Daniel W Clark PhD Critical Concepts Consulting wwwCriticalConceptsorg Overview Crisis Intervention Critical Incidents amp CISM tools CISD Defusing CMB Recommendations WSHPCO drdancriticalconceptsorg ID: 911820
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Slide1
Designing an Effective Debriefing Session
Daniel W. Clark, Ph.D.Critical Concepts Consultingwww.CriticalConcepts.org
Slide2Overview
Crisis Intervention
Critical Incidents & CISM tools
CISD, Defusing, CMB
Recommendations
WSH/PCO drdan@criticalconcepts.org
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Slide3Crisis Intervention
Peer Support
Critical Incidents
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Slide4Crisis intervention
Crisis intervention practice roots can be found in military psychiatry, community mental health, and suicide intervention initiatives.WSH/PCO drdan@criticalconcepts.org
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Slide5Lessons learned from the military
“Nothing could be more striking than the comparison between the cases treated near the front and those treated far behind the lines…As soon as treatment near the front became possible, symptoms disappeared…with the result that sixty percent with a diagnosis of psychoneurosis were returned to duty from the field hospital (p. 994).”
Salmon (1919, NY Med J)
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Slide6Principles of Crisis Intervention
ProximityImmediacyExpectancySimplicity
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Slide7Crisis Incident Stress Management (CISM)
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Slide8Critical Incident Stress Management (CISM)
Comprehensive
Integrated
Phase Sensitive
Multi-component
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Slide9Critical Incident
In a career where day to day you respond to the abnormal events in other people’s lives;A critical incident is the
one
that, for whatever reason, is abnormal even for
experienced personnel.WSH/PCO drdan@criticalconcepts.org
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Slide10Types of Interventions
Tools Pre-Incident Education
Critical Incident Stress Debriefing
Peer Support (Individual Consults)
Defusing
Crisis Management Briefings
Rest Information Transition Services
Pastoral Crisis Intervention
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Slide11Types of Interventions
Tools On Scene Support Services
Specialty Debriefings
Significant Other Debriefings & Support
Follow Up Services
Mental Health Referral Services
Community AssistanceWSH/PCO drdan@criticalconcepts.org
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Slide12Critical IncidentsThe LE Terrible 10
Line of Duty Death
Serious line of duty injury
Suicide of a co-worker
Disaster / Multi-casualty incident
LEO shooting
OKC
, 19 APR 1995
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Slide13Critical IncidentsThe LE Terrible 10
Events involving kids
Relatives of known victims
Prolonged incident - Especially with loss
Excess media interest
Any Significant Event
Baby Jessica Rescue - 16 OCT 1987
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Slide14Intensity of Impact
Personal Relevance Duration Sense of Loss
Previous History
Guilt
Disruption
Social SupportCoping Skills
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Slide15Peer Support/
Individual Crisis Intervention
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Slide16Individual Crisis Intervention
Positives
‘Been there, done that’
Credibility
Rapport
Negatives
May be too close
May over-identify with peer
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Slide17Individual Crisis Intervention
Communication SkillsAwareness of Acute Stress Symptoms
Intervention Protocol
Referral Options
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Slide18Crisis Management Briefing
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Slide19Crisis Management Briefing
“…a group psychological crisis intervention designed to mitigate the levels of felt crisis and traumatic stress in the wake of terrorism, mass disasters, violence, and other “large scale” crises.”
IJEMH
v2(1) p. 53-57 (2000)
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Slide20Crisis Management Briefing
GoalsSupply facts about the incident
Allow psychological decompression
Provide stress management info
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Slide21Defusing
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Slide22Defusing
Defusing means to render something harmless before it can do damage.
A small group intervention applied within
hours of a critical incident.
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Slide23Goals of Defusing
Stabilization of the traumatized groupRestore unit cohesionRestore unit performance
Assessment tool to determine if group members need something else in addition to the defusing
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Slide24Defusing
An interactive group processSame day (up to 8 hours after incident ends)Has little effect or no effect after 12 hoursGroup must be homogeneous
If opportunity is missed, provide one-on-one support followed later by CISD
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Slide25Defusing
In some cases, a defusing may be all the group needs.In other cases a CISD should followIf reactions are intense or suppressed and if there appears to be unfinished business, then a CISD is indicated a few days later.When a CISD is necessary, it is generally made stronger by holding the defusing first.
5-phase CISD is taught in the Advanced Group course.
