Justin Terney, a 22-year-old police officer who had served at the Tecumseh, Oklahoma, Police Department for merely six months, died on March 27, 2017, after a shootout with a man trying to flee a traffic stop. Officer Terney pulled over a vehicle around 11:30 p.m. The suspect, a passenger, was outside the car and fled after Officer Terney confronted him about false information that the suspect provided. He then shot at Officer Terney, who returned fire. Both men were wounded, and paramedics rushed them to surgery; Officer Terney did not survive.
Hundreds of people from across the state came together to honor the life of the fallen Tecumseh officer at a memorial service. Then-Assistant Chief JR Kidney said,
This has probably been one of the toughest weeks of our lives here at Tecumseh Police Department. Been an officer here for about 21 years and this is the first time in my history to ever have to bury one of my brothers.1
JR Kidney, now chief of Tecumseh Police Department, had experienced a horrific critical incident himself 13 years earlier while on duty in his hometown. A young women driving over a hill collided with a parked utility truck, and her small sedan became engulfed in flames. Officer Kidney tried to extinguish the fire in the cabin and under the hood. Despite a valiant effort to pull the driver out of the burning car, Officer Kidney could not disengage her legs from the pedals, and she perished in the fire. Deeply affected by his inability to save the young woman, Officer Kidney sought counseling from a chaplain who previously assisted victims of the 1995 Oklahoma City bombing, as well as from other law enforcement support programs. Based on his own traumatic experience, Chief Kidney actively encouraged several officers from the Tecumseh Police Department who worked with Officer Terney to attend counseling sessions. Then, at an annual statewide meeting, Chief Kidney learned of the Emergency Responders Assistance Program (ERAP), a nonprofit dedicated to supporting first responders who experience trauma following critical incidents.
ERAP Overview
ERAP was established in 2015. It is a voluntary citizens’ organization committed to supporting first responders and their families after work-related critical incidents. While ERAP is an Oklahoma-based organization, similar organizations exist in other areas, some of which are supported by state funds, with the same vision of assisting first responders. A critical incident is any incident likely to have debilitating emotional consequences for anyone involved in it and is likely to create adverse consequences for these individuals’ engagement in future stress-inducing circumstances. Some people exposed to trauma may display signs and symptoms of acute traumatic stress such as flashbacks, outbursts of anger, aggression, problems with authority, belligerence, substance abuse, forgetfulness, hypervigilance, and increased risk-taking behaviors. After 30 days, if these symptoms persist, the person may be considered to be experiencing Posttraumatic Stress Disorder (PTSD).
First responder support organizations recognize that critical incidents can lead to significant stress for those involved, resulting in domestic violence, family breakdown, deterioration in job performance, detachment, and even suicide. Statistics show that suicides are more common than work-related homicides in first responders, demonstrating a dire need for assistance and support.
Such organizations provide training, education, and psychological assistance in a structured, strictly confidential, three-day seminar known as the Post Critical Incident Seminar (PCIS). The goal of the seminar is to increase family and peer-to-peer communications to restore first responders’ self-image, extend careers, and reestablish healthy family relationships. The ERAP model utilizes private donations with an executive board composed of doctors, lawyers, businesspersons, and law enforcement professionals. Another model of law enforcement support that also uses PCIS, is the South Carolina Law Enforcement Assistance Program (SCLEAP). South Carolina has offered law enforcement personnel PCIS sessions since 2000 through SCLEAP. According to Dr. Eric Skidmore, SCLEAP’s Program Director, four South Carolina state agencies, along with the state’s adjutant general’s office, participate in this state-sponsored program.2
PCIS
PCIS was originally created by the FBI in 1983 after the agency recognized that 50 percent of law enforcement personnel involved in a shooting or a similar traumatic event leave the force within five years after the event. The creators of PCIS recognized that traumatized first responders are more likely to speak to peers rather than to mental health professionals (MHPs) or to non–first responders about their issues. First responders, especially law enforcement personnel, often come from a subculture that encourages the suppression of emotions and independent, isolated methods of coping with problems.
