Commissioner's directive 253-2: Critical incident stress management

Guidelines

POLICY OBJECTIVE

1. To provide details regarding application of the Critical Incident Stress Management Program principles, in accordance with Commissioner's Directive 253 - Employee Assistance Program.

CROSS-REFERENCES

2. Commissioner's Directive 253 - Employee Assistance Program
   
   Guidelines 253-1 - Employee Assistance Program

DEFINITIONS

3. Critical Incident Stress Management (CISM) is a program designed primarily for employees of the Service as they are likely to be involved in critical incidents because of the nature of their work. The first element is preventive, aimed at educating and preparing employees to deal with potential hazards of being exposed to very stressful events, and second, it focuses on providing support, assistance and follow-up services to individuals who have been involved in critical incidents. Some support, assistance and follow-up services may also be available for people who could be affected by the events, including employees, their families, visitors, etc., based on an evaluation of the situation, observed needs and/or requests brought forward.
4. Employees include active full-time and part-time term and indeterminate employees at all levels, excluding casual workers, contractual workers and students. Retirees and terminated employees are eligible for the Program for six months following the end of employment.
5. Peer-support persons are individuals who have received appropriate CISM training, as approved by CSC, to provide support to employees.
6. CISM mental health professionals are registered mental health professionals who have been trained in CISM intervention as approved by CSC.
7. A critical incident is a traumatic event, outside the usual range of human experience, which could happen in an institution or in the community, which can cause a strong emotional reaction with the potential to affect one's ability to cope with the after-effects. CISM services shall be available in such circumstances as:
   • death of a colleague in the line of duty;
   • hostage taking;
   • death or injury of any person during use of force in the conduct of duties;
   • witnessing of another person being mutilated or dying;
   • being the victim of physical violence;
   • receipt by an employee of any serious threat to his or her physical well-being or that of his or her family, arising from the employee's employment with CSC;
   • having to work in an area where a critical incident is occurring, even though not directly exposed to this situation;
   • suicide of a colleague;
   • suicide of an offender;
   • any incident where there is intensive or negative media coverage; and
   • any other incident deemed critical by management in joint consultation with the Regional EAP Coordinator and a CISM mental health professional.

LINKS TO THE EMPLOYEE ASSISTANCE PROGRAM

8. CISM does not involve therapy or counselling. When required, counselling and follow-up intervention will be provided through the Employee Assistance Program (EAP), following a referral to resources identified as being professionals or agencies, having appropriate specialised training in post-traumatic intervention. Employees are also encouraged to recognize their own need for assistance and voluntarily contact a peer helper confidentially at any point in time during their career.

PRINCIPLES

9. Working in a correctional environment poses significant, often demanding challenges that increase the risk of stress and cumulative stress for employees.
10. The CISM Program is in place primarily to respond to the needs of employees directly involved in critical incidents. These employees will be expected to receive CISM services following a critical incident. However, all employees affected by an event are encouraged to recognize their own need for assistance and voluntarily contact a peer helper confidentially at any point in time during their career.
11. Following a critical incident, although the best managerial practices support that initial communications and discussions ideally occur among management, employees and union representatives to determine how employees are coping, the formal decision to provide additional CISM services should be based on a needs assessment performed by trained CISM peer-support persons.
12. Support services may be provided during and/or immediately following an incident and/or subsequently when new elements arise, are added or resurface following the initial incident.

