Critical Incident Stress Management

1. Critical Incident Stress Management FBI NAA Summer Conference July 2011 Chuck Russo, PhD American Military University Daytona Beach Police Department SPS Group, LLC

2. Chuck Russo, PhD Team Leader RDBHAT (ESF-8) Team Member: Volusia County CISM Daytona Beach PD CISM • Professor • AMU • Police Officer • Daytona Beach PD

3. Why I’m Here… NY Daily News Newsday

4. Goal of Presentation • Identify the importance of dealing with critical incident stressors • Psychological and physiological responses related to traumatic stress • Addressing how to break the code of silence

5. What is Critical Incident Stress Management? • Critical Incident Stress Management (CISM) is a brief intervention utilized to mitigate the stressors associated with exposure to a traumatic event • CISM is frequently confused with Critical Incident Stress Debriefing (CISD) • Debriefing just one component of the overall response

6. Stress and Law Enforcement • Police officers address their sworn duties and responsibilities with dedication and valor • Sometimes the compounded stresses of daily tragedies can become overwhelming and can lead to personal and professional stressors • Other first responders tend to respond to critical incidents in a team structure; police officers frequently do not

7. Sources of Stress and Law Enforcement • Organizational/administrative stressors • Daily field/job related stressors • Interaction with the criminal justice system • Personal stressors including the co-existence of the officer’s personal life and their professional life

8. How Has Law Enforcement Become More Stressful? • Unfortunately with current reductions in community resources, officers are faced with more complex emergencies • Community policing has intensified the level of responsibility placed on officers • Police officers have to react quickly to solve a multitude of problems

9. How Does Stress Impact Law Enforcement Officers? • Heightened divorce rates • Substance dependence/abuse • Depression • Financial difficulties • High rates of suicide

10. Critical Incident Stress & Traumatic Stress • Critical Incident Stress = Traumatic Stress • These terms are frequently used interchangeably • A critical incident usually occurs suddenly, is disturbing, or is an unusually challenging event that generates a strong emotional and/or reaction

11. Examples of Critical Incidents • Events that overwhelm an individuals normal coping mechanisms • Officer involved shootings • Line of duty injuries/deaths • Incidents when a child is a victim • Incidents involving death/serious injury to others • Disasters • Employee suicide

12. Impact of Traumatic Stress Engaging in response efforts during a critical incident is often stressful for all those involved in emergency response efforts; regardless of the responder’s ability to acknowledge the impact of their involvement

13. Impact of Traumatic Stress While this type of work is personally rewarding and challenging, it also has the potential for affecting responders in negative psychological and physiological ways

14. Commonly Recognized Definition of Stress The most commonly accepted definition: • Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize

15. Definition of Traumatic Stress • In the line of duty, first responders are trained to utilize tactical strategies in crisis situations, and they are quick to respond to protect the lives and property of those they serve • Unfortunately, a hidden danger is often ignored: TRAUMATIC STRESS!

16. What is Traumatic Stress? Precipitated by stressors that include sudden, disturbing, or unusually challenging events that generate a strong emotional and/or cognitive reaction Stressors Include: • Gruesome crashes • Homicides • Vicious crimes against a child/children • A close personal brush with death/injury • Officer involved shooting Return

17. Psychological and Physiological Responses to Traumatic Stress Exposure and side effects to traumatic stress are individualized and may include: • Physical symptoms • Psychological symptoms • Reoccurrence or re-victimization can occur if the first responder does not address the symptomology

18. Physiological Responses Examples encountered may include: • Increased fatigue – poor sleep and/or nightmares • Headaches • Muscle twitches • Unexplainable body aches and pain • Gastrointestinal distress

19. Physiological Responses Additional examples encountered include: • Weight loss or gain • Grinding of teeth • Chest pain • Difficulty breathing • Elevated heart rate and blood pressure

20. Psychological Responses Examples encountered may include: • Emotional detachment • Withdrawal from social situations • Mood swings, anger and aggression • Intrusive thoughts/obsessive compulsive behaviors • Anxiety, panic attacks, and nervous energy

21. Additional Psychological Symptoms More examples encountered may include: • Attention difficulties • Feelings of helplessness/hopelessness • Burnout • Depression • Grief • Interpersonal difficulties

22. Exposure to Traumatic Stress Often challenges an individual's sense of: • Sense of self-worth or self-esteem • Personal safety or sense of control • Impairs an individual’s ability to control their emotions • Increases their feelings of vulnerability

