Critical Incident Stress Management (CISM)

Critical Incident Stress Management (CISM)
9/17/2018 Headquarters Southwest Region Civil Air Patrol/USAF-Auxiliary Critical Incident Stress Management (CISM) ================================= Welcome remarks: Good morning (afternoon, etc.). I would like to welcome you to this PEP Talk on critical incident stress management. I’m (your name). Tell a little bit about yourself. As appropriate, tend to any “housekeeping” chores, eg, location of exits, bathrooms, break and lunch times, etc. 9/17/2018 Southwest Region CAP CISM PEP Talk

Pre-Exposure Preparation Talk
9/17/2018 A CISM PEP Talk Pre-Exposure Preparation Talk We call this presentation a PEP Talk… A “pre-exposure preparation talk.” It is not designed to train you to be a Critical Incident Stress Team member, but it is designed to give you an in-depth over-view of CISM and how we use it in the Civil Air Patrol. 9/17/2018 Southwest Region CAP CISM PEP Talk

Objectives of this presentation:
9/17/2018 Objectives of this presentation: To provide the participants with ... A review of the causes and effects of stress Some cues to identify stress and tools to manage it An overview of critical incident stress, crisis management, and critical incident stress management (CISM) An orientation to CAP’s CISM program ================================= Read slide 9/17/2018 Southwest Region CAP CISM PEP Talk

CISM is a Mandated Operations Program!
9/17/2018 CISM is a Mandated Operations Program! ================================= Within CAP, CISM is not just a Chaplain’s program, and it’s not a mental health program. It is a peer-driven Operations program with mental health oversight (Click to put red oval around “Operations.”) mandated by CAP Regulation 60-5 (E). (Click to put red oval around “CAP Reg.”) “This regulation prescribes concepts, policies, and standards that govern all CAP personnel in the training, qualification and implementation of Critical Incident Stress Teams (CIST).” CAPR 60-5 Let’s start off by talking a little about stress. (go to next slide) It is not just a Chaplain’s program! 9/17/2018 Southwest Region CAP CISM PEP Talk

“A state of physical and emotional arousal.”
9/17/2018 Just What is Stress? “A state of physical and emotional arousal.” ================================= Read slide title. Ask participants for their definitions. Then click again for answer to appear. We’ve all been here at one time or another. 9/17/2018 Southwest Region CAP CISM PEP Talk

Where Does Stress Come From?
9/17/2018 Where Does Stress Come From? Stimulus Stressor stimulus/demand Response Stress Response ================================= For every stimulus, there is some sort of response. Ask for examples: eg, kick a ball, it rolls away; call “ten hut,” and cadets, hopefully, snap to attention. :-) ; smell a pot roast cooking, begin to salivate. Likewise, for every stressor or demand in our lives, there is also a physical or psychological response. Let’s back up a bit and review a few definitions. Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

Southwest Region CAP CISM PEP Talk
9/17/2018 Some Definitions ... Stressor -- a stimulus that causes, evokes, or is otherwise strongly associated with the stress response Stress response -- Nonspecific response of the body to a demand(s) Target organ(s) -- The part of the body, or mind, that is the recipient of the stress response and which develops the signs & symptoms of over-arousal ================================= These definitions are taken directly from Mitchell and Everly’s CISM manual “Critical Incident Stress Management: Group Crisis Intervention.” Read slide. Imagine a stressor like being caught in a traffic jam. What might the stress responses and target organs be? Elicit student responses. The stress response may be increased adrenaline or feelings of anxiety. The target organs then might be increased heart rate, increased blood pressure, or anxiety. Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 For example ... While flying, the stressors of heat and G-forces affect the body. Next a stress response occurs in the inner ear leading to a condition known as “vertigo.” Then the target organ of the stomach is over-aroused and decides to “get rid of food!” ================================= Here’s an example to which many of us can relate. Read or paraphrase each bullet. After the third bullet: And what does that give us? Click to bring in “airsickness.” … airsickness 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 2 “Varieties” of Stress ... “Eustress” equals Good Stress --- Positive, motivating stress “Distress” equals Bad Stress --- Negative, excessive, debilitating stress ================================= Read slide. Depending on time frame, ask participants to give some examples of good and bad stressors or provide these yourself. Some examples: Good stressors: Physical exercise Flying Birth of a child Holidays Bad stressors: Late to an appointment Work project behind schedule or over budget Traffic Disasters: natural or man-made Death of family or colleague 9/17/2018 Southwest Region CAP CISM PEP Talk

