Programs based on the ICISF-CISM model of peer support have shown to increase resistance to the psychological effects of stress and critical incidents, foster resiliency by equipping public safety personnel with the skills needed to “bounce back” to their normal functional levels, and inherent in any CISM program is addressing recovery through adaptive functioning or a seamless link to additional supports and services to address their specific need, which through our partners will be available.

Whether new to the role or after many years of service, any incident, regardless of magnitude, can have significant negative impacts on public safety personnel’s mental well-being. Having a network of trained peers accessible 24-7:

• • • • Decreases lost time arising from psychological injury.
      • Reduces the impact of psychological injuries.
      • Increases public safety personnel’s length of service to their communities.
      • Lowers attrition by helping to manage extreme workplace stress.
      • Addresses the increased risk of suicide.
      • Provides for healthier work and personal lives.
      • Helps to support and educate spouses and families of public safety personnel.

Key Philosophies of Peer Support:

• • Confidentiality: Confidentiality must be upheld in order for the program to maintain integrity and trustworthiness. Without confidentiality the program will fail and not be utilized. Peers need to be seen as trusted, ethical and safe so that any frontline staff member can access support in a time of need, regardless of the reason or issues causing the impact, knowing that what they share with a peer will be held within the normal bounds of confidentiality. Confidentiality statements should be prominent in program policy documents such as SOPs and Peer member Contract forms. (See templates of CISM SOPs, Peer Contract forms and Confidentiality forms in ICISF-Canada Best Practices & Procedures Manual. Exclusions to confidentiality only occur when physical safety is threatened in such cases as suicidal or homicidal ideation, child abuse or neglect and legal requirements which may vary from region to region and country to country. Since peers never record personally identifying information in the case that a peer were to be mandated by a spinae to divulge information of their peer support contact to a judge or courtroom, which has only happened once within Canada in over 30 years of practice, the peer only has their memory to go on and in such a case the right answer to respond to a judge or lawyer pressing for information is simply; “I cannot recall, or I do not remember.”

• • Political Neutrality: Teams should be peer-led, peer driven, and not seen in a position of management or representative of a union. It is important that they maintain this difficult balance of being part of the organization while being as politically neutral as possible neither aligning with leadership or union. This includes avoiding taking on welfare functions such as Occupational Health and Safety Officers as well as harassment contact persons. Essentially, anything organizational should be handled by HR or a separate department or program so that the peer support program is never in a position that could be seen as aligning with their leadership.

• • Self-Referral: The peer program is accessed by those who self-refer and identify with their desire to receive peer support services during a time of duress and never be mandated by leadership. When members in leadership notice individuals or a group may be impacted, they can notify the CISM Team who then are trained to monitor, assess and check-in with those involved to provide reminders of how to access support if they choose to, but should never be enforced or coerced to participate in any way.

• The voluntary nature of peer support: the majority of peer work is conducted within a voluntary basis. Most peer programs are independent of the organization although supported by leadership and is common to have training and expenses covered or reimbursed however the provision of peer support interventions are always free of charge where the peer is altruistically volunteering their time to provide support to a colleague in duress. This way there are no conflicts with a peer’s altruism for providing the support.

A Step by Step Guide for Developing & Implementing a CISM Peer Support Program

Phase I: Program Planning and Development:

1. Identify the need for a peer support program: there should be members within the organization’s management and frontline that are both supportive and committed to the concept of peer support within their organization.

2. Clearly state the goals of the CISM team and who the team is to support. What is the mandate, mission and scope of the program?

3. Identify a project lead or two co-leads who are seen as key champions who are representative of the group this peer support program aims to provide services to. The project lead(s) will be responsible for coordinating the initial development of the program including forming a project committee that can support the lead(s) consisting of members within the organization’s leadership, HR department (if they have one), union reps, and anyone else within the organization who would be key in influencing the program’s success.

4. Seek Expert Consultation regarding program development from an experienced Clinical Director or CISM Coordinator. They will assist the project committee in creating a strategic plan to develop, implement and evaluate your internal integrated peer-led, peer driven CISM program for your organization.

5. Educate/Inform the project committee: Make sure the project lead(s) and project committee receive some kind of initial training or education of the model of peer support, including members in leadership who will then be able to best understand the scope and best practices of a peer support program and be in a more informed position to support the program appropriately and work on gaining buy-in from other members up the management chain.

6. Adopt the CISM Best Practices & Procedures Manual for team membership and the specific roles to be performed:

• Administrative structure
• Dispatching functions
• Response functions, listing mental health providers’ roles
• Clinical mental health oversight/supervision from a Clinical Director
• Team member selection criteria

7. Generate Standard Operation Procedure Policies based on how the team will be legally constituted.

8. Determine how the team will be funded.
9. Obtain legal counsel to operationally define issues such as malpractice, standards of care, confidentiality, “good Samaritan” practices, necessary liability insurance coverage, etc.
10. Determine what criteria and mechanisms will be used to activate the team. Determine what backup systems will be used in the case of a mass disaster or widespread communication failure.
11. Determine what criteria and mechanisms will be used to deactivate the team.

