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Psychology in the Schools, Vol. 44(8), 2007 2007 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20264

SOCIAL VALIDITY OF THE CRITICAL INCIDENT STRESS MANAGEMENT MODEL


FOR SCHOOL-BASED CRISIS INTERVENTION
JULIE Q. MORRISON
University of Dayton

The Critical Incident Stress Management (CISM) model for crisis intervention was developed
for use with emergency service personnel. Research regarding the use of the CISM model has
been conducted among civilians and high-risk occupation groups with mixed results. The pur-
pose of this study is to examine the social validity of the CISM model for school-based crisis
intervention as perceived by school psychologists and school social workers trained in the model.
The results suggest that the CISM Model had a positive effect on service delivery, but the
training itself did not adequately address the developmental appropriateness or the cross-cultural
appropriateness for school-based application. 2007 Wiley Periodicals, Inc.

Crisis in the context of a school has many unique features related to the social structure and
the sense of community within schools (Allen, Jerome, et al., 2002). A school crisis exposes
children and staff to threat, loss, and trauma that undermines the safety and stability of the entire
school (Johnson, 2000). Recent incidents of school violence have led to a heightened awareness of
the need for effective crisis intervention in schools (Canter & Carroll, 1999; Cunningham &
Sandhu, 2000; Larson & Busse, 1998; Poland, 1994; Poland, Pitcher, & Lazarus, 1995; Riley &
McDaniel, 2000). Yet, an examination of the research literature on crisis intervention reveals the
need for empirical support for the effectiveness of early intervention for individuals experiencing
a crisis in the community (Richards, 2001; Rose & Bisson, 1998) and even less is known about the
effectiveness of crisis intervention for school crises (e.g., Brock, Sandoval, & Lewis, 1996; Kling-
man, 1996; Nelson & Slaikeu, 1990; Pagliocca, Nickerson, & Williams, 2002).

The Critical Incident Stress Management Model and Its Empirical Support

The Critical Incident Stress Management (CISM) model for crisis intervention was devel-
oped by Mitchell (1983) for use with emergency service personnel. The CISM model is a multi-
faceted package of crisis intervention service delivery. Components of the CISM package include
but are not limited to preincident training, incident assessment and strategic planning, risk and
crisis communication, acute psychological assessment and triage, crisis intervention with large
and small groups and individuals, and facilitating access to appropriate levels of care when needed.
Critical Incident Stress Debriefing (CISD) is the crisis intervention tool used in CISM to assist a
homogeneous group of people after an exposure to a crisis (Mitchell, 2003; Mitchell, n.d.). CISD
consists of seven defined phases: introduction phase, fact phase, thought phase, reaction phase,
symptoms phase, teaching phase, and the reentry stage (see Everly & Mitchell, 1999; Mitchell &
Everly, 1995). As a single-session, semistructured intervention, CISD is designed to reduce initial
distress and to prevent the development of more severe psychological responses, including post-
traumatic stress disorder (PTSD). The goal of CISD and the comprehensive CISM package is to
promote emotional processing by permitting individuals to vent reactions and receive supportive
feedback that enables the normalization of these reactions. CISD is designed to prepare individ-
uals for anticipating possible experiences they may expect in the future in the wake of the trau-
matic incident and identify individuals who may require more intensive intervention.

Correspondence to: Julie Q. Morrison, University of Dayton, 300 College Park, Dayton, OH 45469-0530. E-mail:
Julie.Morrison@notes.udayton.edu

765
766 Morrison

Research supporting the use of CISM has been conducted among civilians and high-risk
occupation groups (Everly, 1995; Everly & Mitchell, 1999; Parkinson, 1997), victims of armed
robberies (Campfield & Hills, 2001; Manton & Talbot, 1990), child and adolescent victims of a
shipping disaster (Stallard & Law, 1993; Yule, 1992), emergency service personnel (Robinson &
Mitchell, 1993), and psychiatric workers after a traumatic event at work (Matthews, 1998). More
recently, Richards (2001) found that the structured CISM package resulted in superior outcomes
compared to a stand alone CISD intervention during a field trial of the two interventions designed
to support and ameliorate symptoms of post-traumatic stress after armed robbery. It must be noted,
however, that none of the studies supporting the effectiveness of CISM were conducted in a school
setting in response to a school crisis.

