CAP Critical Incident Stress Management: Should it Exist?

[Gunner C]

I would have to agree.  While USAF has chaplains on their teams, they are absolutely PROSCRIBED from being in charge.  Chaplains are for the chaplaincy.  In CAP, the chaplains have taken over the program.

I, too, am a person who has suffered from PTSD.  If we would have had that program back then, I wouldn't have had some of the challenges that I've gone through.  Having said that, the last person I wanted to talk to was a chaplain.  Most folks don't want to hear their cutsey sayings and spiritual twinkies (if I ever hear another chaplain use the term "round tuit" I think I'll puke  ).  What a person needs is someone who has been there - a peer GTM/GTL who has seen what broken bodies look like and how you feel.

That doesn't call for someone who has a degree in reading ancient Greek and knows a cute and snappy comeback for every occasion.  Frankly, "pastoral counseling" isn't going to help much either.  What will help is someone who understands what you're feeling.

Chaplains:  give the operations stuff back to the operators.  We'll let you know if we need you.  :angel:

Sir, with all due respect, Chaplains are involved in CISM because NO ONE else seems to want to be trained and involved.  Chaplains aren't "controlling" the program, rather many are trying to keep it alive!

Your comments about chaplains seem to enforce a stereotype that is far from the norm (at least in my wing and region).  Chaplains are professionals, endorsed by our religious bodies for this ministry, and we have our own code of ethics.  If you see chaplains not abiding by that code you have a duty to report them up the chain of command.
Further, there are many of us in the chaplain corps that have "real" (whatever that means) experiences in traumatic situations.  Does that give us liscense to be "peers?" No.  But, it does give us an empathetic understanding of what others facing trauma are going through.

Who is your region CISM coordinator?  I'll bet he's a chaplain.

Traditionally and by law (in the Real Military), chaplains are absolutely not allowed to lead units on the ground or in the air.  Chaplains are not peers.  That defeats the purpose of the chaplaincy.  That's why you are addressed as "Chaplain" and not "Captain".  I'm not trying to be a schnook, it's the way it's supposed to be.  I've seen military chaplains (two of them) resign their chaplaincy, revert to 2nd Lt and become line officers.  I've also seen two line officers resign as field grade officers and become chaplains (both became captains).

[DogCollar]

Sir, are you trained to be a CISM peer?  If you are thanks for your service.  If you aren't why not? 

The regional cism officer is NOT a chaplain, but there is nothing preventing a chaplain from being a CISO.  You are right.  Chaplains cannot be "peers."  But, they are still needed on the teams.   Again, trained peers are what drives a debriefing, which is only one part of CISM.  Please, become a peer if you are not already.

[Dragoon]

No.

Well, why not?  Nothing is keeping Chaplains (or any other CAP member) from also being GTMs.

This is the basic issue - we claim that unlike other support functions, we HAVE to do this ourselves because we HAVE to have peers.  And then we don't require the folks to be peers.

This just doesn't make sense to me.

[DogCollar]

No.

Well, why not?  Nothing is keeping Chaplains (or any other CAP member) from also being GTMs.

This is the basic issue - we claim that unlike other support functions, we HAVE to do this ourselves because we HAVE to have peers.  And then we don't require the folks to be peers.

This just doesn't make sense to me.

A CISM team performing a debriefing is made up intentionally of trained peer(s), mental health professional, and a team leader.  The chaplain should not be a leader.  A chaplain can be a mental health professional with the right credentials.  But the trained peer is someone from CAP, trained in basic group intervention, and if debriefing a GT, should have experience as a GTM, etc...  It is CRUCIAL for the CISM team members not to have served in any capacity on the traumatic situation they are trying to debrief.

But,,,AND I ASK EVERYONE TO REMEMBER, the debriefing is one part of CISM, and as the program evolves, it is becoming a secondary option to One to One interventions, demobilizations, and Critical Information Briefings.  In some of these other parts of the progam, chaplains can actually be very helpful!!  Imagine that...a helpful chaplain!!!!

[John Bryan]

Chaplains can be peers. I know Chaplains who are mission pilots, ground team leaders, ground team members, etc.

