International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: John D. Hunt, MA, CCISM, Co-Founder and COO, Crisis Response Canines, &
Mary Law, MSN, RN, CCISM, Crisis Response Canines Healthcare Liaison
There are likely few among us who would disagree that these past two years have been exceptionally challenging. Every sector of society has been affected, perhaps none more than our extraordinary frontline heroes.
COVID has only exacerbated preexisting mental health challenges, and created new societal dilemmas. There has been a dramatic down-shift in social support, increased isolation, rise in substance abuse, unrelenting stress and anxiety, as well as an unprecedented increase in violence and aggression aimed at frontline workers [1]. Never before has the need for Critical Incident Stress Management (CISM) and Animal Assisted Therapy (AAT) for these professionals been more urgent.
In this milieu, the impact the New Jersey-based, non-profit organization, Crisis Response Canines (CRC) has had through their interventions has been profound. The inspirational volunteers who comprise the membership of CRC have dedicated countless hours in providing CISM interventions and AAT to extraordinary frontline heroes.
CRC’s mission is to provide strength, comfort, and emotional support to individuals, families, communities, and first responders experiencing intense traumatic emotions in the aftermath of critical incidents.
Team members have a wide range of backgrounds including law enforcement, military, health care, and education. This highly experienced complement of team members affords for a broad range of peer to peer support in virtually any situation.
Canine handlers are required to participate in robust education and training to achieve and maintain certifications. They participate in FEMA’s National Incident Command Structure training, and learn the principles of Critical Incident Stress Management (CISM). Several members completed the CISM certification of knowledge exam offered through the University of Maryland, Baltimore County, Deptartment of Emergency Health Services thru its Professional and Continuing Education Program (PACE). Other required certifications include Pet First Aid, CPR, and specific courses associated with healthcare, and behavioral health. ICISF is a significant source for robust reference materials.
CRC canines have extensive training and certifications including (not limited to): Alliance of Therapy Dogs, AKC Canine Good Citizen, AKC Canine Good Citizen Advanced, Canine Good Citizen Urban, Crisis Working Dog Certification, and Law Enforcement Defensive Systems Crisis Working Dog Certification.
The role of the Crisis Response Canine team is multifactorial. One is to deploy carefully selected and highly trained teams to scenes following traumatic events. In most cases, pre-incident relationships, established during routine visits to organizations enables the team to be contacted and quickly respond within hours of any traumatic event. CRC leadership has created a national network of contacts to support rapid deployments.
As a result of training in FEMA’s incident response operations, CRC members are easily able to integrate their operations and work within the defined incident command structures and coordinate with local, state, and national agencies, as well as local social support groups prior to and during deployments.
Over the past several years, CRC members have responded to a myriad of events including (but not limited to) shootings at PULSE Nightclub, The Las Vegas Harvest Festival, Sutherland Texas First Baptist Church, Pittsburgh Tree of Life Synagogue, and the El Paso Walmart shooting. Most recently, the CRC team deployed to the Surfside Florida Champlain Towers collapse and following a shooting at Jefferson Hospital in Philadelphia.
By combining CISM interventions with AAT, the team is present onsite and able to effectively support not only the survivors and victims’ families, but also affected frontline workers. The quiet moments spent with the team provides an opportunity for comfort and decompression during unique bonding moments between humans and canines. Front line workers have indicated those interactions have provided them the strength to continue their duties.
The foundation of CRC has always been to provide ongoing support utilizing canine therapy. Through cultivated, longstanding affiliations with police, fire, EMS dispatch units, and military organizations—as well as local communities, school districts, and healthcare organizations, teams regularly conduct rounds for therapy visits. CRC teams are a familiar presence at these locations and over time, become trusted partners. This established trust enables members to provide meaningful contacts with the canines, help workers build resilience, assess baselines, and if needed, better support effective interactions in the wake of a traumatic event.
