A Comprehensive Critical Incident Stress Management (CISM) Programming a Correctional System: It's More Than Dealing with Workplace Violence

Background

A shift from rehabilitation to a more custodial approach, an increase in long-term sentences,
overcrowding, and more violent and mentally ill offenders, led Cheek and Miller (1979) to
examine the effects of stress in staff and inmates in the New Jersey Department of Corrections.
Cheek & Miller (1982) also investigated the strategies that the Department implemented to
reduce those stressors. Brodsky (1982) conducted one of the earlier analyses of correctional
stress from an organizational and cultural perspective. The evidence indicated that correctional
employees experience a significant amount of stress in their work which may lead to high job
turnover, high rates of sick leave and troubled relationships with inmates, other staff, and family
members. Lindquist and Whitehead (1986) investigated burnout, job stress and job satisfaction
among southern correctional officers. They found that 20% to 39% experienced burnout and
stress but that only 16% expressed job dissatisfaction. It was suggested that correctional officers
mask their dissatisfaction to prevent facing job changes. There was no analysis or implication
regarding the effect this could have on families.

Stohr (1994) and associates studied stress in contemporary jails by examining jails in five areas
across the U.S. They found that stress in workers was a serious problem and approaching
dangerous levels in some facilities. The contributing factors were primarily related to
management and organizational methods. There was less stress when fair compensation,
investment in employee development and participatory management practices were employed.
Similarly, Wright, Saylor, Gilman and Camp (1997) in a study of U.S. Federal Bureau of
Prisons' employees, found lower job-related stress a factor when workers were involved in
decision making.

Although not new to correctional employees on the front line, workplace violence was identified
as having a negative impact on employees' wellness in the 1990s. The National Crime
Victimization Survey (NCVS) report for 1992-1996 (U.S. Dept. of Justice, 1998) revealed that
the field of Law Enforcement was the second largest group in the Nation to experience
workplace violence. Prison guards experienced non-fatal workplace violence at the rate of 117.3
per 1,000 workers. Additional investigations of staff victimization have been cited in the
literature (Andring, 1993; Dowd, 1996; Seymour & English, 1996; VandenBlos & Bulatao,
1996).

From November 21 through December 4, 1987, prisoners rioted and took hostages in Federal
Prisons in Oakdale, Louisiana and Atlanta, Georgia (National Victim Center [NVC], 1997).
Bales (1988) reported about the stressors and follow-up for the hostages including a family
resource center. There was no indication of pre-incident stress inoculation or family support
planning. Additional hostage situations which reached National media attention were Attica,
New York, 1971, Wyoming State Penitentiary, 1988, and Pennsylvania State Correctional
Institution, Camp Hill, 1989, (NVC, 1997).

Throughout the 1980s and 1990s the recognition of the need for crisis intervention, after a
critical incident, became apparent. The earliest crisis intervention programs for correctional
employees were conducted post-incident. Bergman and Queen (1987) credited the retention of
employees after the riot at Kirkland Correctional Institution Columbia, South Carolina to the
"critical incident debriefing" (Mitchell, 1983; Mitchell & Everly, 1993) conducted immediately
after the incident. Van Fleet (1991) also referred to debriefing traumatized correctional staff to
mitigate stress that could lead to posttraumatic stress disorder (PTSD). Training workshops and
training guides/manuals became available (Concerns of Police Survivors [COPS], 1996; Finn &
Tomz, 1997; NVC, 1997;U.S. Office of Personnel Management, 1998). Directly or indirectly the
resources referred to Critical Incident Stress Management (CISM) (Everly & Mitchell, 1997).

Traditionally, in the correctional field, any type of assistance offered to employees' and their
families was post-incident, usually at the employees or families' request, and in the form of
referrals to the agencies Employees Assistance Program or private contractors. Little mention is
made of preventive or stress inoculation programs for employees and families at the front end or
when entering correctional employment. On the other hand, police (COPS, 1996; National
Institute of Justice [NIJ], 1997) and fire-fighting agencies have initiated families awareness and
educational programs which range from a few hours to several weeks.

An Introduction to Critical Incident Stress Management

A critical incident is defined as " any event which has a stressful impact sufficient enough to
overwhelm the usually effective coping skills of either an individual or a group are typically
sudden, powerful events outside of the range of ordinary human experiences" (Mitchell &
Everly, 1993). Most employees entering the criminal justice system recognize that verbal and
minimal physical abuse from those in their care, custody, and control is a reality of the job.
Critical incidents and stressors experienced by employees in correctional, prison, forensic
settings include: held hostage, riot, physical/sexual assault, death or serious injury in line of duty,
suicide of inmate or employee, use of lethal force on inmate, participation in execution and
witness to any of the above.

Historically, the approaches to help staff deal with critical incidents and stressors fall into three
broad categories including:

(1) Employee Assistance Program (EAP), a contracted service with the state, agency or facility.
Traditionally, the EAP provider is typically an individual mental health clinician (i.e., counselor,
social worker, and psychologist). Since employees in these settings tend to be cautious and
somewhat suspicious of mental health providers and outsiders, a few EAP programs include
clinician-trained peer support personnel selected from the employees likely to be represented in
an event.

