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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