Indiana Wing CISM Team has a Chaplain who is a member. He is also a GTL, GBD-T, and has done some training for scanner.

I would encourage Chaplains to get out in the field we need you there as much as at the unit meetings and mission bases.

Thanks
John Bryan
Lt Col, CAP
INWG CISM Officer

[Dragoon]

Absolutely right.  In CAP ANYONE can be a GTM, barring physical disability. 

And our CISM teams, if we're gonna have 'em, need to be stocked with folks who truly be peers.

If we can't get those folks, it sounds like we shouldn't be doing this.  It needs to be a requirement.  Otherwise, we might as well let some other organization provide those services, and focus on the things we CAN find qualified folks for - like SAR.

[DogCollar]

Unfortunately, I think this conversation will continue to be circular.  I'm not going to convince you...you're not going to convince me.  I did join CAP a couple of years ago to do chaplaincy (I am a hospital chaplain by calling) and to be actively involved in CISM (I have taken multiple training offerings).  I have basic GES rating and I have a CAP radio operators card.  Yet, the people I am with don't look at me as being somehow "deficient" because I an not a GTM or a pilot.  Instead they look to me as someone who brings skills and experiences to the role of chaplain and CISM team member.
I'm glad that there are good dedicated, trained and experienced pilots and GTL's in CAP.  I'm glad that there those among us who have every ES rating and the experience to go with it.  I would never think to say that CAP shouldn't be involved in SAR unless all member are rated as at least GTL's!  I think that the requirement that ALL CISM members be GTL's is a wrong direction for CAP to consider, as it would be turning away people who are highly trained, skilled and passionate about the gifts they have to offer the organization.

[John Bryan]

I think a lot of folks miss the PEER lead part of CISM. Ground teams should be debriefed/defused by CISM trained peers so GTM or GTL who have CISM training. Pilots/aircrews should be debriefed/defused by aircrew members who are CISM trained.

I am CISM trained and part of a CAP team. I am a peer for CAP members. I could not debrief/defuse firefighters or police officers because I am not one.

The MHP is not always a peer ie someone with the background of the members being serviced. But chaplains are not MHP.

This is a basic principle of CISM.

[DogCollar]

So, let Chaplains be chaplains...I'm done!

[Dragoon]

I'm actually a big fan of chaplains and what they do.  I think a mission chaplain is a great asset, and wish we had more of them.

It's the circular reasoning behind CISM (which is specifically not a required chaplain function) that's, frankly driving me nuts.

On one hand, we say "WE HAVE TO DO THIS OURSELVES" because it requires peers.

Then we don't require peers to do the debriefings.  (Chaplain, I get your point about there being a place in CISM for non-peers.  But it's the lack of the requirement for debreifers to be peers that's eating me.)

It all hinges on the definition of "peer."  Some believe that just wearing a CAP uniform makes you a "peer" to the GTM with the stress issue.  I guess that's where we differ. 

If it's not gonna a guy who's walked a mile in my particular boots, it might as well be a guy from a external agency.  No need to waste CAP resources on a program that (it seems) we can't execute according to its guidelines.

This would all be cleared up if CAP would mandate that all CISM debriefers be required to hold ES ratings equal to the folks they debrief.  But I wonder if they could find enough folks willing to do this.

[DogCollar]

1.I'm actually a big fan of chaplains and what they do.  I think a mission chaplain is a great asset, and wish we had more of them.

I'm glad.  And I agree that mission chaplains should be a part of every live incident command structure.


2. On one hand, we say "WE HAVE TO DO THIS OURSELVES" because it requires peers.

Then we don't require peers to do the debriefings.  (Chaplain, I get your point about there being a place in CISM for non-peers.  But it's the lack of the requirement for debreifers to be peers that's eating me.)

What you are talking about is a CISM debriefing, which is only one of a multitude of CISM responses to crisis; including One-to-One Crisis Intervention, Pastoral Crisis Intervention, Suicide Prevention Intervention, Demobilizations, Managment Briefings, etc...and not all of these require a "peer."  I would argue that the Debriefing protocol should not be the first offered in a crisis, but rather, only when an assessment of need has been done, by the CISM trained personnel.  Most crises that are faced in CAP don't need debriefing, in my opinion.

