A Comprehensive Review of Extant Research on Crisis Intervention Team (CIT) Programs -- Compton et al. 36 (1): 47 -- Journal of the American Academy of Psychiatry and the Law Online

A Comprehensive Review of Extant Research on Crisis Intervention Team (CIT) Programs -- Compton et al. 36 (1): 47 -- Journal of the American Academy of Psychiatry and the Law Online

good article reviewing CIT

abstract: The Memphis model of the Crisis Intervention Team (CIT) program has established itself as a prototype of law enforcement-mental health collaboration for a large number of municipalities across the country, and several states are implementing statewide training programs that seek to train approximately 20 percent of their police forces. Given the enthusiasm of advocates, law enforcement/public safety personnel, and mental health professionals for the CIT program, and in light of the increasing pace of implementation of this complex collaboration in a multitude of localities across the country, we seek in this review to provide a systematic summary of the very limited available research that has been conducted on CIT to date and to comment on future avenues for research.

The NC DRN is proud to announce that the new DRN on-line training has been launched this week! This is a much-anticipated course that has been one of the primary tasks of the DRN Task Force over the past year.

As many of you know, the NC DRN held workshops providing day-long orientations to disaster mental health workshops which were held throughout the state as a way to increase the number of trained mental health professionals able to respond in a disaster. Approximately two years ago, our DRN identified a need for alternative methods of training busy mental health professionals across the state, so we partnered with the UNC School of Public Health Preparedness Center to produce an online training format. Advantages of this new training are greatly improved flexibility, accessibility to anyone with Internet access, and reduced time away from home to complete the required training.

The on-line training consists of eight 30 minute modules featuring topics ranging from the phases of disaster and mental health intervention to ethical issues and volunteer activation. The modules were prepared and narrated by volunteer members of the Disaster Response Network who are practicing mental health professionals with disaster response experience. Once participants have completed the on-line didactic portion of the training, they will be invited to attend a 2 hour workshop featuring disaster simulations and hands-on practice. (We have just about finished development of these live workshops and hope to begin offering them in early 2008.) Upon the completion of both the on-line training and the live workshop, licensed mental health professionals from NC will be able to receive 6 hours of CE credit.

Our primary aim is to have more licensed mental health professionals from NC trained and ready to provide pro bono services in times of a disaster; however, anyone is free to register to take the on-line training of 8 modules. The training can also be used as a refresher for those of you who received training quite some time ago or prior to deployment in a disaster situation. We also are hoping that some of you experienced DRN members will consider attending some of the live 2 hour simulation workshops, as we suspect these will be quite interesting, informative and experiential. The more varied experience and input we have, the better I suspect these workshops will be!

Being a disaster volunteer yourself, I know you can appreciate how disaster response is different than other types of mental health work and how specialized training is essential. I hope you will help us in spreading the word to friends and colleagues who have expressed interest in this area. And, of course, we also welcome you to check out the training as well!

To register go to http://nccphp.sph.unc.edu/NCDRNtraining.

Thank you for your ongoing work and interest in the DRN and in disaster mental health work!

Sandra Wartski, Psy.D.
NC DRN

Good Morning,

working up some information on Missing & Exploited Children--especially to help a client who claims to be a victim 27 years ago.

I want to believe, but I don't understand.

National Criminal Justice Reference Service missing and exploited children resources

Association of Missing & Exploited Children Organizations can help if your child is abducted.

But what if your child was abducted 20 years ago?

Parental Alienation Syndrome:

Hugs to Heartbreak: A Parent’s Journey Through Parental Alienation Syndrome is a website and book from Jeff Opperman and Dr. David Israel.

The late Dr. Richard A. Gardner, author of The Parental Alienation Syndrome: A Guide of Legal and Mental Health Professionals, coined the term parental alienation almost 20 years ago to characterize the breakdown of previously normal, healthy parent/child relationships during divorce and child custody cases.

