Critical Incident Stress Managment (C-I-S-M)
Not a One Size Fits All Concept
It is not a secret that people that work in the field of public safety are exposed to events outside of the norm. First responders, such as police officers and firefighters, see abnormal events on a daily basis and those incidents can have a long term effect on the workers that are exposed to them. While a member of the general public might have an encounter from time-to-time that leaves them frazzled, it is the repetition of employee exposure that is concerning to the public safety leader. Leadership needs to have a planned response to critical incident stress within their division, and one size does not fit all. Much like being a parent, every employee is another “child” that will react different to what they see and feel differently about how they are treated afterwards. There are many options available on addressing exposure to significant events; the only wrong thing a leader can do is absolutely nothing.
Twenty years ago there was less known about the psychological effects of the job. If there was any counseling at all, it was during choir practice. Contrary to its religious implications, this event had little to do with church. Choir practice is the industry term for the crew getting together after work with a six pack and talking about how f’d up the day was. Sometimes this occurred in the work parking lot on the tailgate of someone’s pickup. Other times, employees would turn their shirts inside out and sit in the local bar that was the favorite watering hole for public service workers. It was better than nothing. In hindsight, we’d rather have employees sharing what was bugging them than taking it home and stewing on it until they returned to duty. Unfortunately, it didn’t always assist employees develop the adaptive tools needed when exposed to psychological trauma.
Suicide statistics are hard to calculate, because they are not always reported, but according to the National Police Suicide Foundation there are 4 to 10 times the number of law enforcement suicides than the number of officers killed in the line of duty. The reasons for the discrepancy? The factors that contribute to suicide — mental health issues, addictions, relationship woes, etc. — are embarrassing and due to the stigma associated with them the reasons behind the death are either underreported or the scene is altered by family members who don’t want the dirty secret revealed to others. So much more is known today about what pushes someone towards self-destructive behavior. CISM programs can help provide the intervention necessary to change their course.
I am a veteran police officer, and have had CISM duties for much of my career. In the most recent years I have managed our agency’s peer support program — which is one sub-unit under the CISM umbrella. Being a member of peer support starts with caring about your co-workers, and having a level of trust with them. However, additional training also helps designated peers recognize when someone is in crisis and where to direct them for professional help, when needed. Every company, both public and private, should consider having a peer support program. It doesn’t take much to organize one and it is the first glimpse we get at whether an employee is having problems that are above and beyond the routine. How do we know if that week of sick leave is because of the flu or due to a major alcohol binge? Peer support works behind the scenes to confidentially help with these issues and direct employees to Employee Assistance Programs, social services, or merely to provide a constructive ear to those that need to vent. When made up of the right employees, no news becomes good news because many of the problems that might come up are addressed before they become much more challenging.
While peer support is important, there are times when it is not enough. Other elements of CISM, including crisis intervention stress debriefs and crisis management briefings, need to be scheduled when the one-on-ones are not enough to quickly reach those that have been involved in a significant event. These options may be more costly, as they require some scheduling and may include some additional labor expenditures. However, they have the benefit of reaching more people in a short period of time then individual meetings. While similar they have some unique differences that are worthy of discussion. The public safety leader should understand the differences and when to implement each one.
A critical incident stress debriefing (CISD) is a seven step small group intervention process. It is not psychotherapy and all the trained personnel involved understand that it doesn’t replace professional counseling — but those in attendance can be referred to additional therapy based on their needs. It is a focused discussion about a traumatic event lead by trained CISM personnel. It is homogeneous, meaning the uninvolved department head, family member or other concerned co-worker cannot attend. It is a small group intervention that allows people to share their individual feelings and one of its goals is to reestablish group cohesion and the performance of the unit. The attendees are guided through this group story-telling and provided with practical information to help them normalize their reactions to the event and aid in their recovery. It should be only used in the aftermath of an event significant enough to have generated strong reactions across the entire group. In other words, dysfunction has occurred and the normal group coping skills are not working. CISD’s can last several hours depending on the size of the group.
A crisis management briefing (CMB) has some substantial differences but also has its place in the realm of CISM. It too is an intervention technique designed to mitigate the effects of a significant event. However, it is a larger scale tool used when the amount of people touched by the event cannot meet in small groups for a focused interaction. These briefings are useful after large terrorist events, active shooters, or other substantial events where responders number in the hundreds. The CMB can accommodate up to 300 people and its goal is to provide information about the incident, control rumors, provide education on psychological distress, how to deal with stress management, and identify resources for additional support. These CMB’s are fairly structured and last around an hour. They are good ways to get out factual information, reduce some of the confusion and give leaders some credibility. Again, outside personnel are not invited into a crisis management briefing, especially media. At the end of a CMB, a short question and answer session is allowed and peer support personnel wander through the crowd in an effort to identify anyone that may be exhibiting psychological trauma. This is the town-hall meeting of the CISM techniques.
To some employees, a critical incident stress debriefing or crisis management briefing is the company’s automatic answer to a traumatic event. Said another way, these people believe a debriefing should occur after all significant events. This is a knife that can cut both ways. On one hand, when a debrief is scheduled employees are given a forum to discuss the event and provided with resources to help them deal with it. What isn’t discussed as often is the potential damage that is done by CISD’s and CMB’s. Some studies have shown that they are not the answer to significant psychological events. In fact, some of those employees that attend are more traumatized when they are given significant details of a horrific scene or must watch a co-worker break down emotionally because of how it affected them personally. This second hand trauma created by these events leads to psychological damage that may not have occurred otherwise. Survivor guilt and rescuer trauma are two types of problems created by these meetings.
On the other hand, if leaders decide to not have a debrief — hopefully after consulting with peer support team members around the company — some employees may be disheartened because the administration didn’t care enough to schedule healing events that would help the workers. These people are usually those on the periphery that were not involved in discussions with peer support and only have minimal information about what was done. When a decision is made to not have a CISD, CMB or some other form of crisis intervention meeting, it is a good idea for the leadership to communicate the department’s response. An e-mail to the work group or a meeting if a face-to-face response is possible, sharing an awareness of the event and the reminder of the peer support program goes a long way in restoring confidence in leadership and avoids the circulation of rumors that nothing has been done.
There are many more forms of critical incident stress management techniques. Defusing, debriefings, one-on-one meetings or some variation of all of them are used across the country to try an bring work groups back to status quo after significant events. It is a good idea for leadership to understand that healing comes in all shapes and sizes and it is worthwhile to proactively decide what some of those responses will be for their work group, before an event occurs. If nothing is done at all, other than the hope that co-workers will take care of each other, we are relying on the old unstructured choir practice mentality to guide the healing. We can’t afford to risk the loss of employees because they are unable to recover from this type of exposure.