Empirical Evidence Refuting the Claims of CISMs Effectiveness

The use of CISM, and CISD in particular, and its increasing popularity has sparked one of
the most contentious debates in early psychological intervention in recent years. Several random-
ized controlled trials have demonstrated that, when carried out with individual trauma victims
rather than in groups, CISD produced either no improvement compared to controls (Hobbs &
Adshead, 1996; Wessely, Bisson, & Rose, 2000) or had the potential to increase levels of post-
traumatic symptoms, especially intrusive thoughts and avoidance of the incident (Bisson, Jen-
kins, Alexander, & Bannister, 1997; Griffiths & Watts, 1992 as cited in Campfield & Hills, 2001;
McFarlane, 1988).
In a review of 12 randomized, controlled trials of one-session early interventions in general,
Bisson (2003) identified three studies with positive outcomes (Bordow & Porritt, 1979; Bunn &
Clarke, 1979; Lavender & Walkinshaw, 1998), six studies where there was no significant differ-
ence between the outcomes for those who received intervention and those who did not (Conlon,
Fahy, & Conroy, 1998; Dolan, Bowyer, Freeman, & Little, in press, as cited by Bisson, 2003;
Hobbs & Adshead, 1996; Lee, Slade, & Lygo, 1996; Rose, Brewin, Andrews, & Kirk, 1999;
Small, Lumley, Donohue, Potter, & Walderstrom, 2000), and two studies in which the individuals
receiving intervention were found to fare worse (Bisson et al., 1997; Hobbs, Mayou, Harrison, &
Warlock, 1996; and a three-year follow-up completed by Mayou, Ehlers, & Hobbs, 2000). One
study examined outcomes for early versus delayed debriefing (Campfield & Hills, 2001). In a
concluding statement, Bisson (2003, p. 41) offered that, the randomized, controlled trials avail-
able provide little evidence that early single session intervention prevents psychopathology fol-
lowing trauma, but appears to confirm that it is well received overall by participants.
The studies reviewed by Bisson (2003) reported outcomes for individuals experiencing a
wide range of traumatic incidents: victims of motor vehicle accidents, robberies, violence (dog
bite, assault), mothers after childbirth (including normal childbirth) or following a miscarriage,
and interventions directed at crisis responders and family members. The techniques used in these
studies did not necessarily follow the standard CISD protocol, but instead included cognitive
behavior therapy, supportive counseling, prolonged exposure, anxiety management, education,
and standard care for medical needs. The results of 12 studies of single-session debriefing inter-
ventions were mixed. In four of the studies, the intervention group fared better and in six of the
studies the researchers found no significant difference between the intervention and the control
group (Bisson, 2003). In one study, the intervention group fared worse than the control group.
Although the quality of these studies of early psychological intervention varied greatly, method-
ological limitations (i.e., small sample size, nonequivalence of the groups during baseline) were
common among the studies (Bisson, 2003). None of these studies were conducted in a school
setting in response to a school-based crisis.

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Simon Wessely, in his published debate with Martin Deahl on the effectiveness of debriefing,
speculates that the process of debriefing, which serves to warn individuals of the emotional reac-
tions they might expect to experience over time, actually increases the occurrence of these symp-
toms (Wessely & Deahl, 2003). Or, according to Wessely, it may be that debriefing is appropriate
for some individuals, and yet not talking may be equally appropriate for others (Wessely & Deahl,
2003). Finally, Wessely questions whether talking to a person one has never met before and will
not likely meet again may impede the normal process of recovery that utilizes ones own social
networksfamily, friends, general practitioner and others who may be better able to place the
trauma in context of ones own life (Wessely & Deahl, 2003, p. 12).

Is CISM an Acceptable Model for School-Based Crisis Intervention?