PAS is ultimately a force started by one alienating parent & supported by the child. The victim is the alienated parent. For this parent the therapeutic work is grief resoultion--if resoultion can be found. As Dr. Barbara Steinberg writes, "it is imperative that you forgive the other parent." This is prep work for the healthy assimulating of the experience into your life.

Good Morning,

Here is some information about getting trained in Red Cross Disaster Mental Health Response:

Take the time to carefully read this post. The formatting leaves something to desire. Please email with any questions.

Be sure to follow up with the appropriate chapter.

Watauga Chapter: 828 264 8226

Triangle Chapter, 100 N. Peartree Ln., Raleigh, NC 27610 to attention of Jennifer Pipa (Phone: 919-231-1602, ext. 410.) or fax to Jennifer at 919-231-6314.

Charlotte NC:
Greater Carolinas chapter Education and Disaster Operations Center (EDOC) located at 2401 Park Road, Charlotte, NC 28203
Katie Hughes 704.378.4634.

Introduction to Disaster Services is a self study course that serves as a prerequisite for all other disaster courses offered. This class is not offered in a classroom setting, but can be completed on–line or by CD--which is available at the chapter. To Take this class, visit online self study. Please complete the self study before registering for any other disaster classes.

To receive course credit, please complete and print the “Where Do You Fit In” page & return it to your home chapter.

October 27 Foundations of Disaster Mental Health for Licensed MH Workers, Greater Carolinas Chapter.

Disaster Mental Health Overview Friday, 27th 11:00 am - 2:00 pm Raleigh, Chapter Headquarters Instructor: Sandra Wartski

International Critical Incident Stress Foundation Training calendar (people that do CISM trainings):
rmcox

Good Morning,

Governor Mike Easley has proclaimed the month of September as "READY NORTH CAROLINA MONTH." Our state was recently impacted slightly by Tropical Store Ernesto, and we are in the midst of hurricane season. Please evaluate your preparedness -- whether at work or home, and if at home, remember to plan ahead for any pets.

The following web sites provide valuable information:
http://readync.org
http://listonc.org/ (Spanish)
FEMA site for emergency planning
American Red Cross 3 day disaster supply kit

Please make/ review emergency plans and assemble a disaster supply kit so that you will be more self-sufficient and ready, if a disaster occurs.
rmcox

Good Morning,

"To all,
Just thought all might be interested in the fact that there is someplace
relatively close by that is in the planning stages of having the Crisis
Intervention Team, or CIT, training. This is a program developed by
Memphis a number of years ago [1987, apparently] to train a special team of law enforcement
personnel to be called when there is an event where law enforcement
personnel are involved with a person with mental illness. This is so-o-o
needed in our area and I am excited that there might be a possibility
that our local law enforcement officials might be able to receive this
training."

"Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24 hour, seven day a week coverage.

The CIT Model has been instrumental in offering:

1. Special trained officers to respond immediately to crisis calls
2. Ongoing training of CIT officers at no expense to the City of Memphis
3. Establishments of partnerships of police, National Alliance for the Mentally Ill Memphis, mental health providers, and mental health consumers.

The Crisis Intervention Team program is a community effort enjoining both the police and the community together for common goals of safety, understanding, and service to the mentally ill and their families."

Learn more about the CIT model from the National Alliance on Mental Illness.

"In case you missed it, buried toward the end of the last article from the
Asheville Citizen-Times on law enforcement shootings in Western North
Carolina was the news that A-B Tech (Asheville-Buncombe Technical
Community College) had started an initiative to introduce Crisis
Intervention Team training to area law enforcement officers. Considering
the Citizen-Times July 23 article [article is available for purchase. A quick search shows that there is discussion in the letters to the editor about the importance of starting CIT in Asheville, NC] calling for CIT, I had thought this would make a bigger "splash," but I supposed it's just as well to wade
into the CIT waters (from a publicity standpoint) rather than dive so as
to not to alienate anyone."