3.  It all hinges on the definition of "peer."  Some believe that just wearing a CAP uniform makes you a "peer" to the GTM with the stress issue.  I guess that's where we differ.  I think there SHOULD be more of the kind of "peer" you speak of.

4. This would all be cleared up if CAP would mandate that all CISM debriefers be required to hold ES ratings equal to the folks they debrief.  But I wonder if they could find enough folks willing to do this.
Let me put another way...rather than having debriefers become GTM's, etc...why not have those trained AND experienced become debriefers?  Would you be willing to be trained as a CISM peer?

[Chaplaindon]

I'm actually a big fan of chaplains and what they do.  I think a mission chaplain is a great asset, and wish we had more of them.

It's the circular reasoning behind CISM (which is specifically not a required chaplain function) that's, frankly driving me nuts.

On one hand, we say "WE HAVE TO DO THIS OURSELVES" because it requires peers.

Then we don't require peers to do the debriefings.  (Chaplain, I get your point about there being a place in CISM for non-peers.  But it's the lack of the requirement for debriefs to be peers that's eating me.)

It all hinges on the definition of "peer."  Some believe that just wearing a CAP uniform makes you a "peer" to the GTM with the stress issue.  I guess that's where we differ. 

If it's not gonna a guy who's walked a mile in my particular boots, it might as well be a guy from a external agency.  No need to waste CAP resources on a program that (it seems) we can't execute according to its guidelines.

This would all be cleared up if CAP would mandate that all CISM debriefs be required to hold ES ratings equal to the folks they debrief.  But I wonder if they could find enough folks willing to do this.

A few specific clarifications are in order ...

1.  Much of this would-be "circular logic" is nothing more than people attempting to offer criticism about something most have not even bothered to read the relevant regulations about, much less complete the training.

2.  The concept of the "PEER" in CISM is an ideal/normative one. CISM works BEST with exact peers supervised and led by experienced MHPs (ideally MHPs with direct experience with the group being intervened with ... e.g. an MHP --like Dr. Jeff Mitchell, author of CISM originally who was a firefighter/paramedic while persuing his PhD).

Reality must rear its "ugly head" and state that idealism and normative goals are wonderful --and something to work toward-- but scarcely (based on my 30+ years of civilian emergency services and 23 years of CAP ES experience) experienced.

While the BEST peer for an affected GTM would be another GTM, likewise the BEST peer for a flightcrew member would be another green-bagger, and the BEST peer for a CUL/MRO would be an exact counterpart ... CISM can and is effective with less exacting CAP peers. A CAP member peer is still far better than a 3rd-party non-CAP CISM peer or MHP.

3.  To proffer that only GTM/GTLs are affected by CIS and thus only GTM/GTL qualified members should be peers is patently absurd.

Although, granted (if focused narrowly enough) it COULD be true that only GTM/GTLs are likely to actually walk up upon a grotesque crash site or get close enough to "appreciate" the smells and sights thereof, such scenarios are only a VERY SMALL part of the CAP operations and/or activities wherein CIS can occur.

A couple of examples:

a.  (This actually happened) A Squadron meeting is "invaded" by a shotgun wielding criminal who threatens everyone, takes a member hostage, walks he/she to his/her car and then forces them to turn away and walk away at gunpoint. No one in the meeting might even possess a CAPF101, but all could easily be poised for a CIS reaction and CISM could be a potential aid.

b.  (this JUST happened) a CAP aircraft crashes on a SAR/DR mission killing all aboard. Mission staff, to the 3 crewmember's squadron-mates, to the Wing and Region CC's may be affected by grief and CIS. I know CISM was used in NVWG, CAWG, and WYWG within the last month to deal with the aftermath of such events. Few, if any were actually exposed to the crash site but many were helped by CAP CISM personnel.

c.  (Another REAL event) a Cadet commits suicide ... CISM assisted the other cadets and squadron members deal with their CIS reactions.

CISM, thus, is NOT just for GTM/GTLs (and I say that as a GTM1/GTL/IC and former firefighter/paramedic) it potentially has a wide range of situations where one, or more, of its numerous interventions might be helpful.