(2) Peer Support Program (PSP) which consists of non-clinician employees, who are
representative of the workforce, and trained in crisis intervention.

(3) Critical Incident Stress Management (CISM) Program, the International Critical Incident
Stress Foundation (ICISF) model. The CISM Team is " described as a partnership between
professional support personnel (mental health professionals and clergy) and peer support
personnel (employees) who have received training to intervene in stress reactions" (Mitchell &
Everly, 1993). Professional support personnel are required to have academic training at the
master's degree or higher level and/or recognition of their training and skills through
certification or licensure. They must also have education, training and experience in critical
incident stress intervention.

Components of a Comprehensive CISM Program

A comprehensive CISM program is multi-faceted (Mitchell & Everly, 1993; PDOC, 1992). Pre-
incident prevention and stress inoculation are essential. All employees receive education and
training in everyday and work-related stress awareness and stress management techniques as
well as how to access the EAP program and CISM team, when necessary, while attending Basic
Training Academy. Employees whose job requires direct contact with inmates/patients attend
biannual refresher stress management classes. Managers receive training in recognition of
employee stress and referral procedures. Families and significant others are provided similar
stress awareness and coping skills and how to access referral services at the Family Academy.

CISM team development, member selection and training needs to be well-planned and foster a
partnership between employees, management and labor relations. A CISM Program
policy/standards and procedures manual, applicable to the agency, must be established. Best
results are achieved if team membership is voluntary. A selection committee comprised of
management and employees/ labor representatives should develop an application form and
include an interview in the selection process. Team members, professional and peer, must be
trusted and accepted by their fellow employees. Peer members must be representative of the
employee population including custody, maintenance, counseling, education, medical, clerical,
etc. It is recommended that each facility have a Team available for rapid deployment. In order to
respond to major events, in large systems, regional teams composed of members from various
facilities are also suggested. Although there are similarities in the training programs available,
this article and model adheres closely to the ICISF standards. All Team members should be
required to complete ICISF Basic Critical Incident Stress Debriefing Training. Peer
Support/Crisis Intervention Strategies is also recommended. All members should also have an
understanding of Incident Command system, if used in their setting, and specialized units such
as Emergency Response, Hostage Recovery and Hostage Negotiation Teams. The CISM team
and specialty teams should participate in a joint training exercises at least once annually.

The CISM Program services should include:

1. On-scene support (usually provided by peer support members during a major/prolonged
event).

2. Demobilization or de-escalation (brief intervention to assist employees in making the
transition from the traumatic event back to routine or stand-by duty, formal debriefing to follow
in several days).

3. Defusing (a three-phase group crisis intervention provided immediately or within twelve hours
after the event to mitigate the effects of the stressors and promote recovery, usually twenty to
forty-five minutes in duration).

4. Debriefing (a seven-phase group crisis intervention process to help employees work through
their thoughts, reactions, and symptoms followed by training in coping techniques, usually
lasting one and one-half to two hours).

5. One-on-one support (individual intervention if a single or small event and a group
intervention is not possible or additional individual assistance is deemed necessary after a group
process).

6. Significant other/family defusing/debriefing (services may be provided separately from
traumatized employees).

7. Line-of-duty death support (defusing provided immediately after event for staff, team assists
family, and a debriefing provided for staff after the funeral).

8. Referrals (team member recommends and instructs employee to access additional
support/treatment through EAP or other resources).

9. Follow-up (team leader or designated member contacts employee(s) and/or employees
supervisor a few days after team services).

Records and Program Evaluation

Client(s) confidentiality must be maintained. However, in order to maintain service continuity
and program quality improvement minimal record keeping is necessary. A request for service
form including time of event, mature of incident, number of personnel involved, contact person
and contact number will assist the team leader in selecting team members and establishing
meeting location and time. The service provided form should include information from the
request form and a summary or themes of reactions, thoughts, and symptoms presented,
educational material provided and coping techniques recommended and if referrals were made.
Individual(s) names and comments are not recorded. The team leader may, with the majority
consensus and participants' permission, provide administrative staff with a report of
recommendations to improve conditions or remedy situations that led to the critical event.

In most situations consumer satisfaction will be determined informally through follow-up with
the participants and from supervisory staff. However, after major events, a participant's
satisfaction questionnaire is recommended. A combination of checklist, multiple choice and
general comment format works best in this employment setting.

Interagency and Community Support

Traditionally correctional facilities are scattered through the state and many times located in
rural areas. Correctional CISM Teams can be a resource for smaller counties and municipalities
and provide services for jails, probation and parole agencies, police and community emergency
responders. The Correctional CISM Team professionals may act as consultants or supplement
communities volunteer peer teams. The CISM teams can, along with other correctional special
response teams, assist communities affected by a disaster. The Correctional CISM Teams may
also work very effectively with other state agencies such as state police and probation and
parole.

References

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Bales, J. (1988, November). Prisoners of prisoners. APA Monitor, 24.

Bergman, L. H. & Queen, T. R. (1987, August). The aftermath, treating traumatic stress is
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Brodsky, C. (1982). Work stress in correctional institutions. Journal of Prison and Jail Health, 2,
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