Some Generic Sources of Stress ...
9/17/2018 Some Generic Sources of Stress ... Biogenic Environmental Personality ================================= Some generic sources of stress are biogenic, environmental, and individual personality. Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

Some Biogenic Stressors ...
9/17/2018 Some Biogenic Stressors ... Caffeine Nicotine Amphetamines Cold & allergy medicines Theophylline Illness Lack of sleep ================================= Read slide. FYI WARNING: Phenylpropanolamine can still be found in some cold remedies; however, PPA increases the risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain), and the FDA recommends that consumers not use any products that contain PPA. Theophyline is a bronchodilator used to relieve acute bronchospasms. It can cause central nervous system, cardiovascular, gastrointestinal and respiratory reactions. Now let’s talk about environmental stressors. Ask for some examples, then click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

Some Environmental Stressors ...
9/17/2018 Some Environmental Stressors ... Rain Temperature extremes Sounds --- screams Mud Smells G-forces Time of day ================================= Read slide. What are some ways that these environmental stressors affect our bodies and psychological states? Get a couple of examples from the group. Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

The way people are “hard-wired.”
9/17/2018 Personality The way people are “hard-wired.” ================================= We’re all hard-wired differently, each with our own personalities and ways of coping with stresses that come our way. Of course, something that stresses any one of us may have little effect or a different effect on others of us. However…Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Stress is Cumulative It builds up over time ... ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Cumulative Stress Is stress that ... Piles up (snowballs). Increases with time. Deteriorates: * Performance * Relationships * Health ================================= Cumulative stress is stress that can pile up or snowball. As it increases over time, it can ultimately cause deterioration of your performance (both at work and at play), in your relationships, and/or in your health. 9/17/2018 Southwest Region CAP CISM PEP Talk

We Used to Call it “Burnout”
9/17/2018 We Used to Call it “Burnout” Increased cynicism. Increased physical lethargy. Procrastination. In the extreme … even … suicidal or homicidal thoughts or ideations. ================================= We used to call this cumulative stress “burnout.” I’m sure we’ve all seen this manifested in many ways, such as… Read slide. These things can happen both at work and in our volunteer activities. 9/17/2018 Southwest Region CAP CISM PEP Talk

Some Signs & Symptoms of Cumulative Stress
9/17/2018 Some Signs & Symptoms of Cumulative Stress Tardiness Fatigue Detachment Depression Medication or drug use. Irritability “Gallows” humor Paranoia, or irrational fears. Derogatory speech or labeling of others. Denial Increased workplace absences. Irresponsibility ================================= Here are some signs and symptoms that one might experience with cumulative stress. Read off a few from the slide. We may all feel some of these things from time to time. They become a problem as they build up and increase in number. 9/17/2018 Southwest Region CAP CISM PEP Talk

An Example of Cumulative Stress ...
9/17/2018 An Example of Cumulative Stress ... ================================= One of the most tragic stories of the jet age revolves around the unfortunate de Havilland Comet (D.H.106 Comet). Following World War II, de Havilland developed and flew the first commercial jet aircraft in 1949. Because it represented such a revolutionary advance in commercial travel, the Comet was put through an extensive series of test flights and certifications over the next three years. These 500 hours worth of flight crew training and proving flights included long overseas flights, tropical operations, and high altitude takeoffs. Having successfully completed these tests with no apparent difficulties, launch customer BOAC received permission to begin commercial operations in early The first hint of trouble with the design came exactly one year after these operations began when a Comet mysteriously crashed shortly after takeoff on May 2, Two similar crashes in early 1954 forced British authorities to ground the entire fleet pending investigation. Over the following months, extensive tests were performed on the aircraft to determine what could have caused these mysterious accidents. The answer finally came after a fuselage had been submerged in a tank of water and repeatedly pressurized and depressurized to represent repeated flight cycles. After several thousand of these cycles, fatigue cracks were found to be spreading from the square edges of the windows in the passenger cabin. These cracks would eventually reach a critical size where they would grow rapidly resulting in a catastrophic depressurization that would destroy an aircraft in flight. The De Havilland “Comet” -- The World’s First Commercial Jet Airliner 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Like With The Airliner ... Stress is the “wear and tear” on our human coping systems. Over time minor stresses can have major and damaging effects. This is the cumulative effect of stress. ================================= Read first paragraph of slide. Click to have graphic appear. Then click for last of text and read it. … and we can crash too! 9/17/2018 Southwest Region CAP CISM PEP Talk

