International Journal Of Emergency Mental Health[JOURNAL]
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200 papers
Crisis intervention services and empirical data: lessons learned from the Assaulted Staff Action Program (ASAP).
Flannery RB
Int J Emerg Ment Health · 2008 · PMID 19278143
Nationally, health care is moving toward standards of evidence-based treatments and practices. Evidence-based care is rooted in empirical data that demonstrate safety and efficacy for the intervention in question. In tim...
Nationally, health care is moving toward standards of evidence-based treatments and practices. Evidence-based care is rooted in empirical data that demonstrate safety and efficacy for the intervention in question. In time, all medicines, surgical interventions, rehabilitation approaches, and psychological treatments will be expected to be rooted in data. Crisis intervention services will not be exempted from this national standard. This paper reviews the lessons learned from the Assaulted Staff Action Program (ASAP) data base to illustrate how empirical data can meet the national standard of evidence-based care and improve the quality of services provided. The ASAP data have demonstrated the safety and efficacy of ASAP as well as providing insights for risk management strategies in the changing face of patient violence.
Resistance and resilience: the final frontier in traumatic stress management.
Everly GS, Welzant V, Jacobson JM
Int J Emerg Ment Health · 2008 · PMID 19278142
This paper asserts that the constructs of resistance and resilience represent a domain rich in potential for a wide variety of applications in the field of traumatic stress. Resilience holds great potential for those wor...
This paper asserts that the constructs of resistance and resilience represent a domain rich in potential for a wide variety of applications in the field of traumatic stress. Resilience holds great potential for those working in applied settings such as public health planning and preparedness, Employee Assistance Programs (EAPs) and business continuity, as well as transportation, law enforcement, fire suppression, emergency medical services, pre-deployment training for military and other high risk professional groups. Additionally, its application to "the war on terrorism" cannot be denied. Finally, the construct of resilience may have direct applicability to businesses and organizations wherein there is perceived value in preparing a workforce to effectively function under adverse or high stress conditions. The putative value of resistance and resiliency in such applied settings resides in their ability to protect against stress-related behavioral morbidity, as well as counterproductive behavioral reactions. Given its importance, the question arises as to whether resilience is an innate trait or an acquired skill. This paper will report on preliminary data suggesting resiliency may be an attribute that can be acquired through participation in a relatively brief training program.
Reflections on the debriefing debate.
Robinson R
Int J Emerg Ment Health · 2008 · PMID 19278141
This article examines the debate on debriefing that has persisted for two decades and remains largely unresolved to this day. A brief history of Critical Incident Stress Management (CISM) and Critical Incident Stress Deb...
This article examines the debate on debriefing that has persisted for two decades and remains largely unresolved to this day. A brief history of Critical Incident Stress Management (CISM) and Critical Incident Stress Debriefing (CISD) is given, these being the subject of the debate, followed by a summary of the development and current status of the debate. Discussion follows on why the opposing positions appear to be at a stalemate.
From controversy to confirmation: crisis support services for the twenty-first century.
Mitchell JT
Int J Emerg Ment Health · 2008 · PMID 19278140
The field of Critical Incident Stress Management (CISM), a comprehensive, integrated, systematic, and multi-component staff support program, developed, expanded in its scope, and spread rapidly with little criticism for...
The field of Critical Incident Stress Management (CISM), a comprehensive, integrated, systematic, and multi-component staff support program, developed, expanded in its scope, and spread rapidly with little criticism for over a decade. The next ten years (1996-2006) could be characterized as a period of intense scrutiny and opposition. CISM has recently emerged from the hostile inspection process stronger and more organized, in many ways, than earlier in its history. Numerous positive outcome studies were completed during the period of evaluation; these support the principles of CISM. Most importantly, the United Nations has recently adopted the concepts of CISM for support of its personnel.
A systematic, integrated behavioral health response to disaster.
Fojt DF, Cohen MD, Wagner J
Int J Emerg Ment Health · 2008 · PMID 19112934
The behavioral health aspects of disaster have not historically been addressed as a priority in emergency preparedness planning. The overwhelming evidence of significant to severe psychological consequences of disaster h...
