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Critical Incident Stress Management Study


May 27, 2015
By Sean Wentzel

Forensic Science and Criminal Justice MSc
Research Methods (CH7204)
Course Intake October 2013
Assessment 2
(3713 Words)

Student #: 12904579

                University of Leicester

Department of Science
June 30th, 2014
1. Rationale for the study:

A critical incident does not always have to be a mass disaster, it could be a single event a police officer experiences that might affect the rest of their life. Police officers, as well as other emergency services, do not often respond to a mass disaster and are therefore more likely to be affected by smaller incidents throughout their careers. Policing in rural communities will have different lasting stresses on police officers. This may be compounded by their high profile in the community, both on and off duty; relationships with people in the community in which they live and work, and scrutiny by the local media. It is therefore the responsibility of police leadership to be able to identify when members are experiencing critical incident stresses and provide them with debriefing, resources, training and critical incident management systems.

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A critical incident interferes with an individual’s ability to act or function at the scene of a crime or at a later stage (1). Critical incident stress occurs when an individual experiences a traumatic event. The event might be over, but could cause strong emotional or physical reactions at a later time. It depends on the individual when these reactions could be experienced, as well as how long they would last (2).

Some police officers experience nightmares due to critical incidents, which in turn affect their sleep quality. Sleep quality in turn has health and occupational performance implications. During their careers, police officers may experience physical injury, the death of fellow officers or civilians, as well as having to injure individuals in the line of duty (3).

Threats of death or serious injury to officers or to someone who the officer has a close relationship with, is more likely to cause greater peri-traumatic emotional distress and dissociation. This will also lead to higher levels of hyper-arousal than incidents with lower threats to the officer (4).

After experiencing a critical incident an officer might move to an altered state of consciousness, which could affect all five senses. This in turn could lead to tunnel vision, distortion in hearing, hyperawareness and also dissociation. If these symptoms are not recognized, it could lead to post traumatic stress disorder. It needs to be understood that a police officer who was involved in a critical incident is in crisis, emotionally unstable and depending on the incident, they may improve or deteriorate (5).

It is important to treat traumatized officers as victims and not as suspects. Common symptoms and feelings after a critical incident could be difficulty in expressing feelings, emotional exhaustion, introversion, acute hyper-arousal, lack of hobbies, dissatisfaction with organizational support and insecure job future. Each of these can be worsened by insufficient time allowed off by the employer to come to terms with trauma (5).

When measuring the heart rates of police officers during critical incidents, it was found their heart rate does not often lower after the incident, but stays at an elevated rate. An elevated heart rate was still observed even during the report writing period after the incident. It was found that every time an officer is asked to re-tell the critical incident, elevations in heart rates were seen, often up to 36 beats per minute above the resting rate. In certain individuals, elevated heart rates, up to 45-60 beats per minute after the critical incident were seen (6).

It is important that police officers receive help with developing mechanisms to cope with stress during critical incidents, as part of their training. A social support network and seminars addressing coping skills and critical incidents might be a useful tool for Police agencies training departments. Police officers in general are taught to repress their emotions and feelings and therefore it is difficult to determine the real amount of stress an officer experiences during a critical incident (6).

In the early 1990’s research was done in the United States of America by Johnson, in regards to violence in police families. Out of 728 officers, 40% indicated they had lost control or behaved violently towards their spouse. A further study indicated that of the 425 officers, 40 % reported violent behavior ranging from pushing, to using a gun. There are many factors associated with domestic violence in police families. Various theories such as isolationism, violence exposure such as stress from critical incidents, which leads to post traumatic stress syndrome and job burnout, are all examples. Violence exposure, such as the post-traumatic stress theory indicates that events likely to cause or threaten death or serious disability to the police officer or others can result in effects such as nausea, bowel release, fainting and hyperventilation over the short term. Chronic anxiety, insomnia and mood disorders are some of the long term effects (7).

Being exposed to life threatening events is often part of police officers duties and it is common for officers to struggle to `turn off’ the job when at home. Because of this we see higher rates of negative family life in individuals exposed to violence at work. Police domestic violence is within an isolated subculture and therefor there is less of a risk for detection, than in non-police families. Effective intervention is important when it comes to officers with high violence exposure. When looking at domestic violence the terms such as “lost control” and “the little woman made me do what I did not want to do”, are often terms used by officers who are involved in domestic violence, the same as an alcoholic would rationalize his/her behavior (7).

