The following is a list of and brief descriptions for various forms of crisis intervention services offered:
Click on a title to expand.
Click on a title to expand.
- There are a wide variety of orientations and trainings to assist you and your organization in preparing for various worst-case scenarios.
The purpose of Pre-Incident Education is to provide you and your organization with the ability to pre-plan initial responses to a traumatic event. Those who plan ahead can recover much faster.
Defining critical incidents as well as outlining the various physical, emotional, cognitive, and behavioral signs and symptom patterns of critical incident stress is the main theme in addition to providing an overview of basic crisis intervention principles. Pre-incident education can be a brief 30-minute orientation and/or an entire series of one and two-day classes, depending upon the anticipated needs of your organization and the level of preparation desirable. Here is a list of available presentations including but not limited to the following:
- Critical Incident Stress Management – An Introduction to Comprehensive Crisis Intervention
- Basic Group Interventions (ICISF Approved)
- Advance Group Interventions (ICISF Approved)
- Terrorism: Psychological Impact and Implications (ICISF Approved)
- Current Trends in Crisis and Disaster Response (ICISF Approved)
- Crisis Intervention In A Healthcare Setting
- Crisis Intervention In A School Setting
- Working in the Emergency Department: the Impact of Working In A High Acuity – High Patient Volume Environment
For an expanded list of presentations and training, please visit Training and Workshops
- On-scene support services are offered 24/7/365 based upon availability. On-scene support literally includes providing consultation by phone; in-person organizational consultations; one-to-one consultations and small group meetings with supervisors, staff, employees, and others who may have been or already impacted by an event. This occurs as the incident is actually happening and/or or immediately post-incident.
- Whenever circumstances allow, this is truly an excellent time to activate a crisis response assessment and evaluation because it automatically and proactively puts your organization in a far better position to understand what the initial and delayed impact of the event may be on your organization. This facilitates faster and more effective Plans of Action and implementing of the crisis intervention response and that, in turn, increases the possibility of returning you and your people to your previous level of functioning sooner than later.
- This specific intervention prior to, during, or after an incident is an important element for assisting impacted personnel. Emergency mental health consultation is available for institutional management/command staff and is another important aspect of crisis intervention.
Organization leaders often find consultation about the expected human responses, phases of recovery, timing of recovery, identification of high-risk groups, recommendations for specific interventions; and the monitoring of rest, respite, and organizational stressors to be helpful. These services are also helpful in support of an overall Plan of Action and are available on site and via telephone.
Crisis Management Briefing (CMB)
- A Crisis Management Briefing is a form of “town meeting” or assembly that is used to facilitate social support, mitigate the spread of dysfunctional rumors, and provide functional empowerment information for large groups – up to 300 at a time. This event-driven intervention attempts to achieve these goals almost exclusively through the provision of information to groups that are affected by the event.
- A demobilization is a large-group intervention typically utilized for multi-casualty incidents when significant numbers of responders or employees are or could be adversely impacted. The primary goal of this tactic is to assist people to transition from the scene and return to home or their normal duties.
Typically a demobilization lasts for about 5-10 minutes and is a time used to inform and educate about typical and normal psychological reactions that they may experience in the coming hours, days, and weeks post-incident.
It is an opportunity to help them normalize their response and also an opportunity to help identify those individuals, units, and departments who may be particularly vulnerable to the adverse consequences of critical incident stress. This helps considerably in post-incident planning for management and leadership and further serves the goal of returning people to their normal levels of functioning.
- A defusing is a structured small group discussion following a critical incident. An ideal size is in the range of 8-10 people but a defusing can have as few as two people. The immediate goals of a defusing are to (1) provide normalization of people’s responses and to lower their immediate levels of tension in the immediate aftermath of the incident; (2) accelerate their recovery; (3) assess the need for debriefings; and (4) identify individuals who may need additional assistance. The leader will set expectations and provide information about useful coping mechanisms as well as appropriate referral sources.
A defusing is structured in three phases and is typically provided within the first 12-hours of the event. Depending upon the number of people involved and the nature of the incident, the duration of the defusing is generally in the range of 30-45 minutes. The duration is also dependent upon the number of people attending and the initial degree of impact.
The best location for a defusing is a secluded room that is adequate for the purpose. Participants in a defusing are homogenous in that each of the participants will have had relatively similar exposure to the incident. Defusings are increasingly being utilized as the small-group intervention of first choice.
One of the additional advantages of providing a defusing is that it often mitigates the need for a more formal debriefing. This is especially helpful when considering staffing requirements in their normal work functions.
