1. Connecting the 3 C’s- CIT, CNT & CISM
Dara N. Rampersad, Ph.D., LPC, NCC
First Responder & Forensic Psychologist
Detective Sabrina Taylor
Phoenix Police Department, CIT Coordinator

2. The Why
In our lines of work we are exposed to and see crisis & trauma responses across the continuum.
What if we could identify the things that will preserve public safety & our own safety (physically and mentally).
-We can by using the strengths across training modules and disciplines to maximize positive outcomes. 2

3. Key Terms and Concepts of Crisis and Crisis Intervention
Critical Incidents
Powerful traumatic events that initiate the crisis response
Without critical incidents there would be no crisis reactions and no need for crisis intervention.

4. “The Terrible Ten” Significant events involving children
Prolonged incidents especially with loss of life
Personally threatening situations
Events with excessive media interest
Any highly distressing event
Line-of-duty death
Suicide of colleague
Serious line-of-duty injury
Disaster / multi-casualty incident
Killing or wounding an innocent person 4

5. Goals of Crisis Intervention
Reduce emotional tension
Stabilize the person
Mobilize personal resources
Identify individuals who may need professional assistance and refer as necessary
Mitigate the impact of the traumatic event
Enhance unit cohesion and unit performance in homogeneous groups
Normalize reactions and facilitate normal recovery processes.
Restore individuals to adaptive functions 5

6. Crisis Intervention Team (CIT)
Typically- Mental Illness/Substance Illness Driven
Non-specified time to work
Stage 1 and Stage 2 protocol followed
Non-Barricaded- F2F
Barricaded
Resolution
Crisis Negotiation Team (CNT)
Hostage
May or may not involve Mental/Substance Illness
Involve FBI or other agency
Time is on your side
Non-Hostage
CISM

7. Structure of CIT Teams
Prefer a minimum of 2 officers for CIT to be used safely (one primary and the other cover)
Primary utilizes non-threatening posture and engages to de- escalate
Cover officer maintains scene safety and listens for key content in the event they need to assist as primary

8. Structure of CNT Teams
Utilizes 4 main positions: Primary, Coach, Intelligence/Scribe, and Tactical Liaison Officer (TLO).
Other supervisory and support roles also include: Crisis Negotiation Coordinator (CNC); Assistant CNC, Team Leader, and Mental Health Professional.
While primary is de-escalating crisis, coach passes along recommendations or intelligence obtained, while the TLO coordinates with tactical. The intelligence officer maintains the situation boards, and records pertinent information.

9. Structure of CISM Teams
Minimum: Two CISM trained team members
At least one mental health clinician
Other team member(s) may be “peer support personnel,” spiritual leader, another mental health, or physical health professional
ALL TEAM MEMBERS MUST BE TRAINED IN the interactive group process - CISD

10. Nature of the CIT intervention
Usually face to face interventions assisting people with an altered mental status due to mental or substance illness.
CIT officer trained extensively in face to face de-escalation and the use of body language/posturing.

11. Nature of the CNT intervention
Preferred use is in non-face to face encounters/barricaded person in crisis. This way we can utilize all roles on the team most effectively.
CNT officer trained extensively on the use of non-face to face techniques of de-escalation.
Technical experts in utilizing active listening skills since there is generally no body language to read.

12. Nature of the CISM intervention
Typically involves peers who are not currently experiencing symptoms due to a secondary mental illness/substance use episode.
CISM peer/leader trained in active listening skills working with someone who is face to face.
Can be done with individuals, and various sized groups.

13. Techniques Used in CIT Scene Assessment 5 plays-
Introduce Self Obtain name Thank the person Listen to the content and feeling of the Person in Crisis (PIC) Reflect/paraphrase/summarize.

14. Techniques Used in CNT Third Party Intermediary
(MOREPIES) model of Active Listening Skills (ALS) M- Minimal Encouragers O- Open Ended Questions R- Reflecting/Mirroring E- Emotional Labeling P- Paraphrasing I- I messages E- Effective Pauses S- Summary
Understanding the OODA loop

15. Techniques Used in CISM
Techniques vary widely depending on type of intervention you’re doing, but some core skills are:
- Listening skills, SAFER-R (Stabilize, Acknowledge, Facilitate Understanding, Encourage Effective Coping, Recovery or Referral- Revised), Individual Crisis intervention
-Strategic assessment and planning
-Informational group processes
-Interactive group processes
-Personal and Community resilience: resistance, resilience, and recovery

16. CIT Training Strengths
Understanding the psychological motives of the behavior of the PIC
Have a readymade broad network of mental health professionals to obtain intel and assist with de-escalation
Other…

17. CNT Training Strengths
Determining if this is a hostage/non-hostage encounter (instrumental vs. expressive)
Assessing tactical needs for entry
Use of a TPI that can be used for leverage (used sparingly and at right time)
Being aware of the action imperative “what are we doing and why now?”