We need peers from every specialty ... including WG/Region Commanders ... and chaplains.

4.  Chaplains CAN be peers ... in fact the only personnel on a CISM team (a "CIST" in CAP) are peers and MHPs ... chaplains who serve on CISTs are either serving as a peer or as a MHP (provided they have the requisite professional training and licensure). In an earlier permutation of CAPR 60-5, there were a variety of CIST positions listed (including a chaplain) but in the current 60-5 IAW ICISF standards there are only MHPs and peers.

Chaplains can be peers. I am a chaplain and I am a peer.

5.  About the nonsense that, ["Chaplains are for the chaplaincy.  In CAP, the chaplains have taken over the program" ... this is absurd too. The CAP CISM program rightly belongs where it is ... under OPERATIONS. The plan is to move it to health services. It has never been under the chaplaincy. To say that "chaplains have taken over the [CISM] program" is to demonstrate a fundamental misunderstanding of the CISM program.

CAP CISM, currently (and since its inception in CAP) has been led by an RN/paramedic. CISm works closely with the chaplaincy, but hasn't ever "taken over the program" or even tried.

I would suggest reading the relevant regulations (e.g. CAPR 60-5, 265-1) before proffering such an absurd allegation again.

6.  While on the subject of chaplains, the rhetoric excoriating CAP chaplains for doing things that USAF chaplains cannot do (e.g. "While USAF has chaplains on their teams, they are absolutely PROSCRIBED from being in charge") is to misidentify the CAP chaplaincy with the USAF chaplaincy. Although we share many things with our USAF HC counterparts ... and, we wear the USAF chaplain badges ... there are many
differences:

a.  We are not in the military. CAP members and their chaplains are civilians.
b.  We are not under or bound by the UCMJ.
c.  CAP chaplains can hold additional operational positions (e.g. pilots, observers, GTM/GTLs, ICs, etc.) USAF chaplains cannot.

Perhaps USAF chaplains are, in fact, proscribed from "being in charge" on a CISM team ... in CAP, IF the chaplain is a qualified/endorsed MHP she/he can be the MHP in charge of a CISD. Beyond that, if a chaplain can be in charge of a SAR/DR mission as IC (as I have done and continue to do), why could they not lead a defusing team, or lead a demobilization?

If they required chaplains to refrain from leading certain CISM interventions, they need to take the control yoke of CAP airplanes our of their hands as well. Allowing chaplains to be a PIC (pilot in command) of our aircraft and forbid them from leading a CISM intervention seems duplicitous.

I suggest that the only confusion or "circular logic" concerning the CISM program and/or the CAP chaplaincy (on this thread anyway) comes from folks who --based upon their own words-- ostensibly do not understand either program.

I would recommend studying the programs (and their Regs) and learning the FACTS before proffering commentary or criticism about either program.

[Horn229]

I would recommend studying the programs (and their Regs) and learning the FACTS before proffering commentary or criticism about either program.

It's very interesting you say that. Because, not only did I research CISM, I researched the effectiveness of it. Results? CISM does NOT work.

I spent many hours on multiple databases searching trying to find information on the effectiveness of CISM. Excluding articles written by Mitchell and Everly, all of the research articles and meta-analyses I located has the same results, Psychological Debriefings do not work.

A ten year old article on the ICISF website pertaining to CISM in the LAFD said that CISM works. Currently, however, the LAFD has switched to using Psychological First Aid and Cognitive-behavioral Therapy. In an interview I conducted with the current Director of Behavioral Health for the LAFD stated:

It doesn't meet the criteria of science for me to do it for eight years and say "well ya know, I did a lot of groups, I've done hundreds of debriefing groups" most people walk away and say "Thank you that was helpful", but I never had someone come up and say "that sucked, it upset me a lot". So my experience was it was pretty positive, but again that's not science. And just because someone said it was helpful doesn't mean that a year from now that it didn't... they still perceived it as helpful or that it didn't cause some other reaction that I never found out about.

According to the article on the ICISF's website, the LAFD had one of the oldest CISM programs, and they stopped using it.

