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
I’m a volunteer firefighter. It’s been twenty fives years but I can still see the young mans face as he lay there void of life at a motorcycle crash during my first year of service. I think that’s why it took me 25 years to figure things out. I compartmentalized everything to survive. It took years to let those barriers relax enough for my experiences to blend and realize I can help other first responders.
In the volunteer model there’s no-one there to follow up to see how providers are managing the stressors after a call. The responder goes back to empty firehouse and then home. There was nothing in place to mitigate or manage a “bad” call. The connection of seeing my dog at the door when I came home from a bad call was powerful. I didn’t understand the science, I just knew how it made me feel. Call after all and year after year I continued to receive healing comfort from the many dogs that lived with me and the ones that crossed my path.
The purpose of this presentation is to reach as many first responders and provide them with tools to mitigate or interrupt the process of PTS/PTSI.
There are four levels of intervention in this model. In level one and two the dog belongs to the handler responder and trained and certified at the therapy dog level and exposed to the components present in debriefing and various settings. Level 3 uses puppies. Most are obtained from breeders.
There are several different organizations that provide services dogs and they all have their own different ways of doing so. Some use rescue dogs, others use breeders. Each has pros and cons. The ideal breed for service is the breed with which the handler is most comfortable. Any breed is suitable for service, but the requirements for temperament are not. Temperament is critical and cannot be compromised. Again, keeping the mantra of “safety” in mind is key. If the responder/handler is afforded a safe environment (which becomes mobile with a service dog), this process becomes life changing and all possibilities are on the table.Level 1. K9 CISM
To provide peer debriefings for fire fighters, EMS personnel and police; essentially providing Critical Incident Stress Management support for first responders who have experienced trauma — in the line of duty, during active duty or after leaving service – in order to attempt to prevent the onset of PTSI using the Mitchell model of peer support.
To support various first responder agencies to create preventative support strategies to head off PTSI before it takes hold, by creating safe places to process traumaLevel 2. Therapy/”Mobile Service” (1:1 – K9 Team: Responder)
Handler uses their personal therapy dogs for those who require K9 intervention, but for some reason are not able/do not want their own dogLevel 3. PTS Service Dogs
To network with breeders and trainers in order to provide affordable service dogs to first responders, veterans and others who suffer with PTSI who are in need of PTSI Service Dogs. The canines are puppies obtained from established selected breeders and provided to handler at minimal cost.
The puppy is in handlers possession at 8 weeks, then to trainer for 1-2 week B/T for polishing and detailing4. Education
To speak to as many groups as possible to educate in PTSI prevention in high risk environments in order to be able to access what ever services are needed when the time comes.Learning Objectives:
Upon completion, participants will be able to- Know the two hormones stress reduction and production.
- Know the five levels of K9 Intervention.
- Know the difference between “PTSD” and “PTSI”.
Presenter
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Michelene L. McCloskey, EMT, FF, EMSI, K9 Handler
EMT, FF, EMSI, K9 Handler
K9 PTS Intervention
With over 20 years of service as a Fire Fighter/Emergency Medical Technician, 20 as a CISM provider and 14 as an Emergency Medical Services Instructor, Michelene became the Coordinator of the Animal Response Team in her home town of Chester County, PA after hurricane Katrina. In 2015 she became the event manager for a local Search dog team and has since founded K9 PTS Intervention, an organization providing interventions in many different models to responders traumatized in the line of duty or during active duty.
Handouts
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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
The purpose of this presentation is to shed light and start the conversation of addressing PTSD in the 911 telecommunications profession. In 2015 I was working as a police dispatcher for Boston police, and successfully managed an officer involved shooting. While I received many awards for how I managed the situation, the fallout of PTSD and lack of support had me making the difficult decision to leave 911 altogether in order to address my mental health. During my journey of healing, I came to the realization that the 911 field was my passion, and that dispatchers everywhere are lacking the support needed in order to continue in the field. I’ve now been back in the filed for 4 years. In addition to sharing my story, I’ve applied my experience to working on NENA’s Wellness Committee, specifically the Peer Support sub-committee, and the Acute Stress working group. Locally, I attended the Group and Individual Counseling Training, and applied to be a part of the local CISM team, which recognizes the important of including 911 personnel for defusing and debriefings. I am currently the point of contact for my agency. Recently, myself and other 911 professionals on the team have been meeting to discuss the 10 top calls for dispatchers, as well as discuss how we can spread the word that CISM teams in our area is a resource available to all dispatchers. In addition to walking viewers through my story – the initial call, the PTSD fallout, and the steps I took to change my mindset and heal – I want to be able to present the dispatcher’s point of view in handling critical incidents, and how agencies can help stop burnout and high turnover by providing resources to their dispatchers.
Learning Objectives:
Upon completion, participants will be able to:- Identify problems 911 professionals face on the job
- Understand how they can contribute to changing the conversation about PTSD in first responders
- Identify obstacles 911 personnel face utilizing a CISM team
Presenter
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Nicole Janey
Emergency Communications Supervisor
Chelsea Emergency Management
Nicole has been working in the 911 field for 15 years. Highlights of her career include working the Boston Marathon Bombing and the ensuing week, as well as successfully managing an officer down call. Following that event, she took a break from 911 in order to address the PTSD. She returned to 911 with a passion for all things related to 911 mental health and wellness, and is particularly focused on spreading the word about the effects of PTSD in the 911 community, and the need for better support and services for our personnel. She is also involved in the Greater Boston Law Enforcement CISM team, and the National Emergency Number Association. She is active in several subcommittees within NENA's wellness continuum. As a side project, she is currently curating “You Are Not Alone: Portraits of the Gold Line Family” , a photography project that seeks to put a face to all members of the 911 profession, and showcase how everyone is effected by the job, regardless of role.
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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