1. Critical Incident
Stress Management
CISM Update
Learning from the Past, . . . Progressing into the Future
Civil Air Patrol
Annual Conference & National Board Meeting
Friday, September 4, 2009
Developed by Lt. Col. Sam D. Bernard, Ph.D.
CAP CISM National Team Leader
Partial content from Chevron Publishing
3. Goals
To provide information concerning
various CISM topics concerning:
ICISF
CISM information
CAP CISM Program
4. ICISF
10th World Congress Jan-Feb 2009
Corporate downsizing
Staff reductions
Still viable and hosting regional
conferences nationwide
5. Other ICISF Courses
Group Basic CISM
Peer & Individual Crisis Intervention
Building Skills in CISM
Responding to School Crisis
Suicide: Prevention, Intervention & Postvention
Advanced Group CISM
Ps N
Strategic Response to Crisis ych ew C
olo ou
Emotional & Spiritual Care in Disaster gic rse
al F !
Pastoral Crisis Intervention I & II irs
tA
Stress Management for the Trauma Service Provider id
Team Evaluation and Management (TEAM)
Grief Following Trauma
Psychological Response to Terrorism: Impact and Implications
The Changing Face of Crisis Response and Disaster Mental
Health Intervention
6. Certificate of Specialized
Training
Emergency Services
Mass Disaster & Terrorism
Workplace & Industrial Applications
Schools & Children Crisis Response
Spiritual Care in Crisis Intervention
Substance Abuse Crisis Response
7. International
Critical Incident Stress
Foundation
3290 Pine Orchard Lane
Suite 106
Ellicott City, MD 21042
(410) 750-9600
Fax: (410) 750-9601
Emergency: (410) 313-2473
www.icisf.org
9. Take Home Message The Terrible 10 for CAP
1. 6.
...
not
2. l imi 7.
ted
to mis
3. 8. sio
ns !
4. 9.
5. 10.
10. Resistance
If the stressor continues,
the body mobilizes to Exhaustion
withstand the stress and Ongoing, extreme
return to normal. stressors eventually
deplete the body’s
resources so we
Alarm function at less
The body initially than normal.
responds to a
stressor with
changes that lower
resistance.
Return to
homeostasis
Homeostasis
Stressor The body systems
The stressor maintain a stable
may be threatening and consistent
or exhilarating. (balanced) state.
Illness
Illness and Death
The body’s resources are not
replenished and/or additional
stressors occur; the body Death
suffers breakdowns.
11. The brain becomes more alert.
Stress can contribute to headaches, anxiety,
and depression.
Sleep can be disrupted.
Stress hormones can damage the brain’s ability to
remember and cause neurons to atrophy and die.
Baseline anxiety level can increase.
Heart rate increases.
Persistently increased blood pressure and heart
rate can lead to potential for blood clotting and
increase the risk of stroke and heart attack.
Adrenal glands produce stress hormones.
Cortisol and other stress hormones can increase
appetite and thus body fat.
Stress can contribute to menstrual disorders in women.
Stress can contribute to impotence and
Red = immediate response premature ejaculation in men.
to stress Muscles tense.
Blue = effects of chronic Muscular twitches or “nervous tics” can
of prolonged stress result.
12. Mouth ulcers or “cold sores” can crop up.
Breathing quickens.
The lungs can become more
susceptible to colds and infections.
Immune system is suppressed.
Skin problems such as eczema and
psoriasis can appear.
Cortisol increases glucose production
in the liver, causing renal hypertension.
Digestive system slows down.
Stress can cause upset stomachs.
Red = immediate response to stress
Blue = effects of chronic of prolonged stress
14. Take Home Message Stress Reactions
Physiological Based
not
Characteriologically Flawed
16. Critical Incident Stress
Take Home Message
Identifiable traumatic event
Reactions begin with an event
Reactions worsen after event
Reactions follow expected patterns
Sudden changes are common in CIS
CIS reactions usually reduce with:
Peer assistance and,
With the passage of time
17. Characteriological &
Disciplinary Problems - continued
Take Home Message
Disciplinary problems have a long and
diffuse history
Problems may have preexisted entry into
the CAP job
Identifiable traumatic event(s) missing
Problems may exist in several other
important areas of the person’s life.