Critical Incident Stress
9/17/2018 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) ================================= Read slide. In other words, critical incident stress is a NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT. 9/17/2018 Southwest Region CAP CISM PEP Talk

Cumulative stress can exacerbate critical incident stress.
9/17/2018 Cumulative stress can exacerbate critical incident stress. ================================= Cumulative stress CAN make critical incident stress even worse. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Critical Incidents are events that have the potential to create significant human distress and can overwhelm the usual coping mechanisms of individuals and/or groups. ================================= Read slide. Not all critical incidents will create significant distress or overwhelm our coping mechanisms, but the potential is there, nonetheless. This is what we all must be aware of and watch for. 9/17/2018 Southwest Region CAP CISM PEP Talk

How to Recognize Excessive Stress?
9/17/2018 How to Recognize Excessive Stress? ================================= Now let’s talk a little bit about recognizing excessive stress. Ask participants to identify some signs of stress in this picture from 9/11. Be sure to note that even the animals react to stress in their environment and need care as well. 9/17/2018 Southwest Region CAP CISM PEP Talk

Manifestations of Distress Can Take a Number of Forms...
9/17/2018 Manifestations of Distress Can Take a Number of Forms... Physical Cognitive Emotional Behavioral ================================= Stress can manifest itself in several ways: Physical…the way our body responds Cognitive…the way we think or perceive Emotional…the way we feel Behavioral…the way we act 9/17/2018 Southwest Region CAP CISM PEP Talk

Physical Manifestations
9/17/2018 Physical Manifestations Excessive sweating Nausea and/or vomiting Elevated pulse rate Elevated blood pressure Rapid breathing Dizziness ================================= Physical manifestations include such things as….Read slide.Click to make each line of text appear. If time permits, ask one or two participants to describe a personal example of their physical response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). 9/17/2018 Southwest Region CAP CISM PEP Talk

Cognitive Signs Confusion. Mumbling of words
9/17/2018 Cognitive Signs Confusion. Mumbling of words Difficulty making decisions Decreased concentration Memory dysfunction ================================= Cognitive manifestations include such things as….Read slide. If time permits, ask one or two participants to describe a personal example of their cognitive response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). 9/17/2018 Southwest Region CAP CISM PEP Talk

Feeling totally overwhelmed
9/17/2018 Emotional Signs Emotional Shock Anger Grief Depression Feeling totally overwhelmed ================================= Emotional signs include such things as….Read slide. If time permits, ask one or two participants to describe a personal example of their emotional response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). 9/17/2018 Southwest Region CAP CISM PEP Talk

Behavioral Signs Changes in ordinary behavior Changes in eating habits
9/17/2018 Behavioral Signs Changes in ordinary behavior Changes in eating habits Decreased personal hygiene Prolonged silences Withdrawal ================================= Behavioral signs include such things as….Read slide. If time permits, ask one or two participants to describe a personal example of their behavioral response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). 9/17/2018 Southwest Region CAP CISM PEP Talk

Stress Response Timelines
9/17/2018 Stress Response Timelines Immediate -- up to 24 hours post event. Delayed to 72 hours post event. Cumulative -- buildup of stress over time. ================================= Responses to stress generally fall into 3 groups w/respect to time. Immediate--up to 24 hours after the event. Ask for examples. Refer back to previous slides (cognitive, emotional, behavioral reactions. Delayed--one to three days after the event. Ask for examples. Refer back to previous slides (cognitive, emotional, behavioral reactions. Cumulative--as stress builds up over time. Ask for examples. Refer back to previous slides (cognitive, emotional, behavioral reactions. 9/17/2018 Southwest Region CAP CISM PEP Talk

Post-Traumatic Stress is ...
9/17/2018 Post-Traumatic Stress is ... “… a normal reaction in a normal person, to an abnormal event.” “… a survival mechanism, whereas Post-Traumatic Stress Disorder (PTSD) is a pathogenic (unhealthy) variation of that normal survival mechanism.” ================================= Read slide. Emphasize that post-traumatic stress is NORMAL, whereas post-traumatic stress disorder is an unhealthy response to PTS. 9/17/2018 Southwest Region CAP CISM PEP Talk

