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Health/Wellness

Beyond critical incident stress management

Why the trauma intervention model you use is important

Dr. Mariya Dvoskina Published August 31, 2021 @ 8:00 am PDT

iStock.com/izusek

Police officers are highly resilient individuals. However, as first responders to the distress and suffering of others, these individuals are also at a particularly high risk of exposure to both vicarious and, in some cases, impact (or direct) trauma. Given this, many departments and leadership teams look to police psychologists and trauma specialists in developing interventions that facilitate post-traumatic growth (or, in non-psychobabble terms, find ways to help officers recover from traumatic stress). 

It is important to note that a critical incident in and of itself does not mean that an officer will experience traumatic impact. The most common thing I hear when I meet with an officer after a shooting (OIS) is “It’s bothering me that I am doing OK.” What I tell these officers is that it is absolutely normal and expected that they would be doing OK. While officers may experience a brief period of what we refer to as “deviation from baseline” (trouble sleeping, thinking about the call and other short-term shifts) we generally see that they return to normal functioning without developing any concerning symptoms. 

However, there is a special category of critical incidents that require additional attention. Dr. Nicoletti and I describe these as “extreme events.” Extreme events are critical incidents that are impactful and traumatic, but are low-frequency occurrences. As a result, they become more difficult for the responders to process and mitigate. A line-of-duty death or a mass casualty event are some examples of an extreme event. These types of events are more likely to lead to traumatic impact. Historically, departments have turned to the critical incident stress management (CISM) model to help their officers.

CISM has been a commonly implemented tool and has undoubtedly helped many first responders cope with trauma. However, research currently suggests that this model has yielded mixed results, including harmful outcomes for some participants. Many CISM supporters continue to strongly adhere to their view that this is a good model, with the authors themselves attempting to empirically demonstrate the effectiveness of this practice. However, a new model called psychological first aid (PFA) has more recently become the gold standard in trauma intervention.

One of the main ways in which PFA differs from CISM is in its understanding that each individual is different in their response to trauma and may need varied, flexible interventions. In other words, one size does not fit all. This does not mean that departments should not look to CISM-trained clinicians as appropriate resources; rather, it means asking whether the clinician has had continuing education and training in a variety of trauma intervention models. I also recommend utilizing the International Association of Chiefs of Police (IACP) Post-OIS Guidelines for a thorough review and guide to post-critical-incident trauma response. Most importantly, departments should have standardized policies in place to address both pre-incident psychological training and preparation and post-incident standardized response protocols, working with police-culture-competent and experienced clinicians. The more normalized these protocols are within the department and the more trustworthy the clinician, the more likely it is that officers will utilize their resources.

Dr. Mariya Dvoskina

Dr. Mariya Dvoskina

Dr. Mariya Dvoskina is a police and public safety psychologist working with Nicoletti-Flater Associates in Colorado. She provides consultation, training, counseling, peer support supervision and critical incident response services to local and federal agencies. 

View articles by Dr. Mariya Dvoskina

As seen in the August 2021 issue of American Police Beat magazine.
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