The behavioral health aspects of disaster have not historically been addressed as a priority in emergency preparedness planning. The overwhelming evidence of significant to severe psychological consequences of disaster has remained in the shadows compared to the more widely televised dramatic physical destruction and trauma. However, the aftermath of September 11, as well as 2005's Hurricane Katrina and 2008's Hurricane Ike disasters reminded the country that the psychological footprint of disaster easily dwarfs the more visual physical footprint. Disaster behavioral health is now recognized as a major public health concern and a national issue that deserves a logical, systematic, proactive approach within the structure of the National Incident Management System (NIMS) and Incident Command Structure (ICS; Fojt, Cohen, Wagner 2008). With increased commitment, collaboration, and organization we can better utilize our qualified yet limited behavioral health resources, meeting the predictable needs of future disasters' survivors, communities, and responders.
Juror stress: symptoms, syndromes, and solutions.
Miller L
Int J Emerg Ment Health · 2008 · PMID 19112933
As civic duties go, jury service can be among the most stressful experiences that a citizen can undergo. This article describes the common sources of juror stress, including jury summons, jury selection, understanding an...
As civic duties go, jury service can be among the most stressful experiences that a citizen can undergo. This article describes the common sources of juror stress, including jury summons, jury selection, understanding and coping with complex or disturbing evidence and testimony, jury deliberation, and the pressure to arrive at a just verdict. The article then goes on to delineate a number of intervention models for helping jurors manage stress reactions and prevent the development of more serious traumatic stress syndromes. Finally, some recommendations are offered for professionalizing jury service that would act in the interests of civil and criminal justice.
A short guide to giving bad news.
Mitchell JT
Int J Emerg Ment Health · 2008 · PMID 19112932
Approaching an individual or a family with bad news, but without an appropriate plan to present the information in a structured manner, is almost a guarantee of greater emotional pain and disruption for the recipients of...
Approaching an individual or a family with bad news, but without an appropriate plan to present the information in a structured manner, is almost a guarantee of greater emotional pain and disruption for the recipients of the news. Crisis interveners must develop a strategic plan for the announcement of bad news. That plan should entail a lead-up phase, a transmission phase, and a followup phase. The lead-up phase encompasses the gathering of accurate, verifiable information and the clear identification of the targets of the information. The transmission phase includes immediate preparation for the presentation of the information, the actual announcement, and the presentation of additional details as questions arise. The follow-up phase includes a range of supportive interventions to assist people in the immediate crisis reaction. It also includes a system of referrals for people who might benefit from additional professional care. This article provides practical guidelines for providing bad news to the loved ones of injured, ill, or deceased people.
Characteristics of patients in restraint: fifteen-year analysis of the Assaulted Staff Action Program (ASAP) with EMS implications.
Flannery RB, Walker AP
Int J Emerg Ment Health · 2008 · PMID 19112931
Research on the demographic and precipitant characteristics of restrained patients has documented that younger male/female patients diagnosed with schizophrenia, affective disorder, or personality disorder are at risk of...
Research on the demographic and precipitant characteristics of restrained patients has documented that younger male/female patients diagnosed with schizophrenia, affective disorder, or personality disorder are at risk of being restrained when acutely psychotic or confronted with excess sensory stimulation or denial of services. However many patients with these same characteristics are not restrained Thus, these variables have yielded little predictive power. This study compared restrained/nonrestrained subjects on the demographic, precipitant variables and added three clinical variables (past violence to others, personal victimization, and substance use disorder) to assess the possible predictive power of clinical variables. Demographic and precipitant variables were similar to previous research findings. Violence toward others in combination with personal victimization was associated with higher restraint usage. The implications of the findings for emergency services are outlined.
Cognitive-affective resilience indicia as predictors of burnout and job-related outcome.
Everly GS, Smith KJ, Welzant V
Int J Emerg Ment Health · 2008 · PMID 19112930
Resiliency has emerged as a critical construct in areas as far ranging as child development to disaster mental health. Resiliency may be thought of as the ability to rebound, or bounce back, from adversity (Kaminsky, McC...
