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Critical Incident Stress Management (CISM)
National Guard Critical Incident Stress Management (CISM) Trained Crisis Responder Program LTC Clarence Bowser State Family Programs Director
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Overview Military References… Trained Crisis Responder (TCR)…
Crisis Intervention… Critical Incidents… Post-Traumatic Stress… TCR Services… Rationale…
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References DoD: 6490.5 – Combat Stress Control Program Air Force:
AFI – Critical Incident Stress Management AFI Survivor Assistance Army: Field Manual FM 16-1, Annex F-1 "Critical Event Debriefings"
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Trained Crisis Responder
The National Guard TCR Program was developed from Critical Incident Stress Management (CISM) principles…
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(J.T. Mitchell, G.S. Everly, 1995)
Crisis Intervention “CISM is a subset of the general field of Crisis Intervention (CI) and may be thought of as the application of Crisis Intervention knowledge and techniques to high risk groups, e.g., emergency services, military, etc.” (J.T. Mitchell, G.S. Everly, 1995) CISM Critical Incident Stress Management
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CISM Services Trained Crisis Responders are the first line of defense in coping with Post-Traumatic Stress Reactions to Crisis events. CISM Services extend beyond the training levels of Trained Crisis Responders, therefore it is important for the TCR’s to work in concert with military and civilian CISM Teams… CISM Critical Incident Stress Management However it begins with AWARENESS!!!!!
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CISM Core Components Pre-Crisis preparation Demobilization
Crisis Management Briefing Defusing Critical Incident Stress Debriefing Individual crisis intervention 1:1 Family CISM Community consultation Pastoral Crisis Intervention Follow-up/Referral CISM Critical Incident Stress Management
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Trained Crisis Responder
Trained Crisis Responders provide psychological and emotional “Self-Aid and Buddy-Care”
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Spectrum Of Care Incident Crisis Intervention EAP TCR’s Legal
Chaplain CISM Mental Health Psychotherapy Hospitalization Refer where needed… Family Support Rehab An incident can be actions in combat, being shot at, fear of dying, suicide or death of a friend, (Ask audience!!!! What are some other examples of crisis incidents etc…. (Air crashes, vehicle accidents, disasters, multiple casualties, shootings, etc.) EAP????
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Critical Incidents Major Accidents (Air Crashes, etc.)…
Line of Duty Death(s)… Serious Line of Duty Injury(s)… Suicide of a Co-Worker… Disaster / Multi-Casualty Incident(s)… Shooting(s)…
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Critical Incidents Significant Events Involving Children…
Prolonged Incident(s) - Especially with loss… Excessive Community Media Interest… Any Significant Traumatic Event… Significant events involving children (lack of patience) All these events bring on added stress…
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Primary Goal CISM and the TCR Program are forms of crisis intervention designed to help reduce Post-Traumatic Stress Reactions to Critical Incidents… CISM Critical Incident Stress Management TCR Trained Crisis Responders
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Post-Traumatic Stress
is a normal reaction, in a normal person, to an abnormal event.
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Hallmarks of Crisis Intervention
Immediacy Proximity Expectancy Brevity Practical It’s learning how to toss a life raft, not a course in ship building
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NO.. NO ..NO Post traumatic stress
Is everyone who experiences traumatic distress suffering from the disorder know as Post Traumatic Stress Disorder? NO.. NO ..NO
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Post Traumatic Stress Disorder
PTSD represents a contradiction to some critically important assumption or belief about self and/or the world. (G.S. Everly, 1995)
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Post Traumatic Stress Disorder
A pathological and disabling variant of a normal stress reaction Very clear criteria …symptoms must be over 30 days and it is impairing function
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Important TCR Concept The TCR Program is NOT a stand alone process. Rather it is meant to be one part of a comprehensive CISM intervention program. TCR Trained Crisis Responder CISM Critical Incident Stress Management
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TCR Services… TCR’s can be in any section (personnel, security forces, fire, chaplain, medical, family support, etc.)… TCR’s are normally among your first responders to an incident… TCR’s can support official military and civilian CISM Teams… Trained Crisis Responders CISM Critical Incident Stress Management
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TCR Services… Pre-incident education, preparation…
One-on-one crisis intervention… Demobilizations (large groups of public safety)… Crisis Management Briefings [large groups of primary, secondary (emergency personnel), and tertiary (family, co-workers, etc.) victims]
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TCR Services… Family Support…
Organizational / Community intervention, consultation… Follow-up and referral for TCR’s & CISM services and/or continued care… Trained Crisis Responders CISM Critical Incident Stress Management
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Why have TCR’s and CISM programs? We can learn from past experience.
