CISM as the Standard of Care in Response to COVID
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(Video)
Overview
Learning Objectives:
- Estimate surge of mental health distress
- Define CISM
- Explain why CISM is the standard of care for COVID
Presenter
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George S. Everly, Jr., PhD, ABPP, CCISM
Co-Founder
The ICISF, Inc.
George S. Everly, Jr., PhD, CCISM is an award-winning author and researcher. In 2016, he was ranked #1 published author in the world by PubMed PubReMiner in the field of crisis intervention. He holds appointments as Professor in the Department of International Health (affiliated) at the Johns Hopkins Bloomberg School of Public Health, Associate Professor (part time) in Psychiatry at the Johns Hopkins School of Medicine, and Professor of Psychology at Loyola University in Maryland (core faculty). He is considered one of the founding fathers of the field of disaster mental health. He was a co-founder of the Dept of Psychiatry at Union Memorial Hospital and served on the management committee 12 years. In addition, he has served on the adjunct faculty of the Federal Emergency Management Agency, the FBI’s National Academy at Quantico, Virginia, and ATF’s Peer Support Team. He is an advisor to the Hospital Authority of Hong Kong. Dr. Everly is co-founder of, and serves as a non-governmental representative to the United Nations for, the International Critical Incident Stress Foundation, a non-profit United Nations-affiliated public health and safety organization. He was Senior Advisor on Research in the Office of His Highness the Amir of Kuwait. Prior to these appointments, Dr. Everly was a Harvard Scholar, visiting in psychology, Harvard University; a Visiting Lecturer in Medicine, Harvard Medical School; and Chief Psychologist and Director of Behavioral Medicine for the Johns Hopkins Homewood Hospital Center.
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Overview
“When everyone walked away Charlie stayed by my side.
Not coping to healthy coping, he brought me from sinking further into that dark downward spiral back up into the light and life”After losing 6 friends on my FD to suicide, I went to Chaplain Mario Gonzalez, the director of my peer support program and he called for a meeting with the clinical director. It was decided there was an obvious need and I was instructed to do a 3 month pilot study with Charlie at my station. That’s how the MDFR Response K9 program got started. It looked different back then but has grown into what it is today.
When I started doing research into the benefit of therapy and service dogs I decided certification was the way to go for our teams and our organization as we already had CISM training for the humans. It was through the connections with I.C.I.S.F. and our CISM training program that I ended up meeting Cindy Ehlers, an expert in the field of civilian canine crisis response and a K9 handler at the WTC site after 9/11.
After seeing the direct benefits as backed up by current research indicating therapy and service dogs play a role in resiliency and post traumatic growth we set up the program with 3 separate tiers for this specific responder program.
The purpose of this presentation is to promote an awareness of how crisis response canines can help both civilian and responder organizations and explain the differences in training and certification currently available for both.
There are three parts to the program:
(1) CISM Response K9
In this tier, the responder with his or her own trained K9 is an active member of the CISM Peer Support team. In all CISM settings the benefit to the recipients is the oxytocin release and immediate physiological responses for calming. The dogs help create a safe space for responders where its ok not to be ok and process what they just experienced.
We’ve noticed the dog can also become a focal point for people who are struggling to share. when the guys have a hard time talking they automatically start staring at Charlie.
its easier to look at a dog than other people when they have something difficult to say. the dogs can be a focal point for people having a hard time sharing and some have used Charlie as a shield to lean on when they flat out broke down. In a diffusing setting we expect the dogs to alert to mood changes when humans change emotions and pheromones are produced. In this way the dogs aren’t just a prop for people to look at, they become active participants in the diffusing.(2) Station Dogs
Because of cumulative trauma, station dogs are justified as reasonable to have something in place before and after each call as responders are not able to process the events of the last call before running the next call.
The expected benefits from long term exposure to the same dog include less time off from work, more cohesive crews, less discipline issues, etc.(3) Service dogs
To be able to provide personnel with service dogs that can provide healing to the soul, reduce symptomology and build the foundation of the person, not just the first responder.Learning Objectives:
Upon completion, participants will be able to- List why the use of trained certified canines are beneficial for responders in CISM/ Stress management roles
- Define and describe the training and certification criteria such as ethical care of canines, what advocacy really means, why learning how to read your canine’s signs are paramount in the training process, etc.