Problems do not easily resolve over time
even with help.
18. Take Home Message Crisis
Noun Bo
vs th
Verb
An acute reaction to a critical incident.
A name of a particular critical incident.
20. Psychological Crisis
An acute RESPONSE to a trauma,
disaster, or other critical incident
wherein there is evidence of
clinically significant:
1. Distress,
2. Impairment,
3. Dysfunction
adapted from Caplan, 1964, Preventive Psychiatry
21. Eustress vs Distress vs
Dysfunction
Eustress …positive, motivating stress… May be
associated with posttraumatic growth. No reliable
estimations on prevalence post disaster.
Distress…dyphoria post disaster…60-90% of those
directly affected experience acute distress (Rx =
Identify & Monitor)
Dysfunction…impairment of function post
disaster…20-49% of those directly affected may
experience more lasting or impairing dysfunction
(Rx = Identify, Assess, & Intervene)
[Assessment of dysfunction may be the sine qua non of disaster mental health]
22. Prioritizing the Intervention
Initially, given limited resources and the
potential to interfere with natural coping
mechanisms, intervention should be
targeted to issues that are URGENT and
IMPORTANT.
DISTRESS…urgent, but unimportant
DISTRESS…important but not urgent
DYSFUNCTION…urgent AND important
23. EUSTRESS vs. DISTRESS vs.
DYSFUNCTION
Eustress No Action Needed
(Positive, motivating)
Distress Identify, Assess,
(benign, mild) & Monitor
Dysfunction Identify, Assess,
(severe, impairment, & Take action
incapacitating)
24. Functionality…
may be defined as the ability of
an individual to recognize and
successfully attend to his/her
current responsibilities.
25. Signs and Symptoms
of
Distress and Dysfunction
I. Cognitive
II. Emotional
III. Behavioral
IV. Physical
V. Spiritual
26. I. Cognitive Distress
Inability to Concentrate
Difficulty in Decision Making
Preoccupation (obsessions) with Event
Confusion (“dumbing down”)
27. I. Severe Cognitive
Dysfunction
Suicidal/ Delusions
Homicidal Hallucinations
Ideation Persistent
Inability to
Hopelessness/
Understand Helplessness
Consequences of
Behavior
28. II. Emotional Distress
Anxiety
Irritability
Anger
Sadness
Fear
Phobia
Grief
30. After traumatic events, DEPRESSION
is most commonly associated with
LOSS.
ANXIETY, on the other hand, is
commonly associated with FEAR and
life-threatening exposure.
31. Posttraumatic stress (PTS)
is a normal survival
response; Posttraumatic
Stress Disorder (PTSD) is a
pathologic variant of that
normal survival reaction.
32. PTSD
A. Traumatic event
B. Intrusive memories
C. Avoidance, numbing, depression
D. Stress arousal
E. Symptoms last > 30 days
F. Impaired functioning (This is the most
important aspect of PTSD for the crisis
interventionist)
33. Crisis Intervention
Goals:
The Goal of Crisis Intervention is to foster
Resilience via:
1. Stabilization
2. Symptom reduction
3. Return to adaptive functioning, or
4. Facilitation of access to continued care
(adapted from Caplan, 1964, Preventive Psychiatry)
34. Crisis Characteristics
The relative balance between thought
processes and emotional processes is
disturbed,
The usual coping methods do not work
effectively,
There is evidence of mild to severe
impairment in individuals or groups
exposed to the critical incident,
Chevron Publishing, 2002
35. Pre-CRISIS Post CRISIS
FEELINGS
THOUGHTS
FEELINGS
THOUGHTS
CRISIS
37. Assessing the Need for
Crisis Intervention (CISM)
Take Home Message
Is this one of the CAP “Terrible 10”?
