Crisis Intervention Training Requirements

[EMDispatch]

So I'm curious to know what education requirements any of your local CISM or peer counseling service.

I was invited to join our local group, which involves attending a short course, 27 hours. It was simply an introduction for us to the various methods of psychological first aid and group crisis intervention, taught by a highly qualified instructor.

Is this kind of the norm, or are there still groups out there that just kind of wing it?

 

[Summit]

27 hours of training is psychological counseling is the very definition of winging it.

How is CISM still a thing?

 

[EMDispatch]

27 hours of training is psychological counseling is the very definition of winging it.

How is CISM still a thing?

That is initial requirements to begin joining the team as a peer support person. The team includes mental health professionals as well. This is just the jumping off point to becoming active member.

I'm not trying to start a debate on effectiveness... Yes I'm aware of the Cochrane Reviews, and I agree with the critique that they were poorly done studies.

 

[Summit]

The team includes mental health professionals as well.

What kind?

I'm not trying to start a debate on effectiveness...

Effectivness is always a valid subject for healthcare providers.

Cochrane Reviews ... they were poorly done studies.

Those words are rarely if ever found together. You are probably not aware that the Cochrane Review is the healthcare gold standard of systemic meta-analysis and is globally respected for its methodological rigor.

Let me ask you this: have you read the review, or are you just "aware" of it and heard from a CISM supporter that it was "poorly done?"

 

[Summit]

I'll just repost this here in case you want to read some other studies...

How is CISM is still a thing in 2016???

The bottom line is that I am not the authority. I am relating what the evidence says, what the experts in many fields say, what the consensus and professional organizations state, and that is the best practice we should follow. WE cannot let well meaning persons with big hearts and a history of dedicated service cause us to be stuck in time because that is what they know. We cannot let anecdotes guide away from overwhelming evidence. We cannot let a dinosaur plod on. The CISM industry had great intentions, but was a good idea shown to be not such a good idea.

CISM is supposed to be an inoculation of sorts against PTSD and ASR by intervening early in a presumed acute stress reaction. The studies show clearly that it does not work in this role and may actually cause PTSD or worsened PTSD. This appears related to the basic philosophy that all rescuers are alike in personality, have the same coping mechanisms, coping timeframes, and all experienced an event similarly. These assumptions are patently false. Thus persons with different coping mechanisms, with different experiences, with different personalities, and at different points in their recovery are placed in theoretically therapeutic environment where they are actually exposed to more emotional trauma and experiences. This is an older treatment philosophy, though well meaning, that attempts to fit the patients to the treatment rather than fitting the treatment to the patient.

The evidence seems to show that there might be a short term positive feeling about the debrief by slightly more providers than providers who have a negative feeling about the debrief. Providers with negative feelings feel discouraged from reporting. In the long term, there is no improvement in outcomes and some studies have shown increased negative outcomes for rescuers! Rescuers have diverse personalities, differing coping mechanisms, and coping timelines because they experience events differently. Most rescuers do not have acute stress reactions to each event; who does is not predictable. Blanket preemptive self-selection is not a sufficient determinant for the CISM intervention. It is a great determinant for individual assistance.

CISM style debriefings are not recommended by trusted entities from the APA to the Society of Clinical Psychology to the World Health Organisation to the National Center for Child Traumatic Stress. International Red Cross, World Health Organization, NATO... the big players do not use CISM style debriefings!

Cochrane is essentially the highest standard out there for analysis of studies and best practices:
http://summaries.cochrane.org/CD006869/multiple-session-early-psychological-interventions-for-prevention-of-post-traumatic-stress-disorder

American Psychological Association’s recommendation against single session debriefing/CISM.
https://www.div12.org/psychological...ebriefing-for-post-traumatic-stress-disorder/

British Journal of Psychology: “Debriefing does not reduce PTSD”
http://www.rxpgnews.com/research/psychiatry/anxiety/ptsd/article_4806.shtml

Effectiveness of psychological debriefing
http://onlinelibrary.wiley.com/doi/...ionid=2F636A4148B6CC53AA90644173DB4678.d04t01

Rescue Personality, Fact or Fiction?
http://www.massey.ac.nz/~trauma/issues/2005-2/wagner.htm

Myth of CISM
http://www.emsworld.com/article/103...m-is-effective-in-managing-ems-related-stress

Old EMTLife Thread on CISM
http://www.emtlife.com/showthread.php?t=9785&highlight=CISM

JEMS - Killing Vampires
http://www.jems.com/articles/2008/01/killing-vampires.html

http://www.stish.org/home/advice/health/professional-help/debriefing

NICE - the trusted, independent UK body that provides health advice - is a chief culprit. Based on seven randomly controlled trials (RCTs) comparing psychological debriefing against control groups, NICE recommended in 2005 that brief, single-session interventions not be routinely offered to individuals who have experienced a traumatic event.

