Houston Fire Department Critical Incident Stress Management Team PDF

HOUSTON FIRE DEPARTMENT SUBJECT: CRITICAL INCIDENT STRESS MANAGEMENT TEAM VOLUME NO. I ALL DIVISIONS REFERENCE NO. I-48 SECTIONS 1.00-6.11...

HOUSTON FIRE DEPARTMENT SUBJECT: CRITICAL INCIDENT STRESS MANAGEMENT TEAM VOLUME NO. I ALL DIVISIONS REFERENCE NO. I-48 SECTIONS 1.00-6.11 1.00 PURPOSE 1.01 The purpose of this policy is outline the Houston Fire Department’s (HFD) response to personnel who, as a result of responding to or becoming involved in a critical incident, may be in need of peer counseling or mental health services. 2.00 OBJECTIVES 2.01 The duties of the fire service profession are emotionally demanding. Stress and related emotional difficulties may have a negative impact on personnel performance, and, in extreme instances, may present a danger to the safety and welfare of the employee, their family, or the public. Therefore, it is the policy of HFD to provide all personnel with access to peer counseling and/or mental health services to help them resolve emotional difficulties and to ensure the well-being of the employee, his/her family, and the public. 3.00 DEFINITIONS 3.01 Chaplain: A member of the Department who has been endorsed by his or her own denominational authority, church, synagogue, or other religious authority and who has been appointed by the Fire Chief to serve the spiritual needs of the employees. 3.02 HFD CISM Team: A team composed of peer support personnel and mental health professionals who provide peer counseling to department employees who have experienced critical incidents. 3.03 Peer support personnel: HFD employees, either classified or civilian, who have volunteered and completed the training requirements of the CISM Team and have been screened through the Team’s application process. 3.04 Mental Health Professional (MHP): A person possessing at least a Master’s Degree and license in a mental health field (e.g. counseling, social work, psychology), and who has specialized training in critical stress management and post-traumatic stress. 3.05 Clinical Director: A mental Health professional who provides oversight of the activities of the CISM Team, training to members of the Team, and who serves as a resource for those department members needing psychological care beyond the level of peer support personnel. 3.05 Confidentiality: Privacy of information obtained during CISM actions. Confidentiality of information is an essential ingredient for the success of the CISM Team. The Texas Health and Safety Code (Chapter 784.003) provides that “a communication made by an emergency service provider….while the provider receives critical incident stress management services is confidential and may not be disclosed in a civil, criminal, or administrative proceeding”. 3.06 Critical Incident: An event outside the usual realm of human experience that is I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 1 of 6  markedly distressing, or an incident with the potential to interfere with a person’s ability to function either at the scene or following the incident. 3.07 Crisis Intervention: Urgent psychological/behavioral care designed to, first stabilize, and then reduce the symptoms of distress/dysfunction following a critical incident. The goals of crisis intervention are to assist persons in achieving a state of adaptive functioning or, when necessary, to facilitate the individual’s access to continued care. 3.08 Critical Incident Stress Management (CISM): A crisis intervention protocol developed specifically for dealing with traumatic events. It is a formal, highly structured, and professionally recognized process for helping those involved in a critical incident to share their experiences, vent emotions, learn about stress reactions and symptoms, and be given referral for further help if required. It is not psychotherapy. It is a confidential, voluntary and educative process, sometimes called 'psychological first aid'. 3.09 Defusing: A brief CISM group intervention used soon after members have encountered a traumatic crisis event (e.g. LODD, pediatric death). Defusings involve peer responders and those persons involved in the event. They are targeted at the group of persons who had similar exposure to the event (e.g. a crew, all persons responding to an incident). They are typically utilized within 24 hours of the event and are more limited in time and scope than debriefings. They are intended to: A. Provide rapid reduction in the intense reactions to the incident. B. Normalize the experience of personnel so that they can return to work as soon as possible. C. Reinforce group cohesiveness and reduce crewmember isolation. D. Offer information on signs and symptoms of stress and information on coping with stress. 3.10 Debriefing (Critical Incident Stress Debriefing—CISD): A CISM intervention consisting of a small group meeting or discussion held after a distressing critical incident. A. CISD is a peer-driven, clinician guided discussion (a Mental Health Professional should be present) usually held at least 24 hours after the critical incident. B. A CISD is intended to: 1. mitigate the impact of a traumatic incident 2. facilitate normal recovery processes and restore people to normal functioning 3. Screen persons to determine who might benefit from additional support services or a referral for professional care. C. A debriefing is not at operational critique. D. Attendance at a CISD may be required of personnel involved in a critical incident; however, participation in the discussion is voluntary. E. A CISD is standard procedure following an LODD. 3.11 On-scene support: CISM services provided at the scene of an on-going event. A. On-scene support may include: 1. Brief crisis interventions with emergency personnel who show signs of distress. 