Crisis intervention in the schools has advanced in recent years (i.e., Brock, Lazarus, & Jimer-
son, 2002). Leading experts in the field advocate for a comprehensive approach to crisis preven-
tion and intervention driven by crisis theory and sensitive to the ecology of schools (Brock, 2002).
Yet, despite repeated calls for research and evaluation of school-based crisis interventions (e.g.,
Brock et al., 1996; Klingman, 1996; Nelson & Slaikeu, 1990; Pagliocca et al., 2002), there have
been few attempts to investigate the impact of school-based crisis intervention (Morrison, 2007).
The traditional school-based crisis intervention literature features copious how to crisis inter-
vention publications and descriptive accounts of specific incidents and responses (e.g., Brock
et al., 1996; Nelson & Slaikeu, 1990; Pitcher & Poland, 1992; Poland & McCormick, 2000).
The purpose of this study is to examine the social validity of the CISM model for school-
based crisis intervention from the perspective of school psychologists and school social workers
trained in the model. The social validity of an intervention refers to the social significance of the
goals, the social appropriateness of the procedures, and the social importance of the effects (Wolf,
1978). The degree to which a school-based intervention is easy to implement, positive (as opposed
to punitive or adverse), perceived to be effective, and matched to the intervention context impacts
judgments of the social validity of an intervention (Telzrow & Beebe, 2002). At present, little
is known about the social validity of school-based crisis intervention, particularly from the
perspective of the service providers. Measuring social validity is crucial because participants who
do not like an intervention may be less likely to continue their participation no matter how poten-
tially effective the intervention might be (Gresham & Lopez, 1996; Nastasi & Truscott, 2000).
This study is a follow-up to a previous study that explored the effectiveness of the CISM
model from the perspective of teachers and school staff across a 5-year period (Morrison, 2007).
This current study extends the limited research on the school-based crisis intervention by exam-
ining the empirical evidence for the effectiveness of crisis intervention from the perspective of
those who provide school-based crisis intervention. Although previous research has surveyed
school psychologists (Allen, Jerome, et al., 2002) and school counselors (Allen, Burt, et al., 2002)
about their professional training and background in crisis intervention, no research to date has
examined the degree to which the crisis intervention providers perceive the goals, procedures, and
outcomes of their crisis intervention training model to be acceptable.

Method

Setting
This research was conducted within an urban school district located in the Midwest. The
district served 35,839 students during the 200405 school year. The student populations racial
composition was 71.3% African American, 23.2% White, 3.5% multiracial, 1.0% Hispanic, 0.9%
Asian or Pacific Islander, and 0.1% American Indian or Native Alaskan. The majority of the

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768 Morrison

students lived in poverty (64.5%) and a substantial proportion of the students had an identified
educational disability (18.5%).

Participants
Crisis intervention providers were recruited from the population of 125 professionals who
attended all sessions of the CISM training. Only those professionals who had an occasion to
implement the CISM model in response to a school-based crisis participated in the study. Informed
written consent was obtained from each of the 28 participants at the time they were recruited.
The participants included 18 school psychologists and 10 school social workers. Among the
school psychologists interviewed, there were 13 women and 5 men. Fourteen of the school psy-
chologists were White and 4 were African American. Four of the school psychologists had earned
a Ph.D. in school psychology. The mean number of years the professionals had practiced school
psychology was 14.3 (range of 130). The mean number of years the professionals had been
employed by the school district was 11.0 (range of 126).
Among the school social workers interviewed, there were 9 women and 1 man. Six of the
school social workers were White and 4 were African American. The mean number of years the
professionals practiced school social work was 15.9 (range of 333 years). The mean number of
years the professionals had been employed by the school district was 18.4 (range of 435 years).

