CAP Critical Incident Stress Management: Should it Exist?

[Dragoon]

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."

Right.  Those are our missions.  CISM isn't a CAP mission.  It's a support function.  Unless the intent is for CAP to provide CISM to non-CAP members as a new mission.

  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.

Actually, it's true all over the rest of the government.

The USMC decided it was best to let the Navy handle it's medical assets, and the Army handle heavy logistics and maintenance.

USA and USMC outsource strategic air mobility to USAF.

Very few police departments have their own robust medical assets - they let the Fire Department/Ambulance folks handle most of that.

The Army decided to use civilians to guard gates at many installations, rather than soldiers.

USAF lets NASA carry many of its satellites into orbit.

CAP has chosen to use outside medical support for treating its own members, outside mechanics to repair its planes and it's vans, ,agencies like the Salvation Army and Red Cross to provide food and shelter support for extended missions, etc, etc.

There's a difference between core mission and support.  Support is critical - but you don't have to do it yourself.  You only do it yourself if you can do if it adds value without distracting from the core mission.  Otherwise, best to someone who specializes in that support function handle it.


Again, I'm not getting into the debate about whether CISM is useful or not - that's for guys more steeped in the details to debate. 

But  can someone make a cogent argument, with data,  on why we need to do this ourselves?  For example, does anyone have data about how screwed up things were before we started this, and how we're so much better now?  How about a study showing how other volunteer groups handle this (internal or external) and the results they've had?  What do the Boy Scouts do?

Or are we just doing it because we have some CAP members who want to do it?  Because I know members who want to use their search dogs, or parachute, or set up SCUBA teams - there's no end to how people wish to reshape CAP in their own image.

But we have core missions - ES, AE, CP.  We should consider support functions only as they relate to those core missions.  We can't do everything the best ourselves - sometimes best to let others take the lead in things they specialize in.

[whatevah]

I think this point may be getting lost from the original post...

the topic isn't about whether or not there should be any stress/ptsd/whatever support, but if CISM should be the method employed while many agencies and military branches have stopped using it in favor of other methods.

[John Bryan]

I think this point may be getting lost from the original post...

the topic isn't about whether or not there should be any stress/ptsd/whatever support, but if CISM should be the method employed while many agencies and military branches have stopped using it in favor of other methods.

Military is getting away from it??? 

The Air Force has been using it since the 90's....

http://findarticles.com/p/articles/mi_qa3912/is_200209/ai_n9094754/pg_1

AFI44-153 , which is now titled Traumatic Stress Response (but looks like CISM), the old title was CISM.

From March 06
http://www.e-publishing.af.mil/shared/media/epubs/AFI44-153.pdf

July 06
http://www.e-publishing.af.mil/shared/media/epubs/DOVERAFBI40-305.pdf

From July 1999
http://www.calguard.ca.gov/oc/csc/page%20info/afi44-153.pdf

July 05
http://www.af.mil/news/story_print.asp?id=123012627

========================================
US Coast Guard

http://www.uscg.mil/hq/cg3/cg3pcx/administration/fv157.asp
http://www.uscg.mil/hq/g-w/g-wk/wkw/EAP/pdf/CI_1754_3%5B1%5D.pdf
========================================

[Horn229]

Again, I'm not getting into the debate about whether CISM is useful or not - that's for guys more steeped in the details to debate. 

But  can someone make a cogent argument, with data,  on why we need to do this ourselves?  For example, does anyone have data about how screwed up things were before we started this, and how we're so much better now?  How about a study showing how other volunteer groups handle this (internal or external) and the results they've had?  What do the Boy Scouts do?

The most important aspect of CISD, when Jeff Mitchell created it, was the peer members of the debriefing team. That in and of itself is the only reason many EMS, Firefighter and Police personnel ever step foot into the debriefing room. If you replace the peers with just anyone who has gone through CISM training, then you've got a MHP and a few random people listening to professionals vent, or more likely you'll have the random people and the MHP trying to get the unwilling members to open up.

EMS and not the peers for Police, Firefighters are not the peers for radio dispatchers; EMS, Firefighters and Police all have different duties to perform at any given scene. They may all have scene the same thing, but due to their duties, were exposed to different aspect and stresses of the incident. Therefore none of the above groups should be debriefing together, nor debriefed by peers of a different profession.

Likewise, it would be ridiculous to have the someone trained in Admin/Finance debrief a Ground Team,  or Logistics to debrief an Aircrew. I hope I've answered your question.


Now then, in my previous post I stated CISD's do not work and have asked for a reason why CAP has chosen to continue on with CISM, while other organizations have switched to something more effective. I'd still like to see an argument as to why we continue on with this specific method when there are better options out there.

[John Bryan]

Could you name the other programs that "work better"?

[Horn229]

I've cut out the quote to just two specific links I'd like to talk about

Military is getting away from it??? 

The Air Force has been using it since the 90's....