Are coping mechanisms working
effectively for EVERYONE?
Is there evidence of mild to severe
impairment in individuals or groups
exposed to the critical incident?
39. Peritraumatic Stress
Dissociation
Depersonalization, derealization, fugue states, amnesia
Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans
Intrusive Re-Experiencing
Flashbacks, terrifying memories or night mares, repetitive
automatic re-enactments
Avoidance
Agoraphobic-like social withdrawal
Hyperarousal
Panic episodes, startle reactions, fighting or temper problems
Anxiety
Debilitating worry, nervousness, vulnerability or powerlessness
Depression
Anhedonia, worthlessness, loss of interest in most activities,
awakening early, persistent fatigue, and lack of motivation
Problematic Substance Use
Abuse or dependency, self-medication
Affairs, 1998
Psychotic Symptoms
Delusions, hallucinations, bizarre thoughts or images, catatonia
40. Highest Risk for
Extreme Peritraumatic Stress
Life-Threatening danger, extreme violence, or
sudden death of others;
Extreme loss or destruction of their homes,
normal lives, and communities;
Intense emotional demands from distraught
survivors (rescue workers, counselors, caregivers);
Prior psychiatric or marital/family problems;
Prior significant loss (death of a loved one in the past year)
Cardena & Spiegel, 1993; Joseph et.al, 1994; Kooperman, et.al., 1994&5;
La Greca et.al.,1996; Lonigan, et.al., 1994; Schwarz & Kowalski, 1991;
Shalev, et.al., 1993 Disaster Mental Health Services-A guidebook for Clinicians & Administrators; Dept of Veterans
Affairs, 1998
41. Effects of Hyper-Arousal
Trouble sleeping Being more emotional
Difficulty Panicking
concentrating Intensified alertness
Heightened vigilance Reminders of the
Being easily startled trauma leading to
Being wary physical reactions
Rapid heart beat
Sudden crying Sweating
Becoming suddenly etc
angry Increased anxiety
42. Hyper-Arousal
Sleep Disturbances
Longer to fall asleep
Unable to fall asleep
More sensitive to noise
Awaken more often during the night
Have dreams and/or nightmares about the
trauma
Repetitive trauma dreams may awaken
and leave frightened and exhausted
43. CISM as Mitigation
Efforts attempt to prevent hazards from
developing into disasters altogether, or to
reduce the effects of disasters when they
occur.
Differs from the other phases because it
focuses on long-term measures for reducing
or eliminating risk.
Implementation of mitigation strategies can
be considered a part of the recovery process
if applied after a disaster occurs.
44. CISM as Mitigation
Structural or non-structural,
Is the most cost-efficient method for
reducing the impact of hazards.
Does include providing regulations . . . and
sanctions against those who refuse to
obey the regulations . . . potential risks to
the public fema.gov
A natural mesh with Public Affairs
45. Mitigating C I S
Take Home Message
Even with all the right programs,
briefings, teams, personnel, etc
lined up & available – there can still
be CIS.
We don’t know our member’s
baggage.
(Pre-existing conditions)
Pre-Exposure Training can help
ID potential psych/perceptual
contaminants
46. Mitigating Operational
Stress (OpStress)
Take Home Message
Frequent information / feedback to staff
Frequent rest breaks
Cold or hot environments might require
more frequent rest breaks
Rest areas away from stimuli
12 hour limit for same scene stimuli
Assure proper rehabilitation sector
Provide lavatory facilities
continued...
47. Mitigating OpStress - continued
Provide hand washing facilities
Take Home Message
Provide medical support to staff
Monitor hyper- or hypo-thermia
Proper food
Limit fat, sugar and salt
Fluid replacement
Provide drinking water
Provide fruit juices
Limit use of caffeine products
CISM on scene support services continued...