87 % of all emergency service personnel would have experienced at least one critical incident throughout their career. Law enforcement officers are more likely to develop post-traumatic stress disorder after experiencing a critical incident or repeated critical incidents over their career. It was proven that over a 10 week period, individuals who received wellness counseling sessions, received higher wellness scores than the control groups used (8). Other studies have revealed unexpected results in regards to religiosity and coping with critical stress incidents. One particular study indicated that officers who consider themselves to be religious, experience effects of critical incidents more than non-religious officers (9).

Police officers feel when the community has a negative outlook on police it makes their work even more difficult. Lack of appreciation by the community causes the officers to become cynical of the community. This in turn affects community policing. One of the biggest stress factors related to policing in small towns and communities compared against urban departments is “social factors”. An absence of anonymity is one contributing factor. Police officers in bigger urban communities can go off duty and be anonymous amongst the public, where in small communities this is not possible. When out in the public, even when off duty, police officers in smaller communities are always associated with their employment. This is often seen as the “fish-bowl effect”, which leads in itself to high levels of stress (10).

In smaller communities police officers could often be expected to deal with their own family members, friends or acquaintances. Lack of resources and training due to budget restraints are further issues which contributes to higher stress levels in rural policing. Boredom often contributes to high levels of stress which leads to job dissatisfaction, due to lower crime rates and calls for service (10). The stress within organizations in rural communities were seen by police officers as one of the biggest contributions to their job stress, with emphasis on non-supportive, non-participative practices and leadership styles of supervisors and administrators (11).

Critical incident stress debriefing is commonly used to address police officers who have experienced trauma. It is important to remember that although debriefing might work for some, it is ineffective for others. Debriefing could lead to more traumatic effects and does not always take into consideration the level of arousal, past trauma and current and recent life stresses. Debriefing could be costly as well as ineffective for many individuals. Debriefing might not be appropriately timed and therefore might lead to secondary traumatization (13). It is important to consider the best form of intervention for certain individuals and certain incidents.

A critical incident stress debriefing team in law enforcement should consist of at least one peer, who is a law enforcement officer, and at least one health professional. There are seven stages in a critical incident response debriefing. The first is the introduction phase, which describes the process, rules and expectations. The second phase is the fact phase where officers say who they are and what their involvement was in the critical incident. Third is the thought phase where the officer is asked to share his/her thoughts of the incident. Next is the reaction phase which explores the personal reactions of the officers. The symptom phase is the fifth, where the signs and symptoms are discussed and normalized. During the teaching phase, the officers are taught to deal with critical incident stress in their lives. The seventh phase is the reentry phase where officers can discuss any other issues and ask questions. This is where the focus is on returning the officer to duty (14).

It is also important that members are trained in critical incident debriefing. The presence of supervisors during a critical incident debriefing, the location where it takes place, media involvement in the incident, the presence of a peer, bureaucratic issues and the timing relative to the officers shift work, should be kept in mind prior to the debriefing. Critical incident debriefings do not further investigation in regards to law enforcement (14).

It is important for Critical Incident Stress Management (CISM) to cover pre-crisis planning through acute crisis and post crisis interventions. CISM has proven to improve symptoms of psychological distress (15). A CISM program provides pre-event and crisis management education, planning and policy development as well as training and preparation for managing traumatic stress. Interventions are provided to assist during an intervention, as well as tools to be used afterwards. CISM was started to assist with managing traumatic experiences and is seen as crisis intervention tactics to “mitigate the impact of a traumatic event, facilitate normal recovery process in normal people, who are having normal reactions to traumatic events, restore individuals, groups, and organizations to adaptive function, and identify people within an organization or a community who would benefit from additional support services or a referral for further evaluation, and possibly psychological treatment” (16).

