CISM/Peer Counseling Discussion

[MrJones]

What does that mean?

Can you be a bit more specific regarding what in that statement you don't understand?

 

[Tigger]

Can you be a bit more specific regarding what in that statement you don't understand?

Your work for a crisis intervention service...what does that entail and what education are you provided with/must have?

 

[MrJones]

Your work for a crisis intervention service...what does that entail and what education are you provided with/must have?

It's important to understand that Crisis Response is not the same as Crisis Intervention, although the latter is sometimes conducted as a subset of the former (I am not involved in Crisis Intervention in my role as peer counselor). That said, the specific duties of a peer counselor - and the requisite training and education - vary from organization to organization, so my experiences might not be the same as those of someone volunteering for a different service. If you're interested to learn more about how Crisis Response works, to include how peer counselors function, the publication at this link, though slightly outdated, will provide an excellent primer.

 

[Summit]

It's important to understand that Crisis Response is not the same as Crisis Intervention, although the latter is sometimes conducted as a subset of the former (I am not involved in Crisis Intervention in my role as peer counselor). That said, the specific duties of a peer counselor - and the requisite training and education - vary from organization to organization, so my experiences might not be the same as those of someone volunteering for a different service. If you're interested to learn more about how Crisis Response works, to include how peer counselors function, the publication at this link, though slightly outdated, will provide an excellent primer.

Over 100 words in your response and you didn't answer the very simple question.

What are you qualifications/training in this?

 

[Summit]

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

 

[MrJones]

 

[STXmedic]

So with directly dodging the question three times, I'm going to assume you have no real education and only brought up your "title" to make it appear you were some kind of authority that knew what you were talking about after several people rebutted against your slight against a poster here.

 

[Tigger]

It's important to understand that Crisis Response is not the same as Crisis Intervention, although the latter is sometimes conducted as a subset of the former (I am not involved in Crisis Intervention in my role as peer counselor). That said, the specific duties of a peer counselor - and the requisite training and education - vary from organization to organization, so my experiences might not be the same as those of someone volunteering for a different service. If you're interested to learn more about how Crisis Response works, to include how peer counselors function, the publication at this link, though slightly outdated, will provide an excellent primer.

But, what do I know? I'm only a peer counselor for a crisis intervention service....

So you are or are not a part of a crisis intervention service?

Regardless, what sort of training do you personally possess to hold this role? How does your agency work provide this service? I am curious how other places work, I don't have an axe to grind. I think my agency doesn't take its responsibility to help its providers out after rough calls, though we are lucky to have a paramedic who is also a psychologist.

 

[MrJones]

So you are or are not a part of a crisis intervention service?

OK - I see where the confusion lies, and it's my fault for choosing words poorly. No, I am not part of a crisis intervention service, I am part of a crisis response service. Guess I should proof-read myself a bit closer. Apologies for the miscommunication on my part.

 

[Summit]

OK - I see where the confusion lies, and it's my fault for choosing words poorly. No, I am not part of a crisis intervention service, I am part of a crisis response service. Guess I should proof-read myself a bit closer. Apologies for the miscommunication on my part.

So for the fifth time, what are your qualifications and education as they relate to the crisis response service? Or are you their barista?

 

[Bullets]

 

[Tigger]

OK - I see where the confusion lies, and it's my fault for choosing words poorly. No, I am not part of a crisis intervention service, I am part of a crisis response service. Guess I should proof-read myself a bit closer. Apologies for the miscommunication on my part.

How about communicating what sort of education your program puts you through to hold that role?