Preparing for the Unthinkable

2. Preparing for the Unthinkable Presented by: Tim P. Faulk, PhD, CTS Certified Trauma Specialist Clinical Director, Headland Police Department Clinical Director, Wiregrass Critical Incident Stress Management Team

3. Professional Background • Board Certified Expert in Traumatic Stress • Board Certified Expert in School Crisis Response • Approved CISM Instructor: Individual Crisis Intervention & Peer Support - International Critical Incident Stress Foundation (ICISF) • Approved CISM Instructor: Basic Group Crisis Intervention(ICISF) • Clinical Fellow, American Association for Marriage and Family Therapy

4. Objectives • Preparing for the Situation • Define Critical Incident Stress Management (CISM) • Define conflict and stress • Define the different body responses to stress • Understand the CISM Model

5. A Dale County School Bus Driver Murdered and A Kindergarten Student Taken Hostage

6. The Situation • On January 29th, 2013, an individual boarded a school bus then shot and killed the bus driver when his demand for two children wasn’t met. • He then took a 5 year old boy to an underground bunker where he was held as a hostage.

7. What NOW? • A Critical Incident Response plan became crucial in order to provide all related school employees with the coping skills to deal with the situation. • Implement of the plan to include not only school personnel, but individuals affected by the school crisis.

8. The Pre-Plan • In order to understand how the plan was developed, it is essential that you comprehend the process leading to the Plan. • The model implemented was CISM (Critical Incident Stress Management) which was developed by the International Critical Incident Stress Foundation (ICISF).

9. What is CISM? • Critical Incident Stress Management (CISM) is a comprehensive, integrated, systematic and multi-component crisis intervention program. • It was developed to help manage traumatic experiences within organizations and communities.

10. Overview CISM is a “package” of crisis intervention tactics that are strategically woven together to: 1) mitigate the impact of a traumatic event; 2) facilitate normal recovery processes in normal people, who are having normal reactions to traumatic events;

11. 3) restore individuals, groups and organizations to adaptive function; and to, 4) identify people within an organization or a community who would benefit from additional support services or a referral for further evaluation and, possibly, psychological treatment.

12. CISM is neither a form of psychotherapy, nor is it a substitute for psychotherapy.

13. What CISM really is…. • Instead, CISM is a broad collection of support services that can be selected and applied to assist people who are experiencing a strong reaction to a traumatic event. • In other words, it is “psychological first aid” or “emotional first aid.”

14. Similar to a toolbox with many tools for different purposes, CISM contains many crisis intervention “tools.” • Some of those tools are useful before a traumatic event occurs.

15. Others are useful while an event is ongoing. • Still others are available for when the event is over.

16. Critical Incidents Critical Incidents are unusually challenging events that have the potential to create significant human distress and can overwhelm one’s usual coping mechanisms.

17. Psychological Crisis • The psychological distress in response to critical incidents such as emergencies, disasters, traumatic events, terrorism, or catastrophes is called a psychological crisis. (Everly & Mitchell, 1999)

18. Four goals of crisis intervention • Mitigate the impact of the traumatic event (lower tension); • Facilitate normal recovery processes in normal people who are having normal reactions to abnormal events; • Restoration to adaptive function; • Facilitation of access to continued care.

19. History • 1989 – ICISF formulated an international network of crisis response teams (standardized training), • 1992 – American Red Cross began formalized training for establishing a nationwide disaster response capability,

20. History • 1997 – ICISF gained United Nations affiliation. • 2007 – The United Nations adopts an integrated, multi-component critical incident management approach as the overarching intervention system.

21. History • Although not called CISM until the mid 1980s, critical incident stress management concepts were introduced into the emergency services field in 1974. • They were first developed to assist emergency operations personnel, such as police officers, firefighters, emergency medical and military personnel.

22. History • Over the last few decades CISM support services have extended well beyond their original intended target populations and now include school systems, the business sector, church groups and the industrial sector.

23. The impact of Stress • When a traumatic events happens, there are a collection of bodily reactions that occur. • In order to understand the CISM process, it is essential to understand these reactions and the impact they have following the traumatic event.

24. Understand the Stress Response • Stress is an elevation in a person’s state of arousal or readiness, caused by some stimulus or demand. • As stress arousal increases, health and performance actually improve.

25. Understanding Stress • However, at some point stress arousal reaches maximum level, then the deterioration of health and performance begins. • Some stress is a part of daily life and it affects everyone. Certain kinds of stress are actually helpful because they keep you on your toes.