An Argument for a Comprehensive Disaster Response Plan

“It is the policy of New River Behavioral HealthCare to ensure the safety of all consumers, other visitors and employees during emergencies or disasters. New River will make every effort to be effectively prepared to respond to emergency situations.” (NRBHC EMERGENCY PREPARENESS AND RESPONSE Policy)

There are several reasons to review and update the New River Behavioral Healthcare disaster response plan. These reasons are detailed below. In short, the current plan only addresses isolated critical events occurring on agency property, has not been reviewed in six years, does not meet the expectations that county emergency managers expect, and does not address the needs of responders—even when they are employees.

The simplest reason to review the NRBH disaster response plan is that it is out-dated and inadequate, and that a newly developed comprehensive template is available. The latest revisions to the plan--from August of 2000—were never adopted, although the disaster coordinator attempted to implement best practice and a variety of measures were put in place regarding prevention and response to critical events.

A newly developed disaster response template is available. The new template was developed with input from the DMH disaster response coordinator & funded through a federal grant. Additional input from a wide variety of LME’s including both urban and rural environments. This template includes a partial plan template that addresses some unique features of the provider network. The new template is comprehensive, based on the SAMHSA disaster response checklist and contains additional references from established plans extant around the nation.

When NRBH relinquishes its LME functions, it will remain a public community health center. Until that time, NRBH is a 5-county LME and responsible for the psychological well-being of all citizens. As a service provider, NRBH senior managers have presented a desire to continue under a philosophy of community mental health—a one-stop shop for all citizens & responsive to the dynamic needs of the communities it serves.

In line with the one-stop shop philosophy and the relationships NRBH has built across the years it is not surprising that 4 of the 5 county plans expect NRBH to respond to disasters and work in shelters that are established by county governments. Becoming a 160A intergovernmental organization will only enhance this expectation. Below is a sampling of the language from those county emergency plans:

a) Alleghany County plan:--very similar to Ashe & Wilkes plans.
b) Ashe County plan: [Under Health Director]
“18. Mental Health Coordinator

a. Develop guidelines to provide mental health services during emergencies.
b. Provide sites as available for temporary clinics.
c. Assist ARC with inquiries and inform families on status of individuals injured or missing.
d. Maintain a 24 hour Crisis Line during periods of major disasters.
e. Identify evacuees in reception centers and shelters who have experienced mental stress and provide them with mental health services.
f. Arrange for debriefings or psychological support for emergency workers and disaster victims.”

c) Avery County plan:--currently not available
d) Watauga County plan:

“ C. Mental Health [Under Health Annex]

1. New River Mental Health Agency will coordinate activities with the Emergency Management Coordinator to provide services for the public and emergency workers.

2. Mental Health will be a support agency for coordination of Critical Incident Stress Debriefing Teams and any needed follow up. Request for debriefing teams will be directed to the Watauga County Emergency Management Office.”
e) Wilkes County plan:
Wilkes County Emergency Plan

Mental Health Services Provider

. Develop procedures to provide mental health services during emergencies.

. Develop a Disaster Training Guide for counseling personnel.

. Provide crisis intervention training for personnel assigned to Critical Incident Stress Debriefing Teams.

. Implement disaster plans for mental health facilities.

. Provide mental health professionals for treatment of disaster victims.

. Assist American Red Cross with inquiries and inform families on status of individuals injured or missing.

. Maintain a 24-hour Crisis Line during periods of evacuation.

. Identify evacuees in reception centers, shelters and Disaster Application Centers who have experienced mental stress and provide them with mental health services.

. Ensure continuity of mental health treatment and medication for persons in shelter, as necessary or requested.

. Provide crisis counseling to professionals and support staff working with the relocated population.

. Arrange for debriefings of psychological support for emergency workers and disaster victims.

. Coordinate with the Mental Health Coordinator and provide crisis counselors to shelters.