RESPONSIBILITIES

13. Regional Deputy Commissioners and the Assistant Commissioner, Human Resource Management are responsible for ensuring that procedures are established for providing CISM services and the necessary follow-up within the EAP. Preventive programs should be available to educate employees about the types of personal problems related to various lifestyles and work environments and the possible responses. Training, preventive education and information activities to assist employees throughout their career with personal development on health and wellness issues are to be conducted regularly in the regions. As the Program depends mostly on volunteer employees, the specific needs of peer-support persons and mental health professionals, such as compassion fatigue, also need to be addressed.
14. Regional Deputy Commissioners, the Assistant Commissioner, Human Resource Management at National Headquarters, Institutional Heads, District Directors, managers and supervisors are responsible for ensuring that employees directly involved in critical incidents are quickly identified.
15. Management, in the role of crisis manager, shall ensure that the designated representative of the CISM team is contacted promptly in order to determine the need for CISM intervention and appropriate support.
16. Managers and supervisors shall:
    1. ensure that all employees are informed about CISM;
    2. as part of good managerial practices, be aware of employees that could be affected by a critical incident although not directly involved (when the latter information becomes available, it could be shared with the designated representative of the CISM team);
    3. encourage employees to recognize their own need for assistance and obtain CISM services and/or voluntarily contact a peer helper confidentially at any point in time during their career to access CISM services;
    4. provide all the support necessary to employees using CISM services; and
    5. provide CISM team members with all the support necessary to fulfill their obligations and responsibilities related to CISM.
17. The National EAP Coordinator is responsible for the overall EAP and the CISM Program, at the corporate level, and for the development, operation, administration and review of all aspects of the departmental programs.
18. Regional EAP Coordinators are responsible for the EAP and the overall administrative coordination of the CISM Program at the regional level. Their responsibilities include:
    1. providing leadership and advice to the persons involved in their region and to senior management;
    2. ensuring the management of the regional CISM Program, including budgeting, training and program promotion;
    3. making available CISM information sessions to educate employees on prevention and on the effects of post-traumatic disorders;
    4. making available training for CISM team members; and
    5. monitoring the regional Program and providing appropriate statistical data and information while preserving confidentiality.
19. The National EAP Advisory Committee, the Regional Advisory Committees and local committees have the same responsibilities vis à-vis CISM as they do for EAP. These are set out in the Guidelines 253 1 - Employee Assistance Program.
20. CISM teams composed of qualified trained members shall be established to provide CISM services to operational units. Management, in cooperation with unions, is responsible for identifying selecting and designating a sufficient number of CISM team members, and ensuring that they are ready to intervene, having received training in CISM. The CISM team is composed of at least one peer-support person and one mental health professional trained to provide CISM.
21. A CISM team coordinator is identified among the peer helpers in order to coordinate the team activities, including response to critical incidents.
22. CISM services offered in CSC are mostly peer-managed and peer-driven processes, which use mental health professionals for guidance when needed. Therefore:
    1. most contacts, defusing sessions, and individual interventions and follow-up will be handled by peer-support persons;
    2. in some circumstances, CISM services offered may rely primarily on the use of appropriately trained mental health professionals.
23. CISM teams are responsible for:
    1. providing advice to management regarding CISM intervention;
    2. providing CISM services in the form of assistance, information, advice, referral to appropriate resources, support and follow up;
    3. maintaining confidentiality of the content of the discussions within the context of the law; and
    4. compiling statistical data on CISM intervention and providing these in a confidential manner to the CISM team coordinator, who will forward them to the Regional EAP Coordinator.

SELECTION CRITERIA

24. The CISM team members must be selected based on the criteria set out in Guidelines 253 1 - Employee Assistance Program.

CONFIDENTIALITY OF INFORMATION

25. Confidentiality refers to the obligation to refrain from willingly disclosing information that has been received in confidence. It does not refer to situations in which the law requires a person to divulge information according to the requirements of the Privacy Act, or when humane, moral, or ethical considerations prevail. Confidentiality cannot be maintained in the circumstances set out in subsection 8(2) of the Privacy Act, which include court subpoenas, suspected cases of child abuse, threat of suicide and criminal activity. Also:
    1. Because of the nature of the CISM Program (mostly group interventions), confidentiality and anonymity cannot be guaranteed in some situations. However, employees participating in a group process will be encouraged to respect confidentiality.
    2. As management is responsible for ensuring that employees directly involved in critical incidents are quickly identified, anonymity cannot be guaranteed and/or protected in some situations.

POSSIBLE INTERVENTION PROCESS

26. Management is responsible for ensuring the following services are provided through the CISM Program:
    1. Preventive training: the provision of information on stress related to critical incidents and its potential effects, and information on stress, cumulative stress, vicarious stress, stress management and the CISM Program, to help staff to be well prepared and help mitigate the impact of stress.
    2. On-scene support: individual assistance made available while the incident is still taking place.
    3. Defusing session: intervention held with a small group of people immediately or relatively soon after a critical incident. Defusing sessions typically last for less than one hour and are intended to mitigate the effects of exposure to a traumatic event, prior to the people leaving the work environment or returning to duties. The session allows for the initial sharing of information and reactions about the incident, information and educational material on stress management and re-establishment of a support network within the work environment. The session also serves to establish the need for any other subsequent stress management intervention. Support, follow-up and referrals to appropriate resources are made available, as required. Defusing sessions can be conducted by CISM peer-support persons or by CISM mental health professionals.
    4. Individual interventions: intervention held with one employee following a critical incident. Individual interventions are intended to help an employee to mitigate the effects of exposure to a traumatic event prior to returning to duties or leaving the work environment. The session allows for the sharing of information and reactions about the incident, information and educational material on stress management and re-establishment of a support network within the work environment. The session also serves to establish the need for any other subsequent stress management measures. Support, follow-up and referral to appropriate resources are made available, as requested. Individual interventions are designed to assess the need for a referral to a mental health professional. Generally, CISM peer-support persons provide individual intervention.
    5. Demobilization session: intervention reserved for major incidents that could go on for an extended period of time, with large numbers of personnel, thus making defusing in small groups impractical because of human or operational constraints. Employees are assisted by meeting them briefly in large numbers when they are released from the scene, to offer on-scene support, information, documentation and educational material on stress management and to advise them of the plan for further CISM intervention. Following demobilization, participants are provided with an opportunity to meet informally, relax and get their strength back before returning to duty or leaving the work environment.
    6. Critical incident stress debriefing (CISD): intervention held with a group of people (10 to 15 people) ideally within 15 days following the incident. The session may be held later than 15 days if warranted and/or a need is identified. The goal is to mitigate the effects of exposure to a traumatic event and accelerate the recovery process. CISD is a discussion of the involvement, thoughts, reactions and feelings resulting from the incident, and does not constitute an evaluation of the incident or of the quality of employee's participation to this incident. The session allows for the sharing of information and reactions about the incident, and the provision of information and educational material on stress management and the establishment of a support network within the work environment. The session also serves to establish the need for any other subsequent stress management interventions. Support and follow-up are provided, and referrals to appropriate resources are made available, as required. The CISD intervention is led by a CISM mental health professional. The CISD session may be conducted by a peer-support person with appropriate training, but always in the presence of the CISM mental health professional.
    7. Thematic help session: a session that may be held with a small work group following an event not considered a critical incident per se. The event is significant and, given the emotional impact, likely to have an impact on the work climate or the ability of employees to perform their duties. These sessions may address such subjects as suicide, loss of a colleague, violence at work, etc. These sessions are a cooperative effort between the EAP and the CISM Program in order to support employees during difficult times.
    8. Information session by management - Some situations may require that information be provided to employees not directly involved in a critical incident but who may be impacted. These information sessions are led by management in collaboration with the CISM team. The intent is to provide general information regarding the incident and the subsequent measures that will follow, including the plan for further CISM intervention, when applicable. Employees are reminded about the availability of CISM services. Information, documentation and educational material on stress management and on-scene support is provided to participants, by CISM representatives, if there is a need. The session also serves to establish the need for any other subsequent stress management measures.