26. What Stress Is Not! The confusion created when your mind overrides your body’s basic desire to choke the living mess out of some person who desperately needs it.

27. Common Stress Response • Emotional: • Fear • Anxiety • Overwhelmed • Frustrated • Alone • Anger • Grief

28. Common Stress Response • Physical: • Tired • Nausea • Sweating • Faintness • Shortness of breath • Easily startled • Headaches

29. Common Stress Response • Social • Isolation • Blaming • Difficulty in giving or accepting support or help • Hypervigilant

30. Psychological Crisis An acute responseto a trauma, disaster, or other critical incident wherein: • Psychological homeostasis (balance) is disrupted (increased stress). • One’s usual coping mechanisms have failed. • There is evidence of significant distress, impairment, and/or dysfunction. (adapted from Caplan, 1964, Preventive Psychiatry)

31. Reactions Pre and Post Event PRE-EVENT EVENT FEELINGS THOUGHTS THOUGHTS FEELINGS CRISIS

32. Traumatic Events • A traumatic event is defined as any event that has sufficient impact to overwhelm the usually effective coping skills of either an individual or a group. • These events are typically sudden, emotionally powerful, and outside the range of usual human experience.

33. Traumatic Events • These events may have a strong emotional effect even on well-trained and experienced individuals. • In a crisis, an individual’s sense of psychological balance is disrupted by an adverse event or stressor.

34. Coping?! • Most importantly, the individual’s usual coping mechanisms become temporarily ineffective. This leaves the individual potentially feeling overwhelmed, vulnerable, and/or agitated.

35. Traumatic Responses • There are five reactions to a traumatic event: • Emotional • Cognitive • Behavioral • Physiological • Spiritual

36. Emotional Responses • Shock • Highly anxious • Stunned • Emotionally numb • “In a fog” • Denial • Dazed • Panic/fear

37. Cognitive Responses • Impaired concentration • Confusion • Self-blame • Forgetfulness • Thoughts of losing control • Hypervigilance • Recurring thoughts of the event • Vulnerability

38. Behavioral Responses • Withdrawal • “Spacing out” • Non-communication • Impulsivity • Pacing • Exaggerated startle response • Inability to sit still • Erratic movements

39. Physiological Responses • Rapid heart rate • Elevated blood pressure • Fatigue • Anger • Grinding of teeth • Headaches • Gastrointestinal upset • Dizziness

40. Spiritual Responses • Feeling distance from God • Withdrawal from attending services • Sudden turning to God • Feeling that God is powerless • God doesn’t care • Questioning of one’s basic beliefs

41. Reactions • Important to recognize that these reactions do not represent an unhealthy response. • They may be viewed as a normal response to an abnormal event.

42. The Brain and Trauma • The amygdala, is a part of the emotional center of the brain, begins the process of emotional memories. • For a memory to be “filed” in the amygdala, the event must be logical in nature. If not, the memory lodges in the neurological system (5 senses).

43. The Question………. There must be something that will help alleviate the stress of a critical incident?

44. Now………. • In most situations, an intervention is the standard of care approach. • The intervention should be tailored to the situation and focus on the immediacy of the situation. • Pre-incident planning is the ideal, but…..!

45. The Answer! Having spent more than forty years in the area of crisis intervention, and upon reviewed all available material regarding the best method of crisis intervention it was determined the best method of crisis intervention was the services provided through the International Critical Incident Stress Foundation (ICISF), specifically CISM.

46. A Comprehensive, Integrated Multi-Component Crisis Intervention System (adapted from: Martha Starr) Each “leaf” represents a specific tactical intervention. #5 #7 #6 #4 #8 #3 #9 #10 #2 # 1 CISM

47. The Beauty of CISM CISM is guided by peer’s and directed by the Clinical Director and Team Leader!

48. The Beauty of CISM • “Ethos,” i.e. credibility, is one of the 3 core elements of interpersonal influence.Aristotle (ethos, pathos, logos) • Peer support personnel have an “ethos” (credibility) that no academic training program can create!

49. Elements of CISM • Pre-incident education and preparation • A form of psychological “immunization.” • The goal is to strengthen potential vulnerabilities and enhance psychological resiliency in individuals who may be at risk for psychological crisis and/or psychological traumatization. • Familiarization with common stressors, stress management, stress resistance training and crisis mitigation training.

50. Elements of CISM • Assessment • ALL Crisis Intervention should be based upon the Assessment of NEED…and the further ASSESSMENT of the most appropriate intervention