CISM Training Description


Critical Incident Stress Management (CISM) is a comprehensive, systematic and multitactic
approach to managing traumatic stress within an organization or community. The first 2-day course,
Basic Group Crisis Intervention, was conducted by Jeffrey T. Mitchell and Jeffrey Lating. The
training manual for this course was The Basic Critical Incident Stress Management Course: Basic
Group Crisis Intervention (Mitchell & Everly, 2001). The second 2-day course, Individual Crisis
Intervention, was presented by George S. Everly, Jr. and Linda King-Edrington. The training
manual for this course was Critical Incident Stress Management (CISM): Individual Crisis Inter-
vention and Peer Support (Everly & Mitchell, 2003). The third 2-day course, Responding to
School Crises: Multi-component Crisis Intervention, was conducted by Kendall Johnson and Linda
King-Edrington. The training manual for this course was Responding to School Crises: An Inte-
grated Multi-Component Crisis Intervention Approach (Johnson, Ertle, Everly, & Mitchell, 2002).
These three 2-day courses comprise the standard International Critical Incident Stress Foundation
(ICISF) training program in group crisis intervention, individual crisis intervention, and school
crisis intervention. Each course included a description of stress and trauma reactions, the emo-
tional dynamics of individuals and groups who experienced traumatic events, and the situations in
which a variety of techniques could be utilized. Presenters modeled techniques and provided
feedback to participants who rehearsed the techniques in small groups. During the first 2 days of
training, participants learned about pre- and postincident crisis education, on-scene support ser-
vices, significant other support services, crisis intervention for individuals as well as large and
small groups, and the group intervention known as Critical Incident Stress Debriefing. The next
2-day course presented the fundamentals of and a specific protocol for individual intervention.
During the final 2-day course, participants explored organizing principles, skills, and practical
planning needed to provide effective crisis intervention services in school settings.
One hundred and twenty-five school district school psychologists, school social workers,
school counselors, and school nurses attended the initial CISM training during the summer and
fall of 2003. Follow-up CISM training sessions were provided in the fall of 2004. A total of 110 of
these same professionals attended some of the follow-up sessions and 75 professionals (60% of
those attending all of the initial training sessions) attended all of the follow-up sessions.

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There were 37 crisis events during the 200304 and 200405 school years that warranted a
response from the school districts crisis intervention team. Sixteen of the crises involved the
death of a student (five student deaths due to violence, five student deaths due to illness or a
medical cause, four student deaths due to an accident, and two student deaths due to suicide). One
crisis intervention was in response to a students suicide attempt. Ten crisis events involved an
incident of violence in the school or community. Five crises involved the death of a teacher or staff
member, three crises involved a death in a teachers immediate family, and one involved a medical
emergency of a teacher on school property. Two crisis interventions were in response to a death of
a students parent. On all of these occasions, the supervising school psychologist and school social
worker formed crisis intervention teams from the pool of trained providers based on the location
of the school. During this period of time, an unknown number of crises also occurred at the school
building level in which no district crisis intervention team was deployed.
The degree to which CISM was implemented with integrity was monitored with three Critical
Incident Stress Debriefing Procedural Checklists. These checklists were developed by the school
districts committee of school psychologists, school social workers, and school counselors respon-
sible for advising the district on its crisis intervention efforts. The first procedural checklist per-
tains to briefing activities and consists of four phases: (a) assembly, (b) facts, (c) reactions, and (d)
strategies. The second procedural checklist was designed to measure treatment integrity of crisis
intervention with individuals and consisted of five key steps: (a) stabilize the situation, (b) acknowl-
edge the crisis, (c) facilitate understanding, (d) encourage adaptive coping, and (e) restore auton-
omous functioning or refer. The third procedural checklist was designed to measure the treatment
integrity of defusing activities: (a) introduction, (b) exploration, and (c) information. Procedural
checklists were completed by crisis intervention providers during the crisis intervention. The
limitations of this effort to monitor the implementation of the CISM model are included in the
Discussion.

Design and Procedures


Qualitative research methods were used to examine the acceptability of the CISM models
goals, procedures, and outcomes in addressing the needs of students, faculty, staff, and crisis
intervention service providers according to the crisis intervention service providers. Individual,
face-to-face interviews were conducted with crisis intervention providers using a semistructured
interview format. All of the interviews were conducted in March 2005 regarding crisis interven-
tions that occurred during the 200304 and 200405 school years. Crisis intervention providers
discussed their participation on crisis intervention teams formed to meet the needs of a school
within the district as well as interventions they provided at their own schools. Verbal responses
were recorded using digital audio recording and subsequently transcribed to ensure reliable data
collection.

