Mastering Disaster - Continuing Education in Crisis Response
Social Work Today
By Matthew Robb, MSW, LCSW-C
Vol. 4 No. 5 p. 34

We all want to help in times of crisis. But specialized training in crisis response is the key difference between really helping and just thinking you can.

“There will be another terrorist attack. We will not be able to stop it.” — FBI Director Robert Mueller

Moments after the collapse of the World Trade Centers in Manhattan; after the crash of United Airlines Flight 93 in western Pennsylvania; after the execution of children at Columbine High School; after the bombing of federal offices in Oklahoma City; after the sniper shootings in metropolitan Washington, DC; after the devastation of Hurricane Andrew; after the Amtrak derailment in Crescent City, FL; after the workplace slayings in Cincinnati; after the obliteration of entire communities in “Tornado Alley”; and after countless car crashes, floods, fires, bank robberies, and more, teams of elite crisis responders quietly mobilized and headed into the face of disaster.

Today, these teams—dispatched by the American Red Cross, International Critical Incident Stress Foundation, Inc. (ICISF), National Organization for Victim Assistance (NOVA), and others—continue to employ advanced crisis intervention techniques to help victims, survivors, and their families better handle the sometimes powerful emotional reactions associated with crises and disasters.

As founder and president emeritus of Maryland-based ICISF, Jeffrey T. Mitchell, PhD, CTS, has witnessed crisis intervention morph from raw concept into global phenomenon. Mitchell, 55, and fellow researcher George Everly, PhD, are credited with developing the concepts of critical incident stress debriefing (CISD) and refining the more comprehensive critical incident stress management (CISM).

According to Mitchell, the nonprofit ICISF ranks as the world’s largest trainer of crisis intervention services, educating some 30,000 people yearly. Among its clientele: the FBI, Secret Service, U.S. Marshal Service, Motorola, Kodak, and hundreds of school systems and police and fire rescue departments worldwide. When you hear breaking news reports of shootings, plane crashes, fires, and floods, these are definite telltales that crisis teams are enroute and ready to assist.

The Demand for Specialized Training
While Mitchell is heartened by the international community’s reception of CISM, he sounds a cautionary note about “freelance” crisis responders unschooled in service delivery. “If you’re not specifically trained in crisis intervention,” Mitchell says, “you have no business working at a disaster site—period. Crisis intervention requires a programmatic, systematic approach of phase-sensitive assistance.”

This isn’t quibbling on Mitchell’s part. In September 2001, he stood near the smoldering ruins of the World Trade Centers. Five months earlier, he talked to police officers who witnessed the harrowing drama at Columbine High School. Reflecting on these powerful lessons, he declares, “During big disasters, tremendous numbers of helping professionals go in unannounced, uncalled for, and unnecessarily.”

This same “psychological overresponse”—particularly by untrained, unprepared professionals—also concerns John D. Weaver, LCSW, BCD, ACSW.

Founder of the crisis response organization Eye of the Storm, Weaver says that while the National Association of Social Workers (NASW) Code of Ethics mandates that social workers deliver appropriate professional services in public emergencies, too many of us are unprepared. Nevertheless, this doesn’t deter helping professionals from flooding crisis scenes only to impede or paralyze relief efforts, creating a situation Mitchell describes as “helpers helping helpers rather than victims.”

“At Columbine,” Mitchell recalls, “therapists in the hundreds were showing up to be helpful, but they created massive credentialing problems, screening hassles, and tremendous confusion.” After somehow managing to penetrate the (initially porous) security perimeter, these woefully unprepared freelancers soon found themselves providing psychological support to students and parents, despite having no relevant experience whatsoever.

Mitchell’s advice to social workers: If the world of crisis response intrigues you, approach it as you would any other professional endeavor—as a serious student.

ICISF: Training Globally, Acting Locally
According to ICISF’s Director of Education and Training Victor Welzant, PsyD, not all crisis-response teams are alike. Yet even though ICISF, the American Red Cross, and NOVA espouse their own philosophies, there is much overlap in objectives: to mitigate the acute symptoms of postcrisis psychological stress and thereby help people resume relatively normal lives.