48. Mitigating OpStress - continued
Monitor signs of emotional distress
Take Home Message
Limit overall stimuli at incident
Give clear orders to personnel
Avoid conflicting orders to staff
Delegate authority
Frequent rest breaks for all
Back up leaders
Sectorization of the incident
Delegation of authority
Credit people for proper actions continued...
49. Take Home Message Mitigating OpStress - continued
Limit criticism to absolute minimum
Utilize a staging area for uninvolved
personnel
Limit exposure to event sights, sounds
and smells (reminders)
Announce time periodically
Rotate crews to alternate duties
Others ?
50. Take Home Message After Action Support
Thank personnel for their work
Consult with CISM team
Provide demobilization services on
large scale incident
Utilize services of CISM teams
Arrange defusing for unusual events
Consider debriefing for personnel if it
appears necessary* continued...
51. Take Home Message After Action Support - continued
Allow follow up services by CISM team
members
Critique incident operationally
Teach new procedures from lessons
learned
Consider the need for family support
Other ?
52. Addressing C I S
Take Home Message
Acknowledge the existence of CIS
Pre-incident education
Planning
Drills / practice
Pre-deployment briefings
Avoid avoidance of CIS
53. Summary of Commonly Used Crisis/ Disaster Interventions
(adapted from Raphael, 1986; Everly & Langlieb, 2003; NIMH, 2002; Sheehan, et
al., 2004; DHHS, 2004; Everly & Castellano, 2005; Everly & Parker, 2005; NOVA,
2002)
INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS
1. Pre-event Planning/ Pre-event Anticipated target/victim Anticipatory guidance. Preparation.
population. Foster resistance, resilience.
2. Assessment. Pre-intervention. Those directly & indirectly Determination of need for
exposed. intervention.
3. Indv. Crisis Intervention. As needed. Individuals as needed. Assessment. Screening.
(including "psyc first aid") Education. Normalization.
Reduction of acute distress.
Triage. Facilitation of continued
support.
4. Demobilization. Shift disengagement. Emergency personnel. Decompression.
Screening. Triage.
Education.
Ease transition.
5. Respite Sector. On-going Emergency personnel. Respite.
large-scale events. Refreshment.
Screening. Triage.
Support.
6. Large Group CMB As needed. Heterogeneous large Inform
& Large group groups. Control rumors.
psyc first aid Inc. cohesion.
54. INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS
7. “Group Debriefing” Post event... Small homogeneous groups c/ Ventilation. Information.
(CISD, ~1-10 days acute equal trauma exposure. Often Normalization
PD, GCI, incidents; workgroups, emergency Reduce acute distress.
MSD, ~3-4 wks post services, military. Inc. cohesion, resilience.
CED, mass disaster Screening
HERD) recovery phase. Triage.
Follow-up essential.
8. Defusing On-going events Small homogeneous groups. Stabilization. Ventilation (and
small group & Post event May be similar to HERD in Reduce acute distress.
"psychological first aid.") (< 12 Hrs) process. Screening.
May be repeated. Information.
Inc. cohesion, resilience.
9. Small Group On-going events Small groups seeking info. Information.
Crisis Management & Post event. c/o delving into affect. Control rumors.
Briefing (sCMB) May be repeated, Reduce acute distress
as needed. Inc. cohesion, resilience.
Screening/ Triage
55. INTERVENTION TIMING TARGET GROUP POTENTIAL GOALS
10. Family Crisis Pre-event & Families. Consists of a wide array
Intervention. As needed. of interventions incl.
Pre-event prep., individ.
intv., sCMB, debriefing,”
etc.
11. Organizational/ Leadership Pre-event & Organizations affected Improve organizational
Consultation As needed. by trauma or disaster. preparedness &
response.
12. Pastoral Crisis As needed. Those who desire faith-based Faith-based support, eg,
Intervention presence/ crisis intervention, eg, Info., advocacy, liaison.
Individs., small groups, Ministry of presence.
large groups, congregations, Religious intervention,
communities. if desired.
13. Follow-up, Referral. As needed. Intv. recipients & those exposed. Assure continuity of
care.
