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What are the best practices for facilitating a CISD session with a diverse group of participants?

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Critical incident stress debriefing (CISD) is a group intervention that helps people cope with the psychological effects of a traumatic event. It can be a valuable tool for reducing distress, enhancing resilience, and preventing post-traumatic stress disorder (PTSD). However, facilitating a CISD session with a diverse group of participants can pose some challenges. How can you ensure that everyone feels safe, respected, and supported in the debriefing process? Here are some best practices to follow.

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Tim Jenkins, LCPC

Behavioral Health Director @ Futures Unlimited, Inc. | Leading Expansion

1 Understand the diversity

Before you conduct a CISD session, you need to understand the diversity of the group. This includes their cultural, linguistic, religious, ethnic, gender, and professional backgrounds, as well as their personal experiences and perspectives. You can gather this information by consulting with the group leaders, the incident managers, or the participants themselves. Knowing the diversity of the group can help you tailor the intervention to their needs, preferences, and expectations.

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Tim Jenkins, LCPC

Behavioral Health Director @ Futures Unlimited, Inc. | Leading Expansion
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I think the idea of undestanding the diversity in a group is a great idea. But I also know, having led over 400 CISD events I often arrive at them with precious little information, with likely a scant 24 hour lead time (sometimes only an hours notice), and there is minimal time to get to know the diversity. Instead I would say, I expect the diversity and try not to let it put me on my heels when someone is super angry or feels hurt because of their unique situation or perspective.

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2 Establish the ground rules

At the beginning of the CISD session, you need to establish the ground rules for the group. These are the norms and expectations that guide the behavior and communication of the participants. Some examples of ground rules are: confidentiality, respect, empathy, honesty, voluntariness, and time limits. You can explain the rationale and benefits of each rule, and ask the group to agree on them. You can also invite the group to suggest any additional rules that they think are important for their context.

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Tim Jenkins, LCPC

Behavioral Health Director @ Futures Unlimited, Inc. | Leading Expansion
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I try to lead with a handful of expectations that define why we are here and simple expectations. I have had cisd participants arrive at a group debrief with no knowledge of the incident or loss of life that has occurred. I have had individual debriefs with police officers that did not know their colleague was hurt or why they were meeting me and the department was using me to break the news. - So some introductions and expectations are in order. I would feel blessed if a group talked so much that I told myself to be quiet and not step on their group process flow with my speaking! I speak only to keep the process going and to provide further resources.

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3 Use a flexible approach

During the CISD session, you need to use a flexible approach that adapts to the dynamics and needs of the group. This means that you should not follow a rigid script or structure, but rather adjust the pace, tone, content, and format of the intervention according to the feedback and reactions of the participants. You should also be prepared to deal with any issues or conflicts that may arise, such as resistance, anger, silence, or emotional distress. You can use various techniques, such as open-ended questions, active listening, validation, reframing, and summarizing, to facilitate the dialogue and support the group.

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Tim Jenkins, LCPC

Behavioral Health Director @ Futures Unlimited, Inc. | Leading Expansion
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I would add this: the Irvin Yalom diagram of a subpar group is a circle of participants surrounding a group leader in the middle with lines representing communication going back and forth between the leader and the individual participants. (Reminds me of Mitchell Model training 25 years ago.) The best practices is the lines zinging back and forth between the participants and rarely to the leader. Meaning the the best model of support within CISD is not the leader (supporting diversity of responses) but the participants' own peer support (following the leaders' ground rules to support each other respectful of peers' differences. (And the leader setting limits when one participant does not respect the other)

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4 Respect the differences

Throughout the CISD session, you need to respect the differences among the participants. This means that you should not impose your own values, beliefs, opinions, or judgments on the group, but rather acknowledge and appreciate their diversity. You should also avoid making assumptions, stereotypes, or generalizations about the participants, and instead ask them to share their own views and experiences. You should also be sensitive to the potential impact of language, culture, religion, gender, and other factors on the expression and interpretation of emotions, meanings, and behaviors.

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5 Promote the commonalities

Along with respecting the differences, you also need to promote the commonalities among the participants. This means that you should highlight the shared goals, experiences, feelings, and coping strategies of the group, and foster a sense of connection, solidarity, and mutual support. You can do this by emphasizing the common themes and patterns that emerge from the discussion, and by encouraging the participants to recognize and appreciate each other's strengths, contributions, and efforts. You can also use humor, stories, metaphors, or analogies that resonate with the group.

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Tim Jenkins, LCPC

Behavioral Health Director @ Futures Unlimited, Inc. | Leading Expansion
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The group process is a microcosm of regular life after the leader leaves the group. Establishing solidarity or common ground is a way of insuring the process will continue after the leader is gone. My best cism's have had participants processing or laughing about the deceased's quirky ways, or their sense of humor or unique and special things about them. I feel safer ending and leaving them if there is some sort of bond between them regarding this loss because it lets me know they will be there for each other without a facilitator guiding them. It means, "it is ok to be emotional and to support each other at work."

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6 Evaluate the outcomes

At the end of the CISD session, you need to evaluate the outcomes of the intervention. This means that you should assess the level of satisfaction, relief, understanding, and learning of the participants, and identify any areas for improvement or follow-up. You can do this by asking the participants to provide feedback, either verbally or in writing, about their experience and impressions of the debriefing process. You can also use standardized tools or scales to measure the impact of the CISD session on the psychological well-being and functioning of the participants.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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What are the best practices for facilitating a CISD session with a diverse group of participants?

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1 Understand the diversity

2 Establish the ground rules

3 Use a flexible approach

4 Respect the differences

5 Promote the commonalities

6 Evaluate the outcomes

7 Here’s what else to consider

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