Among the features of the ICISF model are its broad array of techniques, including demobilizations, informational briefings, town meetings, defusings, debriefings, and follow-up and referral.

“We have a different mission than the American Red Cross,” Welzant notes. “We train CISM teams, which then focus on first responders—on firefighters, police, paramedics, hospital staff, and crisis workers. Our training isn’t geared toward the general population as much as that of the Red Cross or NOVA.”

Welzant says social workers who undergo ICISF training “learn how to provide crisis intervention to individuals, groups, and specialty groups. They also develop proficiency in doing psychological triage or differentiating normal posttraumatic response from cases that suggest long-term difficulty.” He notes that behavioral health groups often require their service providers to undergo CISM training. “While specialty training was once extremely helpful,” he says, “today it has become practically mandatory. The field has rapidly evolved since 9/11. We’ve developed best practices, encouraged research, and continue to stress the need to stay current.”

At present, ICISF boasts 26 workshops and a cadre of 500 trainers and 30 faculty members spread across some 20 countries. Once newbies complete the basic two-day appetizer—CISM: Group Crisis Intervention—they can pick and choose from a broad menu of offerings: Preventing Youth Violence, Psychotraumatology for Clinicians, Treatment of Complex PTSD [posttraumatic stress disorder], and Compassion Fatigue. Students seeking advanced classroom experience and credentials can opt for the 100-hour Certificate of Specialized Training.

The ICISF certificate program is tailored toward five specialties: mass disasters and terrorism, emergency services, workplace and industrial applications, schools and children crisis response, and spiritual care in crisis intervention. “Many CISM teams today,” Welzant says, “are embracing ICISF’s certificate program as their minimum standard.” Notably, workshops offered through ICISF, the American Red Cross, NOVA, and select other providers usually meet the continuing education requirements for social workers. As always, check with your state licensing board.

The American Red Cross
In outlining the unique mission of the American Red Cross, Marsha Kovach, LICSW, notes, “We don’t train on the CISM model. We are not training debriefers; we are not first responders. Instead, we are disaster and humanitarianism workers who train people to provide services in the field. We want to keep our workers psychologically safe predeployment, during deployment, and postdeployment. We want to make sure they’re ready to serve on a disaster. If they have coping issues while they’re mobilized, we help them manage those issues and send them back home, where our chapter looks after them.”

Although the American Red Cross offers only one workshop—the 12-CEU Disaster Mental Health Services I—social workers will be heartened to learn it is offered free of charge. To date, the American Red Cross has trained approximately 4,000 people—400 in 2003 alone.

Weaver knows a thing or two about disaster relief services. In addition to founding Eye of the Storm, he has dedicated the last 12 years to helping the American Red Cross. The Pennsylvania NASW Social Worker of the Year (2002) helped organize crisis intervention services at Ground Zero in New York City, assisted with the United Airlines Flight 93 crash outside Pittsburgh, and co-led relief activities at the ValuJet Flight 592 crash site in the Florida Everglades.

From these experiences, Weaver echoes Mitchell’s observations. “A disaster or crisis site attracts many, many spontaneous volunteers, among them social workers,” he says. “Unfortunately, a lot are trained not so much in how to do disaster relief but instead in the regular orientation of mental health and diagnosis of pathology. They’re not always so good in the posttraumatic stress arena.”

Noting the many avenues of disaster response, he says, “I think it’s important for social workers to get as much exposure to these different models—and exposure to the people who are practicing them—because it is as much art as science.”

National Organization of Victim Assistance
If social worker Jeannette M. Adkins, MEd, LPC, CA, seems driven by crises and disasters, it’s for good reason. The Xenia, OH, resident is a board member of—and volunteer with—NOVA.