Dr's McNally, Bryant and Ehlers conducted research into several meta-analyses, pertaining to the efficacy of CISD. They examined both research for and against CISD, and found the CISD does not work.

Dr Bledsoe conducted research using two reputable medical databases and found that CISD does not work.

The chief issue at hand in the psychological community around CISM is not only does CISD not work, it can lead to more adverse reactions. In Randomized Controlled Trials of CISD, control groups (groups that did NOT receive a psychological intervention) had better results than the debriefed groups. -- This is the chief issue that has caused many to cease using CISM. The USAF has even moved away from CISM and are now using the PFA method.

An organization known as the International Society of Traumatic Stress Studies (the world's largest group onthe subject) is in favor of PFA for the initial interaction with potentially traumatized personnel, and CBT and EMDR for treatment methods for PTSD.

All of the articles cited in research studies I located which were adduced in favor of CISD were only printed in the ICISF's journal. There is a very serious bias there, and an even stronger issue is that none (that I could find) were printed in non-biased peer-reviewed medical journals.


Some of you continue to say that CISD is just one part of CISM. Which is true, it is just one part of CISM. However, around here there is no formal training on the affects of stress, none of the other aspects of CISM take place in my wing, and the only time CISM is mentioned is during a SAR Eval, in which the evaluators ask the chaplain what he would do if a ground team was exhibiting severe signs of physical arousal.

Now the reason I say all this. Many very well education psychologists and psychiatrists have either found that CISM/CISD do not work, through scientific research; or have ceased using CISM. Psychologists from all over the country went to New Orleans after Katrina and used the PFA method.



Why, if so many people in the field of traumatic stress have said CISM and CISD do not work, does CAP continue to use this method?

I'd really prefer to not see a "I've been in a debriefing, and it works" or "I've worked in debriefings, and they work" type of response. I'd like to see something with actual scientific proof stating CISM/CISD does work.

I've provided links to articles I've mentioned in this post, in one of my previous posts in this thread, should you like to examine what I've mentioned here.

[Dragoon]

What you are talking about is a CISM debriefing, which is only one of a multitude of CISM responses to crisis; including One-to-One Crisis Intervention, Pastoral Crisis Intervention, Suicide Prevention Intervention, Demobilizations, Managment Briefings, etc...and not all of these require a "peer."  I would argue that the Debriefing protocol should not be the first offered in a crisis, but rather, only when an assessment of need has been done, by the CISM trained personnel.  Most crises that are faced in CAP don't need debriefing, in my opinion.

Again, what you're saying here is that the vast majority of CISM work doesn't need peers.  Which kind of negates the requirement for CAP to do it ourselves.

This is NOT an attack on the validity of the process - merely someone trying to figure out if we wouldn't be better off using external entities for this service, as we do for so many other CAP support services.  Because everything we do which is not a core mission is, to some extent a distraction.

We have to separate the two issues (1)  Does CAP need this service and (2) Is it worth doing it ourselves.

THIS IS IN NO WAY AN ATTACK ON THE COMPETENCY AND INTENTIONS OF THE CAP FOLKS CURRENTLY DOING IT.  Like everyone in CAP, you've got a passion for what you do. But there are equally passionate people interested in dog teams, helicopter SAR, cadet mountaineering, firearms training for cadets, etc etc.  We say no to a lot of these folks because of the corporate pain-to-pleasure ratio of what they want to do.  We don't have to do everything ourselves.

[Dragoon]

A CAP member peer is still far better than a 3rd-party non-CAP CISM peer or MHP.

Chaplain, do we have any data to back that assertion up?  I'm suspect - just because he's wearing the same suit as me doesn't mean I'm gonna think "hey, this guy is like me."  I think I'm looking for someone who's specifically been in my shoes in a similar crisis.  Otherwise, he ain't my peer. 

But mebbe I'm off base - are there any studies to support "members of the same organization who are otherwise unconnected to the patient are better than outsiders with similar credentials"?

Honest question below:

part of the CAP operations and/or activities wherein CIS can occur.