Resiliency has emerged as a critical construct in areas as far ranging as child development to disaster mental health. Resiliency may be thought of as the ability to rebound, or bounce back, from adversity (Kaminsky, McCabe, Langlieb, & Everly, 2007). Numerous interventions have been postulated and/or shown to enhance resiliency, e.g., journaling, social support, psychological first aid, and formal crisis intervention systems, such as Critical Incident Stress Management. As the search to develop more efficient and effective resiliency enhancement interventions continues, it becomes important to search for the mechanisms of action that actually serve to account for the ability to rebound after adversity. One such postulated mechanism is that of positive emotionality. Positive emotionality may be thought of as the presence of ambient positive emotions, as well as the ability to express positive emotions in the wake of adversity. Constructs such as confidence, optimism, and the ability to find meaning may underlie such expressions. This investigation attempted to assess the relationship between the expression of ambient emotions (within the last few weeks) upon measures of burnout, job satisfaction, perceived performance, and intention to leave one's job. This study represents a randomized sample of 2,500 out of approximately 91,333 potential subjects. Four hundred eighty-nine and four hundred ninety-one usable responses were received for inclusion in the analyses. Correlational analyses revealed that expressed positive emotions, as well as expressed negative emotions, were related to the outcome variables in a significant but complementary manner.
Characteristics of four types of patient assaults: fifteen-year analysis of the Assaulted Staff Action Program (ASAP) with EMS implications.
Flannery RB, Walker AP
Int J Emerg Ment Health · 2008 · PMID 19112929
Thirty years of empirical research have documented the recurring risk of assault by psychiatric patients on emergency services and health care providers. Most studies have reported all patient assaults in the aggregate....
Thirty years of empirical research have documented the recurring risk of assault by psychiatric patients on emergency services and health care providers. Most studies have reported all patient assaults in the aggregate. However six studies that have reported physical assault, sexual assault, nonverbal intimidation, and verbal threats as separate categories have reported significant patient/staff victim differences in characteristics by category. This 15-year retrospective study examined patient assaults and their impact by four standard assault categories. Similarities and differences across assault categories are presented Methodological issues and the safety implications for emergency services are discussed.
A quantitative expression of resiliency in the workplace: an odds ratio analysis.
Everly GS, Sherman MF, Nucifora F … +3 more , Langlieb A, Kaminsky MJ, Links JM
Int J Emerg Ment Health · 2008 · PMID 19112928
This paper reviews four empirical investigations into the effectiveness of workplace-based crisis intervention programs designed to enhance psychological resiliency. As an extension of a previously published review of ef...
This paper reviews four empirical investigations into the effectiveness of workplace-based crisis intervention programs designed to enhance psychological resiliency. As an extension of a previously published review of effect sizes of workplace-based crisis interventions (Everly et al., 2006), this paper extends the expression of intervention effectiveness by proposing, then utilizing, the odds ratio statistic. It is proposed that the odds ratio is a more useful tool by which to express the practical utility of workplace-based psychosocial interventions. Thus, the use of odds ratios may be a tool that serves to ease the translation of research into practice. That is, odds ratios may aid in expressing the potential usefulness of workplace-based crisis intervention programs in terms that can be easily understood by program managers and policy makers without extensive training in inferential statistics, thereby potentiating increased utilization of such programs as indicated.
Hardiness and psychological distress in a cohort of police officers.
Andrew ME, McCanlies EC, Burchfiel CM … +4 more , Charles LE, Hartley TA, Fekedulegn D, Violanti JM
Int J Emerg Ment Health · 2008 · PMID 18788348
Since police officers are frequently exposed to high stress situations, individual differences in the response to stress and trauma are of interest. We examined the association of hardiness components (commitment, contro...