Measures and Analysis


The semistructured interview was comprised of nine items. Seven of the items used an open-
ended response format, one item employed a yes/no response format, and one item required a
short answer (see the Appendix). The method used to identify themes was adapted from Jehn and
Doucet (1996). Three reviewers independently reviewed all of the transcripts from the interviews
and identified segments from the interviews that pertained to providers perceptions of the appli-
cation of the CISM model for school-based crisis intervention. Segments were coded as either
positive perceptions or negative perceptions with regard to the goals, procedures, and outcomes of
CISM. Statements representing similar themes were grouped and counted to show the concepts
weight relative to other, less common themes evident in the transcripts. The most prevalent themes

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770 Morrison

were identified as general themes, whereas ideas expressed less frequently across the 28 inter-
views were labeled provider-specific themes.
After independently analyzing the data from the transcripts, the three reviewers compared
their findings. Themes agreed by all three reviewers to be general themes were reported in the final
analysis.

Results

Acceptability of the CISM Goals


The goal of CISD and the comprehensive CISM package is to promote emotional processing
by permitting individuals to vent reactions and receive supportive feedback that enables the nor-
malization of these reactions. Twenty-four professionals (85.7%) expressed unconditional posi-
tive perceptions of the goal of CISD/CISM, and three additional professionals (10.7%) expressed
positive perceptions of the goal under certain conditions. In the words of one school social worker
with 20 years of experience in the field, I think in any situation where you are genuinely con-
nected with the persons experiencing crisis, they need that outlet. We need to see what is the effect
on the person who brings out that emotion. Debriefing is so important. Several additional crisis
intervention providers expressed positive perceptions of acceptability of the goal of CISM that
were qualified by their recognition that there was potential for harm if the crisis intervention
provider were not competent (i.e., not properly trained, overly emotional during crises).

Acceptability of the CISM Procedures


Three general themes were identified from the responses of school psychologists and school
social workers regarding their perceptions of the acceptability of the CISM procedures. These
general themes reflected positive perceptions of having a structured framework for crisis inter-
vention service delivery and negative perceptions of the degree to which the CISM training addressed
the developmental and cross-cultural needs of school-age children and youth.
A structured framework. A major general theme among the responses of the school psy-
chologists and school social workers was that CISM provided an orderly structure and set of
procedures that crisis intervention providers could follow, which in turn enabled them to share a
common approach among other providers from different disciplines, levels of experience, and
school settings. In the words of one school social worker with 12 years of experience in the field,
At this time I felt that I was much more stronger . . . I knew what to do. I knew the stepswhat
we should be doing. I knew that as soon as we found out we had to act right away and get a plan
in place. According to the professionals interviewed, the CISM model provided a common lan-
guage for the professionals to communicate what needed to be accomplished. In contrasting how
crisis intervention efforts using CISM compared to service delivery prior to the adoption of CISM,
one school social worker with 20 years of experience in the field explained, I found it to be a
more systematic way of approaching a crisis. That you understand how to handle the triage with-
out a lot of chaos and whos going to do this and whos going to do that. Prior to the training, you
know, you had a crisis team supposedly in place at the school but it wasand then if they brought
in outside peopleit still wasnt clear as to who was the point guard person so to speak, and what
were the different roles and how to deploy the personnel out. I dont think it was as well thought
out. And then the fact that depending upon what school you got called out to, they did everything
differently.
Developmental appropriateness of the CISM model. A shortcoming voiced by half (50.0%)
of the school psychologists and school social workers was the limited applicability of the CISM