14. Strategic planning. Pre-event & Anticipated exposed/victim Improve overall
during. populations. disaster MH response.
56. Objectives of
Crisis Intervention
Stabilize situation
Mitigate impact
Mobilize resources
Normalize reactions
Restore to adaptive function
Chevron Publishing, 2002
59. Basic Crisis Guidelines
Never go beyond one’s level of training
Do not open discussions unless there is
sufficient time to process
The end of every crisis intervention occurs
when either the person is showing signs of
recovery or it becomes evident that a
referral is necessary
Chevron Publishing, 2002
60. Critical Incident
Stress Management
Comprehensive
Integrated
System utilizing a
Multi-Tactical
Crisis Intervention Approach
to Managing Traumatic Stress
61. Pre-Crisis Preparation /Education
On-scene Support / Consultation
Group Intervention
CISM: Menu of Services
Demobilization “T
ac
Crisis Management Briefing ti c
Defusing
s”
Critical Incident Stress Debriefing
Individual Crisis Intervention
Pastoral Crisis Intervention
Family / Sig. Other Support
Organizational Consultation
Follow-up and / or Referral
Post -event Education & Lessons Learned
62. Core Competencies in CISM
The ability to properly assess both the
situation and the severity of impact on
individuals and groups
Ability to develop a strategic plan
Individual crisis intervention skills
Large group crisis intervention skills
Small group crisis intervention skills
Referral skills
Chevron Publishing, 2002
63. Essential CISM Courses
(2 Days Each)
Assisting Individuals in Crisis
Basic Critical Incident Stress
Management: Group Crisis Interventions
Suicide
Grief Following Trauma
Advanced Critical Incident Stress Management: Group Crisis
Interventions
T.E.A.M.
Emotional & Spiritual Care in Disasters
Chevron Publishing, 2002
64. In addition to the essential
courses,
CISM providers are
encouraged to participate in a
variety of other training
opportunities to enhance their
skills.
Chevron Publishing, 2002
66. Pre-Crisis Preparation /Education
On-scene Support / Consultation
Group Intervention
CISM: Menu of Services
Demobilization “T
ac
Crisis Management Briefing ti c
Defusing
s”
Critical Incident Stress Debriefing
Individual Crisis Intervention
Pastoral Crisis Intervention
Family / Sig. Other Support
Organizational Consultation
Follow-up and / or Referral
Post -event Education & Lessons Learned
67. Strategic Planning
AKA: Tactics
Target Type Timing Theme Team Resources
Team Resources
On-Scene NOW! Victim Peers Peers
From Circles
CMB After Shift Grief Flight Friends
Demob. Tomorrow Loss Crew Neighbors
Defuse AM Survivor Ground Family
CISD Before Survivor Team Faith
1:1 Going Guilt Admin Community
Family Home Boss Commo Work
Admin After IC Cadet EAP
Consult Been CC Mental PCP
IC/CC Home 1-2 Violated Health Support
F/U Day World Outside Groups
View Tm Outside Tm
68. CISM Tactics
Must be Available for:
Individuals
Groups
Organizations
Families
Significant others
Chevron Publishing, 2002
69. CISM Components
Before an Incident
Education (PEP)
Team training
Planning
Administrative support
Protocol development
Guideline development
Networking with other teams
& resources
70. CISM Components
During an Incident
On-scene support services
One-on-one crisis intervention
Advice to supervisors/IC
Support to primary victims (CAP)
Provision of food, fluids, rest and other
services to operations personnel
Organizational Consultation (CC)
71. CISM Components
After an Incident
One-on-one crisis intervention
Demobilization (post-disaster, large group)
Crisis Management Briefing (CMB, large
group)
Defusing (small group)
Critical Incident Stress Debriefing (CISD,
small group)
Significant other support services
. . . more . . .