Since police officers are frequently exposed to high stress situations, individual differences in the response to stress and trauma are of interest. We examined the association of hardiness components (commitment, control and challenge) with depression, posttraumatic stress disorder (PTSD) symptoms, and symptoms of general psychological distress in police officers. The random sample included 105 officers (40 women and 65 men) from the Buffalo Cardio-Metabolic Police Stress (BCOPS) study baseline visit. Components of hardiness were measured using a 15-item hardiness scale. Depressive symptoms were measured using the Center for Epidemiological Studies Depression scale (CES-D), PTSD symptoms were measured using the impact of events scale (IES), and symptoms of general psychological distress were measured using the Brief Symptoms Inventory (BSI). Associations were assessed using linear regression analysis. Models were adjusted for age, education and marital status. Because of significant gender interactions, analyses were stratified by gender. The hardiness control dimension was significantly and negatively associated with CES-D for both genders but was not associated with IES. Hardiness commitment was significantly and negatively associated with both CES-D and IES in women. Men had negative but non-significant associations for commitment with CES-D and IES. Hardiness commitment was negatively associated with the overall BSI score for both men and women but the association was only significant for men, though the strength of the association was stronger for women. This is likely a result of the impact of the smaller sample size for women. The magnitude of gender differences in these associations shows that for depressive and PTSD symptoms, the commitment dimension of hardiness may be more protective in female police officers than in male officers.
Law enforcement response to terrorism: the role of the resilient police organization.
Paton D, Violanti JM
Int J Emerg Ment Health · 2008 · PMID 18788347
Since September 11 the environment of contemporary policing has changed substantially. At the same time, it has become increasingly evident that police officers often demonstrate considerable resilience in the face of th...
Since September 11 the environment of contemporary policing has changed substantially. At the same time, it has become increasingly evident that police officers often demonstrate considerable resilience in the face of the critical incidents they face. This paper examines how resilience can be developed to promote officer well-being and performance when responding to acts of terrorism. It argues that to achieve this objective, it is necessary to expand the conceptualization of resilience in two important ways. First, terrorism has created an operating environment that differs qualitatively from that in which police agencies had been used to operating. Second, the agency itself plays a more important role in developing resilience than has hitherto been acknowledged. These new perspectives are integrated to argue that, when developing police resilience, the focus should be on recognizing the reality of contemporary policing and understanding how agencies and officers can learn from their experience of challenging events to develop in ways that facilitate their capacity to adapt and cope with challenges posed by their response to acts of terrorism. The ways in which agency and officer learning can occur and how the lessons learned can be sustained in the form of enhanced resilience are discussed.
Stress and resilience in law enforcement training and practice.
Miller L
Int J Emerg Ment Health · 2008 · PMID 18788346
For law enforcement and emergency services professionals, stress and resilience are not academic topics or luxuries; they are essential to the physical and mental health, as well as to optimum job functioning. This artic...
For law enforcement and emergency services professionals, stress and resilience are not academic topics or luxuries; they are essential to the physical and mental health, as well as to optimum job functioning. This article traces the history of the stress and resilience concepts in psychology, the military, and law enforcement, outlines the major risk and protective factors for traumatic stress responses, and presents a general psychophysiological model of stress and coping. The article next applies these concepts to the proactive fostering of mental toughness and resilience, using lessons learned from sports psychology and the mental conditioning literature. It then describes psychological debriefing, mental health counseling, and psychotherapeutic strategies for facilitating resilient recovery from critical incidents and traumatic events. Although directed mainly to law enforcement, the principles set out in this article may be productively applied to emergency medicine, public safety, military, and civilian trauma counseling settings.
Stress shield: a model of police resiliency.
Paton D, Violanti JM, Johnston P … +3 more , Burke KJ, Clarke J, Keenan D
Int J Emerg Ment Health · 2008 · PMID 18788345
This paper discusses the development of a new model of police officer resiliency. Following Antonovsky's definition of resilience, the model is built on the view that the resilience of a person or group reflects the exte...
This paper discusses the development of a new model of police officer resiliency. Following Antonovsky's definition of resilience, the model is built on the view that the resilience of a person or group reflects the extent to which they can call upon their psychological and physical resources and competencies in ways that allow them to render challenging events coherent, manageable, and meaningful. The model posits that a police officer's capacity to render challenging experiences meaningful, coherent, and manageable reflects the interaction of person, team, and organizational factors. The paper argues that a model that encompasses these factors can be developed using theories drawn from the literatures of occupational health and empowerment. The development of the model is also informed by the need to ensure that it can accommodate the importance of learning from past experiences to build resilience in ways that increase officers' capacity to adapt to future risk and uncertainty. By building on recent empirical research, this paper outlines a new multi-level model of resilience and adaptive capacity. The Stress Shield model of resilience integrates person, team and organizational factors to provide a proactive framework for developing and sustaining police officer resilience.