Developing trust amongst leadership and senior officers within critical incident management is very important during decision making of high profile critical incidents. If there is a lack of trust, this could affect how senior officers make decisions during a critical incident. Public enquiries in regards to critical incident management have been criticized due to lack of management skills (17). The longer help is delayed for a police officer who was involved in a critical incident, the worse the effects could be. It is therefore important that management, senior officers and supervisors in police agencies are trained to identify critical incidents, as well as individuals showing signs and symptoms that might need intervention. Early treatment and recognition has proved to be effective, where officers were able to return to work after 2 – 46 weeks, and in some cases officers would resign their duties (18). The treatment of critical incident related stress wilt likely cost organizations more than $150 billion in the next two decades, due to low productivity, absenteeism and disability. Half of employee turn overs are due to job stress (12).

Critical incident stresses are experienced differently by different individuals in different situations in the line of their duty. It is important that police leaders and management are trained in recognizing the signs and symptoms of critical incident stresses and are appropriately trained to manage it. Each police department should provide training to police officers as well as seminars in regards to critical incident stress and should have support systems in place for their family. Critical incident response teams, debriefing and management, is important and should be clearly defined in the police organizations policy and procedures.

  1. Research Question:

    What is the lived experience of police officers living and working in rural communities, who experience critical incident stress?

    This research is intended to give a better understanding of the effects of critical incidents stresses on police officers and their families in a rural community. Obtaining a better understanding could be useful in the coaching and mentoring of support groups, peers, as well as assist in future critical incident stress debriefings and the management of it. It is important that individuals overseeing the management and implementation of debriefing are trained in each aspect of the process. This research will take the format of a qualitative study, where the lived experiences of police officers are evaluated.

  2. Methodology

  3. Participants

Voluntary participants will be used for this research study. It is important to gain an understanding of how both junior and senior members experience the lived effects of critical incidents. Even if a police officer states he/she had not experienced a critical incident, this information will be recorded.

Three municipal Police Forces will be contacted in rural Southern Alberta, Canada; Medicine Hat Police Service (MHPS), Lethbridge Regional Police Service (LRPS) and Taber Police Service (TPS). Each of their Executive Teams, as well as their Police Association Presidents, will be contacted by phone and letter. In the letter the research outline will be explained and will include a request for approval for accessing their members.

If approval is obtained each association president will then present the research request to their members and provide them with the contact details of the researcher. Individuals willing to participate would then have to contact the researcher by email, stating their voluntary willingness. The researcher would then arrange interview dates and times in each individual’s city, as well as an appropriate interview location, which the participant would feel comfortable with. The outline of the research with a letter of consent and a link to an online questionnaire will be mailed to the participants. Each letter will include a self-addressed stamped envelope, to be returned to the researcher.

  1. Materials

An online questionnaire will be provided to each participant through a link provided with a deadline date for completion.

The TT

questionnaire will consist of no more than 50 questions in regards to experience, any previous military or law enforcement experience, age, gender, description of work related critical incidents experienced, as well as non-work related, questions in regards to the debriefing process as well as what impact the incident had on their job, themselves and their perception on how it affected their family. How did living in a rural community affect them and what, if any role did the media play in their critical incident? Was there any loss in work time and were suitable resources provided. What role, if any did senior supervisors and leadership play and what are the participant’s feelings towards their role? Post incident effects, departmental policy, training, alcohol abuse and emotions would also be looked at.

The researcher will then review each questionnaire and arrange with each participant an interview date and location. Each interview will be audio recorded. The researcher will go over each question and answer with the participant and determine if anything needs to be changed, note non-verbal language, as well as emotions expressed. The participants will be encouraged to speak openly about their thoughts and emotions and the researcher will be taking notes during the interview. The researcher will transcribe each interview within 24 hours. 
  1. Method/Procedure

Phenomenology is the framework which would be followed for this qualitative study, because it “acknowledges and values the meanings people ascribe to their own existence (19).” Phenomenologists view human existence as meaningful and interesting because of people’s consciousness of that existence.” It acknowledges peoples physical ties and how they think, see, hear and feel. It is often by experiencing the same phenomenon through participation, observation and introspective reflection that the researcher gains better understanding (20).

By completing a questionnaire prior to the interviews, the researcher will gain a better understanding of the participant. This will help in preparing for the interview. To allow participants to “maximize the depth of description of the thing as it is experienced ” (20), they would be asked to bring any notes or dairies they might of kept or made, between the time of the incident, questionnaire and interview. This is not a requirement and the participants do not have to share this information.