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model for use with a school-age population. Frequent among the concerns was that the CISM
training itself was geared to adults in first responder professions, such as fire fighters, police
officers, and emergency medical technicians. According to one school social worker with 24 years
of experience, I dont know that the training gave us the specifics for me. I mean, it provides the
framework, but it wasnt really targeted toward children and young children.
In spite of frustrations that the CISM training itself focused on supporting adults in commu-
nity settings, rather than children and adolescents in schools, half of the school psychologists and
all but one of the school social workers perceived the model to be a flexible framework that could
be adapted by a competent professional to varying age levels. According to a school social worker
with 16 years of experience, I think thats where you come in as a practitioner and kind of, um,
modify and adapt as needed. . . . I think that is where you take your expertise and apply it knowing
the kids and the ages.
Cross-cultural appropriateness of the CISM model. A general theme evident in the responses
of the seven (25.0%) school psychologists and school social workers was that the CISM training
did not adequately address cross-cultural competence in school-based crisis intervention. Twenty-
one (75.0%) of the crisis intervention providers interviewed judged that the CISM model could be
adapted by competent providers sensitive to the needs of students of varying cultural backgrounds.
In the words of one school psychologist with 26 years of experience in the field, I think part of it
depends on the style of the person whos doing the facilitating of the group. If they are in tune with
some of those cultural differences, or, you know, the different issues for themselves in working
with groups, then I think you can do those adaptations and youre going to make it more accessible
other diverse populations. Yet another school psychologist with 30 years of experience in the
field was more tentative in her judgment of the ability of the provider to adapt CISM cross-
culturally. In her words, I am kind of divided on that, because I think sometimes, depending on
what the incident is, you may, people who are diverse may want to hear from, I hate to say this,
kind of like one of their own, as opposed to someone from the outside who doesnt understand,
you know, like, for example, like how African Americans might feel, you know, well this whole
thing happened because of some social-political type reasoning. Ah, but then on the other hand,
you know, if there is a crisis, everybody needs some assistance, some reassurance, so, I think it can
work both ways. Um, I just think it depends on the person who is providing the service and they
have to be knowledgeable when to call in for maybe more African American counselors or maybe
more Hispanic counselors or whomever.
Notably, eight respondents, all of whom were school psychologists, expressed that crisis
intervention met universal needs of students and did not need to be adapted based on the cultural
background of the students served. This distinction between school psychologists and school
social workers in this sample may reflect differences in the graduate training and professional
development between the two professions.

Acceptability of CISM Outcomes


Two general themes identified in the responses of the school psychologists and school social
workers provided evidence of their perceptions of the acceptability of the outcomes of the training
and implementation of the CISM model for school-based crisis intervention. These two themes
included (a) the impact on the school-age children and youth served and (b) the professional
impact on the crisis intervention provider.
The impact on school-age children and youth served. The school psychologists and the
school social workers overwhelmingly voiced the perception that the CISM model resulted in
socially significant outcomes for children and youth. Twenty-six (92.9%) of the professionals

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772 Morrison

expressed a perspective that was consistent with the words of one school psychologist with 13
years of experience: Its been my experience that it is helpful that, um, children do need to deal
with [the crisis] that and they may or may not find a kind, caring colleague or teacher that they
could talk to. . . . so I think that is essential that they be able to talk about it . . . in a contained
setting where there can be an appropriate referral should they get out of hand . . . in different ways
that may be dysfunctional. Socially significant outcomes for students identified by the profes-
sionals included (a) providing students with a forum to express their emotions, (b) connecting
students to resources, (c) providing facts and dispelling rumors, and (d) identifying students in
need of more intensive counseling. Positive perceptions of the outcomes obtained with the imple-
mentation of the CISM model were qualified with the recognition that the CISM model was only
effective to the degree that the professional implementing the intervention was competent.
The judgment that CISM led to positive outcomes for students was not, however, shared by
two (7.1%) of the crisis intervention providers in this study. A school psychologist with 26 years
of experience stated, I have always thought that sometimes our response may exacerbate a situ-
ation. I have always been somewhat skeptical of this pouring in of mass people in these buildings
when something goes wrong. And its almost like youre trying, youre telling kids, you should be
upset now.
The professional impact on the crisis intervention provider. Twenty (71.1%) of the school
psychologists and school social workers judged themselves to be much more knowledgeable about
crisis intervention as an outcome of the training and implementation of the CISM model. This
increase in knowledge and proficiency translated, according to the perceptions of these profes-
sionals, into a more systematic approach to serving a school community in crisis. One school
social worker with 17 years of experience described the recent change in her professional practice
in this way: I think mostly it has changed because Im more conscious of trying to remember
what Im supposed to do according to the training. You know, Im used to dealing with crisis since
I am a career social worker, I guess. But I havent always had things written down, you know, and
steps to follow. I just kind of know how to do things in my head. Other school psychologists and
school social workers highlighted specific procedures, such as debriefing, triage, relating to indi-
viduals in crisis, and knowing when to refer out for more intensive support, as the aspect of the
CISM model that had the biggest impact on their professional practice. Still other professionals in
this sample expressed that the CISM training and implementation had a personal impact of them
as crisis intervention providers following a crisis. According to a school psychologist with 26
years of experience in the field, the CISM training brought to light what you have to kind of do
for yourself afterward. I always knew it was kind of hard on you that day and Id come home
feeling really washed out. And, I guess, back in the past I thought, man its just me, I dont deal
very well with this stuff. Now you are finding, yeah it is a difficult situation and you need to, you
know, kind of take care of yourself after a while.

