critical incident group debriefing
TRANSCRIPT
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CRITICAL INCIDENT GROUP DEBRIEFINGTRAINER: JOHN KOOP HARDER, MSW, RSW
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AGENDA
• Understanding critical incidents and common
responses
• CIGD considerations
• Preparation
• CIGD model
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DEFINITION
Critical incidents are situations outside our normal frame
of reference that instantly challenge us to understand and
cope with what has happened.
Factors:
• Loss: real or perceived
• Sense of being out of control
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TYPES OF CRITICAL INCIDENTS
• Natural disasters
• Accidents
• Sudden death(s)
or injury
• Violence
• Other
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TRAUMA CONSIDERATIONS
• The event itself
• The meaning given
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CORE ASSUMPTIONS
• Good things happen to good people
• If we are good, good things will happen to us
• Everything happens for a reason
• The world around us is largely predictable,
and we can know how to keep ourselves safe in it
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COMMON REACTIONS
• Emotional: Numbness, anger, sadness, fear, guilt, etc.
• Cognitive: Scattered, preoccupation with the event,
blaming or intrusive thoughts, etc.
• Physical: Sleep, aches, feeling “on edge”, exhausted, etc.
• Behavioural: Seeking closeness, withdrawing, numbing,
changes in appetite, return to previous coping patterns,
etc.
• Spiritual: Seeking meaning – the “why’s”, seeking
closeness, or anger towards a higher power, etc.
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REMEMBER…
• After a critical incident…
“Normal People having Normal Reactions to Abnormal
Events”
• Our systems are trying to accommodate the
shock and reset their balance.
• Reestablishing a sense of safety is key.
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• Event variables
• Personal variables
• Social variables
TRAUMA RESPONSE VARIABLES
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TRAUMA RESPONSE VARIABLES
•Connection to the crisis situation
•Relationship to people impacted
•Physical injury sustained
E V E N T C H A R A C T E R I S T I C S
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• Shock factor
• Probability of reoccurrence
• Expected or unexpected
• Duration of the incident
• Cause of trauma
E V E N T C H A R A C T E R I S T I C S
TRAUMA RESPONSE VARIABLES
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• Personality
• Prior ability to cope
• Past history of mental health issues
• Spirituality
• Age
• Self-assessment regarding their crisis response
P E R S O N A L C H A R A C T E R I S T I C S
TRAUMA RESPONSE VARIABLES
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• Supports
• Media
S O C I A L V A R I A B L E S
TRAUMA RESPONSE VARIABLES
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TRAUMA SUMMARY
• Not everyone will be traumatized (do not assume)
• The event may take weeks, years, or a lifetime to process
• Educate and normalize around stress and trauma reactions
• Meanings attached to events are often “fixed”
• Grief response is an individual reaction
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CIGD IS ONE OPTION
• CIGD is an option that a Crisis Response Team
may utilize after a critical incident, but there are
others:
• Individual Debriefing
• Individual Counselling
• Family Counselling
• Safe Room/Grief Room
• Large Group/Town Hall Info Session
• Other?
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SETTINGS
Where CIGD may be more appropriate:
• Community based
• School
• Emergency service personal
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B E NE F I TS & C HA L L E NG ES O F C I G D
• Reduces rumor mill
• Is an acknowledgment
• Creates stability
• Can create new meanings
• Group support, not alone
• Assessment and resources
• Normalizing can occur
• Support those who do not seek individual help
P O T E N T I A L B E N E F I T S
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BENEFITS & CHALLENGES OF C IGD
• “Safety” can be difficult to achieve
• Re-traumatizing/vicarious trauma
• Oversharing, regrets
• Not enough time to share
• People leave feeling worse
• Becomes something it is not intended to be (blaming session)
P O T E N T I A L C H A L L E N G E S
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C.T.R . I GROUP DEBRIEF ING
• Preparation
• Response: 3 days – 1 to 2 weeks after the incident
• Natural groups preferred
• Co-facilitation model
• Voluntary involvement
• Process is fluid – not rigid
K E Y E L E M E N T S
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THE SEVEN P ’S OF CIGD
1. Proper
2. Prior
3. Preparation
4. Prevents
5. Piss
6. Poor
7. Performance
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INTAKE
• Contact information
• What happened
• Impacts
• Preexisting issues
• Hopes
• Suggestions
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PREPARING
• Is this a safe environment?
• Who ought to lead?
• How large a group will this be?
• Should there be separate groupings?
• How long should the session last?
• What if people want to leave?
F O R A G R O U P D E B R I E F I N G
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PREPARING
• Will people be called by name to share?
• How will you manage intense emotions?
• Should individuals be met with ahead of time?
F O R A G R O U P D E B R I E F I N G
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CO-FACILITATION
• Co-facilitators
• A lead facilitator and a second facilitator
• A lead facilitator and helpers/watchers
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THE GROUP DEBRIEF ING PROCESS
1. Introduction
2. Reactions and Experiences
3. Education/teaching
4. Follow-up and Closure
O U T L I N E
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PHASE 1
• Introduce self
• Purpose
• Role
• What to expect
• Guidelines (confidentiality, nonjudgemental, etc.)
• Seek acknowledgement
• Questions?
I N T R O D U C T I O N
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PHASE 2
Questions related to:
• Reactions and experiences
• Perspective taking
• Interpretation and meaning
• Remembering
• Coping
E X P L O R AT I O N O F T H O U G H T S
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QUESTIONS
• What happened…?
• Where were you when…?
• What stood out ...?
• When did you know it was over?
• When did you know you were safe?
R E A C T I O N S & E X P E R I E N C E
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PERSPECTIVE TAKING
• From your point of view, tell me about…
• From your experience…
• What was the worst part of…?
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MEANING QUESTIONS
• What has changed in the way you go about life?
• How will things be different for you?
• What are your feelings/thoughts right now?
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REMEMBERING QUESTIONS
• What kind of person was _________?
• Tell me a story about ____________?
• What are the things you remember about _________?
• What will you miss the most about ___________?
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COPING QUESTIONS
• How are you managing life now?
• What do you normally do when you feel
sad/scared/worried, etc.?
• Do you have someone to talk to about this?
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PHASE 3
• Review normal symptoms of grief/trauma/stress
• Review coping and stress management skills
• Review who may need more individual help
T E A C H I N G
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PHASE 4
• Summarize the discussion
• Message that one-on-one help is available
• Give information regarding upcoming activities
• Loitering with intent
F O L L O W U P A N D C L O S U R E
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GENERAL CONSIDERATIONS
• Be okay with silence
• Be perceptive to the unspoken things going on
• Be empathic without being dramatic
• Stay away from probing
• Don’t take notes
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DEBRIEFING THE DEBRIEFING
• What was that like?
• What was the hardest part?
• What was the most rewarding?
• What do you need now?
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