Peer support personnel are not clinicians and are neither trained nor licensed to make diagnoses. They are employed to assist traumatized colleagues by facilitating verbal communication in an attempt to promote an open atmosphere. This atmosphere should provide personal interactions and assist sufferers in developing coping skills. Properly trained peer support members are equipped not only to deal with affected personnel but also to sense when more professional care is needed. PCIS offers first responders a confidential and safe method for dealing with post-incident stress. It is currently offered in South Carolina, North Carolina, Georgia, Virginia, Ohio, Arkansas, Texas, Oklahoma, and Kentucky.
Peer support is essential in the acute and delayed phases of assistance, but it must be provided by well-trained individuals, most of whom may have experienced critical incidents themselves and are able to relay their recovery story to their traumatized peers. Such peers should be able to identify those who may need professional psychological assistance from MHPs. MHPs must be familiar with first responders’ culture and sensitive to their unique needs. Immediate assistance following a critical incident must not be an unstructured, single-session debriefing, but rather a well-structured, peer-supported process such as the Critical Incident Stress Debriefing (CISD) process. Later, usually after 12 months or more of structured peer support, attendance in PCIS might be recommended to those still in need of assistance. Peer support sessions must be strictly confidential and may include family members when appropriate.
The format of PCIS is similar regardless of where it is offered. Each PCIS averages 25–35 participants (first responders and significant others); 3–7 MHPs; and several peer support personnel trained in individual and group crisis intervention to facilitate discussions in small group sessions. During the three-day seminar, participants and staff stay at the same hotel and share common meals. This allows staff to be available throughout the evenings to provide services for participants as needed.
The intensive seminar, entirely underwritten by the sponsoring organization or by the entity that sends a first responder, starts with the participants sharing their own critical incident experiences. Seminar participants typically experience high anxiety and apprehension at the onset, given their background. As the first day unfolds and common experiences are shared, however, anxiety gives way to a sense of relief and reassurance. On the second day, the group is divided into smaller groups based on common themes associated with their critical incidents (e.g., shooting incidents, military combat) and discussions are facilitated by trained peers. MHPs who are first responder–friendly and familiar with the culture are integral to the seminar. These clinicians are available for one-on-one sessions throughout the seminar. On the third day, participants are encouraged to explore and describe the positive aspects of their traumatic experiences and lessons learned. Throughout the three days, lectures are given about topics such as overcoming adversity, communication with family and coworkers, suicide, resiliency, and stress management. Small groups may convene to discuss healing strategies.
PCIS is not a debriefing nor a process to be used immediately following a critical incident. Three to six months after an incident is the earliest that first responders should consider attending the seminar, with most participants typically attending it 9–12 months or more after the incident. It is vital to distinguish between the PCIS process and the CISD, which is a specific, seven-phase, small group, supportive crisis intervention process. It is just one of the many crisis intervention techniques that are included under the umbrella of critical incident stress management (CISM).3 The CISD process does not constitute any form of psychotherapy, and it should never be utilized as a substitute for psychotherapy. It is simply a supportive, crisis-focused discussion of a traumatic incident using peer support teams.
Most forms of debriefing do not equate to CISD, which typically takes place 24 to 72 hours after the conclusion of an incident. Those who practice the CISD model of psychological debriefing consider it an effective crisis intervention method that mitigates distress, especially when practiced by appropriately trained personnel. With the exception of four randomized field trials supportive of CISM and small group CISD, however, its effectiveness is still widely debated and strong evidence supporting its efficacy is often anecdotal. Less-structured, immediate post-incident debriefing is even more controversial in its utility, with some studies actually showing an increased incidence of PTSD following debriefings that occur within one month of the incident; consist of a single session only; and involve some form of emotional processing by encouraging the individual’s recollection or reworking of the traumatic event.
The culture among first responders is changing positively toward accepting counseling.
A study by a South Carolina research team, assessed PTSD, depression, and anxiety in more than 468 PCIS participants at three points: during the seminar, two months after the seminar, and six months after the seminar. The study period was between 2012 and 2017. According to the study, PCIS participants experienced marked improvements in trauma and stressor-related depression and anxiety symptoms when comparing pre- and post-PCIS scores. In addition to objective improvement in depression and anxiety scores, most participants found the PCIS experience meaningful; were able to establish distance from their critical incidents; found opportunities in adversity; and learned to balance their emotions. According to the participants, several features of PCIS such as the large group and didactic presentations and the peer-led small groups, were helpful.4 This is essentially the first study strictly addressing the effectiveness of PCIS and providing support to the premises that the seminar addresses. The scarcity of solid scientific evidence regarding the benefit of PCIS or CISD should not deter professionals from offering assistance as long as the seminars are structured and the peers and MHPs are appropriately trained.
