DNP Graduates – Craig Smith

Craig Smith, DNP
Spring 2013

Abstract Title
Critical Incident Stress Management Attitude Survey

A number of brief treatment models exist which agencies, institutions and governments have utilized to provide crisis support to those affected by these traumatic events. This study will explore clinicians’ attitudes towards one particular approach for crisis intervention that has become increasingly popular over the last twenty-five years: Critical Incident Stress Management (CISM), a series of crisis interventions versus single-session Critical Incident Stress Debriefing (CISD), both developed by Mitchell (1983). Mitchell conceptualized the debriefing (CISD) process as one component of critical incident stress management (CISM), a broader term for the spectrum of supportive interventions that includes processes such as longer term supportive counseling, family interventions, follow-up, and referral when indicated over the period of recovery of an individual.

CISM was never intended to be implemented as a stand-alone intervention (Everly, Flannery, & Mitchell, 2000). The use of CISM as a one-time debriefing – a brief group intervention -has become commonplace. In fact, it has become common for institutions to provide only a “one time” structured group counseling session as a response to a critical incident. This trend has come under scrutiny in the literature and research on this topic which suggests CISD may be ineffective as such au intervention and perhaps harmful as noted by Bledsoe (2003), Rose et al. (1999) and Rose, Brewin, Andrews & Kirk (1999) among others.

CISM is an intervention that may follow a critical incident (such as a tragedy) in the community, workplace, school or neighborhood. Many clinicians within the mental health service sector are trained in CISM and are involved as leaders in the intervention when there is a community tragedy. There is an identified need to clarify which variant of CISM (single-session or multiple session) is most effective in preventing trauma reactions. There is little or no extant research from the perspective of the trained and experienced clinician as to the efficacy of the CISM : DNP Dissertation Project Proposal Page 3 interventions. This study assesses efficacy from the clinician’s viewpoint. There is evidence in the associated literature that the single session variant may be less beneficial and perhaps harmful (Macnab, Russell, Lowe, & Gagnon, 1999; (Macnab, Sun, & Lowe, 2003; Mayou, Ehlers & Hobbs (2000); Sijbranij, Olff, Reitsma and Carlier (2006); Devilly and Annab (2008). This study will examine the following questions:

Research Questions
1.Is multiple-session Critical Incident Stress Management (CISM) perceived by clinicians as being more effective than single-session CISD in reducing symptoms of stress or posttraumatic stress disorder after an experienced trauma (Items 1-9)?
2: Do clinicians who administer the interventions feel they have had sufficient training in administering CISM/CISD (Items 1-9)?
3. What demographic and experiential factors (items 10-15) predict attitude toward single session CISM?

Definition of Key Terms
Critical Incident Stress Debriefing (CISD) refers to that program of one time, single- session group crisis debriefing developed by Mitchell (Mitchell, 1983).

Critical Incident Stress Management (CISM) refers to the larger program of crisis intervention techniques also developed by Mitchell (Mitchell, 1983) of which CISD is one part.

Post-traumatic Stress Disorder (PTSD) refers to the DSM-IV (American Psychiatric Association, 1994) diagnostic criteria for Post-traumatic Stress Disorder.