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Basic Critical Incident Stress Management

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Presentation on theme: "Basic Critical Incident Stress Management"— Presentation transcript:

1 Basic Critical Incident Stress Management
Daniel W. Clark, Ph.D. WSP Department Psychologist

2 What is Stress? "The nonspecific response of the body to any demand made upon it" (Selye) "Demands on the person which tax or exceed his adjustive resources" (Lazarus) "A particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his/her resources and endangering his/her well-being"

3 anything that threatens us pushes us scares us worries us thrills us
Components of Stress necessary for life subjective positive and negative anything that threatens us pushes us scares us worries us thrills us

4 Prolonged Stress… Physical Effects
muscle tension headaches lack of energy stomach problems immune system high blood pressure strokes sexual problems

5 Prolonged Stress... Psychological effects
depression anxiety anger confusion irritability impatience fear negativism memory problems helpless/hopeless

6 Prolonged Stress... Behavioral effects
Alcohol and drug use Change in usual behavior Withdrawal Acting out Silence / talkative Under / Overeating Hypervigilance Impulsive

7 Stressor Any event acting as a stimulus which places a demand upon a person, a group, or an organization.

8 What are your stressors?
Home Work Environment Biogenic Law Enforcement Psychosocial

9 Home Stressors Spouse/SO Children Family demands Finances
Role in the home Family illness Shift changes Relatives

10 Work Stressors Supervisor/subordinates Time demands Personal safety
Role at work Environment Shift work Work pace

11 Environmental Stressors
Pollution Crowding Temperature Noise

12 Biogenic Stressors Caffeine Nicotine Amphetamines
Stimulants which cause stress by virtue of the biochemical actions they exert on the body. Caffeine Nicotine Amphetamines

13 Law Enforcement Stressors
Irregular work schedule Danger of job/injury Human suffering/death Absence of closure Excessive paperwork Inadequate rewards Special assignments Unfavorable court decisions Corrections system Distorted media reports Public sentiment

14 Psychosocial Stressor
Those events that are interpreted or appraised as being challenging, threatening, or otherwise adverse. Like beauty -- They lie in the eye of the beholder.

15 “Real Life” Job Home Family Personal Nutrition Finances Security
Health Environment

16 Coping Techniques for Managing Stress

17 Steps in stress management
accept that you are constantly under stress explore areas causing negative stress practice effective stress management

18 Time Management Decide what's important and worth worrying about
Get organized Schedule time for relaxation and exercise Write it down!

19 Positive Attitude Know yourself and your "automatic thoughts"
Communicate and express your feelings Rally your support system Adopt a problem-solving approach

20 Problem-solving Approach
Can I change this?? Yes No Do it! Accept it!

21 (from The Seven Habits of Highly Effective People by Covey)
Think Win/Win Lose/Win Lose/Lose Win/Win Win/Lose I Win I Lose You Win You Lose (from The Seven Habits of Highly Effective People by Covey)

22 Relaxation Do something you enjoy, whether indoors
or out, alone or with others Do what is satisfying for you Set aside time for yourself

23 Exercise Exercise is a great way to relieve
physical and mental tension Improves physical resistance to stress Choose an activity that appeals to you

24 Don't accept substitutes for stress management

25 Crisis Intervention Peer Support Critical Incidents

26 Post-Traumatic Stress
is a normal reaction, in a normal person, to an abnormal event. WB page 31-35 Common theme throughout training

27 Post-Traumatic Stress
Post-traumatic stress is a survival mechanism, Post Traumatic Stress Disorder is a pathogenic version of that survival mechanism. Note difference between PTS and PTSD

28 Post Traumatic Stress Disorder Brief History
First Named in DSM - III, 1980 Military awareness Civil War - nostalgia WWI - war neurosis, shellshock WWII - combat fatigue/exhaustion Post Vietnam - PTSD Prevalence General population: 1-2% Emergency Services: 16-20%

29 PTSD Diagnostic criteria – DSM V (A-E)
Exposure to a traumatic event (experienced/witnessed death/serious injury) Persistently reexperienced (intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuli (internal and external reminders) Negative alterations in cognition/mood (amnesia, anhedonia, detached) Increased arousal symptoms (sleep changes, anger, startle, hypervigilance)