23. Frequent Exposure to Traumatic Stress Can lead to hypervigilance: • A heightened state of alert; whereby an individual is constantly awaiting additional real or perceived threats • An individual is constantly on guard and this is also referred to as increased arousal

24. How to Alleviate Symptoms Associated with Traumatic Stress? Engage in: • Debriefing • Defusing • Seek peer or supervisory support • Speak with a chaplin • Access EAP

25. Minimizing the Effects of Traumatic Stress Goal: • To facilitate a normal recovery process • To restore an individual’s level of adaptive functioning to their normal state of functioning

26. CISM • Definition of a Critical Incident • The Role of CISM • What CISM Does Not Do • How CISM Helps the First Responder • The CISM Team

27. Break Time We will begin again in 5 minutes.

28. Definition of a Critical Incident A critical incident is defined as: • A sudden or disturbing event • That generates a strong emotional and cognitive reaction

29. Critical Incidents Examples encountered in may include: • Officer involved shootings • Line of duty injuries/deaths • Incidents when a child is a victim • Incidents involving death/serious injury to others • Disasters • Employee suicide

30. What is CISM CISM is: • Early psychological support for First Responders

31. Goals of CISM • To mitigate the impact of the event • Facilitate normal recovery processes • Restoration to adaptive function

32. Role of CISM To provide: • Temporary • Active • Supportive • Confidential Assistance to aid the individual in crisis

33. What CISM Does Not Do CISM is NOT a function of/to: • Professional standards/internal affairs • Determine fitness for duty • Determine if policy was followed • Determine if state law was followed • Pass judgment on someone’s actions

34. How CISM Helps First Responders CISM helps by providing: • One-on-one peer support • Demobilization of information • Crisis management briefings • Defusing • Critical incident stress debriefings

35. One-on-One Peer Support Peer support is provided to individuals: • Mitigate symptoms • Return to previous level of functioning • Provide referrals if needed

36. Demobilization Information This occurs: • At shift disengagement • To inform and consult • Provide psychological decompression • Stress management • Typically occurs in large groups

37. Crisis Management Briefings This occurs: • At anytime post crisis • To inform and consult • Provide psychological decompression • Stress management • Typically occurs in large groups

38. Defusing This occurs: • Post crisis (within a 12 hour time period) • To address symptom mitigation • To assist with providing possible closure • Triage of services and presenting symptoms • Typically occurs in small groups

39. Critical Incident Stress Debriefing This occurs: • Post crisis (occurs within 1-10 days, 3-4 weeks following mass disasters) • Facilitates psychological closure • To address symptom mitigation • Triage of services and presenting symptoms • Typically occurs in small groups

40. Advantages of a CISM Team • Temporary • Active • Supportive • Confidential • Assistance to aid individuals involved in crisis situations

41. CISM Team The CISM Team consists of: • Team Coordinator • Team Leader • Team Members • Mental Health Professional • Police Chaplin Volunteers

42. Member Training • Specialized crisis intervention training • Small or large group crisis tactics • Recommended 50 to 80 hours of crisis intervention training in specialized areas

43. CISM Team Team members: • Have a responsibility and duty to keep information confidential • Shall not accuse or blame others of wrong doing • Shall refrain from engaging in any discussion involving responsibility or blame

44. CISM Team Activation • Responsibility of On-Scene Commander • Notify the CISM Team Coordinator of: • Officer involved shootings • Employee suicide • Mass casualty incident • Death or life threatening injury to a child • Incidents producing a high level of immediate or delayed emotional reaction

45. When Activated Team members should: • Avoid direct involvement in the incident • Make contact with the involved employees • Separate the employee from the scene if approved • Ensure involved employees are allowed to contact family members if desired • Assist the involved employee until stabilized

46. When Activated Team members should ensure employees: • Are allowed to stabilize/calm down in a private environment • Permitted to shower and change when approved for such action • Have clergy and other spiritual needs met • Have food and drink if desired • Encouraged to seek follow up counseling, if needed

47. Consequences of Failure to Address Critical Incident Stress • Negatively impacts all involved • Can lead to faulty decision making • Increased disciplinary problems

48. Consequences of Failure to Address Critical Incident Stress • Excessive use of sick leave, tardiness, and on-the-job accidents • Increased citizen complaints • Re-occurring officer turnover

49. CISM • Is for the employee experiencing a normal reaction to an abnormal event • Is to help the employee recover quicker from such an event • Is temporary, active and supportive • Is confidential

50. Every year, hundreds of officers experience intense, traumatic events that can have serious long-term consequences for them, their families, and their departments.