A few days after the 7.1 magnitude earthquake struck Anchorage on Nov. 30, 2018, the Alaska Native Tribal Health Consortium held its second training about critical incident stress management.

The room rattled with aftershocks as ANTHC employees -- emergency responders and health care workers alike -- learned how to support their peers after traumatic events.

Although coincidental, the timing was, perhaps, fitting. Critical incidents happen unexpectedly, and without fail.

“It’s not a question of if something is going to happen, it’s a matter of when,” said Rebecca Robinson, clinical psychologist at ANTHC.

In less than two years, ANTHC developed a full team of employees trained in Critical Incident Stress Management, or CISM, to help their peers navigate stressful incidents that occur while on duty. The system is “built off a model of resilience,” according to Robinson, helping the organization prepare for critical incidents and bounce back after a crisis. By keeping both the organization and its employees healthy, ANTHC will be best equipped to continue serving its patients in the midst of a stressful event, Robinson said.

“The vision of ANTHC is Alaska Native people are the healthiest people in the world,” said Leann Stubblefield, risk manager and director of ANTHC’s CISM team. “Having a CISM team to help people through traumatic events is part of being healthy.”

Conducted in a small group setting, those trained in the model help their peers process what they’ve experienced, said Gene Wiseman. Wiseman heads Alaska’s statewide CISM group housed under Alaska Police and Fire Chaplains.

“We tend to bottle things up,” Wiseman said. “When you’re sitting in a circle and everyone is allowed to talk in a safe environment … you learn that you’re not alone. So that in itself is crucial.”

The teams use training from the International Critical Incident Stress Foundation, or ICFSF -- the “gold standard,” Wiseman said.

At a recent CISM training presented by ANTHC in partnership with the State of Alaska, a group of about 50 people sat in a session called Grief Following Trauma. Led by Rev. Dr. Naomi Paget, an FBI Chaplain and certified ICISF instructor, the group talked about the different ways people respond to grief.

Paget discussed two styles of grief people have after a traumatic experience: Instrumental and intuitive. People who skew toward instrumental grieving will often direct their energy into activities and problem-solving, whereas intuitive grievers will experience and share deep emotional responses. People who grieve in one of these styles may not understand the responses from people who grieve in the other style.

“You and I need to learn how to speak both languages,” she told the group.

Many in attendance worked in the health care field or as emergency first responders. At one point the conversation steered toward violent incidents toward employees. Three-fourths of workplace assaults occur in health care settings, according to the American Journal of Managed Care.

Violence in the health care field is a serious issue, Paget said, and “our caregivers aren’t getting enough care.”

Responding to critical incidents can weigh heavily on responders. A 2017 report found that firefighters and police officers were more likely to die by suicide than in the line of duty. PTSD and depression rates for these two professions were five times higher than the general population.

In past decades, talking about trauma wasn’t always encouraged within the emergency fields, Wiseman said -- instead, there was a sentiment to “suck it up” and keep going.

“There literally was a time when it was not OK to talk about this. And those days are gone,” Wiseman said.

‘Be the rock’

The evidence-based CISM model has been used in Alaska for decades, Wiseman said; the Alaska Police and Fire Chaplains have provided support to first responders for about 30 years. Roughly a decade ago, Wiseman said, he was working in emergency medical services for the Matanuska-Susitna Borough and leading CISM responses in the area, and the two groups decided to merge their efforts.

Today, about 50 volunteers from Wiseman’s team help conduct CISM sessions across Alaska. Each response is tailored to the group requesting it -- for instance, if a police organization is asking for support, Wiseman will make sure a police officer is leading the sessions.

ANTHC started exploring the CISM model three years ago at the direction of CEO Roald Helgesen, said risk manager Stubblefield. The first trainings were provided by Crisis Response Care, a nonprofit funded by national Christian radio network K-LOVE.

Stubblefield, now the director of ANTHC’s CISM team, remembers leaving her first course feeling empowered. She had never known what to say to people who were grieving, and now she had the tools to help them.

“The training reinforced how important it was to be there for people and give them time to talk. It made me feel better when I responded,” Stubblefield said.

To build its group, ANTHC started small, Stubblefield said. Just 10 people were trained in the first year, and another 15 in the second year. Today, all employees are encouraged to take part.

“Everyone who takes the training gets something out of it,” Stubblefield said.

By the summer of 2018, the team was in the beginning stage of development, and they realized they needed a formal infrastructure. That’s when clinical psychologist Robinson became part of its core team of response leaders, she said.

To be a part of the team one must take the training and then apply. ANTHC’s CISM team has about 15 official members. They have responded to numerous critical incidents across different departments, Robinson said. The model provides for a shared language between the group and a shared way to help others process difficult incidents.

“The most important thing is that you don’t add chaos to chaos,” she said. “You want to be the rock within that chaos.”

CISM isn’t therapy, Robinson added, but an important opportunity to process alongside peers.

“There’s no better pressure relief, there’s no better way of healing than to talk,” Wiseman said. “It’s so therapeutic to just share and get that off your chest. It paves the road for recovery.”

Long term, ANTHC would like to build capacity across the state to respond to incidents, whether that means responding to communities that request help or providing support to communities building their own CISM teams. Stubblefield said the State of Alaska has been a major supporter of the initiative, sponsoring this year’s training and making sure the statewide CISM team is utilized when needed.

“There’s so many life changing events that happen to people daily with the work that we do,” Stubblefield said. “We touch so many people throughout the state that I just want our employees to be able to leave a positive impression on people during trying circumstances.”


This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.