Conclusion
According to Dr. Kathy Thomas, ERAP’s clinical director, the culture among first responders, especially law enforcement, is changing positively toward accepting counseling, sharing traumatic experiences with peers and MHPs, and being actively involved in the healing process to mitigate the negative consequences of traumatic experiences.5 There is an increasing recognition that “bottling in” stress and anguish in keeping with a “tough guy” mentality may lead to grave consequences for first responders and their families. The realization that they are as human and vulnerable as anybody to the impact of trauma leads increasing numbers of first responders to seek help and guidance by peers and MHPs, including through intensive seminars such as PCIS. This culture change has resulted in the proliferation of support organizations like ERAP and SCLEAP who utilize PCIS as their primary counseling tool. Moreover, there is a remarkable collaboration between some of these support organizations. Often, first responders from one state will participate in a PCIS in another state if there is an immediate need for assistance or if such a program is not offered at their own state. Mental health workers might also conduct seminars in several states.
Police chiefs and other supervisory first responders should consider the following action items when their personnel are involved in critical incidents.
n Ensure that support services to traumatized first responders are conducted by appropriately trained personnel using an appropriately administered format.
n Identify employees with alarming symptoms suggestive of adverse response to critical incident exposure (flashbacks, angry outbursts, aggression, problems with authority, belligerence, substance abuse, forgetfulness, hypervigilance, increased risk-taking behavior, and depression).
n Become familiar with support services locally, regionally, and nationally.
n Refer personnel to either individual counseling by a mental health specialist or a peer support program such as a CISD immediately following a critical incident or within 12 months.
n Refer personnel to a peer support program such as a PCIS 12 months or later following a critical incident.
n If located in a state that does not offer PCIS, first responder executives can contact ERAP or SCLEAP to accommodate officers in need of assistance. While it is preferred that the organization sending an officer for PCIS underwrite the cost of attendance, both ERAP and SCLEAP will endeavor to enable those in need to attend a seminar in any location regardless of financial resources.
IACP Resourcesn Vicarious Trauma Toolkit |
In October 2018, ERAP Arizona was formed and plans are in place to initiate PCIS there in 2019. ERAP has an interest in developing a PCIS programs for first responders in adjoining states such as Utah, Nevada, Washington, and Idaho, as well.
In Chief Kidney’s words, seeking emotional assistance was the “best decision I’ve ever made in my life,” allowing him not only to return to duty and be productive, but also to identify officers in his charge who are in need of these services.6 d
1 Kristen Shanahan, “’One of the Toughest Weeks of Our Lives,’ Hundreds Gather to Remember Fallen Tecumseh Officer,” KFOR4, March 30, 2017.
2 Erik Skidmore (program director, SCLEAP), telephone interview, October 10, 2018.
3 George S. Everly Jr. and Jeffrey T. Mitchell, “The Debriefing ‘Controversy’ and Crisis Intervention: A Review of Lexical and Substantive Issues,” International Journal of Emergency Mental Health 2, no. 4 (2000): 211–255; George S. Everly Jr. and Jeffrey T. Mitchell, Critical Incident Stress Management (CISM): A Practical Review, 1st ed. (International Critical Incident Stress Foundation, Inc., 2016).
4 Joseph C. Cheng et al., “Mental Health Outcomes of the Post Critical Incident Seminar: Pilot Data from the South Carolina Law Experience” (poster, Annual Meeting of the American Psychiatric Association, New York, NY, 2018).
5 Kathy Thomas (clinical director, ERAP), telephone interview, October 6, 2018
6 JR Kidney (chief, Tecumseh Police Department), interview, KOCO TV Channel 5, July 27, 2018.
Please cite as
Douglas White and JR Kidney, “A Culture Change: Emergency Responder Assistance Programs,” Police Chief 86, no. 2 (2019): 36–39.
