A Primer on Critical Incident Stress Management (CISM)

A Primer on Critical Incident Stress Management (CISM)

A PRIMER ON CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

George S. Everly, Jr., Ph.D., C.T.S. and Jeffrey T. Mitchell, Ph.D., C.T.S.
The International Critical Incident Stress Foundation

As crises and disasters become epidemic, the need for effective crisis response capabilities becomes obvious. Crisis intervention programs are recommended and even mandated in a wide variety of community and occupational settings (Everly and Mitchell, 1997). Critical Incident Stress Management (CISM) represents a powerful, yet cost- effective approach to crisis response (Everly, Flannery, & Mitchell, in press; Flannery, 1998; Everly & Mitchell, 1997) which unfortunately is often misrepresented and misunderstood.

What is CISM? CISM is a comprehensive, integrative, multicomponent crisis intervention system. CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis. CISM interventions range from the pre-crisis phase through the acute crisis phase, and into the post-crisis phase. CISM is also considered comprehensive in that it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are defined below and are summarized in TABLE 1.

1. Pre-crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations.

2. Disaster or large-scale incident, as well as, school and community support programs including demobilizations, informational briefings, “town meetings” and staff advisement

3. Defusing. This is a 3-phase, structured small group discussion provided within hours of a crisis for purposes of assessment, triaging, and acute symptom mitigation.

4. Critical Incident Stress Debriefing (CISD) refers to the “Mitchell model” (Mitchell and Everly, 1996) 7-phase, structured group discussion, usually provided 1 to 10 days post crisis, and designed to mitigate acute symptoms, assess the need for follow-up, and if possible provide a sense of post-crisis psychological closure.

5. One-on-one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.

6. Family crisis intervention, as well as, organizational consultation.

7. Follow-up and referral mechanisms for assessment and treatment, if necessary