REACH CISM Response Intake Form

Critical Incident Stress Management

REACH CISM Response Intake Form

A critical incident is a traumatic event which can cause strong physical, emotional, mental, and spiritual reactions which can affect an individual’s ability to cope with the immediate and after-effects.

A critical incident refers typically to an urgent emergency-type situation that occurs outside the range of usual human experiences. These incidences can occur at any given moment or in any given situation, such as a home, institution, or community, and any time of the day or at any point in an individual’s life.

CISM services are available to help assess, organize, manage, and facilitate the typical or a-typical response that happens in the event of a crisis. The services may be provided during and/or immediately following the crisis as well as afterward if new elements arise or resurface following the initial crisis. The REACH CISM Response is designed to be a critically responsive short-term support, following the model of the ICISF (International Critical Incident Stress Foundation) whose model REACH is trained in and listed under as an active CISM Team.

The model follows delivery of 1-4 weeks of CISM Response offered by the REACH CISM Team to the various parties in need, at which point referrals and/or long-term supports should be in place and implemented as are necessary. The REACH CISM Response Team has adapted various aspects of the CISM model to provide smaller scale, but equally critical support, to smaller groups such as families, extended families, rural communities or reserves, small agencies, churches, community groups, etc.

*Please inquire if you would like to learn more about REACH CISM Response and having a standby option for when critical incidents happen. It is not if critical incidents happen, it is when they happen.

  • MM slash DD slash YYYY
  • Contact Information

    Check and give any additional information possible, to what critical incident best indicates your reason for request of CISM services
  • CISM Model Funnel of Impact

    There are multiple categories of individuals who are affected when a crisis occurs. The CISM Model is to be aware of each category who may have been affected and ensure they all have access to CISM Response. The approach is described as a funnel method, which works with those closest to the critical incident and moves outward, providing response to all groups.
  • Categories of Impact

    Check known categories of impact related to this incident.
  • Ongoing Support Services – those who will be involved in on-going follow-up support

  • Intervenor/Response Services – this includes those first responders/social workers/child protection/etc., who are dispatched and arrive first on scene, the switchboard who takes the emergency calls and supports those on the line, the bystanders witness the incident and who intervene/provide support immediately… those who provide response and resolution to the incident (hospital staff, etc.)