- Learn the best practices for using canines in CISM and stress management roles in First Responder organizations
Presenters
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Shawn Campana, CK9RT, CDT, CISM
Response K9 Coordinator for Peer Support Team
Miami Dade Fire Rescue
Captain Shawn Campana has worked for Miami Dade Fire Rescue for 24 years. She has been on the department's CISM Peer Support team since 2015. Shawn started a Response K9 program 5 years ago in response to the PTSD and Suicide Ideation epidemic that has impacted her fire department. She started the program with her dog Charlie who was also her service dog, and has grown the program into what it is today. The team has grown to 10 Peer Support handler K9 teams. She is looking forward to expanding the program to provide station dogs, and service dogs for firefighters, and continues to help other organizations implement their own Peer Support canine programs.
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Cindy Ehlers, D.N.C.C.M., CT, CFE, FT
Cindy Ehlers
Green Cross
Cindy’s passion is helping responders and civilians through the human animal bond. After responding to a high school shooting in Oregon in 1998, she developed and implemented programs utilizing dogs to reach at risk populations and those in crisis. In 2001, at the request of the American Red Cross, Cindy and three other handler/dog teams provided comfort on the ferry boats and provided respite foot responders at the WTC site. She has achieved diplomate status through the National Center for Crisis Management for her experience & contribution in the field of Canine Crisis Response and Animal Assisted Crisis Interventions. Cindy provides expert advice in the field of canine crisis response to both civilian and responder organizations. She is a member of ICISF, Green Cross and National Center for Crisis Management.
Handout
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Overview
Health and safety legislation exists to protect the mental health of workers, including those at high risk of psychological injury, by separating the responsibilities between the worker (for self and others) and the manager (for the work environment). However, the traditional clinical viewpoint seems to ignore this in favour or seeing all psychological injuries as phenomena in need of medical, psychiatric or psychological expertise once symptoms have emerged and persisted. For example, symptoms of posttraumatic stress disorder (PTSD) have to await the passage of 28 days before diagnosis and treatment, while health and safety law demands immediate action. As crisis intervention is designed for immediate action and clinical guidance requires a delay, crisis intervention appears to be in keeping with legislation created to secure mental health. The tension that exists between the clinician’s advice to ‘watch and wait’ and the peer’s compulsion to ‘act now’ might be resolved by a psychological risk assessment undertaken in the immediate 28 day post-incident period.
Risk assessment for any health condition has three steps: 1. Identify the hazard, 2. Intervene to minimise or eliminate the hazard, and, 3. Monitor to ensure the intervention has worked. An online portal that measures depression, anxiety and PTSD and reports results to the completer themselves has several advantages. First, the assessments can be the same as those likely to used by the clinician should symptoms persist and recovery does not occur. Second, the completer is now aware of their likely condition and the level of risk exhibited by the scores. Third, the organisation can be informed of the overall levels of mental health by demographic variables including team, department and location. With information shown to the worker and statistical patterns shown to the manager both carry their own legal responsibility to act to ‘minimise or eliminate’ the hazard represented by high scores on clinical assessments.
Taking the discrepancy that exists between the clinical viewpoint and the crisis intervention viewpoint a secure online portal has been designed to meet the health and safety demand for risk assessment by informing the worker themeslves (with contact details for support and guidance), informing the organisation’s managers of ‘hot-spots’ of mental health hazards in the workplace and putting both ‘on notice’ that they should now act. The ‘I didn’t know’ claim to justify inaction would become invalid for both parties. This presentation will show how the backdrop of health and safety legislation justifies the use of crisis intervention following critical incidents. It also offers a means by which workers can self-assess and decide how they will tackle the risk they have been informed of, In addition this will allow managers to shape the workplaces structure and policies in light of the patterns emerging from the de-identified data generated by the workers collectively. The potential to use the data generated to underpin mental health policy, identify training needs and show the effectiveness of crisis intervention will be discussed.
Learning Objectives:
Upon completion, participants will be able to:- Recognise key indicators that return to duty is safe following a critical incident
- Assess risks to mental health in compliance with workplace safety and health legal demands
- Complete assessment, intervention and return-to-duty within 28 days of a critical incident
Presenter
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John Durkin, MSc. PhD
STAGE-28 International
John Durkin Ph.D sits on the Boards of the International Critical Incident Stress Foundation (ICISF), Crisis Intervention Management, Australasia (CIMA) and is co-director of STAGE-28 International offering training, research and consultancy in crisis intervention and psychological risk assessment. His interest in posttraumatic growth took hold in his early career as a firefighter and was later strengthened by his role in the post-9/11 support effort at New York’s fire and police departments. Convinced that critical incident stress management (CISM) delivered by peers had the potential to prevent a number of mental disorders he sought enhancements that might challenge clinical therapies for effectiveness. Further qualifications and training persuaded Dr Durkin that peers delivering crisis intervention in a person-centered fashion would prove superior to standard treatments for PTSD and facilitate posttraumatic growth. A number of pilot projects have supported this and led to training a team of firefighters in CISM, informed by person-centered theory. When Dr Durkin was called to lead the crisis response for the Metropolitan Police Service following London’s 2017 terrorist attacks and Grenfell Tower fire, the same team of firefighters came in support. Over 80 police officers were seen and no report of PTSD or depression had been received three years later. Growth in police officers and firefighters has been widely reported and awaits empirical confirmation in future projects. The legal demands of occupational safety and health were met during this period leading to the design of a psychological risk assessment for use in the emergency, medical and military services.