Two weeks after the researcher receives the completed questionnaires, interview dates and times would be scheduled with each participant. The questionnaire would be briefly discussed with the participant as well as the different critical incidents experienced. The interviews will be audio recorded to assist with thematic analysis.

These themes could assist further studies and research, in regards to effects of critical incident stresses experienced by police officers and policing in rural communities. The themes and the frequency with which they occurred will then be calculated.

  1. Analysis

Data collected from the questionnaires and interviews will be thematically analyzed using interpretive phenomenological analysis (IPA). Therefore it requires the participants interpretation of their lived experiences and interpretation of the participants own interpretation by the researcher (20).

Certain themes will be recognized during the interview phase, which would be assisted through the completion of the questionnaires. Each of the questionnaire questions will be scored depending on whether they were answered yes, no or unsure to. This will be reflected in a pie chart indicating the total percentage. Individual police agency results as well as a total for all three agencies will be shown.

Questions with multiple answers as to what effects were experienced post incident, as well as comparison data (i.e. male/female members; members with less than vs members with more than five years policing experience) would be represented by a bar graph in percentages. Pie charts would be used to illustrate summary data of the thematic analysis.

During the interview phase the real lived experiences in regards to each participant’s critical incident will be explored. Themes will be identified that describe the participant’s experiences. These themes will provide insight to the effects of stresses experienced by police officers, which could provide a better understanding and methods of prevention through training and education. This could assist police officers who are currently experiencing critical incident stress, to establish better coping and prevention strategies, as well as decreasing the effects of critical incidents.

  1. Ethical Considerations :

When conducting research with human subjects the involvement of a human research ethics committee is necessary, to ensure the rights and privacy of the participants are protected. Risk of emotional harm from sharing intimate life details is one of the main concerns (21). To minimize risk the researcher will seek ethical approval from the Human Subject Research Committee (HRSC). This will ensure that both researcher and participants understand their roles, rights and responsibilities (22).

Participants should understand that total confidentiality would be maintained throughout the research. The participants would have the right to anonymity and to withdraw at any stage during the interview. When a participant is interviewed, the critical incident support team for that agency will be notified that an interview is taking place, and the time that the interview is concluded. The clinical support member should also be notified by the support team, when interviews are going to be held, in case a participant needs to contact him or her.

Requests to withdraw from or stop the interview will be honored. At any time a participant showing any overwhelming emotions, distress or symptoms affecting their ability to participate, would be given options to contact a support person, stop or take a break. The researcher will ask only the approved questions, to prevent any bias. Participant’s names will not be mentioned in the research paper. Only the researcher will have access to research materials. When completing the online questionnaire, each participant will be assigned a number, and therefor they would not have their names associated to the questionnaire at all. The researcher would be able to link each participant’s questionnaire number, to each participant when interviewed.

  1. Anticipated problems

The “boys club” theme is often adopted within police agencies. Speaking about thoughts and emotions or seeking professional help, are often seen as being weak. Critical incident debriefing teams are often managed by ranking members and a chaplain, who often report back to police administration. For these reasons officers may choose not to participate honestly. Individuals acting on the debriefing team often join these teams for the wrong reasons; for personal gains and not to act in the best interest of the members who are victims. Individuals also often do not seek help because of this.

The definition of what a critical incident is could be different to every individual. It is important to remember that each individual’s reaction to an event is unique. Police officers often become resilient to certain incidents and they may not view them as critical. This may skew the true numbers of critical incidents and themes. Experience could also skew numbers, as experienced officers are often more resilient, where junior officers might perceive lesser incidents as being critical.

The researcher could experience logistical problems when interviewing individuals in Lethbridge and Taber, depending on the number of participants, and their availability to be interviewed; the researcher would have to incur all travel expenses, so ideally interviews in each location would occur on the same day. It would be important for the researcher to stay emotionally detached during the interviews, as the researcher may know some of the participants and could familiar with some of their lived critical incidents.

Only a small portion of police officers in rural southern Alberta, Canada will be interviewed. The total estimated population is roughly 130,000 for all three areas and the total number of potential participants is less than 300 officers. The mortality rates and larger scale critical incidents are much lesser in these areas than in bigger cities in Southern Alberta. Participants might also have experienced several critical incidents throughout their career and this might have a larger impact on them, comparing to individuals with lesser incidents. Some participants may have previously sought help in regards to their critical incidents, where others might not of.