72. CISM Components
After an Incident
continued
Post-incident education
Follow-up services
Referrals according to needs
73. CISM
Typically: 3-5 contacts
After that,
Recovery is evident
Referral is indicated
74. Maslow’s Need Hierarchy
(1943)
SELF-ACTUALIZATION
Personal growth and fulfillment
Psychotherapy SELF-ESTEEM
Self-efficacy, empowerment
AFFILIATION, SUPPORT
Crisis Interpersonal & family relationships
Intervention SAFTEY
Physical and psychological security, law & order
Start here PHYSIOLOGICAL NEEDS
Basic life needs - air, food, water, shelter
75. Spectrum of Care
Critical Incident
Family Support
EAP
Crisis Intervention r
Chaplain
Human Resources
CISM Refer as
Family Advocate
needed Legal
to any
Mental Health
Psychotherapy
Hospitalization
Rehabilitation
Other resources
76. Treatment Referral Options
Medical Care Professional
MD / DO
PA / NP
Mental Health Care Professional
Psychologist
Counselor
Social Worker
Psychiatrist / NP / PA
Spiritual Care Professional
Faith Leader
“Chaplain”
77. CISM
Is not psychotherapy
Is not a substitute for psychotherapy
Is not a stand-alone
Is not a cure for PTSD, Depression,
Anxiety, etc
78. CISM has far more to do with
group support
and
assessment (triage)
than it does with
treatment and cure.
79. Follow-Up
Must be provided after every CISM service:
Assess impact of intervention
Assess for uncovering prior issues
Assess trajectory of reactions
• Decreasing 1w
• Same 1 m eek p
ont ost
• Increasing hp CIS
ost Ms
Assess for possible referral: CIS erv
Ms ice
Health Care Professional erv
i ce
Mental Health Care Professional
Spiritual Care Professional
80. P. A. S. S.
Post Action Staff Support
Dennis Potter, LCSW
81. Goals For PASS
Increase longevity of team members
Increase learning from the experience
Increase stress management skills
Decrease the chance for personal reactions
To take care of ourselves (too)
Increase effectiveness of team members
Monitor team for any adverse reactions
82. Why Do It?
To Prevent:
Vicarious Traumatization
Cumulative Stress
Critical Self Judgment
To Teach
To Practice What We Teach
“The same professionalism we provide to others,
we deserve ourselves” SDB
83. When Should It Be Done?
Should be a normal part of the team’s
standard operating guidelines,
Should be done prior to the team going
home (at least a defusing),
At the earliest next opportunity,
Soon,
Its never too late!
84. Where Should It Be Done?
Away from the site and participants,
Neutral site if possible,
Somewhere you will not be interrupted,
If the Critical Incident is particularly difficult
you may want to consider more time or
bringing in someone else,
Somewhere private if you are concerned
about the difficulty of the CISM response.
85. How Long Does It Take?
For “normal” events usually 10-15 minutes
is adequate,
For “abnormal” events 30-60 minutes may
be required,
If you always do it, you will discover the
difference between a normal and
abnormal event.
86. Who Should Do It?
Usually the “Event Team Leader”
Probably 90% can be done by the team itself
Occasionally, by someone not involved in
the response itself
Particularly difficult or events of long duration
87. Important Notice:
• All CISM services should be provided
only by people who have been
properly trained in Critical Incident
Stress Management courses,
• Having attained an advanced
academic degree alone does NOT
indicate knowledge of CISM or
related protocols.
89. Where We Are Now:
Web-Site
cism.cap.gov
Staff listings & contact information
Calendar of events / trainings
Forms & Handouts
Send training certificates / reports to . . .
