Critical Incident Stress Management and Eap

Critical Incident Stress Management (CISM) and EapIRJCF Psychology Training

Critical incident Stress managementYou have experienced a traumatic event or a critical incident when that incident causes responding personnel to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later.It is very common, in fact quite normal for people to experience emotional aftershocks when they have been through a horrible event.

Critical incident Stress managementSometimes the emotional aftershocks (or stress reactions) appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. In some cases, a few weeks or months may pass before the stress reactions appear.

Critical incident Stress managementThe signs and symptoms of a stress reaction may last a few days, a few weeks, or a few months and occasionally longer depending on the severity of the traumatic event. With understanding and support of a loved one the stress reaction usually passes more quickly. Occasionally, the traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply you are crazy or weak. It simply indicates that the particular event was too powerful for the person to manage by himself or herself.

PTSD Lisas Story

Common signs & Symptoms of a Stress ReactionPhysicalFatigue+ Visual DifficultiesNausea+ Grinding of TeethMuscle Tremors+ WeaknessTwitches+ DizzinessChest Pain*+ Profuse SweatingDifficulty Breathing*+ ChillsElevated Blood Pressure+ Shock Symptoms*Headaches+ VomitingThirst+ Fainting

Common signs & Symptoms of a Stress ReactionCognitiveConfusionPoor AttentionPoor Decision-MakingHeightened or Lowered AlertnessPoor Concentration or MemoryProblems with Hyper VigilanceDifficulty identifying familiar objects or people

Common signs & Symptoms of a Stress ReactionCognitive (Continued)Increased or decreased awareness of surroundingsPoor problem solvingPoor abstract thinkingLoss of time, place, person, orientationDisturbed thinking, nightmares, intrusive images

Common signs & Symptoms of a Stress ReactionEmotionalAnxiety+ UncertaintyGuilt+ Loss of emotional responseGrief+ Inappropriate emotional responseDenial+ AgitationSevere Panic (rare)+ ApprehensionEmotional Shock+ Feeling OverwhelmedFear+ Intense Anger

Common signs & Symptoms of a Stress ReactionBehavioralChange in speech patternLoss or increase in appetiteWithdrawalEmotional OutburstsSuspiciousnessChange in Usual Communication SkillsPacing

Common signs & Symptoms of a Stress ReactionBehavioral (Continued)Startle ReflexHyper alert to environmentAlcohol ConsumptionInability to RestAntisocial ActsNonspecific Bodily ComplaintsErratic MovementsChange in Sexual Functioning

Within the first 24-48 hoursPeriods of physical activity (based on your physical condition and physical limitations), alternated with relaxation will alleviate some of the physical reaction.Structure your time keep busy.Youre normal and having normal reactions dont label yourself crazy.Talk to people talk is the most healing medicine.

Within the first 24-48 hoursBe aware of numbing the pain with overuse of drugs or alcohol. You dont need to complicate this with a substance abuse problem.Reach out people do care.Maintain as normal a schedule as possible.Spend time with others.Help your co-workers as much as possible by sharing feelings and checking out how they are doing.

Within the first 24-48 hoursGive yourself permission to feel rotten and share your feelings with others.Keep a journal; write your way through the sleepless hours.Do things that feel good to you.Realize those around you are under stress.Dont make big life changes.Eat well-balanced and regular meals (even if you dont feel like it).

Within the first 24-48 hoursDo make as many daily decisions as possible which will give you a feeling of control over your life, if someone asks you what to eat answer them even if youre not sure.Get plenty of rest.Reoccurring thoughts, dreams, flashbacks are normal do not try to fight them they will decrease over time and become less painful.

For Family and FriendsListen Carefully.Spend time with the traumatized person.Offer your assistance and a listening ear if they have not asked for help.Reassure them that they are safe.Help them with everyday tasks like cleaning, cooking, caring for the family, and minding children.

For family and friendsGive them some private time.Dont take their anger or other feelings personally.Dont tell them that they are lucky it wasnt worse that statement does not console traumatized people. Instead, tell them that you are sorry such an event occurred and you want to understand and assist them.

IRJCF LOP 403.37.00-01 Critical Incident DebriefingCritical Incident A serious suicide attempt and/or a successful suicide; an attempted or complete escape; serious injury to staff or youth, riot, disturbance, etc.Critical Incident Debriefing Team Deputy Superintendent Direct, Deputy Superintendent Indirect, Deputy Superintendent of Programs, Psychology Supervisor, Social Worker Supervisor, Chaplain, Operations Administrator or designee, and Health Services Administrator.EAP Employee Assistance Program.

IRJCF LOP 403.37.00-01 Critical Incident DebriefingPROCEDURE:

Following a critical incident, as ascertained by the Superintendent or designee, the Superintendent will authorize mobilization of a Critical Incident Debriefing Team. The Operations Manager will contact the Ohio State Highway Patrol and any necessary medical services, and the Critical Incident Debriefing Team Coordinator (Psych Supervisor) will meet with the team to present the facts of the crisis and to design a plan.

Members of the Psychology Department will be available for immediate debriefing of staff and youth. The Psychology Supervisor will contact Central Office and, as necessary, will arrange for the mobilization of psychologists throughout the Ohio Department of Youth Services system to assist Indian River JCF psychology staff. As necessary, the Psychology Supervisor will contact the Employee Assistance Program (EAP) for on-site assistance. Employees will also be given the EAP hotline number for any necessary follow-up.