Rationale Why have TCR’s and CISM programs? We can learn from past experience. Trained Crisis Responders CISM Critical Incident Stress Management
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141 ARW Suicide December 1998 - Fairchild AFB WA
Just-retired Wing Commander Prior incidents in unit Impact on unit Chaplains from outside called in for first UTA following incident Ministered to entire wing UTA Unit Training Assembly
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141 ARW CRASH Six weeks after suicide of commander
Four members killed in Germany Chaplains called from outside; some had just been there Assigned to each family to assist local clergy and chaplains Memorial Service and Funerals
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Red Horse Crash March 2001 Army NG Sherpa crashed over Ga.
18 ANG and 3 ARNG members killed Chaplains called in for ministry Memorial Service and Funerals Continuing care for families
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Red Horse, cont’d Late July - Early August report
Some possible questions Chaplains and Line Colonels formed teams for each family Trained at Langley then deployed There to walk families through report and to offer pastoral care
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Comparison Total Killed 125 82 Plane Survivors 0 0
San Diego, CA Air Crash Cerritos, CA Air Crash Total Killed Plane Survivors Homes Destroyed Killed On Ground Emergency Personnel Body Parts Found 10,000 10,000
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Support Services Provided
Comparison Support Services Provided San Diego, CA Air Crash Sporadic One on One Cerritos, CA Air Crash On Scene One on One Demobilizations 12 Debriefings Hot Line Number One on One Follow Up Since 1978 to 1986 more services were available and provided
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Comparison Personnel Lost in 1 Year
San Diego, CA Air Crash Cerritos, CA Air Crash Police 5 - Fire 7 - 1 Paramedics 17 - Increase in Mental Health Services increase of 31% increase of 1% With increased emphasis and support provided the result is significant….
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Rationale Trauma and stress-related disorders are sometimes disabling and costly to treat… Interventions are designed to assist in preventing “burnout” and PTSD… Healthy employees are more productive and effective on the job… PTSD Post Traumatic Stress Disorder
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Friedman, et al, EAP Digest, 1988
Example 1… 100 trauma victims Intervention began after 6 months Average cost = $46, ea. 94% filed civil litigation Friedman, et al, EAP Digest, 1988
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Friedman, et al, EAP Digest, 1988
Example 2… 100 trauma victims Intervention began within 6 months Average cost = $8, ea. 13% filed civil litigation With action and support the cost and the civil litigation filed is lower….. Result savings in Medical costs and litigation Friedman, et al, EAP Digest, 1988
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Rationale On any given trauma/disaster, 4%-97% of the individuals exposed will develop Symptoms similar to PTSD. 16-30% of emergency responders are at risk of developing PTSD symptoms.
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Yandrick, EAPA Exchange, 1990
Rationale Disaster / Trauma planning (including CISM protocols) is appropriate for not only emergency response personnel and institutions, but for all business and industrial (and military) settings as well. Yandrick, EAPA Exchange, 1990 CISM Critical Incident Stress Management
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Trained Crisis Responders help
Main Goal Trained Crisis Responders help keep your team on the job!
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Academy for Innovative Ministry
WHERE YOU CAN LEARN THIS STUFF! Ch, LtCol Charles E. Woods Chief, Crisis Intervention McGhee Tyson ANG Base, TN
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AIM COURSES AIM course offerings available on-line:
https.//tys.tnknox.ang.af.mil/AAIM/AAIM.HTM This web site is accessible from a ".mil" computer only!
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CHAPLAIN SERVICE AND FAMILY SUPPORT
WHY DO CHAPLAINS EXIST? - First Amendment - ‘Provision without establishment’ Requirements Skills ‘neutral zone’ 100 % Confidentiality FIRST Amendment (Protects religious freedom, guarantees free speech, freedom of the press and assembly and the right to petition the government). PROVISION WITHOUT ESTABLISHMENT??????? (id what this is?)
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Chaplain Service and Family Support
LET’S TALK!
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