2. Advice and counsel to the Incident Commander. B. Members of the Team who arrive at a scene to provide peer support will report to the Incident Commander or his/her designee prior to providing CISM services. 3.12 One-on-one: Informal consultations between a trained peer responder or mental health professional and a member who is showing signs of distress. This intervention is more conversational and less structured than the formal group processes of group defusings and debriefings. It is not psychotherapy or counseling, but peer support and guidance. It may be used in situations where a group intervention is not required or appropriate. I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 2 of 6 3.13 Demobilization: A CISM group intervention used in large-scale events which require large numbers of first responders working for long durations. A demobilization is conducted in an area separate from the emergency scene and may include separate spaces for one-on-one meetings, comfortable places to relax, food and drink, resources such as Chaplains or support animals, and rooms for group crisis interventions such as CMB’s or defusings. The goals of the demobilization are to: A. Facilitate shift disengagement. B. Provide information to responders. C. Allow for psychological decompression. 3.14 Crisis Management Briefings (CMB): Large group CISM interventions intended to help fill the information void that typically follows any critical incident. Unlike the defusing or debriefing, the CMB is usually open to anyone who wants to attend, and they are appropriate for large, even heterogeneous audiences. Factual information about the incident is shared, rumors are dispelled, stress management coping skills are suggested, and questions are addressed. The CMB can be repeated as often as necessary depending on the availability of personnel and the release of new factual information. 3.15 International Critical Incident Stress Foundation (ICISF): An international organization which provides leadership, education, training, consultation, and support services in comprehensive crisis intervention and disaster behavioral health services to the emergency response professions, other organizations, and communities worldwide. The ICISF model is the one most widely accepted in the United States Fire Service. It provides a standard of care that is recognized internationally. 3.16 CISM Team Shift Leader: A senior member of the CISM Team who is on-duty. The CISM Team Shift Leader will assist the Shift Commander and the Clinical Director in ensuring that there are adequate CISM Team resources available to meet a request for CISM services. 4.00 SCOPE 4.01 This guideline applies to all members of the Houston Fire Department 4.02 While some events are more likely to affect involved personnel, not all exposed members will be affected in the same ways by such events. Some members may be in need of CISM services while others will be relatively unaffected. 5.00 RESPONSIBILITIES 5.01 All responsibilities are outlined within the context of this guideline. 6.00 GUIDELINES 6.01 Critical Incidents are situations that are so stressful that they have the potential to overwhelm the normal coping mechanisms of people. Critical incidents in the Fire Department may include but are not limited to: A. Serious line-of-duty injuries B. Suicides by first responders C. Critical injury or death of a child D. Knowledge of the victim of an emergency event E. Prolonged incidents I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 3 of 6  F. Multi-casualty incidents/disasters G. Terrorist/WMD incidents H. Multiple significant incidents within a short time frame I. Workplace violence incidents J. Incidents involving mutilation of victims. K. Line-of-duty deaths (LODD’s) 6.02 CISM Team Member Qualifications: Members of the CISM Team may be employees of any rank in the Fire Department who have a minimum of three years in the Department. They must meet any other requirements for membership deemed appropriate by the Mental Health Professional who serves as the Clinical Director of the Team. 6.03 Membership Applications for the CISM Team: HFD personnel wishing to become members of the CISM Team must complete an application available from the Member Advocate of the Firefighter Support Network. Applications will be reviewed and screened by senior members of the CISM Team and by the mental health professional who serves as the Clinical Director of the Team. An interview of applicants may be required. 6.04 Training of CISM Team Members: The CISM Clinical Director is responsible for the ensuring that all members have adequate training to perform their duties on the Team. A. As soon as feasible after being selected for the CISM Team, members of the Team must complete courses in: 1. Individual crisis intervention (one-on-one). 2. Group crisis intervention (e.g. CMB’s, defusings, debriefings). 