Discussion
The use of CISM, and debriefing in particular, is a source of contentious debate among
experts in the field of crisis response. Both the proponents and critics of CISM point to a few key
studies in the effort to support their arguments. These key studies focus on outcomes for a variety
of community crises, including bank robberies, work-related injuries, shipping disasters, and mis-
carriages. Critically absent from the systematic evaluation of crisis intervention outcomes is the
inclusion of school-based crisis interventions.
This study was designed as a follow-up to the only known empirical investigation of school-
based crisis intervention outcomes (Morrison, 2007). The purpose of this study was to examine

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School-Based Crisis Intervention 773

the social validity of the CISM model for school-based crisis intervention from the perceptive of
school psychologists and school social workers trained in the model. The social validity of an
intervention refers to the social significance of the goals, the social appropriateness of the proce-
dures, and the social importance of the effects (Wolf, 1978).
The school psychologists and school social workers interviewed voiced considerable consen-
sus regarding their positive perceptions of the social significance of the goals of CISM. Imple-
menting CISM in the pursuit of these desirable goals, however, depends in large part on the
knowledge and skills of the crisis intervention provider.
The procedures comprising the CISM model were judged to be acceptable to the school
psychologists and school social workers on the basis that it provides a structured framework and
a common language and approach for school-based crisis intervention. According to the crisis
intervention providers, the CISM procedures could be adapted to meet the developmental needs of
school-age children and youth cross-culturally; however, the CISM training itself was thought to
be weak in addressing the developmental needs of school-age children, particularly those from
culturally diverse backgrounds. The majority of the school psychologists and school social work-
ers, however, did assert that the shortcomings of the training could be overcome by the knowledge
and skills of a competent crisis intervention provider who understands the developmental level
and cultural context of the student population. Still, this remains a weakness of the CISM model,
given the possibility that crisis intervention services could be provided by an inexperienced or
insensitive provider. Explicit directives regarding the application of CISM across developmental
age groups and cross-culturally need to be incorporated into the CISM training.
School psychologists and school social workers judged the CISM model to be acceptable
with regard to the social importance of the effects of the CISM for crises in a school community.
The CISM training and implementation of the model were perceived to result in positive outcomes
for the children and youth served and for the professional providing school-based crisis intervention.
The results of this qualitative study were mostly consistent with previous findings from a
quantitative study examining the perceptions of teachers and staff regarding the impact of CISM
for school-based crisis intervention by comparing baseline and CISM model data over a 5-year
period (Morrison, 2007). In the Morrison study, the teacher and staff ratings suggest that the
implementation of the CISM model did have a positive effect on service delivery components (i.e.,
informing students, meeting with staff members). The implementation of the CISM model, how-
ever, did not result in a change in teacher and staff perceptions regarding the impact of CISM on
student outcomes. The fact that school psychologists and school social workers did perceive pos-
itive effects of the CISM model and teachers and staff did not perceive a change relative to
baseline (pre-CISM) crisis intervention begs further investigation.