12. Stipulate guidelines and procedures for the follow-up for team members after a crisis response. See templates for Peer Activation Contact Forms. ICISF-Canada Best Practices & Procedures Manual.
13. Make arrangements for ongoing “in-service” training. See template for team meeting algorithm that includes structuring frequent training and practicing skills with other team members.

Phase II: Implementation of the CISM Program:

1. Selecting Participants for training to become peers on your integrated CISM Team:
   
   1. Peer Nominations Approach: the recommended and preferred approach for the best outcome. Frontline staff nominate colleagues that they think would be a good fit for the peer support role. These should be colleagues they see as natural caregivers or approachable people during times of stress, trustworthy and respected by the majority with minimal dual roles.
   2. Self-Selection Approach: Another approach can be to start with training anyone who self-selects as showing interest in receiving the training. Training becomes part of the vetting process and where some candidates who don’t see themselves being able to commit or provide such services on a voluntary basis may drop out while successful candidates will gain a better understanding of what they are committing to and be able to make an informed decision to join the team.
   3. Leadership Approval: Leadership should be included in the selection process since all peers should be in a good standing status with their employer.
   4. Approved Instructors Review final candidate list: Approved instructors should be provided with a list of names and their rank/positions prior to the training so that they can prepare to direct the training experience with appropriate discussions and explanations that are culturally relevant to the participants.

2. Choosing an appropriate Approved Instructor to provide certified ICISF-CISM peer support training.
   
   1. Acquire an ICISF Approved Instructor for the courses you need.
      
      1. Basic CISM Training for Peer Support includes minimum certification in core courses:
         1. 1. “Assisting Individuals in Crisis” 2-Day Course
               Followed by;
            2. “Group Crisis Intervention” 2-Day Course (Assisting Individuals in Crisis is the prerequisite to Group Crisis Intervention and peers cannot be operational without both certifications)
   2. Cultural Competency: Approved Instructors demonstrate knowledge of the nature of the operational and organizational stress and impact of the participants’ workplace or can adapt to the needs of the participants in order to provide training and scenarios that are practical and familiar to the participants in a way that provides context and facilitates a transformational learning experience.
   3. References and Experience of past CISM Training.
   4. For more information please refer to Section #4: Approved Instructors, in the ICISF-Canada Best Practices & Procedures Manual.

3. Peer Team Vetting Process:
   
   1. Completion of Core Courses: All peers must complete certification in basic ICISF-CISM training which includes the two core courses: “Assisting Individuals in Crisis” and “Group Crisis Intervention”
   2. Informed Decision-Making: after completing training peers can now make an informed decision about their ability to commit to the CISM Team (usually a one-year term that gets renewed based on Team Contracts).
   3. Team Contracts and Code of Conduct forms to be signed by all CISM Team members.

4. Selection of CISM Team Positions:
   
   1. Team Lead or co-leads: should be a frontline peer and not anyone in a position that could be seen in a dual role.
   2. Clinical Director: mandatory that all CISM Teams work with the guidance and support of a Clinical Director, a registered mental health professional as determined by the Health Professions Act; or a regional equivalent’s legislature.
   3. CISM Coordinator: not necessary for small internal teams but if within the organization’s budget to hire a part-time or full-time CISM Coordinator can actually save costs by improving team performance and operations.
   4. Peer Advisory Committee: responsible for analysing effectiveness, needs and gaps in the CISM programming and communicating to the organization’s leadership what their needs are. Also, serves as a committee that address and makes decisions on complaints of peer support malpractice.
   5. Executive CISM Committee: usually consists of members representative of the organization’s leadership, HR/Wellness department (if they have one), the Clinical Director, CISM Coordinator (if they have one), sometimes the Teams Lead or co-leads, and whose primary mandate is to respond to the Peer Advisory Committee’s needs for programming through providing financial and resource support to ensure that the on-going sustainability of the CISM Team is maintained.
   6. For more information and templates for Code of Conducts, Team Contracts and Peer Contact Forms please refer to Sections #3: Training, #4: Approved Instructors, #5: Team, and #6 Team Maintenance in the ICISF-Canada Best Practices & Procedures Manual.

5. CISM Team orientation meeting: the entire CISM Team should meet to go over basic policies, procedures, expectations, and to sign and submit their CISM Team Contracts and Code of Conduct forms. A schedule for CISM Team meetings should be developed and agreed to with the plan to practice a skill and go over training for each meeting.

6. CISM Peer Support Program Launch: The program is ready to become fully operational. A schedule for Team members to provide educational information presentations to their colleagues about the purpose of the program and how to access support when needed should be developed and implemented as soon after the orientation meeting as possible. These information sessions could be provided as pre-incident education presentations, the proactive component of the program, which should be as frequent and repeated as possible. Essentially, 80% of the CISM Team’s activities throughout the entire life of the program should be devoted to this proactive component rather than implementing interventions that are only reactive to impact that has already occurred.

7. On-going Program Evaluation: Be sure to track utilization trends and record areas in the program that show deficits so that these issues can be brought back to the team to address and remedy.