Examples of Critical Incidents
9/17/2018 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 ================================= 90% of US citizens will be exposed to a traumatic event during their lifetime. (Breslau, et al., 1998) Here are some examples of critical incidents. Left click to add each example. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 A Crisis A response to an event wherein ... 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. ================================= Click to bring in each component. A crisis is a response to an event wherein: 1. an individual’s psychological homeostasis, or psychological balance, is disrupted, 2. one’s usual coping mechanisms have failed, and 3. there is evidence of distress and significant functional impairment. (Everly and Mitchell, 1999) 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Crisis Intervention ================================= This brings us to crisis intervention. 9/17/2018 Southwest Region CAP CISM PEP Talk

Crisis Intervention is ...
9/17/2018 Crisis Intervention is ... The provision of timely “emotional first aid:” 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) ================================= Crisis intervention is psychological or emotional “first-aid.” Read slide. By way of analogy, then, crisis intervention is to psychotherapy, as physical first-aid is to surgery. Crisis intervention has 4 goals: 1. To stabilize symptoms of distress or impairment and prevent them from worsening 2. To reduce symptoms of distress 3. To re-establish functional capacity, or 4. To seek further assessment and/or a higher level of care. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Crisis Intervention Is but one aspect of a continuum of care. It requires specialized and unique training. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

Crisis Intervention Principles ...
9/17/2018 Crisis Intervention Principles ... Spell B -I -S -E -P Brevity Immediacy Simplicity Expectancy Proximity B I S E P ================================= Crisis intervention procedures have evolved from: the studies of grieving conducted after a major nightclub fire; from military writings on the three basic principles in crisis work--immediacy of interventions, proximity to the occurrence of the event, and the expectancy that the victim will return to adequate functioning; and an emphasis on primary and secondary prevention through community mental health programs. Crisis intervention may be thought of as urgent and acute psychological intervention. The hallmarks of these first interventions are: Click twice to have graphic and text appear. 9/17/2018 Southwest Region CAP CISM PEP Talk

Critical Incident Stress Management (CISM) is
9/17/2018 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. ================================= There is no single model of crisis intervention. CISM is a relatively new term that has emerged in the mental health literature within the last decade. CISM is a comprehensive, systematic program designed to mitigate stress resulting from a critical incident. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 The goals of CISM ... Prevent traumatic stress Mitigate traumatic stress Intervene to assist recovery from traumatic stress Accelerate recovery Restore function Maintain worker health and welfare ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

this year to maintain our fleet of airplanes.
9/17/2018 By way of analogy ... 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? ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 CISM is a comprehensive, systematic maintenance program for the overall well-being of our most valuable assets ================================= Read slide. … our members. 9/17/2018 Southwest Region CAP CISM PEP Talk

CISM involves many facets ...
9/17/2018 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) ================================= CISM involves a number of different kinds of interventions depending on need. List each item on this and the next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 CISM also involves ... One-on-one, individual crisis intervention Pastoral crisis intervention Family CISM Organizational crisis intervention / consultations Follow-up and referral mechanisms ================================= Continue reading list. We’ll discuss some of these in a bit more depth in a moment. 9/17/2018 Southwest Region CAP CISM PEP Talk

It is First Aid, not definitive care.
9/17/2018 CISM deals with the current circumstances, the current event or crisis … NOT … personal histories. ================================= CISM is not designed to deal with personal histories. It deals with the current event or crisis only. It is not designed to provide definitive care or psychotherapy. It does provide mental health “first aid” and referrals if further care is needed. It is First Aid, not definitive care. 9/17/2018 Southwest Region CAP CISM PEP Talk

Some Key Elements of CISM ...
9/17/2018 Some Key Elements of CISM ... ================================= Now let’s talk about the key elements of CISM in a bit more detail. 9/17/2018 Southwest Region CAP CISM PEP Talk

