. Starting a CISM Team Development Team / Board of Directors: Administration (Director, funding source) Clinical Director (MHP) Service Provider(s) (Peer-customer) Third Party (objective individual) Team Coordinator Development Team / Board of Directors: Administration (Director, funding source) Clinical Director (MHP) Service Provider(s) (Peer-customer) Third Party (objective individual) Team Coordinator

10. Starting a CISM Team What is your Team’s Focus: Peer Support or Peer Assistance (Listen & Refer) Does not normally perform CISDs Chaplancy (Chaplains) Crisis Team (MHPs only) EAP/Human Resources (contracted, referral) Multi-disciplinary CISM Team (CISD Team) What is your Team’s Focus: Peer Support or Peer Assistance (Listen & Refer) Does not normally perform CISDs Chaplancy (Chaplains) Crisis Team (MHPs only) EAP/Human Resources (contracted, referral) Multi-disciplinary CISM Team (CISD Team)

11. Questions to Answer Have users been educated in CISM - Activation? Is their significant financial support? (estimate approximately $8,000 per year) Do you have access to a reliable communication system/call-out service? Do you have psychotrauma experts to recruit? How are you going to training Team members? Who is going to manage the daily function? Who is coordinate emergency services? Who is going to write the protocols/policies? Have users been educated in CISM - Activation? Is their significant financial support? (estimate approximately $8,000 per year) Do you have access to a reliable communication system/call-out service? Do you have psychotrauma experts to recruit? How are you going to training Team members? Who is going to manage the daily function? Who is coordinate emergency services? Who is going to write the protocols/policies?

12. Program Goals Provide preventive education programs to emergency response agencies with the benefits of the CISM Program. Provide post-incident services to those you serve. Enhance the quality of services as needed Provide education and services to family and significant others of emergency services. Participate in a cooperative program with other CISM Teams Provide preventive education programs to emergency response agencies with the benefits of the CISM Program. Provide post-incident services to those you serve. Enhance the quality of services as needed Provide education and services to family and significant others of emergency services. Participate in a cooperative program with other CISM Teams

13. Sample Policies Needed Organizational Guidelines (Org. Chart) Program Administration - Mission Team Membership, Duties and Responsibilities Recruitment and Selection procedure Training and Continuing Education Process Revocation/Suspension of Membership Mobilization - Activation Service Definition Program Record Keeping and Evaluation Organizational Guidelines (Org. Chart) Program Administration - Mission Team Membership, Duties and Responsibilities Recruitment and Selection procedure Training and Continuing Education Process Revocation/Suspension of Membership Mobilization - Activation Service Definition Program Record Keeping and Evaluation

14. Organizational Chart Seattle/King County Public Health Dorothy Teeter Seattle/King County Public Health Dorothy Teeter EMS Division Thomas Hearne, Manager EMS Division Thomas Hearne, Manager Regional EMS Medical Director Mickey Eisenberg, MD Regional EMS Medical Director Mickey Eisenberg, MD Community Program & Education Section Linda Culley, Section Manager Community Program & Education Section Linda Culley, Section Manager CISMAdvisoryBoardCISMAdvisoryBoard CISM Program Manager Ron Quinsey, Paramedic CISM Program Manager Ron Quinsey, Paramedic Administration Training ~ Recruit. ~ Evaluation Administration Operations Mobilization (State Net) 24 Hour Activation Operations Mobilization (State Net) 24 Hour Activation CISMClinicalDirector Norm Mar, Ph.D. Ph.D.CISMClinicalDirector Norm Mar, Ph.D. Ph.D.

15. “Helping The Helper Help” King County CISM Mission Statement Exposure to traumatic incidents on the job is an occupational hazard for emergency response and public safety personnel. It is our belief that emergency service workers who have been exposed to critical incident stress while performing a public service should have access to critical incident debriefing interventions designed to help them identify and cope with their responses to these events. The cost of such services should not be borne by workers but should either be provided by management in the form of employee assistance programs or provided by trained debriefing teams on a no fee basis. The King County CISD Program has been developed to provide debriefing following critical incidents to any emergency response agency requesting assistance. The focus of this service is to minimize the harmful affects of job stress, particularly in crisis or emergency situations. As such, the highest priorities for the team are to maintain confidentiality and to respect the feelings of the individuals involved. It is not the function of the team to replace on-going counseling, but to provide immediate crisis intervention. Through the CISD process, the team provides emergency personnel with a tool to potentially alleviate stress related symptoms. Workers who require additional psychological intervention should be referred for follow-up services to agencies or mental health professionals who are familiar with current advances in trauma theory and have experience in working with trauma victims. King County CISM Mission Statement Exposure to traumatic incidents on the job is an occupational hazard for emergency response and public safety personnel. It is our belief that emergency service workers who have been exposed to critical incident stress while performing a public service should have access to critical incident debriefing interventions designed to help them identify and cope with their responses to these events. The cost of such services should not be borne by workers but should either be provided by management in the form of employee assistance programs or provided by trained debriefing teams on a no fee basis. The King County CISD Program has been developed to provide debriefing following critical incidents to any emergency response agency requesting assistance. The focus of this service is to minimize the harmful affects of job stress, particularly in crisis or emergency situations. As such, the highest priorities for the team are to maintain confidentiality and to respect the feelings of the individuals involved. It is not the function of the team to replace on-going counseling, but to provide immediate crisis intervention. Through the CISD process, the team provides emergency personnel with a tool to potentially alleviate stress related symptoms. Workers who require additional psychological intervention should be referred for follow-up services to agencies or mental health professionals who are familiar with current advances in trauma theory and have experience in working with trauma victims.

