CISM Team

A typical CISM team is made up of 20-40 people from a large jurisdiction. Roughly one-third of the team is made up of mental health professionals and two-thirds are peer support personnel. (images may take some time to load).

The basic organizational structure of a CISM team.

Clinical Director

A mental health professional that provides oversight and consultation to other team members on matters relating to mental health.

Senior Team Coordinator

The day to day manager of the team. Deploys the three or four team members to provide the debriefing. Arranges team meetings, responsible for record keeping, provides guidance to the efforts of the assistance coordinators and provide stress education programs to emergency personnel.

Assistant Team Coordinators

Providing back up to Senior Team Coordinator who may be away or occupied with other functions. There may be multiple Assistant Team Coordinators depending on the size of Team.

Mental Health Professionals

Mental Health professionals lead the three of four member team assigned to provide the formal debriefing. should a person need further one on one attention beyond the group intervention the Mental heal professional may provide a brief consultation for additional support. They are available to provide advice and back up to the peer counselors. May be called upon to provide stress education programs to various organizations.

Peer Support Personnel

The majority of team members on a CISM team which serves emergency personnel are emergency workers themselves. They work actively in concert with he mental health professionals and handle most of the none to one contacts and defusings.

When the call comes in, it is likely to come from someone who is familiar with CISM and may be coming in as the event unfolds or several days afterwards. It is best that the call come into a 24- hour dedicated line where a trained communications operator or dispatcher answers the call. Preliminary information is taken and then passed off to the team coordinator.

First Contact- 24 Hour Communications Center

What is the nature of the call?
Is the situation considered an emergency or is the caller asking for information of a routine nature.
Is there a need for an immediate deployment of a CISM team or Community Response Team?
Is the incident complete or ongoing?
Where is the caller now?
What are the call back numbers?
Is there someone else to call if the caller is unavailable for the call from the team member?

Once this information is collected, the dispatcher contacts the team coordinator and passes on the information. The Team Coordinator must determine what services are needed. A contact to the initial caller is made and an assessment is done to make this determination. Not all requests require a CISM response. The following questions can be used as a guide to determine the type of intervention that will best serve the clients:

Questions for the Team Coordinators Assessment

What is the nature of the critical incident?
How long ago did it occur? Is the event ongoing?
Is the event of sufficient magnitude as to cause significant emotional distress among those involved?
Does the event fit within the definition of a critical incident?
How many individuals are involved in the incident?
If more than three, think CISD! If less, perhaps a defusing or an individual consult would suffice.
Are there several distinct groups of people involved or is there only one? For example, are the targets of CISD operations personnel, victims, witnesses, or community members? If so, more than one CISD will be required.
What is the status of the involved individuals? Where are they and how are they reacting? Some incidents may need a more immediate defusing rather than waiting for a debriefing.
What signs and symptoms of distress are being displayed by participants or the witnesses of the incident?
How long have the reactions or signs and symptoms of distress been gong on? Significant symptoms which have continued longer than a few days are a good sign that a debriefing my be necessary. If symptoms of distress are gong on longer, than a week after the incident, a debriefing is definitely necessary.
Are symptoms growing worse as time passes?
Is the distressed group unusually fearful or anxious?
Is the distressed group suffering sleep disturbance?
Are members of the group avoiding certain activities?
Has the behavior of the group changed significantly?
Is the group preoccupied with death or fear of death?
Are members of the group suffering from mental confusion?
Is there anyone who seems so distressed that they may be contemplating suicide?
Is the formal debriefing process necessary or are group members requesting information on stress and stress management?
Is the group willing to come to the debriefing or are they being ordered to come?
Are there other concurrent stressors going on?
Has the place and time been chosen?
Are there any other issues that should be discussed?
Are any of the following key indicators of a need for a debriefing present:

behavior change
continued symptoms
new symptoms arising
regression
intensifying symptoms
group symptoms

These questions serve only as a guide for the retrieving the information necessary to determine the type of intervention and who needs to be contacted to provide the following services.

On-Scene Services
Defusing Team
Demobilization
Debriefing Team
Individual Consults
Follow-up Services

Onsite Debriefings generally have ONE interventionist. While there may be additional organizational support, the work is done solo and can only be done if modifications are made. This is not the recommendation, but the reality and expectation within the field. If the incident is on a larger scale, additional resources must be provided.