Some very reasonable guidance that applies to every debriefing, but perhaps even more important in other cultures: http://traumalines.wordpress.com/2011/03/15/can-critical-incident-stress-debriefing-increase-chances-of-ptsd/

“The validity of CISM in preventing or mitigating PTSD still is controversial, and the existence of such a thing as CISM has not been recognized in Japan yet.18–21 Only the Tokyo Fire Department has established the use of the “CISM system” for stress management at the time of disaster,22 but it is not being applied throughout the country.” http://pdm.medicine.wisc.edu/Volume_20/issue_2/okada.pdf

One of my personal mantras is “Don’t be attached to the outcome.”  When I read about people who are headed to a disaster to “get people to talk about it,” I cringe.  What I’d like to see is people who (1) realize that nobody needs or is ready for debriefings until their more immediate needs – food, shelter, etc. – are under control and (2) go there with only the goal of inviting those who wish to talk into a safe place to do so.  When we get attached to the idea that people must talk, there’s little doubt in my mind that we’re likely to re-traumatize by taking away their choice.

This article confuses me – it does a good job of describing what I understand to be appropriate support, while also saying that CISM is discredited! http://newamerica.net/node/46674

Excerpt:  Research and experience have led experts to focus instead on promoting social interventions that decrease stress and restore a sense of control, safety and normality whenever possible. That includes ensuring that survivors have social support and access to information about the emergency. It also means arming people with practical knowledge about how to help themselves and those around them, a sort of emotional first aid that anyone can offer to a neighbor, friend or loved one. Helping others “is good for the people being helped as well as the people providing that help,” says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health. “The more people know what they’re supposed to do and what they can expect, the more capable they will be in responding to a disaster.”

My experience says the same. Working through translators poses challenges, but it forces us to train the counselors – they’re going to pick it up anyway – and once we’re in that frame of mind, especially knowing we’re only there for a short time, it makes sense to spend a lot of time teaching and encouraging people to support one another.

This all goes right into one of the first things I always say when starting a debriefing – I’m not here to fix this or make it better.  I’m only here for a little while – your primary source of resilience is your own network of family, friends and institutions.  That’s what gets you through this kind of thing.

“Immediate intervention [after a disaster] usually reduces tension, which can mitigate the negative impact on individual, family, and work life and improve health,”

Lessons Learned From Flight 3407 – The Spectrum – News

Looks like there’s a proposal in the Texas House to make debriefings privileged.

I’m fairly sure that the extent to which I fail to allow silence during a debriefing, I’m failing at the fundamental goal of giving the group back a sense of control.  My silence tells them that they choose who participates, when to speak and what to talk about.  They own the debriefing,  I just facilitate, saying as little as possible.

So one of the questions I’m going to be more deliberate about asking myself when being debriefed after a debriefing is “How much silence did I allow?”

There is another benefit to allowing silence.  In a group of people who are care-givers, there are going to be those who, despite our efforts, will not participate because they put everyone else’s needs ahead of their own.  If there is a sufficiently long silence, they may finally given themselves permission to speak… if only because they think that’s best for the group!

From Australia, conversations about what is or isn’t appropriate and backed up by research.

http://psychology.nuim.ie/documents/CISMNetworkIrelandConference2010.pdf

My take on his presentation is that it all makes a lot of sense… except his conclusion that agencies should stop doing debriefings because of liability exposure, because there isn’t enough evidence that it helps – and there is some evidence that it can do harm.

First, I’ll say that I have zero doubt that badly run debriefings can do harm.  I don’t think there is any question about that.  But my response is to train, train, train.

I was relieved to see that the points Dr. Bledsoe targets seem to be aligned with those that the Bay Area team consistently promotes:

• Your primary source of support is not the CISM team, it is your own network – family, co-workers, church, etc.
• CISM is peer support (“been there, done that”), not an outsider fixing things.
• Voluntary participation – zero pressure to speak.  Our entire approach needs to be an invitation.  Erase “should” from your vocabulary.
• Never, ever probe or dig for a reaction.
• Early intervention is better.
• Focusing on post-traumatic stress response (you may have the following symptoms…) is not particularly helpful and may trigger it!  Go easy on the education phase.  I wonder if we should be forward-looking about this at all – why try to normalize something that hasn’t happened yet?
• Give people control over their stress response – this is so much about control, which may be where the process  fails most often, given the nature of responders to try to control things.
• Encourage ongoing stress management as part of organizational culture.
• Occupational stress often is the worst.
• Operational debriefings are part of stress management.
• One-on-one debriefings are questionable; the power is in the group of peers.

P.S. Found a good response to Bledsoe’s analysis, written by a Texas fire chief: What we Can Learn from the Criticism of CISM

CERT Unit 9 Disaster Psychology_na

Where I have added material to the DHS curriculum, the text is in red or the DHS logo in the lower left corner is X’d out, so that hopefully it is clear which material I added.  I also replaced the original photos with some of my own from Haiti.

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