16. “Helping The Helper Help” King County CISM Mission Statement The King County EMS-CISM Program exists to serve the emergency services providers within Seattle/King County and state of Washington. By nature of the emergency services work, emergency service professionals are subject to effects of stress, on and off the job. To reduce the effects of this stress and prolong their public service a specially training CISM Team will provide pre-incident education, on-scene response and post critical incident services. The costs of these services will not be bore by the agency or individual who request said services. King County CISM Mission Statement The King County EMS-CISM Program exists to serve the emergency services providers within Seattle/King County and state of Washington. By nature of the emergency services work, emergency service professionals are subject to effects of stress, on and off the job. To reduce the effects of this stress and prolong their public service a specially training CISM Team will provide pre-incident education, on-scene response and post critical incident services. The costs of these services will not be bore by the agency or individual who request said services.

17. Writing a Mission Statement Who is going to provide the service, and To whom are you going to serve Why you want to provide this service How you are going to serve. When you are going serve. Write a Focus or Vision Statement: Your Team should establish a future and goal Who is going to provide the service, and To whom are you going to serve Why you want to provide this service How you are going to serve. When you are going serve. Write a Focus or Vision Statement: Your Team should establish a future and goal

18. WHAT IS CRITICAL INCIDENT STRESS MANAGEMENT(CISM) CISM is the process of pre-educating, preventing or mitigating the effects from exposure to an abnormal or highly unusual event. A comprehensive CISM program would include: Preventive/Educational/Informational programs for Emergency Workers On Scene Support Advice to Command Demobilization Services Formal Debriefings Resource Referral Services Family/Loved One Support Services Support to EAP Programs Community Awareness CISM is the process of pre-educating, preventing or mitigating the effects from exposure to an abnormal or highly unusual event. A comprehensive CISM program would include: Preventive/Educational/Informational programs for Emergency Workers On Scene Support Advice to Command Demobilization Services Formal Debriefings Resource Referral Services Family/Loved One Support Services Support to EAP Programs Community Awareness

19. Team Membership CISM Team will be comprised of : Mental Health Professionals (State Licensed) Peer Support: (Active or recently retired Emergency Service Worker) Fire/EMS/Police/Communication/Corrections/Hospital Chaplain: Chaplains will meet the requirements for peers CISM Team will be comprised of : Mental Health Professionals (State Licensed) Peer Support: (Active or recently retired Emergency Service Worker) Fire/EMS/Police/Communication/Corrections/Hospital Chaplain: Chaplains will meet the requirements for peers

20. Recruiting and Selection Process Criteria for a Peer Debriefers - Volunteer: 1.Currently affiliated with an emergency services agency either as a paid employee or a volunteer; 2.Knowledge, training and/or experience in stress management or CISD; 3.Knowledge in counseling? 4.Applicable work history or experience which demonstrates personal characteristics such as leadership ability, self-confidence, ability to communicate effectively, and ability to work as a team. Criteria for a Peer Debriefers - Volunteer: 1.Currently affiliated with an emergency services agency either as a paid employee or a volunteer; 2.Knowledge, training and/or experience in stress management or CISD; 3.Knowledge in counseling? 4.Applicable work history or experience which demonstrates personal characteristics such as leadership ability, self-confidence, ability to communicate effectively, and ability to work as a team.

21. Duties and Responsibilities Criteria for Mental Health Professionals - Volunteer Establishes clinical leadership and education to the Team Provide CISM and CISD services Will refer individuals who need additional services Be available to CISD attendees if requested Responds to request for services on-scene; post incident Completes the required post-CISD form Follows all policies and procedures of the CISM Team Criteria for Mental Health Professionals - Volunteer Establishes clinical leadership and education to the Team Provide CISM and CISD services Will refer individuals who need additional services Be available to CISD attendees if requested Responds to request for services on-scene; post incident Completes the required post-CISD form Follows all policies and procedures of the CISM Team

22. Duties and Responsibilities Peer Support Debriefer - Volunteer Initiates contact with those who have responds to critical incident (peers/co-workers) - refer as needed Perform an initials assessment of CISM need Provide CISM and CISD services Lead the CISD (work with the MHP) Be available to CISD attendees if requested Responds to request for services on-scene; post incident Completes required post CISD form Follows all policies and procedures of the CISM Team Attend Team training sessions Peer Support Debriefer - Volunteer Initiates contact with those who have responds to critical incident (peers/co-workers) - refer as needed Perform an initials assessment of CISM need Provide CISM and CISD services Lead the CISD (work with the MHP) Be available to CISD attendees if requested Responds to request for services on-scene; post incident Completes required post CISD form Follows all policies and procedures of the CISM Team Attend Team training sessions