Outlining NOVA’s mission, she says, “We train thousands of people every year—from social workers and medical professionals to clergy and victim advocates. I was in Oklahoma City with a NOVA crisis team on the day of the bombing. While ICISF focused on search and rescue teams and emergency responders, NOVA trained teams of clergy who later debriefed volunteer search and rescue people. We worked hand in hand with ICISF.” As with the American Red Cross, NOVA is geared toward the community at large yet also provides training that assists local relief workers.

According to Adkins, even experienced social workers “can be so much more effective by undergoing training through NOVA, ICISF, or the American Red Cross.” This specialized educational process, she says, “provides unique information into disaster or traumatic response that really augments the social work experience.”

Presently, NOVA offers a 40-hour basic community response workshop that typically satisfies continuing education requirements for social work. “We also offer an advanced three-day, 24-hour community response course that takes it a step further, built upon our field experience,” she notes. For a fee of $5,000 to $8,000, NOVA will provide a five-day, 40-hour training module that can accommodate up to 50 attendees.

On one central matter, all respondents agree: The best format for developing skills in CISM or disaster mental is by way of a live, interactive setting. Online training, they assert, is a poor substitute.

Highlighting the seriousness of disaster-relief work, Mitchell says, “Many of these disaster scenes are filled with grotesque sights, sounds, and odors. It has caused stress disabilities even among New York City firefighters—
and these are battle-hardened professionals. I know of a social worker who went to a plane crash and saw a beheading in progress, which later had a profound impact on her. Some people witness these horrendous things and say, ‘Oh my God’ and they just start unraveling.

“Lacking proper training and exposure,” he continues, “the practitioner who might be fully competent in a mental health setting can still suffer vicarious trauma at a disaster scene. There is an entire body of science—and an art—that needs to be mastered.”

— Matthew Robb, MSW, LCSW-C, is a freelance writer based in suburban Washington, DC.

Appealing, Yes … but Is CISM Bad Science?

As the world continues to beat a path to trainers in disaster response, psychologist Richard Gist, PhD, and a rising chorus of dissenters have spent the better part of a decade asking one heated question: Why?

Says the University of Missouri at Kansas City researcher, “In the world of serious psychological research, the jury’s back, the verdict is in, the debate is over. [Crisis intervention] is an empirically demonstrated bad idea.” Citing meta-analyses published in The Lancet, Cognitive and Behavioral Practice, and other weighty publications, Gist says researchers keep arriving at the same conclusion: “No matter from what angle we approach it,” he says, “debriefings have no particular effect on prevention of PTSD [posttraumatic stress disorder] and may have negative outcome for some folks. It’s notably less efficacious than leaving people alone.”

Describing critical incident stress debriefing (CISD) and its “conceptual cousins” as the “current poster child for intervention gone awry,” Gist says CISD has found—and continues to find—warm reception because, at first blush, it sounds so plausible.

But Gist maintains that new studies “are leading us to seriously question our very basic assumptions about how people respond to crises, how they react, and how they try to deal with them.” As it turns out, he says, “We have seriously, grossly overestimated the degree of pathology that occurs and have failed to understand and appreciate the extreme degree to which resiliency leads to natural resolution.”

And what of other crisis intervention models—those that guide the practice of the American Red Cross and the National Organization of Victims Assistance (NOVA)? “A rose by any other name still has thorns,” Gist says.

Not surprisingly, folks at the International Critical Incident Stress Foundation (ICISF), American Red Cross, and NOVA disagree. Counterattacking The Lancet article as “fundamentally flawed,” ICISF founder Jeffrey Mitchell, PhD, says, “Every single study author of a negative study did it wrong. The critics lack proper training and education in CISM [critical incident stress management].” Adds NOVA’s Jeannette M. Adkins, MEd, LPC, CA, “Let’s just say we have seen evidence to the contrary. Our approach takes some of that steam off the pressure cooker after a traumatic event.” Adkins says some variant of the disaster intervention set has been adopted by military, corporate, nonprofit, and emergency response organizations worldwide.

Gist and his peers are insistent: CISM is bad science. Further research, they say, will only corroborate their thumbs-down assessment.

Unfazed, the CISM bandwagon keeps rolling on.

— MR