. Additional duties are also found in the various annexes and procedures.
Retrieved 06 Jan 2006 by rmcox from http://www.wilkescounty.net/emmgmt/eplan/basic.asp#Mental%20Health%20Services%20Provider

While attending shelters is usually thought of as a Red Cross function (with it’s own mental health staff), not every county has a Red Cross presence & not every shelter will be a Red Cross Shelter. The question of payment was raised during the development of the template; Red Cross mental health volunteers may be NRBH employees & who pays for their time during response must be answered. Some considerations include:
a) It is the responsibility of the Department of Social Services to insure that emergency shelters are available in an effected area.
b) In some counties the American Red Cross is poised to carry out this responsibility (Watauga).
c) In other areas (Ashe) Red Cross will play a supportive role, rather than a lead role.
d) Red Cross shelters are general public shelters where all residents are expected to take care of themselves. Those persons with greater need (Special Needs) are not eligible for Red Cross shelter services and must take refuge elsewhere.
e) Special Needs Shelters are the responsibility of the county where they are located.

Fortunately behavioral health response in disaster is expected. Experience taught that there are far more psychological survivors than those with strictly medical need. “Research has shown that 20% or more of people exposed to traumatic events typically develop clinically significant psychological problems” (retrieved 31 July 2006 by rmcox from http://www.istss.org/terrorism/professionals.htm). The DeWolfe Disaster Population Model is often used to visualize need in order to prepare for an individual response. However, “defining the victims is not an easy process, as many people who are exposed to most large-scale events are impacted. Even though people may be negatively affected, not all will need, accept, or necessarily benefit from various interventions. Definitions also may differ depending on the type of event - especially the difference between natural disasters and terrorist events (i.e. victims of terrorist events are crime victims and may therefore be eligible for services and resources not available in natural disasters). Some States have identified groups that represent primary populations who must be served (e.g., adults with severe mental illness; children and adolescents with severe emotional difficulties) and then identified other populations who can be served if possible or if additional resources are available.

“In the priority-setting process, both research and practical experience points to exposure as a prime predictor of the development of psychological sequelae. Figure 1 is an illustration of exposure categories. It generally is agreed that all who experience a disaster are somehow affected by it. However, a number of groups warrant specialized approaches and services, even if they're not at great risk, including, but not limited to, children, those with pre-existing mental disorders, disaster and emergency workers, the frail elderly, and racial and cultural minorities. An excellent summary of the empirical research, including a discussion of risk and status factors, can be found at http://www.ncptsd.org/facts/disasters/fs_range.html.” 20/80 Rule: expect 20% of survivors to have some physical casualty; 80% to be psychological casualties—of that 80%, half will have anxiety problems. (Everly Jr, George S PhD. Aug 2004 conference presentation.)
Population Exposure model fig. 1
INSERT DeWOLFE POPULATION EXPOSURE MODEL HERE
A Seriously injured victims • bereaved family members
B Victims with high exposure to trauma • victims evacuated from the disaster zone
C Bereaved extended family members and friends • rescue and recovery workers with prolonged exposure • medical examiner's office staff • service providers directly involved with death notification and bereaved families
D People who lost homes, jobs, pets, valued possessions • mental health providers • clergy, chaplains, spiritual leaders • emergency health care providers • school personnel involved with survivors, families, of victims • media personnel
E Government officials • groups that identify with target victim group • businesses with financial impacts
F Community-at-large

Researchers realized that a behavioral health response is for both survivors and for responders. Despite controversy about what to do, many responders report that cognitive-behavioral strategies for relieving distress are helpful. There are several models (one is CISM, a comprehensive continuum approach to building resiliency, enhancing response, and speeding recovery in an effected community—debriefing as a system) currently in use; although none have gained best practice status. One thing is clear: Responder care is community self-care & as such, integral to providing a response.

The purpose of planning is to be proactive in developing relationships & in preparing the public to respond to critical events. The SAMHSA All-Hazards Planning Guide: “There seems to be a consensus that the process of planning is nearly as important as the content of the plans” (retrieved on 31 July 2006 by rmcox from http://www.mentalhealth.samhsa.gov/publications/allpubs/SMA03-3829/part_two.asp). Building relationships prior to an event will enhance response because everyone knows what to do & how to do it. Of course, the worst time to develop and test a plan is during a critical event. Procrastination is a poor planning strategy.