23. MHP Qualifications Minimum of a Master’s Degree in Psychology related area (MA, MSW, PhD, MD ) Psycho-Trauma experience Must complete specific training in: Basic and Advanced CISM/CISD; PSTD Crisis Intervention Group Processes Human communication skills Directive intervention strategies Emergency Services “Ride Alongs” Minimum of a Master’s Degree in Psychology related area (MA, MSW, PhD, MD ) Psycho-Trauma experience Must complete specific training in: Basic and Advanced CISM/CISD; PSTD Crisis Intervention Group Processes Human communication skills Directive intervention strategies Emergency Services “Ride Alongs”

24. MHP Qualifications Beneficial Training: Substance Abuse Family Therapy Neuropsychology Physiological behavior Beneficial Training: Substance Abuse Family Therapy Neuropsychology Physiological behavior Hold-Harmless Agreement: MHP must possess their own liability insurance and provide a Hold-Harmless agreement to the CISM Team.

25. Peer Debriefer Qualifications Emergency services experience Emotional maturity Respect of one’s peers/co-workers Ability to keep information confidential Willingness to work as a part of a Team Willingness to learn psychosocial behavior and CISM principles. Demonstrate effective communication skills Training as required for the position: Basic and Advanced CISM, Peer Support, LODD Emergency services experience Emotional maturity Respect of one’s peers/co-workers Ability to keep information confidential Willingness to work as a part of a Team Willingness to learn psychosocial behavior and CISM principles. Demonstrate effective communication skills Training as required for the position: Basic and Advanced CISM, Peer Support, LODD

26. Training and Continuing Education Process Recruit and Select only quality Team Members Establish the leadership and structure within the team Train or validate the quality of their training (if you are seeking already trained team members) Invoke written protocols and policy (adherence) Maintain team operations and focus to service statement Evaluate Team performance Recruit and Select only quality Team Members Establish the leadership and structure within the team Train or validate the quality of their training (if you are seeking already trained team members) Invoke written protocols and policy (adherence) Maintain team operations and focus to service statement Evaluate Team performance

27. Continuing Education Topics Overview of stress

28. MAINTAINING A CISM TEAM PRIMARY GUIDELINES FOR CISM TEAM HEALTH 1. Education to Provider Agencies (customers) 2. Cross Familiarization 3. Regular team Meetings PRIMARY GUIDELINES FOR CISM TEAM HEALTH 1. Education to Provider Agencies (customers) 2. Cross Familiarization 3. Regular team Meetings

29. Educating Provider Agencies Pre–Incident Education S TRESS M ANAGEMENT E DUCATION FOR E MERGENCY S ERVICES P ERSONNEL Helping the Helper Help Emergency Medical Services Division Critical Incident Stress Management Program

30. Cross Familiarization Team Education and Building 1. Mental Health teach a session(s) (i.e Psychotrauma, Stress Management, PTSD, and Obsessive/Compulsive Disorders) 2. Peers teach a session(s) (i.e. Incident Command, Terminology, emergency services specialties) 3. Team building exercises: Pictionary, Body Language Team Education and Building 1. Mental Health teach a session(s) (i.e Psychotrauma, Stress Management, PTSD, and Obsessive/Compulsive Disorders) 2. Peers teach a session(s) (i.e. Incident Command, Terminology, emergency services specialties) 3. Team building exercises: Pictionary, Body Language

31. Regular Team Meetings Standard Format: Administration Team News and Announcements Upcoming education opportunities Training: MHP lead training Peer lead training Outside trainer CISD Review (kept confidential – lesson learned) Standard Format: Administration Team News and Announcements Upcoming education opportunities Training: MHP lead training Peer lead training Outside trainer CISD Review (kept confidential – lesson learned)

32. Revocation/Suspension of Membership Any Breech of confidentiality Failure to follow Team policies and procedures Organizing or providing CISD services without notifying the Team Manager Using the team membership for personal business (see Peer Review Process) Unprofessional behavior Unexcused failure to appear after making a commitment Any Breech of confidentiality Failure to follow Team policies and procedures Organizing or providing CISD services without notifying the Team Manager Using the team membership for personal business (see Peer Review Process) Unprofessional behavior Unexcused failure to appear after making a commitment

33. Final Development Steps Recruit and Select only quality Team Members Establish the leadership and structure within the team Train or validate the quality of their training (if you are seeking already trained team members) Invoke written protocols and policy (adherence) Maintain team operations and focus to service statement Evaluate Team performance Recruit and Select only quality Team Members Establish the leadership and structure within the team Train or validate the quality of their training (if you are seeking already trained team members) Invoke written protocols and policy (adherence) Maintain team operations and focus to service statement Evaluate Team performance