Critical Incident Stress Management

1
Critical Incident Stress Management
2
Why Prepare?

• The psychological states of emergency response
  personnel can have a direct effect on the mental
  and physical health of survivors of a trauma or
  disaster
• (Glass, 1956)

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Crisis

• An acute response to a Critical Incident wherein
• Psychological homeostasis has been disrupted
• Usual coping mechanisms have failed
• Some evidence of impairment is present

4
Seven Basic Truths

• Many experiences can be traumatic
• Some are traumatic to some, but not to all
• Various factors may make some more vulnerable
  than others
• Traumas create reactions now and later

• Experiencing these reactions means the situation
  was serious for you
• Reactions sometimes get worse before they get
  better
• Sometimes they reappear later

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Crisis Intervention

• Urgent and acute psychological first aid
  characterized by
• Immediacy
• Proximity
• Expectancy
• Brevity

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Goals of Crisis Intervention

• Stabilization of symptoms
• Mitigation of symptoms
• Restoration of independent functioning
• Facilitation to higher level of care if necessary

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Relative Intensity of Interventions
Demobilization
Introduction
Information
Defusing
Reentry
Exploration
Fact
Teaching
Fact
5 Phase CISD
Teaching
Reaction
Thought
Symptoms
7 Phase CISD
Reaction
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Common Problems

• Failure to understand ingredients of CISM
• Failure to understand group processes
• Inappropriate timing of interventions
• Group size
• Group is too heterogeneous
• Incomplete instructions/expectations
• Participants rush from FACT to REACTION

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Common Problems

• Failure to return to the Cognitive level
• Doing psychotherapy instead of Crisis
  Intervention
• Watch the F word
• Dwelling on past rather than current events
• Failure to provide closure
• Failure to follow-up

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Children Trauma2 6 Years

• Sleep disturbances
• Short and frequent expressions of sadness
• Tantrums
• Death is temporary
• Reunion fantasies
• Anxious attachment
• Reenactments
• Mute and withdrawn
• Regression

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Children Trauma6 10 Years

• Withdrawal of trust from adults
• Somatic complaints
• Regression/slowed maturation
• Behavior problems

• Expression through play and art
• Concentration problems
• Radical changes in behavior
• Savior fantasies

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Children Trauma10 14 Years

• Suppress thoughts and feelings
• Sense of meaninglessness of existence
• Somatic complaints

• Childlike behaviors and attitudes
• Symbolic interpretations
• Sense of foreshortened future

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What to do Ways to be helpful

• Offer hope that alternatives are available.
  Avoid glib reassurances.
• Take action. Remove means such as guns and other
  weapons.
• Get help from persons or agencies specializing in
  crisis intervention and suicide prevention.

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Intervention

• Gather information known stressors, family
  background, academic history, observable
  behaviors, childs statements.
• Approach child establish trust, show concern,
  offer self as a resource.

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Intervention

• Listen. Use normal speaking pattern. Keep
  questions gentle and respectful. Show concern
  with body language posture, eye contact,
  position
• Do not promise confidentiality. Let him or her
  know what youre going to do.