CISM Overview: The How

CISM Peer Support is Comprehensive in that it covers the entire scope of a critical incident and disaster mental health from pre-incident education, during time of impact, to post incident intervention and education, to the recovery/referral process. CISM is Integrated in that all of these interventions are integrated within one another and are not meant to be used as stand-alone techniques since they all build on one another. CISM is Systematic in that the interventions are phase-sensitive and work with the timing of the incident and the effects of the exposure. CISM is a Multi-Component (Components 1-6) approach in that it involves surveillance and assessment techniques to inform the peer team what interventions may be useful for the peer group. There are interventions that can reach individuals that are affected, other interventions can reach larger mixed groups, and other interventions that can reach smaller groups.


  1. We start with building resistance through pre-incident education where we teach our colleagues how to recognize the signs and symptoms of distress and dysfunction in themselves and each other. Giving factual information about stress management and how to access external resources and services that are available to them through their departments and communities.

  2. The first thing we do when our colleagues have been exposed to a critical incident is use our surveillance skills to assess for the impact the critical incident has on those involved. We are looking for signs and symptoms of distress and dysfunction and any change in the group’s cohesion, performance, or communication.

  3. Once we have made a full assessment we are now able to formulate a strategic plan using the 5 Ts: Theme, Target, Type, Timing, and Team. This will answer the what, where, why, when, and how of crisis intervention tactics.

  4. The majority of interventions we use in Peer Support are Individual interventions such as the SAFER-R. We start with individual interventions so that we can immediately provide support to those showing signs of need and help us gain a better assessment of the level of impact the event has had on those involved. This will give us information that will help us determine the appropriate next steps, maybe an informational group intervention, such as a CMB, is required to fill in the gaps of factual information about the incident, how to recognize the signs and symptoms of stress, and stress management. This is meant to control the spread of rumours and mitigate stress reactions. Afterwards we would continue with more individual interventions and assess for the need of an interactive group intervention such as a defusing or CISD that is meant to mitigate stress reactions and restore the group back to their cohesive functioning.

  5. Finally, we would follow up with those we provided interventions and assess for whether or not they have recovered adaptive functioning or require a referral to formal mental health or other external support services appropriate for their needs.