Comparative trials specifically on aid workers also show harmful effects of CISM style debriefing...

http://dx.doi.org/10.1348/000711200160327
http://dx.doi.org/10.1080/10811440290057639
http://dx.doi.org/10.1002/(SICI)1099-1700(199807)14:3<143::AID-SMI770>3.0.CO;2-S

Or report no effect:

http://www.ingentaconnect.com/content/routledg/ulat/2002/00000007/00000003/art00004

http://www.ncbi.nlm.nih.gov/pubmed/10473306

Bledsoe has written plenty:

http://www.bryanbledsoe.com/data/pdf/journals/CISM (Bledsoe).pdf

Bledsoe BE, Barnes DE. The Traction Splint: An EMS Relic
Journal of Emergency Medical Services (JEMS). 2004; 29(8):64-78

Bledsoe BE. CISM: A Rational Perspective.
Lifeline. 2003; Spring:2-5

Bledsoe BE. EMS Mythology Part 3: Critical Incident Stress Management.
Emergency Medical Services (EMS). 2003; 32(5):77-80

Bledsoe BE. CISM: A Rational Perspective.
EMS Professionals. 2003; May-June:32-36

Bledsoe. CISM: A Rational Perspective.
Journal of Maine EMS. 2003; 14(2):18-22

Bledsoe BE. Uncover Hidden Trauma (Case of the Month).
Journal of Emergency Medical Services (JEMS). 2003; 28(1):16

Bledsoe BE. Searching for the Evidence Behind EMS.
Emergency Medical Services (EMS). 2003; 31(1):63-67

 

[EMDispatch]

Our mental health professional is a licensed psychiatrist.

The issue with the reviews is the way CISM mehtods were performed. As in not correctly, with people who were experiencing extreme physical trauma.

I'm also just going to point out that Bledsoe is a D.O., not in mental health.

While WHO, NATO,etc. do not "support" it. The UN sure does use it, as well as key players in NATO.

And some reading literature for you as well.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334529/

 

[EMDispatch]

I apologize for the double post. I can't Edit or delete the other post from my phone.

CISM and debriefing are not synonymous, it is a tool that can be used when appropriate. The goal is also not innoculation against PTSD, it is to explain the persons reactions, encourage healing through non-dangerous behaviors, and encourage access to other more qualified services if needed. Feel free to read some material by George Everly or Mitchell to understand what it really is all about.

I'm also sorry how quickly this whole thing devolved. I just wanted to open a dialog about what training people are recieving.

 

[Summit]

The issue with the reviews is the way CISM mehtods were performed. As in not correctly, with people who were experiencing extreme physical trauma.

You clearly haven't read the review because it is a meta-analysis of many studies.

Aslo, CISM isn't aimed at extreme physical trauma.

I'm also just going to point out that Bledsoe is a D.O., not in mental health.

He is emergency medicine and EMS, highly respected in those fields, well published (including EMS texbooks) and very familiar with the evidence. EMS is the only field that really still uses CISM.

While WHO, NATO,etc. do not "support" it. The UN sure does use it, as well as key players in NATO.

The UN?
WHO is the health agency of the UN, so not sure what you mean when you say the UN uses CISM.

What "key players" in NATO?

And some reading literature for you as well.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334529/

What did you want me to see here?

1. This single retrospective study of a single incident.
2. It doesn't mention CISM once.
3. "Postdisaster crisis interventions have been in used in the past. However, the effectiveness and safety of these interventions have been debated (Gist and Devilly, 2002; Roberts et al., 2009; van Emmerik et al., 2002). Our research suggests that emergency mental health services may be associated with better outcomes up to 2 years after a disaster. It is important to stress that this study does not suggest that brief, single-session interventions are effective (van Emmerik et al., 2002). Rather, it suggests that brief mental health interventions conducted by professionals at the worksite, community center, and other places may be effective following a large-scale traumatic event. However, as noted elsewhere, the reasons for this association are unclear (Boscarino et al., 2005, 2006), but may be due to indirect effects, such as later treatment-seeking or by facilitating professional referrals, or by some other indirect treatment effect."

In other words, the authors think there MAY be correlation but no clear causation.

Also, suggesting I go read papers by Mitchell of the "Mitchell Model," the creator of CISM/CISD is not going to convince me of anything.

 

[akflightmedic]

You mean "it" is not true because the papers say "it" is true??

Circular reasoning is not logic or fact? Since when??

I do like how every statement made was prompting more questions...such as WHO says that. Or where does it say that. These topics become old quick when people blast with generic assumptions which usually are simple parroting of someone within their circle with no outside questioning or actual research of their own.

OP...do not take this personally. If you have a strong position, answering the questions asked back of you will either lead you or others to more discovery. This is how "peer review" logic and reason work...

 

[EMDispatch]

It he link was not intended honestly it got put up when I got kicked offline while putting up a reply.

The US military being a big key player in NATO, the Red Cross uses it still just rebranded as crisis response, and UN crisis response teams use the same framework. The National Health Trust in the UK is still using it under the same kind of rebrand as well.

I wasn't encouraging you to read Mitchell to change your mind, just so you could read up on the actual process, not just what most of us conceive it to be.

I don't take any offense to this discussion, and it's worthwhile to have, but not my intention right now.

Let's try a different topic in the same realm for now. Is it beneficial for us to have some sort of psychological first aid or crisis intervention training? Does your agency do anything in particular?

My primary job is in the comm center, and we have plenty of training in crisis communications and interventions, that seem to never make it out to our field people.