Handouts
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Overview
Presentation Details:
This presentation will be prerecorded followed by a live breakout session with interactive activities and facilitated conversation. The content will include educational information on the particular types of stress that comes with disasters and impacts an activated Emergency Operations Center environment. Whether that EOC is a government agency, a private business or a school system, the work is impacted by the intensity of the task at hand. Emergency Managers of all kinds often see themselves as immune since they are not in the field dealing hands-on with victims or survivors.
The reality is they are at times more prone to disaster stress than their counterpart first responders. The appropriate use of CISM activities are designed to keep people productive, not take them off line. Just like trickle charging a battery, effective in the moment disaster stress management can help ensure good judgement and appropriate decisions are being made. This workshop will use case studies and facilitated conversation to explore this topic.Learning Objectives:
Upon completion, participants will be able to- Participants will examine the unique stressors in an EOC environment
- Participants will be able to differential between Disaster Stress Management on Disaster Mental Health
- Participants will increase their knowledge of deploying to an activated Emergency Operations Center
Presenter
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Mary C. Schoenfeldt
Emergency Management Professional
Green Cross Academy of Traumatology
Dr. Mary Schoenfeldt is an Emergency Manager with a specialty in school and community crisis. She has a passion for Disaster Psychology delivers Disaster Stress Management for a non profit ..Green Cross Academy of Traumatology. She responded to Columbine HS shooting, Hurricane Katina, Haitian Earthquake, Sandy Hook Elementary Shooting, Hurricane Harvey and was in the Emergency Operations Center for 6 weeks following the 530 Mudslide. She currently is providing support manage COVID 19. When she isn’t traveling she is behind the podium as Past President of Everett Port Gardner Rotary.
Handouts
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Overview
Communities are demanding police change how they respond to incidents, which someone is in crisis or with mental health and/or social issue concerns. Traditionally, police have responded with a law & order approach, which at times is hurtful to those in need of help. This approach may further escalate someone in crisis, which is not helpful, but further hurts the person in their time of need. Even worse is when officers use physical force when de-escalation would have been far more appropriate.
Jen Corbin and Lieutenant Steven Thomas will discuss how the SAFER-R model and CISM can be utilized to assist the community in their time of need. Law enforcement routinely responds to traumatic incidents and they will discuss how CISM interventions can be used to help families and the community. Further they will discuss how the SAFER-R model can be adapted to assist citizens whether it be: for children living in traumatic living conditions, someone looking for recovery from substance abuse, someone facing re-entry into the community from incarceration or to assist someone making threats.
Learning Objectives:
Upon completion, participants will be able to- Describe how the SAFER-R model can be modified for various community policing interventions.
- List situations which the SAFER-R can be utilized in community policing.
- Describe a “trauma responsive mindset”
Presenters
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Steven J. Thomas
Lieutenant
Anne Arundel County Police
Lt. Steven Thomas, CCISM has a BA from UMBC and a MA from the University of Baltimore. He started as a patrolman with the Anne Arundel County Police in 1996 where he remained in patrol until he became the CIT and Peer Support Coordinator in 2016. In 2020 the Anne Arundel County CIT Unit was named International CIT Unit of the Year.
He is the Anne Arundel County CISM Team Coordinator. Further, he is an ICISF approved instructor and in the spring of 2019 received the ICISF Pioneering Spirt Award.
He is a Youth & Adult Mental Health First Aid Instructor and in 2018 he was named a top 100 instructor. -
Jennifer Corbin
Director
Anne Arundel County Crisis Response
Jennifer Corbin, LMSW is Director of the Anne Arundel County Crisis Response System. Much of her work is in collaborating with outside agencies to work with the crisis system such as A. A. County Police and Fire, Health Dept., Public Schools, local hospitals, and local providers. She is a trained instructor in Mental Health First Aid (MHFA). Ms. Corbin is also trained in Critical Incident Stress Management (CISM) and helped develop a peer support team for A.A. County Police. Ms. Corbin received her master’s degree in Social Work from The UMD School of Social Work.
Handouts