For purposes of responding it is important to know what consumers are at elevated risk for direct effects through location and/or symptoms. “An adult's risk will increase linearly along with the number of these factors that are present:
• Female gender
• Age in the middle years of 40 to 60
• Little previous experience or training relevant to coping with the disaster
• Ethnic minority group membership
• Poverty or low socioeconomic status
• The presence of children in the home
• For women, the presence of a spouse especially if he is significantly distressed
• Psychiatric history
• Severe exposure to the disaster, especially injury, threat to life, and extreme loss
• Living in a highly disrupted or traumatized community
• Secondary stress and resource loss.
With a few modifications - primarily the deletion of age and minority group status -- this risk-factor model holds reasonably well for children and adolescents” (retrieved on 31 July 2006 by rmcox from http://www.istss.org/terrorism/victims_speak.htm) 50,000 Disaster Victims Speak: An Empirical Review of the Empirical Literature, 1981 – 2001. Prepared by: Fran H. Norris, Georgia State University. With the assistance of: Christopher M. Byrne and Eolia Diaz. Georgia State University and Krzysztof Kaniasty, Indiana University of Pennsylvania. For The National Center for PTSD And The Center for Mental Health Services (SAMHSA) September 2001. Lists created by various agencies outline the need for special needs shelters and for who to check on during a disaster.
NRBH should be part of every county Emergency Operations Center (EOC) to insure an adequate and appropriate behavioral health response. In fact, the NRBH INTRA-AGENCY DISASTER PLAN indicates such.
RESPONSIBLE PARTY

In the event of an external emergency, all New River Area Program employees will follow the plan set by the County Manager or the Emergency Management for the county. A copy of the Emergency Action Plan for each county that we service should be obtained by the Unit Director.
The Area Director, Unit Director, or Risk Management Nurse will act as Emergency Coordinator in the event of an internal emergency.

It quickly became apparent that New River would follow the lead of the County EOC & that the EOC would expect New River to know what to do. It also became apparent that neither has a plan should one be needed. Currently, In 4 of the 5 counties there is currently someone working with Emergency management regarding planning and response. NRBH does have resources to call on; there are trained and experienced responders in each county.

In conclusion, it appears that some thought was given to the response that New River would take should a disaster occur on the property of the agency. Plans are in place for coping with those events, if they are isolated and easily contained—any event requiring closure of a facility or multi-day response is not planned for. This is true also for the response of the counties—it is expected that NRBH will respond when called; although it is not clear who will be called and how they will respond. For these reasons, I request your permission to create a New River Behavioral Healthcare disaster response plan that addresses continuity of operations for the agency, care for our consumers, adequate and appropriate response to other emergency responders, and a working relationship with the county EOCs in our service region.

Good Morning,

Today I am writing a rationale for a community mental health agency to have an updated disaster response plan.

My employer does have a plan that focuses primarily on small, isolated internal incidents (ie, fire, violence, bad weather) that do not effect operations. For larger community events the plan reads simply to follow the county Emergency Operations plan. The county plans are pretty sketchy on behavioral health response & say--pretty much--for the mental health coordinator to follow the plan he/she developed.

So, a little non-productive tailchasing ensues and the plan has to be worked out on the ground. Not a situation that I find fun.
While looking around for statistics on the need for psychological response I found the International Society for Traumatic Stress Studies. The organization has some good resources for professionals and citizens & is soon holding its annual conference. The group is research-oriented more than practice-oriented. The site appears comprehensive and worth a second look.

Chevron Publishing Corporation is committed to publishing and
distributing books and videos which promote the understanding
and management of crisis, stress, trauma, and violence.

We specialize in books relevant to disaster mental health,
emergency services, crisis intervention, and rescue professions.

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rmcox