1. 22 February 20081 Critical Incident Stress Management (CISM) Northeast Region Civil Air Patrol/USAF-Auxiliary

2. 22 February 20082 Objectives of this Presentation An introduction to NER CISM To provide the participants with An overview of critical incident stress, crisis management and critical incident stress management (CISM) An orientation to CAP’s CISM program

3. 22 February 20083 Part I Everything you ever wanted to know about Critical Incident Stress and CISM

4. 22 February 20084 A Crisis One’s normal psychological balance (homeostasis) has been disrupted, One’s usual coping mechanisms have failed to reestablish the needed homeostasis, or There is evidence of functional impairment. A response to an event wherein

5. 22 February 20085 Critical Incident Stress “Any event in which there is a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.” (Everly & Mitchell, 1999)

6. 22 February 20086 Examples of Critical Incidents Line of duty death or death at workplace Serious line of duty injury or workplace injury Suicide of coworker, friend, family member Multiple casualty incidents (MCI’s), disasters Significant events involving children Prolonged events especially with loss Any powerful event which overwhelms a person’s normal coping mechanisms

7. 22 February 20087 Crisis Intervention An exercise in psychological damage control…stopping the bleeding! Not a cure An opportunity for assessment and for follow-up Guided by a mental health professional (MHP) The provision of timely “emotional first aid”

8. 22 February 20088 Crisis Intervention Is one aspect of a continuum of care It requires specializeduniquetraining specialized & unique training

9. 22 February 20089 Crisis Intervention Principles BISEP Spell B -I -S -E -P BISEPBISEP Immediacy – Rapid Intervention Simplicity – KIS – Keep it Simple Expectancy – A reasonable positive outcome Proximity – Close to operational zone is most effective Brevity - few minutes up to 1 hour

10. 22 February 200810 Post-Traumatic Stress A normal reaction in a normal person abnormal event to an abnormal event It is a survival mechanism (PTSD) pathogenic (PTSD) is a pathogenic ( unhealthy ) variation of that normal survival mechanism Post-Traumatic Stress Disorder

11. 22 February 200811 Stress Response Timelines Immediate – up to 24 hours post event. Delayed – 24 to 72 hours post event. Cumulative – buildup of stress over time.

12. 22 February 200812 Critical Incident Stress Management (CISM) is One type of crisis intervention It is a comprehensive, systematic program for the mitigation of critical- incident related stress.

13. 22 February 200813 The goals of CISM Prevent Prevent traumatic stress Mitigate Mitigate traumatic stress Intervene Intervene to assist recovery from traumatic stress Accelerate Accelerate recovery Restore Restore function Maintain Maintain worker health and welfare

14. 22 February 200814 CISM involves many facets Pre-crisis preparation and education Demobilization (for large groups) Crisis management briefings (large groups also) Defusings Critical incident stress debriefing (CISD)

15. 22 February 200815 CISM also involves One-on-one, individual crisis intervention Pastoral crisis intervention Family CISM Organizational crisis intervention/consultations Follow-up and referral mechanisms

16. 22 February 200816 CISM deals with the current circumstances the current event or crisis NOT personal histories It is First Aid, not definitive care.

17. 22 February 200817 Some Key Elements of CISM

18. 22 February 200818 Pre-Incident Education “PEP Talks” General information: stress, trauma, etc. Set expectations for actual experiences Teach stress management and coping skills Appropriate for ALL members

19. 22 February 200819 Demobilizations Provide decompression Transition workers from disaster work (large- scale incident) to routine duties or home Used with large numbers of people A 10- to 30-minute session An opportunity for assessment of group needs Alert workers to possible stress effects Always followed by a CISD (debriefing, usually within one week

20. 22 February 200820 Defusing A small group intervention conducted within hours of the incident, usually within 12 hours Shortened version (20-45 mins) of the CIS- Debriefing May eliminate the need for, or increase effectiveness of, CISD – opportunity to assess the need for CISD Seeks to reduce intense reactions to a trauma Seeks to “normalize” the effects of the event