“Distress is a type of stress to which the individual finds him or herself unable to adequately respond, to which response is unsustainable in the long term, and which results in impaired adaptation” [5]. Unfortunately, calls for acute intervention with frontline workers has amplified in the past several years. The ongoing pandemic has intensified the physical and psychological impacts of chronic stressors, threatening long-term well-being [2].
Within the healthcare setting, a high prevalence of burnout can lead to negative impacts or outcomes for workers, such as poor mental and physical health, increased absenteeism and turnover, and diminished job satisfaction. Negative effects can also include decreased healthcare quality and safety, such as more frequent medical errors, reduced empathy toward patients, and diminished patient [6]
This environment has created a greater need for crisis intervention and mental health support services [2]. The American Hospital Association notes “Concern about clinician well-being has been top of mind for years, but the pandemic has intensified stress and trauma and presented a unique opportunity to reframe core approaches to fostering a thriving workforce. More than ever, clinicians require compassionate, holistic support to ensure that they feel safe, valued and engaged” [3]. Frontline clinicians are especially at risk of long-term harm [4].
Traditional healthcare wellness initiatives that are passively offered to staff and providers have not achieved the desired results, and frontline clinicians often are unable or unwilling to get help when needed. Twenty percent said they thought they needed them but didn’t receive them, either because they were too busy, unable to get time off work, couldn’t afford them, or felt afraid or embarrassed.
Physicians have typically been reluctant to seek help, fearing that colleagues or employers will see them as weak or unfit to practice, or that it will jeopardize their licensure status. It is vital to reassure clinicians that it is not only normal, but expected and acceptable to feel overwhelmed at times and to seek help as needed. [3]
CRC members serve as advocates for CISM interventions to call those seeking help out of the shadows and dispelling the stigma of being seen as weak. Through their dedication to their mission to serve others, they have brought countless episodes of healing and moments of respite and comfort to those impacted by traumatic or stressful experiences. Canines have the ability to open previously closed doors and allow for moments of decompression. CRC’s required, ongoing training only strengthens the team’s skill set and ability to effectively support successful interventions.
Innovative methods to support employees and providers includes Animal Assisted Therapy (AAT), which brings canines and handlers to those in the environment in which they work. The presence of the canines and handlers within healthcare facilities has proven to improve well-being [7]. Well-designed and managed programs present an opportunity for the staff to take a few moments to experience a therapeutic interchange, as well as assess staff who may be struggling and identify the need to refer for further interactions.
The CRC team’s collective experience with helping first responders, healthcare, and other professionals cope with the psychological stresses inherent in their professions make them uniquely qualified, deeply respected, relatable, and therefore trusted.
The mere presence of the dogs is truly transformational. While the canines therapeutically engage, the team assesses any need for further referrals for intervention.
A typical episode of CRC team rounding includes pre-planning to identify the location, complement of staff and providers, and to ascertain if any recent events have occurred that may have implications for the visit. The CRC team is then carefully selected to ensure the members and canines are well-matched for the interaction. Organizational leadership is informed in advance so personnel expect the visits.
The CRC team meets on site to review the plan for the rounding. Members then travel to assigned locations to interact with staff. They spend time on the designated units and departments for an average of two hours. Visits to all staff occurs on all shifts and is always very much appreciated by the staff. The visits tend to unfold organically as the canines’ presence is welcomed by the team, and conversations between CRC members allow for assessments of current psyche, hearing concerns, or recognizing events to be celebrated. The team regroups following rounding and conducts a debrief to identify follow-up actions as needed.
The calls for CISM sessions have continued to increase in the past several years, and it has been the experience of CRC that AAT can be an effective part of preventive programs for healthcare professionals who may be exposed to significant stress daily, by helping create strategies to reduce it. [6] The effect of Animal Assisted Therapy (AAT) on reducing depressive symptoms has been noted. [8]
In these challenging times, CRC and similar organizations are relied upon even more to be that consistent and trusted presence. Their humble dedication to their mission to serve the nation and their community, results in countless episodes of healing to those impacted by traumatic or stressful experiences.
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International Critical Incident Stress Foundation, Inc is a 501(c)3 Non Profit