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Slide26Clues that a CISD should follow a Defusing
Absence of appropriate emotionExcessive emotionExpression of inappropriate emotionsA sense of unfinished businessWithdrawal and inability to communicate during the defusing
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Slide27Criteria for Homogeneous Group
Group members have a relationship with each other before the traumatic eventThey have a shared historyThey have spent considerable time together prior to the eventThey have experienced the same traumatic event.
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Slide28Defusing: 3 phases
Introduction – Introduce team; lay out the guidelines; lower anxiety about the process
Exploration
– Allows a brief discussion of the experience. A brief “story” of the event
Information
– Provide information, normalize, teach, guidance, summarize key points
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Slide29Critical Incident
Stress Debriefing
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Slide30Critical Incident Stress Debriefing
(CISD)A structured GROUP discussion concerning a critical incidentFirst described by Mitchell (1983) for use with homogeneous groups of emergency services personnel
Requires a team approach
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Slide31CISD Goals
Mitigate distressFacilitate psychological normalization and psychological “closure”Set appropriate expectations for psychological / behavioral reactionsServe as a forum for stress management education
Identification of external coping resources
Psychological triage and referral
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Slide32CISD Team
Minimum: Two CISM trained team members.At least one mental health clinician.
Peer driven, clinician guided
**
Other team member(s) may be “peer support personnel,” spiritual leader, another mental health, or physical health, professional.
All team members must be trained in the small group process - CISD!WSH/PCO drdan@criticalconcepts.org
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Slide33CISD Considerations
Convenient timeNeutral location
All involved operations personnel invited
Ideal group size is 3-20
Homogeneous groups (with regard to traumatic exposure/ psychological toxicity)
Ideally, one team member for every 5-7 participants - minimum of 2 WSH/PCO drdan@criticalconcepts.org
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Slide34CISD Considerations
Strict ConfidentialityNo breaksTiming is important
Location and physical environment
Large scale, significant incident
**
Circumstances out of the ordinary**Closed circle format
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Slide35MHP
Door
Peer
Physical Format
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Slide36MHP
Door
Peer
Peer
Physical Format
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Slide37MHP
Door
Peer
Peer
Peer
Physical Format
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Slide38Peer
MHP
Peer
Peer
Avoid tables, distractions, dispatch speakers, equipment,
And CPR training dummies. Try to avoid snacks until after.
These are impediments to communications!
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Physical Format
Slide39CISD Structure: 7 Phases
Introduction (C) Fact (C)
Thought (C A)
Reaction (A)
Symptom (A C)
Teaching (C)
Re-Entry (C)
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Slide40Phases of a CISD
COGNITIVE
AFFECTIVE
INTRODUCTION
FACT
REACTION
THOUGHT
SYMPTOMS
TEACHING
RE-ENTRY
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Slide41Recommendations
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Slide42Recommendations
Consider
For more “routine” incidents, use a Defusing
For more extraordinary or significant incidents, use a CISD.
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Slide43Recommendations
The majority of individuals exposed to a traumatic event will not need formal psychological intervention.
2. The focus should be upon the
individual
more so than the event; assessment is essential. Assessment is an on-going dynamic process, rather than a once and done.
3. Normalization of the crisis response is encouraged, but should never lead one to dismiss serious crisis reactions.
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Slide444. Unless the magnitude of impairment is such that the individual represents a threat to self or others, crisis intervention should be voluntary.
5. Be careful not to interfere with natural recovery or adaptive mechanisms.
6. Individuals should be encouraged to talk about or relive the event only if they are comfortable doing so.
7. When in doubt, seek assistance/supervision.
Recommendations
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Slide458.
The risk of adverse outcome is associated with all human intervention and helping practices including medicine, surgery and counseling.
Improper, inadequate training
is the greatest risk factor associated with crisis intervention.
Training and supervision may be the best way to reduce the risk of adverse outcome.
Recommendations
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Slide46Recommendations
Avoid Saying!
“I know how you feel.”
“It’s not so bad.”
“This was God’s will.”
“God won’t give you more than you can handle.”
“Others have it much worse.”
“You need to forget about it.”
“You did the best you could.”
“You really need to experience this pain.”
Confrontation
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Slide47Questions??
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Slide48Questions?
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WSH/PCO drdan@criticalconcepts.org
Slide49Daniel W. Clark, Ph.D.
Critical Concepts Consulting
2103 Harrison Avenue NW
Suite 2183
Olympia, WA 98502-2607
(360)-786-0292drdan@criticalconcepts.org
Washington State Patrol
1405 Harrison Avenue NW
Suite 205
Olympia, WA 98502
(360)-586-8492
wsp-psych@att.net
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