“Certificates”
“Wing Reports” & “Region Reports”
90. Decentralization of Staff
Wings “Get’r done dudes” – Providing Frontline Service
Providing CISM services
Networking with other local non-CAP CISM teams
Regions “Make it happen” – Administrative Support
Administrative support and facilitation / paperwork
Technical assistance if needed
Maintains team records
Maintains ICISF Registered Team status with ICISF
Monthly conference calls with Wings
National “Lead into the future” – Overall Leadership
Develop training based on Wing and Region needs
Keep everyone updated on new ideas/issues
Monthly conference calls with Region s
91. Staff Structure
Wings – “Doing the CISM Work”
Officer/Coordinator
Clinical Director
Region – “Team Support & Administration”
Officer / Coordinator
Clinical Director
National – “Leading into the Future”
Team Leader
Clinical Director
92. Staff Structure
Officer / Coordinator
Administrator of the program within Wing or Region
Point person for Wing or Region
Coordinates service requests and services
Maintains paperwork for Wing or Region
Officiates “administration” portion of meetings/trainings
Clinical Director
Supervises all clinical aspects of program
Must be licensed in the state of residence and/or Wing of
membership
Conducts “clinical” portion of meetings/trainings
93. Required Training
Introduction to ICISF (On-line or classroom)
Program Orientation (On-line or classroom)
CISM Basic Concepts (On-line or classroom)
Group Crisis Intervention (Classroom only)
AND
Peer / Individual Crisis Intervention (Classroom Only)
NIMS:
NIMS 100 http://training.fema.gov/IS/NIMS.asp
NIMS 700 http://training.fema.gov/IS/NIMS.asp
ICS 300 and 400 is not required, but can aid in understanding command and general
staff issues.
94. Renewal / Refresher
Renewal / Refresher:
Group (2 Classroom days)
and
Individual (2 Classroom days)
or
Building Skills in CISM (2 Classroom days)
or
The Changing Face of CI and DMHI
(1 Classroom day or internet)
* CISM Service provision does not qualify for
renewal/refresher
While other ICISF and other organization’s courses are encouraged, to maintain basic CISM
skill sets and knowledge currency, the above courses are required on a 3 year rotation.
95. Recruiting
Ground team members and support personnel
Air crew member and support personnel
Administration personnel
Communications personnel
Physical health personnel (doctors, nurses, etc.)
Mental health personnel (psychologist, counselors, social
workers, etc)
Spiritual health personnel (chaplains, character
development, etc)
Cadets (training our replacements)
Elders - “Recycling” . . .
96. “Recycling” Members
Because:
•Physical injury nor disability
•Normal “aging”
does not eliminate:
•Experience & insight,
•Cognitive abilities & strategizing
•Positive coping skills, abilities, outlooks,
The CISM Program welcomes:
•Flight crews members who no longer fly
•Ground teams who don’t “ground pound”
•Administration and Communications folks
We still need you . . . you aren’t done yet
97. Cadets & CISM
•Introduction to CISM at “technician” level
•Cadet-to-Cadet Peer Support:
•Educate on effective listening & communication skills
•Provide awareness of suicide warning signs & how to
summons help
•How to help a friend
•Prepare for Senior Member CISM program
•Will Not:
•Participate in “Senior” CISM service provision in
support staff roles only,
•Be considered “peer” to any “senior” member
e need you . . . We’re Training Our Replacements
98. CISM Specialty Track
Technician: “Learning the program”
Knowledge Requirement:
Service Requirement:
Senior: “Doing & mentoring the program”
Knowledge Requirement:
Service Requirement:
Master: “Managing the program”
Knowledge Requirement:
Service Requirement:
99. Technician: Learning the program
Knowledge Requirement:
Introduction to ICISF
Orientation to CAP CISM Program * NIMS 100
CISM Basic Concepts * NIMS 700
ICISF’s Group Crisis Intervention
ICISF’s Individual/Peer Crisis Intervention
Service Requirement:
Serve in support role until completion of courses (above)
Actively participate in 6 CISM responses as an observer only
Actively participate in 4 Debriefings (non leader)
Actively participate in 4 Individual/Peer contacts
Actively participate in 6 Follow-Up contacts
Actively provide 4 Intro to ICISF presentations