30 Critical Incident In a career where day to day you respond to the abnormal events in other people’s lives; A critical incident is the one that, for whatever reason, is abnormal even for experienced personnel. Baby Jessica, child’s head falls off in your arms, overwhelming disaster like OKC or NY Trade Towers bombing

31 Critical Incidents The Terrible 10
Line of Duty Death Serious Line of Duty Injury Suicide of a Co-Worker Disaster / Multi-Casualty Incident Law Enforcement Shooting

32 Critical Incidents The Terrible 10
Events Involving Children Relatives of Known Victims Prolonged Incident - Especially with loss Excessive Media Interest Any Significant Event

33 Intensity of Impact Personal Relevance * Duration Sense of Loss
Previous History Guilt Social Support Coping Skills Relevance - ‘just like…’ Duration - more time=more trauma Previous History - ‘reminds me of…’ Guilt - esp. in “failed” endeavors Social support - when lacking, say in shooting like Trooper Linn’s or Trooper Sweet Coping skills - sufficient for this stressor?

34 Types of Interventions
Pre-Incident Education On Scene Support Services Peer Support (Individual Consults) Defusing Demobilization Critical Incident Stress Debriefing

35 Types of Interventions
Specialty Debriefings Significant Other Debriefings and Support Follow Up Services Mental Health Referral Services Community Assistance

36 Pre-Incident Education
Heart of Successful CISM Program Discuss Stress/Human Stress Response Describe CISM Services Explain What CISM Is Not Provides Outline for CISM Access Generates Positive Contacts

37 Peer Support/ Individual Crisis Intervention

38 Individual Crisis Intervention
Positives ‘Been there, done that’ Credibility Rapport Negatives May be too close Very vulnerable to counter-transference May over-identify

39 1:1 Crisis Intervention Communication Skills
Awareness of Acute Stress Symptoms Intervention Protocol Referral Options

40 Rest Information Transition Services (RITS)

41 Rest Information Transition Services (RITS)
Renamed from Demobilization Provided by trained CISM personnel. 10 minute informational talk. Describe stress reactions. List signs and symptoms. Outline stress survival strategies. 20 minute rest after talk is completed. Low fat, low sugar, low salt foods Non-caffeinated drinks Talk: intro speaker - only speaker talks stress sx are normal under the circumstances can become a problem if ignored describe stress sx (see page 34 of workbook) specific advice on eating, resting, avoid alcohol, etc announce CISD if one is planned Questions?? Move into food area and start next group EX: Guyana Do not send back to scene - only used after finished at scene and prior to deploying home

42 Crisis Management Briefing

43 Crisis Management Briefing
“…a group psychological crisis intervention designed to mitigate the levels of felt crisis and traumatic stress in the wake of terrorism, mass disasters, violence, and other “large scale” crises.” IJEMH v2(1) p (2000)

44 Crisis Management Briefing Goals
Inform and consult Allow psychological decompression Stress management Similar to Demobilization but for non-operational personnel

45 Defusing

46 Defusing means to render something harmless before it can do damage.

47 Defusing A small group intervention applied within
hours of a critical incident.

48 Defusing Introduction Exploration Information

49 Critical Incident Stress Debriefing

50 Critical Incident Stress Debriefing
The goal of a Critical Incident Stress Debriefing is psychological closure.

51 Debriefing Considerations
Large scale incident. Prolonged incident. Circumstances out of the ordinary. CISD is not therapy CISD is not a substitute for therapy.

52 Debriefing Phases Introduction (C) Fact (C) Thought (C E) Reaction (E)
Symptom (E C) Teaching (C) Re-Entry (C)

53 Mental Health Services
Psychotherapy for employees and family members: Individual Marital/couples Group Trooper applicant screening Training/Academy instruction Command consultation

54 Referrals & Appointments
Directed Voluntary Appointments Days off Medical leave Supervisor’s discretion

55 Confidentiality/ Privileged Communication
Privacy: a personal right which limits the access of others to certain information about one’s self, body, mind, etc. Confidentiality: a professional duty to refrain from speaking about certain matters Privilege: a legal decision which provides relief from the duty to speak in court proceedings about certain matters

56 Limits of Confidentiality
RCW 71.05 RCW 26.44 RCW 74.34 Danger to self or others Abuse of children or DD adults Abuse of vulnerable adults Case review

57 Questions??

58 Washington State Patrol
Daniel W. Clark, Ph.D. Washington State Patrol 1405 Harrison Avenue NW Suite 205 Olympia, WA (360)

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