Abstract

In crisis situations, community management has two populations to attend to and manage: their civilian citizens and their own employees. While a lot of emphasis has been channelled towards addressing the emotional needs of the civilians affected, emergency personnel have been left to their own means. However, CISM was conceived to cater for the emotional needs of emergency personnel in terms of traumatic stress and help them in dealing with the various work related stress. While this intervention model has for long been used to treat emergency personnel, it has attracted dissent from various stakeholders who claim it is ineffective in addressing the problem. Subsequently, various alternatives to the CISM model have been devised with the hope that they will better help in helping emergency personnel in their dealing with traumatic and highly stressful components of their occupation.

Introduction

It is estimated that stress-related disorders will be the second leading cause of disability by the year 2020, and it is the primary strategic goal for the world health organization’s Global Burden of Disease of the NIOSH work organization and Stress-related Disorders Program (Fagel, 2011). In the United States, work-related stress is estimated to cost $171 billion annually, which is the same as cancer and cardiovascular disease, and greater than Alzheimer’s’ or HIV or AIDS. There is an estimated $300 billion annual cost due to lost hours from absenteeism, decreased work productivity, and cost of health expenditures. One key source of work related stress streams from personnel who are involved in emergency situations. Research demonstrates that individuals without the benefit of prior disaster training or experience are at a greater risk for posttraumatic stress disorder. In a study of PTSD post world trade Centre, the rate was 21.1 percent for construction, engineering, sanitation and unaffiliated workers compared to a rate of 12.4 percent for rescue/recovery workers. Thus, it is very important to consider the mental health needs of not only primary survivors, but also of the secondary survivors and response personnel. This paper presents an in-depth examination of CISM as an intervention approach for emergency personnel, evaluating whether itis the best solution for long-and short-term mental health related issues. In addition, the paper will present some of the alternate interventions that can be employed to assist emergency personnel.

Introduction

One of the earliest interventions to be employed by personnel involved in the provision of emergency services was CISM. Since it was first adopted in the beginning of 1980, CISM has continuously been employed as the intervention of choice.Critical incident stress management is a comprehensive, multicomponent, well-integrated work-based programme that is designed to assist emergency service workers, or allied professionals, to deal effectively with the traumatic and highly stressful components of their work. CISM has also been described as trauma management programmes and psychological support programmes. The core elements are the comprehensiveness of the approach (preventative and remedial) and their exclusive focus on traumatic stress as opposed to general work stress or organizational stress.CISM programmes comprise many elements, including education on trauma and its management, one-on-one counselling/support, group meetings, follow-up and partner support. CISM programmes manage day-to-day traumatic events as well as large-scale incidents.

Critical Incident Stress Management (CISM) is a system of crisis interventions that encompass the spectrum from acute crisis phase into the post crisis phase of stress management and critical incident exposure. Although there has been debate over its efficacy, when done according to the defined structure by trained facilitators, it has been found to be very helpful, educational, preventative, and supportive.

Criticism of the use of CISM has been addressed where the founder of the approach stated that the criticism of the model came from situations where the techniques were in fact used by untrained individuals, misapplied to people for whom the techniques were not designed, and by individuals who used them in a psychotherapy context.

• analyze 3 professional literature or other professional sources that is within 5 years to determine whether CISM is the best solution for long-and short-term mental health related issues for emergency personnel.

While the use of CISM has attracted varied dissent in its use, it remains a favourite intervention approach for many agencies and has been supported by various studies. This is for the reason that in many contexts the approach has proved to be effective in helping the individuals involved in coping with their stress. Some of the strengths of CISM lie in its goals which are to minimize or completely minimize the incidence, duration as well as severity of, or impairment of an emergency personnel from traumatic stress that has been occasioned by crisis environments traumatic stress. CISM has been credited with successfully facilitating an individuals’ psychological closure of a traumatic situation by means of group interventions expedited by mental health professionals and counsellors.Additional strengths which have been associated with the CISM intervention include leadership training and support through CSTS (Centre for the study of traumatic stress), and pre and post-incident teaching and education aspect which are critical to making any intervention successful. The inclusion of informal non-compulsory group discussions and social support post incident with referrals to mental health professionals for individual requiring advanced intervention makes CISM a good intervention for long-term mental health related problems.

negative of CISM

while the negative criticism directed at CISM are few, they pre-empt the use of CISM as an intervention. Criticism has been founded on the efficacy of the approach in exhaustively assisting emergency personnel deal with traumatic stress and ability of the approach to be applied to different individuals with similar positive results. Contemporary studies in the area of post incident and disaster mental health have brought into question the efficiency of CISM as well as its component CISD, and have suggested that these models could be ineffectual and sometimes harmful to particular individuals. Studies have revealed that majority of the personnel are not in need of structured group interventions such as CISM, and that the personnel who would be in need of clinical attention avoid this model as it would be too traumatic too soon after an event.