3. Suicide intervention and prevention. B. Team members are encouraged to continue developing their competencies in crisis intervention by attending additional courses offered by the ICISF or similar classes offered by other entities. The Clinical Director will consult with members regarding appropriate courses for continuing education. 6.05 Deployment of the CISM Team: The CISM Team will typically be deployed to assist firefighters or civilian employees who are on-duty. A. A person requesting CISM services should notify their chain-of-command of this need. The request should be relayed through the chain-of-command to the Shift Commander who will make the decision to deploy members of the CISM Team who are on-duty. B. If a request for CISM servicers is made to a CISM Team member, the OEC/Dispatch, or the Clinical Director, that request will be relayed to the Shift Commander. C. The Shift Commander may be assisted by an on-duty CISM Team member who serves as the CISM Shift Leader for that day. The CISM Shift Leader will be familiar with the available CISM personnel on-duty that day as well as with the resources needed to meet the CISM request. D. The Clinical Director of the CISM Team will be notified of a CISM request by either the Shift Commander or the CISM Shift Leader. The Clinical Director will ensure that adequate resources are available to meet the needs of the situation. E. Requests for assistance for off-duty personnel or family members are to be relayed to the Clinical Director who will make the decision about the appropriate response to the need which may include: 1. Referral to an outside agency 2. Police involvement 3. Follow-up with HFD Psychology Service I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 4 of 6  4. Referral to EAP 6.06 The ICISF Model: The HFD CISM Team primarily utilizes the model of critical incident stress intervention developed by the International Critical Incident Stress Foundation (aka the “Mitchell Model”). A. The HFD CISM Team maintains an affiliation with the ICISF and extensively utilizes ICISF training for its members. B. The CISM Team may also utilize other proven and empirically supported methods of crisis intervention such as psychological first aid and methods from the Israeli Trauma Coalition. 6.07 CISM Interventions: The specific individual or group interventions to be employed as part of CISM will be determined by Team members in consultation with the Clinical Director. These interventions may be for individuals or for groups and could include: A. One-on-one crisis interventions B. On-scene support C. Defusings D. Debriefings E. Demobilization F. Crisis Management Briefings 6.08 Post-Intervention: CISM Team members are not psychotherapists, but they are experienced members of the Fire Department, familiar with the work and stressors inherent in firefighting and EMS services. They are effective listeners who provide feedback, clarify issues, and assist employees in identifying problems and potential options. A. During CISM deployments CISM Team members will assess participants for potential follow-up support. B. When employees are identified as in need of more professional services, they will be referred to appropriate resources such as the Department’s Staff Psychologists, the Chaplain, or the City EAP. 6.09 Role of Clinical Director: Typically, a Staff Psychologist will serve as the Clinical Director. The Clinical Director will oversee the operations of the Team and will ensure that its members have adequate training to complete their mission. 6.10 Confidentiality: Information about events or personnel that is shared with CISM Team Members will not be shared with the Department’s Chain of Command, with other members of the Department, or with persons outside the Department without written consent from the employees involved or a court order. A. The peer responder must explain the limits of confidentiality to recipients of CISM services. B. Information about events and personnel during CISM actions will only be shared within the Team on a need-to-know basis (i.e. information will not be shared with Team members who are not involved in that response). C. Confidentiality of information also applies to all forms of social media. No Team Member should ever post such information on any website or electronic forum. D. A breach of confidentiality is considered a very serious event and could result in removal from the CISM Team or other disciplinary action. E. Exceptions to Confidentiality include, but are not limited to: 1. When there is reason to believe that a person poses a significant danger to him/herself or others. 2. When abuse of children, an elderly person, or a disabled person is suspected. I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 5 of 6  3. Any exceptions or breaches of confidentiality must be reported to the Clinical Director of the CISM Team. 6.11 Professional Behavior: CISM Team members are not to engage in romantic or sexual relationships with recipients of CISM services. Even after CISM services have been completed, it is considered unprofessional for Team members to develop a romantic or sexual relationship with former recipients of services. Failure to abide by this guideline could result in removal from the Team. I-48 Critical Incident Stress Management REVISED 08/24/2018 REVIEWED 3/18/23 Page 6 of 6