Pre-Incident Education
9/17/2018 Pre-Incident Education General information: stress, trauma, etc. Set expectations for actual experiences Teach stress management and coping skills ================================= Pre-crisis preparation and education is delivered to groups and organizations to provide general information on critical incident stress, To help set expectations for actual experiences, and To teach stress management and coping skills. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Demobilizations 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 ================================= Demobilizations are held to inform and consult, allow psychological decompression, and for stress management. They help transition large groups of emergency workers from large-scale disaster work to routine duties and home. Most sessions last about 30 minutes and allow an opportunity to assess group needs and alert workers to the possible effects of stress. These sessions are always followed by a more in-depth critical incident stress DEBRIEFING within a week. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 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 ================================= Defusings are symptom driven and occur within 12 hours of the incident. They are shortened versions of the CIS Debriefing, which is a much more intensive intervention that can take 2-3 hours. Defusings outnumber the formal debriefings by almost 2 to 1. Defusings are designed to mitigate symptoms and intense reactions to trauma, provide closure, and facilitate triage and the identification of those needing referral for follow-up. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 The Defusing 3-Step ... *Introduction *Exploration *Information ================================= Defusings are conducted in a 3-step process. Click to have dancers appear.Then click again for each line to appear. During the INTRODUCTION, the facilitator will do such things as state the purpose and goals for the session, motivate participants, set the rules, stress confidentiality, and describe the process. In the EXPLORATION phase, the facilitator will ask members of the group to describe what happened and share their experiences and reactions, and will assess the members need for further help. In the final INFORMATION phase, the facilitator will sum up the session, explain that the experiences and reactions are normal, and teach the participants stress survival skills. 9/17/2018 Southwest Region CAP CISM PEP Talk

The Critical Incident Stress Debriefing (CISD)
9/17/2018 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 days post event NOT psychotherapy! C I S D ================================= Both defusings and CISDs are group meetings or discussions about a traumatic event(s). They are based in crisis intervention and educational intervention theories. Although CISDs are guided by a mental health professional, they are peer driven. That is, the CISTeam will have members who have training and experience similar to the group being debriefed. This helps to establish trust and validate the experience. CISDs are held from 1-10 days after the event and last from 1-3 hours. They are held in a closed-circle format: no one enters or leaves once the debriefing starts. It is considered highly confidential. What is said in the room, stays in the room. However, CISDs are NOT psychotherapy. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Objectives of the CISD Education Ventilation Reassurance and forewarning Positive contact with a MHP Improvement of interagency cooperation Increase group cohesiveness Restore self-confidence Facilitation of follow-up ================================= The objectives of the CISD are to : Provide EDUCATION about stress and the effects of a critical incident on those involved Allow for VENTILATION of emotions in a supportive environment. Provide REASURANCE Provide POSITIVE CONTACT with a MH professional Improve INTERAGENCY COOPERATION Increase group COHESIVENESS Restore SELF-CONFIDENCE Facilitate FOLLOW-UP 9/17/2018 Southwest Region CAP CISM PEP Talk

CISDs consist of 7 stages ...
9/17/2018 CISDs consist of 7 stages ... ================================= The CISD process consists of 7 stages that begin on the COGNITIVE domain, progress into the EMOTIONAL domain, an ultimately return to the COGNITIVE domain. The process begins with INTRODUCTIONS, an explanation of the process and expectations. FACT: Describe the traumatic event from each participant’s perspective on a cognitive level. THOUGHT: Describe cognitive reactions and transition to emotional reactions REACTION: Identify the most traumatic aspect of the event and emotional reactions to it SYMPTOMS: Identify personal symptoms of distress and transition to cognitive level TEACHING: Educate participants about normal stress reactions and coping mechanisms. This provides a cognitive anchor. RE-ENTRY: Time to clarify ambiguities and provide “psychological closure.” Mitchell, 1991 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Family Support An essential component of a comprehensive CISM program Consists of: * Educational programs * CISD for significant others * Bereavement support -- grief and crisis counseling Provided by peers, MHP, clergy, trained spouses Includes children and elderly as well ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Referral ... Is made to obtain a more thorough a 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. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Follow-up ... Essential element in all CISM interventions. Can be made by: * Phone calls * Station / workplace visits * Home visits ================================= Follow-up is an essential element in all CISM interventions. It can be made by phone calls, station or workplace visits, or by home visits as appropriate. 9/17/2018 Southwest Region CAP CISM PEP Talk

All CISM Interventions Are Strictly Confidential!
9/17/2018 All CISM Interventions Are Strictly Confidential! ================================= All CISM interventions are strictly confidential. Anything--thoughts, feelings, and behaviors--brought out in an intervention are not talked about outside of the intervention. 9/17/2018 Southwest Region CAP CISM PEP Talk