Studies have stated that affected emergency personnel can individually settle their own stresses given ample time and with minimal outside assistance. That is, CISM has been blamed for interfering with the natural recovery process that is preconditioned in the mind of any individual. CISM has also been blamed for making emergency affected emergency personnel overlook reputable and tested intimate support systems such as co-workers, family, clergy and friends.  Further criticism of CISM stems from the generalized approach of the intervention. Studies claim that CISM is contraindicated. This isbecause emergency personnel who have been intensely traumatized and are experiencing PTSD are required to revisit the location of the incident whereasis such situation person-to-person intervention maybe more appropriate. Finally, CISM has been shown to be harmful when used in particular individuals and situations. This makes the use of CISM a trial-and-error intervention that can result to negative effects on a traumatic stressed individual.

Conclusion

The last thing any organization wants is to expose their employees to services that harm the individual as opposed to helping them recover from an exposure to a stressful situation. While CISM as an intervention approach has been effective in addressing the challenge of ******. Research has showed that it is not completely effective and in some cases has proved to be harmful to individuals. Thus in the face of new, modern and more effective intervention to address the problem of **** it is critical that these interventions are employed and in some situations where CISM is appropriate, it be used.

• what other mental health professionals can assist emergency personnel?

The efficacy of the CISM model as an intervention approach to handle emergency personnel mental health has been a subject of debate among stakeholders such medical professionals, emergency service workers, and allied professionals.

While CISM has been the intervention of choice for majority of the emergency service personnel since the early 1980, beginning the 1990 there has been an increase in dissent concerning its effectiveness. With the increased dissent on the use of CISM, there has been increased interest in identifying additional interventions that can be of assistance to emergency personnel. As a result, various intervention programs have been identified for emergency personnel. These include Crisis Counselling Program (CCP), Psychological First Aid (PFA), and Resiliency Development.

Critics have put a case for the adoption of alternative interventions to CISM. This has been necessitated by the widespread complaints that the model is not effective in addressing emergency personnel mental needs, and the unavailability of alternate programmes to address post incident traumatic stress.

Other interventions

Psychological First Aid (PFA) is an intervention that is predominantly employed by disaster relief workers and first responders. The use of PFA has been recommended by the National center for posttraumatic stress disorder (NCTSN) and the substance Abuse and mental health services administration (SAMHSA). Both bodies advocate for the use of PFA for first responders. The approach has been hailed as being the emerging crisis intervention program of choice. It was especially regarded effective especially as the intervention used by law personnel deployed during 9/11. PFA is highly considered as an intervention that promoted a supportive atmosphere and encouraged individual resiliency. It has been endorsed as an alternative to CISM and it is consistent with studies findings as a successful and effective approach for handling risk and resiliency in the face of trauma.

Crisis Counselling Program (CCP) is another alternative to CISM. It was conceived by the Federal emergency management authority Agency and is founded on the belief that crisis counseling takes on a natural resiliency. At first, the approach was meant to provide assistance to regions and personnel affected in disasters resulting from terrorism. The approach is implemented on a grand scale and necessitates the involvement of a mental health corps.

Resiliency Development primarily targets the resiliency of first responders in an emergency situation. This approach has been suggested as an alternative to CISM for the reason that it purges reliving graphic details of an emergency situation by emergency personnel and is founded on the internal strength of an individual to build on the individuals’ natural resilience. The American psychological association help center reports that resilience comprises behaviors and actions that can be learned and developed.

Other available alternative to the use of CISM include the use of competent and licensed mental health professionals who have experience working with, and treating people suffering from trauma-related stress. Professional therapist have also proved to be more effective that CISM in some cases. The session would mostly involve the individual talked with the therapist who simply listens and allow the individual to speak.

Psychiatrists have also been suggested as effective mental health professionals who can help emergency personnel deal with stress. Psychiatrists employ the use of psychological treatments such as interpersonal therapy, medication or behavior therapy and in situations where stress levels are severe requiring hospital admission, a psychiatrist will oversee the individual’s treatment. Alternative mental health professionals include occupational therapists in mental health, mental health nurses, social workers in mental health, as well as general practioners.

 
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