International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Andrew Maher, BSc, MIACP
Since my CISM training in Lexington, North Carolina in 2016, my debriefing approach has grown and developed into an adaptable inclusive ethos where a first serve philosophy is at the forefront.
I am a qualified psychotherapist, cross-professional supervisor and EMDR therapist and I have worked within a company providing critical incident support for the past 5 years. During this time, I have facilitated multiple debriefings where I have gained invaluable learning and experience.
My experience has covered a multitude of incidences from the tragedy of an employee suicide, bereavement, redundancy, bank robberies, terrorist attacks, natural disasters, and tragic fatalities. The debriefing pattern was structured, allowing it to become familiar to me. I not only understood but believed in the power of the model and for me integrating an interpersonal and relational approach when facilitating the debriefings became central to a positive outcome. However, throughout these experiences I encountered a challenge to integrate change and support while maintaining clinical and ethical boundaries when corporate demand may be driving the process. CISM, for me, is submerged within the corporate world of multi-nationals and while it provides incredible support, I believe and have witnessed its own set of limitations towards the level of support that can be offered to those who are not deemed eligible. Without being too cynical, at times I felt some corporate CISM interventions may have been agreed from an optics tick box organisational point of view, without considering everyone involved in the incidences and this is something that doesn’t sit well with me as a facilitator.
With that being said, sometimes your greatest sceptic or critic can be the creative catalyst towards progression in a sink or swim struggle towards uncovering a resolution. This was the reality I faced when a National Railway Service wanted an Employee Assistance Program (EAP) and Critical Incident Support Provider. We as a company took a very different approach, although we would be managing one off incidents, the core cohort of responders would be from the same internal railway incident team. This means that for any self-harm or fatalities, mainly from suicide jumpers, the same team/people would be responding, therefore subjecting them to witnessing similar injuries and fatalities time and time again, possibly increasing the onset of PTSD from the multiple exposures. This team’s responsibilities include the safety of all passengers and staff when an incidence occurs, liaising with Central Control to cut the power on the line, assessing safety prior to granting access to emergency responders and the incident management team, and organising of and assisting in removing the body from the scene which as you can imagine can be extremely challenging. In some incidences passengers may be required to disembark the train for safety reasons, the incident team would need to oversee this adding additional safety measures and ensuring the passengers do not witness the body, as quite often, this is a horrendous and traumatising sight. When the site is clear and passengers are safe, the emergency responders and incident team will coordinate to safely restore the live network rail so that rail service can resume. The team would then be required to consult with the Scenes of Crime Officer which might even involve reviewing real time footage of the incident to rule out any foul play. The above happens all too often and team are required to manage this time and time again. Prior to our hybrid CISM approach, these teams did not have a psychological support system in place.
After our first meeting in a clinical and corporate boardroom with all the usual suspects present, procurement, human resources, and safety and well-being managers, and reviewing the extent of the team’s experiences and how alien a boardroom felt to them, I adopted that the best way forward would be embedded in a more interpersonal, relational and grass roots approach in an environment familiar to the teams involved. This decision was also informed by my own personal affinity to the rail network and the knowledge I absorbed from my Grand Uncle, Tom Carton, and his stories from more than forty years working the for the railway, which I believe offered me insight and understanding of the rail culture that helped choose the direction we took in supporting employees.
Coming from an external company and witnessing the reluctance of the team and employees to open up to us, the question arose of how would this team trust us to do the work and engage in the debriefing process? Trust, visibility, approachability and a willingness to demonstrate that we will lead from the front line together as a unit was essential to the success of the project. Our integrated systemic approach evolved out of this realisation. In order to connect myself, the risk and safety manager and incident response team managers for the network, we agreed to meet on site out at the railway HQ, where the safety of familiarity was present. We all agreed that it could be a challenge to do a stand-alone CISM debrief considering the uniqueness of these debriefs; this team never before participated or felt the need for CISM debriefings. The question remained “why now?” this was the first challenge we needed to surmount. This proved easier than expected to overcome when we framed it against a backdrop of specialised support for this team.
Putting the wheels in motion and integrating the dynamics, we created the hybrid CISM model that myself and the safety manager would co-facilitate. In a normal CISM debriefing we always speak of the facts of the incident to avoid confusion or misunderstandings. It was here we incorporated the Plus-Delta model of debriefing. This became hugely beneficial as this part of the debrief fulfilled the investigatory aspect for the company while helping them to create action items and tasks to make improvements, equally from my perspective it gave me very detailed facts to work with as we transitioned into the more confidential and emotional process supporting space of the CISM debriefing. So now we had a collaborative model, fulfilling the needs of all involved.
The Plus – delta piece was invaluable it was like a precursor to the main event. Everyone felt comfortable sharing from their experience which we supported and maintained throughout the debriefing entirety.
For context Plus-Delta is one of the most straightforward models among debriefing techniques and involves using two columns, where the plus column (+) refers to good actions or things that went well, while delta refers to actions that need improvement or change in the future. This technique allows the team to participate in the discussion then use this feedback to change how they manage future incidents, keeping the practices that worked well for everyone and making changes based on the suggested deltas.
Another piece to consider is that our debriefing style was built as already mentioned from a first serve inclusive philosophy. In real world terms, the fire, police and ambulance service had their own CISM debriefing process from their own service providers. Under the umbrella of rail network we wanted to facilitate a debrief that included all responders on the day in one homogenous group. This ultimately proved extremely successful in building relationships and a cohesive collaborative approach towards future debriefs as all emergency services were now on board.
Out of our debriefs and action items we were able to access a feedback loop to better support the responders and their needs. For example the physical needs like PPE, lighting, trolleys, access points were all discussed and policy and process improved across the rail network. Also, much more attention was given to the psychological well-being of staff. We have worked collectively and collaboratively on the program for the past three years and now have more strings to our bow. For example we now offer a pre-incident psychological preparedness training to all existing train drivers that we co-created. We also have trained and built a peer support network of volunteer train drivers to offer a care call to staff after the incident and support them with return to work linking both the medical department and the EAP both services available with confidential individual support. Most of these volunteers had experienced a critical fatality themselves and understand the recovery and return to work process.
This systematic CISM integrated approach is one that is working and I have no doubt will continue to work as we expand and connect the different parts of the program together. It has been a true privilege to be part of something so supportive and meaningful.
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