Limitations of the Study


Several limitations deserve attention to aid in the interpretation of the findings of this study.
First, this was a descriptive research study based on interviews with a small sample of profession-
als from one urban school district in the midwestern United States. The design of this study does
not permit the assumption that the results of this study will generalize to other professionals in
other school settings. Instead, this study, the first known study examining the social validity of a
model for school-based crisis intervention, should be viewed as an early step on a path to more
systematic inquiry of an empirically based evaluation of school-based crisis intervention services.
A second limitation of this study was the reliance on the perceptions of school psychologists and
school social workers to judge the effects of CISM on the students served in the absence of
standardized measures of coping. Although the use of standardized assessment was beyond the
scope of this study, the professionals interviewed in this study were judged to provide valid

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774 Morrison

assessment of students coping, given that they were assigned to serve a particular school through-
out an entire school year and had frequent and sustained contact with students in crisis and their
teachers.
A third limitation of this study is the varying definition of what constitutes a crisis from the
perspective of the school-based crisis intervention providers. Although there were 37 official
crisis intervention responses during the 2-year period CISM was implemented, many of the school
psychologists and school social workers interviewed discussed crisis interventions they provided
at their schools on a regular basis. Future research should explore the social validity of the CISM
model in response to school-based crises that vary in type and scale.
A final limitation of this study was that it focused exclusively on crisis intervention, one
component of a comprehensive school-based crisis prevention and intervention model. Current
advances in school-based crisis intervention emphasize the importance of embedding crisis coun-
seling within a multilevel system that includes prevention and preparedness. The provision of
crisis counseling in direct response to a crisis event in the absence of comprehensive planning for
prevention and preparedness is not considered effective crisis intervention. Primary prevention
activities that include crisis preparedness and crisis prevention (e.g., creating safe and nurturing
school and classroom environments, identifying students at risk for self- or other-directed vio-
lence) are essential elements of a school-based crisis intervention model that were not addressed
in this study. Future research should include an investigation of the impact of crisis prevention
activities.

Future Directions for School-Based Crisis Intervention


The most consistently positive finding of this study is that school-based professionals valued
the structure, framework, and common language provided by CISM. It remains unknown whether
CISM is any more socially valid than any other structured model for crisis intervention. Most
notably, the National Emergency Assistance Team (NEAT) affiliated with the National Associa-
tion of School Psychologists provides professional development to school-based professionals in
crisis preparedness and response (www.nasponline.org/neat). Future research needs to explore the
relative strengths of the most prominent models for school-based crisis intervention in terms of
student outcomes, providers judgments of social validity, and fiscal costs of training and on-going
professional development.
The results of this study suggest that school psychologists and school social workers value
crisis intervention approaches that take into account the ecology of a school. Schools present a
unique context for crisis intervention. The selection of a crisis intervention model should consider
the degree to which the model and the professional development is geared toward and sensitive to
the school context. Given that crisis events do not occur on a frequent basis in schools, frequent
professional development is needed to maintain the knowledge and skills of the school-based
crisis responder. Building administrators often dictate the course of action in the face of a school
crisis and must be included in professional development activities.
The evaluation of crisis intervention services in the schools is an integral part of future crisis
intervention planning. Evaluation should be formative in nature and focus on monitoring imple-
mentation adherence and the attainment of desired outcomes for students and school staff. Partic-
ular attention should be paid to meeting the needs of all members of the school community cross-
culturally and developmentally.

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Appendix

Interview Questions
1. Did you have an occasion to provide crisis intervention since attending training on Crit-
ical Incident Stress Management?
YES NO
2. [If YES] Describe what it was like for you to implement the Critical Incident Stress
Management model.
3. Describe how your approach to crisis intervention has changed since the Critical Incident
Stress Management training?
4. How do your perceive the effectiveness of Critical Incident Stress Management in meet-
ing the needs of students at varying age levels?
5. How do your perceive the effectiveness of Critical Incident Stress Management in meet-
ing the needs of culturally and racially diverse students?
6. Would you recommend the Crisis Incident Stress Management approach to other profes-
sionals providing crisis intervention in schools?
7. Describe your level of preparedness for providing crisis intervention prior to the CISM
workshop (e.g., graduate level coursework, practicum or internship experiences, other
professional development opportunities).
8. How many of the CISM trainings did you attend? ___________
9. One final question: two criticism of the Critical Incident Stress Management model are
that it is no more effective than talking to a sympathetic colleague after a crisis and that
it might actually cause more harm than good by eliciting strong emotional reactions.
What is your response to these criticisms?

Psychology in the Schools DOI: 10.1002/pits