Note: It should be understood by attendees and their supervisors that these interventions are not operational critiques of how people did their job or a critique of how they reacted to the incident. Rather, these interventions are designed to provide a safe and confidential environment in order to help people begin the recovery process and, hopefully, to speed up their recovery.
Critical Incident Stress Debriefing (CISD)
- A critical incident stress debriefing (CISD) is a more formal seven-stage small group intervention that can be offered at any time but is typically offered within the first 12-96 hours post incident.
All of the criteria and goals for a CISD are the same as for a defusing. The main goals are to (1) mitigate stress; (2) facilitate psychological normalization of responses; (3) psychological closure through reconstruction of the event; (4) serve as a forum for stress management education; (5) provide access to external coping resources; and (6) serve as a platform for psychological triage and referral as needed.
The duration is also dependent upon the same criteria determined for defusings. Typically, a debriefing lasts for about 60-90 minutes. That number is a general guideline and, like a defusing, is completely dependent upon the number of people attending and the degree of impact of the incident.
Again, the best location for a debriefing is a secluded room that is adequate for the purpose. It is best if there are no distractions and if there are enough chairs to place in a circle for those who are attending the debriefing. Participants in a debriefing are homogenous in that each of the participants will have had relatively similar exposure to the incident. The leader will work with management to determine who might be best suited to attend if there are varying degrees of exposure.
All information shared in a defusing or debriefing is strictly CONFIDENTIAL. Unless unanimously authorized by the participants, the leaders of these small group interventions are prohibited, by law, from disclosing anything discussed that would identify a specific individual in the group. Although rare, the only exception to this rule is if someone presents a potential danger to themselves and/or others. At that point, public safety supersedes the need for confidentiality.
- Face to face and/or phone contact is the most commonly used form of crisis intervention. It is sometimes the case that what is not a particularly traumatic incident for an entire group, can still have a negative impact for one or two individuals who have been exposed to the trauma. Private and discreet, a one-to-one contact is often the primary way in which those who have been impacted by a particular trauma can process the event and return to their normal level of functioning. It is also an excellent way to determine if someone may need additional resources to facilitate their recovery.
- It is frequently the case that when some has had direct exposure to a critical incident that their loved ones at home can become vicariously traumatized. In those cases where marriage and family life has been profoundly impacted, a discreet and confidential outreach to the family can often help in compassionately supporting the family in very meaningful and tangible ways. Spouses of people impacted by an incident often state that they had been informed of the potential impact on their loved one. Information can be provided to spouses and loved ones to help allay some of their concerns. This can also reinforce this naturally occurring support system.
- More often than not, when there has been a critical incident, one or more fatalities may have impacted members of an organization. At those times it is often beneficial to offer bereavement counseling to assist them through the initial stages of the loss after a death notification has been made. Participants are provided with a means to begin processing the death; preparing for memorials and funerals; given proven techniques that have helped others; offered education about what to normally expect while grieving; and afforded the opportunity to do this in either a group setting and/or on an individual basis. This can often help to speed up their recovery and thus help return them to their normal levels of functioning at work and at home.
- It is completely understandable that some people are simply not comfortable talking with a mental health professional. In those cases they may prefer to meet with a member of the clergy. Through his numerous affiliations, Dr. Brown is more than happy to refer those individuals to members of the clergy who are specifically trained in crisis response.
- One of the most important but sometimes overlooked aspects of crisis intervention is to simply inquire within a few days or a week as to the well-being of those who may have been impacted by one or a series of critical incidents. Follow-up, generally accomplished via telephone or in person helps to track a person’s recovery.
IMPORTANT NOTE: FOLLOW-UP ATTEMPTED UTILIZING ELECTRONIC MEANS SUCH AS E-MAIL, TEXTING, OR THROUGH THE UTILIZATION OF VARIOUS INTERNET-BASED SOCIAL NETWORKING SITES POSES NUMEROUS OPPORTUNITIES FOR CONFIDENTIALITY TO BE BREACHED. VOICE-TO-VOICE COMMUNICATION, EITHER IN PERSON AND/OR ON THE PHONE, SHOULD BE THE STANDARD OF CARE.
- While initial CISM efforts are usually sufficient to assist people in their recovery from the incident, there are going to be those cases it which someone has been so impacted that they cannot return to their normal level of functioning without some additional assistance. In those instances it may be necessary to refer someone to the next level of care. A licensed mental health specialist who has specific education, training, and experience in acute stress reactions as well as post-traumatic stress syndromes is the most appropriate referral.
IMPORTANT NOTESThese services are designed to be delivered by those who are qualified to do so by virtue of their education, training, and experience in the field.
Utilizing persons who meet these qualifications will help to ensure that your organization is operating within established standards of care and best practices.
Early interventions tend to be the most effective.