18. CISM Training Strengths
Created to decrease the incidence of traumatic stress experienced by an individual following a critical incident.
Serve as a platform for psychological triage and referral
Excellent for group formats, such as in debriefings.
Mitigate distress
Facilitate psychological normalization and psychological “closure” (reconstruction)
Set appropriate expectations for psychological / behavioral reactions
Serve as a forum for stress management education
Identification of external coping resources

19. How CISD can help you with ALS
INTRODUCTION
FACT PHASE
THOUGHT PHASE
REACTION PHASE
SYMPTOM PHASE
TEACHING PHASE
RE - ENTRY PHASE 19

20. Phase Progression of a CISD
COGNITIVE
INTRODUCTION
RE-ENTRY
FACT
TEACHING
THOUGHT
SYMPTOM
REACTION
AFFECTIVE

21. Clarified Phase Progression of a CISD
COGNITIVE
Introduction
Summary
Brief Situation Review
Stress Management and Recovery Process
First Impressions of the Incident
Signals of Distress
Aspect causing most personal distress
AFFECTIVE

22. FACT PHASE
CISD Prompt “Tell who you are and what happened from your perspective.” This can be turned into a question such as: “Tell me what happened to get us here right now from your perspective?”

23. THOUGHT PHASE
CISD Prompt “What was the first or most prominent thought that entered your mind regarding the incident?” “Any unusual or disquieting thoughts?” Reworked depending on situation to: “What is the most distressing thing that you keep thinking about and cannot shake?” Once we can label and identify it, we can work on it.

24. REACTION PHASE
CISD Prompts “What was the worst part of this event for you?” “Any aspects of the event that have caused you the most pain or distress?” “If you had the power to erase one single aspect what would you most want to eliminate from the total experience?” Reworked: “What is the worst part of this whole situation for you? Something that is causing you the most pain…”

25. SYMPTOM PHASE CISD Prompt
“What physical or behavioral changes have you experienced since the event?” Or, “What has life been like for you since the event?”
Reworked:
“Have you had anything else happen to you that has been stressful?”

26. TEACHING PHASE
(When the appropriate time is right for this, and emotions are no longer driving the response rationale): Team members normalize reactions, provide anticipatory guidance, teach stress management, describe external resources available. Teach to what has been expressed. Encourage participants to continue the recovery process. The group should be used as a resource to identify coping techniques that have been useful in the past.

27. RE-ENTRY PHASE
Prompts Reiterate normalization Q & A, if indicated Summarize key points, “lessons learned” Offer cognitive reframe if useful to facilitate closure, reconstruction Foster group cohesion, if indicated

28. Integrated Approach of 3 C’s
Introduce Self Obtain name Thank the person (MOREPIES) model of Active Listening Skills (ALS): M- Minimal Encouragers O- Open Ended Questions R- Reflecting/Mirroring E- Emotional Labeling P- Paraphrasing I- I messages E- Effective Pauses S- Summary
Understand the OODA loop (Observe, Orient, Decide, Act)
SAFER-R (Stabilize, Acknowledge, Facilitate Understanding, Encourage Effective Coping, Recovery or Referral- Revised)
Strategic assessment and planning
Determining if this is a hostage/non-hostage encounter (instrumental vs. expressive)
Assessing tactical needs for entry
Use of a TPI that can be used for leverage (used sparingly and at right time)
Facilitate psychological normalization and psychological “closure” (reconstruction)
Being aware of the action imperative “what are we doing and why now?”
Set appropriate expectations for psychological / behavioral reactions
Identification of internal & external coping resources

29. Bridging Goals of the 3 C’s
In all scenarios- we’re trying to move that person from their Hind Brain (Amygdala-emotion) to their Pre-frontal Cortex (Executive functions- reasoning, logic, etc.)
There are times when someone may need to move a little more back to emotion and not stay in pre-frontal cortex exclusively- you determine urgency needs.
All trying to balance Emotionality with Rationality to get back to desired functioning level of compliance. We use time as our friend.
We focus on building rapport using ALS and common ground.

30. Discussion Points
How do we use behavioral principles in what we do? Operant (respondent) vs. Classical Conditioning; +ve & -ve reinforcement, and +ve &-ve punishment.
Addressing transference/countertransference issues, bonding, and attachment issues (reactive attachment- borderline, etc.)
Cortisol Responses- Fight, Flight, or Freeze; identifying stage of crisis the PIC is currently experiencing.
Duluth Power and Control Wheel, and how violent offenders use this.
Avoid rushing to prevent “Yes But’ers”- build relationship; can always fall back to move forward.
Paying attention to how Spectrum Disorders affect affect/cognition and compliance.

31. Extras

32. Things to look for when negotiating with violent offender
In many domestic violence cases, there are usually elements of this Duluth model wheel in play. It’s important to know what happening as you’re trying to negotiate and assist.

33. Power and Control Wheel

34. Resources
BluePaz, LLC (Training, Coaching and Counseling services For First Responders): (602) ; Safe Call Now (First Responder Crisis Line): (206) National Alliance on Mental Illness (NAMI): (602) National Suicide Prevention Lifeline: (800) 273-TALK (8255)

35. Questions/Comments