Crisis intervention and fostering resiliency.
Lating JM, Bono SF
Int J Emerg Ment Health · 2008 · PMID 18788344
Current estimates are that most people living in the United States will experience at least one violent or life-threatening event during their lives. Recent data suggest, however that most people exposed to traumatic eve...
Current estimates are that most people living in the United States will experience at least one violent or life-threatening event during their lives. Recent data suggest, however that most people exposed to traumatic events do not experience serious disruptions in normal life functioning, and are in fact resilient. The purpose of this article is to review the constructs of resilience and recovery, and to suggest how early crisis intervention, historically linked with the mitigation or prevention of psychological distress, may more accurately be conceptualized in terms of fostering or enhancing resiliency.
Introduction to special issue focusing on resiliency and invulnerability in law enforcement.
Levenson RL
Int J Emerg Ment Health · 2008 · PMID 18788343
Abstract loading — click title to view on PubMed.
Certification and the pledge of excellence in traumatic stress interventions.
Sanders S
Int J Emerg Ment Health · 2008 · PMID 18546760
Traumatic stress interventions used by practitioners in the field of traumatic stress are constantly developing as knowledge expands. The competency of the providers must keep pace with the developments in the field of p...
Traumatic stress interventions used by practitioners in the field of traumatic stress are constantly developing as knowledge expands. The competency of the providers must keep pace with the developments in the field of psychological trauma. Further it is imperative that a high degree of provider competence be communicated to the public at large to insure an atmosphere of trust and safety. Traumatic stress certifications represent one viable method of communicating competence. Rigorous certification standards serve as a safeguard and demonstrate the ongoing development of expertise in an evolving field.
The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents.
Diaz AB, Motta R
Int J Emerg Ment Health · 2008 · PMID 18546759
The purpose of the study was to investigate the impact of aerobic exercise on the severity of symptoms of Posttraumatic Stress Disorder (PTSD), depression, and anxiety. Twelve institutionalized female adolescents complet...
The purpose of the study was to investigate the impact of aerobic exercise on the severity of symptoms of Posttraumatic Stress Disorder (PTSD), depression, and anxiety. Twelve institutionalized female adolescents completed a 15-session aerobic exercise program consisting of moderate-intensity walking. All participants completed the Child PTSD Symptom Scale (CPSS), Trauma Symptom Checklist for Children (TSCC), Multidimensional Anxiety Scale for Children (MASC), and Children's Depression Inventory (CDI) twice at pretest. Data were collected twice during an extended baseline period, at postintervention, and again at a 1-month follow-up assessment. Yarnolds (1988) ipsative z-score comparison method for single-case repeated measures design was utilized in data analysis for participants with stable levels of symptomatology during baseline. Strong effects of aerobic exercise were found for PTSD and trauma symptom severity but not for anxiety and depressive symptom severity. Follow-up results were mixed. The results of this study were fairly consistent with previous research findings. Strong effects of aerobic exercise on depression and anxiety were not found; however, relatively low levels of such symptomatology had been noted for many participants during the baseline phase of the study.
Group process research and emergence of therapeutic factors in critical incident stress debriefing.
Pender DA, Prichard KK
Int J Emerg Ment Health · 2008 · PMID 18546758
Critical incident stress debriefing is a highly utilized and often debated form of post-trauma exposure intervention. This article presents exploratory group process research that utilized a mixed method approach and gro...
Critical incident stress debriefing is a highly utilized and often debated form of post-trauma exposure intervention. This article presents exploratory group process research that utilized a mixed method approach and group process research techniques. The article's findings, the emergence of therapeutic factors, support that CISD group work does yield indicators consistent with support/ psychoeducation groups with a crisis theme. Further the events that trigger the intervention yield specific therapeutic factors. CISD group work may be better understood through established group research patterns.
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