IRJCF LOP 403.37.00-01 Critical Incident DebriefingThe Critical Incident Team shall be responsible for the following:A review of staff and juvenile actions during the incidentA review of the incidents impact on staff and juvenilesA review of corrective actions taken and still neededPlans for improvement to avoid another incidentThe Critical Incident Team will inform staff of the facts of the incident and the plan for dealing with it. Staff will be dispatched to all areas to monitor youth. All youth will meet with members of psychology in a group format for debriefing. Youth requiring individual attention will be seen as soon as is possible. Documentation of youth requiring Suicide Watch Status or special follow-up will be posted on a Central Information Board.The Critical Incident Team will provide updates and debriefings every four hours.

IRJCF LOP 403.37.00-01 Critical Incident DebriefingAs necessary, psychology staff members and Critical Incident Team members, in conjunction with all institutional staff, will continuously monitor staff and youth for on-going debriefing needs.If appropriate, a memorial service will be available.

Where do I go if I need help?The Ohio Employee Assistance Program is a great resource if you are experiencing difficulty with an enduring stress reaction. The following are some FAQs regarding the program:

Q. What is the OEAP? A. The OEAP is the State of Ohio Employee Assistance Program (OEAP) counseling referral program. Because problems at work may spill over into problems at home and vice-versa, the OEAP will provide confidential assistance with counseling referrals to employees and their immediate family members (i.e., dependents such as spouse and children who live in the home) to help in resolving personal problems. In addition, OEAP Consultants are available to respond to traumatic events in the workplace; OEAP offers a variety of presentations and trainings that can address many different problems. The OEAP is supported by both labor and management. It has been a benefit to all state employees and their families since 1984.

Q. What is the purpose of the OEAP? A. OEAP is available to offer help to State of Ohio employees who are experiencing personal problems that may affect their job performance. OEAP provides counseling referrals and self-referral opportunities to employees seeking professional assistance for various problems.

Q. Who is eligible to use OEAP? A. All current, disabled or retired State of Ohio employees and their immediate family members may contact OEAP for assistance. There is no limit to the number of telephone calls that can be made to OEAP.

Where do I go if I need help?Ohio Employee Assistance Program FAQs (Continued)

Q. What other services are provided by OEAP? A. Other services available include: Consultation services when you have concerns about family members, a friend or co-worker who may be experiencing problems. Critical Incident Stress debriefings (CISDs) may be arranged and facilitated by OEAP staff during traumatic events such as death or serious injury of a co-worker. Intervention services for organizations in transition for agencies and institutions that may be experiencing workforce reductions or reorganizations. Advocacy with the managed mental health care provider, if necessary.

Q. Is the OEAP voluntary? A. Yes, the decision to participate in the OEAP is up the individual employee or family member. However, a supervisor, union representative or co-worker may recommend an employee seek help, but the final decision is the employees.

Q. Do callers/clients have to follow the OEAP recommendations? A. No, individuals who use the OEAP can decide whether to follow the recommendations provided by an OEAP Consultant. This is a decision totally up to the caller or client.

Where do I go if I need help?Ohio Employee Assistance Program FAQs (Continued)

Q. What is the relationship between the OEAP and State of Ohio Drug Free Workplace Program? A. Employees who have been in violation of the State Drug Free Workplace policy may be offered an opportunity to enroll in a Participation Agreement with the OEAP. If a Participation Agreement is offered and accepted these employees are required to contact and follow through the recommendations of the OEAP.

Q. Will my call and information be confidential? A. Yes, the OEAP ensures strict confidentiality as governed by State Law (Ohio Revised Code 3701.041) and the Federal Regulations (42 CFR Part 2) to protect clients. No information regarding an employees participating in OEAP will be released unless the employee provides authorization in writing. Otherwise, only the EAP clients and the OEAP Consultants will know what has been discussed. The only exception is if child or elder abuse is suspected or if a person is in immediate danger of harming him/herself or others. State law requires that such instances or suspected instances be reported.

Where do I go if I need help?Ohio Employee Assistance Program FAQs (Continued)

Q. How much does it cost to use OEAP or who pays the bills? A. OEAP is part of the employee benefit package and there is no charge for using this service. If a referral is made for ongoing counseling, a co-payment will be charged for each session, for which the employee is responsible. Employees can contact OEAP for services regardless of whether the person carries health insurance. Referrals to other resources may or may not be free depending upon the resource provided. If there is a fee, it is the employees responsibility to pay the associated fees.

Q. What types of records are maintained in OEAP? A. The OEAP maintains records on the type of in-take calls and referrals made. A quarterly composite of types, number of calls and utilization of service is sent to State agencies for program performance. These reports contain no reference to individual callers or clients.

Q. As a supervisor or union representative, how do I communicate information about the OEAP to employees? A. Supervisors should ideally be communicating with employees prior to the identification of a problem. If there are employees experiencing performance problems, they should be reminded of the OEAP. Supervisors may want to hold brief informational sessions with employee(s) to share information about the OEAP or request that OEAP come in to provide an informational session with employees. Also, new employees will learn about the OEAP during new employee orientation.

Where do I go if I need help?Ohio Employee Assistance Program30 E. Broad Street, 27th FloorColumbus, Ohio 43215Toll Free: 1 (800) 221-6327Office: (614) 644-8545Fax: (614) 564-2510