Let’s compare two airliner crashes to see ...
9/17/2018 How well does CISM work? ================================= Let’s take a look at how well CISM works by comparing the responses to two airliner crashes. Let’s compare two airliner crashes to see ... 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 San Diego 1978 v. Cerritos 1986 San Diego Cerritos Total Killed Aircraft Survivors Homes Destroyed Killed on Ground ESP used Body Parts Recovered 10, ,000+ San Diego, PSA-182: 9/25/1978 Cerritos, Aeromexico: 8/31/1986 ================================= As you can see, both crashes are similar with respect to loss of life, damage, and number of emergency service personnel involved. 9/17/2018 Southwest Region CAP CISM PEP Talk

San Diego v. Cerritos cont’d …
9/17/2018 San Diego v. Cerritos cont’d … Types of Critical Incident Interventions Provided San Diego Cerritos 1986 Sporadic 1 on CISDs Crisis Interventions Demobilizations Crisis hotline Follow-ups with MHP’s ================================= After the San Diego crash, only sporadic 1-on-1 crisis interventions were performed. After the Cerritos crash, a number of crisis interventions were used including: critical incident stress debriefings, demobilizations, a crisis hotline, and follow-up referrals to mental health professionals. Here are the results of the interventions. Click to next slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

San Diego v. Cerritos 9/17/2018 Personnel losses, among responders, within 1 year of event: SD CER Ranking PD FD Personnel EMS Personnel ================================= Take a look at the personnel losses among responders within 1 year of the event. San Diego clearly had greater losses, especially among EMS responders, while Cerritos lost only 1 responder from their fire department. There is also significantly greater utilization of mental health services in San Diego vs Cerritos. Increase in MH utilization within community within 1 year: 31% % 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 CISM Works! ================================= Click to bring in graphic. As you can see, CISM works! 9/17/2018 Southwest Region CAP CISM PEP Talk

CISM in the Civil Air Patrol
9/17/2018 CISM in the Civil Air Patrol ================================= Now let’s talk a bit about CISM in the Civil Air Patrol. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 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. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

CAP’s CISM Program cont’d
9/17/2018 CAP’s CISM Program cont’d Wings are to “… assess the need for a CIST.” All personnel are encouraged to receive CIS training. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 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 ================================= Whenever possible, the CAP encourages the use of a local, non-CAP team which will limit the use of trained CAP teams to some extent and preserve resources. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 CAP’s CISM Program ... “… Each active duty Air Force base is required to have a CIST, which, with prior coordination, may be able to support CAP” --CAPR 60-5 (2)e ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 A CAP CIST Consists of: Mental Health Professionals (MHP) Peer Representatives CAPR 60-5 (3)a 2 ================================= A CAP CIST consists of trained peer and mental health senior members. --Mental health professionals include psychiatrists, clinical psychologists, Licensed Professional Counselors, Licensed Social Workers, mental health RNs, etc. --Peer representatives include chaplains, pilots, flight crews, ground team members, etc, who perform functions similar to those persons being helped. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 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. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Funding CISM CISM is not, presently, a specifically USAF funded mission (by itself). CAP CISM may be funded through an existing mission’s funding. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Funding CISM The CAP Natl HQ has approved limited funding to support CISM missions nationally. Housing and feeding of a team will normally NOT be reimbursed. The “… use of host families…” is encouraged to mitigate housing costs. ================================= Each of the CAP regions is eligible for limited funding from National HQ; however, CAP CIS teams normally receive NO reimbursement for food and lodging. While team members usually must pay these expenses, such costs can usually be itemized on their tax returns. When feasible, host families may be used to defray housing costs. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 For More Information ... Visit the web site of the International Critical Incident Stress Foundation (ICISF) at Join the ICISF. Review CAPR 60-5. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 For More Information ... Call Chaplain Don Brown at (936) or him at Sign up for the “Basic Critical Incident Stress Management” and other ICISF CISM courses. ================================= Read slide. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Any Questions? ================================= Read slide and answer questions. 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 ================================= Ask participants to describe how the characters in each panel could be responding to this incident. Include cognitive, emotional, and behavioral responses. Note the two characters in the background of the third panel. What might be going on there? What kinds of teams might be involved in this scenario? 9/17/2018 Southwest Region CAP CISM PEP Talk

9/17/2018 Credits Ch, Lt Col DONALD R. BROWN II, CAP SWR Deputy Chaplain and CISM Director Lt Col Sherry Jones, RN, CAP Special Advisor to the National Commander for CISM 1st Lt Penny Herndon-Finuf, RN, CAP SWR/TXWNG CISM Educational Officer 9/17/2018 Southwest Region CAP CISM PEP Talk

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