Actively provide 4 Orientation to CAP CISM Program presentations
Attend 4 PEP trainings
Attend 75% of the Wing CISM meetings
100. Senior: Doing & mentoring the program
Knowledge Requirement:
ICISF’s Advanced Group
ICISF’s Suicide
ICISF’s Grief Following Trauma
Service Requirement:
Achieve Technician rating
Mentor 4 upcoming Technicians
Actively participate in 6 more CISM Mission/Training responses
Actively participate in 4 more debriefings (as leader)
Actively provide 4 more Individual/Peer contacts
Actively provide 6 more Follow-Up contacts
Meet with 1-2 local CISM teams 3 times minimum
Provide 3 CISM Basic Concepts presentations
Assist a Wing CISM Officer/Coordinator for 1 year (Team Coordinator,
Clinical Director, etc)
Attend 75% of the Wing CISM meetings/trainings
101. Master: Managing the program
Knowledge Requirement:
Strategic Response to Crisis
Team Evolution and Management
Emotional & Spiritual Care in Disasters
Service Requirement:
Achieve Senior rating
Mentor 4 upcoming Seniors
Actively participate in planning CISM involvement in 4 CAP
Exercises/Drills
Develop MOUs with 2 local non-CAP CISM teams
Participate in 4 meeting/trainings with non-CAP CISM teams,
Serve as a co-instructor (maximum of 10%) for a Group and
Individual/Peer course
Assist a Region CISM Officer for 1 year (Team Coordinator,
Clinical Director, etc.)
Attend 75% of the Wing and Region CISM meetings
102. Where to from here?
Satisfied with the knowledge & awareness
How to do more:
Join a team
Attain further CISM education
Provide further CISM education & awareness
Advocate for appropriate CISM services
Provide more:
Within your Squadron, Group, Wing, Region
With your family
At your place of work
In your community
For yourself
103. How To Become a Member
Complete basic trainings (technician)
Complete application & be accepted to a team
Participate in quarterly Team trainings
Participate in CAP CISM functions
Maintain currency
Participate in non-CAP CISM teams & functions
CISM Team membership is a privilege not a right.
104. “Knowledge itself is power”
Sir Francis Bacon
“Action is the proper fruit
of knowledge”
Thomas Fuller
106. National Staff
Lt Col Sam D. Bernard, PhD
National CISM Team Leader
(423) 322-3297 sam@sambernard.info
Maj Chris Latocki
Administrative Officer
( 813) 412-9231 clatocki@cism.cap.gov
110. Critical Incident Stress
Management
Lt. Col. Sam D. Bernard, Ph.D.
National CAP CISM Team Leader
(423) 322-3297Cell
sam@sambernard.info
www.sambernard.info
cism.cap.gov
111. Critical Incident
Stress Management
CISM Update
Learning from the Past, . . . Progressing into the Future
Developed by Lt. Col. Sam D. Bernard, Ph.D.
CAP CISM National Team Leader
Partial content from Chevron Publishing
Notes de l'éditeur
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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Resources Raphael, B. (1986). When Disaster Strikes…NY: Basic Books. NIMH. (2002). Mental Health and Mass Violence. NIH Pub. # 02-5138. Wash.DC: US Govt Printing Office. Everly, G.S., Jr. & Castellano, C. (2005) Psychological Counterterrorism & World War IV. Ellicott City, MD: Chevron Pub. Everly, G.S., Jr. & Parker, C.I. (Eds) (2005). Mental Health Aspects of Mass Disasters: Public Health Preparedness and Response. Balto: Johns Hopkins Center for Public Health Preparedness. 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
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Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
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Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
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Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Customize for National CISM Staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Customize for Region CISM Staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Customize for Wing CISM staffers 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
Learning Lab DO08: CISM Update Sam D. Bernard, PhD (Lt Col) National CISM Team Leader 9/4/09 1:30-3:00 pm
This slide should be customized for the presenter to provide specific contact information for participants. 9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update
9/4/09 1:30-3:00 pm Sam D. Bernard, PhD (Lt Col) National CISM Team Leader Learning Lab DO08: CISM Update