TARGET GROUPS

27. Elements to be considered when structuring groups - Identify the categories of individuals affected:
    • Primary category: the individuals who directly experienced the traumatic events, i.e., the first observers or interveners on the scene that respond to bring the situation to a resolution, and direct witness of the critical incident.
    • Secondary category: the individuals who have lost someone close to them or who are affected by the consequences on victims because of a link or an emotional link with them.
    • Tertiary category: other groups affected by the critical incident. The intent is to evaluate the possibility that other groups not directly involved in the critical incident per se, such as support staff, could require support. For these groups, it is more appropriate to enquire about their level of stress, the needs being felt and to offer appropriate individual or group services.
    • Intervention groups category: individuals who contributed to the resolution of the crisis (IERT, negotiators, command post personnel, etc.).
    • Management category: following a critical incident, employees in the management category must receive support services separate from those offered to employees and by interveners from outside the operational unit.
      1. Personnel - CISM services are to be provided to personnel who are likely to be involved or have been involved in critical incidents. When required, in conjunction with the EAP, additional follow-up services are made available to personnel.
      2. Visitors - Appropriate support and assistance shall be offered to visitors, contractual workers, volunteers and National Parole Board members who are affected by a critical incident while they are on the working premises of the Service.
      3. Families of staff - When families affected by a critical incident have to be contacted, because of the direct involvement of an employee (victim), the crisis manager or delegate will liaise with the designated representative from the CISM team to determine the most appropriate way of notifying the families. These families shall be given the opportunity to receive separate support and assistance during and following a critical incident. In conjunction with the EAP, additional follow-up services are made available.
      4. Offenders in institutions and in the community - Support and assistance is available to offenders in accordance with Commissioner's Directive 800 - Health Services, Commissioner's Directive 840 - Psychological Services, Commissioner's Directive 843 - Prevention Management and Response to Suicide and Self-Injuries, and Commissioner's Directive 850 - Mental Health Services. Following an incident, offenders affected may contact psychological or chaplaincy services on a voluntary basis.
      5. Other - Following a request for support, assistance could be made available to organizations that are associated or have a close relationship with CSC (e.g. Community Residential Centres). These services are limited to immediate interventions following a critical incident.

IMPARTIALITY OF INTERVENERS

28. Peer-support persons should avoid providing CISM services to close relatives, friends or people they supervise or work with very closely. When a formal critical incident stress debriefing session is being conducted, peer-support persons work actively in the presence of a mental health professional team leader. For this type of intervention, the ideal model relies on the services of a mental health professional who is not from the operational site where the event has occurred.
29. Regional protocols should be developed to ensure backup to replace local teams when situations last for a long period or when the impact of a critical incident is such that the capacity of the local team to intervene impartially is at risk.
30. The selection of CISM team members should be done by considering primarily individuals who are least likely to be involved in different responsibility areas which could be too demanding and/or in conflict.
31. Any person on the contingency team involved in the resolution of an incident shall not be involved in the CISM team dealing with that incident.
32. CISM team members shall not be involved in investigations or personnel evaluation with respect to fitness for work.

Assistant Commissioner,
Human Resource Management

Original signed by:

Denis Méthé