21. 22 February 200821 The Defusing 3-Step *Introduction *Exploration *Information

22. 22 February 200822 The Critical Incident Stress Debriefing (CISD) A group discussion of a traumatic event Peer driven Clinician (MHP) guided Lasts 1-3 hours Closed circle format Held 1-10 days post event NOTNOT psychotherapy! C I S D

23. 22 February 200823 Objectives of the CISD  Education  Ventilation  Reassurance and forewarning  Positive contact with an MHP  Improvement of interagency cooperation  Increase group cohesiveness  Restore self-confidence  Facilitation of follow-up

24. 22 February 200824 Referral Is made for those requiring a more thorough process of assessment and evaluation The mental health provider should understand the “culture” of the agency in which the person is employed, and Should have specialized training/experience in post-traumatic stress.

25. 22 February 200825 Family Support  An essential component of a comprehensive CISM program  Consists of - Educational programs - CISD for significant others - Bereavement support/grief & crisis counseling  Provided by peers, MHP, clergy, trained spouses  Includes children and elderly as well

26. 22 February 200826 Follow-up Essential element in all CISM interventions Can be made by - Phone calls - Station/workplace visits - Home visits

27. 22 February 200827 Part Two Everything you always wanted to know about the CAP CISM Program

28. 22 February 200828 CISM a comprehensive, systematic maintenance program for the overall well-being of our most valuable assets our members

29. 22 February 200829 A CAP CIST The CIS Team consists of:  Mental Health Professionals (MHP)  Peer Representatives CAPR 60-5 (3)a 2

30. 22 February 200830 CAP’s CISM Program “The use of qualified, local, non-CAP teams to respond to incident stress-affected CAP members is highly encouraged … The use of local non-CAP teams will somewhat limit the need to dispatch a trained CAP CIS [Team]” --CAPR 60-5 (2)e

31. 22 February 200831 CISM is a Mandated Operations Program!

32. 22 February 200832 CAP’s CISM Program  Mandated by CAPR 60-5  Not optional  Specifically an operations program  Implementation is assigned to Region Commanders by CAPR 60-5  Wings are to “assess the need for a CIST”  All personnel are encouraged to receive CIS training.

33. 22 February 200833 Funding CISM  CISM is not, presently, a specifically USAF funded mission (by itself).  CAP CISM may be funded through an existing mission’s funding.

34. 22 February 200834 Funding CISM CAP National HQ has approved limited funding to support CISM missions.  Housing and feeding of a team will normally NOT be reimbursed.  The “use of host families” is encouraged to mitigate housing costs.

35. 22 February 200835 Compare these... $187,000.00 According to the Wing Aircraft Maintenance Officer, HQ- TX Wing expects to spend approximately $187,000.00 this year to maintain our fleet of airplanes. But … How much are we spending to maintain our most valuable asset OUR PEOPLE?

36. 22 February 200836 Everything you ever wanted to know about CAP CISM in Northeast Region

37. 22 February 200837 Request & Deployment  After a SAR or DR mission “… a review of the need for CIS intervention should be made for all personnel...”  The Incident Commander or Unit Commander will pass a request to Wing Commander.  In consultation with staff, the Wing CC will coordinate use of a local non-CAP team or request one of the Region Teams.

38. 22 February 200838 For More Information...  Visit the website of the International Critical Incident Stress Foundation (ICISF) at http://www.icisf.org.  Join the ICISF.  Review CAPR 60-5.

39. 22 February 200839 For More Information Contact the NER CIS Staff - Jack Arena, NER CIS 631-645-7912 (cell), mission 442002@yahoo.commission 442002@yahoo.com - Paul Mondoux, NER Deputy CIS 603-424-3019 (home) or 603-759-0178 (cell), paul@nhplm.org  www.icisf.org www.icisf.org  www.capcism.com www.capcism.com  www.ner.cap.gov/cism/ops_cism.htm www.ner.cap.gov/cism/ops_cism.htm  http://cism.nhplm.org/index.php

40. 22 February 200840 All CISM Interventions Are Strictly Confidential!

41. 22 February 200841 Any Questions?