References:

  1. Mitchell, J.T. When disaster strikes: The critical incident stress debriefing process. Journal of the Emergency Medical Services, 1983, Volume 8, pp: 36-39;
  2. www.trauma-pages.com, accessed June 20th, 2014.
  3. Neylan, T.C., Metzler, T.J., Best, S.R., Weiss, D.S., Fagan, J.A., Liberman, A., et al. Critical incident exposure and sleep quality in police officers. Psychosomatic Medicine 2002, Volume 64, pp: 345 – 352.
  4. McCaslin, S.E., Rogers, C.E., Metzler, T.J., Best, S.R., Weiss, D.S., Fagan, J.A., et al. The impact of personal threat on police officers’ responses to critical incident stressors. The Journal of Nervous and Mental Disease, August 8th, 2006, Volume 194 (8).
  5. Abdollahi, M.K. Understanding Police Stress Research. Journal of Forensic Psychology Practice, 2002, Volume 2(2).
  6. Anderson, G.S., Litzenberger, R., Plecas, D. Policing: Physical evidence of police officer stress. The International Journal of Police Strategies & Management, 2002, Volume 25 (2), pp: 399 – 420.
  7. Johnson, L.B., Todd, M., Subramanian, G. Violence in police families: Work-family spillover. Journal of Family Violence, 2005, Volume 20 (1).
  8. Tanigoshi, H., Kontos, A.P., Remley, T.P. The effectiveness of individual wellness counselling on the wellness of law enforcement officers. Journal of Counselling & Development, 2008, Volume 86.
  9. Clark-Miller, J., Brady, H.C. Critical stress: Police officer religiosity and coping with critical incidents. Journal of Police Crime Psych, 2013, Volume 28, pp: 26 – 34.
  10. Oliver, W.M., Meier, C. Stress in small town and rural enforcement: Testing the assumptions. American Journal of Criminal Justice, 2004, Volume 29 (1).
  11. Scott, Y.M. Stress among rural and small town patrol officers: A survey of Pensylvania municipal agencies. Police Quaterly, June 2004, Volume 7 (2), pp: 237 – 261.
  12. Caine, R.M., Ter-Bagdasarian, L. Early identification and management of critical incident stress. Critical Care Nurse. 2003, Volume 23 (1).
  13. Raphael, B., Meldrum, L. Does debriefing after psychological trauma work? BMJ, June, 1995, Volume 310.
  14. Malcolm, A.S., Seaton, J., Perera, A., Sheehan, D.C., Van Hasselt, V.B. Critical incident stress debriefing and law enforcement: An evaluative review. Brief treatment and crisis intervention, June, 2005, Volume 5, pp: 261 – 278.
  15. Everly, G.S., Flannery, R.B., Eyler, V.A. Critical incident stress management (CISM): A statistical review of the literature. Psychiatric Quarterly, 2002, Volume 73 (23).
  16. www.info-trauma.org accessed June 15th, 2014, Critical incident stress management, Mitchell, J.T.
  17. Wheatcroft, J.M., Alison, L.A., McGrory, D. The influence of trust on senior investigating officers’ decision making in high-profile critical incidents. Police Quarterly. 2012, Volume 15(4), pp: 386 – 413.
  18. Chapin, M., Brannen, S.J., Singer, M.I., Walker, M. Training police leadership to recognize and address operational stress. Police Quarterly. 2008, Volume 11 (3), pp: 338 – 352.
  19. Holloway, I. & Wheeler, S. Qualitative research in nursing and health care 3rd Ed. Wiley-Blackwell, West Sussex UK, 2010.
  20. King, N. & Horrocks, C. Interviews in qualitative research. Sage Publications Ltd, London, 2010.
  21. Taylor, B., Kermode, S. & Roberts, K. Research in nursing and health care: Evidence for practice, 3rd Edition, Thomson, 2005.
  22. Human Subject Research Committee 2010. Research & Innovation Services, University of Lethbridge, viwed June 19th, 2014.
    http://www.uleth.ca/research/ethics/human-subjects/human-subject-research-committee