AFI44-153 , which is now titled Traumatic Stress Response (but looks like CISM), the old title was CISM.

From March 06
http://www.e-publishing.af.mil/shared/media/epubs/AFI44-153.pdf

From July 1999
http://www.calguard.ca.gov/oc/csc/page%20info/afi44-153.pdf

If you actually read those two documents, you'll find the the July 1999 document was the old CISM base intervention guide for the USAF. The March 2006 document is a complete revision of their stress management program, they have completely done away with CISM and have switched to Psychological First Aid. In the "Summary of Changes" paragraph it states

This document is substantially revised and must be completely reviewed. This revision establishes
TSR teams at all active duty Air Force installations. TSR teams (1) serve as trauma response consultants
to unit leaders; (2) prepare personnel likely to be exposed to potentially traumatic events; and (3) provide
screening, education, psychological first aid, and referral for those exposed to potentially traumatic
events. This document also provides revised training guidance.

The other steps mentions in item number 3 are all aspects of Psychological First Aid. The references can be found in attachment 1 of the new version. If you go to the links in the references, you'll find most are about PFA, one link no longer works, and the other seems to discuss mass traumatic stress (irrelevant to us at this current time).

So it is clear, the USAF once used CISM, in the old version if you use the "Find" option and search "CISM" or "CISD" you'll get numerous responses, try again in the new version and you'll find none. In the new version, you will only find Psychological First Aid.

[Horn229]

Could you name the other programs that "work better"?

To save myself time in typing the same thing, I'll direct you to my previous post.

http://captalk.net/index.php?topic=3534.msg71170#msg71170

[John Bryan]

Yes but the Dover AFB pub is published after the latest AFI and it still says CISM. Why the difference?

The US Coast Guard still uses it. The Indianapolis police and fire depts still use it. Los Angeles County Fire Dept has a CISM team, City of Pittsburgh has a CISM team, Dallas Fire-Rescue has a CISM team......the list goes on and on.....

Not every department uses the ICISF CISM, so use other programs. Some fire departments train their firefighters with American Red Cross CPR , so use American Heart Assc, other use the National Safety Council......does this mean one is better then the other ?

[John Bryan]

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.

It is interesting that the person you quote says most people said "it was helpful but....."

Is there any proof it hurts? Also just wondering It was my understanding that LA County still has a team.....did you interview the LA City Fire Dept or LA County Fire Dept?

[Horn229]

Yes but the Dover AFB pub is published after the latest AFI and it still says CISM. Why the difference?

The US Coast Guard still uses it. The Indianapolis police and fire depts still use it. Los Angeles County Fire Dept has a CISM team, City of Pittsburgh has a CISM team, Dallas Fire-Rescue has a CISM team......the list goes on and on.....

Not every department uses the ICISF CISM, so use other programs. Some fire departments train their firefighters with American Red Cross CPR , so use American Heart Assc, other use the National Safety Council......does this mean one is better then the other ?

I have no idea the reason why Dover AFB has their own thing going. From reading paragraph 3.2, they reference AFI 44-153 for the training CIST's must go through. I'm going to assume it's similar to a CAP wing, someone wrote up a supplement and forgot to make sure the regulation didn't get updated prior to approval.

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.

It is interesting that the person you quote says most people said "it was helpful but....."

Is there any proof it hurts? Also just wondering It was my understanding that LA County still has a team.....did you interview the LA City Fire Dept or LA County Fire Dept?

Yep, people do walk away and say it was helpful, however that is not science, and the scientific studies say it doesn't work.

The interview I conducted was with the head of the behavioral health program for the LA City Fire Department.

And yes, there has been studies saying it hurts. Most studies find the control groups faired better, and a few say the debriefed groups had more adverse reactions. For reading material I'll quote myself again:

https://www.psychologicalscience.org/pdf/pspi/pspi421.pdf  -  A meta-analysis of studies for and against CISM, also discusses CBT.
http://www.bryanbledsoe.com/data/pdf/journals/CISM%20(Bledsoe).pdf  -   A review of information on CISM
http://www.bryanbledsoe.com/data/pdf/mags/CISM%20(CEN).pdf  -  Another article by the same person on CISM
http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_treatmentforptsd.html  -  Talks about some treatment methods for PTSD
http://www.thefreelibrary.com/Psychological+first+aid-a0158907275  -  An article on on Psychological First Aid, if you can find a .pdf from the journal it came from, it will be much easier to read.


A few other techniques to look up would be Eye Movement Desensitization & Respocessing (EMDR) and Thought Field Therapy (TFT). EMDR was just recently endorced by the International Society of Traumatic Stress Studies (ISTSS), TFT is still being reviewed, but is similar to EMDR.

The first link is a very interesting read, but on document page 58 (.pdf page 14 of 35 for me) starts the review of studies adduced in favor of CISD, then it moves on to studies showing null or adverse reactions, and some more good material continues on.