A couple of examples:

a.  (This actually happened) A Squadron meeting is "invaded" by a shotgun wielding criminal who threatens everyone, takes a member hostage, walks he/she to his/her car and then forces them to turn away and walk away at gunpoint. No one in the meeting might even possess a CAPF101, but all could easily be poised for a CIS reaction and CISM could be a potential aid.

b.  (this JUST happened) a CAP aircraft crashes on a SAR/DR mission killing all aboard. Mission staff, to the 3 crewmember's squadron-mates, to the Wing and Region CC's may be affected by grief and CIS. I know CISM was used in NVWG, CAWG, and WYWG within the last month to deal with the aftermath of such events. Few, if any were actually exposed to the crash site but many were helped by CAP CISM personnel.

c.  (Another REAL event) a Cadet commits suicide ... CISM assisted the other cadets and squadron members deal with their CIS reactions.

How do the Boy Scouts handle this stuff?   Your examples are likely to apply to them as well (except they're more likely to lose members in a car crash rather than a plane crash).  Have they stood up a CISM program equal to what CAP is shooting for?  Or do they use external resources.

[John Bryan]

If we only did cadet programs I might think you had a point. BUT we are an emergency services agency and thus are members are more likely to be exposed to CIS.

I think you should be asking things like do volunteer fire dept with as many members as my wing stand up their own teams? Do police dept with as many members as my wing stand up their own teams.

I think the regulations make it clear that the use of outside resources is ok but that does not mean wings and regions should not stand up their own programs.

Using the logic of someone else could do it and maybe better could be used to cross out all are programs and close down the CAP.....so be careful.

[Dragoon]

The reason I asked the question about the boy scouts was because the good chaplain's examples weren't related to ES.  In fact, he was arguing for the importance of CISM for non-ES purposes.  Hence the question.

The ES questions have already been covered under "how come you don't have to be a peer, when peers are the whole reason we do it ourselves" argument.

[DogCollar]

Using the logic of someone else could do it and maybe better could be used to cross out all are programs and close down the CAP.....so be careful.

This is most certainly true!  There is nothing that CAP does that outside groups aren't doing...including cadet-style youth programs.

AND, utilizing outside CISM resources is permitted in the regulations.

[Dragoon]

So why waste time and energy doing it ourselves?  (hint - the only good answer is "we can do it better than anyone else for less hassle.")

There's a big difference between support functions (like maintenance, accounting, CISM, etc) and mission functions (SAR, cadet programs, AE).  We have to do the latter ourselves.  We need to make smart choices about the former.

Now back to the Boy Scout question - they have same non-ES CISM need we do.  How do they handle it?

[DogCollar]

Why waste time doing SAR at all?  Do we do it any better than anyone else?  I doubt it.  We do it because it's our mission.  Why waste time doing cadet programs?  Certainly there are equal programs (albeit with differing starting points) to ours?  We do it because it's our mission.  Why teach and promote aerospace?  There are certainly flying clubs and rocket clubs galore.  We do it because it's our mission.
Now, I have training in multiple facets of critical stress management.  I utilize this training in my career in healthcare, but I also offer it voluntarily to Civil Air Patrol.  Now, I could offer it in countless other agencies and organizations that utilize a process for caring for those who experience traumatic stress, however, I believe in the multiple missions of Civil Air Patrol and I can best serve in this "support" capacity (along with being a unit chaplain).
Now, if CAP decides that it would be better to ONLY utilize outside resources for caring for those exposed to traumatic stress, I would find another agency to volunteer my CISM training and experience. 
You have said that the ONLY good answer is that "we can do it better than anyone else for less hassle."  I don't think that should EVER be the ONLY answer.  I think we do CISM as well as outside agencies can. 
Finally, it would be foolish for CAP to jettison it's support functions to "outside" sources (which would ultimately COST $$$$$), besides, outsourcing rarely works.  By your logic not only would CAP have to jettison CISM, but also the Chaplain Corp, Medical Services, DDR, etc...
Now maybe most members joined CAP to be on an aircrew or ground team...but not all.  You intimate, unless I completely misuncersand your logic, that support functions are not only "different" they are somehow less important.  That' s not the case in the "real military", Law Enforcement, Emergency Services, Government...and it certainly isn't true in CAP.